角膜层间微创术治疗大泡性角膜病变临床分析

目的 :探讨角膜层间微创术治疗大泡性角膜病变的临床效果。方法 :在眼科手术显微镜下 ,对 2 1例大泡性角膜病变患者行施 8～ 9mm深达 1 / 3～ 2 / 3角膜的层间分离并进行层间微创术。结果 :所治病例角膜愈合良好 ,无不良反应 ,眼部症状如眼痛、畏光、流泪、异物感有不同程度减轻或消失 ,甚至视力有不同程度提高 ,随访 6～ 2 4个月 ,临床疗效稳定。结论 :角膜层间微创术在患者尚不具备穿透性角膜移植条件下 ,既能起到重建眼表结构 ,又能缓解大泡性角膜病变症状。同时它提供了一种简便、安全、不需特殊材料。

慢性浅表性胃炎100例报告

目的通过对慢性浅表性胃炎的临床特点和病因,掌握诊断方法及治疗方式。方法通过收集100例慢性浅表性胃炎的临床资料以及采取食物和药物并重的调养方法。结果本100例中治愈85例,死亡5例,10例康复又复发。这死亡5例是由于病人耽误的最佳救治时间,慢性浅表性胃炎发展成慢性萎缩性胃炎,而慢性萎缩性胃炎是又癌变了。这10例主要是因为没有得到很好的静养,许多患者回家后由于痛感降低或者减轻,自以为好了而忽略了自我保护和配合治疗。结论要认真分析慢性浅表性胃炎病因和病症,对症下药,患者要及时发现和增强自我保护。

持续治疗预防病发

不像治疗头疼这类去症状性治疗,治疗后症状不见了,患者能清楚地看见治疗起效,但预防性治疗是防止疾病发生,只要患者持续治疗,预防疾病发生就是最好的效果。有些人天生有心房纤维颤动,但大部分是因为年龄增长、机能退化而发生的。统计数字显示,40岁以上人士中有四分之一可能患有心房纤维颤动症状。

Hemosuccus pancreaticus: Problems and pitfalls in diagnosis and treatment

Hemosuccus pancreaticus is a rare cause of intermittent upper gastrointestinal bleeding. We report two cases of hemosuccus pancreaticus with multiple episodes of upper gastrointestinal bleeding. The causes of hemorrhage were rupture of pseudoaneurysm of the splenic artery and bleeding from the wall of pancreatic pseudocyst. Interventional radiology is the first modality for early diagnosis and possible treatment of hemosuccus pancreaticus. When angiography shows no abnormal findings or interventional radiological therapy can not be successful, surgery should be considered without delay. Our patients herein underwent surgery without recurrence or sequelae. Intraoperative ultrasonography and pancreatoscopy were helpful modalities for confirming the source of hemorrhage and determining the cutting line of the pancreas. When we encounter intermittent upper gastrointestinal bleeding with an obscure source, hemosuccus pancreaticus should be included in differential diagnoses especially in patients with chronic pancreatitis, which would lead to a prompt and proper treatment.

Extreme gastric dilation caused by chronic lead poisoning: A case report

Lead is a toxic metal that affects many organ systems and functions in humans. In the majority of adults, chronic lead poisoning comes from exposures to work places and can occur in numerous work settings, such as manufacturing, lead smelting and refinement, or due to use of batteries, pigments, solder, ammunitions, paint, car radiators, cable and wires, certain cosmetics. In some countries, lead is added to petrol. We present a rare case of gastric dilation caused by long-term petrol ingestion. A 16-year-old young man was admitted to our hospital due to a 6-mo history of exhaustion, dizziness, nausea, abdominal cramps and constipation. X-ray examination revealed dilated stomach descending into the pelvis and small bowel distension. After a long clinical observation, we found that the reason for the chronic lead poisoning of the patient was due to a 3-year history of petrol ingestion. The patient spontaneously recovered and stomach returned to its normal position and size. Lead poisoning should be taken into consideration in all unexplained cases of gastric dilation.

State-of-the-art of irritable bowel syndrome and inflammatory bowel disease research in 2008

Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two of the leading causes of chronic intestinal conditions in the world. This issue of World Journal of Gastroenterology (WJG ) presents a series of papers from world experts who discuss the current knowledge and opinions on these important conditions. Although great strides have been made in the diagnosis, treatment and pathology of IBS and IBD; much has yet to be explained. The etiologies and risk factors of these multifactorial conditions remain elusive. Specific diagnostic biomarkers need to be developed and safer treatments developed. The burden of IBS and IBD on the healthcare system is felt with repeated medical care visits and high costs. IBS and IBD patients can account for 30%-50% of office visits at gastroenterology services/clinics. Over one million people have IBD in the United States, with 30 000 new cases being diagnosed every year. One-quarter million people in the UK are afflicted with IBD. The cost of medical care in the United States for IBD is estimated to be $1.8 billion/year.

Impact of alanyl-glutamine dipeptide on severe acute pancreatitis in early stage

AIM:To evaluate the therapeutic effect of alanyl- glutamine dipeptide (AGD) in the treatment of severe acute pancreatitis (SAP) in early and advanced stage. METHODS: Eighty patients with SAP were randomized and received 100 mL/d of 20% AGD intravenously for 10 d starting either on the day of (early treatment group) or 5 d after (late treatment group) admission. Groups had similar demographics, underlying diseases, Ranson score, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, and Balthazar’s computed tomography (CT) score at the beginning of the study and underwent similar other medical and nutritional management. RESULTS: The duration of acute respiratory distress syndrome (2.7 ± 3.3 d vs 12.7 ± 21.0 d, P < 0.01), renal failure (1.3 ± 0.5 d vs 5.3 ± 7.3 d, P < 0.01), acute hepatitis (3.2 ± 2.3 d vs 7.0 ± 7.1 d, P < 0.01), shock (1.7 ± 0.4 d vs 4.8 ± 3.1 d, P < 0.05), encephalopathy (2.3 ± 1.9 d vs 9.5 ± 11.0 d, P < 0.01) and enteroparalysis (2.2 ± 1.4 d vs 3.5 ± 2.2 d, P < 0.01) and hospital stay (28.8 ± 9.4 d vs 45.2 ± 27.1 d, P < 0.01) were shorter in the early treatment group than in the late treatment group. The 15-d APACHE Ⅱ score was lower in the early treatment group than in the late treatment group (5.0 ± 2.4 vs 8.6 ± 3.6, P < 0.01). The infection rate (7.9% vs 26.3%, P < 0.05), operation rate (13.2% vs 34.2%, P < 0.05) and mortality (5.3% vs 21.1%, P < 0.05) in the early treatment group were lower than in the late treatment group.CONCLUSION: Early treatment with AGD achieved a better clinical outcome in SAP patients.

Ileal pouch surgery for ulcerative colitis

Ulcerative colitis (UC) is a relapsing and remitting disease characterised by chronic mucosal and submucosal inflammation of the colon and rectum. Treatment may vary depending upon the extent and severity of inflammation. Broadly speaking medical treatments aim to induce and then maintain remission. Surgery is indicated for inflammatory disease that is refractory to medical treatment or in cases of neoplastic transformation. Approximately 25% of patients with UC ultimately require colectomy. Ileal pouch-anal anastomosis (IPAA) has become the standard of care for patients with ulcerative colitis who ultimately require colectomy. This review will examine indications for IPAA, patient selection, technical aspects of surgery, management of complications and long term outcome following this procedure.

Construction and characterization of a cDNA library from human liver tissue with chronic hepatitis B

Objective: To construct a cDNA library from human liver tissue with chronic hepatitis B and check its quality for investigating the expression level of liver tissue infected by hepatitis B virus. This will then be used to find the relevant genes and interesting proteins associated with the development of hepatitis B. Methods: The total RNA from liver tissue with chronic hepa- titis B was extracted and the mRNA was purified using TRIZOL method. Switching mechanism at 5′ end of the RNA transcript (SMART) technique and CDS III/3′ primer were used for first-strand cDNA synthesis. Long distance polymerase chain reaction (LD PCR) was then used to synthesize the double-strand cDNA that was then digested by Sfi I and fractionated by CHROMA SPIN-400 column. The longer than 0.4 kb cDNAs were collected and ligated to λTriplEx2 vector. Then λ phage packaging reaction and library amplification were performed. The qualities of both unamplified and amplified cDNA libraries were strictly checked by conventional titer determination. Fourteen plaques were randomly picked and tested using PCR with universal primers derived from the sequence flanking the vector. Results: The titers of unamplifed and amplified libraries were 1.94×106 pfu/ml and 1.49×109 pfu/ml respectively. The percentages of recombinants from both libraries were 98.15% in unamplified library and 98.76% in amplified library. The lengths of the inserts were 1.23 kb in average, 1?2 kb in 64.29%, and 0.5?1.0 kb in 35.71%. Conclusion: A high quality cDNA library from human liver tissue with chronic hepatitis B was successfully constructed.

Special issues in pediatric inflammatory bowel disease

The incidence of pediatric inflammatory bowel disease (IBD) is rising and recent advances in diagnostics and therapeutics have improved the care provided to these children. There are distinguishing features worth noting between early onset and adult onset IBD. Physical and psychosocial development remains a critical target for the comprehensive management of pediatric IBD. Children are not just little adults and consideration must be given to the stages of development and how these stages impact disease presentation and management. The final stage will be the transition from pediatric care to that of adult oriented care and special consideration must be given to make this a successful process. This review highlights special considerations in the management of the child with IBD.

What’s new in inflammatory bowel disease in 2008?

Ulcerative colitis and Crohn’s disease represent the two major forms of inflammatory bowel disease. In this highlight topic series of articles we cover the latest developments in genetics and epidemiology, intestinal physiology, mucosal immunology, mechanisms of epithelial cell injury and restitution, current medical therapy, modern surgical management, important extra- intestinal complications such as primary sclerosing cholangitis, cholangiocellular carcinoma and autoimmune hepatitis as well as endoscopic and molecular screening, detection and prevention of small bowel and colorectal cancer.

Pancreatic pseudocyst

Pancreatic pseudocysts are complications of acute or chronic pancreatitis. Initial diagnosis is accomplished most often by cross-sectional imaging. Endoscopic ultrasound with fine needle aspiration has become the preferred test to help distinguish pseudocyst from other cystic lesions of the pancreas. Most pseudocysts resolve spontaneously with supportive care. The size of the pseudocyst and the length of time the cyst has been present are poor predictors for the potential of pseudocyst resolution or complications, but in general, larger cysts are more likely to be symptomatic or cause complications. The main two indications for some type of invasive drainage procedure are persistent patient symptoms or the presence of complications (infection, gastric outlet or biliary obstruction, bleeding). Three different strategies for pancreatic pseudocysts drainage are available: endoscopic (transpapillary or transmural) drainage, percutaneous catheter drainage, or open surgery. To date, no prospective controlled studies have compared directly these approaches. As a result, the management varies based on local expertise, but in general, endoscopic drainage is becoming the preferred approach because it is less invasive than surgery, avoids the need for external drain, and has a high long-term success rate. A tailored therapeutic approach taking into consideration patient preferences and involving multidisciplinary team of therapeutic endoscopist, interventional radiologist and pancreatic surgeon should be considered in all cases.

Desmopressin for the treatment of female storage lower urinary tract symptoms

Female storage lower urinary tract symptoms are prevalent and bothersome. They are usually attributed to an overactive bladder and treated with antimusca-rinics. Nevertheless, failure of conventional treatment to alleviate nocturia in particular and epidemiological data suggesting that nocturnal polyuria is the only or a contributing factor to nocturia, has attracted interest in decreasing nighttime urine production as a method of managing nocturia. A reduction in urine production could also, at least temporarily, delay daytime stor-age symptoms by delaying bladder filling. Therefore, desmopressin, the synthetic analogue or naturally oc-curring antidiuretic hormone, could have a role in the management of female frequency, urgency and urgency incontinence. This work aims to review data on the use of desmopressin in females with storage symptoms. Available evidence indicates that desmopressin is eff-cacious in reducing nighttime urine production and epi-sodes of nocturia, resulting in fewer sleep interruptions. This translates into improved quality of life. Desmopres-sin is also effective in postponing micturition, urgency and incontinence for several hours after being taken on demand. The tolerability profle of desmopressin is good and signifcantly improved compared to historical figures due to the introduction of new oral formula-tions, tailoring the dose according to gender and age and adhering to instructions for fuid restriction before administration. The incidence of hyponatremia, desmo-pressin’s most important side-effect, is less than 3% in recent trials. The efficacy of desmopressin, combined with its improved safety profle, makes it an interesting method for treating female storage lower urinary tract symptoms.

Primary Clinical Evaluation of the Joint Replacement for the Treatment of the First Metatarsophalangeal Arthritis

Objective To retrospectively assess the primary clinical results of a cohort of the first metatarsophalangeal joint replacement with double-stemmed hinge silicone implant. Methods A total of 12 patients (15 feet) received the joint replacement with double-stemmed hinge silicone implant. There were 2 males and l0 females with a mean age of 61.4 (range, 56-75) years old. Of them, 9 cases (11 feet) were hallux valgus with osteoarthritis; 1 case (2 feet) was rheumatic arthritis; 2 cases (2 feet) were traumatic arthritis. The sub)ective and objective results were evaluated during follow-up. Results All of the patients were followed up regularly with an average of 24.7 months, ranging from 12 to 38 months. Ten patients were completely satisfied with the operation; I patient showed partial saris- faction, and 1 patient was not satisfied because of the first matatarsophalangeal joint pain due to severe hy- perosteogeny surrounding the cut bone surface 3 years after the operation. Osteolysis around the implant occurred in 2 cases without clinical symptoms, and no special treatment was given. Conclusion The joint replacement is a preferable method in alleviating pain and improving walking function with proper indication.

早期帕金森病开始药物治疗时机的考量

帕金森病是一种常见于中老年人的神经系统退行性疾病，其发病机制尚不明确，与多种因素引起的中脑黑质多巴胺能神经元丢失有关［1］。传统观点认为，目前帕金森病的药物治疗仅仅是症状性治疗，并不能修饰疾病的进程。为了避免药物相关的不良反应和抗帕金森病药物使用到后期时失去疗效，确诊为帕金森病的患者，若症状轻，可等待症状发展至影响工作和生活时再开始药物治疗［2-3］。这一观点长期主导着帕金森病的治疗策略，很多帕金森病患者往往会在确诊后推迟几年才开始抗帕金森病药物治疗。然而，神经病理学、影像学以及临床研究证据表明，帕金森病早期的疾病进展速度快于晚期，随时间延长疾病进展速度逐渐减缓。因此，有观点认为帕金森病确诊后应尽早开始药物治疗，从而修饰疾病的进程。基于这一争议，我们将总结现有的神经病理学、影像学及临床证据，对早期帕金森病开始药物治疗的时机作一综述。

罗替高汀透皮贴剂用于中国早期帕金森病患者：一项随机、双盲、安慰剂对照关键性研究

帕金森病是一种慢性进行性神经系统疾病,主要临床表现为运动症状和非运动症状,给患者的生活质量及其照料者、家庭和社会带来不良影响.多巴胺受体激动剂单药治疗是早期帕金森病症状性治疗的基石,在控制症状的同时,可以延迟左旋多巴有关的运动并发症.罗替高汀透皮贴剂是一种非麦角类多巴胺受体激动剂,能够提供长达24 h平稳的血浆药物浓度,作为临床上唯一的透皮贴剂,一天使用一贴用来改善帕金森病症状.虽有多项国际研究证实罗替高汀透皮贴剂用于早期帕金森病患者的疗效和耐受性,但尚未有治疗中国早期帕金森病患者的疗效和安全性的评估数据.因此,我们对罗替高汀透皮贴剂治疗中国早期帕金森病患者进行一项关键性研究.此论文全文已于2016年4月发表于Parkinsonism＆amp;Related Disorders杂志[1].

浅谈慢性浅表性胃炎的临床特点和病因

目的:通过对慢性浅表性胃炎的临床特点和病因,掌握诊断方法及治疗方式。方法:收集我院100例慢性浅表性胃炎的临床资料以及采取食物和药物并重的调养方法。结果:本100例中治愈85例,死亡5例,10例康复又复发。死亡的5例是由于病人耽误的最佳救治时间,复发的10例主要是因为没有得到很好的静养。结论:要认真分析慢性浅表性胃炎病因和病症,对症下药,患者要及时发现和增强自我保护。

Clinical Observation on Curative Effect of Dissolving Phlegm-Stasis on 50 Cases of Knee Osteoarthritis

Objective： To observe the curative effect of dissolving phlegm-stasis on knee osteoarthritis. Methods： The 100 patients with knee osteoarthritis were randomly divided into two groups. The 50 patients in the treatment group orally took Chinese medicine while the other 50 patients in the control groups orally took Votalin and Vitamin C for one week as a course of treatment. At the end of 2-week treatment, analytic comparison was carried in evaluate the curative effect and the changes in total score of symptoms before and after treatment between the two groups. Results： The total score of symptoms after treatment was significantly lower than that before treatment in both groups （P〈0.01, P〈0.05）. The total score after treatment of patients with X-ray grade I and II in the treatment group was more obviously reduced as compared to the control group （P〈0.05）. The remarkably effective rate after treatment of patients with X-ray grade I and It in the treatment group was also higher than that in the control group （P〈0.05）. Conclusion： The treatment of knee osteoarthritis with dissolving phlegm-stasis can effectively improve the clinical symptoms.