Polski tygodnik lekarski (Warsaw, Poland : 1960)最新文献

Epidemiologic and demographic characteristics of 285 patients operated for perforated duodenal ulcer in 1972-1991 are discussed. A decrease in the number of patients undergoing surgery for the uncomplicated duodenal ulcer is being noted. However, surgery rate in patients with perforated duodenal ulcer remains constant. Only 14% of patients undergoing surgery for perforated duodenal ulcer is under 60. Most frequently such operations are performed in young and middle aged male patients. The obtained results suggest that there is a strong correlation between perforated duodenal ulcer and long duration of the disease, family ulcer history, and smoking.

Indications to manometric measurements in patients complaining for esophageal disorders are discussed. Such symptoms most frequently include: dysphagia, heartburn, and angina-like pain after exclusion of the coronary artery disease. Radiological and endoscopic examinations should precede esophageal motility measurements to eliminate organic causes of patients' complaints. Initial manometric measurements may be repeated after the application of pharmacologic stimuli or functional tests. Most frequent esophageal motor disorders have been described.

Detection rate of G. intestionalis in feces with direct microscopy has been compared with the immuno-enzymatic technique detecting protein GSA 65 with Alexon Inc., ProSpec T/Giardia reagents kit. The results obtained with both methods have further been compared with those obtained by microscopic examination of the duodenal content. Detectability of Giardia intestinalis with EIA technique with the use of ready-made kit has been assessed. Feces have been collected from 371 patients. Protein GSA 65 has been present in 170 samples, 45.8%, examined with the use of ProSpec-T/Giardia kit. Giardia intestinalis cysts have been detected microscopically in the feces of 37 patients, i.e., in 22.3%. Microscopic examinations carried out by three independent examinators have shown marked diversity in the rate of positive results, being 0.1% (examinator A), 28.6% (B), and 45.2% (C). Comparison of G. intestinale detectability of all 3 techniques used have shown absence of protein GSA 65 in 2 out of 9 examined patients. However, trophozoites have been present in the duodenal content. Test performed with kits made by Alexon Inc. and DIALAB have given 45.8% and 60.7% of the positive results, respectively.

An effect of cimetidine and famotidine on the lower esophagus sphincter pressure and esophageal body motility has been investigated. The studies involved 30 patients with duodenal ulcer. The lower esophagus sphincter pressure, mean force and mean duration of spasms as well as wave transmission velocity in esophageal body, 1-13 cm above the sphincter, have been recorded with Polyphysiograph R-611. The lower esophagus sphincter pressure and esophageal body motility have been recorded 15 minutes prior to and following the administration of 200 mg cimetidine or 20 mg famotidine. It was shown that cimetidine has net changed the lower esophagus sphincter pressure and esophageal body motility parameters. Famotidine increased the lower esophagus sphincter pressure from the initial 2.31 +/- 1.19 kPa to 3.51 +/- 1.61 kPa (p < 0.05) and had no effect on the esophageal body motility parameters. It may be concluded that within H2-receptor antagonists famotidine may be considered a drug of choice in the treatment of gastroesophageal reflux.

A case of a 12-year old boy with hemolytic-uremic syndrome complicated with cholelithiasis is presented. Due to severe course of the hemolytic-uremic syndrome (enhanced catabolism, coagulation disorders) a laparoscopic cholecystectomy as a new, modern surgical technique has been considered. Postoperative period has been uncomplicated. Therefore, laparoscopic cholecystectomy proved useful and is recommended in patients with high postoperative risk.

A case is presented of hepatic amebic abscesses in a young man after return from India. After establishing of the aetiology of the disease conservative treatment was started which was completed with success. The authors point to the possibility of transmission of amoeba dysentery to Poland due to journeys to tropical or subtropical countries.

The results of the emergency radical treatment of 285 patients with perforated duodenal ulcer are discussed. The authors compared 4 surgical techniques: 1) truncal vagotomy with traditional antrectomy, 2) truncal vagotomy with mucosal antrectomy, 3) truncal vagotomy with pyloroplasty, and 4) proximal gastric vagotomy. The best early results have been achieved in case of the proximal gastric vagotomy. However, the best late results have been noted in case of vagotomy with mucosal and traditional antrectomy. The overall perioperative mortality was 3.5%. Recurrent ulcer has been mainly observed in patients operated with proximal gastric vagotomy several years after the surgery.

The presence of Helicobacter pylori in the gastric mucosa of 150 patients with gastric, duodenal ulcer and endoscopic gastritis was investigated by rapid urease-based test, culture, histological examination and serology. Overall, 78% were positive for Helicobacter pylori by rapid urease-based test, 69.3% by culture, 53.7% by histological staining and 93.2% by serology (p < 0.001). The frequency of Helicobacter pylori was higher in patients with gastric or duodenal ulcer compared with those with endoscopic gastritis and those after gastric resection. However, the differences were significant only with reference to rapid urease-based test, (p < 0.02). The EIA (Roche) serological test had the highest sensitivity and the lowest specificity. This indicates the seed for serological kit to be independently evaluated on the population to be studied. The rapid urease-based test was simple, rapid and inexpensive, and it was more sensitive and equally specific compared with culture and Giemsa stain.