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<p><b>BACKGROUND</b>Patients with sliding hiatus hernia (HH) and reflux esophagitis (RE) usually suffer from esophageal dysmotility. The aim of the present study was to investigate the role of acid reflux and duodenal gastroesophageal reflux (DGER), esophageal manometry, and esophageal dysmotility by applying the barium meal examination.</p><p><b>METHODS</b>RE with HH was initially diagnosed using the reflux disease questionnaire, and was further confirmed by a barium meal examination and an endoscopy. The radiographic technique was used to test for spasms, strictures, and the coarseness of the mucosa, also was to study the types of reflux and clearance. Then, the esophageal manometry, the esophageal 24-hour pH, and the bilirubin monitoring were observed.</p><p><b>RESULTS</b>Fifty-five patients were diagnosed as HH combined with RE and divided into two groups according to the severity of their esophagitis: group HH1 (grades A and B) and group HH2 (grades C and D). The barium meal examination revealed that the mucosa was either granular or nodular in all cases. The dump reflux and delayed clearance were more significant in patients in the HH2 group than those in the HH1 group (P < 0.05). The percentages of total, supine, and upright acid exposure time were greater in patients with HH than those in the control group (P < 0.01), but the differences between the HH1 and the HH2 groups were not significant. Lower esophageal sphincter pressure (LESP) was lower in the HH group than in the control group (P < 0.05). Three DGER parameters: the percentage of time with absorbance greater than 0.14, the number of bile reflux episodes, the number of bile refluxes lasting longer than 5 minutes were (28.43 +/- 23.34), (40.57 +/- 31.30), and (15.15 +/- 8.72), respectively in the HH2 group; these statistics were significantly higher than those for the HH1 (P < 0.05). The frequency and amplitude of peristalsis were all lower in HH patients than in the control (P < 0.05). Of all the patients, 54.3% (30 of 55) with acid reflux and DGER simultaneously in the HH group exhibited refluxes of barium from the stomach to the esophagus in the recumbent position, and 29.4% (5 in 17) with delayed clearance in the HH group were correlated with esophageal body peristalses. The result was that the frequency and amplitude of peristalsis were less and the duration of esophageal peristalsis was longer than those of control group.</p><p><b>CONCLUSIONS</b>Esophageal dysmotility may play an important role in the severity of RE combined with HH. Esophageal motility results on a barium examination may coincide with esophageal manometry, 24-hour pH, and bilirubin monitoring in the RE and HH, but the radiologic method was the simplest to apply.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Bilirubin , Esophageal Motility Disorders , Pathology , Esophageal pH Monitoring , Esophagitis, Peptic , Pathology , Esophagoscopy , Hernia, Hiatal , Pathology , Manometry , MethodsABSTRACT
Objective To design radioactive biliary stents and to evaluate the feasibility and safety of the stents.Methods Plastic stents with inserted iodine-125 seeds were designed and tested in sixteen normal pigs. In the brachytherapy group,the pigs were implanted radioactive stents in the common bile duct (CBD) and then divided into three groups on the basis of radiation dose of the reference point,50 Gy group (n=4),100Gy group (n=4),and 150 Gy group (n=4).In the control group,the same plastic stents with non-radioactive seeds were implanted (n=2),whilst in the blank control group,no stents were implanted (n=2).Blood routine,serum amylase,liver and kidney function were tested before and 1,7,14,30,60 days after the implantation of stents. Animals were sacrificed on the 14,30 and 60 days after stem implantation.Some relevant index such as perito- neal bleeding and inflammation,ascites,injury of adjacent organs,as well as perforation,stricture and dilatation of bile duct were investigated.Bile duct tissues were stained with H-E,and observed under microscopy. Results The radioactive plastic biliary stents were successfully prepared and implanted.There was no effusion, hemorrhage or necrosis in the adjacent organs of radioactive biliary stent implanted group.Perforation of the CBD wall was not observed in the brachytherapy group.By pathological examination in the CBD,obvious hyperplasia of the mucosa and mucosal glands were seen in the control group.Necrosis of mucosal layer existed in brachy- therapy groups.In 50 Gy group,mucosal layer was incomplete and mild hyperplasia of mucosal glands was seen. In 100 Gy group,mucosal layer disappeared and almost no hyperplasia of the mucosal glands could be found.In 150 Gy group,mucosal layer disappeared and mucosal glands obviously decreased.There were no obvious abnormalities noted in blood tests after implantation in each group.Conclusions The design of radioactive biliary stents are feasible and safe.The radioactive stents have obvious radiation effect besides the mechanical effect on the mucosal layer of CBD.
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Objective To investigate the effects and mechanisms of selective angiotensinⅡtype 1 receptor antagonist ZD7155 on the inhibition of pancreatic cancer in vitro.Methods MTT assays were used to determine the inhibition of pancreatic cancer cell line PaTu8988s by ZD7155 in different concen- trations and at different time.PaTu8988s cell cycle and cell apoptosis were detected by flow cytometry. Transmission electron microscope was used to investigate the apoptosis of PaTu8988s before and after the incubation with ZD7155 under different concentrations.PaTu8988s cell morphology was observed be- fore and after the incubation with ZD7155.Results MTT showed that the increase of inhibition of pan- creatic cancer cell by ZD7155 was in agreement with the increase of the concentrations of ZD7155 and the time of the incubation with ZD7155.The inhibition rates of PaTu8988s cells were 9%,18%,30%, 51%,60% and 78% by ZD7155 with the concentrations of 5?10~(-11),5?10~(-10),5?10~(-9),5?10~(-8),5?10~(-7) and 5?10~(-6) mol/L,respectively.The inhibition rates of PaTu8988s cells were 15%,25%, 36%,51%,67% and 85% by ZD7155 with the same concentration(5.0?10~(-8) mol/L)at 12,24,36, 48,60 and 72 hours,respectively.ZD7155 could also inhibit PaTu8988s cell cycle significantly and was dose-dependent.Cell electron microscopy showed that there were chromatin margination and apoptotic body in the cell nucleus when the cells were incubated with ZD7155,and these changes were increase with the concentrations of ZD7155.The morphology of PaTu8988s cell didn't have any change after in- cubation with ZD7155.Conclusions ZD7155 can inhibit the growth of pancreatic cancer cells in vitro by suppressing the S-phase of cell cycle and induce cell apoptosis without visible cell toxic effects.
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Objective:To investigate the aberrant methylation of CpG island in 5′promoter region of p16 gene in the pancreatic juice and its value in diagnosis of patients with pancreatic cancer.Methods:Pure pancreatic juice(PPJ)was collected from the pancreatic duct by a nasopancreatic tube put under endoscopic retrograde cholangiopancreatography(ERCP). Cytological examination was performed by H-E staining in pure pancreatic juice.Aberrant p16 methylation was detected using the methylation specific PCR(MSP)in the PPJ.Results:The sensitivity,specificity,positive predictive value,negative predictive value and accuracy cytological examination in diagnosis of pancreatic cancer were 40%,100%,100%,45.4% and 60.0%,respectively.The DNA sequences were successfully extracted from the PPJ of 30 patients with pancreatic diseases and were subjected to MSP.Seven(35%)of the 20 cases with pancreatic cancer showed aberrant methylation of p16 gene.No aberrant methylation was detected in the pancreatic juice samples of patients with chronic pancreatitis and mucinous cystoadenocarcinoma of pancreas.When cytological examination combined with p16 methylation detection,the sensitivity, specificity,positive predictive value,negative predictive value and accuracy for diagnosis of pancreatic cancer were 55%,100%, 100%,52.6% and 70%,respectively.Conclusion:Pancreatic juice collected by nasopancreatic drainage during ERCP can be used for molecular analysis.Detection of aberrant methylation of p16 gene in pancreatic juice combined with cytological examination is a better method for diagnosis of pancreatic cancer.
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Objective:To investigate the inhibitory effect of selective angiotensinⅡtype 1 receptor antagonist ZD7155 on pancreatic cancer xenografts of nude mice.Methods:Sixty nude mice were given subcutaneous injections of PaTu8988s cells to establish the pancreatic cancer xenograft models;then the animal models were evenly randomized into 3 groups:low-dose (10 mg?kg~(-1)?d~(-1))ZD7155,high-dose(20 mg?kg~(-1)?d~(-1))ZD7155 and normal saline groups.Ten mice in each group were sacrificed 10 d after treatment and the tumor sizes and body weights were measured.The microvessel density(MVD)was assessed by immunostaining of endothelial cells for CD31 and the cell apoptoses were observed by transmission electron microscope.Another thirty mice were treated for 30 days;the survival period of mice and toxicity of ZD7155 were observed till the 49th day of treatment.Results:Ten days after treatment,the mean tumor volumes in the control,low-dose and high-dose groups were(35.8?6.7)cm~3,(21.5?6.1)cm~3 and (10.7?4.1)cm~3,respectively(P