Clinical features of esophageal foreign bodies difficult to remove by gastroscopy / 中华全科医师杂志

Objective To analyze the clinical features of esophageal foreign body(EFB) difficult to remove by gastroscopy.Methods The clinical data of 159 patients with EFBs treated in Renmin Hospital of Wuhan University from January 2013 to April 2017 were analyzed retrospectively.Among 159 cases,the EFBs were removed by gastroscopy in 101 cases(gastroscope group)and removed by non-gastroscope method in 58 cases (non-gastroscope group),including 42 cases removed by esophagoscopy and 16 cases by surgery.The general information of patients,the types of EFB,the condition of impaction,treatments and outcomes of the two groups were analyzed.Results There was no significant difference in age and sex between gastroscope group and non-gastroscope group (P ＞ 0.05).The food typeEFBs included fish bone (n =77),chicken bone (n =45),jujube seeds (n =15),food bolus (n =4);and the non-food type FEBs included spectecleslens (n =2),bottle cap (n =11),denture (n =5).More than one half of FBs were located in the upper esophagus:63.4％ (64/101) in gastroscope group and 66.7％ (28/42) in esophagoscope subgroup;however,EFBs were mostly located in the middle esophagus in surgery subgroup (62.5％,10/16).In gastroscope group and esophagoscope subgroup,the sharp EFBs of length-diameter ＞ 2 cm were rare(n =4,3.9％ and n =3,7.1％),but were common in the surgery group (n =9,56.3％).The EFBs were successfully removed in all patients without massive hemorrhage or death.In gastroscope group (n =101),93 cases had mucosal abrasion and bleeding,5 cases had mild active bleeding,and 1 case had esophageal fistula.In surgical removal (n =16) there were 4 cases of esophageal perforation and postoperative inflammation,3 cases of mediastinal inflammation and 2 cases of mediastinal abscess.Inesophagoscopic removal group (n =42),there were 2 cases of esophageal muscle layer abscess,1 case of esophageal fistula and 1 case of pulmonary infection.Conclusions The most common type of EFBs is of food source.Foreign bodies in the upper and middle segments of the esophagusare difficult to remove with gastroscopy.In case of a sharp foreign body embedded in the middle esophagus,surgical removal is preferred to avoid severe sequences.

Correlation between sentinel polyps and proximal colon carcinoma and analysis of its clinical features / 中华消化杂志

Objective To explore the clinical features of sentinel polyps (rectal polyps with proximal colon carcinoma) and its correlation with proximal colon carcinoma.Methods From January 2003 to December 2013,the clinical features of 963 hospitalized patients with rectal polyps were retrospectively analyzed.According to whether the patient with colon carcinoma,the clinical data of rectal polyps patients were divided into pure polyps group (n=855) and sentinel polyps group (n 108).The characteristics under endoscopy,clinical pathological features,treatment and prognosis of the two groups were observed.Chi square test was performed for differences comparison between groups.Results The length of stay in hospital of 963 patients was from four to 33 days,the average age was (49.7 ± 9.4) years,and the majority of the patients were male (n=610,63.3％).A total of 785 patients (81.5％) had non-specific abdominal symptoms,such as frequency or habit change of defecation,hematochezia,abdominal pain,abdominal distension.The relatives within three generation of 78 patients (8.1 ％) were diagnosed with tumor and some relatives of the patients diagnosed with familial adenomatous polyposis (2.2％,21/963).The positive rate of tumor marker of sentinel polyps group was higher (69.4％,75/ 108) than that of pure polyps group (6.8％,58/855; x2 =316.285,P＜0.01).The proximal colon carcinoma of patients with sentinel polyps appeared as neoplasma with circumferential growth,there was no specific appearance between distal rectal polyps and proximal colon carcinoma.When compared with pure polyps group,most polyps of sentinel polyps group were in maximum diameter over 1 cm (61.1％ (66/108) vs 46.9％ (401/855)),multi polyps (n＞5,38.9％ (42/108) vs 11.8％ (101/855)) and adenomatous polyp (83.3％ (90/108) vs 35.6％(304/855),x2=7.752,55.595 and 90.544,all P＜ 0.01).Majority of the proximal colon carcinoma with rectal polyps was papillary adenocarcinoma and tubular adenocarcinoma which was account for 75.9％ (82/108).Some were mucinous carcinoma and signet ring cell carcinoma.Most of the proximal colon carcinoma with rectal polys did not penetrate the serosa layer (Duk A-+Duk B,59.3％,64/108) and with little distant metastasis (Duke D,17.6％,19/ 108).Ninty-five point six percent (817/855) of patients with pure polyps underwent endoscopic treatment and all of them were cured and discharged.Forty-one point seven percent (45/108) of patients of sentinel polyps group accepted the radical operation and 19.4％ (21/108) received endoscopic submucosal dissection.Conclusions If multiple,maximum diameter over 1 cm and adenomatous rectal polyps were detected under colon endoscope,the possibility of carcinogenesis of the polyps or the proximal colon should be awared.If the endoscope is difficult to go further or the patient can not tolerate the whole colon examination,the patient should be followed up in short-term and complete the whole colon examination.

Effect of exogenous H2 S and ATP-sensitive potassium channels on colonic hypermotility in a rat model of chronic stress / 中国病理生理杂志

[ ABSTRACT] AIM:To investigate the potential role of exogenous hydrogen sulfide ( H2 S) and ATP-sensitive po-tassium ( KATP ) channels in chronic stress-induced colonic hypermotility.METHODS:Male Wistar rats were divided into water avoidance stress ( WAS) group and sham WAS ( SWAS) group.Organ bath recordings were used to test the contrac-tile activity of colonic strips.The effects of H2 S donor NaHS and pretreatment with glibenclamide on the contractions of co-lonic smooth muscle were studied and the IC50 of NaHS was calculated.The localization and expression of the subunits of KATP channels were determined by the methods of immunohistochemistry and Western blotting.RESULTS:WAS increased contractile activity of colonic strips.NaHS concentration-dependently inhibited the spontaneous contractions of strips from the SWAS and WAS rats.The IC50 of NaHS for longitudinal muscle ( LM) and circular muscle ( CM) of the WAS rats was 0.2033 mmol/L and 0.1438 mmol/L, significantly lower than those of the SWAS rats.Glibenclamide significantly in-creased the IC50 of NaHS for LM and CM from the SWAS and WAS rats.In both SWAS and WAS rat colon, Kir6.1, Kir6.2 and SUR2B were expressed on the plasma membrane of the smooth muscle cells.WAS treatment resulted in up-reg-ulation of the expression of Kir6.1 and SUR2B in the colon devoid of mucosa and submucosa.CONCLUSION: The in-creased expression of Kir 6.1 and SUR2B in colonic smooth muscle cells may be a defensive response to chronic WAS.H2 S donors may have potential clinical effect on treating chronic stress-induced colonic hypermotility.