Pulmonary hemodynamic changes after intravariceal sclerotherapy with absolute alcohol

To investigate whether alcohol used as variceal sclerosant has any effect on pulmonary hemodynamics, 14 patients with portal hypertension received intravariceal injections of absolute alcohol. Six additional patients were injected with equivalent volumes of saline and they served as controls. After intravariceal injection of absolute alcohol (8 ml in 12 patients and 12 ml in 2 patients), mean +/- SD pulmonary artery pressure was seen to increase significantly (p less than 0.01) at 1 and 5 min and return to basal level by 15 min. Similar changes in pulmonary arterial pressure were seen after intravariceal injection of saline; the difference in the rise in pulmonary arterial pressure between the two groups was not significant. The pulmonary capillary-wedged pressure and systemic blood pressure did not change significantly after intravariceal injection of alcohol. Absolute alcohol in the amount usually used for sclerotherapy has minimal and transient effects on pulmonary hemodynamics and, in this respect, it appears to be a relatively safe sclerosant.     

Esophageal motility changes after endoscopic intravariceal sclerotherapy with absolute alcohol

Endoscopic sclerotherapy (EST) leads to structural and motility changes in the esophagus; the former are thought to be commoner after EST with absolute alcohol (AA), which is a commonly used sclerosant in India as it is cheap and effective. There are no previous studies on changes in esophageal motility after EST with AA. Accordingly, we studied patients with portal hypertension before (n = 24) and after (n = 22) variceal obliteration by EST with AA using a water perfusion esophageal manometry system. Contraction amplitude in the distal esophagus was reduced in the post-EST group compared with the pre-EST group (63.4 +/- 24.9 vs. 18.2 +/- 14.3 mmHg, p < 0.01). Duration of esophageal contraction in both the proximal and distal esophagus became prolonged in the post-EST compared with the pre-EST group (3.3 +/- 0.8 vs. 5.4 +/- 2.6 and 4.3 +/- 1.1 vs. 6.6 +/- 2.3 s, p < 0.001 for both). Lower esophageal sphincter (LES) pressure was reduced in the post-EST compared with the pre-EST group, although the difference was not significant statistically. Abnormal contraction waveforms were more frequent in the post-EST group. One patient in the post-EST group had persistent dysphagia in the absence of endoscopically documented stricture at the time of manometric study. This study shows frequent occurrence of esophageal dysmotility after EST with AA; however, esophageal dysmotility after EST was infrequently associated with motor dysphagia.     

Esophageal motility and symptoms after endoscopic injection sclerotherapy

Endoscopic injection sclerotherapy is known to cause a variety of motility abnormalities, but the correlation between these changes and symptomatology has not been clearly defined. To assess the effects of endoscopic sclerosis of varices on esophageal function and symptoms, we prospectively studied esophageal motility in 25 patients undergoing sclerotherapy (group I). Thirteen patients underwent studies before and after sclerosis, and 12 patients were studied after completion of therapy. Acid clearance was studied in five patients (group I). Twenty-four of the 25 patients (group I) completed a course of sclerosis without the development of persistent dysphagia. We found that endoscopic sclerotherapy did not significantly alter the velocity of peristalsis or lower esophageal sphincter pressure, amplitude of contraction, or the duration of contraction. Acid clearance was diminished in three of five patients. Four patients who developed an esophageal stricture following sclerotherapy were studied manometrically (group II). Three of these four patients had a manometric pattern characterized by repetitive, nonperistaltic contractions, and all four patients experienced dysphagia which was relieved by bougienage. We conclude that esophageal motility is generally well preserved following endoscopic injection sclerotherapy and does not result in a long-lasting disturbance of swallowing. Dysphagia and disordered esophageal motility do occur after sclerotherapy when a sufficient fibrotic response has resulted in an esophageal stricture.     

A prognostic evaluation of endoscopic intravariceal injection sclerotherapy for esophageal varices

Eighty cases of endoscopic injection sclerotherapy for esophageal varices were retrospectively studied to evaluate their prognoses. These cases were evaluated in terms of post-therapeutic bleeding, survival rates and causes of death. Post-therapeutic bleeding occurred in 50% of the emergency cases (26 cases), 25% of the elective cases (16 cases) and 23.7% of the prophylactic cases (38 cases). The frequency of post-therapeutic bleeding was significantly lower in cases with variceal obliteration than in cases without obliteration. An evaluation of the survival rates by the Kaplan-Meier method revealed that poor prognostic factors in sclerotherapy cases were emergency cases, Child's C group, post-therapeutic cases with unsuccessfully obliterated varices, and cases with post-therapeutic bleeding. Concerning early death within 7 days after sclerotherapy, 4 emergency cases died from initial variceal bleeding despite sclerotherapy. Three of these 4 were hepatocellular carcinoma cases, and all 3 cases had tumor thrombi of the portal vein. We recommend prophylactic sclerotherapy from the standpoint of the prognosis after sclerotherapy. However, in the bleeding cases of hepatocellular carcinoma in Child's C group complicated by tumor thrombi of the portal vein, overly enthusiastic application of the therapy should be avoided.     

Effect of intravariceal sclerotherapy combined with esophageal mucosal sclerotherapy using small-volume sclerosant for cirrhotic patients with high variceal pressure

AIM: To explore the effect of intravariceal-mucosal sclerotherapy using small dose of sclerosant on the recurrence of esophageal varices.METHODS: We randomly assigned 38 cirrhotic patients with previous variceal bleeding and high variceal pressure (> 15.2 mmHg) to receive endoscopic variceal ligation (EVL) and combined intravariceal and esophageal mucosal sclerotherapy (combined group) using small-volume sclerosant. The end-points of the study were rebleeding and recurrence of esophageal varices.RESULTS: During a median follow-up period of 16 mo, varices recurred in 1 patient in the combined group as compared with 7 patients in the EVL group (P = 0.045). Rebleeding occurred in 3 patients in the EVL group as compared with 1 patient in the combined group (P = 0.687). No patient died in the two groups. No significant differences were observed between the two groups with respect to serious adverse events.CONCLUSION: Intravariceal-mucosal sclerotherapy using small dose of sclerosant is more effective than EVL in decreasing the incidence of variceal recurrence for cirrhotic patients.     

Repeated endoscopic sclerotherapy of oesophageal varices due to non-cirrhotic portal fibrosis using intravariceal polidocanol

Forty patients with variceal bleeding due to non-cirrhotic portal fibrosis have been treated by repeated endoscopic injection sclerotherapy using intravariceal polidocanol (1%). This has decreased re-bleeding as evidenced by a decrease in mean bleeding risk factor (BRF) and transfusion requirement; difference between presclerotherapy and postsclerotherapy parameters were significant ( P < 0.001). Low doses of polidocanol (mean 13.2 ml per session) were effective in the obliteration of varices. The mean sclerotherapy sessions required for obliteration were 8.04 (s.d. = 2.24). Complications were infrequent. Cumulative survival for 4 years was 92.5%. Based on these results endoscopic sclerotherapy is recommended for managing variceal bleeding due to non-cirrhotic portal fibrosis and is a reasonable alternative to surgery.     

颈部淋巴结结核自然破溃和淋巴结切开术后伤口愈合时间的影响因素分析

目的 分析影响颈部淋巴结结核自然破溃和淋巴结切开术后伤口愈合时间的危险因素。方法 收集2014年1月至2018年7月同济大学附属上海市肺科医院结核科经伤口分泌物培养及临床综合诊断确诊为颈部淋巴结结核且符合入选标准,并于结核科门诊因自然破溃和淋巴结切开术后行伤口换药的189例患者。189例患者伤口愈合时间为62~166d,平均(90.3±12.1)d。以伤口愈合平均时间90d作为界限值,47例(24.9%)伤口愈合时间≥90d (≥90d组),142例(75.1%)<90d (<90d组)。采用SPSS 17.0软件将两组患者的年龄、性别、文化程度、经济收入、有无吸烟史、有无饮酒史、体质量指数(BMI)、病灶最大直径、受累淋巴结数量、是否并发糖尿病、是否并发肺结核、是否规律换药等12项相关因素进行对颈部淋巴结结核伤口愈合时间影响的单因素及多因素logistic回归分析,计数资料间的比较采用χ²检验,以P<0.05为差异有统计学意义。结果 单因素分析结果显示,<90d组和≥90d组患者在BMI<18.4[58.5%(83/142)和85.1%(40/47)]、受累淋巴结≥2枚[22.5%(32/142)和38.3%(18/47)]、病灶最大直径≥2.0cm[61.3%(87/142)和80.9%(38/47)]、并发糖尿病[36.6%(52/142)和57.4%(27/47)]、不规律换药[13.4% (19/142) 和72.3% (34/47))]等方面差异均有统计学意义(χ²值分别为11.040、4.509、6.047、6.296、61.835,P值分别为0.001、0.034、0.014、0.012、0.000)。多因素logistic回归分析结果显示,BMI<18.4[Wald χ²=3.553,P=0.019,OR(95%CI)=4.062(0.117~7.981)]、受累淋巴结≥2枚[Wald χ²=4.223,P=0.040,OR(95%CI)=2.134(1.172~19.119)]、病灶最大直径≥2.0cm[Wald χ²=8.573,P=0.003,OR(95%CI)=2.669(1.169~10.815)]、并发糖尿病[Wald χ²=5.021,P=0.025,OR(95%CI)=2.337(1.776~4.442)]、不规律换药[Wald χ²=26.346,P=0.000,OR(95%CI)=16.900(14.061~32.786)]是影响颈部淋巴结结核伤口愈合的危险因素。结论 应重视BMI<18.4、受累淋巴结≥2枚、并发糖尿病、病灶最大直径≥2.0cm、不规律换药的颈部淋巴结结核换药患者,避免淋巴结结核伤口迁延不愈。     

Anal fissure: correlation between symptoms and manometry before and after surgery

The study compared symptoms and manometric results in 76 patients (42 men and 34 women; median age: 45 years) before and at long-term follow-up (median time: 54 months) after fissurectomy with posterior midline sphincterotomy for anal fissure. The fissure healed in all cases. Sporadic loss of continence for flatus or for liquid stool occurred in 21 patients (27.6%) and soiling was present in 7 other patients (9.2%). Preoperative maximum resting anal pressure was significantly greater in the study group compared with 40 control subjects (p<0.001). Postoperative resting anal pressure fell significantly (p<0.001) and remained low on long-term assessment. Postoperative maximal squeeze pressure remained unchanged. No correlation could be found between preoperative and postoperative clinical symptoms (including continence) and anorectal manometry.

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Résumé Cette étude compare les symptomes et les résultats manométriques de 76 patients (42 hommes et 34 femmes; âge moyen 45 ans) avant et longtemps après (recul moyen 54 mois) une fissurectomie avec sphinctérotomie médiane postérieure pour fissure anale. La cicatrisation de la fissure fût obtenue dans tous les cas. Une perte de continence sporadique pour les gaz ou pour les matières lipuides est survenue chez 21 malades (27.6%) et un suintement a été présent chez 7 autres (9.2%). La pression anale maximale de repos avant l'opération était significativement plus grande. Ces malades ont été comparés avec un groupe contrôle de 40 sujets (p<0.001). Après l'opération la pression anale de repos diminuait significativement (p<0.001) et demeurait plus basse à long terme. La pression de retenue maximale post-opératoire demeurait inchangée. Aucune corrélation n'a pû être trouvée entre les symptomes cliniques pré et post-opératoires (incluant la continence) et la manométrie ano-rectale.

     

食管静脉曲张硬化治疗后溃疡的发生及相关因素分析

目的评价食管静脉曲张硬化治疗后溃疡的发生情况及其相关因素分析。方法141例食管静脉曲张出血并接受硬化治疗的患者，选择临床上涉及的15种可能相关因素，采用多元逐步回归方法对食管静脉曲张硬化治疗后溃疡发生的相关因素进行分析。结果食管溃疡的出现与硬化剂用量呈正相关（r=0．012，P〈0．001），与溃疡出现时间、肝功能呈负相关（r=-0．688、-0．008、-0．029，P〈0．001），与年龄、病因、是否合并糖尿病、总注射点、治疗方法、治疗模式、食管静脉曲张分期、门脉供血等情况无关。结论硬化剂总量、肝功能是影响食管静脉曲张硬化治疗后食管溃疡发生的主要因素。     

Giardia intestinalis genotypes: Risk factors and correlation with clinical symptoms

This study was conducted to identify genotypes related risk factors of Giardia intestinalis in an Orang Asli (aboriginal) community in Pahang, Malaysia. Stool samples were collected from 321 individuals aged between 2 and 76 years old, of whom 160 were males and 161 were females. Faecal samples were processed with trichrome staining technique for the primary identification of G. intestinalis. Molecular identification was carried out by the amplification of a partial SSU rRNA gene using nested PCR. PCR products were purified and genotyped. 42 samples successfully amplified from the 76 positive faecal samples, only 1 was Assemblage A, the rest were Assemblage B. Risk analysis based on the detected genotypes of Giardia using univariate analysis and logistic regression identified three significant risk factors of giardiasis caused by assemblage B which included children ≤12 years (OR = 13.56, 95% CI = 1.79–102.64, p = 0.012), females (OR = 2.52, 95% CI = 1.11–5.75, p = 0.027) and eating fresh fruits (OR = 7.78, 95% CI = 1.01–60.00, p = 0.049). Assemblage B infection was significantly correlated with clinical symptoms of giardiasis (OR = 2.4, 95% CI = 1.13–5.12, p = 0.019). Females infected with Assemblage B were at higher risk of manifesting gastroenteritis signs and symptoms (OR = 3.9, 95% CI = 1.50–10.31, p = 0.004). It has been concluded that giardiasis is still a public health problem in Orang Asli community and most commonly caused by assemblage B. The dynamic of transmission is most probably anthroponotic which is human to human either directly or indirectly through contaminated food. This route of transmission should be considered in the control strategy of the disease. Mass treatment together with health education could be the most practical intervention for reducing the infection. Those at high risk should receive more attention from public health authorities.     

Risk factors affecting pancreatic fistulas after pancreaticoduodenectomy

AIM： To analyze the risk factors of pancreatic leakage after pancreaticod uodenectomy. METHODS： We retrospectively reviewed 172 consecutive patients who had undergone pancreaticoduodenectomy at Inha University Hospital between April 1996 and March 2006. We analyzed the pancreatic fistula rate according to the clinical characteristics, the pathologic and laboratory findings, and the anastomotic methods. RESULTS： The incidence of developing pancreatic fistulas in patients older than 60 years of age was 21.7% （25/115）, while the incidence was 8.8% （5/57） for younger patients; the difference was significant （P = 0.03）. Patients with a dilated pancreatic duct had a lower rate of post-operative pancreatic fistulas than patients with a non-dilated duct （P = 0.001）. Other factors, including clinical features, anastomotic methods, and pathologic diagnosis, did not show any statistical difference. CONCLUSION： Our study demonstrated that pancreatic fistulas are related to age and a dilated pancreatic duct. The surgeon must take these risk factors into consideration when performing a pancreaticoduodenectomy.     

Effect of sucralfate granules in suspension on endoscopic variceal sclerotherapy induced ulcer: analysis of the factors determining ulcer healing

Oesophageal ulcers commonly occur after endoscopic variceal sclerotherapy and usually cause complications and a delay in further sclerotherapy. The aims of this study are to investigate the effect of sucralfate granules in suspension on the treatment of endoscopic variceal sclerotherapy induced ulcer and analyse the factors determining the ulcer healing. Fifty-two patients with oesophageal variceal bleeding received elective endoscopic variceal sclerotherapy. After endoscopically proved oesophageal ulcers, they were randomized to receive either sucralfate granules in suspension (n = 22) or antacid (n = 23). Follow-up endoscopy was performed weekly. Ulcer healing rates were compared between the groups using the log-rank test. Forty-one ulcers receiving sucralfate and 48 ulcers receiving antacid treatment were evaluated. The clinical characteristics of the ulcers were similar in both groups. The ulcers in patients receiving sucralfate healed faster than those receiving antacid (P<0.02). On analysis of factors affecting ulcer healing, ulcers smaller than 1 cm2 (n = 59) appeared to heal faster than those larger than 1 cm2 (n = 30; P= 0.059) and shallow ulcers (n = 46) healed faster than deep ulcers (n = 43; P<0.001). On multifactorial analysis, ulcer depth was the only factor determining ulcer healing. The ulcer healing effects of sucralfate became more prominent when the ulcer was larger than 1.0cm2 (1.7+/-0.6 weeks vs 2.3+/-0.6 weeks, P= 0.011) and deep (1.7+/-0.7 weeks vs 2.5+/-1.0 weeks, P= 0.013) when compared with those receiving antacid. Sucralfate granules in suspension speed the healing of endoscopic variceal sclerotherapy induced ulcer, especially deep and large ulcers.     

Incidence,risk and protective factors of symptoms after colonoscopy

BackgroundFew studies focused on minor adverse events which may develop after colonoscopy.AimsTo investigate the incidence and factors associated to post-colonoscopy symptoms.MethodsThis is a prospective study conducted in 10 Italian hospitals. The main outcome was a cumulative score combining 10 gastrointestinal (GI) symptoms occurring the week following colonoscopy. The analyses were conducted via multivariate logistic regression.ResultsOf 793 subjects included in the analysis, 361 (45.5%) complained the new onset of at least one GI symptom after the exam; one symptom was reported by 202 (25.5%), two or more symptoms by 159 (20.1%). Newly developed symptoms more frequently reported were epigastric/abdominal bloating (32.2%), pain (17.3%), and dyspeptic symptoms (17.9%). Symptoms were associated with female sex (odds ratio [OR]=2.54), increasing number of symptoms developed during bowel preparation intake (OR=1.35) and somatic symptoms (OR=1.27). An inverse association was observed with better mood (OR=0.74). A high-risk profile was identified, represented by women with bad mood and somatic symptoms (OR=8.81).ConclusionAbout half of the patients develop de novo GI symptoms following colonoscopy. Improving bowel preparation tolerability may reduce the incidence of post-colonoscopy symptoms, especially in more vulnerable patients.     

Endoscopic sclerotherapy versus endoscopic variceal ligation: esophageal symptoms, complications, and motility

Endoscopic sclerotherapy is an effective method for treating bleeding esophageal varices. However, a number of complications may limit its usefulness. A newly developed method for treating bleeding varices, endoscopic variceal ligation, that uses small rubber bands to occlude and eradicate the varices, may cause less damage to the esophagus. Twenty-eight patients (seven with no prior treatment, eight undergoing sclerotherapy, and 12 undergoing variceal ligation) were evaluated with a symptom questionnaire and esophageal manometry. The lower esophageal sphincter (LES) pressures in the three groups did not differ. The percent LES relaxation was significantly (p = 0.04) less in the sclerotherapy group than in the untreated group. Contraction waves in the esophageal body were not different in amplitude, duration, and propagation speed in the three groups. There was no increase in the amount of heartburn after either form of treatment. Eight of the nine sclerotherapy patients had a stricture after treatment that required dilatation, whereas none of the ligation patients had strictures. We conclude from this that early in the course of sclerotherapy, stricture formation is common, but any long-lasting adverse effect on esophageal function is minimal. We also conclude variceal ligation therapy causes less esophageal dysfunction and has fewer local complications. Thus, endoscopic variceal ligation may be a safer and more easily tolerated alternative to endoscopic sclerotherapy.