胰腺结石的超声内镜检查和ERCP的对比研究

目的探讨胰腺结石的EUS和ERCP表现及其诊断价值.方法分析经手术或内镜下胰管取石确诊35例胰腺结石患者的EUS和ERCP检查结果.结果 35例中ERCP诊断27例(78.3%),8例诊断不明.伴有胰实质结石的4例患者ERCP均未能对胰实质结石做出诊断.而EUS诊断33例(94.3%),其中4例胰实质结石全部显示,2例胰管小结石未能诊断,EUS和ERCP联合检查全部35例均获得诊断.结论 ERCP联合EUS可提高胰腺结石诊断的准确率.     

磁共振胰胆管成像和直接胰胆管造影对胆胰疾病诊断价值自身对比的前瞻性研究

目的 比较直接胰胆管造影（ERCP和PTC）和磁共振胰胆管成像（MRCP）对胆胰疾病的诊断价值。方法 临床怀疑胆胰系疾病63例。每例先行MRCP,在此后24h内行ERCP。影像科和内镜医师分别报告自己所见结果,待研究结束后,以ERCP或PTC为参照标准统一对比分析。结果 63例行ERCP中,成功率为88.9%（56/63例）,7例ERCP失败者改行PTC检查成功;所有MRCP均获成功,成功率为100.0%;MRCP的灵敏度为98.2%、特异度83.3%、误诊率为16.7%、漏诊率为1.8%。MRCP和ERCP（或PTC）总符合率85.7%,其中在胆系结石及胆管肿瘤分别为100.0%和92.9%,乳头病病变为70.6%（12/17例）,在慢性胰腺炎和肝吸虫的诊断符合率分别为3/3和66.7%。63例ERCP者,术后并发胰腺炎5例、肾周脓肿1例（为B-Ⅱ术后）,并发症发生率为9.5%（6/63例）;而MRCP无并发症发生。结论 对胆管内疾病,MRCP可达到ERCP的单纯诊断水平,而对乳头部病变（尤其是小病变）和肝吸虫,MRCP却无法与ERCP相比拟。对不能耐受ERCP及禁忌症者,MRCP是较好的选择。MRCP的最大不便在于不能同时进行治疗。     

胰腺结石的超声内镜检查和ERCP的对比研究

目的 探讨胰腺结石的EUS和ERCP表现及其诊断价值。方法 分析经手术或内镜下胰管取石确诊35例胰腺结石患的EUS和ERCP检查结果。结果 35例中ERCP诊断27例(78．3％)，8例诊断不明。伴有胰实质结石的4例患ERCP均未能对胰实质结石做出诊断。而EUS诊断33例(94．3％)，其中4例胰实质结石全部显示，2例胰管小结石未能诊断，EUS和ERCP联合检查全部35例均获得诊断。结论 ERCP联合EUS可提高胰腺结石诊断的准确率。     

胰腺分裂症的ERCP诊断与治疗价值（附10例临床分析）

目的探讨胰腺分裂症(Pancreatic     

Abstinence in patients with alcoholic liver cirrhosis: A follow-up study

Aim:  To investigate the proportion of patients with alcoholic cirrhosis who abstained from alcohol after contact with a hepatology unit, the predictors for abstinence, and the role of clinical and psychosocial factors in short-term mortality in these patients.
Methods:  Eighty-seven consecutive patients with alcoholic cirrhosis from a transplant center were included. Data on cirrhosis severity and complications, as well as on abstinence and psychosocial factors were collected. Patients were followed up for 19 (12–25) months. Data on abstinence during follow up, alcohol abuse treatment, psychiatric contact, severity of cirrhosis, mortality, and liver transplantation were analyzed.
Results:  Prior to inclusion, 53/87 (61%) patients had abstained from alcohol for 24 months (interquartile range: 18–33). Twenty percent had a history of other substance abuse, 47% had undergone alcohol abuse treatment, and 21% had a previous psychiatric diagnosis. Forty-eight percent lived with a partner, 23% worked/studied, and 53% were pensioners. During follow up, 26% died, 20% received a liver transplant, 55% abstained from alcohol, 47% received alcohol abuse treatment, and 33% had psychiatric contact. In a multivariate analysis, abstinence during follow up was found to be related to abstinence upon inclusion in the study, to the model for end-stage liver disease (MELD) score at follow up, and to no abuse treatment in a detoxification unit, whereas mortality was related to index MELD and alcohol abuse treatment during follow up. Neither abstinence nor mortality was related to psychosocial factors.
Conclusion:  More than half of patients with alcoholic cirrhosis were found to abstain from alcohol during follow up, which was related to prior documentation of abstinence and cirrhosis severity. Cirrhosis severity (expressed as the MELD) and alcohol abuse treatment during follow up were related to short-term mortality.     

Sexual dysfunction in men with alcoholic liver cirrhosis. A comparative study

Sexual dysfunction in men with alcoholic cirrhosis was investigated in young (less than 56 years) outpatients with steady female partners. Sixty-one per cent (11/18) claimed sexual dysfunction, with erectile dysfunction and/or reduced sexual desire being the most common symptoms. Comparing patients with (n = 11) and without (n = 7) sexual dysfunction, no significant differences were found concerning a number of pertinent clinical variables. This should be interpreted with caution, however, owing to the small number of patients in each group. The prevalence and type of sexual dysfunction were not significantly different comparing alcoholic cirrhotic men to chronic alcoholic men without overt liver disease (matched for duration of alcoholism, age and duration of partnership) and to insulin-dependent diabetic men (matched for age and duration of partnership). However, all groups had a significantly (p less than 0.025) raised prevalence of sexual dysfunction when compared to men without chronic disease (matched for age and duration of partnership).     

A prospective comparison of the diagnostic accuracy of ERCP,MRCP, CT,and EUS in biliary strictures

BACKGROUND: The differential diagnosis of biliary strictures remains a challenge. This study evaluated magnetic resonance cholangiopancreatography (MRCP) as a new procedure in comparison with the established methods of diagnosis including ERCP or percutaneous transhepatic cholangiography (PTC), CT, and EUS. METHODS: Fifty patients (21 men, 29 women, mean age 65.7 years) with jaundice but no pain suspected to have biliary strictures were enrolled in this prospective study. MRCP, ERCP/PTC, CT, and EUS were performed prospectively; images and videotapes (EUS) of these tests were reviewed blindly under standardized conditions. Reference standards for comparison were surgery, a biopsy confirming malignancy, or the clinical course during follow-up (at least 12 months) in cases without histopathologic proof of malignancy. RESULTS: Seven patients ultimately proved to have jaundice caused by parenchymal liver disease and 43 had a biliary stricture (17 benign, 26 malignant). Forty patients underwent all 4 imaging tests. There were 10 patients in whom patient-specific problems precluded some procedures but who were included in an intention-to-diagnose analysis. The sensitivity and specificity for diagnosis of malignancy in the 50 patients were as follows: 85% / 75% for ERCP/PTC, 85% / 71% for MRCP, 77% / 63% for CT, and 79% / 62% for EUS, with similar values in the 40 patients who underwent all 4 imaging methods. The combination of MRCP and EUS improved specificity. CONCLUSIONS: Although MRCP provides the same imaging information as direct cholangiography, it has limited specificity for the diagnosis of malignant strictures. In the differential diagnosis of biliary strictures, several tests including ERCP-guided tissue diagnosis are still required, and MRCP has only a limited clinical role.     

Complications of diagnostic and therapeutic ERCP: a prospective multicenter study

OBJECTIVES: Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP/ES) can be associated with unforeseeable complications, especially when involving postprocedural pancreatitis. The aim of the study was to investigate risk factors for complications of ERCP/ES in a prospective multicentric study. METHODS: One hundred fifty variables were prospectively collected at time of ERCP/ES and before hospital discharge over 2 years, in consecutive patients undergoing the procedure in nine endoscopic units in the Lombardy region of Italy. More than 150 ERCPs were performed in each center per year by a single operator or by a team of no more than three endoscopists. RESULTS: Two thousand four hundred sixty-two procedures were performed; 18 patients were discharged because the papilla of Vater was not reached (duodenal obstruction, previous gastrectomy, etc.). Two thousand four hundred forty-four procedures were considered in 2103 patients. Overall complications occurred in 121 patients (4.95% of cases): pancreatitis in 44 patients (1.8%), hemorrhage in 30 (1.13%), cholangitis in 14 (0.57%), perforation during ES in 14 (0.57%), and others in 14 (0.57%); deaths occurred in three patients (0.12%). In multivariate analysis, the following were significant risk factors: a) for pancreatitis, age (< or = 60 yr), use of precutting technique, and failed clearing of biliary stones, and b) for hemorrhage, precut sphincterotomy and obstruction of the orifice of the papilla of Vater. CONCLUSIONS: The results of our study further contribute to the assessment of risk factors for complications related to ERCP/ES. It is crucial to identify high risk patients to reduce complications of the procedures.     

麻醉状态下内镜超声、胰胆管造影串联与分开诊治胆胰疾病的对比研究

【摘要】目的探讨丙泊酚静脉麻醉状态下内镜超声检查术（EUS）与经内镜逆行胰胆管造影术（ERCP）串联诊治胆胰疾病的临床价值。方法回顾性总结105例EUS、ERCP串联执行的胆胰疾病患者（观察组）和90例EUS、ERCP分开执行的胆胰疾病患者（对照组）的临床资料,对比分析操作时间、丙泊酚用量、诊断情况、心肺并发症和内镜并发症发生情况。结果观察组操作时间（78．56±15．88）min、丙泊酚用量（314．21±223．54）mg,对照组操作时间（97．78±34．56）rain、丙泊酚用量（521．23±245．12）mg,两组比较差异均有统计学意义（P〈0．05）。观察组EUS、ERCP诊断率以及心肺并发症发生率、内镜并发症发生率分别为91．4％（96／105）、81．9％（86／105）、6．67％（7／105）、3．81％（4／105）,对照组对应分别为94．4％（85／90）、82．2％（74／90）、5．56％（5／90）、3．33％（3／90）,两组比较差异均无统计学意义（P〉0．05）。结论静脉麻醉状态下EUS、ERCP串联诊治胆胰疾病安全可行,较分开执行可缩短操作时间、减少丙泊酚用量。     

A prospective study of alcoholic liver disease and mortality

We report the 10-year survival of 510 patients with a histological diagnosis of alcoholic liver disease. Eight centres in Scotland and North England contributed to this study. Information was available on 92% of the initial cohort. Age was important, with each decade increasing mortality by 55%. A highly significant interaction between sex and histology was observed with a marked survival benefit for males with non-cirrhotic alcoholic liver disease, while in cirrhotic subjects the pattern was reversed. Patients with decompensated liver disease had a relative increase in mortality in excess of 86% while the increase in mortality for alcoholic hepatitis, 'active' cirrhosis and 'inactive' cirrhosis were 52%, 57% and 91% relative to fatty liver. Alcohol intake at the time of diagnosis did not influence outcome. This study emphasises yet again the increased mortality rate of individuals abusing alcohol compared with the general population.     

Liver iron is predictive of death in alcoholic cirrhosis: a multivariate study of 229 consecutive patients with alcoholic and/or hepatitis C virus cirrhosis: a prospective follow up study

BACKGROUND/AIMS: A study was undertaken of liver biopsy samples from 229 consecutive patients with alcoholic or hepatitis C virus related cirrhosis who were prospectively followed until January 1996 to evaluate the influence of liver iron content on survival and the occurrence of hepatocellular carcinoma. METHODS: Hepatic iron content was measured with a validated semiquantitative score, and its predictive value for survival and the occurrence of hepatocellular carcinoma was assessed. RESULTS: 130 patients had detectable iron at enrollment. During follow up (57 (28) months), 95 patients died and 39 patients developed hepatocellular carcinoma. No significant relation was found between hepatic iron and the occurrence of hepatocellular carcinoma. Conversely, the presence of iron was predictive of death in alcoholic patients (p = 0.007) by the log rank test but not in patients with hepatitis C virus related (p = 0.71) or mixed (p = 0.98) cirrhosis. The predictive value of hepatic iron content in patients with alcoholic cirrhosis was confirmed by the Cox model using either a binary coding (p = 0.009; relative risk = 2.27; 95% confidence interval 1.2 to 4.19) or the continuous values (p = 0.002). CONCLUSIONS: These results suggest that hepatic iron enhances liver lesions caused by alcohol but not those caused by hepatitis C virus.     

Preoperative diagnosis and staging of pancreatic cancer by endoscopic ultrasonography (EUS)--a comparative study with other diagnostic tools]

Endoscopic ultrasonography (EUS), ultrasonography (US), computed tomography (CT), and angiography (Angio) were performed in 26 patients with pancreatic cancer which were all resected. Preoperative findings of each diagnostic tools were compared with histological findings. In order to discuss the effectiveness of each body imagings, the preoperative staging of pancreatic cancer was evaluated in direct invasion to the anterior pancreatic capsule and stomach (S), direct invasion to the duodenum (D), direct invasion to the retroperitoneal adjacent vessels (Rp), and regional lymph node metastasis (N). The overall accuracy rate was 77% with EUS (50% with US, 38% with CT, 56% with Angio) in S, 81% with EUS (44% with US, 38% with CT, 63% with Angio) in D, 77% with EUS (58% with US, 42% with CT, 73% with Angio) in Rp, and 65% with EUS (58% with US, 38% with CT) in N. EUS revealed high accuracy rates because EUS images of the whole pancreas, surrounding organs and major vessels were clearly visualized through the gastroduodenal walls. Also, the accuracy rates of Angio in Rp and US in N were almost the same as those of EUS in Rp and N. However, it was difficult for every procedure to diagnose the retroperitoneal perineural invasion. From these results, EUS is one of the most beneficial procedures for detecting of the extent of cancer. EUS is expected to be popularized in the diagnosis and staging of the pancreatic cancer.     

Electrocardiographic abnormalities in patients with diphtheria: a prospective study

PURPOSE: To determine the incidence of and risk factors for electrocardiographic (ECG) abnormalities in adults with diphtheria. METHODS: A prospective study was conducted involving 122 adult patients with respiratory tract diphtheria. Diphtheria was confirmed by isolation of a toxin-producing strain of Corynebacterium diphtheriae. Patients had serial clinical evaluations and ECGs for a minimum of 21 days. RESULTS: Cardiac involvement was detected in 25 (28%) of 88 evaluable patients, with a median time from symptom onset to an abnormal ECG of 9 days (range, 4 to 24 days). In a logistic regression analysis, age (odds ratio [OR] = 4.1; 95% confidence interval [CI]: 1.6 to 11.0), shared accommodation (OR = 2.9; 95% CI: 1.0 to 8.6), fever (OR = 4.2; 95% CI: 1.1 to 16.6), and extensive respiratory tract infection with subcutaneous edema (OR = 7.0; 95% CI: 1.2 to 42.2) were independent risk factors for cardiac involvement. CONCLUSION: Cardiac involvement is a common complication of respiratory tract infection with C. diphtheriae, and occurs more often among older patients, those with lower socioeconomic status, and those with severe respiratory tract involvement.     

视黄醇脂对慢性酒精性肝病患者肝脏纤维化的抑制作用

目的:证明维生素A(Vit A)对慢性酒精性肝病 (ALD)患者的肝脏纤维化形成有抑制作用,为肝纤维化的治疗提供一条简便有效的新途径．方法:选择58例ALD患者,采用临床观察的方法,通过外源性的给予Vit A,以酶联免疫吸附法检查ALD患者血清Ⅲ型前胶原肽(PⅢP)及血清透明质酸(HA)的变化．结果:Vit A可以降低ALD患者血清Ⅲ型前胶原肽及血清透明质酸水平．Vit A治疗后 18 mo,血清Ⅲ型前胶原肽(16．9±6．8 μg/L vs 28．2±9．7 μg/L)及透明质酸(132．3±71 μg/L vs 210．0±87 μg／L)水平均较治疗前显著降低 (均P<0．01),且较对照组也有显著降低(PⅢP: 16．9±6．8μg/L vs 23．6±9．6μg/L,P<0．01:HA: 132．3±71 μg/L vs 192．0±97 μg／L,P<0．05)．结论:Vit A可以抑制ALD患者肝脏纤维化的形成,其机制可能是Vit A参与肝星状细胞 (HSC)的代谢,从而抑制胶原的释放．