Effects of intragastric balloon on obesity in obese Korean women for 6 months post removal

BACKGROUND/OBJECTIVESThe prevalence of morbid obesity in Korean women has consistently been increasing, while the overall prevalence rate of obesity in Korean women seems to be stable. In addition to bariatric surgery, intragastric balloons (IGBs), as a nonsurgical therapy, have been reported to be effective in weight loss. However, the beneficial effects of IGB in Korean women with obesity have not been fully investigated. The aim of this study was to evaluate the changes in fat mass in Korean women with obesity who had undergone IGB treatment for 6 mon.SUBJECTS/METHODSSeventy-four women with obesity (body mass index [BMI] ≥ 25.0 kg/m²) were recruited. Clinical data, including general information, comorbidities with obesity, anthropometric data, and changes in the body fat composition before and after IGB treatment, were obtained from the subjects.RESULTSMost subjects had one or more comorbidities, such as osteoarthropathy and woman''s disease, and had poor eating behaviors, including irregular mealtimes, eating quickly, and frequent overeating. Body composition measurements showed that weight, fat mass, and waist-hip circumference ratio decreased significantly at 6 mon after IGB treatment. In particular, women with morbid obesity (BMI ≥ 30 kg/m²) showed 33% excess weight loss. There was no significant difference in skeletal muscle mass and mineral contents after IGB treatment.CONCLUSIONSThis study suggested that 6 mon of IGB treatment can be a beneficial treatment for obesity without muscle mass and bone mineral loss.     

21例胰管结石的诊断及治疗

目的探讨胰管结石的诊断和综合治疗。方法回顾性分析收治的21例胰管结石患者的临床资料。21例术前均得以确诊,其中B超确诊率为90.5％( 19/21),CT扫描因不能区分结石与钙化,确诊率为66.7％（14/21）,MRI确诊率为55.6％(5/9)。17例手术治疗,4例内镜治疗。结果术后1例出现胰漏带管出院,1例内镜治疗后发生急性胰腺炎,经保守治疗后痊愈,术后10～21d出院。19例获得随访,随访时间4～72个月,疼痛症状明显缓解,无结石复发、吻合口狭窄和恶变等并发症,6例有轻度脂肪泻。结论对于胰管结石,B超、CT基本能够明确诊断,且B超确诊率高于CT,胰管切开取石+胰管空肠Roux-en-Y吻合术是外科治疗胰管结石的主要术式,内镜已经成为处理胰管结石的一种方法。     

Gray matter volume increases induced by intragastric balloon treatment and their associations with neuroinflammation: A magnetic resonance study

ObjectiveWe simultaneously performed structural MRI, ¹H magnetic resonance spectroscopy, and whole-body hydration status assessment to evaluate brain changes in patients with morbid obesity treated with intra-gastric balloon (IGB) for six months. We asked, if changes in myo-inositol ratios (marker of neuroinflammation) are related to brain volume increases accompanying IGB-induced weight loss.MethodsTwenty five patients with morbid obesity (OB, 43.9 ± 11.8 years, BMI = 49.1 ± 7.2, 12 females, 9 without co-morbid conditions) were treated with IGB for six months. They underwent magnetic resonance imaging at 3T one month before IGB insertion, three months after insertion (N = 19), and one month after IGB removal (N = 14).ResultsInsertion of IGB lead to 8.9% and 12.3% weight reduction over the first three months and over the entire treatment, respectively. Over the entire treatment, total gray matter volume increased by 2.0% (p = 0.009). These changes were mostly pronounced in the left precuneus and in the right frontal pole (>1.9%, p < 0.009). The increases in cortical volume in the right hemisphere and the left posterior cingulate cortical thickness over the entire treatment were significantly related to decreases in myo-inositol ratios measured over the first three months of the treatment (r < −0.740, p < 0.006).ConclusionsIGB treatment lead to brain structural improvements consistent with earlier studies of bariatric patients without co-morbid conditions. Our results also pointed to improvements in brain regions, where atrophy in other studies was related to type 2 diabetes and hypertension. The correlations point to neuroinflammation as one of the potential processes behind brain volume reductions in patients with morbid obesity.     

Pancreatic injury in abdominal trauma in children: difficult to diagnose and treat

Traumatic injury of the pancreas is rare in children. It is often difficult to diagnose due to the lack of signs and symptoms, and shortly after trauma laboratory values may be normal. In addition, ultrasound and CT are often not specific. The treatment of grade 1 and 2 injury is non-operative. Although there seems to be a shift towards non-operative management of grade 3-5 injuries (with injury of the pancreatic duct), this is still a matter of debate. We describe 3 children, a girl of 2.5 years-old and a boy of 7 years-old, with grade 3 pancreatic injuries and an 8-year-old boy with a grade 2 injury. We demonstrate that the diagnosis is hard to establish, while the consequences of this injury can be serious. Thinking of pancreatic injury is most important to its diagnosis. We advocate referral to or consultation of specialized centres in these cases.     

人工鼻泪管植入治疗慢性泪囊炎

目的　探讨人工鼻泪管植入术的手术技巧,评价其疗效.方法对49例(56眼)慢性泪囊炎患者行人工鼻泪管植入术,经逆行扩张鼻泪管后植入特制的人工鼻泪管,均于术前行泪道造影检查.结果术后53眼泪道冲洗均通畅,溢泪、溢脓症状完全消失,另外2眼仍有轻度溢泪.1例无明显改善.显效率为94.64％　(53/56),有效率为3.57％(2/56),总有效率为98.21％　(55/56).结论人工鼻泪管植入术治疗鼻泪管阻塞操作简单,安全性好,有效率高.     

Determination of the site of zinc absorption in rat small intestine.

We have studied net uptake of zinc from segments of rat duodenum, jejunum, and ileum using in vivo intestinal perfusion. We have also evaluated the effect of pancreatic and bile secretions on duodenal zinc absorption. Segments of duodenum, jejunum, and ileum and duodenum with bile and pancreatic duct obstruction, 10 cm in length, were studied in six rats each. Percentage absorption of zinc as determined by atomic absorption spectrophotomety was greater from the ileum (60.1%) when compared to duodenum (19.1%) or jejunum (20.2%). Exclusion of bile and pancreatic secretions from the lumen increased zinc absorption in the duodenum (32.0%). Postperfusion mucosal zinc content comprised 29.0% of absorbed zinc from jejunum, 7.4% from ileum, 5.2% from duodenum, and 2.7% from duodenum with bile and pancreatic duct obstructed, indicating rapid transport of zinc across epithelial cells after uptake from the duodenum and ileum. Our data indicate that the ileum has the greatest capacity for zinc absorption.     

大鼠急性胰腺炎模型脾脏免疫状态的研究

目的 检测大鼠急性胰腺炎模型外周血及脾脏T淋巴细胞亚群，探讨急性胰腺炎病情发展过程中脾脏免疫功能状态的改变。方法 雄性SD大鼠随机分为对照组和实验组，胰管内逆行注射4％牛磺胆酸钠建立实验组胰腺炎模型，两组分别在3、6、12h分3批处死，每批12只。每只大鼠取胰腺组织观察病理改变，取股静脉血2ml及脾脏2g制成单细胞悬液，用流式细胞仪测定T淋巴细胞亚群CD3^ 、CD4^ 、CD8^ 及CD4^ ，／CD8^ 比值。结果 在胰腺组织炎性水肿阶段T淋巴细胞亚群无明显改变，在出血坏死阶段外周血CD3^ 、CD4^ 降低、CD8^ 轻度升高、CD4^ ／CD8^ 明显降低，脾脏细胞与外周血相比CD3^ 、CD4^ 及CD4^ ／CD8^ ，明显降低，脾脏呈现负性免疫状态，且随着炎症的加重变化更加明显。结论脾脏在重症急性胰腺炎中起负性免疫作用，加重SAP病情发展。     

经内镜胆道支架治疗梗阻性黄疸

目的：探讨梗阻性黄疸时塑料和镍钛记忆合金镀金网状支架内镜置入的操作技术及其临床疗效。方法：本组塑料支架组129例,包括：十二指肠乳头炎性狭窄28例,胆总管下段炎性狭窄16例,老年胆总管巨大结石11例,胆漏17例,胆管外科损伤狭窄10例,肝移植术后胆管吻合口狭窄34例,肝门部胆管狭窄8例,胰腺癌5例;镀金支架组42例,包括：中下段胆管癌15例,肝门部胆管癌8例,十二指肠乳头癌9例,胰腺癌10例。所有病人均行ERCP以证实狭窄部位及其程度,选择合适的支架。经十二指肠镜插入导丝至梗阻远端,狭窄明显者沿导丝进行球囊扩张;在x线监视下沿导丝用支架推送器将支架送至狭窄远端2cm。术后观察病人黄疸改善情况,同时观察肝功能、血清淀粉酶变化,并随访3-6月。结果：本组支架均一次置入成功,成功率200％。镍钛记忆合金网状支架置入后1周,患者血清总胆红素（STB）下降68.50％,谷丙转氨酶（ALT）下降64.37％,r-谷胺酰转肽酶（r-GT）下降51.12％,碱性磷酸酶（ALP）下降45.10％;塑料支架置入后1周,STB下降64.24％,ALT下降59.70％,r-GT下降52.83％,ALP下降44.61％。早期并发症包括：高淀粉酶血症、ERCP术后胰腺炎、胆管炎,晚期并发症有支架堵塞。镀金支架组随访期间有4例（14.29％）死于肿瘤进展。结论：经内镜塑料和镍钛记忆合金镀金网状支架治疗胆道梗阻性黄疸安全、有效、并发症少;塑料支架在胆漏及胆道损伤治疗中的应用为肝胆外科手术并发症的治疗提供了较好的弥补手段。     

Feeding tolerance in preterm infants: randomized trial of bolus and continuous feeding

OBJECTIVE: To test the hypothesis that continuous gastric infusion (CGI) is better tolerated than intermittent gastric bolus (IGB) in small very low birth weight (VLBW) infants. DESIGN: Two-center, prospective, randomized, unmasked clinical trial. PATIENTS: 28 VLBW infants (birth weight <1250 g). A strict feeding protocol was followed. INTERVENTION: Patients were randomized to IGB or CGI. MAIN OUTCOME MEASURES: Time to reach full feeds (160 cc/kg/d)(by design and real), daily weight, caloric intake, residual gastric volume and type of feeding (formula vs. human milk vs. both). RESULTS: Five infants failed to complete the study because of death (n = 4) or protocol violation (n = 1). The two groups did not differ by birth weight or gestational age; infants fed via IGB reached full feeds earlier (p = 0.03) and had less delay in reaching full feeds than infants fed via CGI. CONCLUSION: Contrary to our hypothesis, gravity IGB is more effective than CGI in improving feeding tolerance in small VLBW infants.     

External Bolster Placement After Percutaneous Endoscopic Gastrostomy Tube Insertion: Is Looser Better?

BACKGROUND: Abdominal and gastric wall inflammation, infection, and necrosis after percutaneous endoscopic gastrostomy (PEG) placement is a topic of importance but of limited study. Healing of the abdominal wound after PEG placement is thought to be dependent on a number of factors, including the patient's nutrition status, comorbid disease status, and postprocedural PEG wound care. Another important factor that may influence wound healing is tissue tension and compression. This requires special attention to the correct placement of the external bolster of the PEG tube against the abdominal wall. METHODS: We performed a study in mongrel dogs to determine the relevance of tissue compression on PEG-tube wound healing; 8 mongrel dogs each received 3 separate 24 Fr PEG tubes at 1 endoscopic setting. After PEG placement, the external bolster was placed at 0 cm, 1 cm, or 4 cm from the abdominal wall. Post-PEG care and enteral feedings were standardized. The dogs were killed at 3 weeks. RESULTS: Partial migration of the PEG internal bolster into the gastric wall occurred in 1 of 8 of the PEG tubes with the external bolster at 0 cm. PEG-tube-tract tissue inflammation was worse in the dogs with the external bolster placed at 0 cm. CONCLUSIONS: The position of the external bolster in relation to the abdominal wall may be an important factor in the healing of a post-PEG-tube-placement tissue tract.     

Cystic abnormalities of the pancreas: inflammatory pseudocyst or neoplasm

A 79-year-old woman presented with complaints of upper abdominal pain, nausea and vomiting since a few days. Laboratory tests showed no abnormalities except for some indications of an inflammation. Based on the medical history, physical examination and findings from radiological examination, initially the diagnosis was 'chronic pancreatitis with formation ofa pseudocyst caused by alcohol abuse'. After one week the patient developed cholestatic liver function disorders with elevated serum pancreatic enzymes. A CT scan of the abdomen showed a dilated gallbladder and progression of the cystic lesion in the pancreatic head with compression of the distal common bile duct. An endoscopic retrograde cholangiopancreatography was performed and the findings fitted a diagnosis of an intraductal papillary mucinous neoplasm. Differentiation between an inflammatory or neoplastic origin of cystic lesions in the pancreas can be difficult. There is a risk ofmisdiagnosing a cystic neoplasm for a pseudocyst. This may lead to delays in making the correct diagnosis.     

MRI联合MRCP在自身免疫性胰腺炎诊断中的应用

目的探讨常规MR、动态增强扫描（THRIVE）联合磁共振胰胆管造影（MRCP）对自身免疫性胰腺炎的诊断价值。方法对经临床证实的18例自身免疫性胰腺炎进行回顾性分析,18例均行MR平扫及动态增强扫描检查、MRCP检查。结果胰腺弥漫性受累（12／1＆）,胰头局限性肿块（4／18）,胰体尾部受累（d／18）;12例可见“假包膜”征。MRCP：14例胆总管胰腺段狭窄,13例见胰管局限性或弥漫性狭窄,4例主胰管未见显示;动态增强后病变区呈延迟性强化。结论常规MRI、动态增强扫描联合MRCP的联合应用对自身免疫性胰腺炎的诊断有重要价值,其影像学结果对临床治疗决策有指导意义。     

Gastrointestinal surgery and gastroenterology. VI. Chronic pancreatitis: surgical aspects

The indications for surgical treatment of chronic pancreatitis are intractable pain or local complications. The purpose of preoperative investigation, apart from establishing the indications for operation, is to select the kind of procedure to be performed. Important factors include narrowing or dilatation of the pancreatic duct and the presence or absence of an inflammatory mass in the pancreas and of pseudocysts. A pylorus preserving pancreatoduodenectomy or duodenum preserving pancreatic head resection is performed in case of an inflammatory mass in the pancreatic head. In limited clinical trials, duodenum-preserving resection was associated with better recovery, this also applies to the Frey procedure, consisting of local resection of the pancreatic head in combination with lateral pancreaticojejunostomy. In case of dilatation of the pancreatic duct (> 8 mm), without an inflammatory mass drainage of the pancreatic ductal system by a lateral pancreaticojejunostomy is appropriate. A pancreatic tail or body resection can be performed for inflammatory lesions confined to the pancreatic tail or body. Symptomatic pseudocysts are drained internally into the stomach, duodenum or a jejunal loop.     

AngII受体拮抗剂对急性胰腺炎影响的研究

目的　探讨血管紧张素II(AngII)受体拮抗剂对急性胰腺炎 (AP)炎症的影响。方法　SD大鼠随机分为正常对照组、AP组、AP +低剂量缬沙坦 (5mg/kg)组、AP +高剂量缬沙坦组 (8mg/kg)、低剂量缬沙坦组、高剂量缬沙坦组 (每组 6只 ) ;腹腔注射雨蛙肽建立AP动物模型 ;缬沙坦用灌胃针灌注。观察胰腺病理变化并评分 ,评估胰腺水肿情况 ,检测血清淀粉酶 (AMY) ,胰腺组织髓过氧化物酶 (MPO)。结果　AP +缬沙坦的两组胰腺水肿程度、AMY、MPO与AP组比较均下降 ,胰腺组织病理学评分也有所降低。结论　应用AngII受体拮抗剂的AP动物模型可以明显减轻胰腺的炎症及损伤。     

Gastro-intestinal surgery and gastroenterology. V. Chronic pancreatitis: gastroenterologic aspects

Chronic pancreatitis causes irreversible damage to the pancreatic parenchyma and ultimately leads to exo- and endocrine insufficiency. In the Western world, alcohol is the main cause of chronic pancreatitis; part of the patients with idiopathic or alcoholic pancreatitis conceivably have a raised sensitivity to the toxic effects of alcohol because of a certain genetic predisposition. The most striking symptom, severe recurrent or persistent pain is often difficult to manage. Various forms of imaging examination provide complementary information on lesions of the pancreatic parenchyma, the pancreatic duct, the bile ducts and adjacent structures; ultrasonoscopy is the technique of first choice in case of suspicion of a pancreatic disorder. Endoscopic therapies are booming: sphincterotomy, calculus extraction, insertion of an endoprosthesis in the pancreatic duct and drainage of pseudocysts (transpapillary or through the jejunum or stomach).     

The effect of early postoperative jejunal feeding on the exocrine function of the pancreas

Subsequent to pancreatoduodenectomia with pylorus retention on 12 patients suffering from chronic pancreatitis we analysed the effect of artificial nutrition on pancreas-secretion by examining the pancreatic juice extracted directly from the Wirsung duct. We used post-operative nutrition administered by fine-needle catheter jejunostomy in 7 patients and 5 patients received postoperative support by total parenteral nutrition as a control-group. We analysed the pancreatic juice collected in four hour fractions for volume, direct protein, amylase, chymotrypsin, bicarbonate. It has been found that on the first two days after the operation we can see a slow increase in the measured values and on the third postoperative day after an abrupt rise the pancreas secretion became steady. Between the two methods of artificial nutrition applied it was impossible to prove an observable difference concerning their effect on the pancreas. According to our observations the two methods are equivalent in the postoperative therapy of patients operated on because of chronic pancreatitis.     

Percutaneous endoscopic gastrostomy complication rates and compliance with the American Society for Gastrointestinal Endoscopy guidelines for the management of antithrombotic therapy

Background: The American Society for Gastrointestinal Endoscopy (ASGE) has published recommendations in regards to anticoagulant (AC) and antiplatelet (AP) therapy management during endoscopic procedures. So far, no study has assessed either ASGE recommendation compliance during percutaneous endoscopic gastrostomy (PEG) placement or procedure‐associated complication rates as related to the observance of these recommendations. The aims of this study were to compare the incidence and type of complications during PEG placement in patients receiving or not receiving AC and/or AP therapy and to determine the compliance with ASGE's AC and AP management guidelines. Methods: Medical files of patients who underwent PEG placement from January 2004 to December 2008 were reviewed. Clinical and procedure‐related data were recorded. Patients were separated into 1 of 2 groups: patients under AP and/or AC therapy prior to PEG placement (n = 51) and a control group of patients (n = 40) not receiving any AP and/or AC treatment at least 6 months prior to the procedure. Results: A total of 91 patients (51 cases) were included. Groups were comparable in demographics and clinical characteristics. No differences in the frequency and type of complications were found between groups. ASGE's recommendations were not followed in any of these patients. Conclusions: Overall PEG placement complication rate was 13.7%. AP therapy may be safely discontinued closer to the time of endoscopic procedure than the time currently recommended by the ASGE guidelines.     

慢性胰腺炎36例内镜治疗

目的探讨慢性胰腺炎(CP)的内镜治疗方法及效果。方法回顾性分析2000年1月～2010年12月住院确诊为CP并行内镜治疗的患者36例,随访观察其临床疗效。结果采用内镜ERCP技术治疗36例CP患者,其中33例行EST/P;9例胰管明显狭窄行ERPD;2例副胰管扩张则行副乳头括约肌切开并行副胰管内支架置入;18例胰管结石先扩张,内支架置入再取石,其中7例取石困难:ERPD后再取石3例、ESWL后取石1例、中转手术3例;12例患者分别于术后第5、11个月出现支架阻塞予更换支架治疗。并发症发生率为9.1%(3/33),其中急性胰腺炎1例,感染1例,支架移位1例,无穿孔发生。术后腹痛、脂肪泻等症状完全缓解率、分别在1、6、12个月为75.86%、65.52%、68.97%,胰腺假性囊肿内支架引流3例,鼻胰管+内支架引流术4例。结论内镜治疗能有效缓解CP患者的腹痛症状,增加患者的体质量,是治疗CP的一种安全、微创、有效的手段。     

The pathophysiology of pancreatitis.

The pancreas is an exocrine and endocrine gland that is required for normal digestion and metabolism of proteins, carbohydrates, and fats. Acute pancreatitis (AP) is an inflammatory process of the pancreas that involves peripancreatic tissues and remote organs. Mild AP occurs in 80% of patients requiring hospitalization and severe AP occurs in the other 20%. Chronic pancreatitis (CP) is an inflammatory disorder that causes anatomic changes, including infiltration of chronic inflammatory cells and fibrosis of the pancreas. This review discusses biochemical and histologic features of pancreatic injury in AP and CP and some of the important clinical sequelae associated with these abnormalities.     

Ultrasound-guided percutaneous antegrade wirsungography in chronic calcifying pancreatitis

Dilated pancreatic duct was found by ultrasonography in a patient in association with the characteristic sonographic features of chronic calcifying pancreatitis. Endoscopic retrograde pancreatography showed an obstruction of the Wirsung's duct 3 cm far from the papilla of Vater. Further parts of the duct could not be opacified by this manner. However, visualisation of the rest of the pancreatic duct was successfully performed by ultrasonically guided antegrade wirsungography making the preoperative planning of the suitable type of surgery possible. Beside the case history the importance of the is method is also discussed in diagnosis of pancreatic diseases.