NASOGALLBLADDER DRAINAGE FOR MIRIZZI’S SYNDROME

The authors experienced a case of Mirizzi’s syndrome successfully treated with endoscopic nasogallbladder drainage (ENGBD). The patient was a 63‐year‐old man. He was admitted with abdominal pain and jaundice. Laboratory data indicated leukocytosis and elevation of serum bilirubin level. Abdominal ultrasound showed marked swelling of gallbladder and debris in the gallbladder, therefore, the authors strongly suspected Mirizzi’s syndrome. He had past history of acute myocardial infarction and treated with anticoagulation therapy. Then, the authors couldn’t perform surgical removal or percutaneous transhepatic drainage, and tried endoscopic transpapillary drainage. Endoscopic retrograde cholangiopancreatography revealed smooth stricture in the superior portion of common bile duct and occlusion of the cystic duct, and ENGBD was then performed. After ENGBD, his complaints, laboratory data, swelling of gallbladder and stricture of common bile duct were all remarkably improved.     

TCD观察动脉瘤性SAH后脑血管痉挛的血流动力学改变

目的探讨动脉瘤性蛛网膜下腔出血(SAH)后脑血管痉挛的血流动力学改变。方法经CT、DSA证实为动脉瘤性SAH患者179例,床旁经颅超声多谱勒(TCD)在术前、术后1~3d、5~7d、9~11d、12~14d记录并分析大脑中动脉(M CA)的血流参数及频谱改变。结果M CA平均血流速度(Vm)于SAH后1~3d开始升高,5~7d、9~11d达到高峰;L I(血管痉挛指数)为3~6时预后良好;>6时可以出现神经系统功能损害,颅内压增高且有脑血管痉挛(CV S)者预后较差。结论TCD能无创、实时评价SAH后CV S的动态变化,可以推断SAH后CV S的严重程度及临床转归。     

ENDOSCOPIC MANAGEMENT OF A DIEULAFOY‐LIKE LESION IN A DUODENAL DIVERTICULUM

We present a 70‐year‐old man who had two episodes of melena during the preceding 8‐year period. He had a Dieulafoy‐like lesion in a diverticulum in the third portion of the duodenum. While emergency endoscopy revealed neither apparent blood nor clots around the diverticular orifice, there was a non‐bleeding vessel in the fundus of the diverticulum. The vessel ceased bleeding after argon plasma coagulation and, since then, the patient has not experienced bleeding. In cases of gastrointestinal bleeding of obscure origin, duodenal diverticulum should be considered as a possible source of bleeding, even when endoscopy discloses no apparent bleeding.     

糖耐量减低患者胰岛素抵抗与颈动脉粥样斑块的相关性分析

目的　探讨胰岛素抵抗 (IR)在糖耐量减低 (IGT)大血管并发症中的作用。方法　测定 1 2 0名IGT患者和 96名糖耐量正常(NGT)对照者的空腹血糖 (FBG)、胆固醇 (TC)、甘油三酯 (TG)、胰岛素 (FINS)及餐后 2h血糖 (PBG) ,并测量身高、体重、腰围、臀围 ,计算相对胰岛素敏感指数 (RISI)、体重指数 (BMI)、腰臀比 (WHR) ,结合其颈动脉多普勒超声检测结果进行对比分析。结果　IGT组及NGT组颈动脉粥样斑块发生率有显著性差异 (P <0 .0 0 1 ) ,斑块面积与RISI呈负相关 (r =- 0 .45 ,P <0 .0 1 ) ,与餐后 2h血糖 (r =0 .39,P <0 .0 1 )、BMI(r=0 .48,P <0 .0 1 )及WHR(r=0 .41 ,P <0 .0 1 )正相关 ,而与TG、FBG、TC、FINS无相关性 (P >0 .0 5)。IGT组患者有斑块和无斑块者之间RISI、WHR、BMI、餐后 2h血糖、TG之间也存在显著性差异 (P <0 .0 1 )。结论　胰岛素抵抗与颈动脉粥样硬化的发生密切相关 ,是IGT患者发生大血管并发症的重要原因。     

胆管癌误诊和漏诊的影像学分析

目的：分析胆管癌误诊和漏诊的原因，评价不同检查方法对肝门区胆管癌诊断的价值，提高胆管癌的影像学诊断和鉴别诊断水平。方法：收集31例临床和病理诊断为胆管癌的病例(ERCP检查31例，B超检查31例，25例CT检查，11例行MRCP检查)，回顾性分析不同检查方法的影像学表现。结果：31例中发生在肝门区的胆管癌25例。2例初次ERCP显示胆管内出血，再次行鼻胆管造影后诊断为胆管癌，4例合并有总胆管结石。6例为总胆管中下段癌。初次诊断准确性为90．3％。11例MRCP中9例显示病变，2例显示不满意，7例显示胆管或胆囊结石。25例CT中23例显示肝内胆管扩张，9例显示肝门区肿块，2例见后腹膜转移淋巴结，1例见肝内多发性转移瘤。12例初次诊断正确(48％)。B超检查23例提示肝内胆管扩张，6例提示总胆管结石，18例诊断为胆囊炎、胆囊结石，8例提示胆管占位(25．8％)。结论：良好的直接胆管造影是诊断胆管癌的金标准，MRCP可以在一定程度上准确显示病变的范围，是ERCP的良好补充，很大程度上取代了诊断性ERCP；CT诊断的关键在于显示扩张的胆管和梗阻的定位，肝门区梗阻多为胆管癌所致。多种影像检查方法的结合明显提高了诊断的准确性，对胆管癌治疗方案的选择有重要价值。     

Acute Osteomyelitis: Early Diagnosis by Ultrasonography

A prospective study was carried out to evaluate the role of ultrasound in early detection of infections of bone. Presence of a hypoechoic collection adjacent to bone was considered highly suggestive of osteomyelitis whereas a hypoechoic collection away from the bone implied a soft tissue abscess. Cellulitis presented as increased subcutaneous thickness. Of the 31 patients clinically suspected to have osteomyelitis, and subjected to ultrasound, 25 were proven to be osteomyelitis at surgery or by subsequent radiological changes, 4 had soft tissue abscesses and the remaining 2 had cellulitis. Co-existent hip joint effusion was seen in 2 patients. It is felt that ultrasound is simple and non-invasive investigation, capable of detecting bone and soft tissue infections.     

Endoscopic photographic comparison of drug delivery by ear-drops and by aerosol spray

The Otomize (Stafford-Miller Ltd) aerosol spray is a new device for delivering topical ear medication in otitis externa. Both the manufacturers and a recent study have claimed that the spray produces better coverage of the external ear canal than do traditional ear-drops. We performed an endoscopic photographic comparison study to investigate this claim. The area of tympanic membrane and ear canal covered with medication was greater in those ears treated with the aerosol (P < 0.001, paired t-test). The ability of the aerosol to deliver drug to the level of the tympanic membrane suggests a possible role for this device in the treatment of chronic otitis media. The technique of endoscopic photography provides an objective and reproducible means of investigating drug delivery systems for otological conditions.     

New ways of performing in vivo flow velocity measurements in the basilar artery

The basilar artery is the only large artery in which two flows merge, and this is reflected in the flow downstream. We report quantitative flow — velocity measurements with a phase-based MR technique, i.e. the Fourier velocity encoding method, in the basilar artery of a volunteer. To our knowledge, this has not previously been performed successfully. A comparison is made with the results of flow velocity measurements in the basilar artery with transcranial Doppler ultrasonography; the techniques agreed very well. Although Doppler ultrasonography is still most widely used, no information on the flow rate and the flow velocity distribution in the basilar artery can be provided. MR flow measurement techniques appear promising when detailed information on the flow velocity distribution and flow rate is needed.     

Effects of cimetropium bromide on gallbladder contraction in response to oral and intraduodenal olive oil

Summary To evaluate the influence of the stomach and the cholinergic system on gallbladder contraction induced by physiological stimuli, the reduction in gallbladder volume in 7 healthy volunteers has been studied by real-time ultrasonography after the oral and intraduodenal administration of olive oil, preceded by pretreatment with cimetropium bromide or placebo. After an overnight fast, each subject swallowed 50 ml olive oil or it was administered through a naso-duodenal tube in the proximal duodenum. Cimetropium bromide 5 mg or placebo was given intravenously under double-blind control.After the placebo pretreatment, gallbladder contraction was greater and faster after intraduodenal oil than after oral oil. Cimetropium bromide decreased the extent, velocity and duration of gallbladder contraction induced by intraduodenal olive oil but it only reduced the velocity of the contraction induced by oil given orally.It is concluded that in normal human subjects the stomach modulates the extent and velocity of postprandial gallbladder contraction and that anticholinergic agents antagonize the gastric and duodenal phases of the response of the gallbladder to a meal.