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Background
An estimated 15% of the UK population has gallstones. Gallstones in the biliary tree can result in complications such as cholangitis and pancreatitis, which have high morbidity and mortality rates. To prevent such complications, patients can undergo endoscopic sphincterotomy. In our centre, an initial study was undertaken in 2002 to examine outcomes of endoscopic sphincterotomy in patients under the age of 50 years. The aim of our current project was to examine the long-term outcomes until Nov 30, 2015.Methods
Data from the study in 2002 were used to identify patients who had undergone endoscopic sphincterotomy between 1984 and 1992. The case notes for these patients were examined to identify outpatient hepatobiliary appointments, serial liver function tests, further investigations or procedures, and development of upper gastrointestinal malignancy or death. Data available included letters and scan reports. In the case of patient death, patients' general practitoners and the coroner's office were contacted.Findings
42 patients (32 women [76%]) had undergone endoscopic sphincterotomy between 1984 and 1992. At data collection in November, 2015, mean age was 55 years (SD 6·49), and mean follow-up since endoscopic sphincterotomy was 25 years (SD 2·40). Eight patients (19%) had died, two during the 2002 study, and six between 2002 and 2016. Two deaths were due to pancreatic adenocarcinoma at 8 months and 19 years after endoscopic sphincterotomy. One patient died from hepatocellular carcinoma; no other deaths were due to hepatobiliary or pancreatic disease or malignancy. Ten patients had no follow-up scans, imaging, or outpatient appointments. Of the 32 patients who had follow-up or investigations, two required further endoscopic sphincterotomy for recurrent stone disease at 22 and 25 years after their initial endoscopic sphincterotomy. Three patients had abnormal liver function tests but had no further investigations; three patients underwent further imaging but had no further interventions.Interpretation
To our knowledge this is the first cohort study with such lengthy follow-up after endoscopic sphincterotomy. Our results suggest that endoscopic sphincterotomy is generally a safe and effective long-term treatment option that is not associated with major levels of recurrent disease or malignancy. This was a small single-centre cohort study and future population based studies should be conducted to better evaluate these findings in a larger cohort of patients.Funding
None. 相似文献2.
Viken Douzdjian MD FACS Prathivadi R Rajagopalan MD FACS 《Journal of the American College of Surgeons》1997,185(5):471-475
Background:Historically, primary enteric drainage (ED) of exocrine secretions in pancreas allografts was associated with a poor outcome, mostly as a result of infectious complications. On the other hand, bladder drainage (BD), which is presently used in the majority of institutions, is associated with substantial urologic morbidity. The aim of this study is to reassess the role of primary ED by reviewing our experience with ED versus BD in simultaneous pancreas-kidney transplantations.Study Design:The records of all pancreas-kidney transplantations performed between October 1990 and September 1996 were reviewed (n = 42). Enteric drainage was used in the last 16 (38%) and BD in the first 26 (62%). The BD and ED groups were comparable with respect to donor and recipient characteristics.Results:Length of stay for the transplantation (mean ± standard deviation) was significantly shorter with ED than with BD (12.9 ± 5.6 versus 20.4 ± 9.6 days, p = 0.007). The total number of readmissions (1.7 ± 1.5 versus 1.2 ± 1.2 days, p = 0.2) and the length of hospital stay in the first 6 months after discharge (13.7 ± 16.2 versus 10 ± 11.3 days, p = 0.4) were similar between BD and ED. Complications requiring admission were distributed as follows in BD and ED recipients: recurrent/persistent urinary complications (46% versus 6%, p = 0.01), dehydration (27% versus 6%, p = 0.05), symptomatic graft pancreatitis (8% versus 6%, p = 0.9), gastrointestinal disturbance (27% versus 12%, p = 0.1), and wound infection (12% versus 19%, p = 0.5). The duration of the operative procedure was shorter in ED than in BD (4.3 ± 0.9 versus 5.4 ± 0.8 hours, p = 0.01). Reoperation during the initial transplantation stay was necessary in 23% of the patients having BD, compared with none having ED (p = 0.04). Similarly, fewer ED patients underwent reoperations compared with BD patients in the first 6 months after discharge (38% versus 69%, p = 0.04). Hospital charges for ED were lower than for BD for the initial admission ($73,458 ± 17,103 versus $107,193 ± 32,965, p = 0.001). Actuarial patient (96% versus 94%, p = 0.6), kidney (85% versus 87%, p = 0.9), and technically successful pancreas (90% versus 85%, p = 0.6) survival rates at 1 year were similar for BD and ED.Conclusions:Our results indicate that, compared with BD, ED is associated with less morbidity and shorter hospitalization without compromising outcome. Primary ED is a viable alternative to BD in simultaneous pancreas-kidney transplantation. More clinical experience with careful cost-effectiveness analysis is needed to better assess the implications of primary ED. 相似文献
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Aflatoxins are carcinogenic mycotoxin, produced by Aspergillus species. These molds infect food crops in warm humid conditions causing economic losses and affecting the consumers' health adversely. In this study, antifungal activity and aflatoxin inhibiting ability of four probiotic strains against Aspergillus flavus and Aspergillus parasiticus were studied. The aflatoxin secreted was analyzed and quantified by both UV spectrophotometer and HPLC. It was found that Lactobacillus delbrueckii subsp. lactis showed maximal antifungal (67.43% reduction) and anti-aflatoxigenic (94.33% reduction) activity against A. flavus whereas A. parasiticus was inhibited by Lactobacillus brevis with the antifungal reduction of 69.38% and anti-aflatoxigenic reduction of 96.12%. 相似文献
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