RESUMEN
Many devices and techniques have been developed to assist in cases of difficult biliary cannulation. Guidewire-assisted cannulation has become the first-line technique for biliary cannulation. Precut sphincterotomy can be safe and effective if used soon after encountering difficulty. Pancreatic duct stents are an important adjunct to reduce the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis in difficult access. Ultimately, cannulation success of greater than 95% and complication rates of less than 5% is the standard that endoscopists doing ERCP should achieve.
Asunto(s)
Conductos Biliares/cirugía , Cateterismo/métodos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Conductos Pancreáticos/cirugía , Esfinterotomía Endoscópica/métodos , HumanosAsunto(s)
Antiinflamatorios/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Colitis Ulcerosa/terapia , Fármacos Gastrointestinales/uso terapéutico , Complicaciones del Embarazo/terapia , Adulto , Colitis Ulcerosa/diagnóstico , Femenino , Humanos , Infliximab , Valor Predictivo de las Pruebas , Embarazo , Complicaciones del Embarazo/diagnóstico , Tercer Trimestre del Embarazo , Índice de Severidad de la Enfermedad , Sigmoidoscopía , Resultado del TratamientoRESUMEN
Until now, peripheral vascular endothelial function testing has been performed in research laboratories under highly controlled conditions, thus limiting its clinical applicability. In this study, we evaluated endothelial function in two peripheral vascular beds before and during reactive hyperemia in an outpatient clinic setting. The brachial artery was imaged with a portable ultrasound device and changes in vessel diameter were expressed as percent flow-mediated dilation (%FMD). Pulse wave amplitude of the finger was detected by peripheral arterial tonometry (PAT) and PAT hyperemia was defined as the maximal plethysmographic recording compared to baseline. Sixty individuals (43 men) were enrolled with an average age 53 +/- 2 years (mean +/- SE). The 31 individuals with more than two cardiac risk factors (CRF) had lower FMD (7.0 +/- 1.1%) and PAT hyperemia (2.1 +/- 0.9) compared to the 29 individuals with 0-2 CRF (FMD 11.3 +/- 0.8%, PAT hyperemia 2.4 +/- 0.1; p < 0.05 for both). The 32 individuals with coronary artery disease (CAD) had lower FMD (6.8 +/- 1.1%) and PAT hyperemia (2.0 +/- 0.1) compared to the 28 individuals without CAD (FMD 11.5 +/- 0.8%, PAT hyperemia 2.4 +/- 0.1; p < 0.05 for both). Thus, peripheral vascular endothelial function testing in the ambulatory setting correlates with the extent of CAD risk and the presence or absence of CAD. In conclusion, these data suggest that peripheral vascular endothelial function testing is feasible in ambulatory patients, and this is an important next step in bringing this technology to clinical applicability.