Multiple imaging techniques in the diagnosis of ampullary carcinoma.

BACKGROUND: Ampullary carcinoma is a neoplasia with a good prognosis compared to pancreatic cancer. But it is difficult to early diagnose because it lacks clear clinical symptoms. This study aimed to evaluate the efficacy of abdominal ultrasonography (US), enhanced computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in detecting ampullary carcinoma. METHODS: Forty-one patients with ampullary carcinoma who had been confirmed pathologically among the inpatients at the First Affiliated Hospital of Zhejiang University School of Medicine from February 2003 to March 2007 were analyzed retrospectively. The accuracy of US, CT, MRCP and ERCP were compared in the diagnosis of ampullary carcinoma. RESULTS: The accurate rate for detection of ampullary carcinoma with US was 26.83%. The accuracy of CT and ERCP in detection of ampullary tumors was 84.62% and 100%, respectively, which were significantly higher than that of US (P<0.05). The accuracy of MRCP in detection of ampullary tumors was similar to that of US in spite of visualization of obstruction and dilatation of the pancreaticobiliary duct with MRCP. CONCLUSIONS: Because of the obscure and late onset of symptoms, ampullary carcinoma is difficult to diagnose early. Multiple imaging techniques should be carried out appropriately in order to early diagnose the disease and improve the prognosis.

[T lymphocyte subgroups and serum levels of trace elements in patients with diarrhea type of irritable bowel syndrome].

OBJECTIVE: To investigate the T lymphocyte subgroups and the levels of serum zinc (Zn), selenium (Se), iron (Fe), copper (Cu) in patients with diarrhea type of irritable bowel syndrome (D-IBS). METHODS: A total of 30 D-IBS patients and 30 control subjects were enrolled in this study, and their peripheral blood samples were collected. The percentage of peripheral CD3, CD4, CD8 T lymphocytes were analyzed by flow cytometry, and the ratio of CD4/CD8 was calculated. Serum Zn, Fe and Cu levels were determined by atomic absorption spectrometry(AAS), and the Se level by atomic fluorometry. RESULT: Compared with control group,the percentage of CD4 T lymphocyte and the ratio of CD4/CD8 in D-IBS group were significantly lower (P<0.01). However, there was no significant difference in serum Zn, Se, Fe, Cu levels between two groups (P>0.05). CONCLUSION: The declines of peripheral blood CD4 T lymphocytes and the ratio of CD4/CD8 may suggest a cellular immune abnormality in D-IBS patients. There was no significant difference in trace elements levels between the two groups.

Hepatic veno-occlusive disease induced by Gymura segetum: report of two cases.

BACKGROUND: Hepatic veno-occlusive disease (VOD) or sinusoidal obstruction syndrome is associated with a high mortality because of its severity. Gymura segetum, a Chinese herbal medicine, is always used to cure injury and bleeding in rural areas in China. This study was undertaken to better understand VOD and its relations to the effect of Gymura segetum. METHODS: Between 2000 and 2002, two patients were admitted to our department because of VOD. Before admission, both of them had been injured and taken oral decoction of patent drug Gymura segetum. We analyzed the clinical manifestations, diagnosis and therapy of the two patients. RESULTS: Pyrrolizidine in Panax notginseng was proved to induce VOD. The diagnosis of VOD depended on hepatic biopsy. CONCLUSION: Gymura segetum can induce VOD. More attention should be paid to its unsuscepted side effects.

Clinical manifestations of patients with chronic pancreatitis.

BACKGROUND: Recent advances in molecular and genomic technologies and pancreatic imaging techniques provided some insights into genetic, environmental, immunologic, and pathobiological factors for chronic pancreatitis (CP). This study was undertaken to investigate the clinical manifestations of patients with chronic pancreatitis at our hospital. METHODS: The data of the patients with CP who had been treated at our hospital between 1997 and 2004 were analyzed. RESULTS: The major symptoms of the patients with CP were abdominal pain, dyspepsia, loss of weight, diabetes mellitus, pancreatic pseudocyst, steatorrhea, and calcification. Biliary diseases were found to be the first cause of CP in this study; but alcohol abuse was the major cause of CP in men and biliary diseases were the first etiological factors for CP in women. The etiological difference of constituent ratio between men and women was related to alcohol consumption (P<0.01). CONCLUSIONS: During the past 8 years, biliary diseases have been the major etiological factors for CP, but their constituent ratio is decreasing, and the constituent ratio of alcohol abuse is increasing gradually. Alcohol tends to replace biliary diseases as the primary etiological factor for CP.

[Clinical characteristics of hepatic sinusoidal obstruction syndrome: analysis of 8 cases].

OBJECTIVE: To investigate the diagnosis and treatment of sinusoidal obstruction syndrome (SOS). METHODS: The data of 8 patients with SOS, including clinical manifestations, laboratory results, imaging, pathology, and the course of diagnosis and treatment were reviewed. All cases were followed up. RESULTS: The main clinical manifestations included abdominal distention, hepatalgia and signs of ascites and hepatomegaly. There were mild or moderate hepatocellular injury in 6 patients and heavy injury in 2. All patients' serum-ascites albumin gradient exceeded 11.1 g/L. The levels of CA125 in both serum and ascites elevated significantly. All patients' ultrasonography showed hepatomegaly, appearance of portal hypertension and attenuated hepatic veins. Reverse blood flow in portal vein was observed in 5 cases. Magnetic resonance imaging showed that contrast agent accumulated unevenly in liver in both portal period and lag period, but filled poorly in hepatic veins. Per cutsem liver biopsy showed that all patients' hepatic sinusoids were congested, but venular occlusion was observed in only 3 cases. Five cases had been misdiagnosed. One patient healed after liver transplantation, 4 patients recovered gradually by treatment with heparin and so on and 3 patients died. CONCLUSIONS: Signs of outstanding portal hypertension with mild hepatocellular injury is the main clinical feature of SOS. Both serum and ascites CA125 levels in SOS patients are elevated significantly. The misdiagnosis rate of SOS is quite high, ultrasonography and magnetic resonance imaging have significant value in diagnosis and differential diagnosis, while the value of per cutsem liver biopsy is limited. Combination of imaging and pathology should contribute to correct diagnosis of SOS. Application of anticoagulant in early course is vital, liver transplantation should be considered in severe cases.

Association of nonalcoholic fatty liver disease with type 2 diabetes: clinical features and independent risk factors in diabetic fatty liver patients.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLDéis a common chronic liver disease in China, of which diabetic fatty liver (DFLéaccounts for a large proportion in clinic. DFL is a disease without specific clinical features and lacking of confirmatory laboratory tests, and the etiology of hepatic steatosis remains poorly understood. The aim of this paper was to explore the clinical characteristics and to determine associated risk factors in type 2 diabetes patients with fatty liver. METHODS: A total of 166 patients, 53 in DFL group and 113 in NDFL (diabetes without fatty liverégroup participated in this study. Serum fasting blood glucose (FBG), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphate (AKP), gamma glutamyl transpeptidase (GGT), total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C)were measured in both groups. And these variables were analyzed by using Student's t test and logistic regression model. RESULTS: A progressive increase in the level of FBG, ALT, AST, AKP, GGT, TG (P < 0.05) and a decrease of HDL-C (P < 0.01) were observed from DFL group to NDFL group. And there was no statistical difference in the level of TC between the two groups. CONCLUSIONS: Dyslipidemia, dysglycemia and elevation of liver enzyme can be seen more frequently in the DFL patients than in the NDFL patients. The successive escalation of serum ALT and TG levels and the lower HDL-C level are the independent risk factors of DFL.

Sedation and safety of propofol for therapeutic endoscopic retrograde cholangiopancreatography.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is the most complex gastrointestinal procedure, which needs patients' cooperation. The aim of this study was to observe the quality and safety of sedation with propofol in patients undergoing therapeutic ERCP. METHODS: Seventy patients who had undergone therapeutic ERCP were randomly divided into two groups. One group,given intravenously propofol,and the other sedated with routine method,served as the control. Blood pressure,heart rate, oxygen saturation were monitored and cardiorespiratory event was observed. Patient cooperation, performance, recovery time and amnesia served as variables postoperation. RESULTS: Blood pressure elevated in four patients in the propofol group, less than in the control group (P < 0.01). Seven patients showed decreased blood pressure after administration of propofol, but none in the control group (P < 0.01). Twelve patients in the control group showed mild or significant resistance, but none in the propofol group (P < 0.01). The time for performance in the propofol group (P < 0.05) was shorter than in the control group. Patient recovery was quicker in the propofol group than in the control group (P < 0.01). The degree of amnesia better in the propofol group than in the control group (P < 0.01). The degree of amnesia was also better in the propofol group than in the control group (P<0.01). CONCLUSIONS: Propofol proves to be an excellent sedative for therapeutic ERCP. Being effective and safe, it shows a shorter ERCP duration but quick recovery and better amnesia. It is better than other routine sedatives.