ABSTRACT
Background and aim: Variable techniques could be used to raise the success rate and reduce complications of endoscopic retrograde cholangiopancreatography [ERCP]
Patients and methods: From 73 patients subjected to ERCP in our endoscopy unit, during the period between January 2016 to December 2017, 47 patients were managed with standard free direct cannulation maneuver [group- I], 21 patients managed with indirect maneuvers [DGT and\\or TPS as group-II] and ERCP was failed in 5 cases; in 3 of them temporary pancreatic stent was placed but with no value
Results: From 73 patients, standard free direct cannulation was done in 47 patients with success rate 64.4%, the remaining 26 patients managed with indirect maneuvers with successful cannulation of CBD in 21 cases with success rate 80.7% and total success rate of 94.4%. Procedure duration was longer in patients of indirect maneuvers than patients of standard free direct cannulation maneuver, with high significant difference [P value of 0.0036]. The post-ERCP complications were noticed in 21 patients with complications rate of 28.8 %. Complications were significantly higher in patients of indirect maneuvers than patients of standard direct maneuver [47.6% vs. 23.4%]. Post-ERCP pancreatitis recorded in 7 patients [9.6%] with significant higher rate in patients of indirect maneuvers than patients of direct maneuver [23.8% vs. 4.3%]
Conclusion: Indirect biliary cannulation [DGT and/or TPS] solved the problem of failed cannulation but had a higher rate of complications and took longer time
ABSTRACT
Thyroid disorders had been incriminated a lot in reversible dementia at the end of the last century. Yet, the relation between myxedema per se and cognitive dysfunction has been of great concern nowadays. is to screen the incidence and delineate the characteristics of cognitive dysfunction that may occur in association to hypothyroidism; also to decide the best test to achieve rapid diagnosis in such a problem our study included 50 subjects; 30 patients [20 patients with overt hypothyroidism and 10 with subclinical hypothyroidism] and 20 healthy subjects serving as control group. All were submitted to general medical and neurological examination, laboratory investigations to complete the diagnosis of hypothyroidism, MRI brain, P300 latency assessment and neuropsychological assessment [WAIS-R,WMS-R and tests for frontal executive functions]. A definite cognitive impairment in both hypothyroid patient's group was noted in comparison to controls, as proved by statistically significant prolonged absolute P300 latency and positive neuropsychological tests among them. WAIS subtests especially: [Picture arrangement test, Block design test and Digit backward test] can be used as a premonitory test to detect cognitive dysfunction with hypothyroidism