Comparison of endoscopic papillary large balloon dilation and endoscopic sphincterotomy for retrieval of choledocholithiasis

Background: Endoscopic sphincterotomy [EST] combined with balloon catheters and/or baskets are the routine endoscopic techniques for stone extraction in the great majority of patients. Whereas large common bile duct [CBD] stones are treated conventionally with mechanical lithotripsy, large balloon papillary dilation after endoscopic sphincterotomy [ELPBD] represents the onset of an era in large CBD stone extraction and the management of [impaction]. That is because it seems effective, inexpensive, less traumatic, safe and easy method that does not require sophisticated apparatus and can be performed widely by skillful endoscopists. Studies comparing the efficacy and safety of EPLBD with EST have reported mixed outcomes. The aim of the study to compare the success and complications rates between endoscopic papillary balloon dilation and endoscopic sphincterotomy for enlargement of papillary opening during endoscopic removal of common bile duct stones

Methods: Randomized prospective comparative study was conducted on seventy four patients with CBD stone[s], subjective to therapeutic ERCP procedures for endoscopic extraction of common CBD[s]

The enrolled patients were randomly divided into two groups according to the maneuver for dilate the papillary orifice into: Group I: Thirty one patients underwent EPLBD technique combined with balloon catheters and/or baskets for stone extraction. Group II: Forty three patients underwent EST combined with balloon catheters and/or baskets, which is considered as conventional endoscopic technique for stone extraction in the great majority of patients

Results: Complete extraction CBD stones among the patients of groupl; EPLBD was effective for clearance of [92.5%] of CBD stones in patients with the stone sized < 1cm and in [83%] of patients with stone size > 1cm, [overall clearance rate=87%]

Overall adverse effects of patients of groupl was [29%] as mild self-limiting post ERCP pain occurred in [9.6%] and mild intra- procedure bleeding occurred in [9.6%], whereas more serious complication as melena which occurred in [3.2%], and mild pancreatitis occurred in [6.4%]. Whereas complete CBD stones clearance among the patients of group 2; EST was effective in [96%] of patients with the stone sized < 1 cm, while stone clearance occurred in [56%] in patient with stone size> 1cm, [overall clearance rate=79%]. Overall adverse effects of patients of group 2 was [18.5%] as mild self-limiting post ERCP pain occurred in [7%] and mild intra-procedure bleeding occurred in [4.6%], whereas more serious complications as mild pancreatitis developed in [4.6%], and post ERCP cholangitis in [2.3%] The comparison between the two groups regarding the extraction of CBD stones revealed combination of papillary large balloon dilation after EST is not required in patients whose the CBD stone size < 1 cm. Whereas the clearance rate of CBD stones in the patients with stone size > 1cm among the group 1 was [83%] which better than among the group 2 which was [56%] with nearly statistical difference [P value=0.07]

Conclusion: Conventional EST is an effective method for removal of common bile duct stones < 1 cm in diameter whereas the use of large papillary balloon dilation after endoscopic sphincterotomy improve the clearance rate of bile duct stones> 1cm which is difficult to be extracted by conventional sphincterotomy and extraction devices. Endoscopic papillary large balloon dilation is an adjunctive tool to endoscopic sphincterotomy for removing large or difficult CBD stones

Relationship between serum sialic acid and cardiovascular risk factors in Egyptian children and adolescents with type 1 diabetes mellitus

The aim of the present study was to investigate the relation between serum sialic acid and cardiovascular risk factors in Egyptian children and adolescents with uncomplicated type 1 diabetes mellitus. The study included 40 [25 males and 15 females] type 1 diabetic children aged 4 to 16 years and 20 non diabetic healthy controls with age and sex matched. All children were subjected to full clinical examination, blood pressure measurement, anthropometrical measurements [weight, height, body mass index]. The children were investigated for biochemical variables: total cholesterol [TC], triglycerides [TG], high-density lipoprotein cholesterol [HDL], low-density lipoprotein cholesterol [LDL], fasting blood glucose [FBG], glycated hemoglobin [HbA1c] serum sialic acid [TSA] and serum creatinine. There was no significant difference between mean serum TSA in type 1diabetic children [69.77 +/- 8.38] and their controls [67.77 +/- 7.7]. In diabetic children, mean serum TSA was significantly higher in females [72.03 +/- 3.04] than in males [67.29 +/- 8.7] p<0.05. Significant correlations were found between serum TSA and each of diabetic duration [p,0.02], BMI [p, 0.01], cardiovascular risk factors: TC [p,0.01], TG [p, 0.001], LDL [p, 0.0001]. In diabetic children mean serum TSA was significantly higher in children with family history of cardiovascular disease [p, 9.04], BMI [kg/m 2] >/= 85 percentile [p, 0.03], poor glycemic control; HbA1c >9% [p, 0.02], raised LDL [p, 0.03]. Serum TSA might be considered as a marker for cardiovascular disease [CVD] risk factor, especially in diabetic children

Genotyping of human giardiasis in relation to anti - giardia secretory IgA and mucosal histopathology

Comparative study between the prevalence of pathological grading and giardia [groups I and I] genotypes revealed that out of patients having giardia genotype I, the prevalence of grade 0 was 13.16%, grade I was 21.05%, grade II was 47.37%, grade III was 13.16% and grade IV was 2.26% in comparison with 0%, 30.77%, 46.15%, 7.69% and 15.38% in genotype II [13 patients]; 10%, 40%, 20%, 20% and 10% in group III [10 patients]; 25%, 43.75%, 18.75%, 6.25% and 6.25% in mixed genotype infections group [16 patients] as well as 25%, 25%, 35.71%, 10.71% and 3.57% in undetermined infection group [28 patients] for grade 0, I, II, III and IV pathology respectively. There was no statistically significant difference regarding the prevalence of pathological grading in different giardia genotypes in Groups I and II. The means of OD of anti-giardia secretory IgA in relation to giardia genotypes in patients infected with giardia Groups I and II were significantly different, where 1.091 +/- 0.377, 1.079 +/- 0.474, 1.524 +/- 0.503, 1.292 +/- 0.472 and 1.004 +/- 0.31 groups of genotype I, II, III, mixed genotypes infection and undetermined infection group respectively], being more increased in patients infected with giardia genotype III and in mixed genotype infection

histo-pathology of human Giardiasis

This study was carried out on a sample of 1240 adult persons. In giardiasis symptomatic group [I], the prevalence of diarrhea was 71.43%, 100% in grade 0, I, II, III and IV pathology, respectively, which was statistically insignificant in comparison with each other. The prevalence of abdominal pain was 71.43%, 73.33%, 95%, 91.67% and 100% in grade 0, I, II, III and IV pathology, respectively, which was statistically insignificant compared with each other. The prevalence of flatulence was 42.86%, 40%, 80%, 83. 33% and 100% in grade 0, I, II, III and IV pathology, respectively, which was statistically significant in comparison with each other. So, the prevalence of flatulence was more frequent in patients with marked pathological changes in the duodenum. The prevalence of anorexia was 14.29%, 53.33%, 65%, 50% and 100% in grade 0, I, II, III and IV pathology, respectively, which was statistically significant in comparison with each other. The prevalence of vomiting was 0%, 13.33%, 15%, 16.67% and 85.71% in grade 0, I, II, III and IV pathology, respectively, which was significantly increased in grade IV and disappeared in grade 0