ABSTRACT
Objective To investigate the diagnostic value of multiplex polymerase chain reaction (m-PCR) for diagnosing second infection of severe acute pancreatitis ( SAP), and to provide evidence for anti-infection treatment of SAP .Methods From January 2011 to December 2014 , thirty five patients of SAP were enrolled .Seven to fourteen days after SAP onset , patients′blood samples were taken and the presence of infection was determined by mP-CR.In the meantime, peripheral blood or the paracentesis fluid was cultured , and the result of culture was regard as golden standard to diagnose infection .Rseults The m-PCR could simultaneously detect 9 kinds of intestinal resident pathogenic bacteria , and the lower limit of detection was 10~1 000 copies.The detection rates were as follows (cultivation vs. m-PCR):staphylococcus aureus 6 vs 5 cases, staphylococcus epidermidis 11 vs 9 cases, enterococcus faecalis 2 vs 3 cases, enterococcus faecium 6 vs 7 cases, escherichia coli 19 vs 17 cases, klebsiella pneumoniae 2 vs 3 cases, pseudomonas aeruginosa 6 vs 4 cases, acinetobacter baumannii 2 vs 2 cases, malt narrow food aeromonas 4 vs2 cases.The 7th~14th days after SAP onset, the blood or paracentesis fluid culture was positive in 27 patients,and negative in 8 cases. And the m-PCR results were positive in 30 patients, and negative in 8 cases.The m-PCR results were positive in 30 patients, negative in 5 patients.The m-PCR results were positive in 3 patients who had negative culture results.In the remaining 32 cases, the results were consistent between the two detection methods .When the culture result was regarded as golden standard , the sensitivity, specificity and accuracy of m-PCR were 100%, 62.5%and 91.43%, respectively.The positive predictive value and the negative predictive value were 90%and 100%, respectively.It took (26 ±15) hours on average to obtain the result of culture method , and it took (102 ±32) hours on average to obtain the confirmative results .It took (12 ±8) hours on average to obtain the result of the m-PCR method.The time course of m-PCRwas significantly shorter than that of the traditional culture method, and the difference was statistically significant (P<0.05).Conclusions The m-PCR method can be used to monitor the bacterial infection in patients with SAP .The m-PCR method is a highly sensitive and rapid detection approach , which is worth of clinical application .
ABSTRACT
Objective To assess the effects of Danhong injection on the perfusion function of the pancreas in patients with acute pancreatitis (AP). Methods A total of 102 patients with AP were collected, and there were 25 patients with severe acute pancreatitis ( SAP) and 77 patients with mild acute pancreatitis (MAP). They were randomly divided into routine treatment group ( RTG,n =54) and Danhong treatment group (DTG,n =48) , respectively. Another 33 normal individuals were used as controls. Patients in RTG received gastric decompression, acid inhibition, anti-infection and nutritional support. Patients in DTG received Danhong injection 30 ml i. v. b. i. d besides routine treatment. The hemodynamic parameters ( BF, BV, MTT, and PS) of perfusion of the pancreas were measured by 16-slice spiral CT scanner. Results The values of BF of control, MAP, SAP group were time was ( 12.6 ± 2.7) d in DTG, which were significantly shorter than those in routine treatment group [(14.5 ±3.2)d, (18.5 ±5.5)d, P <0.05]. Conclusions The parameters of CT perfusion imaging of the pancreas can be a quantitative criterion to assess the severity of microcirculation dysfunction in patients with AP, and Danhong injection is effective to improve the blood perfusion of the pancreas during the treatment of AP.
ABSTRACT
Objective To evaluate the effect of enteral nutrition (EN) versus total parenteral nutrition(TPN) on gut barrier function in patients with severe acute pancreatitis (SAP). Methods Sixtythree patients with SAP enrolled from 4 hospitals were randomly assigned into EN group(29 cases) and TPN group(34 cases). EN group patients were fed via a spiral nasojejunal feeding tube placed routinely by endoscopy or fluoroscopy, and TPN group patients were nourished intravenously with TPN during the same period. The changes of serum endotoxin, diamine oxidase, and urinary excretion of lactulose and mannitol ratio (L/M) were observed. Results Plasma concentration of endotoxin were markedly decreased in EN group as compared with that in TPN group at the 7th,14th ,21th day of entry trial [(39. 30 ± 15. 82) EU/L vs (73.05 ±21.16) EU/L,(22.64 ±14.31) EU/L vs (49.34 ±24.54) EU/L,(14.81 ± 10.93)EU/L vs ( 30. 08 ± 14. 10 ) EU/L, P ＜ 0. 05]. Plasma concentration of diamine oxidase were markedly decreased in EN group as compared with that in TPN group at the 7th, 14th day of entry trial [(9. 97 ± 3. 84)U/Lvs (19.89±9.89)U/L,(5.42±1. 84) U/Lvs (8.79 ±4.08) U/L, both P ＜ 0. 05]. The urinary L/M decreased significantly in EN group than those in TPN group at the 7th, 14th,21th day of entry trial (0.28 ±0.25 vs 0. 65 ±0.45,0.21 ±0. 18 vs 0.54 ±0.41,0.08 ±0.04 vs 0.29 ±0.06, all P＜0.05).Conclusion EN has better effect on improving intestinal barrier function than TPN in treatment of patients with SAP.
ABSTRACT
Objective To explore clinical strategies of treating in bile microlithiasis-associated cholangitis and preventing the recurrence of ursodeoxycholic acid(UDCA).Methods Forty-one cases of bile microlthiasis-associated cholangitis from January 2006 to July 2007 Were analyzed and followed up.All patients underwent endoscopic therapy who were divided into UDCA group(21 cases)and non-UDCA group (20 cases)according to the use of UDCA or not besides endoscopic therapy.After using UDCA for 12 months,the complications and the incidence rate of recurrent cholangitis in each group were compared.Results Forty-one cases had no serious complications after endoscopic therapy.None had recurrent cholangitis in UDCA group,4 cases in non-UDCA group got recurrent cholangitis.One case developed pancreatitis.There was statistical significance between the two groups(P=0.021).Conclusion Endoscopic therapy is a safe and effective treatment of bile microlithiasis-associated cholangitis,and UDCA can prevent the recurrent cholangitis effectively after endoscopic therapy.
ABSTRACT
Objective To explore the effects of batroxobin on the microcirculation of patients with severe acute pancreatitis (SAP). Methods A total of 38 patients with SAP were randomly divided into group A (21 cases) and group B (17 cases). Patients in group A were treated with routine method andpatients in greup B were treated with routine method plus batroxobin injection. Another 18 normal individuals were used as control. The levels of plasma endothelin (ET), thromboxane B_2 (TXB_2) and 6-keto-PGF_(1α)were measured by radioimmunoassay. At the same time, the ratio of TXB_2/6-keto-PGF_(1α) was observed. The Balthazar CT and APACHE Ⅱ scores were monitored and compared between group A and group B. Results The levels of plasma 6-keto-PGF_(1α) were significantly higher while the levels of plasma ET, TXB_2 and the ratio of TXB_2/6-keto-PGF_(1α) were significantly lower in group B at 6 days after admission [(129.3 ± 12.9) ng/L, (93.8 ± 9.9) ng/L, (254.4 ± 24.9) ng/L and 1.83 ± 0.31]as compared with those in group B on admission [(98.9 ± 10.7) ng/L, (140.3 ± 13.1) ng/L, (311.4 ± 31.5) ng/L and 3.16 ± 0.54]and group A at 6 days after admission [(108.2 ± 11.6) ng/L, (120.3 ± 11.4) ng/L, (308.5 ± 31.1) ng/L and 2.84 ± 0.43](P < 0.05). The Balthazar CT and APACHE Ⅱ scores in group B at 6 days after admission were significantly lower than those in group B on admission and group A at 6 days after admission (P< 0.05 or < 0.01). Conclusion Batroxobin is an effective way to improve the microcirculation in SAP.
ABSTRACT
Objective To explore the value of trypsinogen activation pepfide (TAP) levels in blood plasma and urine in the diagnosis of acute pancreafitis at early stage and severity predicting combined with the CT results. Method Sixty-five patients with acute pancreatitis who scanned with enhanced CT were di-vided into mild acute pancreatitis (MAP) group and severe acute pancreatitis (SAP) group according to the CT results, 29 patients with acute abdomen except for acute pancreatitis were as control group. TAP levels in blood plasma and urine were measured in all patients. Results At the time of 6, 12 and 24 h after admis-sion, the level of blood plasma TAP in SAP group ( > 9.0 nmol/L) was significantly higher than that in MAP group(< 3.5 nmol/L), there were significant differences between SAP group and MAP group or control group (P<0.05). And the median urinary TAP in SAP group (102.8, 78.2, 52.3 nmol/L)was significantly higher than those in MAP group (32.5, 28.7, 25.6 nmol/L)and control group(12.6, 12.2, 11.5 nmol/L), there were significant differences among three groups (P<0.05). At the time of 3, 5 d after admission, there was no significant difference in TAP levels in blood plasma and urine among three groups (P>0.05). Conclusions Early dynamic detection of TAP levels in blood plasma and urine is of higher diagnostic value and predictive value for acute pancreatitis, which is of benefit in the early diagnosis and treatment of acute pancreatitis.
ABSTRACT
Objective To investigate the expression of resistin in rats of acute pancreatitis and the relationship between its expression and pancreatic pathologic changes. Methods Forty Sprague-Dawlev rats were randomly divided into four groups:control group,sham operation group,AEP group and ANP group. AEP model was induced by intraperitoneal injection of cerulein and ANP model was induced bv intrapefitoneal injection of L-arginine while the control group received no treatment,and the sham operation grouD rleceived same volume injections of 0.9%saline solution.The serum amylase,C-reactive protein,TNF-alpha.IL-1 beta were determined by using ELISA,pancreas/body weight(g/kg)ratio was recorded,pancreatic pathology was examinated,the expression of resistin mRNA and protein in pancreas was detected by real-time PCR and immunohistochemistry. Results The levels of amylase,pancreas/body weight ratio.pancreatic pathology score,expression of resistin mRNA,IL-1-beta,TNF-alpha and C-reactive protein in AEP group were(4377±343)U/L,8.67 ±1.43,5.39 ±0.26,2.04 ±0.19,(10.21 ±1.34)ng/ml,(184.18±45.24)pg/ml, (194.24 ±44.81)pg/ml,(3586±63)ng/ml,respectively;and the corresponding value8 in ANP group were (6750±322)U/L.9.33±1.76,7.81±0.28,3.29±0.30,(15.14±0.84)ng/ml,(349.31±94.54)pg/ml,(315.59±37.04)pg/ml,(4345±244)ng/ml,respectively;which were significantly higher than(1442±183)U/L,4.34±0.42,1.10±0.21,0.88±0.08,(5.13±0.74)ng/ml,(108.74±31.03)pg/ml,(106.44±21.31)pg/ml,(2895±165)ng/ml in sham operation group(P<0.01 or P<0.05).Resistin wag positively correlated with the increase of C-reactive protein,TNF-alpha,IL-1 beta and the pathologic score of pancreas,respectively(r=0.711,0.812,0.794,0.812,P<0.01).Conclusions Resistin was correlated with the pathogenesis and development of acute pancreatitis,and may be useful to predict the severity of acute pancreatitis.
ABSTRACT
Objective To evaluate the model of end-stage liver disease (MELD) and Child-Tur-cotte-Pugh (CTP) in prognosis for cirrhotic patients with massive hemorrhage from esophageal varieosis, who underwent emergency endoscopic sclerotherapy (EIS). Methods The clinical and follow-up data of a co-hort of 65 liver cirrhotic patients with massive hemorrhage from esophageal varicosis treated by EIS were ana-lyzed retrospectively. Correlation between MELD values and CTP score and classification was analyzed. The area under the receiver operating characteristic (ROC) curve was used to compare MELD with CTP score and classification in predicting mortality risk. The optimal threshold of MELD to determine the prognostic death risk was calculated by ROC curves. Results MELD, CTP score and classification correlated signifi-cantly with each other. Seven patients died within six months and 9 died within the first year of follow-up.There was no significant difference in gender, age and serum bilirubin between the survival and death groups, while the serum creatinine, international normalized ratio (INR), CTP score, and MELD score were significantly different. The areas under the ROC curve of MELD were both greater than 0.8 to predict 6-month and 1 -year survival, and also were greater than those of CTP score and classification. Areas under the ROC curve of MELD is superior to, but not significantly different though, CTP score or classification. The optimal threshold values of MELD and CTP score both showed satisfactory predicting accuracy of mortality risk. Conclusion MELD is an accurate predictive system for 6 months and 1 year in liver cirrhotic patients with massive hemorrhage from esophageal varicosis treated by EIS. The MELD value is very important in the selection of patients for E1S. But it is not more efficient than CTP score and classification.
ABSTRACT
Objective To study the clinical application of endoscopic retrograde cholangiopancre-atography(ERCP)combined with biliary microlithiasis exploration in acute cholangitis.Methods The clinical data of consecutive 54 cases of acute cholangitis were analyzed.Before ERCP,all cases were examined by routine examinations,including abdominal uhrasonography,CT or magnetic resonance cholangiopancre atography(MRCP).The bile Was collected through ERCP or endoscopic mtsobiliary drainage(ENBD),then all the samples were choked by polarization microscope.Results Thirty-six cases(66.67%)out of 54 patients with common bile duct(CBD)stones or dilation of common bile duct were diagnosed by routine examination.ERCP Was performed in all patients,only 3 cases failed,and the rest were successful.Through ERCP,39 cases with CBD stones(76.47%),4 cases with CBD inflamnmtory smcmre were diagnosed,and 12 cases were normal.Among the 12 cases,9 cages were found with biliary microlithiasis by polarization microscope.The diagnostic effectiveness of ERCP combined with biliary microlithiasis exploration was highest(94.12%),and there Was significant difference between them(P＜0.05).Conclusions It may improve the diagnostic accuracy to combine ERCP with biliary microlithiasis exploration in CBD stones.Biliary microlithiasis may play an important role in the pathogenesis in unknown aetiology acute unexplained cholangitis.
ABSTRACT
Objective To investigate the clinical and histopathologic features of patients with primary gastrointestinal malignant lymphoma ( PGIML). Methods The clinical and histopathologic data of 22 patients with PGIML were reviewed and analyzed retrospectively. All cases were confirmed with histological specimen obtained from endoscopic biopsies or surgery. Results Abdominal pain was the most common presenting symptom, seen in 15 of 22 patients (68.2% ). The incidence of PGIML was highest in stomach, seen in 12 of 22 patients (54. 5% ). Modularity of the mucosal surface was the most common endoscopic finding, seen in 15 of 21 patients (71. 4% ). The positive rate of endoscopic biopsy for the diagnosis of PGIML was 52. 6% (10/19 biopsy cases). All cases were non-Hodgkins lymphomas ( NHL). Twenty cases were muco-sa associated lymphoid tissue (MALT) lymphoma, and 13 of 20 cases were extra-nodal marginal zone B-cell lymphoma of MALT. Conclusions Abdominal pain is the most common symptom and the stomach was the most common location in PGIML. Extra nodal marginal zone B-cell lymphoma of MALT is the main histopathologic feature. The prognosis of PGIML is related to the surgical procedure and the post operative chemotherapy.
ABSTRACT
Objective To evaluate the effective of emergent endoscopic injection sclerotherapy ( EIS) for lethal bleeding from esophagogastric varices. Methods In this study, endoscopic injection of 5% sodium morrhuate was used to control esophagogastric variceal bleeding in 176 patients. In all 209 cases, 181 cases suffered from acute lethal bleeding from esophagogastric varices received endoscopic variceal sclerotherapy under the modified Senstaken-Blakemore tube compression. Results The exact bleeding site at the first procedure could be visualized in 166(94. 3% ) patients. The effective rate of EIS was 96. 2% . Multiple procedures were required in the 21 cases of relapsed bleeding. Complications of EIS occurred in 15 cases (8. 5% ) , of which 3(1. 7% ) died. Conclusion Endoscopic injection sclerotherapy under the modified Senstaken-Blakemore tube compression is relatively safe and effective procedure in the treatment of lethal bleeding from esophagogastric varices.
ABSTRACT
Objective To investigate the clinicopathological and immunohistochemical expression in 8 cases with synchronous occurrence of digestive tract cancer and GIST. Methods Clinical and pathologic data of 8 out of 70 cases of GIST coexisted with gastrointestinal cancer were recorded, and immunohistochemical stain ( Envision method) was used to detect the expressions of CD117, CD34 ,Vimenlin etc. Results In 8 cases of GIST (4 benign, 3 borderline, 1 malignant) coexisted with GI carcinoma, of which 6 cases featured the simultaneous occurrence of GIST and adenocarcinomas (5 cases in slomach and 1 case in colon) , whereas the other 2 cases associated with squamus cell carcinoma of esophagus. In 4 cases, tumors arose from the same organ, in the other 4 cases they developed from different sites of digestive tract. In all of the cases two kinds of neoplasms were developed in different areas without any connection, preoperative endoscopy and biopsy showed adenocarcinomas and squamous cell carcinoma, but histologic and clinical diagnosis of coexisted tumors were not achieved in any case. All GIST expressed Vimentin and CD34; 7 cases expressed CD117; 2 cases were focally positive for S-100 protein and 1 each for SMA and Desmin. Conclusion The simultaneous occurrence of epithelial tumor and GIST in digestive tract is not less than that usually expected, in clinical practice we should pay much attention on the diagnosis of this entity. Endoscopic biopsy conjugated with profound inspection during operation and pathological examination of specimen postoperatively can improve the possibility of early diagnosis.
ABSTRACT
Objective To investigate the treatment of intractable bile duct stones. Methods Of the total 149 cases of biliary stones, some are multiple bile duct stones,large stones,stones obstructed in the duodenal ampulla or residuary stones after T-tube surgery, others are associated with small papilla or papilla with neighoring diverticulum. All the stones were extracted with several endoscopic methods, such as choledochoscopy during or after operation, mechanical lithotripsy after EST(endoscopic sphincterotomy), biliary mother-baby endoscopy, ENBD(endoscopic nasobiliary drainage) or biliary-duodenum internal drainage. Results In general, extrahepatic bile duct stones were effectively removed in 94. 6% cases. In 19 out of 20 cases, stones were completely removed with choledochoscopy during operation; In 35 out of 40 cases stones were fully extracted through T-tube endoscopy, and in 72 of 76 cases stones were thoroughly removed with mechanical lithotripsy after EST. Conclusion The intractable bile duct stones can be effectively managed with combined endoscopic therapy, which is attributed to the high success rate in removing biliary stones and should be popularized in this field.