ABSTRACT
Intraoperative flexible choledochoscopy can help in the diagnosis and treatment of various biliary tract diseases by providing direct visualization of the bile ducts. This study discusses the role of choledochoscopy in diagnosing and treating most diseases of the hepato-biliary-pancreatic system particularly in patients in whom laparotomy with or without choledochotomy is planned or performed and in whom ERCP, MRCP, or other advanced techniques are not applied, deficient or unsuccessful. Choledochoscopy was performed via a vertical choledochotomy using a flexible choledochoscope during the surgical procedures on the patients, who were operated on because of hepato-biliary-pancreatic system diseases, and the choledochotomy line was closed by primary closure, t-tube application or choledochoduodenal anastomosis. The clinical records of 216 patients over the course of 23 years were retrospectively evaluated. The age range was 19-92 years [mean: 63.1 years], and 139 patients [64.4%] were female. The most common indication included the presence of suspected choledochal stones in 77 patients [35.6%]. Additional diagnostic or therapeutic endoscopic procedures [stone or hydatid vesicula removal, biopsy or cytology, balloon dilation, and stent removal or placement] were performed on 106 patients [49.1%]. The average choledochoscopy duration was 8.5 minutes [range: 5-25 minutes]. Choledochoscopy confirmed the anticipated diagnosis in 98 patients [45.4%], whereas it provided additional unanticipated diagnostic information in 68 [31.5%] patients; the results were normal in 50 patients [23.1%]. In the present series, complications occurred in four patients [1.9%], whereas no choledochoscopy-related mortality was observed. Intraoperative flexible choledochoscopy is a safe and useful procedure that can aid in the diagnosis and treatment of various biliary tract diseases
ABSTRACT
To investigate the effects of combined use of glutamine and growth hormone on bacterial translocation. The study was performed at the laboratories of the Department of Physiology at Ataturk University Medical School, Erzurum, Turkey between June and September 2007. Forty rats divided into 5 groups of 8, were included in the study. In the study groups, the common bile duct was ligated to obtain obstructive jaundice. The rats in the control group CG were given sodium chloride, in the glutamine group GLG they were given glutamine, in the growth hormone group GHG, growth hormone, and in the glutamine + growth hormone group GLGHG glutamine + growth hormone at equal doses by the same methods. Blood, spleen, liver, lymph node, and cecal content samples were obtained. Total bilirubin TB, alkaline phosphates ALP, and gamma glutamine transferase GGT activities were evaluated. In the CG, cecal contents were higher than in the GLG, and cecal contents and BT were higher than in the GHG and the GLGHG. The BT rate was the lowest in the GLGHG, with a borderline difference with the values of the GLG and GHG. We found that in preventing BT, combined use of glutamine, and growth hormone was more effective than using each of these agents alone