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Objective To investigate the pathogenesis,diagnosis,treatment and prognosis of aort-oesophageal fistula(AEF).Methods Retropective analysis was performed on 6 patients presenting with AEF between January 2002 and December 2014,and relative literature was reviewed on its pathogenesis,di-agnosis,prognosis and treatment.Results Five men and 1 woman with a mean age of 49 (range,27-71 years)were recruited to the study.One case of AEF was caused by esophageal foreign body,2 cases were caused by aneurysm while the other 3 patients presented AEF after aortic surgery.All 6 patients showed he-matemesis,among whom 3 presented sentinel hemorrhage,1 presented exsanguination after sentinel hemor-rhage,2 presented sudden exsanguination.Among 4 patients with sentinel hemorrhage,2 accompanied with chest pain,1 with dysphagia and 1 with fever.Two patients had a history of hypertension.Diagnostic rate was nearly 100% by gastroscopy or CT/CTA.Four patients died from hemorrhagic shock and 2 patients re-covered from surgery.Conclusion AEF should be seriously considered for patients with a history of hyper-tension,aortic disease or esophageal foreign body presenting sentinel hemorrhage,chest pain,dysphagia,fa-tal exsanguination followed by symptom-free interval.Prompt examinations and aggressive surgery are of great significance for survival.
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Objective To investigate the expression of BAMBI in pancreatic carcinoma tissue and its clinical value.Methods Expression of BAMBI was detected by immunohistochemistry in 69 cases of pancreatic cancer and 15 normal pancreatic samples.The survival and its association with clinicopathologic parameters were analyzed.Results The expression of BAMBI in the cancer tissue was much higher than that in the normal tissues (56.5％ vs 16.7％,P ＜0.01).The expression of BAMBI was not associated with age,sex and tumor size,differentiation,but expression of BAMBI in patient with lymph node metastasis was higher than that in patient without lymph node metastasis (67.4％ vs 38.5％,P =0.019),the expression of BAMBI in TNM stage Ⅲ was higher than that in stage Ⅰ + Ⅱ (75.0％ vs 31.0％,P =0.001).The median survival of BAMBI-positive group (6 months) was lower than that of BAMBI-negative group (10 months).Conclusions BAMBI is over-expressed in pancreatic carcinoma,and its expression is associated with lymph node metastasis,TNM staging,differentiation and prognosis.
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Objective To explore the diagnostic value of alcohol fixation and liquid-based cytology method for malignant stricture of common bile duct and to study the interval time between sampling and fixation for procedure of alcohol fixation.Methods Data of 82 patients were retrospectively studied,who were suspected of having malignant stricture of common bile duct underwent brushing through endoscopic retrograde cholangiopancreatography (ERCP),and were confirmed by follow-up for 2 years or pathology after surgery from October 2008 to June 2013.These patients were randomly divided into alcohol fixation group (n =30),liquid-based cytology group (n =28) and conventional cytology group (n =24).The positive diagnostic rates of brush cytology in each group were compared.The alcohol fixation group were randomly divided into 2-minute group and 5-minute group according to the interval time between sampling and fixation.Positive diagnostic rates were also compared.Results The positive rates were 73.33％ (alcohol fixation group,22/30),75.00％ (liquid-based cytology group,21/28) and 20.83％ (conventional cytology group,5/24),respectively.The positive rate of conventional cytology group was obviously lower than alcohol fixation group (x2 =21.525,P=0.000) and liquid-based cytology group (x2 =22.208,P =0.000) with statistical significance.But the positive rate of alcohol fixation group was similar to the liquid-based cytology group (x2 =0.683,P =0.898).In alcohol fixation group,the positive rate of 2-min group (88.24％,15/17) was significantly higher than the 5-min group (53.85％,7/13) with statistical significance (x2 =4.535,P =0.033).Conclusion Compared with conventional fixation,alcohol fixation and liquid-based cytology can improve positive diagnostic rate of brushing during ERCP.The alcohol fixation is more simple in procedure and low in cost than liquid-based cytology.The interval time between sampling and fixation should be reduced to no more than 2 minutes.
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Objective To evaluate curative effects of treatment of malignant biliary and gastric outlet-duodenal obstruction with endoscopically placed self-expandable metal stents.Methods A retrospective analysis was performed in 17 patients who underwent enteral stenting after placement of the biliary stent.The success rate of insertion,the effective palliation of biliary and duodenal obstruction,the rate of complication,recurrent stent obstruction and the median patency were observed.Results In 17 patients,biliary stenting were all performed for obstructive jaundice and then enteral stents were inserted.The levels of tatal billirubin [from (263.4 ± 62.5) μmol/L to (157.6 ± 25.1) μmol/L],direct billirubin [from (1233.2 ±66.5) μmol/L to (130.9 ± 27.7) μmol/L] and alkaline phosphatase [from (233.2 ± 66.5) IU/L to (130.9 ±27.7)IU/L] decreased significantly (P ＜0.01),and the gastric outlet score increased significandy [from (0.9 ± 1.1) points to (2.1 ±0.7) points] (P ＜0.01).No serious complication in all patients.Lifetime of patients ranged from 70 days to 332 days,and the median survival time was 192 day.Conclusion Combined biliary and enteral stenting is an effective method for palliation of malignant biliary and gastric outlet-duodenal obstruction.