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Objective To explore the normal values for two-dimension solid state high resolution anorectal manometry (HRAM) in healthy adult volunteers.Methods The healthy adult volunteers were recruited by advertisement and underwent solid state HRAM in the left lateral position.Anorectal pressures and rectal sensation were recorded and analyzed.Results (1) A total of 126 Chinese healthy adult volunteers (male:50 cases (39.7％);age:(37.5 ± 14.2) years old) were recruited in this study.(2)Mean anal resting pressure (MERP) was (71.8 ± 17.3) mmHg (1 mmHg =0.133 kPa).Maximum anal resting pressure (MARP) was (79.3 ± 17.8) mmHg,Maximum anal squeeze pressure (MSP) was (178.7 ± 52.8) mmHg.Anal high pressure zone (HPZ) length was (3.4 ± 0.6) cm.During simulated evacuation,residual anal pressure (RAP) was (63.8 ±20.5) mmHg,and anal relaxation rate (ARR) was (37.0 ± 11.5) ％.Rectal threshold volume for first sensation (FST),desire to defecate (DDT),urgency to defecate (UDT) and maximum discomfort (MDT) was (47.4 ±10.0) ml,(84.5 ±18.2) ml,(125.8 ± 28.5) ml,and (175.5 ±36.1) ml,respectively.(3) Compared with female subjects,male subjects had higher MSP [(211.0 ± 50.7) mmHg vs (157.5 ± 42.5) mmHg],RAP [(71.6 ± 18.1) mmHg vs (58.8 ± 20.5) mmHg]and rectal MDT[(187.0 ±36.4) mmHg vs (168.0 ±34.1)mmHg],but lower ARR [(32.1 ±8.0)％ vs (40.2 ±12.3)％],all P＜0.01.(4) MERP,MARP,MSP and rectal MDT were higher in young group (≤ 40 years old),all P ＜ 0.05.Conclusions These observations provide normal values for two-dimension solid state HRAM,which have significant difference between genders and different age groups.
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Objective To provide an objective basis for differential diagnosis of pancreatic diseases through quantitative analysis of the different features of contrast-enhanced endoscopic ultrasonography (CE-EUS). Methods A total of 32 patients with suspected or confirmed pancreatic neoplasms or chronic pancreatitis and 19 patients who underwent EUS due to other digestive problems other than pancreatic disease were enrolled. Features of blood perfusion of the regions of interest during CE-EUS were analyzed quantitatively. The findings were compared with cytological and/or histopathological results of EUS-FNA and/or surgery.Results Quantitative analysis of CE-EUS showed peak intensity (PI) value of 19 normal pancreas was 0.648 ±0. 174, which was statistically different from that of pancreatic cancer and pancreatic cystic lesions. Based on ROC, the cutoff of differential diagnosis was 0. 505, and the sensitivity and specificity were 100. 0% and 84. 2%, respectively. PI value of 6 chronic pancreatitis was the highest (0. 772 ±0. 106). In pancreatic neoplams, PI values of pancreatic carcinoma, pancreatic cyst and pancreatic endocrine tumors were significantly different. Based on a cutoff of 0. 195, the sensitivity and specificity of differentiation of pancreatic carcinoma and pancreatic cyst were 85.7% and 87.5%, respectively. PI value of 14 pancreatic carcinoma and that of 4 pancreatic endocrine tumors were 0. 321 ± 0. 119 and 0. 763 ± 0. 115, respectively. Through the comparison between the AT and TTP of the focal lesions and surrounding pancreatic parenchyma, 78.6% pancreatic carcinoma showed slow falling-in and rapid wash-out and all the endocrine tumors showed rapid falling-in and rapid wash-out. The PI value of 8 patients with pancreatic cyst was 0. 181 ±0. 036, with no enhanced blood flow in the cyst. The TIC was a straight line. Conclusion CE-EUS with quantitative analysis is a promising method that can be a more objective basis in the differential diagnosis of pancreatic diseases.
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Objective To evaluate contrast-enhanced endoscopic uhrasonography(CE-EUS)in the differential diagnosis of pancreatic diseases.Methods Eighteen patients with suspected pancreatic neoplasms and chronic pancreatitis,which would be finally affirmed with EUS-FNA or histophathologic examinations,as well as five normal control subjects were enrolled and underwent CE-EUS by using ultrasonic contrast agent(sonovue,Bracco Co.,Italy).Characteristics of enhancement including form,echo and enhanced blood perfusion of the target areas were investigated in normal pancreas and various diseased ones.Results By CE-EUS,five cases of normal pancreatic parenchyma were presented as punctiform or claviform enhancement pattern with homogeneous distribution(type Ⅰ-Ⅱ);while two chronic pancreatitis cases were presented as claviform or plaquelike enhancement pattern with inhomogeneous distributition(type Ⅱ-Ⅲ).In addition,thirteen pancreatic carcinomas were presented as inhomogeneous punctiform or claviform enhancement(typeⅠ-Ⅱ)partially with border enhancement and with slow enter-in and fast wash-out phase.However,three benign insulinomas were presented as holo-plaquelike enhancement(type Ⅲ),and 2 with fast enter-in and fast washout phase.Besides,different enhancement intensity was identified in different diseases.Conclusion CEEUS,from which different enhancement pattern,phase and intensity would be shown in various pancreas,is a safe and feasible imaging modality in the differential diagnosis of pancreatic diseases.
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Objective To observe the safety and efficacy of oncolytic adenovirus (H101) implantation under EUS guidance combined with gemcitabine in patients of non-operative pancreatic cancer.Methods From May 2007 to December 2007,6 patients with non-operative pancreatic cancer were enrolled in the study.H101 were implanted into 3 sites of the tumor under EUS guidance.Gemcitabine Was siren systemicly on d2,d9 and d16 after implantation, and repeated 1 month later.Tumor size and perfusion were assessed by computed reconstruction and perfusion imaging.Changes of clinical indices,adverse effects and complications were also recorded.Results All patients completed the two periods of treatment as planned.Tumor size decreased in 5 cases(18.21%-38.65%),but without statistical difference (P=0.078).The area of liver metastasis Was found decreased in 1 ease.Perfusion imaging showed significant increase of mean transit time(P=0.049) and improvement in blood flow,blood volume and permeability surface at 2 weeks after the treatment. KPS increased in 2 patients and pain score decreased in 3 patients.Three patients died 2.5,2.5 and 3 months respectively after the procedure.while 3 other patients are still alive with the survival time of 3,5 and 10 months. Major adverse effects associated with H101 implantation were fever and flu-like symptoms.Mild acute pancreatitis occurred in 1 cage.Conclusion EUS guided oncolytic adenovirus implantation in advanced pancreatic cancer is feasible and safe.With the combination of gemcitabine,it is capable of shrinking the tumor size,destroying the angiogenesis of the tumor and improving the patients'living quality.
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Objective To acknowledge the present status of clinical use of nonsteroidal antiinflammatory drugs(NSAIDs) in China. Methods Five hundred and seventy-five valid questionnaires were collected from 50 hospitals in different areas of China including Shanghai, Beijing, Tianjin, Shenyang and Guangzhou. Results 54.7% of doctors used cyclooxygenase-2 (COX-2) selective inhibitors. The ratio of the doctors prescribing loxoprofen, diclofenac, meloxicam were 22.6%, 23.3%, 14.60%, respectively. The ratio of the doctors who prescribe uncoated routine-dose aspirin, uncoated low-dose aspirin, enteric-coated routine-dose aspirin, enteric-coated low-dose aspirin and others were 17.0%, 14.7%, 36.8%, 28.5% and 3.0%, respectively. The ratio of doctors who only "some-times" prescribed co-medicine to prevent gastrointestinal damages when they prescribed aspirin, conventional NSAID and COX-2 selective inhibitors were 41.10%, 40.70% and 45.1%, respectively, while the most commomly used co-medicine were H2 receptor antagonist (H2 RA) and proton pump inhibitor respectively. 37.1% of doctors examined H. pylori infection status, and 76.3% of doctors would eradicate H. pylori if positive. Conclusions The most commonly used conventional NSAID is diclofe-nac. The most commonly used formulation of aspirin is enteric-coated aspirin. Most doctors only "sometimes" prescribe co-medicine together with aspirin, conventional NSAID and COX-2 selective inhibitors to prevent gastrointestinal damages, and the most commonly used co-medicine is acid inhibitor. Only a few doctors examine H. pylori infection prior to the administration of NSAID.
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Objective To evaluate the accuracy and clinical application of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in diagnosis of occupying lesions in upper digestive tract and its pe-ripheral areas. Methods The data of 64 patients who underwent EUS-FNA for occupying lesions in upper di-gestive tract, between July 2006 and December 2007, were retrospectively analyzed. Results EUS-FNA was successfully performed on 62 patients, with a success rate of 96.88%. The overall diagnostic accuracy, sensi-tivity, specificity, positive predictive value and negative predictive value of EUS-FNA for occupying lesions in upper digestive tract and its peripheral areas were 88.71%, 86.54%, 100.00%, 100.00%, and 58.82%, respectively. There was no significant difference between the foei larger and smaller than 3cm (P > 0.05), re-garding the diagnostic accuracy and average puncture numbers. Diagnostic accuracy of those with real-time cy-tolngical evaluation was significantly higher than those without (P=0.029), and the puncture numbers were less (P=0.001). Among the total 99 punctures, the positive diagnostic accuracy of those with 5ml negative pressure suction was significantly higher than those of 10 ml (P = 0.044). Conclusion EUS-FNA is a safe and applicable approach to diagnosis of occupying lesions in upper digestive tract and its peripheral areas with higher diagnostic accuracy, sensitivity, specificity and positive predictive value. Moreover, the real-time cyto-logical evaluation and adequate negative pressure might facilitate the diagnosis accuracy.