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Objective:To investigate the clinical characteristics of choledocholithiasis com-bined with periampullary diverticulum and influencing factor for difficult cannulation of endoscopic retrograde cholangiopancreatography (ERCP).Methods:The retrospective case-control study was conducted. The clinical data of 1 920 patients who underwent ERCP for choledocholithiasis in 15 medical centers, including the First Hospital of Lanzhou University, et al, from July 2015 to December 2017 were collected. There were 915 males and 1 005 females, aged (63±16)years. Of 1 920 patients, there were 228 cases with periampullary diverticulum and 1 692 cases without periampullary diverticulum. Observation indicators: (1) clinical characteristics of patients with choledocholithiasis; (2) intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis; (3) influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and com-parison between groups was conducted using the Wilcoxon rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The Logistic regression model was used for univariate and multivariate analyses. Results:(1) Clinical characteristics of patients with choledocholithiasis. Age, body mass index, cases with complications as chronic obstructive pulmonary disease, diameter of common bile duct, cases with diameter of common bile duct as <8 mm, 8?12 mm, >12 mm, diameter of stone, cases with number of stones as single and multiple were (69±12)years, (23.3±3.0)kg/m 2, 16, (14±4)mm, 11, 95, 122, (12±4)mm, 89, 139 in patients with choledocholithiasis combined with periampullary diverticulum, versus (62±16)years, (23.8±2.8)kg/m 2, 67, (12±4)mm, 159, 892, 641, (10±4)mm, 817, 875 in patients with choledocholithiasis not combined with periampullary diver-ticulum, showing significant differences in the above indicators between the two groups ( t=?7.55, 2.45, χ2=4.54, t=?4.92, Z=4.66, t=?7.31, χ2=6.90, P<0.05). (2) Intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis. The balloon expansion diameter, cases with intraoperative bleeding, cases with hemorrhage management of submucosal injection, hemostatic clip, spray hemostasis, electrocoagulation hemostasis and other treatment, cases with endoscopic plastic stent placement, cases with endoscopic nasal bile duct drainage, cases with mechanical lithotripsy, cases with stone complete clearing, cases with difficult cannulation, cases with delayed intubation, cases undergoing >5 times of cannulation attempts, cannulation time, X-ray exposure time, operation time were 10.0(range, 8.5?12.0)mm, 56, 6, 5, 43, 1, 1, 52, 177, 67, 201, 74, 38, 74, (7.4±3.1)minutes, (6±3)minutes, (46±19)minutes in patients with choledocholithiasis combined with periampullary diverticulum, versus 9.0(range, 8.0?11.0)mm, 243, 35, 14, 109, 73, 12, 230, 1 457, 167, 1 565, 395, 171, 395, (6.6±2.9)minutes, (6±5)minutes, (41±17)minutes in patients with choledocholithiasis not combined with periampullary diverticulum, showing significant differences in the above indicators between the two groups ( Z=6.31, χ2=15.90, 26.02, 13.61, 11.40, 71.51, 5.12, 9.04, 8.92, 9.04, t=?3.89, 2.67, ?3.61, P<0.05). (3) Influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Results of multivariate analysis showed total bilirubin >30 umol/L, number of stones >1, combined with periampullary diverticulum were indepen-dent risk factors for difficult cannulation in patients with periampullary diverticulum who underwent ERCP for choledocholithiasis ( odds ratio=1.31, 1.48, 1.44, 95% confidence interval as 1.06?1.61, 1.20?1.84, 1.06?1.95, P<0.05). Results of further analysis showed that, of 1 920 patients undergoing ERCP for choledocholithiasis, the incidence of postoperative pancreatitis was 17.271%(81/469) and 8.132%(118/1 451) in the 469 cases with difficult cannulation and 1 451 cases without difficult cannula-tion, respectively, showing a significant difference between them ( χ2=31.86, P<0.05). In the 1 692 patients with choledocholithiasis not combined with periampullary diverticulum, the incidence of postopera-tive pancreatitis was 17.722%(70/395) and 8.250%(107/1 297) in 395 cases with difficult cannula-tion and 1 297 cases without difficult cannulation, respectively, showing a significant difference between them ( χ2=29.00, P<0.05). In the 228 patients with choledocholithiasis combined with peri-ampullary diverticulum, the incidence of postoperative pancreatitis was 14.865%(11/74) and 7.143%(11/154) in 74 cases with difficult cannulation and 154 cases without difficult cannulation, respectively, showing no significant difference between them ( χ2=3.42, P>0.05). Conclusions:Compared with patients with choledocholithiasis not combined with periampullary divertioulum, periampullary divertioulum often occurs in choledocholithiasis patients of elderly and low body mass index. The proportion of chronic obstructive pulmonary disease is high in choledocholithiasis patients with periampullary diverticulum, and the diameter of stone is large, the number of stone is more in these patients. Combined with periampullary diverticulum will increase the difficult of cannulation and the ratio of patient with mechanical lithotripsy, and reduce the ratio of patient with stone complete clearing without increasing postoperative complications of choledocholithiasis patients undergoing ERCP. Total bilirubin >30 μmol/L, number of stones >1, combined with periampullary diverticulum are independent risk factors for difficult cannulation in patients of periampullary diverticulum who underwent ERCP for choledocholithiasis.
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Objective To compare the efficacy and side effects of intermittent androgen depriva-tion (IAD) versus continuous androgen deprivation (CAD) in prostate cancer. Methods Forty-four patients with prostate cancer were divided into 2 groups. Twenty-one cases (group IAD) received IAD therapy. Of them, TNM staging showed T2 in 7 cases, T3 in 9 cases, T4 in 5 cases. The patients were treated by maximum androgen blockage until the serum PSA decreased to less than 0.2 ng/ml and maintained for 2 months. The treatment was resumed when the serum PSA increased up to 10.0 ng/ml or the symptoms occurred progress. Twenty-three cases (group CAD) underwent CAD therapy. Of them, TNM staging showed T2 in 7 cases,T3 in 12 cases,T4 in 4 cases. The time to prostate cancer progression,quality of life and side effect rate were compared between the 2 groups. Results The median time to disease progression was (36±4) months in group IAD and (30±4) months in group CAD,respectively. There was no significant difference between the 2 groups (P=0.132). The mean cycle length was (15.9±2.3) months, among them time on treatment and time off treatment were(8.8±1.5) months and (7.3±0.8) months, respectively. The symptom scores related to treatment in the treatment period and intermission of IAD group were 55.9±16.8 and 47.9±19.7, respective-ly, there was significant difference between them(P=0.007). But the differences between the treat-ment period and intermission in bone pain,urinary and intestinal symptoms were not significant (P> 0.05). The urinary symptom scores after 5 months of continuing treatment in groug CAD was signifi-cantly higher than the basis reference value which was obtained in the sixth month of initial treatment(P=0. 023), but there was no significant changes in the scores of bone pain, intestinal symptoms and symptoms related to treatment(P>0.05). The incidences of hot flash and gynecomastia were 28.6% (6/21) and 19.0%(4/21) in group IAD, 60.9%(14/23) and 52.2%(12/23) in group CAD, respec-tively. There were significant differences between the 2 groups(P<0.05). Conclusions IAD thera-py can alleviate the side effects of androgen deprivation therapy and improve the life quality. The effica-cy of prolonging the time to androgen independence of IAD therapy is similar to CAD therapy.
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<p><b>OBJECTIVE</b>To evaluate prostate specific antigen (PSA) and transition zone index (TZI) as predictors of acute urinary retention (AUR) in men with benign prostate hyperplasia(BPH).</p><p><b>METHODS</b>The complete data of 602 cases of BPH were reviewed and analyzed.</p><p><b>RESULTS</b>Mean serum PSA and TZI were (6.60 +/- 3.4) microgram/L and (0.71 +/- 0.14) in AUR group, (3.51 +/- 2.3) microgram/L and (0.46 +/- 0.21) in non-AUR group, respectively. There were significant differences in serum PSA and TZI between the two groups(P < 0.05). The difference in incidence of AUR between serum PSA < 4.0 micrograms/L, 4.0-10.0 micrograms/L and PSA > 10.0 micrograms/L was significant (P < 0.05). There was significant positive correlation between serum PSA and TZI(r = 0.213, P < 0.01).</p><p><b>CONCLUSION</b>Serum PSA and TZI were powerful predictors of the risk of AUR in men with BPH.</p>
Subject(s)
Aged , Aged, 80 and over , Humans , Male , Middle Aged , Acute Disease , Prostate-Specific Antigen , Blood , Prostatic Hyperplasia , Urinary Retention , DiagnosisABSTRACT
Objective This single-institution study was to evaluate various diagnostic means for patients with pancreatic cancer. Methods Three hundred and twenty-one patients with pancreatic cancer admitted into our hospital between Jan. 1990 and Dec. 2000 were enrolled, and the clinical data were analyzed retrospectively. Results The most common symptoms of patients with cancer in the head, body and tail and whole pancreas were abdominal pain (55.6%,81.0%,87.5%,respectively) and flatulance (27.8%,39.2%,50.0%,respectively).CA 19-9 was positive in 89.7% of all cases. The positive rate of image examination was 92.0% with MRI, 91.7% with angiography, 84.3% with CT, 80.1% with B ultrasound and 46.7% with GI series. Conclusions Abdominal pain and fullness are the most common symptoms for patients with cancer in the head, body and tail and whole pancreas.CA 19-9 testing presents valuable clues for the diagnosis of pancreatic cancer. All patients aged above 40 who seek medical advice for abdominal pain and flatulance should undergo ultrasound examination and CT scanning.