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Objective To study the therapeutic value of a second ERCP for the patients with failure of pre-cut ERCP.Methods A total of 167 cases of pre-cut ERCP failure were recruited to the study,among which 109 cases were diagnosed as common bile duct stones and/or benign papillary stenosis,and 58 cases as biliopancreatic lesion.ERCP failed with standard intubation for more than 20 minutes,even with pre-cut or fenestration.A second ERCP was preformed after rest of 3-5 days.The position sequence of intubation for most patients was horizontal,the front and rear.Results The success rate was 79.6％ (133 cases) for the patients with a second ERCP,85 patients received the procedures via the horizontal intubation,36 via anterior,and 12 via posterior intubation.The treatments were performed after successful completion of the endoscopic cannulation.One patient had retroperitoneal infection with duodenal perforation,another patient had severe pancreatitis,who were cured by the intervention methods.Conclusion The success rate of a second ERCP is high with proficient intubation skills.
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Objective To explore the strategies for diagnosis and treatment of anomalous junction of pancreaticobiliary duct (AJPBD) complicated by acute pancreatitis. Methods The clinical dataof 22 patients with abnormal pancreaticobiliary junction were analyzed retrospectively. Results The incidence of acute pancreatitis in this series was 31.8 % (7/22), thereinto, 5 cases(71.4%) in C-Ptype (the common bile duct joining the pancreatic duct) and 2(28.6%) in P-C type (the pancreatic duct joining the common bile duct). Seven patients underwent ERCP+ EST+ ENBD. Two patients with common bile duct stones were treated with stone basket and cholecystectomy was performed in two cases with gallstone. All patients were successfully treated. The follow-up for l year showed that there was no recurrence of pancreatitis. Conclusion Acute pancreatitis usually occurs in patients with AJPBD, especially in C-P type or with gallbladder stone or common bile duct stone. ERCP+EST+ENBD and prophylactic cholecystectomy are effective to prevent and treat acute pancreatitis.
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1263 patients with choledocholithiasis were treated with endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) from January 2005 to December 2008, with 1235 (97.8%) cases successfully treated. One-time ERCP removal of the stones was successful in 982 patients, with two times in 129 patients and three times in 124. 1130 patients (89. 5% ) underwent endoscopic nasal biliary drainage (ENBD) after the procedure. 56 patients with refractory stone were treated with intrabiliary plastic stent, among whom 42 were cured through endoscopic retrograde biliary drainage (ERBD) of 1 -3 times. Complications occurred in 29 patients (2. 3% ) with hemorrhage in 8 patients,acute pancreatitis in 17 and perforations in 4. Mortality rate was 0. We concluded that the majority cases of choledocholithiasis can be successfully treated by ERCP, while intrahepatic cholelithiasis and refractory common bile duct stone remained therapeutic challenges. It is also mandatory to evaluate long-term efficacy and complications of ERCP.
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Objective To investigate the role of endoscopic sphincterotomy(EST)and endoscopic nasobiliary drainage(ENBD)in the treatment of non-biliary severe acute pancreatitis(SAP).Methods 73 patients were randomly divided into the endoscopic treatment group(35 cases)and control group(38 cases).The patients in control group received non-surgical treatment.EST plus ENBD were performed in patients in the endoscopic treatment group 72h within hospitalization.Serum levels of amylase before EST and 1d,3 d,7 d after EST were measured;the ease of pain and recovery of bowel function were documented;the mortality rate,complication rate,surgery rote and hospital stay were also observed.Results The successful cannulation rate in the EST group was 94.3%(33/35),and there was no procedure related complication.Serum levels of amylase before EST and 1d,3 d,7 d after EST were(1376±131)U/L,(675±49)U/L,(238±49)U/L,(75±13)U/L,the serum levels of amylase before EST and 1d after EST in the EST group were not significantly different from those in the control group,but the corresponding values at 3 d,7 d were significantly lower than those in the control group(P＜0.01).The apparent effective rate and total effective rate of pain relief was 37.1%and 48.6%.which was significantly higher than those in the control group (26.3%and 28.9%,P＜0.05).There was no mortality in both groups.The complication rate in the EST group within 30 d was 14.3%,which was signiilcanfly higher than that in the control group(44.7%,P＜0.01).The gurgery rate in EST group was 2.86%,which was significantly lower than that in the control group (21.1%,P＜0.05).The hospital stay in EST group was(27.6±4.0)d,which was significantly shorter than that in the control group[(41.7±5.9)d,P＜0.05].Conclusions EST and ENBD treatment for non-biliary SAP was superior to non-surgical treatment within 72 h of symptom onset with excellent safety and feasibility profile.
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Objective To investigate the inducing effect of acitrotin on the growth and apoptosis of human cutaneous squamous cell carcinoma cell line SCC13 and on caspases expression.Methods Human cutaneous squa-mous cell carcinoma cell line SCC13 was treated with five different concentrations of acitrefin [5×10-7,1×10-6,5×10-6,1×10-5,5×10-5mol/L].Cell proliferation was evaluated by MTT assay.Apoptosis was assessed by en-zyme-linked immunosorbent assay.The cell cycle was assessed by flow cytometry.The protein expressions of caspase-8 and caspase-9 were examined with Western blot.Results Acitretin inhibited the growth ( F = 83.64,96.34 and 123.17, respectively on the first, third and fifth day)and induced the apoptosis of SCC13 cells(F=74.45,107.37,and 64.28, respectively on the first, third and fifth day) in a dose- and time-dependent manner(P<0.05).Acitretin altered cell cycle distribution of SCC13 cells as compared with controls, the G1-phase population increased by 77.66% 72 hours after acitretin treatment, while the control increased only by 63.55%.An active fragment of caspase-8 occurred following 12 hours treatment of acitretin on SCC13 cells, whereas the caspase-9 active fragment occurred 24 hours after acitretin treatment, which increased time-dependently (P<0.01).Conclusion Acitretin plays an important role on the growth inhibition and apoptosis of cutaneous squamous cell carcinoma cells, which may be affected through both Fas receptor way and mitochondria way.
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Objective To explore for the methede and effect of endoscopic treatment on biliary leakage and biliary duct damage. Methods All patients with biliary damage such as biliary leakage and biliary duct stricture were treated by endoscopic sphincoterotomy and endoscopic nasobiliary drainage (ENBD) during abdominal cavity drainage ENBD was removd when biliary leakage healed and abdominal cavity drainage ceased for 1～2 weeks were confirmed. Plastic stents were implanted to distend the biliary duct stricture for 2-3 months. Results Twenty-six patients with biliary leakage were cured 3-4 weeks after ENBD. Fourteen out of 17 patients implanted with plastic stent were recovered uneventfully after stent removed, and 4 patients also recovered after installation of double-stents for 3 months, while another case with calculus and stricture of left hepatic duct in spite of implantation of simple-stent suffered repeatedly from biliary tract infection and one case developed hepatic abscess after repeatedly infection for one year before he had the hepatic lobectomy. Conclution Endoscopic therapy is the first choice in treating biliary leakage or secondary duct stricture.
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Objective To investigate the molecular transduction mechanisms of apoptosis in cuta-neous squamous cell carcinoma cell line SCL-1 induced by acitretin. Methods SCL-1 cells were cultured and continuously treated with various concentrations of acitretin. Apoptosis was assessed by enzyme-linked immunosorbent assay (ELISA) in these cells on day 1, 3 and 5. Apoptotic cells were observed by acridine orange staining on day 5. The protein expressions of Fas, FasL, Fas-associated death domain (FADD), cas-pase-8, caspase-3 and poly ADP-ribose polymerase (PARP) were examined using Western blot in SCL-1 cells treated with acitretin at 1 x 105 mol/L at different time points. Neutralizing anti-Fas antibody (ZB4,1 μg/mL) was utilized to pretreat SCL-1 cells before the treatment with acitretin, following that, ELISA was done to compare the apoptosis in cells treated with ZB4, acitretin, or the combination of ZB4 and acitretin,respectively. Results Acitretin induced the apoptosis of SCL-1 cells in a dose- and time-dependent manner.Morphologically, acitretin-treated SCL-1 cells showed a typical characteristic of apoptosis. Significant increase in Fas, FasL, and FADD protein expression, as well as the activation of caspase-8, caspase-3 and PARP were induced by the treatment with acitretin. The apoptosis absorbance value was 0.78 ± 0.04 in cells treated with acitretin alone, decreased to 0.41 ± 0.03 in cells treated with ZB4 and acitretin (P ＜ 0.05), .suggesting that ZB4 could block the apoptosis of SCL-1 cells inducedby acitretin. Conclusion Acitretin could induce the apoptosis of cutaneous squamous cell carcinoma cells likely by Fas signaling pathway.
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Objective To investigate the effects ofthrce generations oftretinoids on the apoptosis of and caspase expressions in human cutaneous squamous cell carcinoma cell line SCL-1. Methods SCL-1 cells were cultured in vitro in the presence of three tretinoins, namely all-trans retinoic acid (ATRA), acitrefln and tazarotene at a concentration of 1×10-5 mol/L. On day 1, 3, 5, MTT assay and ELISA were used to detect the cell proliferation and apoptosis of these SCL-1 cells respectively; on day3, flow cytometry with Annexin V/PI was applied to analyze the cell cycle and early apoptosis, Western blot to measure the protein expressions of caspase-8 and caspase-9 in these cells. Results The growth of SCL-1 cells could be inhibited by ATRA, acitretin or tazarotene of 1×10-5 mol/L in a time-dependent manner (all P<0.01). All the three tretinoids could induce the cell apoptosis of SCL-1 cells (P<0.01), arrest them in G1-phase, and activate caspase-8 and caspase-9 (F=35.50, 25.79, respectively, both P<0.01). Of the three tretinoins, acitretin exerted the strongest effect on all the parameters tested. Conclusions Tretinoins can inhibit the growth and induce the apoptosis of cutaneous squamous carcinoma cells, which may be mediated through Fas- and mitochondria-way.
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Objective To observe the effect and safety of endoscopic retrograde cholangiopancre-atography(ERCP)in pregnant patients with acute biliary pancreatitis(ABP). Methods Twenty-four ABP patients,14 mild and 10 severe cases combined with pregnancy,were hospitalized from Januaray 2002 to Januaray 2007. Besides conventional managements,emergency endoscopic nasobiliary drainage(ENBD) without monitor of X-ray was performed in all patients to decrease the pressure in bile duct. Once the condi- tion of the patients Was stabilized and the common bile duct stone was confirmed,secondary endoscopic retro- grade biliary drainage(ERBD)with stent was performed in patients at early and midtrimester pregnancy,while secondary ERCP was employed in late pregnant patients after pregnancy termination. Results All pa-tients safely went through emergency ENBD without complication,and 4 patients with ampulla incarceration accepted sphinectomy with needle knife and stones were removed successfully. Common bile duct stone was confirmed in 15 patients and 5 of them underwent ERBD,the other 10 accepted ERCP. No patient died or needed surgical intervention,and they were all discharged with complete remission. Fetus of two patient with severe ABP did not survive. Conclusion Emergency ENBD and secondary ERCP or ERBD are safe and ef-fective in management of pregnancy patient with ABP.