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Objective To investigate the predisposing locations of active hemorrhage in patients with esophageal variceal bleeding. Methods Data of 823 patients with acute esophageal and gastric variceal hemorrhage receiving emergency gastroscopy diagnosed from January 2003 to December 2013 were retrospectively studied. The location and site of active hemorrhage or stigmata were analyzed and its relationship with active hemorrhage was discussed. Results A total of 372(45. 2%,372/823) patients with active bleeding and stigmata were found under emergency endoscopy. Among 372 patients, 190 got accurate hemorrhage and stigmata location and site description. Bleeding or stigmata in 58(30. 5%) patients was 28-32 cm from incisor in group A, and that in 132 (69. 5%) patients was more than 35 cm in group B ( χ2＝57. 642, P＜0. 000 1). In 190 cases, the proportion of bleeding or stigmata at 3:00 point was the highest (37%,70/132), followed by those at 12:00 point(30%,58/132),6:00 point(24%,45/132),and 9:00 point (9%,17/132). The change trend of the percentage of each point in group A and group B was the same as that in all cases. The percentage of almost all points in group B was significantly higher than that in group A except that at 9:00 point ( P＜0. 000 1).Conclusion Esophageal variceal bleeding in cirrhosis is more common at 3:00 point, 6:00 point and 12:00 point of esophagus, and the high risk area is 35 cm below the incisors.
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Objective To evaluate the protective effect of exogenous biliverdin on ultraviolet B (UVB)-radiated HaCaT cells,and to explore its mechanism.Methods Cultured HaCaT cells were divided into 5 groups:control group receiving no treatment,UVB group irradiated with 30 mJ/cm2 UVB,3 biliverdin + UVB groups treated with 100 nmol/L,1 μmol/L and 10 μmol/L biliverdin respectively for 1 hour followed by 30 mJ/cm2 UVB radiation.After 24-hour treatment,changes in the morphology of HaCaT cells were observed,and cell counting kit 8 (CCK8) assay was performed to determine cell survival rates in the above groups.Western blot analysis was conducted to measure the protein expression of antioxidant signaling molecule NF-E2-related factor-2 (Nrf-2) and the photodamage signaling molecules matrix metalloproteinase-1 (MMP-1) and MMP-3.Results CCK8 assay showed that the survival rate of HaCaT cells was significantly lower in the UVB group than in the control group (P ＜ 0.05),but significantly higher in the 100-nmol/L,1-μmol/L and 10-μmol/L biliverdin + UVB groups than in the UVB group (all P ＜ 0.05).Western blot analysis showed that the protein expression of MMP-1 and MMP-3 was significantly higher in the UVB group (1.150 ± 0.187,0.979 ± 0.054 respectively) than in the control group (0.116 ± 0.018,0.636 ± 0.035 respectively;both P ＜ 0.01),but was significantly lower in the 100-nmol/L,1-μmol/L and 10-μmol/L biliverdin + UVB groups (MMP-1:0.825 ± 0.139,0.313 ± 0.047 and 0.286 ± 0.036 respectively;MMP-3:0.888 ± 0.017,0.672 ± 0.042 and 0.569:±:0.037 respectively) than in the UVB group (all P ＜ 0.05).Moreover,the protein expression of Nrf-2 was significantly lower in the UVB group (0.906 ± 0.034) than in the control group (1.242 ± 0.141,P ＜ 0.05),but significantly higher in the 100-nmol/L,1-μmol/L and 10-μmol/L biliverdin + UVB groups (1.556 ± 0.112,1.897 ± 0.234 and 2.035 ±0.274) than in the UVB group (all P ＜ 0.01).Conclusion Exogenous biliverdin protects against UVB-induced photodamage in HaCaT cells,which may be associated with Nrf-2 antioxidant signaling pathway.
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Objective To evaluate the clinical effect of balloon closure combined with endoscopic therapy on spontaneous gastrorenal shunt ( SGRS ) and spontaneous splenorenal shunt ( SSRS ) . Methods The data of 33 patients of gastric varices with SGRS or SSRS diagnosed in the Chinese PLA General Hospital between January 2009 and February 2016 were collected. All patients were treated with the balloon retrograde distributary channel blocking technique and endoscopic histoacryl injection. Patients' clinical data, complications and effect of endoscopic therapy were retrospectively analyzed. Results In the 33 patients of gastric varices, gastrorenal shunt was found in 28 ( 84. 8%) cases and splenorenal shunt was found in 5 ( 15. 2%) cases. After the balloon blocking technique, 24 cases ( 72. 7%) were occluded successfully. Four cases failed in occlusion of SSRS due to tortuosity. There were no postoperative ectopic embolism, infection, hepatic encephalopathy, liver function deterioration, and other complication. Early latex varices were found in 21 cases after three months follow-up. Conclusion The balloon blocking technique combined with tissue adhesive injection could safely and effectively avoid the risk of ectopic embolism and plays an important role in the treatment of gastric varices in merger portasystemic shunt.
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Objective To evaluate the clinical effect of balloon closure combined with endoscopic therapy on spontaneous gastrorenal shunt ( SGRS ) and spontaneous splenorenal shunt ( SSRS ) . Methods The data of 33 patients of gastric varices with SGRS or SSRS diagnosed in the Chinese PLA General Hospital between January 2009 and February 2016 were collected. All patients were treated with the balloon retrograde distributary channel blocking technique and endoscopic histoacryl injection. Patients' clinical data, complications and effect of endoscopic therapy were retrospectively analyzed. Results In the 33 patients of gastric varices, gastrorenal shunt was found in 28 ( 84. 8%) cases and splenorenal shunt was found in 5 ( 15. 2%) cases. After the balloon blocking technique, 24 cases ( 72. 7%) were occluded successfully. Four cases failed in occlusion of SSRS due to tortuosity. There were no postoperative ectopic embolism, infection, hepatic encephalopathy, liver function deterioration, and other complication. Early latex varices were found in 21 cases after three months follow-up. Conclusion The balloon blocking technique combined with tissue adhesive injection could safely and effectively avoid the risk of ectopic embolism and plays an important role in the treatment of gastric varices in merger portasystemic shunt.
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Objective To evaluate the safety and efficacy of endoscopic treatment in patients with primary hepatic carcinoma and gastroesophageal variceal hemorrhage. Methods Thirty cases of hepatic carcinoma with gastroesophageal variceal hemorrhage diagnosed with gastroscopy between January 2008 and June 2015 in Chinese PLA General Hospital and Hainan branch were included. Patients′ clinical data, complications and therapeutic effects of endoscopy were retrospectively analyzed. Results All patients underwent endoscopy successfully. No recurrent bleeding was found in any case after treatment. Eight cases of varicosis nearly disappeared. Six?month follow?up showed three cases of gastrointestinal bleeding, one case of death of bleeding, and no recurrence hemorrhage in 27 others. Conclusion Endoscopic treatment could safely and effectively control the primary liver cancer combined with gastroesophageal variceal hemorrhage, hence may provide opportunity for further treatment of liver cancer.
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ObjectiveTo investigate the clinical effect of endoscopic therapy for patients with esophagogastric variceal bleeding (EVB) after liver transplantation. MethodsA retrospective analysis was performed for the clinical data of 8 patients who experienced EVB after liver transplantation and underwent endoscopic therapy, especially endoscopic features. The clinical outcome was evaluated, including hemostasis rate, change in varicose veins after treatment, and short-term recurrence and bleeding rate. ResultsThe eight patients had a mean age of 55.00(4475-6150) years, and the mean time from liver transplantation to bleeding was 7150(1875-10725) months. As for primary diseases, 6 patients had hepatitis B cirrhosis (among whom one patient each was complicated by liver cancer, alcoholic cirrhosis, and acute liver necrosis, and three were complicated by subacute liver necrosis), one had hepatitis C cirrhosis, and one had unexplained liver cirrhosis. Of all patients, 2 underwent sclerotherapy, 6 underwent endoscopic variceal ligation, and 6 underwent tissue adhesive treatment. The endoscopic therapy achieved successful hemostasis in all patients. No patients experienced rebleeding at discharge or the 12-month follow-up visit. One patient underwent selective endoscopic therapy due to the recurrence of varices. ConclusionGastrointestinal bleeding remains a serious complication after liver transplantation. Besides antiviral therapy, the presence of varices should be closely monitored.
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Objective To assess the efficacy and safety of interventional techniques for the management of symptomatic portal vein (PV) and superior mesenteric vein (SMV) thrombosis. Methods Six patients with thrombosis of the PV and SMV were treated by transjugular intrahepatic portosystemic (TIPS) approach. Contrast PV SMV venography was carried out to verify the access to the PV branch. Then a 8F large bore catheter was used to aspirate thrombus. A J shaped guide wire and pig tail catheter were used to fragment the thrombus. Local thrombolysis with urokinase (UK) was delivered through a catheter in the SMV. An 4 French multiple side hole catheter was put into the SMV and UK was continuously infused for 3 to 13 days.Results The procedure was successful in all cases. One patient died of intra abdominal sepsis 12 days after. Five patients were followed up by color Doppler ultrasonography for 4～36 months with confirmed patency of the PV and SMV in all these patients. Conclusions This procedure is both safe and effective in the treatment of symptomatic PV and SMV thrombosis.
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Objective To study the technique and to evaluate the clinical value of stent implantation by butt joint of percutaneous transhepatic biliary drainage (PTBD) and endoscopic retrograde cholangio-pancreatography (ERCP) for the treatment of obstructive jaundice. Methods 24 patients with obstructive jaundice were treated by butt joint of PTBD and ERCP after the ERCP failure, and the clinical results were evaluated. Results A total of 24 cases with obstructive jaundice were successfully operated by butt joint of PTBD and ERCP. In PTBD, 10 cases were punctured from right side, and 14 cases were from left side. PTBD, ERCP and butt joint were done simultaneously in 16 cases, and separately in 8 cases. The total serum bilirubin decreased by 47.07 in 4 days, and the direct bilirubin decreased by 45.43. Infection of biliary tract was the main complication. Conclusion Stent implantation by butt joint of PTBD and ERCP for the treatment of obstructive jaundice may be chosen to treat the patients who failed in ERCP alone.
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Objective To improve the level of the diagnosis and treatment of gastric ectopic pancreas. Methods We reviewed the data of endoscopic ultrasonography(EUS) examination of gastric submucosal mass from 2000 to 2004 and analyze the EUS features of gastric ectopic pancreas. Results Among 241 cases of gastric submucosal mass, 105 cases were diagnosed as benign stromal tumors, 23 as malignant stromal tumors, 48 as lipomas,45 as ectopic pancreas and 20 as cysts. The EUS features of gastric ectopic pancreas included submucosal lesions (39 cases), clear boundary (37cases),hy-perechoic heterogenous internal echo(42 cases), hypoechoic(3 cases), echoless in the center of the lesions (32 cases). After resection,26 cases confirmed by pathology had no complications. Conclusion EUS examination is helpful to confirm the diagnosis'of gastric ectopic pancreas. Resection under endoscopiy is a an effective measure of treatment.
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Retrospective analysis of 761 case-times successive color Doppler sonography for 518 renal transplant patients was carried out.six parameters of sonography were used to compare, the CsA-NT hemodynamic changes among the patients with normal function, rejected and hy-dronephrotic kidney.It revealed that during rejection of the rendl srafts, besides an elevation of resistance index(RI)and a decrease of D/S ratio, the velocity and volume of renal blood flow were also slowed down and decreased respectively.After combating rejection, the renal function recovered to normal gradually, and RI dropped below 0.75 subsequently.Otherwise R1 would be persistently elevated, which indicated an irreversible rejection.The diagnosis of acute rejection was given at RI≥0.83, with the sensitivity rate being 82.70%and specificity being 80.10%.It was suggested that RI is a relatively sensitive and relialble parameter for the diagnosis of rejection.In combination with the clinical manifestations RI is of great important clinical value for the early diagnosis and treatment of acute rejection.
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To find the rule of alterations in AFP mRNA concentration in peripheral blood in patients with hepatocellular carcinoma(HCC) before and after the treatment with transhepatic arterial chemotherapy and embolization(TAE), 15 cases of the pateints with HCC were included in this survey. The AFP mRNA concentration in peripheral blood of the patients were investigated using compatitive RT PCR technique before and 1,2,3,4, 5,6,7, 14, 28 days after TAE. The results showed that AFP mRNA concentration on the third day after TAE was the highest. It declined to the level before treatment during one week.It suggested that AFP mRNA concentration changed with a rule, and following the rule, preventive measure to distant metastasis could be instituted in clinical work.
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Objective To evaluate the efficacy and safety of thrombolysis treatment of mesenteric and portal venous thrombosis by TIPSS pathway. Methods Six patients with thrombosis of the PV and SMV were treated by transjugular intrahepatic portosystemic shunt (TIPSS) pathway. All 6 patients presented abdominal pain, distention, and anorexia etc. No clinical signs of peritonitis were seen. The diagnosis was established by Doppler ultrasound scan and contrast enhanced CT. Control PV-SMV venography was performed after access to the PV branch. As soon as the diagnosis was established the thrombus in the PV and SMV was aspirated and fragmented. After the majority of the clot was cleared away with restoration of blood flow in the main trunk, a 4-French catheter with multiple side-holes was passed into the SMV, and urokinase (UK) was continuously infused for 3 to 13 days. Anticoagulants were given for 6 months therefter. Results The majority of the thrombus in PV and SMV was cleared away resulting in flow restoration in all patients after the procedure. Clinical improvement was seen in 5 patients, characterized by progressive alleviation of abdominal pain, distention, and diarrhea. Prior to removal of the infusion catheter from the SMV, venography revealed a complete resolution of the thrombosis in 3 patients, and residual thrombus in the PV branches in 3 cases without showing clinical symptoms. Follow-up Doppler ultrasound scan performed during 4-36 months after the procedure confirmed patency of the PV and SMV. The symptoms did not recur. Conclusions Through the TIPSS pathway, catheter-directed thrombolysis is safe and effective in the treatment of PV and SMV thrombosis.