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Objective To assess the value of pulmonary artery CT obstruction index for the evaluation of the severity of pulmonary embolism (PE),and to investigate the relation between pulmonary artery CT obstruction index and D-dimer levels.Methods 125 patients were diagnosed as PE by computed tomographic pulmonary angiography (CTPA)and D-dimer.Patients were separated into high-risk group and non-high risk group.CT obstruction index,D-dimer levels,diameter of the pulmonary artery were compared between two groups. Spearman’s rank correlation coefficients were used to assess the correlation between the CT obstruction index and the D-dimer levels,diameter of the pulmonary artery.Results CT congestion index of high-risk PE group was obviously higher than that of the non-high risk group (P=0.000).The diameter of pulmonary artery in high-risk PE group was obviously greater than that of the non-high risk group,the difference was statistically significant (P=0.000).No statistically significant difference was found in D-dimer levels between the two groups (P=0.103).There was no correction with CT congestion index and D-dimer levels(P=0.71).Conclusion The D-dimer levels of serum was a predictor of pulmonary embolism,cannot evaluate the severity of PE.CT obstruction index can reflect the severity of PE in some extent as an indicator of PE,there was no correlation with CT obstruction index and D-dimer levels.
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Objective To evaluate the feasibility,safety and efficacy of ESD for precancerous lesions and early cancer of remnant stomach after partial gastrectomy.Methods ESD was performed in 11 cases of high grade intraepithelial neoplasia/early cancer of remnant stomach.The short-term and long-term indices including time of procedure,complication,En Bloc resection rate,R0resection rate,local recurrence rate as well as lymph node metastasis were recorded and analysed.Results ESD was completed in all patients with only one case of delayed massive bleeding which was controlled by endoscopy successfully.Average procedure time,En Bloc resection rate,R0 resection rate were 85.5 minutes,100％ and 90％,respectively.No local recurrence or lymph node metastasis was detected during post-ESD surveillance (15 ～ 51 months).Conclusion High grade intraepithelial neoplasia and early cancer of remnant stomach after partial gastrectomy might be indication for ESD because of its safety and definite effect.Additionally,careful management of the fibre tissue is the key to procedure success.
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Objective To investigate the diagnostic value of intraductal ultrasonography (IDUS) and bile tumor marker in differential diagnosis of suspected biliary stricture.Methods A total of 57 patients with biliary stricture (8 benign strictures,49 cases of malignant strictures),who underwent IDUS and tests of serum and bile tumor markers (CA19-9 and CEA),were analyzed.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy were compared among the outcomes of B-ultrasonography,CT,MRCP,IDUS,as well as IDUS combined with bile tumor markers.Results The specificity of the IDUS and the combined group were 63.6％ (7/11) and 77.8％ (7/9) respectively (P ＞ 0.05).The positive predictive value of the IDUS and the combined group were 91.8％ (45/49) and 95.9％ (47/49) respectively (P ＞0.05).The diagnostic accuracy of the IDUS and the combined group were 91.2％ (52/57) and 94.7％ (54/57) respectively (P ＞0.05).Data of the two groups were significantly higher than conventional imaging like B-ultrasound,CT and MRCP.The accuracy of IDUS combined with bile CEA for the diagnosis of distal bile duct cancer was 97.9％ (46/47),significantly higher than that of IDUS.Conclusion IDUS combined with biliary tumor markers is of high value for distinguishing the bile benign from malignant stricture.IDUS combined with biliary CEA test can improve the diagnostic accuracy of distal malignant biliary stricture diseases.
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Objective To investigate the therapeutic efficacy and safety of endoscopic resection of giant gastric stromal tumors without explicit evidence of metastases.Methods A total of 12 giant gastric stromal tumors with no evidence of metastases diagnosed by endoscopic ultrasound (EUS) and computed tomography (CT) scan were managed by endoscopic resection.Operation time,blood loss and the incidence rate of perforation were recorded respectively.The diagnoses of tissue specimens were made by pathological examination and immunohistochemistry.In order to assess local recurrence and distant metastases,endoscopy and endoscopic ultrasound follow-up examinations were performed routinely at 2,6 and 12 months,and the whole abdominal CT scan was also performed at 12 months after operation.Results Endoscopic resections were successfully performed in 10 of 12 cases (83.3％),among which,6 underwent endoscopic submucosal excavation (ESE) without unexpected perforation and 4 endoscopic full-thickness resection (EFR)with intentional perforation.The rate of intentional perforation was 33.3％ (4/12),and all the perforations could be sealed by endoscopic methods.The blood losses were all more than 100 ml,which could be controlled by argon plasma coagulation,electrocoagulation or hemostatic clips.In the 10 encapsulated tumors,8 could be smoothly removed from esophagus,whose long diameter of the minimum cross section was less than 3.5 cm,however,2 tumors whose diameters were larger than 3.5 cm were taken out after segmentation.In the 10 tissue samples,9 were confirmed as low risk GIST,1 larger than 5 cm was pathologically confirmed as high risk GIST.During 1-year follow-up,no local recurrence or peritoneal metastasis was found.2 tumors,larger than 5.0 cm,could not be removed by endoscopic methods due to uncontrolled bleeding.The rate of uncontrolled bleeding was 16.7％ (2/12).The patients were transferred to surgery,and pathologically confirmed as having high risk GIST.Conclusion For low-risk giant gastric stromal tumors whose diameters were less than 5cm without evidence of metastases,endoscopic resection is considered as a safe and effective procedure.Tumors with long diameter of the minimum cross section less than 3.5 cm are more suitable for endoscopic resection,which can be smoothly taken out through cardia.However,for high-risk GIST larger than 5.0 cm,the rate of uncontrolled bleeding is high,so endoscopic resection should be adopted with discretion.
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Objective To investigate the diagnostic value of intraductal ultrasonography for the quality of biliary stricture.Methods Data of the patients who had received operation because of biliary stricture after IDUS examination from 2006 to 2010 were collected.IDUS results were compared with those of operation.Results There were 43 cases of malignant strictures and 6 benign strictures in total.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy of intraductal uhrasonography for the quality of biliary stricture were 97.7％ ( 42/43 ),83.3％ ( 5/6 ),97.7％ ( 42/43 ),83.3％ (5/6) and 95.9％ (47/49),respectively,which were significantly higher than conventional imaging like ultrasound B,CT and MRCP.Twenty one cases in 32 were diagnosed as malignant biliary stricture with cytological brushing,with the diagnostic accuracy of 65.6％.All cases had been diagnosed by IDUS.Conclusion Intraductal ultrasonography is of high diagnostic value for biliary stricture.However,cytological brushing based on IDUS is of limited diagnostic value for malignant biliary stricture.
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ObjectiveTo investigate the clinicopathologic features,therapy,and prognosis of primary small cell carcinoma of the pancreas.MethodsDatabases including Chinese Journal Full-text Database,VIP Database for Chinese Technical Periodicals,Medline/Pubmed,and OVID were searched electronically up to April 2012.A systematic review was performed together with one case in our hospital.ResultsTwenty-eight articles fulfilling the criteria consisting of 46 patients with pathologically confirmed diagnosis of primary small cell carcinoma of the pancreas were studied,together with 1 patient in our Drum Tower Hospital,finally 47patients were included.The results of this systematic review showed:( 1 ) Primary small cell carcinoma of the pancreas was more common in men with a median age of 62.The most common clinical presentations were abdominal pain,jaundice and weight loss.Para-neoplastic syndrome was rarely observed.(2)Most cases were found to have abnormally elevated serum levels of neuron-specific enolase.CT displayed heterogeneous,and marked enhancing masses in most cases.The conclusive diagnosis depended on histological confirmation.(3)63.8％ of the cases were found to be associated with metastasis at the time of diagnosis.The overall median survival time was 28 weeks.(4) There was no consensus on the treatment of primary small cell carcinoma of the pancreas. Chemotherapy was currently considered as the treatment of choice among the systematic management for these patients.ConclusionsPrimary small cell carcinoma of the pancreas was a rare and aggressive neuroendocrine tumor with a poor prognosis.
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ObjectiveTo prospectively assess the efficacy and safety of endoscopic ultrasoundguided celiac plexus neurolysis (EUS-CPN) in the management of pain caused by pancreatic carcinoma.MethodsPatients with confirmed un-resectable pancreatic malignancy were treated with EUS-CPN once or twice.The data including age,gender,pain duration,opioid consumption,tumor location,pain scores before and after the procedure,number of treatment,duration of pain relief and survival time were collected.ResultsA total of 27 cases with cancerous abdominal pain were recruited.The median pain scores were significantly lower after EUS-CPN,and pain relief was obtained in 81.5％ (95％ CI,66.8％ -96.1％ ) patients with a median duration of 56.0 days (95％ CI,17.1-94.9),whose confidence interval was comparable to that of survival time (97.0 days,95 ％ CI,82.7-111.3 ).No clinical factors could predict post-procedure duration of pain relief (x2 =6.757,P =0.239).Procedure-related transient diarrhea and fever were noted only in 1 patient.No major complications occurred.ConclusionEUS-guided CPN is safe and effective in alleviating abdominal pain associated with pancreatic cancer,even at the late stage.Moreover,no clinical factor could predict post-procedure degree or duration of pain relief.
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Objective To investigate the value of a diagnostic criterion of capsule endoscopy (CE)for small bowel Crohn's disease (CD). Methods The clinical data of 50 patients with suspected CD who underwent CE from March 2003 to October 2008 were analyzed retrospectively. Diagnoses were made based on a criterion proposed by De Bona et al. Patients were grouped and followed up for 1 to 5 years. Results A total of 50 patients were enrolled and divided into 3 groups according to the results of CE. Group A included 25 patients as having small intestine CD on CE, in which 3 received surgery and was confirmed by pathology, and the other 22 got improved after treatments for CD. Group B was comprised of 15 patients who were clinically diagnosed as small intestinal CD and received experimental treatments, in which 13 patients improved and 2 others received surgery and were confirmed to be small intestine diverticula. Patients in group C ( n = 10) were diagnosed as non-specific enteritis and received medication of Bifico and metronidazole for at least 3 months. All patients were followed up for 1 to 5 years and no recurrence was observed. Conclusion This diagnostic criterion of CE for small bowel CD enables early diagnosis of the disease.
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Objective To study the clinical features of Crohn's disease(CD)at different location,I.e.small intestine.colon and ileocolon,to facilitate the knowledge of the disease.Methods Data of 103 patients,hospitalized to our department from 2000 to January 2008,were retrospectively analyzed,including general status,clinical manifestations,laboratory findings and pathological changes.Results The cohort included 70 males and 33 females,with the age when the diagnosis was confirmed ranging from 12 to 70,with a peak at 20-29 yr.The location of the main lesion was at small bowel(L1)in 39(38%),at colon (L2)in 16(16%)and at ileum-colon(L3)48(46%).There was no significant difference between each group,regarding the age of onset or the when the diagnosis was confirmed.The incidence of intestinal obstruction was higher in L1 patients than that in L3(P＜0.05).In group L1,12(30.8%)were diagnosed by capsule endoscopy,and 17(44%)were confirmed by colonoscopy.Diagnostic rates of L2 and L3 with reference to clinical manifestations.combined with colonoscopy and pathology were 87.5%and 83.3%,respectivelv.In this cohort,there were 23(22.3%)mild cases,58(56.3%)moderate cases and 22 (21.4%)severe cases,according to simplified CD activity index(CDAI).The rate of severe case in L3 was 59.0%(13/48),which was significantly higher than that in L1(P＜0.05).Conclusion In patients with CD,L1 is characterized by delayed diagnosis and need of emergent surgery,while L3 is featured with extensive involvement.severe complications and systemic manifestations.Severe case is common in 13 patient,capsule endoscopy and Colonoscopy are important in early detection of the disease to decrease operation rate and delay the time of first operation.
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Objective To evaluate the diagnostic value of endoscopic ultrasonography-guided fineneedle aspiration(EUS-FNA)for pancreatic occupying lesion,especially pancreatic cancer.Methods From year of 2005,37 patients with suspected pancreatic cancer by means of uhrasound,CT or MRI received EUS-FNA.Amylase and tumor markers(CEA,CA19-9 and CA125)in cyst fluid were analyzed if applicable.The patients were followed up till July 2008,and the results of EUS-FNA were compared with those confirmed during the follow-up.Results The EUS-FNA yielded diagnosis of 16 cases of pancreatic duetal adenocarcinoma,1 metastatic:renal cancer,5 suspicious malignancy,6 atypia,6 normal pancreatic tissue,and 3 normal non-pancreatic tissue.During the follow-up,25 cases of pancreatic cancer and 10 benigh lesions,including 4 chronic panereatitis,4 cyst-adenoma and 2 pseudocyst,were confirmed,and the other 2 cases still remained un-determined.The sensitivity,specificity,positive predictive value and negative predictive value of EUS-FNA were 80.0%(95% CI:59.0-93.0),100.0%(95% CI:60.0-100.0),100.0%(95% CI:80.0-100.0),and 55.6%(95% CI:27.0-79.0),respectively.No severe procedurerelated complication was observed.Conclusion EUS-FNA is a safe and effective medality for diagnosis of pancreatic occupying lesions,especially pancreatic cancer.
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Objective To assess the efficacy of percutaneous transhepatie variceal embolization (PTVE) in treating esophageal and gastric variceal bleeding after esophageal-gastric devascularization with splenectomy in patients with liver cirrhosis. Methods Twenty-two patients, who had history of esophageal-gastric devascularization with splenectomy, were either underwent PTVE with TH glue (n=10) or endoscopic injection of sclerosis (EIS, n = 12) for treatment of esophageal or gastric variceal rebleeding between Nov. 2006 and Sep. 2008. The patients were followed-up for recurrent bleeding, mortality, grade of esophageal and gastric varices and liver function. Portal vein pressure was measured before and after collateral embolization in PTVE group. Results ① The patients were followed-up for 12.5 months in PTVE group and 13.4 months in EIS group. There was significant difference (P<0.05) between PTVE and EIS groups in rebleeding rate (1/10 vs 7/12) and mortality (0 vs 3/12). ② The degree of esophageal and gastric varices after embolization or EIS was improved significantly. ③ For patients with portal vein thrombosis, combination of PTVE with portal vein balloon plasty could markedly improve portal vein blood supply. ④ Neither PTVE nor EIS aggravated the liver cirrhosis. Conclusion Compared with EIS, PTVE with TH glue may be a more effiective method in the treatment of rebleeding of patients with liver cirrhosis who had accepted esophagealgastric devascularization with splenectomy.
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Objective To analyze the etiology and clinical features of isolated gastric varices.Methods A retrospectives analysis was carried out in 31 patients with isolated gastric varices between January 2003 and January 2008.The patients records including data of etiology,clinical presentation,imaging studies and therapeutic modalities were reviewed.Results Those who had isolated gastric varices were accounted for 7.38 0A (31/420)of all patients with gastroesophageal varices.The etiologies were left-sided portal hypertension(14 cases,45.2%),liver cirrhosis(8 cases,25.8%),unknown origin(6 eases,19.4%),hepatocellular carcinoma(2 cases,6.5%),portal cavernous transformation(1 case,3.2%).Twenty-one patients(67.7%)had variceal hemorrhage.Splenomegaly was present in 21 cases(67.7%),among which 10 cases(32.3%)had concomitant hypersplenism.Venous involvement was identified in 18 patients(splenic vein obstruction in 9 cases and portal vein involvement in 9 cases).Surgical therapy was performed in 8 cases,selerotherapy in 3 cases,and medical therapy in 20 cases.Conclusions Left-side portal hypertension is responsible for most of the isolated gastric varices,and some of which are also caused by liver cirrhosis.Surgery is the appropriate procedure of choice in management of hemorrhage and recurrence.
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Objective To study the effects of rhubarb on the mitogen-activated protein kinase (MAPK) sig-naling transducfon pathway in rats with severe acute pancreatitis (SAP),and to investigate the treatment mecha-nism of rhubarb on SAP. Method One hundred SD rats were provided by from the Animal Center of Nanjing Uni-versity. All animals were randomly divided into sham operation (n=33), SAP (n=33) and rhubarb groups (n=34). SAP model was induced by retrograde injection of 5% sodittm taurocholate. Rhubarb was given with 10% rhubarb decoction (2 mi/100 g) at the time of pancreafitis induction in the rhubarb groups. At 1, 3, 6, and 12 h after the models were established,animals were killed. MAPK activity in pancreatic tissue was examined by West-em blotting and the mRNA levels of TNF-α and IL-6 in pancreatic tissues were detected by RT-PCR. All data were analyzed by SPSS statistical software and statistical differences between values from two sroups were determined by the Student's t -test. Results MAPK activity, TNF-α and IL-6 mRNA levels in pancreatic tissues were signifi-cantly enhanced in the SAP group compared with the sham operation group (all P<0.01). Rhubarb treatment markedlyinhibited MAPK activation,TNF-α,IL 6 mRNA (all p<0.01). Conclusions Rhubarb can alleviate the inflammatory response of SAP by down-regulating MAPK activity.
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Objective To compare the detect abilities of obscure gastrointestinal bleeding by capsule endoscopies and conventional intestinal examinations.Methods To analyze the results of gastrointestinal barium meal examination, arteriography of superior mesenteric artery, push enteroscopy, capsule endoscopy, and enteroscopy during exploratory laparotomy in 67 patients with obscure gastrointestinal bleeding.Results Detectable rates of gastrointestinal barium meal examination, arteriography of superior mesenteric artery, push enteroscopy, capsule endoscopy, and enteroscopy during exploratory laparotomy are 17 6%, 13 4%, 32 0%, 80 6%, and 83 3% respectively, and their diagnostic rates are 13 8%, 13 4%, 32 0%, 67 7%, and 83 3% respectively. Conclusion Capsule endoscopy is superior to conventional methods of intestinal examinations having high detectable and diagnostic rates in obscure gastrointestinal bleeding; it should be the first choice in diagnosing obscure gastrointestinal bleeding.
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Objective The activity and cyclooxygenase (COX-2) protein expression of colorectal adenoc arcinoma cell treated by deoxycholic acids (DCA) were examined in order to find out the carcinogenesis mechanism of DCA. Methods The proliferation of colorectal cancer cells (SW 1116) was detected by MTT metho d . COX-2 protein expression was measured by immunohistochemistry and Western blo t. Results DCA lower than 100 ?mol/L concentration can stimulate the growth of the adenoca rcinoma cells with effect reversible, while higher concentration shows the long -acting effect of inhibition. DCA of 10,50 and 100 ?mol/L concentration can up -regulate the expression of COX-2 in cells, while only 10 ?mol/L can maintain this effect long than 72 hours. The level of COX-2 protein treated by the late r two concentration descends after 48 hours. Conclusion DCA affects the proliferation of SW1116 in two sides. D CA concentration lower than 100 ?mol/L can promote COX-2 protein expression, w hich may be the mechanism of its carcinogenesis.
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Objective To observe the extent of injury in esophageal mucosa resulted from Argon plasma coagulation (APC). Methods The injuries from APC were observed in 55 sites of esophageal normal mucosa in 11 patients with esophageal cancer. APC powers in 45 W,60 W and 90 W were selected with exposure times of 1 sec and 3 sec respectively. The probe of APC was hold approximately at 30?and 2 mm from the mucosa. The histological changes of esophageal wall injured by APC were examined under light and electric microscopy. Results The injuries in 46 out of 55 sites were merely restricted in the mucosa or sub-mucosa,7 out of 55 extended into the muscularis propria.and 2 of 9 sites extended to the whole depth of e-sophageal wall. The depth of injury increased in relation with the elevating of APC power (P 0. 05). Conclusion APC is a safe way for treating esophageal diseases if its power is limited in an appropriate range.
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Objective To study the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) ,cy-clooxygenase-2 ( COX-2 ) inhibitor Piroxicam on the growth of colorectal cancer cells and to evaluate the preventive significance from COX-2 expression and apoptosis. Methods The cell growth of colorectal adenocar-cinoma cell line SW1116 was measured by MTT (3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyl tetrazolium bromide) assay, and COX-2 protein expression by Immunohistochemistry and Western Blot. Apoptosis was characterized by DNA fragmentation. Results The results showed that COX-2 inhibitor Piroxicam could restrain the proliferation of SW1116, which had positively related to its concentration. Concentration higher than 1. 0mmol/L showed cytotoxic effects. The inhibition of COX-2 by Piroxicam appeared within 12 hours, but COX-2 protein level recovered within 24 hours, its expression had negatively related to the concentration of Piroxicam. Apoptosis was induced in SW1116 culture with Piroxicam higher than 0. 1mmol/L. Conclusion It can be concluded that cell inhibition effect is associated with Piroxicam-mediated cell apoptosis and inhibition of COX-2 protein expression in SW1116 cell, because the effects of Piroxicam have the concentration and time dependence, in further clinical research its dosage and time of medication should be considered in preventing or treating colorectal cancer.
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Objective To observe the growth characters of upper gastrointectinal tract leiomyoma. Methods Using endoscopic ultrasonography to detect leiomyoma of upper gastrointestinal tract leiomyoma in 18 cases once every 6 months on follow-up , and to measure the longest diameter ( A mm) and calculate its growth rate per month. Results In this series,the majority of cases have the leiomyoma of longest diameter(A) 10～20mm. Their growth rates in A≤10mm, 10mm
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Objective To investigate the early diagnosis and treatment of primary gastrointestinal malignant lymphoma( PGIML). Methods The clinical materials of 33 cases with PGIML from 1997 to 2005 were retrospectively studied. Results The diagnosis rate of gastroenteroscopy was 44. 4% . The most common immune phenotype was B-cell lineage (90. 9% ). Of the 33 PGIML patients, 30 were treated with operation, 2 with H. poli elimination and 1 gave up treatment. Among the operation cases and operation plus chemotherapy cases 19/21 cases (90. 5% )and 6/9 cases (66. 7% ) survived more than 2 years respectively, the other 6 cases died. Conclusion It is hard to diagnose PGIML in early stage. The effectiveness of surgery on treating PGIML should be further confirmed by profound prospective randomized trials.
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Objective To evaluate the diagnosis of intestinal bleeding by capsule endoscopy ( CE) , and compare with the result of operation. Methods All patients experienced CE had failed to get definite diagnosis from conventional endoscopy. Of 50 consecutive patients, 28 with intestinal bleeding episodes more than 5 times (group A) , 14 with 2-5 times(group B) and 8 with only oace (group C) ,totally 18 patients had received operation. Results Of these 50 patients, 39 ( 78. 0 % ) had abnormal findings, which could be considered as the etiology of bleeding. The detectable rate was 92. 9% , 71. 4% and 37. 5% in-group A, B, and C respectively (P