Influencing factors for stent obstruction after endoscopic retrograde biliary drainage in patients with refractory common bile duct stones / 临床肝胆病杂志

ObjectiveTo investigate the influencing factors for stent obstruction after endoscopic retrograde biliary drainage (ERBD) for refractory common bile duct stones. MethodsA total of 126 patients who underwent ERBD for refractory common bile duct stones in Renmin Hospital of Wuhan University from January 2014 to May 2019 and were readmitted for stent removal at 6 months after surgery were enrolled, and according to the condition of stent removal, they were divided into obstruction group and unobstructed group. General data and related indices were compared between the two groups. The independent samples t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups; a multivariate logistic regression analysis was used to investigate the influencing factors for stent obstruction after surgery. ResultsAmong the 126 patients, 28 were found to have stent obstruction during removal, with a stent obstruction rate of 22.2%. The univariate analysis showed that there were significant differences between the two groups in white blood cell count (WBC), percentage of neutrophils (Neu%), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase, leucine aminopeptidase, endoscopic sphincterotomy (EST), infection, aspirin, and stent type (all P＜005). The multivariate logistic regression analysis showed that WBC［OR(95%CI):1.232(1.033-1.470)］, Neu%［OR(95%CI):1.263(1.021-1.562)］, ALP［OR(95%CI):1.013(1.004-1.022)］, EST［OR(95%CI):5.890(1.114-31.139)］, infection［OR(95%CI):17317(1.349-222.349)］, and stent type［OR(95%CI):0.144(0.022-0.937)］ were independent influencing factors for postoperative stent occlusion (all P＜0.05). ConclusionPatients with elevated WBC/Neu%/ALP, intraoperative EST, and preoperative secondary infection have a high risk of postoperative stent obstruction, and close follow-up and early prevention should be performed for such patients. The double pigtail stent can effectively reduce the rate of postoperative stent obstruction.

Current status of clinical research on hematobilia / 临床肝胆病杂志

Hematobilia is one of the rare causes of upper gastrointestinal bleeding. It is difficult to diagnose in clinical practice, due to its atypical clinical manifestations, rare Quikle triad (abdominal pain, jaundice, and upper gastrointestinal bleeding), and a lack of specificity. At present, it is believed that iatrogenic injury is the main cause of hematobilia, selective hepatic arteriography is the preferred choice for the diagnosis of hematobilia, and interventional embolization is the main treatment method. With reference to related articles, this article mainly elaborates on the current status of the research on the etiology, clinical manifestations, diagnosis, and treatment of hematobilia.

Endoscopic therapy for acute suppurative cholangitis with common bile duct stones / 临床肝胆病杂志

Acute suppurative cholangitis (ASC) is an acute infectious disease of the biliary tract caused by bacterial infection and biliary obstruction. Common bile duct stone is the most common cause of biliary obstruction. Due to the characteristics of rapid onset, rapid progress, various complications, and high mortality of ASC, it has attracted more and more attention in clinical practice. The treatment of ASC includes anti-infective therapy and relief of obstruction, and early relief of obstruction is the key to successful treatment. Endoscopic therapy has long been regarded as the first choice for the relief of obstruction, and with the development of medical technology, various new endoscopic techniques are gradually applied in the treatment of ASC and have thus become the new choices for surgeons and patients. With reference to the advantages and disadvantages of different treatment techniques, this article reviews the endoscopic therapies for ASC caused by common bile duct stones.

Clinical Analysis of Acute Myocardial Infarction Induced by Gastrointestinal Hemorrhage / 医学研究杂志

Objective To analyze the clinical characteristics and risk factors of mortality of acute myocardial infarction induced by gastrointestinal hemorrhage,and improve the diagnosis and treatment of this kind of disease.Methods The clinical data of 28 patients who admitted to renmin hospital of wuhan university between January 2015 and January 2017 was analyzed retrospectively,including general information,clinical features,laboratory examination,the changes of electrocardiogram,the treatment and prognosis of the disease.According to the prognosis,the patients were divided into survival group (13 cases) and death group (15 cases),and the related factors affecting the prognosis were analyzed.Results Among the 28 patients with acute myocardial infarction complicated by gastrointestinal hemorrhage (male 24,female 4),the mean age was (70.8 ± 11.0) years.The clinical symptoms of gastrointestinal hemorrhage included haematemesis in 5 cases,melena in 8 cases,haematemesis concomitant melena in 13 cases and vomiting of coffee-like substance in 2 cases.When acute myocardial infarction occurred,only 6 patients had typical chest pain,4 patients showed palpitation and chest distress and 18 patients had no obvious symptoms.In all patients,21 (75.0％) patients occurred non ST-elevation acute myocardial infarction,and 7 (25.0％) patients occurred ST-elevation acute myocardial infarction,including extensive anterior wall and inferior wall infarction in 2 cases (7.1％),extensive anterior wall infarction in 7 cases (25.0％),inferior infarction in 13 cases (46.4％),anterior wall infarction in 5 cases (17.9％) and posterior wall infarction in 1 cases (3.6％).After treatment,13 cases improved and 15 cases died.Severe anemia and liver cirrhosis had history statistically significant differences in the survival group and death group,logistics regression analysis showed that severe anemia (OR =11.67,P =0.018) was an independent risk factor of mortality.Conclusion Acute myocardial infarction induced by gastrointestinal hemorrhage has no chest pain and other typical symptoms of myocardial infarction,and most of the cases are non ST-elevation myocardial infarction.Such patients are critically ill and have high fatality rate.Severe anemia is an independent risk factor for death in such patients.

Correlation Analysis between Platelet Count and Acute Obstructive Suppurative Cholangitis / 医学研究杂志

Objective To investigate platelet counts and acute obstructive suppurative cholangitis correlation analysis and possible influential factors.Methods Data of 117 patients from October 2012 to October 2015 treated in our hospital,of whom 57 with acute obstructive suppurative cholangitis and 60 with common acute cholangitis were analyzed retrospectively to explore whether there was a correlation between thrombocytopenia (100 × 109/L) and AOSC,then experimental and control groups were established according to thrombocytopenia in the AOSC patients.The patient's age,sex,previous biliary surgery,white blood cells(WBC) count after admission within 6h,the percentage of neutrophils (NEU％),calcitonin (PCT) were retrospectively analyzed to further explore the influence factors of thrombocytopenia in AOSC patients.Results By comparison with the common acute cholangitis group,thrombocytopenia in AOSC group had obvious difference (P =0.01).In experimental group,NEU％,PCT had statistical difference compared with those in control group (P ＜ 0.05),and the patient's age,sex,previous biliary surgery,white blood cells(WBC) after admission within 6h count had no statistical significance.The logistic multivariate regression analysis showed that,NEU％,PCT were the independent predictors.Conclusion Correlated with AOSC,thrombocytopenia can be valued as indicators of the severity of acute cholangitis.In AOSC patients,NEU％,PCT were independent predictors of thrombocytopenia.

Treatment of diarrhea:how to apply reasonable Anti-diarrheal medications / 中国实用内科杂志

Diarrhea can also be a symptom of many serious diseases.Diarrhea is caused by infections or illnesses that either lead to excess production of fluids or prevent absorption of fluids.There are some measures that can prevent diarrhea.There are some medications that can slow down the movement of stool through the intestines and increase intestinal water absorption.The patient may need a combination of drugs adjustments to achieve relief.This review summarizes the reasonable application of anti-diarrheal medications.

Clinical analysis of internal diseases with abdominal pain as chief manifestation / 中国实用内科杂志

ObjectiveTo better understand abdominal pain caused by oth er diseases,improve the diagnosis,and discuss methods for therapy.Methods Totally 94 cases of internal diseases with abdominal pain as chief man ifestation were studied,including etiological factors,symptoms,physical signs,as well as therapy.ResultsOf them,90 4% were caused by organ di sorders in abdominal cavity,and the most common disease was acute gastroenteriti s (19 1%).ConclusionsThe etiological factors of internal dise ases with abdominal pains as chief manifestation are various and complex.More at tention needs be paid to the diagnosis and therapy.