RESUMO
Background: common bile duct [CBD] stones exist among 12% of patients with cholelithiasis. They may result in some complications including pancreatitis and cholangitis. The common therapeutical method is endoscopic sphincterotomy during ERCP[Endoscopic Retrograde Cholangio-Pancreatography] and stones removal. This method does not have a reasonable success rate for stones with a diameter larger than 15 mm and may cause serious complications. The aim of this study was to evaluate the CBD stenting method in the treatment of large CBD stones
Materials and Methods: this study was performed on 32 patients who presented to the ERCP unit of Shahid Beheshti hospital in Qom with large CBD stones. Success rate in CBD clearing and rate of some complications including rupture of CBD, pancreatitis, and cholangitis were evaluated after the first ERCP for stent replacement, and the second for its removal
Results: the success rate in complete CBD clearing was 93.8%. A reduction in size and number of stones was seen during a 2-month period, which was statistically significant. No case of CBD rupture and cholangitis was detected and the incidence of pancreatitis was 18.8%
Conclusion: CBD stenting has a reasonable success rate for reducing the size and number of CBD stones
RESUMO
It seems that demographic and clinical features of patients referred for myocardial perfusion scintigraphy [MPS] is different among populations and healthcare settings. The purpose of the current study is to evaluate the clinical features and risk factors of patients referred for myocardial perfusion scintigraphy to a military hospital. As a cross-sectional study, the clinical and laboratory data of all patients who were referred for MPS were recorded. MPS was performed using [99m]Tc-Sestamibi or Thallium-201 [Tl-201] as the radiotracer. From March 2005 to March 2006, the data of 1392 consecutive patients were recorded. The mean age of the patients was 55.3 +/- 14.8 years. 45.6% of the patients had no major risk factor, while 38.5% had one and 15.9% had two risk factors. Hypertension was the most common risk factor, while cigarette smoking was reported by eight percent of the patients. The method of stress protocol was dipyridamole infusion in 69.2%, Treadmill exercise test in 28.4% and dobutamine infusion in 2.4% of the cases. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of MPS in detection of angiographically positive CAD were 88.5%, 71.4%, 94.3%, 46.8% and 75.3%, respectively. In our population hypertension is the most frequent risk factor, so extensive social programs should be implemented aiming at controlling this variable, in order to prevent its possible cardiac complications. Cigarette smoking is less common than general population, which could be due to social characteristics of the target community and their beliefs, so this distinctiveness should be well defined and promoted. The differences in the pattern of cardiovascular symptoms and risk factors can be considered as indirect evidences to the fact that the pattern of referral for MPS in our country is significantly different from those in developed countries, a fact that warrants further evaluation in order to confirm its appropriateness based on the validated international guidelines