Comparing the efficacy of preoperative magnetic resonance cholangiopancreatography with intra-operative cholangiography in patients suspicious to biliary stones

This study was performed to compare the efficacy of preoperative magnetic resonance cholangiopancreatography [MRCP] and intra-operative cholangiography [IOC] methods in patients suspicious to gall stones. According to previous studies, it is recommended that common bile duct investigation should be done in order to rule out choledocholithiasis in all patients with symptomatic cholelithiasis. IOC is an invasive procedure with probable complications, it would seem that MRCP could replace the direct cholangiography. In a diagnostic clinical trial, Fifty-nine patients with symptomatic biliary stones or cholecystitis were recruited in this study. The included patients had normal size biliary ducts in sonography but high serum alkaline phosphatase level. Preoperative MRCP and IOC were performed for the patients and the obtained results were analyzed and compared. The positive predictive value for IOC was 88% and for MRCP was 43%. The diagnostic accuracy of IOC and MRCP were 98% and 85% respectively, suggesting that IOC is much more diagnostically accurate. There were no significant difference in specificity and sensitivity of these two methods. According to the results, we can conclude that MRCP may not obviate the need for IOC. The suggestion for routine use of MRCP instead of IOC and as a substitution of that procedure needs further investigations on more patients

[ effect of sandostatin on mortality and Ranson's score of patients with acute pancreatitis]

To study the outcome of using Sandostatin on Ranson's criteria among patients with acute pancreatitis. It was a clinical trial. Thirty patients in each group were entered in the study. Patients with acute pancreatitis coming to Imam Hossein Medical Center, Tehran, Iran from 2010 to 2011 were studied. The diagnosis of pancreatitis was based on upper abdominal quadrant pain with radiating to the back, serum amylase higher than 100ng/dL and pancreatic edema observed in CT scan. In the intervention group patients received routine treatment plus 50micro g Sandostatin IV. In the control group patients only received routine treatment. The average Ranson's score in Sandostatine group was 3.5 +/- 1.6 and in control group it was 3.8 +/- 1.6 which did not show a significant difference. In Sandostatin group two patients and in the control group, three patients expired and it did showing no statistical difference. The sepsis accured in 3 patients from Sandostatin group and seven patients from controls [p=0.042]. The length of hospitalization was shorter for Sandostatin group [p<0.0001]. Sandostatine did not significantly changed Ranson's score or mortality among patients with acute pancreatitis, but reduced the chance of sepsis and the length of hospitalization