ABSTRACT
Complications after endoscopic retrograde cholangiopancreatography (ERCP) usually are treated endoscopically or by traditional surgical procedure. We present two cases of laparoscopic treatment. Patient l had mechanical jaundice. Ultrasound scan showed a common bile duct (CBD) extended to 11 mm, and ERCP disclosed a stone wedged up in the extrapancreatic part of the CBD. Endoscopic techniques did not help to remove the stone, and finally tore off the Dormia basket, leaving it in the bile ducts. After unsuccessful attempts at its endoscopic evacuation, laparoscopy was performed. A choledochoscope was introduced into the CBD, and the Dormia basket was removed. However, the removal of the stone "ingrown" in the wall of the CBD was not successful, leading to a laparotomy. Patient 2 had cholecysto- and choledocholithiasis. On ERCP, multiple stones filling the CBD were found. Combining ECRP with extracorporeal shock-wave lithotripsy, sphincterotomy, and mechanical lithotripsy did not lead to removal of all the stones, so an endoscopic biliary prosthesis was introduced. During consecutive ERCP, one of the prosthetic ends moved into the head of pancreas. Endoscopic attempts to remove it were unsuccessful, so laparoscopy was performed. During the operation, the CBD was incised, allowing all the remaining stones and the prosthetic device to be removed successfully. It seems that laparoscopic treatment currently may be an alternative to traditional surgery in the treatment of some complications after ERCP.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Laparoscopy/methods , Postoperative Complications/surgery , Adult , Aged , Cholangiopancreatography, Endoscopic Retrograde/methods , Cholelithiasis/diagnosis , Cholelithiasis/therapy , Female , Foreign Bodies/diagnosis , Foreign Bodies/surgery , Gallstones/diagnosis , Gallstones/surgery , Gallstones/therapy , Humans , Lithotripsy/methods , Prosthesis Implantation/adverse effects , Prosthesis Implantation/methods , Sphincterotomy, Endoscopic/adverse effects , Sphincterotomy, Endoscopic/methodsABSTRACT
To investigate the role of genetic factors on susceptibility to atherosclerotic arterial disease, the influence of haptoglobin phenotypes (Hp) on serum elastase activity, neutrophil count, and elastin concentration in the aorta was measured in patients with abdominal aortic aneurysm (AAA; n=52) and aortoiliac atherosclerotic occlusive disease (AOD; n=37). Findings (serum elastase activity, peripheral blood neutrophil count) were compared to a control group (CG) of 37 subjects without atherosclerosis. Hp phenotyping performed by starch-gel electrophoresis produced a haptoglobin-hemoglobin complex of three phenotypes: Hp1-1, Hp2-2, and Hp2-1. Distribution of Hp phenotypes was similar in the three study groups (AAA, AOD, CG). Significant increases in serum elastase activity and neutrophil count was measured in Hp2-1 phenotype of AAA patients. Although the aorta wall of aneurysm patients contained less (p<0.001) elastin than that of AOD patients, no significant difference of aorta elastin concentration between the three Hp phenotypes, including Hp2-1, was measured. The postulated association of AAA susceptibility with Hp2-1 phenotype was supported by the study data that demonstrated an increase in serum elastase activity in patients undergoing AAA repair.
Subject(s)
Aortic Aneurysm, Abdominal/blood , Aged , Aortic Valve Stenosis/blood , Female , Haptoglobins/genetics , Humans , Leukocyte Count , Male , Middle Aged , Neutrophils/cytology , Pancreatic Elastase/metabolism , Phenotype , PolandABSTRACT
52 patients were operated on for abdominal aortic aneurysm and 38 for aortic occlusion disease. Haptoglobin (Hp) phenotypes were determined in all these patients. Hp and C-reactive protein (CRP) concentrations were determined in each phenotype. On the basis of the statistical analysis the highest percentage of elevated CRP concentrations was found in patients with abdominal aortic aneurysm and phenotype Hp 2-1.
