ABSTRACT
We carried out the first meta-analysis comparing the technical success and clinical outcomes of endoscopic ultrasound-guided drainage (EUD) and conventional transmural drainage (CTD) for pancreatic pseudocysts. We searched PubMed, Embase, Scopus, and the Cochrane library to identify relevant prospective trials. The technical success rate, short-term (4-6 weeks) success, and long-term (at 6 months) success in symptoms and the radiologic resolution of pseudocysts, complication rates, and death rates were compared. Two eligible randomized-controlled trials and two prospective studies including 229 patients were retrieved. The technical success rate was significantly higher for EUD than for CTD [risk ratio (RR)=12.38, 95% confidence interval (CI): 1.39-110.22]. When CTD failed because of the nonbulging nature of pseudocysts, a crossover was carried out to EUD (n=18), which was successfully performed in all these cases. All patients with portal hypertension and bleeding tendency were subjected to EUD to avoid severe complications. EUD was not superior to CTD in terms of short-term success (RR=1.03, 95% CI: 0.95-1.11) or long-term success (RR=0.98, 95% CI: 0.76-1.25). The overall complications were similar in both groups (RR=0.98, 95% CI: 0.52-1.86). The most common complications were bleeding and infection. There were two deaths from bleeding after CTD. The short-term and long-term treatment success of both methods is comparable only if proper drainage modality is selected in specific clinical situations. For bulging pseudocysts, either EUD or CTD can be selected whereas EUD is the treatment of choice for nonbulging pseudocysts, portal hypertension, or coagulopathy.
Subject(s)
Drainage/methods , Endosonography , Pancreatic Pseudocyst/therapy , Adult , Chi-Square Distribution , Drainage/adverse effects , Drainage/mortality , Female , Humans , Male , Middle Aged , Odds Ratio , Pancreatic Pseudocyst/diagnostic imaging , Pancreatic Pseudocyst/mortality , Predictive Value of Tests , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
Although type 1 diabetes mellitus (T1DM) usually begins in childhood or adolescence, the prevalence of complications increases in adulthood. The objective of this study was to determine the complications of T1DM and the factors that influence them. This retrospective study of 43 patients with T1DM was carried out during 2006-2007. We collected and analyzed demographic data, the clinical status of their diabetes, the complications and treatment. The subjects consisted of 16 males (37.2%) and 27 females (62.8%) with a mean age of 17.8 +/- 7.1 years (range 4.1 - 37.5), a mean age at onset of T1DM of 11.3 +/- 5.9 years (range 0.9 - 28.1) and a mean duration of T1DM of 6.8 +/- 4.3 years (range 1.1 - 19.0). The mean HbA1c of the most recent visit of 9.6 +/- 3.1% (range 5.2-17.6). Self - monitoring of blood glucose (SMBG) was performed by 21 patients (48.8%). Acute complications (diabetic ketoacidosis and hypoglycemia) had occurred in 29 patients (67.4%); chronic (microvascular and macrovascular) complications were documented in 13 patients (30.2%). Older age of onset and longer disease duration were factors associated with chronic diabetic complications (p = 0.004 and 0.006, respectively). There were no significant differences in HbA1c level, frequency of daily insulin injections, and presence of SMBG between patients with and without complications. Our results suggest patients with T1DM who had older age at onset or longer disease duration are at higher risk for complications.
Subject(s)
Diabetes Complications/epidemiology , Diabetes Mellitus, Type 1/epidemiology , Acute Disease , Adolescent , Adult , Age Factors , Blood Glucose Self-Monitoring , Chronic Disease , Diabetes Complications/prevention & control , Diabetes Mellitus, Type 1/therapy , Female , Glycated Hemoglobin , Humans , Insulin/therapeutic use , Male , Prevalence , Retrospective Studies , Sex Factors , Socioeconomic Factors , Time Factors , Young AdultABSTRACT
OBJECTIVE: To determine the incidence of T1DM in children under 15 years in 19 provinces in northeast Thailand. MATERIAL AND METHOD: Data of new cases of T1DM during 10 years between 1996 and 2005 were collected retrospectively by a mail survey from 275 hospitals in northeast Thailand. RESULTS: Three hundred forty cases, 134 (39.4%) boys and 206 (60.6%) girls were identified. The incidence rate of T1DM was 0.6/100,000/year (95% confidence interval 0.57; 0.71), a two-fold increased from the previous study between 1991 and 1995. More than half of the cases were diagnosed between the ages of 10 and 14 and the incidence rate in girls was 1.5 fold that of boys. CONCLUSION: Though the increased in incidence rate, the study indicated that the incidence of T1DM in northeast Thailand is still one of the very low incidence rates in the world.
