[Endoscopic ultrasonography in the diagnosis of unexplained extrahepatic cholestasis]. / Endoskopowa ultrasonografia w diagnostyce niewyjasnionej cholestazy zewnatrzwatrobowej.

The aim of this prospective study was to assess the diagnostic value of EUS for extrahepatic cholestasis unexplained before by US, ERCP and CT. Between 1994-1997 we examined 50 patients (24 women and 26 men, age range 21 to 72 years, mean age 53.2 years) with clinical and biochemical parameters of cholestasis, using the ultrasound endoscope with a 7.5 MHz linear electronic array transducer (Pentax FG-32UA/Hitachi 405EUB console). In one patient EUS was normal. In other 19 patients the causes of cholestasis were neoplasms, in 22 patients--inflammatory diseases and in 8 patients--choledocholithiasis. In majority of patients with chronic calcifying pancreatitis anicteric cholestasis was observed. 20 patients were operated on. Endo-sonographic diagnosis was confirmed in all patients with neoplasm of Vater papilla and pancreas, chronic calcifying pancreatitis and pancreatic abscess. Choledocholithiasis were confirmed by endoscopic sphincterotomy in all but one patient, endoscopic biliary drainages were performed in 9 patients. In 4 cases the diagnosis was false, mainly in patients with pseudotumorous pancreatitis. No complications during EUS were observed. EUS is efficacious and safe method in the diagnostics of extrahepatic cholestasis. In some cases it can replace diagnostic ERCP.

[Arrhythmia during endoscopic retrograde cholangiopancreatography (ERCP) and colonoscopy]. / Zaburzenia rytmu serca podczas endoskopowej cholangiopankreatografii wstecznej (ECPW) i kolonoskopii.

A group of 51 patients undergoing ERCP and 33 patients undergoing colonoscopy underwent additionally electrocardiography (ekg) by Holter method so as to define the frequency and character of rhythm disorders during the above examinations and the correlation between those disorders and coexisting circulatory system diseases. Besides, the author compared the percentage of ckg changes observed during ERCP and colonoscopy with the changes found during panendoscopy (described in the previous paper). Ekg monitoring by means of Oxford Medilog System apparatus started half an hour before fibroscopy and continued up to half an hour after the examination. In the ERCP premedication, just before endoscopy, the author made 2-3 spraying of 10% of lignocaine solution on the pharynx mucosa and half an hour earlier s.c. 10 mg of morphine with 1 mg of atropin sulphate. Patients undergoing colonoscopy were given (half an hour before the examination) 10 mg of diazepam with 20 mg noramidopyrin. The percentage of patients with circulatory system diseases was in the two groups similar and amounted to 31.4% (ERCP) and 33.3% (colonoscopy). In the statistical analysis the author used chi-square test, difference test, analysis of variances and standardization of the results by means of the direct method. The examinations made showed a significant increase in cardiac rhythm disorders during ERCP (in 70% of patients) and colonoscopy (in 70.9% of patients). During the examinations, the most frequent disorders were sinus tachycardia above 120/min., ventricular and supraventricular extrasystoles.(ABSTRACT TRUNCATED AT 250 WORDS)

[Arrhythmia during endoscopy of the upper gastrointestinal tract]. / Zaburzenia rytmu serca podczas wziernikowania górnego odcinka przewodu pokarmowego.

Continuous++ electrocardiographic monitoring was performed before, during and after endoscopy on 203 patients undergoing upper gastrointestinal endoscopy. Significant increase of cardiac arrhythmias during fiberoscopy (on 49,83% of the examined patients) was noted. The most common were: tachycardia over 120 beats per minute, ventricular and supraventricular premature beats and ischemic changes in the heart. These changes were increasing in the majority of the examined patients. However, much more of them were observed in patients with coexisting cardiovascular diseases. The research showed that the premedication influences the increase of cardiac arrhythmias and ischemic changes during panendoscopy, mainly with patients with coexisting cardiovascular diseases. The largert number of cardiac arrhythmias appeared during the introduction of the endoscope into the throut and the esophagus.