Endoscopic transpancreatic septotomy as a precutting technique for difficult bile duct cannulation

AIM: To evaluate the technique of transpancreatic septotomy(TS) for cannulating inaccessible common bile ducts in endoscopic retrograde cholangiopancreatography(ERCP).METHODS: Between May 2012 and April 2013, 1074 patients were referred to our department for ERCP. We excluded 15 patients with previous Billroth Ⅱ gastrectomy, Roux-en-Y anastomosis, duodenal stenosis, or duodenal papilla tumor. Among 1059 patients who underwent ERCP, there were 163 patients with difficult bile duct cannulation. Pancreatic guidewire or pancreatic duct plastic stent assistance allowed for successful ERCP completion in 94 patients. We retrospectively analyzed clinical data from 69 failed patients(36 transpancreatic septotomies and 33 needle-knife sphincterotomies). RESULTS: Of the 69 patients who underwent precut papillotomy, common bile duct cannulation was successfully achieved in 67. The success rates in the TS and needle knife sphincterotomy(NKS) groups were 97.2%(35/36) and 96.9%(32/33), respectively, which were not significantly different(P > 0.05). Complications occurred in 11 cases, including acute pancreatitis(n = 6), bleeding(n = 2), and cholangitis(n = 3). The total frequency of complications in the TS group was lower than that in the NKS group(8.3% vs 24.2%, P < 0.05).CONCLUSION: Pancreatic guidewire or pancreatic duct plastic stent assistance improves the success rate of selective bile duct cannulation in ERCP. TS and NKS markedly improve the success rate of selective bile duct cannulation in ERCP. TS precut is safer as compared with NKS.

Gastrotracheal fistula:Treatment with a covered self-expanding Y-shaped metallic stent

A 67-year-old man had a sev-ere cough and pulmonary infection for 1 wk before seeking evaluation at our hospital.He had undergone esophagectomy with gastric pull-up and radiotherapy for esophageal cancer 3 years previously.After admission to our hospital,gastroscopy and bronchoscopy revealed a fistulous communication between the posterior tracheal wallnear the carina and the upper residual stomach.We measured the diameter of the trachea and bronchus and determined the site and size of the fistula using multislice computed tomography and gastroscopy.A covered self-expanding Y-shaped metallic stent was implanted into the trachea and bronchus.Subsequently,the fistula was closed completely.The patient tolerated the stent well and had good palliation of his symptoms.

Particular tumor of the pancreas:A case report

BACKGROUND Granular cell tumor(GCT)of the pancreas is a rare neurogenic tumor.The first case of pancreatic GCT was described in 1975,and up to now,only 7 cases have been reported.CASE SUMMARY A 53-year-old male had a pancreatic mass for 1 mo.He was not treated at the local hospital,but referred to Henan Tumor Hospital for surgery.Preoperative imaging revealed a 2.0 cm×2.5 cm-sized mass located in the body of the pancreas.At the microscopic level,a large number of eosinophilic particles are present in the oval tumor cells.The immunohistochemistry of this tumor cell display CD56(+),blood vessels CD34(+),Ki-67(+)<10%,and S-100(+).CONCLUSION GCT of the pancreas should be recognized as a preoperative differential diagnosis of pancreatic tumors.Surgical resection of the tumor should be attempted;however,GCT of the pancreas has a certain rate of tumor metastasis and recurrence.Therefore,GCT of the pancreas requires regular and long-term followup.

Nitrogenation of Amides via C–C and C–N Bond Cleavage

Amides are among the fundamental chemicals in organic chemistry.Compared to other carbonyl functional groups,the transformation of amide is relatively difficult and remains a challenge.The traditional deconstruction transformations of amides to other functional products are usually limited to twisted or electronically activated amides.Herein,we describe a direct nitrogenation approach to convert amides into nitriles.This chemistry provides a novel amide transformation pathway via both C–C and C–N bond cleavage.Interestingly,the simple,readily available,and inexpensive inorganic salt NaNO2 is successfully employed as a nitrogen source in this organic N-incorporation process.Applications of this study are demonstrated through the latestage modification of drug and natural product derivatives.

Sudden Deaths Among Chinese Physicians

INTRODUCTION Sudden deaths are always an important topic, which catches physicians and health professionals＇ attention. Physicians and clinical scientists have reported their findings of unexpected deaths concerning about infants, children, young athletes, soldiers, adults with chronic diseases, and elderly people in thousands, if not millions of publications. However there are no existing clinical reports about sudden deaths among physicians and medical staff. Recently,