Median arcuate ligament syndrome complicated with gallbladder stones:A case report

BACKGROUND Median arcuate ligament syndrome(MALS)is a rare disease caused by compression of the celiac trunk artery by the median arcuate ligament(MAL).It can cause symptoms of postprandial abdominal pain,weight loss,and nausea and vomiting.CASE SUMMARY A 55-year-old woman was admitted due to abdominal pain,nausea and vomiting.On admission,the patient presented with epigastric pain that worsened after eating,without signs of peritoneal irritation.Computed tomography angiography of the upper abdomen showed compression of the proximal segment of the abdominal trunk,local luminal stenosis with angular“fishhook”changes,which changed significantly during forceful inspiration and expiration;gallbladder stones;and multiple cysts in the liver.Abdominal duplex ultrasonography showed that peak systolic velocity was 352 cm/s.After diagnosis of MALS was confirmed,an arch ligament release procedure was performed.MALS has no specific symptoms and can be misdiagnosed as other abdominal diseases.Awareness of MALS should be improved to avoid misdiagnosis.The commonly used treatment option is MAL release and resection of the peripheral ganglion of the celiac trunk artery.CONCLUSION The diagnosis and treatment of MALS must be individualized,and MAL release is effective and provides immediate symptomatic relief.

Effects of entecavir on inflammatory reaction, liver function and liver fibrosis in chronic hepatitis b patients

Objective:To observe the effect of entecavir on inflammatory reaction, liver function and liver fibrosis in patients with chronic hepatitis B.Method:A total of 100 patients with chronic hepatitis B admitted in our hospital from February 2015 to October 2016 were randomly divided into observation group (50 cases) and control group (50 cases). The control group were given reduced glutathione and compound glycyrrhizin and other conventional liver protection;the observation group received entecavir dispersible tablets based on the treatment of the control group. The changes of inflammatory factors, liver function and liver fibrosis indexes of patients in both groups were compared.Results:Before treatment, the difference in inflammatory factors, liver function indexes and liver fibrosis indexes between the two groups was not significant. After treatment, the TGF-β1, hs-CRP and TNF-α levels in both groups were significantly lower than those before treatment, in the observation group, TGF-β1 (144.94±36.21) μg/L, hs-CRP level (48.81±10.74) ng/L and TNF-α level (82.43±22.29) pg/mL were significantly lower than those in the control group, there was significant difference between the two groups. After treatment, ALT, and AST levels in both groups were significantly lower than before treatment, compared with before treatment, TBiL level after treatment was not significant. After treatment, the ALT level (35.71±17.81) U/L and AST level (38.82±14.51) U/L in observation group were significantly lower than those in the control group, while the TBiL level in the observation group were not significantly different from that in the control group. After treatment, the levels of HA (91.71 ± 20.81) μg/mL and IV-C (140.82 ± 48.51) μg/L and LN (73.02 ± 21.06) μg/mL in the observation group were significantly lower than those in the control group.Conclusion:Entecavir combined with conventional drug therapy can effectively improve the inflammatory state of patients with chronic hepatitis B, enhance liver function and reduce liver fibrosis.