AIM： To compare the efficacy of self-expandable metallic stents （EMS） in the treatment of distal and proximal stricture of malignant biliary tumors. METHODS： From March 1995 to June 2004, 61 patients （40 males, 2...AIM： To compare the efficacy of self-expandable metallic stents （EMS） in the treatment of distal and proximal stricture of malignant biliary tumors. METHODS： From March 1995 to June 2004, 61 patients （40 males, 21 females） with malignant biliary obstruction who received self-expandable metallic stent implantation were reviewed retrospectively. The stents were inserted by an endoscopic or percutaneous transhepatic method. We tried to place two stents in the biliary system in T or Y configuration in cases of hilar tumors with bilateral hepatic duct obstruction. The end points of the study were stent occlusion or patient death. RESULTS： The mean time of stent patency was 421 ± 67 d in the group of proximal stricture（ group Ⅰ） and 168 ± 18 d in the group of distal stricture （group Ⅱ）. The difference was significant in borderline between the two groups （P = 0.0567）. The mean survival time was 574 ± 76 d in group I and 182 ± 25 d in group II. There was a significant difference between the two groups （P = 0.0005）. CONCLUSION： EMS implantation is a feasible, palliative method for unresectable malignant biliary obstruction. The clinical efficacy of EMS in patients with proximal hilar tumors is better than that in patients with distal tumors.展开更多
AIM: To clarify the pathogenesis of biliary dilatation associated with anomalous union of the pancreatic and biliary ducts (AUPBD).METHODS: Direct cholangiopancreatograms of 350 adult patients with or with suspicion o...AIM: To clarify the pathogenesis of biliary dilatation associated with anomalous union of the pancreatic and biliary ducts (AUPBD).METHODS: Direct cholangiopancreatograms of 350 adult patients with or with suspicion of hepatobiliary or pancreatic disorders were reviewed. AUPBD was diagnosed cholangiopancreatographically, when the pancreaticobiliary ductal union was located above the narrow distal segment of the bile duct, which represents the action of the sphincter of Oddi. The narrow portion of the terminal choledochus was defined as symmetrical stricture of the common bile duct just above the pancreaticobiliary ductal union.RESULTS: AUPBD was found in 36 patients. Among cholangiopancreatographic features, the narrow portion of the terminal choledochus was the most pathognomonic for AUPBD (accuracy, 98%); it was present in 29 (81%)patients with AUPBD, but was not found in any patients without AUPBD. Among patients with AUPBD, biliary dilatation (＞10 mm) was more frequent in those with the narrow portion of the terminal choledochus (23/29)than in those without (2/7; P = 0.018) AUPBD. Among the patients with both AUPBD and the narrow portion of the terminal choledochus, there was a strong negative correlation between the minimum diameter of the narrow portion and the maximum diameter of the choledochus (r = -0.78, P＜0.001), suggesting that the degree of biliary narrowing at the narrow portion correlates with that of upstream biliary dilatation.CONCLUSION: The narrow portion of the terminal choledochus, a pathognomonic radiologic feature of AUPBD, may be a cause of biliary dilatation in patients with AUPBD.展开更多
Acute esophageal necrosis (AEN) is extremely rare and the pathogenesis of this is still unknown. We report a case of AEN caused by alcohol abuse. In our case, the main pathogenesis could be accounted for low systemic ...Acute esophageal necrosis (AEN) is extremely rare and the pathogenesis of this is still unknown. We report a case of AEN caused by alcohol abuse. In our case, the main pathogenesis could be accounted for low systemic perfusion caused by severe alcoholic lactic acidosis. After the healing of AEN, balloon dilatation was effective to manage the stricture.展开更多
AIM： To analyze the risk of cardiovascular complications in patients with indication for surgical treatment of Chagasic esophageal achalasia and to correlate the surgical risks with the degree of esophageal dilation,...AIM： To analyze the risk of cardiovascular complications in patients with indication for surgical treatment of Chagasic esophageal achalasia and to correlate the surgical risks with the degree of esophageal dilation, thereby proposing a risk scale index. METHODS： One hundred and twenty-four patients with Chagasic esophageal achalasia, who received surgical treatment at the Hospital das Clinicas of the Federal University of Goiás, were included in this study. The patients were mostly related to the postoperative complications due to the cardiovascular system. All the patients were submitted to： （1） clinical history to define the cardiac functional class （New York Heart Association）; （2） conventional 12-lead electrocardiogram at rest; and （3） contrast imaging of the esophagus to determine esophageal dilatation according to Rezende＇s classification of Chagasic megaesophagus. RESULTS： An assessment of the functional classification （FC） of heart failure during the preoperative period determined that 67 patients （54.03%） were assigned functional class Ⅰ （FC Ⅰ）, 46 patients （37.09%） were assigned functional class Ⅱ （FC Ⅱ）, and 11 patients （8.87%） were assigned functional class Ⅲ （FC Ⅲ）. None of the patients were assigned to functional class Ⅳ （FC Ⅳ）. There was a positive correlation between the functional class and the postoperative complications （FC Ⅰ×FC Ⅱ： P〈0.001; FC Ⅰ×FC Ⅲ： P〈0.001）. The ECG was normal in 44 patients （35.48%） and presented abnormalities in 80 patients （64.52%）. There was a significant statistical correlation between abnormal ECG （arrhythmias and primary change in ventricular repolarization） and postoperative complications （P〈0.001）. With regard to the classification of the Chagasic esophageal achalasia, the following distribution was observed： group Ⅱ, 53 patients （42.74%）; group Ⅲ, 37 patients （29.83%）; and group Ⅳ, 34 patients （27.41%）. There was a positive correlation between the degree of esophageal dilation and the increase in postoperative complications （grade Ⅱ×grade Ⅲ achalasia： P〈0.001; grade Ⅱ×grade Ⅳ achalasia： P〈0.001; and grade Ⅲ×grade Ⅳ achalasia： P = 0.017）. Analyzing these results and using a multivariate regression analysis associated with the probability decision analysis, a risk scale was proposed as follows： up to 21 points （mild risk）; from 22 to 34 points （moderate risk）; and more than 34 points （high risk）. The scale had 82.4% accuracy for mild risk patients and up to 94.6% for the high risk cases. CONCLUSION： The preoperative evaluation of the cardiovascular system, through a careful anamnesis, an ECG and contrast imaging of the esophagus, makes possible to estimate the surgical risks for Chagas＇ disease patients who have to undergo surgical treatment for esophageal achalasia.展开更多
文摘AIM： To compare the efficacy of self-expandable metallic stents （EMS） in the treatment of distal and proximal stricture of malignant biliary tumors. METHODS： From March 1995 to June 2004, 61 patients （40 males, 21 females） with malignant biliary obstruction who received self-expandable metallic stent implantation were reviewed retrospectively. The stents were inserted by an endoscopic or percutaneous transhepatic method. We tried to place two stents in the biliary system in T or Y configuration in cases of hilar tumors with bilateral hepatic duct obstruction. The end points of the study were stent occlusion or patient death. RESULTS： The mean time of stent patency was 421 ± 67 d in the group of proximal stricture（ group Ⅰ） and 168 ± 18 d in the group of distal stricture （group Ⅱ）. The difference was significant in borderline between the two groups （P = 0.0567）. The mean survival time was 574 ± 76 d in group I and 182 ± 25 d in group II. There was a significant difference between the two groups （P = 0.0005）. CONCLUSION： EMS implantation is a feasible, palliative method for unresectable malignant biliary obstruction. The clinical efficacy of EMS in patients with proximal hilar tumors is better than that in patients with distal tumors.
文摘AIM: To clarify the pathogenesis of biliary dilatation associated with anomalous union of the pancreatic and biliary ducts (AUPBD).METHODS: Direct cholangiopancreatograms of 350 adult patients with or with suspicion of hepatobiliary or pancreatic disorders were reviewed. AUPBD was diagnosed cholangiopancreatographically, when the pancreaticobiliary ductal union was located above the narrow distal segment of the bile duct, which represents the action of the sphincter of Oddi. The narrow portion of the terminal choledochus was defined as symmetrical stricture of the common bile duct just above the pancreaticobiliary ductal union.RESULTS: AUPBD was found in 36 patients. Among cholangiopancreatographic features, the narrow portion of the terminal choledochus was the most pathognomonic for AUPBD (accuracy, 98%); it was present in 29 (81%)patients with AUPBD, but was not found in any patients without AUPBD. Among patients with AUPBD, biliary dilatation (＞10 mm) was more frequent in those with the narrow portion of the terminal choledochus (23/29)than in those without (2/7; P = 0.018) AUPBD. Among the patients with both AUPBD and the narrow portion of the terminal choledochus, there was a strong negative correlation between the minimum diameter of the narrow portion and the maximum diameter of the choledochus (r = -0.78, P＜0.001), suggesting that the degree of biliary narrowing at the narrow portion correlates with that of upstream biliary dilatation.CONCLUSION: The narrow portion of the terminal choledochus, a pathognomonic radiologic feature of AUPBD, may be a cause of biliary dilatation in patients with AUPBD.
文摘Acute esophageal necrosis (AEN) is extremely rare and the pathogenesis of this is still unknown. We report a case of AEN caused by alcohol abuse. In our case, the main pathogenesis could be accounted for low systemic perfusion caused by severe alcoholic lactic acidosis. After the healing of AEN, balloon dilatation was effective to manage the stricture.
文摘AIM： To analyze the risk of cardiovascular complications in patients with indication for surgical treatment of Chagasic esophageal achalasia and to correlate the surgical risks with the degree of esophageal dilation, thereby proposing a risk scale index. METHODS： One hundred and twenty-four patients with Chagasic esophageal achalasia, who received surgical treatment at the Hospital das Clinicas of the Federal University of Goiás, were included in this study. The patients were mostly related to the postoperative complications due to the cardiovascular system. All the patients were submitted to： （1） clinical history to define the cardiac functional class （New York Heart Association）; （2） conventional 12-lead electrocardiogram at rest; and （3） contrast imaging of the esophagus to determine esophageal dilatation according to Rezende＇s classification of Chagasic megaesophagus. RESULTS： An assessment of the functional classification （FC） of heart failure during the preoperative period determined that 67 patients （54.03%） were assigned functional class Ⅰ （FC Ⅰ）, 46 patients （37.09%） were assigned functional class Ⅱ （FC Ⅱ）, and 11 patients （8.87%） were assigned functional class Ⅲ （FC Ⅲ）. None of the patients were assigned to functional class Ⅳ （FC Ⅳ）. There was a positive correlation between the functional class and the postoperative complications （FC Ⅰ×FC Ⅱ： P〈0.001; FC Ⅰ×FC Ⅲ： P〈0.001）. The ECG was normal in 44 patients （35.48%） and presented abnormalities in 80 patients （64.52%）. There was a significant statistical correlation between abnormal ECG （arrhythmias and primary change in ventricular repolarization） and postoperative complications （P〈0.001）. With regard to the classification of the Chagasic esophageal achalasia, the following distribution was observed： group Ⅱ, 53 patients （42.74%）; group Ⅲ, 37 patients （29.83%）; and group Ⅳ, 34 patients （27.41%）. There was a positive correlation between the degree of esophageal dilation and the increase in postoperative complications （grade Ⅱ×grade Ⅲ achalasia： P〈0.001; grade Ⅱ×grade Ⅳ achalasia： P〈0.001; and grade Ⅲ×grade Ⅳ achalasia： P = 0.017）. Analyzing these results and using a multivariate regression analysis associated with the probability decision analysis, a risk scale was proposed as follows： up to 21 points （mild risk）; from 22 to 34 points （moderate risk）; and more than 34 points （high risk）. The scale had 82.4% accuracy for mild risk patients and up to 94.6% for the high risk cases. CONCLUSION： The preoperative evaluation of the cardiovascular system, through a careful anamnesis, an ECG and contrast imaging of the esophagus, makes possible to estimate the surgical risks for Chagas＇ disease patients who have to undergo surgical treatment for esophageal achalasia.
