BACKGROUND/AIMS: Cholestatic jaundice caused by a juxtapapillary diverticulum can be treated by excision of the diverticula or endoscopic sphincterotomy(EST). The aim of this study is to evaluate the effectiveness of EST for cholestatic jaundice in patient with juxtapapillary diverticulum with absence of common bile duct stones. METHODS: We recruited patients who underwent Endoscopic Retrograde Cholangio Pancreatography(ERCP) between September 2000 and May 2005. The presence of Juxtapapillary diverticula was seen in 92(29.3%)) out of 315 patients underwent ERCP. Cholestatic jaundice associated with juxtapapillary diverticula was considered when patients have jaundice, elevated serum bilirubin and alkaline phosphatase more than normal, and there are no other obstructive lesion on abdominal ultrasonography or computed tomography(CT) scan. The number of the patients were 13 who had cholestatic jaundice associated with juxtapapillary diverticula without common bile duct stones. All 13 patients underwent EST and had no complications. The patients were followed up to visit outpatient department or interviewed on the telephone. RESULTS: Of the 13 patients, 10 were male and 3 were female. The mean age was 70.4 years and mean duration of follow-up were 28.9 months. All 13 patients who had gallbladder presented RUQ discomfort and jaundice. Seven patients presented gallstone pancreatitis with jaundice. Nine patients had GB stone, 1 patients had GB sludge. In the follow-up period, from 1month to 46 months after EST, 1 patient died of unknown cause within 1 year. One patient had recurred gall stone pancreatitis with jaundice 12 months later. CONCLUSIONS: EST can be considered as a useful therapeutic modality especially in eldery patients with cholestatic jaundice and gallstone pancreatitis associated with juxtapapillary diverticulum.
Alkaline Phosphatase ; Bilirubin ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct* ; Diverticulum* ; Female ; Follow-Up Studies ; Gallbladder ; Gallstones ; Humans ; Jaundice ; Jaundice, Obstructive* ; Male ; Outpatients ; Pancreatitis ; Sewage ; Telephone ; Ultrasonography

Ectopic pancreas rarely produces clinical symptoms. Most commonly reported symptoms were abdominal pain, epigastric discomfort, nausea, vomiting, and bleeding. However, presentation of specific symptoms due to its size and location, including obstructive jaundice, and pyloric obstruction are possible. Ectopic pancreas is subject to various pathological changes occurring in the pancreas itself; namely, cyst, pancreatitis, hemorrhage, necrosis, and neoplastic change. We present a case of 60-year old woman with right upper quadrant pain in whom the surgical pathologic diagnosis was ectopic pancreas of the stomach complicated by pancreatitis and pseudocyst formation.
Abdominal Pain ; Diagnosis ; Female ; Hemorrhage ; Humans ; Jaundice, Obstructive ; Middle Aged ; Nausea ; Necrosis ; Pancreas* ; Pancreatitis* ; Stomach ; Vomiting

Objective To examine the association between genetic polymorphism of rs1409181 in ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) and left ventricular hypertrophy (LVH) among older Chinese in Guangzhou. Methods 390 subjects aged ≥50 years were randomly selected from the Guangzhou Biobank Cohort Study-CVD. Information on personal history, blood pressure, fasting plasma glucose and lipids were collected. Color Doppler ultrasound was used to measure the indicators of LVH, including left ventricular internal diastolic diameter (LVIDD) , thickness of the interventricular septum diastolic wall (IVSD) and the posterior wall diastolic diameter (LVPWD). LVIDD was calculated using Devereux ventricular mass (LVM)equation while the Left ventricular mass index (LVMI) equation was used to estimate LVH. The genotype of rs1409181 was determined by Taqman SNP genotyping kits using the ABI 7900HT real time PCR system. Results In the GG, CG and CC genotype groups, the proportions of LVH were 21.5%, 28.2% and 37.5% respectively. Compared with GG, the adjusted odds ratios (95% confidence interval) for the LVH were 1.39(0.78-2.50) and 2.36(1.21-4.60) for CG genotype and CC genotype of ENPP1 respectively (P for trend=0.01). Conclusion Polymorphism of ENPP1 gene rs1409181 was associated with LVH in the older Chinese people in Guangzhou.

Objective To examine the dose-response relationship of smoking status with carotid atherosclerosis in 959 relatively healthy Chinese men. Methods 959 older Chinese men were selected from Guangzhou Biobank Cohort Study (GBCS) on cardiovascular disease. Personal histories were collected and fasting plasma glucose and lipids, blood pressure, and common carotid artery intima-median thickness (CCA-IMT) were measured. Results ( 1 ) Composition of the cases:39.1% were non-smokers, 25.7% were former smokers and 35.2% were current smokers. The mean (95% confidence interval) carotid IMT was 0.78 (0.77-0.79) mm. 18.4% of the subjects had carotid IMT equal to or thicker than 1.0 mm while 34.1% had carotid plaque. (2)After adjusting for age, sex,physical activity, body mass index, fasting glucose, triglyceride, high-density lipoprotein cholesterol,systolic and diastolic blood pressure, compared to never smokers, current smokers had significantly increased risk for thicker IMT and carotid plaque [odds ratio (OR) = 1.82, 95% GI: 1.30-2.55 and OR=1.95, 95%CI: 1.38-2.75, respectively, all P＜0.001]. The risk for thicker IMT and carotid plaque increased with the increasing amount (cigarettes/day) and duration of smoking (years) as well with cigarette pack-years (P for trend all ≤0.01 ). Conclusion An elevated risk with a clear doseresponse relationship was found between cigarette smoking and carotid atherosclerosis. Quitting smoking or reducing the amount of smoking may lower the risk of atherosclerosis, preventing and controlling the occurrence of cardiovascular diseases, and reducing the related cardiovascular mortalities.

Objective To explore the impact of lifestyle-related,physiological and biochemical factors on aortic arch calcification(AAC).Methods 20 430 subjects aged 50 to 85 years were included in this study from the first and second recruitment phase of the Guangzhou Biobank Cohort Study.All the subjects received face-to-face interviews to collect detailed information on their socio-demographic background,occupational exposures,living environment,lifestyle,family and personal disease histories,and received a physical examination and tests including 12-lead ECG,chest radiograph,and pulmonary function testing.Each subject was screened for a range of fasting biochemical parameters.Radiographs were reviewed by two senior radiologists.300 radiographs were independently read by the two radiologists to assess agreement using Kappa coefficient.Logistic regression was used to assess the association between life style,physiological and biocheroical factors and AAC.Resuits (1)The rate of agreement on diagnosis for the two radiologists was 85% and Kappa coefficient was 0.68(P<0.01) which showed a moderate agreementbetween the two radiologists.(2) Except hypertension,the subjects were significantly difierent on their lifestyle,physiological and biochemical factors in both men and women(P<0.05).(3)AAC was significantly associated with older age,smoking status,LDL-C,and hypertension(P<0.01)in both genders.Ors(95%CI)indicated the following results:age was 1.11(1.10-1.12) in men and 1.12 (1.12-1.13)in women;smoking as 1.31(1.17-1.47)in men and 1.31(1.09-1.57)in women;LDL-Cas 1.16(1.06-1.27) in men and 1.38(1.22-1.56) in women,hypertension as 1.33(1.18-1.50) in men and 1.27(1.18-1.38) in women.However,diabetes was found to be associated with an increased risk of AAC in women[OR(95%CI)]1.38(1.22-1.56).Conclusion Age,smoking,hypertension and Low-density lipoprotcin level were risk factors to beth genders,on AAC,while diabetes increased the risk of AAC,in women.