To measure esophageal manometric parameters in liver cirrhosis, patients with different liver function grades were chosen. In the normal control group ( n =72) gastrointestinal disease history and symptoms, abdominal surgery and injury history were all negative. In liver cirrhosis group ( n =94) liver cirrhosis was diagnosed by clinical picture or pathology, and their liver function in Child grade was: grade A, 38 cases and 8 had ascites; grade B, 37 cases and 20 had ascites; grade C, 19 cases and 18 had ascites. Taking no motility medicines within seven days before measurement, esophageal motility parameters of these subjects were taken by a Biolab System made by Sandhill Company. The data were analyzed with SAS statistical software. The results showed that from Child grade A to C, LESP in cirrhosis group reduced, relaxation pressure increased, and relaxation percentage become lower successively; from Child grade A to C, onset peristaltic wave velocity in upper esophageal body became slower, peristaltic contraction reduced, and abnormal contraction increased; from Child grade A to C, peristaltic wave amplitude reduced in lower esophageal body, and velocity of onset peristaltic wave velocity became slower, peristaltic contraction reduced, and abnormal contraction increased. It suggests that more severe injury in liver function, more serious impact in esophageal motility. At the same time complications of portal vein hypertention such as esophageal varices and ascites behave synergetically.

Objective To compare the diagnostic accuracy of intraductal ultrasonography(IDUS) and endoscopic retrograde cholangiography(ERC) on extrahepatic bile duct stones. Methods 30 patients with suspected extrahepatic bile duct stones by B Ultrasonography, CT,or MRI,were allocated into this study. ERC was performed first by the use of Fujinon duodenal endoscopy ( ED-410XT, ED-410XU) and then followed IDUS by inserting the Fujinon miniprobe (PL2220-15 or PL2226-15) through endoscopic working channel to detect extrahepatic bile duct, finally the substance in extrahepatic bile duct was proved by endoscopic sphincterotomy(EST)and stone extraction. Results Among 30 cases, the diagnoses by ERC were stone 26 cases,floccule 1 cases and misinterpreted 2 cases so the accuracy and sensitivity of ERC were 26/30(86.7%) and 26/28(92.9%)respectively. For IDUS, the diagnoses were totally in accordance with the results of EST and stone extraction.So the accuracy and sensitivity of IDUS in the diagnosis of extrahepatic bile duct stones were 30/30(100%) and 28/28(100%) respectively. Conclusion (1) IDUS was superior to ERC in the diagnosis extrahepatic bile duct stones. (2) IDUS can compensate the misinterpretation of ERC on extrahepatic bile duct stones.

Objective To investigate the correlated factors concerning esophago-gastric variceal bleeding and sclerotherapy in liver cirrhosis. Methods Twenty-six factors were selected for 670 patients with liver cirrhosis and esophagogastric variceal bleeding and received sclerotherapy in our hospital. Spearman relationship analyses were performed on factors concerning esophagogastric variceal bleeding and sclerotherapy. Results Duration and number of episodes of bleeding were not related to grade of esophagogastric varices, diameter of portal vein and hepatic function but negatively related to ascites and hypersplenism.Severity of bleeding was not related to all of the above parameters. Esophageal varices related to gastric varices while neither of them related to diameter of portal vein. Result of sclerotherapy related to grade of esophageal varices, and negatively related to number of operations in first-period sclerotherpy, supplementary sclerotherpy and total number of operations as well as to amount of scleroant of first-period sclerotherpy and total amount of scleroant. Types of sclerosant had no relationship with result of sclerotherapy. Conclusion Esophagogastric variceal bleeding is affected by multiple factors. Diameter of portal vein is not the only factor. Result of sclerotherapy is affected by number of operations and amount of scleroant and has nothing to do with types of sclerosant.

Objective To investigate the role of endoscopic color Doppler ultrasonography (ECDUS) in the preoperative localization of insulinomas. Methods Seven patientsd woman) with biochemically diagnosed insulinoma underwent abdominal US, spiral CT and ECDUS in an attempt to precisely localize the tumor before surgery. Surgical and pathological results were considered as the definite localization of tumor. The role of ECDUS in the preoperative localization of insulinomas was compared with that of abdominal US and spiral CT. Results Ten tumors were detected by surgery and pathology. The sensitivity of ECDUS in identifying insulinomas was 8/10 compared with 1/10 for CT and 0/10 for abdominal US. Two tumors not detected by ECDUS had a size below 0. 5cm. Conclusions ECDUS is superior to spiral CT or abdominal US, and should be served as the first choice in the detection of pancreatic isulinomas. ECDUS identification depends on the size of the tumor and 'is hard to detect the tumors smaller than 0. 5cm.

Objective To investigate the rule of changes in endoscopic and endoscopic ultrsonic findings after endoscopic variceal sclerotherapy in the follow-up period. Methods Patients suffered from esophagogastric variceal bleeding and received endoscopic variceal sclerotherapy were investigated. Patients with liver cirrhosis after viral heptitis and their varices eliminated or reduced to grade Ⅰor Ⅱ after sclerotherapy entered this study for at least 5 years' follow - up. Endoscopic and endoscopic ultrsonic findings were recorded to find its course of transformation. Results Lumens of varices were occluded by thrombus and eventually replaced by white fibrous tissue after endoscopic sclerotherapy. Vessels reappeared within e-sophageal wall gradually after a lot of time in the form of formation of new venules (93. 8% ) or re-vascular-ization (6. 2% ) . Newly formed varices within gastric wall after sclerotherapy were seen in 5. 3% of the cases and some cases of duodenal varices were also found rarely in the follow-up. Endoscopic ultrasonic finding confirmed the revascularization and dilatation of vessles after sclerotherapy. Conclusion From the follow-up results it indicates that varices would reappear gradually after endoscopic sclerotherapy, regular re-examination and appropriate treatment in time are the most important measure to assure its long term effect.

Objective To analyze correlation of drug with acute drug-induced liver injury in 83 patients. Methods According to the international consensus criteria and Danan's causality assessment of a drug in the case of acute liver injury, 83 cases which had been clinically diagnosed as acute drug-induced liver injury were analyzed. Results Among the 590 inpatients of acute hepatitis, 83 (14.07%) were acute drug-induced liver injury, in whom 53 patients had liver cell damage (63.86%), 22 with cholestasis (26.5%), and 8 with mixed type (9.64%). In 34 patients, it was drug related (40.96%), undefined in 37 cases (44.57%), and unrelated in 12 cases (14.47%). Conclusion The international consensus criteria standardized the diagnosis of drug-induced liver injury and are helpful in differential diagnosis, but it needs improvement for actual implementation.

Objective To evaluate the efficacy of scle rotherapy (EVS) for esophageal variceal bleeding. Methods Retrospective analysis was made in 1 010 patients with es ophageal variceal bleeding who underwent sclerotherapy, among them 850 patie nts were cirrhosis and 160 patients were hepatocellular carcinoma. The total num ber of procedures of sclerotherapy were 3 203, including 602 for emergency scler otherapy and 2 601 for selective sclerotherapy. Supplementary sclerotherapy was performed in 502 cases. Average procedures of sclerotherapy for initial treatme nt were 3.18?1.1 in 710 cirrhotic patients. Follow-up was made in 579 cirrhosi s patients for 3-157 months, with an average follow-up period of (42.47?32.78) months. Results 1. The hemostasis rate in the whole group was 97.0%, the c omplication rate was 13.4%, and the mortality was 1.8%. 2. Rate of complete and nearly complete elimination of esophageal varices in cirrhotic patients was 84 .1 %, and long term rebleeding rate was 23.7%. Survival rates were (95.8?0.8)% 、(86.1?1.6)%、(74.5?2.4)%、(53.6?3.8)% at 1,3,5 and 10 year according to t he Kaplan-Meier analysis. Conclusions EVS is an important method of treatment for esophageal variceal bleeding.

Objective Apaf-1 is a key factor involved in activating the Caspase system in apoptosis. The aim of this study was to evaluate the significance of Apaf-1 on the apoptosis process induced by chemotherapeutic agent. Methods We established Apaf-1 hyper- and hypo- expression system by transferred sense and anti-sense Apaf-1 cDNA into cultured AGS cell line. And meanwhile human cyt-c, Apaf-1, caspase-3, bax, and bcl-2 gene expressions were measured by RT-PCR method. Results Cyt-c, caspase-3, and bax gene expressions increased significantly after sense Apaf-1 transfection. On the contrary, anti-sense Apaf-1 transfer has minus effects on cyt-c, caspase-3, and bax gene expressions. No significant changes have been found on bcl-2 gene expression after transfection process.Conclusions Cyt-c pathway may play an important role in the apoptosis induced by chemotherapeutic drugs. The early expression of cyt-c and Apaf-1 may be the key procedure of cyt-c release from mitochondria and of caspases activation.

0.05). 7 cases were complicated with early rebleeding in each group, 3 cases died in the EVL group, and no patient died in the EVS group. During the follow up period of 1 year, the rate of recurrent varices was 39.4%(26/66) in the EVL group, versus 21.3% (13/61) in the EVS group, showing statistically significant difference between the two groups ( P 0.05).

0 05). No adverse reaction was seen in all patients. Our results suggest that intravenous Pantoloc is a good proton pump inhibitor in patients with duodenal ulcer combined with upper gastrointestinal bleeding, and it is similar to Losec in effectiveness and safety.