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ERCP for narrow－ winding cystic duct and surgical treatment

Chinese Journal of Digestive Endoscopy.1996;0(05):-.

Objective The value of endoscopic retrograde choledocho－ pancreatography( ERCP ) to detect narrow－ winding cystic duct and the effect of surgery were studied .Methods The clinical presentations, pathogenesis, diagnostic procedures and outcome of surgery were collected and analysed in 17 patients with this change. All had preoperative ERCP as well as intraoperative cholangiography. The operation was simple cholecystectomy. Results Satisfaction was obtained througthout the followup period for 2～ 5 years . Conclusion Narrow－ winding cystic duct is not a rare biliary disorder with high rate of confirmation by ERCP and fine result following cholecystectomy.

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Intraoperative fibrocholangioscopy: its significance ＆ approach

Jian CHEN ; Zaitong WANG ; Shuping TAN

Chinese Journal of Digestive Endoscopy.1996;0(05):-.

Objective The clinical significance and the approcach of inserting the scope were studied. Methods 148 patients underwent the examination in our hospital through October 1993 to December 1998. The scope was put into biliary system via common bile duct (CBD) in 108 cases, cystic duct in 20 and the confluence of the two in 26. Results Extrahepatic stones were found in 103 cases with total extirpation, while the intrahepatic ones were removed in only 10 out of 18 cases ( rate of residual stone=37.5％ ). Biopsies were taken in 17 cases with a detection of biliary cancer (n=5), CBD malignancy (n=8) and inflammatory change (n=4). Conclusion The application of intraoperative cholangioscopy offers ready reduction of residual stone and correct diagnosis with biopsy. The scope can be passed through cystic duct, CBD or their junction, depending on real conditions.

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Use of laparoscopic ultrasonographic scanning in laparoscopic cholecystectomy

Ding LUO ; Jiamei YANG ; Xunru CHEN

Chinese Journal of Digestive Endoscopy.1996;0(05):-.

Objective The value of laparoscopic ultrasonographic scanning (LUS) in laparoscopic cholecystectomy (LC) and the way of scanning extrahepatic biliary system were reported. Methods 80 patients with gallstone receiving LC had real－ time color Doppler LUS of the extrahepatic biliary system. Results The sonic picture of major extrahepatic bile duct could be clearly visualized by LUS. While the image of the part posterior to duodenum could also be seen satisfactory with the method modified by the authors. But viewing the image of exact cystic duct needs further study.Conclusion LUS gives distinct intraoperative sonographic images of extrahepatic bile ducts , thereby the operator can precisely locate the ducts without injurying them. LUS can be considered as an important and safe supplement to LC.

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A study of magnetic resonance cholangiopancreatography versus endoscopic retrograde cholangiopancreatography

Jianping SHI ; Yunbiao HU ; Zhizheng GE

Chinese Journal of Digestive Endoscopy.1996;0(05):-.

0.05). Conclusion Though the noninvasive MRCP offers a diagnostic means equivalent to that of ERCP it is still too early to say it will take the place of ERCP.

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Application of pancreatic stents in chronic pancreatitis

Zhaoshen LI ; Guoming XU ; Zhenxing SUN

Chinese Journal of Digestive Endoscopy.1996;0(05):-.

Objective The clinical efficacy of pancreatic stent in treating chronic pancreatitis was summarized. Methods The stents were applied in 14 patients with chronic pancreatitis and ductal stricture manifested clinically and roentgenographically. Postoperative abdominal pain, changes in appetite, body weight and fat in stools were observed in follow－ ups. Results The stents, 5～ 10F in caliber, were successfully placed in all patients with first attempt. They were followed up for 210 days ( ranging 28～ 520 days ). The early (3 months ) results showed that the pain remitted in 13/14 (92.9％ ) and 11/13 (84.6％ ) of cases respectively. While abdominal pain persisted in 2 cases inspite of the stents. Along with pain remission the appetite and presence of fat in stools improved associated with increase in body weight. The stents drainage maintained for a median to 256 days (ranging 90～ 520 days) Transient hyperamylasemia occurred in 3 cases. Translocation and occlusion of the stent was found in 1 occasion each on the 98 and 520 day respectively. No other serious complication was detected. Conclusion It is assumed that pancreatic stent is effective to treat chronic pancreatitis with ductal stricture.

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Experimental induction of intestinal metaplasia in stomach＆ expression of tumor-related proteins

Dongxu WANG ; Dianchun FANG ; Weiwen LIU

Chinese Journal of Digestive Endoscopy.1996;0(06):-.

Objective The development and progression of intestinal metaplasia ( IM ) and expression of tumor-related proteins in dog’ s stomach were observed. Methods IM animal model was established in Beagle’ s stomach by feeding N-methyl-N’-nitro-N-trosoguanidine( MNNG ),ranitidine,and local X-irradiation. Expression of APC, p53, K-ras and bcl-2 genes in canine gastric lesion were determined by immunohistochemistry. Resullts IM canine model was successfully induced, with which sequential pathology studied. It was proved that progression of normal epithelial cells to IM cells might undergo several stages including superficial gastritis, chronic atrophic gastritis, mild focal IM, moderate,and severe IM.Aberrant bcl-2 protein was detected in atrophic gastric epithelium and abnormal expression of APC, K-ras, and bcl-2 found in IM mucosa. Conclusion Canine gastric IM was induced by the method mentioned above.The development of normal gastric mucosa to IM in dog seemed to resemble that of human being.The presence of tumor-related proteins might indicate the transformation of IM to malignancy.

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Relationship between gastric acid output＆ H.pylori colonization in atrophic gastritis

Ziyan HAN ; Maolian LI ; Chongmei LU

Chinese Journal of Digestive Endoscopy.1996;0(06):-.

Objective The effect of acidity and severity of gastric atrophy on Helicobactor pylori (H.pylori) colonization was studied. Methods 95 patients with chronic atrophic gastritis (CAG) and positive H.pylori test were categorized into groups.Group 1,48 cases having moderate atrophic antritis with various degrees of fundic atrophy.Group 2,47 cases having mild fundic atrophy with various degrees of antritis. Assessment was made of basic and maximum acid output (BAO, MAO ) as well as of gastrin. H.pylori was tested with Warthin-Starry staining. Results In group 1, H.pylori colonization reduced significantly (P0.05) was found between patients with severe and moderate atrophy in fundus, while H.pylori colonization declined more markedly (P0.05) between cases with moderate and severe antritis,whereas H.pylori colonization reduced more significantly in the latter than the former (P

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Reflux esophagitis : epidemiology＆ clinical study

Jinhai WANG ; Jinyan LUO ; Jun GONG

Chinese Journal of Digestive Endoscopy.1996;0(06):-.

0.05), yet it correlated with RE incidence (P2.6 ,high risk ),obesity( OR=1.7～ 2.5,moderate risk ),over ingestion and intake of coffee and sweets ( OR=1.2～ 1.6,low risk ). Conclusion RE is frequently seen in adult population around Xi’ an area with a variety of risk factors.

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Esophageal variceal bleeding:comparative results with different therapies

Zigang WU ; Qiusheng ZHANG ; Huabin QUAN

Chinese Journal of Digestive Endoscopy.1996;0(06):-.

Objective The therapeutic effect for hemorrhage from esophageal varices(EV)with conservation,surgical intervention,EVL(esophageal variceal ligation)or TIPSS(transvenous intrahepatic portal systemic shunt)were compared.Methods The clinical materials of 72 patients with bleeding from EV were retrospectively reviewed. Results With octreotide(n=23) the rates of hemostasis within 48 hours and hospital mortality maintained 78.3 and 8.7 percent respectively.Rebleeding occurred within 7 days in 3/18 cases(16.7％ ) and within 150 days in 6/18 cases(33.3％ ),resulting in death in 4/18 instances;with emergency surgery death encountered in 4 out of 13 cases(30.8％ ),while with elective operation no death could be traced,7.7 percent of the series with octreotide rebled within 1 year and 19.2 percent did so after 2 years;after EVL(n=8) the varices reduced obviously or eliminated in 75 percent without rebleeding and death in follow-up period of 1～ 33 months;EV disappeared or ameliorated immediately following TIPSS in 9 out of 10 successful cases,yet the rebleeding rate attained 30 and 80 percent within 1 and 5 years respectively.The stent was proved afterwards stenosed or obstructed by ultrasonography.Encephalopathy ensued in 40 percent of the cases with 6 deaths in 61 months. Conclusion It was assumed that octreotide exerted affimative effect in the control of acute bleeding,particularly indicated for patients who were too weak to have endoscopy in 24 hours after admission,however bleeding often recurred following the use;elective surgery might reduce the early rebleeding rate and prolong the interval of rebleeding;EVL was capable of eradicating EV with simplicity;TIPSS had poor long-term effect.

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Ischemic colitis in mid-aged＆ elders

Wei SHI ; Cong ZHAO ; Xiong QIU

Chinese Journal of Digestive Endoscopy.1996;0(06):-.

Objective The clinical and endoscopic characteristics of ischemic colitis (IC) were retrospectively reviewed. Methods 23 aged patients with IC were included; their symptoms,signs,laboratory findings and endoscopic appearances analysed. Results IC occurred most frequently in mid-aged and elders with predominant presentations as acute onset of lower abdominal pains and bloody stools.Endoscopic lesions located mainly in left colon with segmental distribution.Mucosal edema,erosion and submucosal bleeding were common pathological features.Most lesions (91％ ) looked to be nongangrenous, transient and reversible.Only 9 percent of cases turned into chronic stage. Conclusion IC should be suspected in all eldly patients with acute onset of lower abdominal pain and bloody stools.Early colonoscopy is of diagnostic significance.

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