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Selective sphincteroplasty of the papilla in cases at risk due to atypical anatomy

World Journal of Gastroenterology 2007年第22期13卷 3106-3111页

作者： F Mugica G Urdapilleta A Castiella A Berbiela F Alzate E Zapata l zubiaurre P lopez JI Arenas Gastroenterology Department Donostia Hospital San Sebastian Spain Department Donostia Hospital San Sebastian Spain Gastroenterology Department Bajo Deva Hospital Spain Anaesthesia Department Donostia Hospital San Sebastian Spain

AIM: To analyze the indications, effi cacy and safety of sphincteroplasty in our centre. METHODS: A retrospective study of sphincteroplasty in 53 cases of papilla at high risk was performed in 2004-2006. The procedure consisted of duodenoscopy with Olympus TJF 145 Videoduodenoscope, approach to the biliary tract using a catheter with a guidewire, and dilatation of the papilla with a dilatation balloon catheter using a syringe with a manometer for control of the fi lling pressure. RESUlTS: The indications included intradiverticular papilla in 26 patients (49/), stenosis of a previous sphincterotomy in 19 patients (35.8/), small size of the papilla in 4 patients (7.5/), Billroth Ⅱ gastrectomy in 3 patients (5.6/), and coagulopathy in one patient (1.9/). The efficacy was 97.8/, with all the calculi extracted from the common bile duct in 84.4/ of the patients, even though 21 of the patients (39.6/) had calculi with a diameter equal to or greater than 10 mm. Seven patients (13.2/) presented complications: haemorrhage in 1 patient (1.9/) and mild pancreatitis in 6 patients (11.3/). The mean hospital stay in case of complications was of 3 ± 0.63 d. CONClUSION: Sphincteroplasty is highly effective, with a complication rate similar to that of sphincterotomy, furthermore, the complications are of low clinical importance. The use of the 10 mm balloon makes it possible to extract calculi with a diameter of over 15 mm and to extract more than 3 calculi without increasing the rate of complications and reduces the need to resort tolithotripsy or rescue sphincterotomy.

关键词：括约肌切开术解剖学胆总管结石病急性胰腺炎乳头

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Cytomegalovirus hepatitis and myopericarditis

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World Journal of Gastroenterology 2007年第4期13卷 647-648页

作者： leire zubiaurre Eva Zapata luis Bujanda María Castillo Igor Oyarzabal Maria A Gutiérrez-Stampa Angel Cosme Department of Digestive disease Hospital Donostia Spain María Castillo Department of Cardiology Hospital Donostia Spain Department of Digestive disease Hospital Donostia Spain Department of Cardiology Hospital Donostia Spain Department of Urology. Hospital Donostia Spain Department of General Medicine Donostia Spain

Cytomegalovirus (CMV) infection in inmunocompetent hosts generally is asymptomatic or may present as a mononucleosis syndrome but rarely can lead to severe organ complications. We report a case of simultaneous hepatic and pericardic CMV infection in a 36-year old immunocompetent man. He was admitted to coronary unit with fever, chest pain radiated to shoulders, changes on electrocardiogram with diffuse ST elevation and modest laboratory elevations in the MB fraction of creatine kinase (CK-MB) of 33.77 μg/l (0.1-6.73), serum cardiac troponin T of 0.904 ng/ml (0-0.4), creatine kinase of 454 U/l (20-195) and myoglobin of 480.4 μg/l (28-72). Routine laboratory test detected an elevation of aminotransferase level: alanine aminotransferase 1445 U/l, aspartate aminotransferase 601 U/l. We ruled out other causes of hepatitis with normal results except IgM CMV. The patient was diagnosed with myopericarditis and hepatitis caused by cytomegalovirus and started symptomatic treatment with salicylic acid. In few days the laboratory findings became normal and the patient was discharged.

关键词：细胞巨化病毒肝炎单核细胞增多症免疫活性

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