BACKGROUND:Numerous drugs have been proposed to alleviate pain in patients with biliary colic,especially opioids,but still there is a tendency to use less narcotics because of their side effects and the unwillingness ...BACKGROUND:Numerous drugs have been proposed to alleviate pain in patients with biliary colic,especially opioids,but still there is a tendency to use less narcotics because of their side effects and the unwillingness of some patients.The present study aimed to compare the analgesic effect of paracetamol combined with low-dose morphine versus morphine alone in patients with biliary colic.METHODS:A randomized double-blind controlled trial was performed in 98 patients with biliary colic,recruited from two emergency departments from August 2012 to August 2013.Eleven patients were excluded and the remaining were randomized into two groups:group A received 0.05mg/kg morphine+1 000 mg paracetamol in 100 m L normal saline and group B received 0.1 mg/kg morphine+normal saline(100 m L)as placebo.Pain scores were recorded using visual analogue scale(VAS)at baseline and 15 and 30 minutes after drug administration.Adverse effects and the need for rescue medication(0.75 g/kg intravenous fentanyl)were also reported within 60 minutes of drug administration.RESULTS:Before the infusion,the mean±SD VAS scores were 8.73±1.57 in group A and8.53±1.99 in group B.At 15 minutes after drug administration,the mean±SD VAS scores were2.16±1.90 in group A vs.2.51±1.86 in group B;mean difference was–0.35,and 95%CI–1.15 to 0.45(P=0.38).At 30 minutes the mean±SD VAS scores were 1.66±1.59 in group A vs.2.14±1.79 in group B;mean difference was–0.48,and 95%CI–1.20 to 0.24(P=0.19).The mean pain scores in the two groups at 15 and 30 minutes demonstrated no significant difference.CONCLUSION:Paracetamol combined with low-dose morphine may be effective for pain management in patients with biliary colic.展开更多
In order to elucidate the mechanism of liver damage due to acute biliary sepsis,thechanges of hepatocyte mitochondria were observed during biliary sepsis in the rot.Mitochondrial cal-cium content,lysosome fragility of...In order to elucidate the mechanism of liver damage due to acute biliary sepsis,thechanges of hepatocyte mitochondria were observed during biliary sepsis in the rot.Mitochondrial cal-cium content,lysosome fragility of the hepatocytes,lipid peroxide (LPO) level of fiver tissue,omithine carbamyltransferase (OCT),mitochondrial glutamic-oxaloacetic transaminase (m-GOT) andhepatoplastin were determined.It was found that there were overloading of calcium in mitochondria,increase of lysosome fragility,and accumulation of LPO in the liver.These events would result inadverse effects on mitochondrial function The activity of OCT and m-GOT was significantly in-creased,which suggests that mitochondria are seriously damaged since the 2 enzymes mainly comefrom hepatocyte mitochondria.And the liver reserving function declined progressively.Our study indi-cates that mitochondrial damage does exist during acute biliary sepsis,which might playan important role in liver damage.展开更多
Biliary adenoma is uncommon benign neoplasm of the biliary system, of unknown aetiology and account for approximately 0.1%-2% of all gastrointestinal benign tumors. Most of patients are asymptomatic; a few patients ha...Biliary adenoma is uncommon benign neoplasm of the biliary system, of unknown aetiology and account for approximately 0.1%-2% of all gastrointestinal benign tumors. Most of patients are asymptomatic; a few patients have mild jaundice or abdominal discomfort. To our knowledge, there were only a few cases of biliary papillomatosis reported in the previous literatures, which only showed solitary tumor in bile duct. We presented a rare case with multiple biliary adenomas in extrahepatic bile duct confirmed by endoscopic retrograde cholangiopancreatography(ERCP) and histopathology. After 3 months follow-up, the patient remained asymptomatic.展开更多
Ectopic pancreas is a rare congenital malformation with pancreatic tissue in an aberrant loca tion and not contiguous with the main gland. Patients suffering from ectopic pancreas usually have lesions in the stomach o...Ectopic pancreas is a rare congenital malformation with pancreatic tissue in an aberrant loca tion and not contiguous with the main gland. Patients suffering from ectopic pancreas usually have lesions in the stomach or duodenum. Ectopic pancreatic tissue in the gallbladder is very rare, and only several cases have been reported. We report one case of a 33 year old man with ectopic pancreas presenting as repeatedly colic pain in the right upper quadrant of abdomen. He was first diagnosed as recurrent cholecys- titis accompanied by biliary pancreatitis, but surgical pathology proved he suffered from cholecystitis and ectopic pancreas in the gallbladder wall, and the laparoscopic cholecystectomy led to relief.展开更多
The aim of this paper is to describe the mechanism, clinical manifestation, diagnosis and surgical management of congenital choledochal cyst. [WT5”BX] Methods.[WT5”BZ] From 1984 to 1997, 56 cases of congenital chole...The aim of this paper is to describe the mechanism, clinical manifestation, diagnosis and surgical management of congenital choledochal cyst. [WT5”BX] Methods.[WT5”BZ] From 1984 to 1997, 56 cases of congenital choledochal cyst were reviewed. Among them, 8 patients were male, 48 patients were female, the age ranges from 12 to 50 years old with an average of 26 3. [WT5”BX] Results.[WT5”BZ]The main clinical manifestation includes jaundice, abdominal pain and abdominal mass. All of them were confirmed by ultrasonography, while 39 cases were performed ERCP and PTC with the same diagnosis. Fifty one patients were performed cystectomy and hepatojejunostomy, two cases were performed cystjejunostomy because of diffused angioma and severe hemorrhage respectively, external drainage was performed in one case with emergent cholangitis, the other two cases were reported malignancy through biopsy and operation was abandoned. [WT5”BX] Conclusions. [WT5”BZ]Ultrasound diagnostics is essential to accurately diagnose the cyst, preoperative ERCP is helpful for differentiating pancreatic duct from bile duct, while MRCP is a reliable method; cystectomy and cholangiojejunostomy is recommended, laparoscopic procedure is becoming more and more accepted.展开更多
文摘BACKGROUND:Numerous drugs have been proposed to alleviate pain in patients with biliary colic,especially opioids,but still there is a tendency to use less narcotics because of their side effects and the unwillingness of some patients.The present study aimed to compare the analgesic effect of paracetamol combined with low-dose morphine versus morphine alone in patients with biliary colic.METHODS:A randomized double-blind controlled trial was performed in 98 patients with biliary colic,recruited from two emergency departments from August 2012 to August 2013.Eleven patients were excluded and the remaining were randomized into two groups:group A received 0.05mg/kg morphine+1 000 mg paracetamol in 100 m L normal saline and group B received 0.1 mg/kg morphine+normal saline(100 m L)as placebo.Pain scores were recorded using visual analogue scale(VAS)at baseline and 15 and 30 minutes after drug administration.Adverse effects and the need for rescue medication(0.75 g/kg intravenous fentanyl)were also reported within 60 minutes of drug administration.RESULTS:Before the infusion,the mean±SD VAS scores were 8.73±1.57 in group A and8.53±1.99 in group B.At 15 minutes after drug administration,the mean±SD VAS scores were2.16±1.90 in group A vs.2.51±1.86 in group B;mean difference was–0.35,and 95%CI–1.15 to 0.45(P=0.38).At 30 minutes the mean±SD VAS scores were 1.66±1.59 in group A vs.2.14±1.79 in group B;mean difference was–0.48,and 95%CI–1.20 to 0.24(P=0.19).The mean pain scores in the two groups at 15 and 30 minutes demonstrated no significant difference.CONCLUSION:Paracetamol combined with low-dose morphine may be effective for pain management in patients with biliary colic.
基金Supported by National Natural Science Foundation of China,No.38870770
文摘In order to elucidate the mechanism of liver damage due to acute biliary sepsis,thechanges of hepatocyte mitochondria were observed during biliary sepsis in the rot.Mitochondrial cal-cium content,lysosome fragility of the hepatocytes,lipid peroxide (LPO) level of fiver tissue,omithine carbamyltransferase (OCT),mitochondrial glutamic-oxaloacetic transaminase (m-GOT) andhepatoplastin were determined.It was found that there were overloading of calcium in mitochondria,increase of lysosome fragility,and accumulation of LPO in the liver.These events would result inadverse effects on mitochondrial function The activity of OCT and m-GOT was significantly in-creased,which suggests that mitochondria are seriously damaged since the 2 enzymes mainly comefrom hepatocyte mitochondria.And the liver reserving function declined progressively.Our study indi-cates that mitochondrial damage does exist during acute biliary sepsis,which might playan important role in liver damage.
文摘Biliary adenoma is uncommon benign neoplasm of the biliary system, of unknown aetiology and account for approximately 0.1%-2% of all gastrointestinal benign tumors. Most of patients are asymptomatic; a few patients have mild jaundice or abdominal discomfort. To our knowledge, there were only a few cases of biliary papillomatosis reported in the previous literatures, which only showed solitary tumor in bile duct. We presented a rare case with multiple biliary adenomas in extrahepatic bile duct confirmed by endoscopic retrograde cholangiopancreatography(ERCP) and histopathology. After 3 months follow-up, the patient remained asymptomatic.
文摘Ectopic pancreas is a rare congenital malformation with pancreatic tissue in an aberrant loca tion and not contiguous with the main gland. Patients suffering from ectopic pancreas usually have lesions in the stomach or duodenum. Ectopic pancreatic tissue in the gallbladder is very rare, and only several cases have been reported. We report one case of a 33 year old man with ectopic pancreas presenting as repeatedly colic pain in the right upper quadrant of abdomen. He was first diagnosed as recurrent cholecys- titis accompanied by biliary pancreatitis, but surgical pathology proved he suffered from cholecystitis and ectopic pancreas in the gallbladder wall, and the laparoscopic cholecystectomy led to relief.
文摘The aim of this paper is to describe the mechanism, clinical manifestation, diagnosis and surgical management of congenital choledochal cyst. [WT5”BX] Methods.[WT5”BZ] From 1984 to 1997, 56 cases of congenital choledochal cyst were reviewed. Among them, 8 patients were male, 48 patients were female, the age ranges from 12 to 50 years old with an average of 26 3. [WT5”BX] Results.[WT5”BZ]The main clinical manifestation includes jaundice, abdominal pain and abdominal mass. All of them were confirmed by ultrasonography, while 39 cases were performed ERCP and PTC with the same diagnosis. Fifty one patients were performed cystectomy and hepatojejunostomy, two cases were performed cystjejunostomy because of diffused angioma and severe hemorrhage respectively, external drainage was performed in one case with emergent cholangitis, the other two cases were reported malignancy through biopsy and operation was abandoned. [WT5”BX] Conclusions. [WT5”BZ]Ultrasound diagnostics is essential to accurately diagnose the cyst, preoperative ERCP is helpful for differentiating pancreatic duct from bile duct, while MRCP is a reliable method; cystectomy and cholangiojejunostomy is recommended, laparoscopic procedure is becoming more and more accepted.
