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Biomedical subjects

A Smithline

Publications and source records attributed to A Smithline.

3 recordsLinked to original sources

Polycystic liver disease with obstructive jaundice: treatment with ultrasound-guided cyst aspiration.

A 59-year-old woman with polycystic liver (PCLD) and kidney disease (PCKD) presented with jaundice, fever, and abdominal pain. A computered tomographic (CT) scan performed immediately after an endoscopic retrograde cholangiopancreatogram (ERCP) clearly demonstrated a hepatic cyst obstructing the biliary system. The cyst was then aspirated under ultrasound guidance with complete relief of obstruction.

Cholangiopancreatography, Endoscopic Retrograde↗

Sphincter of Oddi manometry: interobserver variability.

To determine the frequency and magnitude of interobserver variability, 50 sphincter of Oddi manometry tracings were read by three separate physicians experienced in reading such manometry. Ninety station pull-throughs were read, and attention was focused on the reference duodenal baseline pressure and two methods of reading the basal sphincter pressure. A high degree of correlation was found among the three observers with correlation coefficients of > 0.9 for reading baseline duodenal and basal sphincter pressures. Differences in basal sphincter pressure readings were greatest in patients with very high basal sphincter pressure. The most clinically relevant parameter was thought to be the mean basal sphincter pressure. All three observers agreed on normal (mean basal pressure < or = 40 mm Hg) versus abnormal (mean basal pressure > 40 mm Hg) in 82% to 90% of tracings. When the definition of agreement was broadened to include patients with pressures of 40 +/- 3 mm Hg (37 to 43 mm Hg), the observers agreed 87% to 94% of the time. Overall, these findings are thought to indicate that interobserver variability for reading sphincter of Oddi manometry is minimal when the observers are experienced in reading these tracings.

Humans↗

Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopic sphincterotomy-induced pancreatitis in high-risk patients.

Pancreatitis is a common complication of endoscopic sphincterotomy. Cautery-induced papillary edema has been implicated as a possible cause. The objective of this study was to determine whether prophylactic stenting of the main pancreatic duct after endoscopic sphincterotomy in high-risk patients would reduce the incidence of pancreatitis. High-risk patients were defined as those with sphincter of Oddi dysfunction, small common bile duct diameter (< 10 mm), or those requiring pre-cut sphincterotomy. Patients were studied in a prospective fashion from October 1990 to April 1992 and were randomized to receive either a main pancreatic duct stent or no stent after biliary sphincterotomy. The stents were generally removed 10 to 14 days after placement. Fifty patients were randomized to the no-stent group and 48 patients were randomized to the stent group, but in five patients stent placement was unsuccessful. Pancreatitis occurred in 18% of patients in the no-stent group compared with 14% of patients in the stent group. Most cases of pancreatitis were mild, occurring in 10% of patients in the no-stent group and 12% of patients in the stent group. Moderate to severe pancreatitis occurred with an increased frequency in patients in the no-stent group (8%) compared with that in patients in the stent group (2%). Mean number of hospital days required to treat pancreatitis was 9.5 days in the no-stent group compared with 2.8 days in the stent group; however, none of these differences reached statistical significance. Small common bile duct diameter (< 6 mm) was found to be an independent risk factor for pancreatitis after endoscopic sphincterotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Common Bile Duct↗