Predictive value of esophageal motility test in the proficiency of esophageal speech

One method of speech rehabilitation following total laryngectomy surgery is esophageal speech therapy (EST). In this method, which has witnessed relatively low success rates at the end of therapy, identification of patients who can benefit from EST beforehand will be important for determining the appropriate method for alaryngeal speech rehabilitation and might be cost-effective, saving time and labor. To this end, this study conducted research on the feasibility of manometric data measured prior to therapy using an esophageal motility test (EMT) in order to determine the candidates most suitable for esophageal speech (ES) beforehand. A total of 51 total laryngectomy male patients who had never been subject to any kind of speech rehabilitation and had always been articulate were included in the study. Data were collected from 44 patients who completed EST, lasting for 6 months in total and consisting of 11 sessions. Manometric measures were obtained through EMT using a water-perfusion system with a Dent sleeve catheter on the patients prior to the therapy. Wepman's scale was used in order to evaluate ES proficiency. Following the therapy, in accordance with this scale, while patients whose scores was 1, 2, or 3 were considered as adequate, those whose scores were 4, 5, 6, or 7 were considered inadequate and were divided into two groups. Manometric correlations were analyzed between 17 patients (group I) who were able to perform ES at an adequate level and 27 patients (group II) who could not. No statistically significant difference between the groups could be observed in terms of average pressure generated within the upper and lower esophageal sphincters obtained through EMT, peak amplitude of esophageal body contraction pressure, contraction duration time, onset velocity, or peak velocity values. EMT conducted prior to application of EST to total laryngectomized patients did not have any value in determining the level of ES that a patient could reach. Our results also suggest that sphincter pressures or esophageal motility patterns do not have any predictive value and should not be performed.

The relationship between the neutrophil-lymphocyte ratio and the coronary collateral circulation in patients with chronic total occlusion

OBJECTIVES

Previous studies showed the association between the major adverse cardiovascular outcomes and both higher neutrophil and lower lymphocyte counts. We aimed to investigate whether there is an association between the neutrophil-lymphocyte ratio (NLR) value and the development of coronary collateral circulation (CCC) in patients with coronary chronic total occlusion (CTO).

METHODS

A total of 274 patients with CTO were included in this study. Patients were then classified according to their Rentrop collateral grades as either poor (Rentrop grades 0-1) or good (Rentrop grades 2-3). Clinical information and analyses of blood samples were obtained from a review of the patients' charts.

RESULTS

Although there was no difference between the two groups with regard to cardiovascular risk profiles, the NLR values were significantly higher in the patients who had poorly developed CCC (2.6 ± 0.5 vs 2.2 ± 0.4, p<0.001). NLR, high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBC), age, diabetes, fasting glucose levels and body mass index were found to have univariate association with poorly developed CCC (p<0.1). In a multivariate logistic regression model, NLR (odds ratio 1.88, 95% confidence interval (CI) 1.37-2.74; p<0.001), high-sensitivity C-reactive protein and WBC were found to be the independent predictors of poor CCC. In receiver operator characteristic curve analysis, the optimal cut-off value of NLR to predict poor CCC was found as 2.17, with 77% sensitivity and 65% specificity.

CONCLUSION

NLR, as a novel cardiovascular risk marker, is an important, simple and inexpensive method which can be used by the cardiologist as a screening inflammation tool to estimate the development of CCC in patients with CTO.

Hypericum perforatum modulates apoptosis and calcium mobilization through voltage-gated and TRPM2 calcium channels in neutrophil of patients with Behcet's disease

Behcet's disease (BD) is a chronic, inflammatory, and multisystemic condition although its pathogenesis is uncertain. Main component of St. John's wort (Hypericum perforatum, HP) is hyperforin and induces antiinflammatory and antioxidant properties. We aimed to investigate effects of HP on oxidative stress, apoptosis, and cytosolic-free Ca²⁺ [Ca²⁺](i) concentration in neutrophil of BD patients. Nine new-diagnosed active patients with BD and nine control subjects were included in the study. Disease activity was considered by clinical findings. Neutrophil samples were obtained from the patients and controls. The neutrophils from patients were divided into three subgroups and were incubated with HP, voltage-gated calcium channel (VGCC) blockers, (verapamil+dilitiazem) and non-specific TRPM2 channel blocker (2-aminoethyl diphenylborinate, 2-APB), respectively. The neutrophils were stimulated by fMLP as a Ca²⁺-concentration agonist and oxidative stress former. Caspase-3, caspase-9, apoptosis, lipid peroxidation, and [Ca²⁺](i) values were high in the patient groups, although cell viability, glutathione (GSH), and glutathione peroxidase (GSH-Px) values were low in patient group. However, the [Ca²⁺](i), caspase-3, and caspase-9 values decreased markedly in patient+HP group although GSH and GSH-Px values increased in the group. The [Ca²⁺](i) concentration was also decreased in the patient group by V+D, 2-APB, and HP incubations. In conclusion, we observed the importance of neutrophil Ca²⁺ entry, apoptosis, and oxidative stress through gating VGCC and TRPM2 channels in the neutrophils in the pathogenesis and activation of the patients with BD. HP induced protective effects on oxidative stress by modulating Ca²⁺ influx in BD patients.

The effect of nebivolol on internal mammary artery blood flow during coronary artery bypass graft surgery

Background:

During coronary artery bypass grafting (CABG), one of the most important complications related to the internal mammary artery (IMA) is perioperative spasm. Nebivolol causes endothelium-dependent vascular relaxation by increasing nitric oxide (NO) release and prevents endothelial dysfunction in long-term use. In our study, we measured the effect of a third generation beta blocker, nebivolol, on the flow dynamics of IMA grafts.

Methods:

We recruited 90 hypertensive patients undergoing isolated CABG operation, who were divided into three groups and each group included 30 patients: Group 1 patients were under antihypertensive treatment other than beta-blockers (angiontensin-converting enzyme [ACE] inhibitors, calcium channel blockers or diuretics; monotherapy or combination therapy), Group 2 received metoprolol (50 mg/day) and Group 3 received nebivolol (5 mg/day). These antihypertensive therapies were given for at least one week before the operation and continued thereafter. IMA blood flow volume was measured for one minute just before cardiopulmonary bypass (measurement A) and before left internal mammary artery (LIMA)-left anterior descending (LAD) artery anastomosis (measurement B) in the three groups. Cardiac output measurements were also achieved simultaneously.

Results:

The measurement A results were 56.3 ± 36.2, 54.6 ± 28.1 and 66.8 ± 34.2 mL/min in Groups 1, 2 and 3, respectively (p<0.05). The measurement B results were 78.3 ± 29.6, 80 ± 28.8 and 91.1 ± 40.8 mL/min in Groups 1, 2 and 3 (p<0.05), respectively. There were no differences in cardiac outputs among the groups; 5.2 ± 1.4, 5.0 ± 1.6 and 5.3 ± 1.1 L/min (p>0.05). While the cardiac outputs were similar within the three groups, the IMA free flow volume was higher in the nebivolol group after local papaverine use.

Conclusion:

Nebivolol might represent a good choice in hypertensive patients undergoing cardiac surgery by preventing perioperative myocardial hypoperfusion which increases early morbidity and mortality.

Reliability and validity of the Turkish version of spinal cord lesion-related coping strategies

OBJECTIVE

Spinal Cord Lesion-Related Coping Strategies Questionnaire (SCL CSQ) is a specific test that is developed for evaluating the coping strategies of the persons with spinal cord injury (SCI). The aim of this study was to evaluate the reliability and validity of the Turkish version of SCL CSQ (SCL CSQ-T) in persons with SCI.

METHODS

One hundred persons with SCI were included in the study. All participants were evaluated with SCL CSQ-T and Brief Coping Styles Inventory (BCSI) at the baseline. SCL CSQ-T was repeated twice in 15 days. American Spinal Injury Association Impairment Scale and Functional Independence Measurement were used for the evaluation of the neurological loss severity and functional status. Emotional status was assessed by Hospital Anxiety and Depression Scale (HADS). Internal consistency reliability, test-retest reliability and construct validity of SCL CSQ-T were evaluated.

RESULTS

Intraclass correlation coefficients of the SCL CSQ-T were between 0.51-0.86. Cronbach's alpha values and test-retest reliability of the acceptance, fighting spirit and social reliance subscales were good. Three factors were found in exploratory factor analysis. There was a positive correlation between the subscales of SCL CSQ-T. There was a statistically significant positive correlation between acceptance strategy of SCL CSQ-T and self-confidence and optimism of BCSI. The fighting spirit strategy positively correlated with self-confidence and optimistic strategies. The social reliance strategy positively correlated with helplessness and seeking social support. Coping strategies did not correlate with HADS.

CONCLUSION

The results of this study revealed good internal consistency reliability, test-retest reliability and concurrent validity of the SCL CSQ-T factors acceptance and fighting spirit in relation to general coping strategies. The coping strategy social reliance needs revisions.

Oxidative stress status in patients with melasma

BACKGROUND

Melasma is an acquired skin disease characterized clinically by development of gray-brown macules or patches. The lesions have geographic borders and most often seen on face and less frequently on the neck and forearms. Pathogenesis has not been completely understood yet. Although the disease constitutes a very disturbing cosmetic problem, it has not obtained an efficient treatment. There were not any studies in the literature that evaluates the role of oxidative stress in melasma.

OBJECTIVES

The evaluation of the role of oxidative stress in melasma.

METHODS

Fifty melasma patients and 50 healthy volunteers were included in the study. The diagnosis was made clinically and the patients were evaluated by Melasma Area Severity Index. Superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) enzyme activities and malondialdehyde, nitric oxide, protein carbonyl levels were measured both in the melasma group and the control group.

RESULTS

SOD and GSH-Px enzyme activities were significantly higher in the patient group in comparison with the control group (p < 0.001). Protein carbonyl levels were significantly lower in the patient group (p < 0.001).

CONCLUSION

The results show that the balance between oxidant and anti-oxidants was disrupted and the oxidative stress increased in melasma. These results improve the understanding of etiology-pathogenesis of the disease and its treatment.

Cardiovascular risk factors, carotid artery intima media thickness, and HSCRP levels in patients with impaired glucose metabolism

AIM

The aim of this paper was to compare serum high sensitivity C-reactive protein (HsCRP) levels and carotid artery intima-media thickness (CIMT) of patients with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) with that in control subjects.

METHODS

Ninety-six subjects with prediabetes, 48 with IFG, of mean age 50.7±11.3 years, and 48 with IGT, of mean age 50.9±12.3 years, were enrolled, along with 44 age-, sex-, and body mass index-matched controls with normal glucose tolerance. Serum HsCRP, lipid profile, insulin levels and the homeostasis model assessment of insulin resistance (HOMA-IR) was evaluated. High-resolution B-mode ultrasonography was performed.

RESULTS

Serum HsCRP levels were significantly elevated in pre-diabetic patients when compared with that of control subjects. Median HsCRP values were 3.1 mg/L in IFG group, 3.47 mg/L in IGT group, and 1.5 mg/L in the controls (P<0.001). CIMT was significantly higher in pre-diabetic groups than that in the control group (IFG: 0.612±0.09; IGT: 0.625±0.1; control: 0.517±0.09, P<0.001). CIMT and HsCRP levels were similar in pre-diabetic groups. CIMT values were positively correlated with HsCRP (r=0.793, P=0.000), age (r=0.435, P=0.000), waist-hip ratio (r=0.170, P=0.044), fasting plasma glucose (r=0.302, P=0.000), HOMA-IR (r=0.173, P=0.041), and low-density lipoprotein cholesterol (r=0.168, P=0.047) levels.

CONCLUSION

Both IFG and IGT were associated with increased cardiovascular risk as assessed by serum hsCRP levels and CIMT. In contrast to previous studies, risk appears to be the same in the two categories of prediabetes.

A new echocardiographic parameter of arterial stiffness in end-stage renal disease

BACKGROUND

Cardiovascular disease is the leading cause of death among patients with end-stage renal disease (ESRD). Arterial stiffness is an independent predictive parameter of overall and cardiovascular mortality in these patients. However, the defined procedures for the measurement of arterial stiffness are time consuming and not practical in daily practice.

METHODS

The study population included 50 patients with ESRD who were treated with hemodialysis (HD; n=23) or peritoneal dialysis (PD; n=27) and 70 age- and sex-matched control subjects. Aortofemoral pulse wave velocity (PWV), carotid intima-media thickness (CIMT), and color M-mode propagation velocity of the descending aorta (aortic propagation velocity, APV) were measured.

RESULTS

Compared to the control group, the patients with ESRD had significantly lower APV (46.4 ± 12.4 vs. 58.5 ± 8.5, p < 0.01) and higher PWV (10.5 ± 2.5 vs. 9.2 ± 1.2, p < 0.01) and CIMT (0.66 ± 0.15 vs. 0.43 ± 0.06, p < 0.01) measurements. There were significant correlations between APV and CIMT (r = - 0.769, p < 0.001), APV and PWV (r = - 0.682, p < 0.001), and PWV and CIMT (r = 0.564, p < 0.001). There were no significant differences in APV and PWV between the PD and HD patients.

CONCLUSION

Arterial stiffness is an important indicator of atherosclerosis and arterial aging in patients with ESRD. The measurement of APV is an easy and practical new echocardiographic method and may be used to identify arterial stiffness in these patients.

Oxidative stress status in patients with acute urticaria

BACKGROUND

The conflicting information related to oxidative stress status in patients with chronic idiopathic urticaria has been reported in several studies. However, the association between acute urticaria (AU) and oxidative stress has not been investigated exhaustively.

OBJECTIVES

To evaluate the role of the oxidative stress in the patients with AU by determining the oxidant/antioxidant activity in AU and to establish its clinical significance.

METHODS

About 50 patients with AU, (10 males, 40 females) and 30 unrelated healthy controls (4 males, 26 females) were enrolled into the study. The activity of the antioxidant enzymes copper-zinc superoxide dismutase (Cu-Zn-SOD), glutathione peroxidase (GSH-Px) and catalase, and the levels of malondialdehyde (MDA), serum NO and protein carbonyls levels in the plasma were measured spectrophotometrically at samples.

RESULTS

A statistically significant increase was observed in serum Cu-ZnSOD activities of the patients when compared with that of the controls (p < 0.001), while a statistically significant decrease was observed in GSH-Px activities of the patients according to the controls (p = 0.002). Serum MDA and NO levels were significantly higher in patients with AU when compared with control group (p < 0.001 for both of them). The levels of protein carbonyls were significantly lower in patients with AU when compared with control group (p < 0.001).

CONCLUSION

It seems there is an oxidative burden in the patients with AU. Cutaneous oxidative stress may play a role in pathogenesis of the disease.

Coronary vessel diameters during and after primary percutaneous coronary artery intervention

BACKGROUND

Primary percutaneous coronary intervention (P-PCI) is the gold standard treatment for acute coronary syndromes. Plasma levels of catecholamines and other vasopressors are elevated during acute myocardial infarction (AMI) and coronary vasoconstriction is frequent. We aimed to compare the reference vessel diameter (RVD) of the infarct-related artery (IRA) during primary PCI and after an average of 3 days.

METHODS

Coronary angiography (CAG) was performed on 58 patients with acute ST-segment elevation myocardial infarction (STEMI) and TIMI 3 flow after P-PCI (43 men, 15 women; mean age, 55.5 ± 10 years). TIMI 3 flow was achieved either by simple balloon dilatation and/or thrombus aspiration. Lesion length, RVD, minimal lumen diameter (MLD), mean vessel diameter (meanD), and area of stenosis were compared during P-PCI and follow-up CAG.

RESULTS

RVD, MLD, and meanD values were significantly higher during the follow-up CAG than after P-PCI (RVD 2.7 ± 0.7 mm vs. 2.9 ± 0.7 mm, p = 0.001; MLD 1.5 ± 0.5 mm vs. 1.7 ± 0.4 mm, p = 0.002; meanD 2.2 ± 0.5 mm vs. 2.4 ± 0.5 mm, p = 0.001). Area of stenosis values were significantly lower during the follow-up CAG than after primary PCI (69.5 ± 16.5 % vs. 62.1 ± 15 %, p = 0.001). Lesion lengths were not statistically significant during the follow-up CAG and primary PCI (lesion length 24.0 ± 10.8 mm vs. 22.1 ± 8.8 mm, p > 0.05).

CONCLUSION

This study showed that RVD was higher at the follow-up CAG a few days after AMI in patients who had TIMI 3 flow after P-PCI with simple balloon dilatation and/or thrombus aspiration. A delay of a few days for stent implantation in P-PCI allows for larger-diameter stent use and may help to reduce stent thrombosis and restenosis rates.

Regulatory T cells in cancer: an overview and perspectives on cyclooxygenase-2 and Foxp3 DNA methylation

Epigenetics has been gaining great attention as a therapeutic target in cancer. The cancer genome usually contains both hyper- and hypo-methylated genes to increase invasion, proliferation and metastasis. These cells not only operate their own growth, but also develop various strategies to escape from immune surveillance, and for this aim, regulatory T (Treg) cells support the cancer-mediated immune suppression. The fate of Treg cells is mainly controlled by DNA methylation within the promoter and intronic regions of Foxp3 gene. Foxp3 transcription factor is involved in the development, differentiation and function of Treg cells. COX-2 is also an epigenetically controlled gene in these processes. This enzyme and its product PGE2 plays essential roles in Treg functionality in cancer. Here, we discuss the effects of DNA methylation on cancer and nTreg cells. We also summarize the mechanisms related with COX-2/PGE2 and Foxp3 on inhibitory function of Treg cells in cancer.

Investigation of various adsorbents for their ability to bind aflatoxin B1

The contamination of animal feed with mycotoxins represents a worldwide problem for the animal industry. The most applied method for protecting animals against aflatoxicosis is the utilization of clay minerals. In the course of a research project adsorption experiments were performed in buffer solutions in order to evaluate the ability to bind Aflatoxin B1 (AfB1) at various pH-values. In order to investigate the strength of binding, the chemisorption index was calculated. Isothermal analysis was used to determine the values for the maximum adsorption capacity. Adsorption experiments in simulated gastrointestinal fluid and real gastric juice were carried out. Furthermore binding capability of the materials regarding selected vitamins was examined. Special attention was paid to the formation of AfB2a during experimental conditions. Based on the obtainedin vitro results, highly promising sorbent materials were ranked for furtherin vivo studies. Some adsorbing bentonites were also analysed mineralogically, but the results did not indicate which smectite property influences the adsorption process for AfB1.

Echocardiographic evaluation of right ventricular functions after successful percutaneous recanalization of right coronary artery chronic total occlusions

BACKGROUND

No data exist on regarding possible improvement will occur in right ventricular (RV) functions after successful recanalization of right coronary artery chronic total occlusions (RCA CTOs).

AIM

Our aim was to evaluate the revascularization induced changes in RV functions by novel echocardiographic techniques like tissue Doppler imaging (TDI) and two dimensional speckle tracking echocardiography (2DSTE).

PATIENTS AND METHODS

Forty-one consecutive successfully recanalized patients with RCA CTOs were included in our study. All included patients underwent standard echocardiography with TDI and 2DSTE to assess RV function before procedure and repeated after 24 hours and 1 month.

RESULTS

There were no significant changes in tricuspid annular plane systolic excursion, systolic myocardial velocities, and fractional area change values. However, RV global longitudinal strain and systolic strain rate values showed a significant increase at 24 hours after percutaneous coronary intervention compared to baseline (-23.6±4.1% vs. -19.7±3.9%, p < 0.001 and -1.55±0.18s-1 vs. -1.18±0.17s-1, p < 0.001, respectively). Moreover, improvement of the RV functions in patients with RCA CTOs was further suggested by the higher RV isovolumic acceleration values at 1-month compared with baseline (2.29±0.62 vs. 2.05±0.5 m/s2, p = 0.014).

CONCLUSIONS

TDI derived isovolumic acceleration and 2DSTE derived global longitudinal strain and systolic strain rate values showed improvement in RV functions after successful percutaneous recanalization of RCACTOs suggesting viability of RV in chronic ischemia.

The role of MMP2 (-1306C>T) and TIMP2 (-418 G>C) promoter variants in age-related macular degeneration

PURPOSE

To investigate the possible association between the matrix metalloproteinase 2 (-1306C>T) (rs 243865) and tissue inhibitors of matrix metalloproteinase 2 (-418 G>C) (rs 8179090) polymorphisms and the risk of age-related macular degeneration.

METHODS

This case-controlled prospective study included 144 age-related macular degeneration patients and 172 control subjects. All subjects were screened for age, gender, hypertension (HT), diabetes (DM), and body mass index (BMI). Serum levels of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), total cholesterol (TC), and smoking were also determined. Genomic DNA was extracted from peripheral leukocytes from ethylenediaminetetraacetic acid anticoagulated blood. Genotyping of the MMP2 (-1306C>T) and TIMP2 (-418 G>C) polymorphisms was performed using real-time polymerase chain reaction.

RESULTS

Genotype distributions or allelic frequencies of MMP2 (-1306C>T) and TIMP2 (-418 G>C) did not significantly differ between patients with AMD and control subjects. Similarly, no significant differences in either genotype distributions or allelic frequencies of MMP2 (-1306C>T) and TIMP2 (-418 G>C) were found between dry and wet AMD.

CONCLUSION

MMP2 (-1306C>T) and TIMP2 (-418 G>C) promoter variants are unlikely to have a major role in age-related macular degeneration risk susceptibility.

Safety of balloon pre-dilatation in the treatment of severe carotid artery stenosis

AIM

To assess early outcome of predilatation prior stenting of severe carotid artery stenosis and to evaluate early major adverse cardiovascular and cerebral events (MACCE).

PATIENTS AND METHODS

The study group consisted of 265 consecutive patients (200 males, 65 female, mean age 66.7 ± 8.6 years) in whom 275 percutaneous transluminal angioplasty (PTA) procedures of carotid arteries were performed. Staged carotid stenting was performed in patients with bilateral carotid stenosis. Neuroprotection with a distal protection device was used in all cases. The patients were divided into two groups: direct carotid stent implantation without previous pre-dilation was performed in 233 patients (direct stenting group) and predilatation was performed in 42 patients (predilatation group). Early events were recorded and analyzed subsequently.

RESULTS

We treated 275 carotid stenoses and the stent was implanted in all patients. Ten patients (3.7%) were treated by staged carotid artery stenting (CAS) due to bilateral carotid artery disease. The technical success rate was 97.1%. During 1-month follow-up, the prevalence of primary endpoint was 2.18%. The prevalence of MACCE at 30 days was higher in the predilatation group (2.4% vs. 2.1%; p = 0.924). Also periprocedural rate of hypotension was higher in predilatation group (7.1% vs. 1.7%; p = 0.04).

CONCLUSIONS

Balloon predilatation prior to stenting can be performed to treat severe carotid artery stenosis with acceptable periprocedural complication rate.

A novel echocardiographic method as an indicator of endothelial dysfunction in patients with coronary slow flow

BACKGROUND

To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Endothelial dysfunction is considered the first stage in the development of atherosclerosis. Brachial artery flow-mediated dilatation (FMD) has been impaired in patients with coronary slow flow (CSF). Recently, color M-mode derived propagation velocity of descending thoracic aorta (aortic propagation velocity-AVP) was shown to be an ultrasonographic marker for atherosclerosis.

AIM

To assess endothelial function in patients with CSF and the correlation of AVP with FMD.

MATERIALS AND METHODS

FMD and AVP were measured in 90 patients with CSF and 39 patients having normal coronary arteries (NCA) detected by coronary angiography.

RESULTS

Compared to patients with normal coronary arteries patients having CSF had significantly lower AVP (39.1±8.4 vs. 53.7±12.7 cm/s, p < 0.001) and FMD (5.6±3.2 vs. 17.6±4.4 %, p < 0.001) measurements. There were significant correlations between AVP and FMD (r = 0.524, p < 0.001).

CONCLUSIONS

Transthoracic echocardiographic determination of color M-mode propagation velocity of descending aorta is a simple practical method and correlates well with coronary slow flow and brachial endothelial function.

"Diagnostic value of MRCP in biliary pancreatitis: result of long-term follow-up"

AIM

Magnetic resonance cholangiopancreatography (MRCP) has increasingly been used to evaluate the common bile duct. This study was to determine the role of MRCP instead of endoscopic retrograde cholangiopancreatography (ERCP) in the management of patients with acute biliary pancreatitis.

METHODS

A total of 81 patients with mild or moderate biliary pancreatitis who underwent MRCP and were treated in our department with selective ERCP between May 2001 and July 2007 were entered into a prospective database.

RESULTS

MRCP was considered abnormal in 13 patients. Ten patients underwent ERCP. Three patients did not undergo ERCP due to protocol violations. In nine patients, stone extraction was performed. The remaining patient who had dilatation of the CBD underwent ES. The false positive rate of MRCP was 10%. The median follow-up of overall patients was 36 months (range 23-99 months). The patients with normal MRCP had a median follow-up of 39.5 months (range 23-99 months). During the follow-up period in the normal MRCP group, five patients were diagnosed with recurrent biliary pancreatitis, of which three underwent ERCP (7.4%). There was no disease-related mortality during this period.

CONCLUSION

In conclusion, the use of MRCP in acute biliary pancreatitis is safe and may be recommended as a tool to aid in the selective use of ERCP.

Case reports: iatrogenic bronchial rupture following the use of endotracheal tube introducers

PURPOSE

Endotracheal tube introducers are often used in difficult tracheal intubations, but they are rarely deemed responsible for airway injuries. There have been only a few reports of severe complications, such as pharyngeal perforation, mainstem bronchus bleeding, perforation of the tracheal mucosa, and tracheal abrasion associated with hemopneumothorax. Using a computed tomography (CT) scan, we illustrate two cases of non-severe airway injuries related to endotracheal tube introducers.

CLINICAL FEATURES

We present two cases of distal bronchial lacerations caused by introducers. The first occurrence was caused by a Muallem ET Tube Stylet (METTS) in a patient who underwent surgery for a total thyroidectomy and presented hemoptysis at suction after tracheal intubation. The second occurrence was caused by an Eschmann® Tracheal Tube Introducer (gum elastic bougie) in a patient whose trachea was intubated before a radiofrequency ablation of a single lung metastasis. There was evidence of blood on the tip of the bougie after withdrawal. In both cases, a CT scan showed a post-traumatic bronchial laceration with an acquired bronchial ectasia surrounded by ground-glass opacity due to alveolar hemorrhage. The patients had no other clinical complications, and bronchial lesions resolved spontaneously at control CT scan.

CONCLUSION

These two cases show that airway damage related to endotracheal tube introducers may not be exceptional. It is not unusual to have some blood on an airway management device, and the rate and severity of these lesions are unknown. However, damage to the airway can be avoided by adapting preventive techniques during tracheal intubation.