RESUMEN
BACKGROUND: The purpose of this study is to assess the value of early abdominal non-enhanced computed tomography (NECT) in developing strategies for treating acute gallstone pancreatitis (AGP). METHODS: AGP patients underwent NECT within 48 h after symptom onset to determine the presence of peripancreatic fluid collection, gallstones, and common bile duct stones. Patients with mild AGP who had neither organ failure by clinical data nor peripancreatic fluid collection by NECT (classified as grade A, B, or C based on the Balthazar CT grading system) were randomized to undergo an early laparoscopic cholecystomy (ELC; LC performed within 7 days after a pancreatitis attack, without waiting for symptom resolution) or late laparoscopic cholecystomy (LLC; LC performed ≥ 7 days following an attack, with the patient being completely free of AGP symptoms). RESULTS: The study enrolled 102 patients with mild AGP defined by clinical data and NECT. NECT was 89.2 % and 87.8 % accurate in detecting gallbladder stones and CBD stones, respectively. Totals of 49 and 53 patients were assigned to an ELC and LLC group, respectively. All patients in both groups were cured, no LC-related complications occurred, and no case of AGP increased in severity following LC. The mean lengths of hospital stay and LC operation time were significantly shorter in the ELC group than the LLC group (P < 0.05). CONCLUSIONS: NECT can accurately detect peripancreatic fluid collection and biliary obstructions; thus, early abdominal NECT is valuable when developing strategies for treating AGP. Patients with mild AGP without organ failure or peripancreatic fluid collection can safely undergo ELC without waiting for complete resolution of their pancreatitis.
Asunto(s)
Cálculos Biliares/diagnóstico por imagen , Cálculos Biliares/cirugía , Pancreatitis/diagnóstico por imagen , Pancreatitis/cirugía , Tomografía Computarizada por Rayos X , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y Especificidad , Adulto JovenRESUMEN
OBJECTIVE: To explore the relationship between clinical ischemic events and carotid calcification detected by 64 slices CT angiography. METHODS: We retrospectively analyzed the carotid calcified plaques in 116 patients underwent the 64 slices CT angiography. The relationship between the carotid calcification and the clinical ischemic events was analyzed. RESULTS: A total of 377 plaques were detected and the incidence of carotid plaque calcification was 63.40%. Incidence of plaque calcification was significantly lower in patients with ages < 50 years than that in patients with ages 51 - 59 years, 60 - 69 years and higher than 70 years (P = 0.003, P = 0.002, P = 0.000, respectively). The incidence of plaque calcification in the common carotid artery was significantly lower than the carotid bifurcation (P = 0.000) and the internal carotid artery (P = 0.000). The incidences of calcification in the mild, moderate and severe degree of stenosis and occlusion were 46.54%, 33.33%, 26.67% and 0% respectively. The distribution of intraplaque calcium was similar between patients with ischemic event and non-ischemic event group. However, the incidence of calcification was significantly lower patients with ischemic event than that in patients without ischemic event (30.34% vs. 43.10%, P = 0.013). Calcified plaque was negatively associated with ischemic event (beta = -0.688, P = 0.006). CONCLUSION: 64 slices CT angiography can analyze the characterization of carotid plaque calcium.