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Hepatocellular carcinoma (HCC) treated with loco-regional therapy from 1996 to 2001: Clinical experience and outcomes
Abstracts
43 ACUTE PANCREATITIS IN THE ELDERLY REFERRED FOR ERCP: VALUE OF AMILASE AND LIPASE MODIFICATIONS Amuw M’, Nardi I*, Reii G’, Gagliardi A’, Sapienza M*. U.O. di Gastroenterologia (l), Divisione di Geriatria (2) and Servizio di Radiologia (3). A.O. Villa Sofia-CTO, PaIermo, Italy. Background/Aims: If normalization or reduction of am&se and/or lipase value can prediit bile duct stone clearence in the setting of acute pancreatitis in the elderly is unknown Patients and methods: Retrospective review of clinical chart of all patients ? 65 years old consecutively admitted in a l&months period at our hospital and referred for ERCP because of acute pancreatitis. Acute pancreatitis was defined as pain and one or both pancreatic enzymes elevated over upper normal limits. Changes in enzymes vahxs were evaluated between admissiin and ERCP. Results: Nii patients had acute pancmatitis, mean amilase and lipase value were 437 and 815 IU, respectively. Two patterns of enzyme behaviour were identified: unchanged, if the number of elevated enzymes was constant; improved if XI& of elevated enzymes reduced (or even both became normal). According to this definition, 5 patients were “unchanged” and 4 were “improved”. Common bile duct stones were found in 8 patients: the only patient without stones &owed an ‘unchanged” pattern. Conclusions: changes in pawreatic enzymes levels are not uselkl in predicting absence (or ckarence) of common bile duct stones in pancreatitk ERCP should be performed in every elder patient with acute pancreatitis, regardless of pancreatic enzyme pattern evolution.
42
ANTIPHOSPHOLIPID ULCERATIVE COLITIS
SYNDROME IN : A CASE REPORT
PATIENT
WITH
ENDOSCOPIC ULTRASONOGRAPHY OF ACUTE BILIARY PANCREAlIllS LeslnigaE. &&
Thromboembohc disease is an infrequent comphcatton in mflammatory bowel diseases, although many clotting defects have been described during Crohn disease and ulcerative colitis In panic&r is not yet established the meaning of the presence of antiphospholipid (CL) antibodies like anticudiolipin (KL) and lupus anticoagulant (LAC) in ulcerative colitis We report the case of a 55 year-old man got to our observation because of a critic ischemia of the fingers I and 5 (outcome in necrosis of only fifth finger) of the right foot with palpable purpura of the skin of the legs The personal history of the patient put in evidence a ulcerative colitis diagnosed 81Ihe age of 32, in clinical remission, without therapy. not Q- wave miocardid infarction at the age of 40, transient cerebral ischemic attack at the age of 44 and deep vencw thrombosis at the age of 48 The colour- doppkr ultrasound study of the abdominal aorta and of the arterial vessels of the legs and of the neck showed absence of significant stenosis The ccmmwn iaborarory tests showed only elevation of inflammatory signs (Eritrocyte sedimentation rate, C-reactive protein, etc.) On the whole ;he clinic signs permitted us Lo suppose the presence of a prothrombotic sue. Consequently we carried out specific res&hs which &wed absence of non org&np&fic auto&body
(ANqAMqASMqanti-ENqp-ANCA,c-ANCA),
tmmlai value of
coagulant protein C, activated protein C resistance, protein S, factor V Leiden, variant factor II and presence of high titres of aPL antibodies (aCL IgG 160 GPL U/ml, Igh4 55 MPL U/ml- anti 1)2-glycoprotein I IgG 150 GPL U/ml and IzM 30 MF’L U/ml- normal ranee O-11 and presence of LAC) During & observation the patient sho&d a slight butbreak of ulceradve colitis, treated with corticostexoid and 5-ASA with quick improvement It is started therapy with oral anticoagulants (acenowumarol) and, 30 days after. we observed the almost total regression of the irchemic lesions and Ihe palpable purpura on the skin of the legs in our patient the association between aPL antibodies with peculiar manifestations such as venow and arterial thrombosis permitted us the diagnosis of aPL syndrome secondary to ulcerative colitis. in this syndrome the%L antibodies-interfere with the kinetics of coagulation reactions or stimulate the prothrombaic activities of endothelial ceils and monocytes (antibody-mediated thrombosis) Although much more evidences are necessary, this case suggest that the aPL syndrome can be associated Lo uicemtive~colitis and that, whatever, the presence of aPL antibodies in patient with ulcerative colitis can determine a prothrombotic state, wen in absenceof overt thrombosis
(ELLS) IN DIAGNOSIS
Rocca E. Rowa F
U. 0. MEDICINA 7’. Azienda Os@da/iwra BUST0 ARSIZIO: Bust0 A. VA
Sackaround. The biiiary iithiasias is the more frequent cause of acute pancreatitis and it has a favourable evolution in more than 80% of the cases, The role of the therapeutic ERCP is thought to be of benefit in case of acute pancreatitis persistently severe. The diagnostic and therapeutic strategy in low or moderate pancreatitis is not well codified. TC and US have low sensibility to identify the choledocholiiiasis. EUS is a little invasive technique with elevated accuracy in defining the presence of stones, even small. in the biliiry tract. & To value if EUS can have a role in the management of acute, non severe, biliary pancreatitis. Methods. From the June 99 to March 01. 55 patients (36 women. medium age 64 year) with acute pancreatitis of suspect bilialy aetiokgy underwent to EUS within the 72 hours from the onset of symptoms. All the patients had acute low or moderate pancreatitis. Choieiithiasis was documented at USilC in 48 patients. EUS was executed with Olympus UM-20 instrument in cnnsdous sedation (Midazoiam iv). Results. 18 patients (33%) had stones in the CEO. The mean dimension was 4.2 millimetzes and 10 patients had stones smaller than 3 miliimetres or sludge. US features of choiedochal phiogosis was present in 5 patients, even in absence of fever. Peripancreatic liquid collection was documented in 28 patients (only in 12 cases at TC). in 3 out of 7 patients v&h apparently aiithiasic gallbladder EUS documented micmiiiiasis. Condusions. EUS is a useful method to identify choiedo&oiithiasis in the patients with acute biiiary pancreatitis. and can select the patients to undergo endoscopic treabnsnt. it alloW documenting small peripancreatic liquid collection not seen at TC and confirming the suspicion of biiiary aetiology in Patients with apparently alithiasic gallbladder documenting the presence of sludge or microiithiasis.
Al01
43 ACUTE PANCREATITIS IN THE ELDERLY REFERRED FOR ERCP: VALUE OF AMILASE AND LIPASE MODIFICATIONS Amuw M’, Nardi I*, Reii G’, Gagliardi A’, Sapienza M*. U.O. di Gastroenterologia (l), Divisione di Geriatria (2) and Servizio di Radiologia (3). A.O. Villa Sofia-CTO, PaIermo, Italy. Background/Aims: If normalization or reduction of am&se and/or lipase value can prediit bile duct stone clearence in the setting of acute pancreatitis in the elderly is unknown Patients and methods: Retrospective review of clinical chart of all patients ? 65 years old consecutively admitted in a l&months period at our hospital and referred for ERCP because of acute pancreatitis. Acute pancreatitis was defined as pain and one or both pancreatic enzymes elevated over upper normal limits. Changes in enzymes vahxs were evaluated between admissiin and ERCP. Results: Nii patients had acute pancmatitis, mean amilase and lipase value were 437 and 815 IU, respectively. Two patterns of enzyme behaviour were identified: unchanged, if the number of elevated enzymes was constant; improved if XI& of elevated enzymes reduced (or even both became normal). According to this definition, 5 patients were “unchanged” and 4 were “improved”. Common bile duct stones were found in 8 patients: the only patient without stones &owed an ‘unchanged” pattern. Conclusions: changes in pawreatic enzymes levels are not uselkl in predicting absence (or ckarence) of common bile duct stones in pancreatitk ERCP should be performed in every elder patient with acute pancreatitis, regardless of pancreatic enzyme pattern evolution.
42
ANTIPHOSPHOLIPID ULCERATIVE COLITIS
SYNDROME IN : A CASE REPORT
PATIENT
WITH
ENDOSCOPIC ULTRASONOGRAPHY OF ACUTE BILIARY PANCREAlIllS LeslnigaE. &&
Thromboembohc disease is an infrequent comphcatton in mflammatory bowel diseases, although many clotting defects have been described during Crohn disease and ulcerative colitis In panic&r is not yet established the meaning of the presence of antiphospholipid (CL) antibodies like anticudiolipin (KL) and lupus anticoagulant (LAC) in ulcerative colitis We report the case of a 55 year-old man got to our observation because of a critic ischemia of the fingers I and 5 (outcome in necrosis of only fifth finger) of the right foot with palpable purpura of the skin of the legs The personal history of the patient put in evidence a ulcerative colitis diagnosed 81Ihe age of 32, in clinical remission, without therapy. not Q- wave miocardid infarction at the age of 40, transient cerebral ischemic attack at the age of 44 and deep vencw thrombosis at the age of 48 The colour- doppkr ultrasound study of the abdominal aorta and of the arterial vessels of the legs and of the neck showed absence of significant stenosis The ccmmwn iaborarory tests showed only elevation of inflammatory signs (Eritrocyte sedimentation rate, C-reactive protein, etc.) On the whole ;he clinic signs permitted us Lo suppose the presence of a prothrombotic sue. Consequently we carried out specific res&hs which &wed absence of non org&np&fic auto&body
(ANqAMqASMqanti-ENqp-ANCA,c-ANCA),
tmmlai value of
coagulant protein C, activated protein C resistance, protein S, factor V Leiden, variant factor II and presence of high titres of aPL antibodies (aCL IgG 160 GPL U/ml, Igh4 55 MPL U/ml- anti 1)2-glycoprotein I IgG 150 GPL U/ml and IzM 30 MF’L U/ml- normal ranee O-11 and presence of LAC) During & observation the patient sho&d a slight butbreak of ulceradve colitis, treated with corticostexoid and 5-ASA with quick improvement It is started therapy with oral anticoagulants (acenowumarol) and, 30 days after. we observed the almost total regression of the irchemic lesions and Ihe palpable purpura on the skin of the legs in our patient the association between aPL antibodies with peculiar manifestations such as venow and arterial thrombosis permitted us the diagnosis of aPL syndrome secondary to ulcerative colitis. in this syndrome the%L antibodies-interfere with the kinetics of coagulation reactions or stimulate the prothrombaic activities of endothelial ceils and monocytes (antibody-mediated thrombosis) Although much more evidences are necessary, this case suggest that the aPL syndrome can be associated Lo uicemtive~colitis and that, whatever, the presence of aPL antibodies in patient with ulcerative colitis can determine a prothrombotic state, wen in absenceof overt thrombosis
(ELLS) IN DIAGNOSIS
Rocca E. Rowa F
U. 0. MEDICINA 7’. Azienda Os@da/iwra BUST0 ARSIZIO: Bust0 A. VA
Sackaround. The biiiary iithiasias is the more frequent cause of acute pancreatitis and it has a favourable evolution in more than 80% of the cases, The role of the therapeutic ERCP is thought to be of benefit in case of acute pancreatitis persistently severe. The diagnostic and therapeutic strategy in low or moderate pancreatitis is not well codified. TC and US have low sensibility to identify the choledocholiiiasis. EUS is a little invasive technique with elevated accuracy in defining the presence of stones, even small. in the biliiry tract. & To value if EUS can have a role in the management of acute, non severe, biliary pancreatitis. Methods. From the June 99 to March 01. 55 patients (36 women. medium age 64 year) with acute pancreatitis of suspect bilialy aetiokgy underwent to EUS within the 72 hours from the onset of symptoms. All the patients had acute low or moderate pancreatitis. Choieiithiasis was documented at USilC in 48 patients. EUS was executed with Olympus UM-20 instrument in cnnsdous sedation (Midazoiam iv). Results. 18 patients (33%) had stones in the CEO. The mean dimension was 4.2 millimetzes and 10 patients had stones smaller than 3 miliimetres or sludge. US features of choiedochal phiogosis was present in 5 patients, even in absence of fever. Peripancreatic liquid collection was documented in 28 patients (only in 12 cases at TC). in 3 out of 7 patients v&h apparently aiithiasic gallbladder EUS documented micmiiiiasis. Condusions. EUS is a useful method to identify choiedo&oiithiasis in the patients with acute biiiary pancreatitis. and can select the patients to undergo endoscopic treabnsnt. it alloW documenting small peripancreatic liquid collection not seen at TC and confirming the suspicion of biiiary aetiology in Patients with apparently alithiasic gallbladder documenting the presence of sludge or microiithiasis.
Al01