ObjectiveTo investigate the value of magnetic resonance (MR) imaging in the assessment of bile duct complications after cholecystectomy. MethodsFifty patients of having bile duct complications after cholecystectomy underwent MR imaging and had some positive manifestations. The indication for cholecystectomy was symptometic cholelithiasis in all cases. MR imaging was performed with a 1.5T clinical imager including all of the sequences of: ①T1 weighted imaging (T1WI) was performed in transverse and coronal plane before and after gadolinium-enhanced. ②T2 weighted imaging (T2WI) was performed in transverse plane. ③A true fast imaging with steadystate precession sequence (True fisp) was performed in coronal plane. ④MR cholangiopancreatography was also obtained. ResultsThe bile duct complications after cholecystectomy including: 22 cases of cholelithiasis, 15 cases of chronic cholangitis with or without bile duct abscess. Bile duct strictures or abruption at the confluence of hepatic and common bile duct in 6 and 3 cases respectively. Tumors of bile duct or pancreas in 9 cases. The other complications after cholecystectomy including bile leak with choleperitonitis and/or biloma and acute pancreatitis.ConclusionMR imaging was a valuable method for the assessment of bile duct complications after cholecystectomy. MR imaging could assess the etiology of bile duct complications. If there were bile duct obstruction, MR imaging could assess the location and the severe of obstruction. For bile duct or pancreatic tumors, MR imaging could assess the areas of tumor infiltration and resection and was helpful to select treatment methods. Before lapatoscopic cholecystectomy, the overall and careful imaging assessment for bile duct and gallbladder and its adjacent hepatic tissue and pancreas so to avoid missing the relative tumors.
Due to the special structure and material of the flexible gastrointestinal (GI) endoscopes, it is difficult to reprocess endoscopes. Infections caused by endoscope reprocessing failure often occur. Strict implementation of the guidelines/relevant national standards and manufacturer's instructions is essential to prevent the occurrence of endoscopy-related infections and ensure patient safety. In 2020, ASGE (American Society for Gastrointestinal Endoscopy) released the "multisociety guideline on reprocessing flexible GI endoscopes and accessories". This paper aimed to promote the understanding of the reprocessing process of flexible GI endoscopes by the endoscope decontamination staff, and to provide references for clinical practice.
ObjectiveTo evaluate the diagnostic value of cryptococcal antigen lateral flow immunochromatographic assay (CrAg-LFA) in bronchoalveolar lavage fluid (BALF) among pulmonary cryptococcosis (PC) patients.MethodsPatients from the Zhongshan Hospital, Xiamen University, Zhangzhou Municipal Hospital of Fujian Medical University, Second Affiliated Hospital of Fujian Medical University, and Quanzhou First Hospital of Fujian Medical University were enrolled prospectively from March 2015 to October 2018. They were confirmed without human immunodeficiency virus infection and were divided into non-PC group (236 cases) and PC group (72 cases). The PC was definitely diagnosed by histopathological evidence from lung biopsy. The CrAg-LFA and culture were performed in both the serum and BALF among the enrolled patients.ResultsAmong 72 PC patients, 54 had a positive serum CrAg-LFA, 1 had positive serum culture; 67 patients had a positive BALF CrAg-LFA, 9 had positive BALF culture. Among the non-PC group, only 1 patient had a weak positive serum CrAg-LFA, none had positive serum culture of PC; 236 cases non-PC patients underwent BALF CrAg-LFA detection, none had a positive BALF CrAg-LFA; none of the 121 cases who had BALF culture yielded a positive result in PC. The sensitivity, specificity, positive predicted value, and negative predicted value in serum were 75.0%, 99.6%, 98.2%, and 92.9%, respectively. Those above mentioned values in the BALF yielded 93.6%, 100.0%, 100.0%, and 97.9%, respectively. Among the PC group, the sensitivity was higher in BALF than that in serum (χ2=8.745, P<0.05).ConclusionsThe CrAg-LFA is a simple and rapid diagnostic method for PC. The diagnostic value of CrAg-LFA in the BALF is superior to that in serum and fungal culture among the PC patients. The positive BALF CrAg-LFA result is consistent with mycological positive results.