Ability to diagnose chronic external biliary fistula calculous origin

Introduction: Chronic external biliary fistulas occur in 0.4-2.4% of patients with diseases of the biliary tract and are likely to be one of the complications of surgical treatment of diseases of the biliary tract. Aim: Choose the most appropriate methods of diagnosis of chronic external biliary fistula calculous etiology by improving the diagnostic algorithm. Materials and methods: Analyzed the results of diagnosis 86 patients with chronic external biliary fistula. 79 were operated previously in other hospitals. Fistula after they have formed the following operations: cholecystostomy - 23, cholecystectomy, holedohostomii on Wisniewski - 37, cholecystectomy, choledochostomy through the cystic duct stump - 24, holedohostomii - 2. Of the 86 patients 72 were operated in urgent procedure. To clarify the diagnosis chronic external biliary fistula used the following methods: fistulocholangiography - 76, ultrasound - 71 CT - 32, fistulocholangioscopy - 9, endoscopic retrograde cholangiopancreatography - 9, the definition of sterkobilina in feces and urine urobilin - 30, determination of bilirubin in the fistulous the discharge - 17, test with methylene blue - 16. Results: One of the most informative methods for studying bile fistula is fistulocholangiography. With it identified: bile duct stones - for 74 people, cystic duct stone - 12, stenosis of the sphincter of Oddi - 48 people. Endoscopic retrograde pancreatography performed in 9 patients with follow-up and removal of stone papillosfinkterotomiey of choledochal - in 5. The accuracy of ultrasound in detecting choledocholithiasis was 86%, computed tomography - 92.3%. Fistulocholagioscopy with lithotomy was effective in 9 patients. Conclusions: None of the methods of preoperative diagnosis of chronic external biliary fistula is universal. The most valuable diagnostic information about the state of the bile ducts give fistulocholangiography, endoscopic retrograde pancreatography in some cases supplemented by ultrasound or computed tomography

Safety and efficacy of the 5-lipoxygenase-activating protein inhibitor AZD5718 in patients with recent myocardial infarction: The phase 2a FLAVOUR study

Background: Leukotrienes are pro-inflammatory vasoactive lipid mediators implicated in the pathophysiology of atherosclerotic cardiovascular disease. We studied the effect of the 5-lipoxygenase-activating protein inhibitor AZD5718 on leukotriene biosynthesis and coronary microvascular function in a single-blind, phase 2a study. Methods: Patients 7–28 days after myocardial infarction (±ST elevation), with coronary artery stenosis and Thrombolysis in Myocardial Infarction flow grade ≥ 2 after percutaneous coronary intervention, were randomized 2:1:2 to once-daily AZD5718 200 mg or 50 mg, or placebo, in 4- and 12-week cohorts. Change in urine leukotriene E4 (uLTE4) was the primary endpoint, and coronary flow velocity reserve (CFVR; via echocardiography) was the key secondary endpoint. Results: Of 129 randomized patients, 128 received treatment (200 mg, n = 52; 50 mg, n = 25; placebo, n = 51). Statistically significant reductions in uLTE4 levels of >80% were observed in both AZD5718 groups versus the placebo group at 4 and 12 weeks. No significant changes in CFVR were observed for AZD5718 versus placebo. Adverse events (AEs) occurred in 12/18, 3/6 and 6/13 patients receiving 200 mg, 50 mg and placebo, respectively, in the 4-week cohort, and in 27/34, 14/19 and 24/38 patients, respectively, in the 12-week cohort. Serious AEs in seven patients receiving AZD5718 and four receiving placebo were not treatment-related, and there were no deaths. </p