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Sample records for bile duct exploration

  1. Early bile duct cancer

    Institute of Scientific and Technical Information of China (English)

    Jae Myung Cha; Myung-Hwan Kim; Se Jin Jang

    2007-01-01

    Bile duct cancers are frequently diagnosed as advanced diseases. Over half of patients with advanced bile duct cancer present with unresectable malignancies and their prognosis has been very poor even after curative resections. Although there has been a need to diagnose bile duct cancer at its early stage, it has been a difficult goal to achieve due to our lack of knowledge regarding this disease entity. Early bile duct cancer may be defined as a carcinoma whose invasion is confined within the fibromuscular layer of the extrahepatic bile duct or intrahepatic large bile duct without distant metastasis irrespective of lymph node involvement. Approximately 3%-10% of resected bile duct cancers have been reported to be early cancers in the literature. The clinicopathological features of patients with early bile duct cancer differ from those of patients with advanced bile duct cancer, with more frequent asymptomatic presentation, characteristic histopathological findings,and excellent prognosis. This manuscript is organized to emphasize the need for convening an international consensus to develop the concept of early bile duct cancer.

  2. Laparoscopic common bile duct exploration and antegrade biliary stenting: Leaving behind the Kehr tube

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    Darío Martínez-Baena

    2013-03-01

    Full Text Available Introduction: single-stage laparoscopic surgery of cholelithiasis and associated common bile duct stones (CL-CBDS has shown similar results when compared to laparoscopic cholecystectomy combined with ERCP. Classically, choledochorrhaphy has been protected by a T-tube drain to allow external bypass of bile flow. However, its removal is associated with a significant complication rate. Use of antegrade biliary stents avoids T-tube removal associated morbidity. The aim of this study is to compare the results of choledochorrhaphy plus T-tube drainage versus antegrade biliary stenting in our series of laparoscopic common bile duct explorations (LCBDE. Material and methods: between 2004 and 2011, 75 patients underwent a LCBDE. Choledochorrhaphy was performed following Kehr tube placements in 47 cases and transpapillary biliary stenting was conducted in the remaining 28 patients. Results: postoperative hospital stay was shorter in the stent group (5 ± 10.26 days than in the Kehr group (12 ± 10.6 days, with a statistically significant difference. There was a greater trend to grade B complications in the stent group (10.7 vs. 4.3 % and to grade C complications in the Kehr group (6.4 vs. 3.6 %. There were 3 cases of residual common bile duct stones in the Kehr group (6.4 % and none in the stent group. Conclusions: antegrade biliary stenting following laparoscopic common bile duct exploration for CL-CBDS is an effective and safe technique that prevents T-tube related morbidity.

  3. Laparoscopic hepatic left lateral Iobectomy combined with fiber choledochoscopic exploration of the common bile duct and traditional open operation

    Institute of Scientific and Technical Information of China (English)

    Kun Zhang; ShaoGeng Zhang; Yi Jiang; Peng-Fen Gao; Hai-Ying Xie; Zhi-Hong Xie

    2008-01-01

    AIM:To investigate the possibilities and advantages of laparoscopic hepatic left lateral Iobectomy combined with fiber choledochoscopic exploration of the common bile duct compaired with traditional open operation.METHODS:Laparoscopic hepatic left lateral Iobectomy combined with fiber choledochoscopic exploration of the common bile duct and traditional open operation were performed in two groups of patients who had gallstones in the left lobe of liver and in the common bile duct.The hospitalization time,hospitalization costs,operation time,operative complications and post-operative liver functions of the two groups of patients were studied.RESULTS:The operation time and post-operative liver functions of the two groups of patients had no significant differences,while the hospitalization time,hospitalization costs and operative complications of the laparoscopic hepatic left lateral Iobectomy combined with fiber choledochoscopic exploration in the common bile duct group were significantly lower than those in the traditional open operation group.CONCLUSION:For patients with gallstones in the left lobe of liver and in the common bile duct,laparoscopic hepatic left lateral Iobectomy combined with fiber choledochoscopic exploration of the common bile duct can significantly shorten the hospitalization time,reduce the hospitalization costs and the post-operative complications,without prolonging the operation time and bringing about more liver function damages compared with traditional open operation.This kind of operation has more advantages than traditional open operation.

  4. Gallblader and bile duct

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    2009215 Construction of the specific MUC5AC-siRNA expression plasmid and effect of siRNA on proliferation and apoptosis in human bile duct cancer line HCCC-9810.HUANG Qing(黄强),et al.Dept General Surg,Affili Prov Hosp,Anhui Med Univ,Hefei 230001.World Chin J Digestol.2009;17(6):566-572.

  5. Bile duct malignancies.

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    Tucek, S; Tomasek, J; Halámkova, J; Kiss, I; Andrasina, T; Hemmelová, B; Adámková-Krákorová, D; Vyzula, R

    2010-01-01

    Bile duct malignancies include intrahepatic cholangiocarcinoma (ICC), extrahepatic cholangiocarcinoma (ECC), gall bladder carcinoma (GC) and carcinoma of Vater's ampulla (ampulloma). Bile duct neoplasms are rare tumours with overall poor prognosis. The overall incidence affects up to 12.5 per 100,000 persons in the Czech Republic. The mortality rate has risen recently to 9.5 per 100,000 persons. The incidence and mortality have been remarkably stable over the past 3 decades. The survival rate of patients with these tumours is poor, usually not exceeding 12 months. The diagnostic process is complex, uneasy and usually late. Most cases are diagnosed when unresectable, and palliative treatment is the main approach of medical care for these tumours. The treatment remains very challenging. New approaches have not brought much improvement in this field. Standards of palliative care are lacking and quality of life assessments are surprisingly not common. From the scarce data it seems, however, that multimodal individually tailored treatment can prolong patients'survival and improve the health-related quality of life. The care in specialized centres offers methods of surgery, interventional radiology, clinical oncology and high quality supportive care. These methods are discussed in the article in greater detail. Improvements in this field can be sought in new diagnostic methods and new procedures in surgery and interventional radiology. Understanding the tumour biology on the molecular level could shift the strategy to a more successful one, resulting in more cured patients. Further improvements in palliative care can be sought by defining new targets and new drug development. The lack of patients with bile duct neoplasms has been the limiting factor for any improvements. A new design of larger randomized international multicentric clinical trials with prompt data sharing could help to overcome this major problem. Defining standards of palliative care is a necessity

  6. Gallbladder and bile duct

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930559 An experimental study on effective hep-atic blood flow and hepatic energy metabolismfollowing acute obstructive cholangitis and bil-iary obstruction.SUN Wenbing (孙文兵),et al.Hepatobili Surg,Center,Southwest Hosp,Chongqing 630000.Chin J Digest 1992;12(5):261—263.The changes of effective hepatic blood flow(E-HBF)and hepatic energy metabolism were stud-ied following acutc obstructive cholangitis(AOC)and bile duct ligation(BDL)in rats.The resultsshowed that EHBF was significantly decreased at24hs after and further decreased at 48hs afterBDL.And EHBF was significantly decreased at

  7. Inappropriate secretion of antidiuretic hormone:a rare complication after common bile duct exploration

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    Yu Ruan; Wei Zhang; Qing-Qing Wang

    2009-01-01

    BACKGROUND: The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) as a dilutional hyponatremia is due to a pathological increase of antidiuretic hormone (ADH). It is characterized by hyponatremia and decreased serum osmolarity as well as an increase in urinary osmolarity. The most common etiological factors of this syndrome include diseases or trauma of the central nervous system and malignant tumor or inflammation of the lung. SIADH following abdominal surgery is rare. METHODS: We report the case of a 68-year-old woman who developed, 24 hours after common bile duct exploration and stone removal, continuous hyponatremia for 20 days and clinical manifestations of nausea, vomiting, and lethargy without focal neurological signs. RESULT: Laboratory examinations supported the diagnosis of SIADH. After therapy with fluid restriction, the patient recovered. CONCLUSION: There are diverse causes for SIADH. It is important to have kept this clinical possibility in mind in the differential diagnosis of refractory hyponatremia under any circumstances.

  8. Bile duct obstruction

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    ... the liver. It contains cholesterol, bile salts, and waste products such as bilirubin . Bile salts help your ... can lead to life-threatening infection and a dangerous buildup of bilirubin. If the blockage lasts a ...

  9. Spontaneous Bile Duct Rupture in Pregnancy

    OpenAIRE

    Piotrowski, Joseph J.; Greg Van Stiegmann; R. Dale Liechty

    1990-01-01

    Spontaneous bile duct rupture occurred in a 23-year-old who required emergency Cesarean section for fetal distress. This condition has not been reported in association with pregnancy. Only forty cases of spontaneous bile duct perforation in adults have been previously reported. Seventy percent of these perforations were related to biliary calculi. Sites of perforation were evenly distributed between common hepatic duct and common bile duct. Recommended treatment includes cholecystectomy, comm...

  10. Primary closure after laparoscopic common bile duct exploration%腹腔镜胆总管探查术后一期缝合的临床应用

    Institute of Scientific and Technical Information of China (English)

    彭云恒; 谢德金; 彭启全

    2014-01-01

    目的 研究腹腔镜胆总管探查(LCBDE)术后胆总管一期缝合的安全性及临床应用价值.方法 分析140例腹腔镜胆总管切开探查取石术的临床资料,对比研究胆总管一期缝合(实验组,n=70)与T管引流(对照组,n=70)的临床效果.结果 两组手术时间、腹腔引流时间、肝功能恢复、黄疸消退、术后胆瘘、残石率、结石复发等情况差异无统计学意义(P>0.05);实验组术后肛门排气时间、住院时间较对照组短(P< 0.05).结论 只要掌握适应证,LCBDE术后胆总管一期缝合是安全可行的,更避免了留置T管的弊端,值得推广应用.%Objective To investigate the safety and clinical value of primary closure after laparoscopic common bile duct exploration (LCBDE).Methods The clinical data of 140 patients undergoing laparoscopic common bile duct exploration were analyzed.70 cases were primarily closed the common bile ducts (experimental group),while the other 70 cases had T-tube drainage of common bile duct (control group).Results There were no statistical differences in operation time,abdominal drainage time,recovery of liver function,decline of serum bilirubin,postoperative bile leakage,retained bile duct stones,bile duct recurrent stones between the two groups (P > 0.05).Postoperative hospital stay and anal exhaustion time were shorter in the experimental group than in the control group (P < 0.05).Conclusions If only the indication is properly mastered,the primary closure after laparoscopic common bile duct exploration can be safe and feasible.It can avoid the disadvantage of T-tube drainage of common bile duct and is worth being generalized.

  11. Iatrogenic bile duct injuries – clinical problems

    Directory of Open Access Journals (Sweden)

    Głuszek Stanisław

    2014-01-01

    Full Text Available Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures in surgical wards. Iatrogenic bile duct injuries (IBDI incurred during the procedures are among postoperative complications that are most difficult to treat. The risk of bile duct injury is 0.2-0.4%, and their consequences are unpleasant both for the surgeon and for the patient.

  12. A rare case of bile duct cyst

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    Qing-Gang Wang; Shu-Tian Zhang

    2009-01-01

    Choledochal cyst is an uncommon disease usually seen in young women and can be divided into five types. We report a 66-year-old woman who was diagnosed with types Ⅱ and Ⅱ bile duct cyst simultaneously after surgery, which is a rare type of bile duct cyst.

  13. Management of excluded segmental bile duct leakage following liver resection

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    Honoré, Charles; Vibert, Eric; Hoti, Emir; Azoulay, Daniel; Adam, René; Castaing, Denis

    2009-01-01

    Background: Postoperative bile leak secondary to a fistula is a known complication of hepatic surgery. Four different biliary fistula sub-types have been described: type A refers to minor leakage from the bile duct stump; type B to major leakage caused by insufficient closure of the bile duct stump; type C to major leakage caused by injury to the bile duct, and type D (the rarest) to the division and exclusion of a bile duct. This complication results from functional liver parenchyma in which bile drainage is excluded from the main duct. Methods: A retrospective review of the database for 163 patients diagnosed with post-hepatic surgery bile leak from April 1992 to June 2007 was performed. Results: Three patients were found to have type D biliary fistula, with durations of 3–21 months. The bile leak developed after a right hepatectomy in two patients and a right hepatectomy extending to segment IV in one patient. All three patients were rescheduled for surgical exploration, following failure of medical treatment. The procedure consisted of repeat resection of the independent liver parenchyma containing the fistula. One patient developed a postoperative leak from a hepaticojejunal anastomosis (treated conservatively) and the other two patients had an uneventful recovery. No recurrence of bile leak was encountered during their follow-up. Conclusions: Our experience indicates that conservative treatment is deceptive and not efficacious. For this condition, surgical intervention is the treatment of choice because it is very effective and is associated with a low morbidity. PMID:19718366

  14. Bile Duct Adenoma with Oncocytic Features

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    E. J. Johannesen

    2014-01-01

    Full Text Available Bile duct adenomas are benign bile duct proliferations usually encountered as an incidental finding. Oncocytic bile duct neoplasms are rare and the majority are malignant. A 61-year-old male with a diagnosis of colorectal adenocarcinoma was undergoing surgery when a small white nodule was discovered on the surface of the right lobe of his liver. This lesion was composed of cytologically bland cells arranged in tightly packed glands. These cells were immunopositive for cytokeratin 7, negative for Hep Par 1, contained mucin, and had a Ki67 proliferation index of 8%. The morphology, immunophenotype, presence of mucin, and normal appearing bile ducts, as well as the increased Ki67 proliferation rate, were consistent with a bile duct adenoma with oxyphilic (oncocytic change. Oncocytic tumors in the liver are rare; the first described in 1992. Only two bile duct adenomas with oncocytic change have been reported and neither of them had reported mucin production or the presence of normal appearing bile ducts within the lesion.

  15. The first case of pediatric bile duct adenoma

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    Zhi Li; Xiaoyi Sun; Jiexiong Feng

    2015-01-01

    Intrahepatic bile duct adenoma (BDA) is a rare benign epithelial liver tumor derived from bile duct cells. We report the first case of pediatric bile duct adenoma in the world. Furthermore, we review the diagnosis, pathology, treatment and prognosis of bile duct adenoma.

  16. Primary hepatocellular carcinoma in extrahepatic bile duct

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    Jeong, Seok Tae; Ham, Soo Youn; Park, Cheol Min; Kim, Jung Hyuk; Cha, In Ho; Chung, Kyoo Byung; Suh, Woon Hyuck; Lee, Chang Hong [College of Medicine, Korea University, Seoul (Korea, Republic of)

    1991-03-15

    Obstructive jaundice due to hepatocellular carcinoma in an extrahepatic bile duct, without a mass lesion in the liver parenchyma, is extremely rare. We experienced two cases of primary hepatocellular carcinoma arising from an extrahepatic bile duct: one in a 53-year-old man whose {alpha} -fetoprotein value was 800 ng/ml, and another in a 39-year-old woman, in whom the mass lesion was found to be attached to an extrahepatic bile duct. These tumors had a well-marginated sausage-like shape on CT and US, and the contrast media passed freely along their margins on both PTC and ERCP. Recurrences of these tumors were observed in the extrahepatic bile duct 6 and 2 months after surgery, respectively.

  17. [Isolated neurofibroma of the common bile duct].

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    Carbia, S; Pagola, J; Flaster, N; Guida, A; Jufe, L; González, B; Caniparoli, A

    1995-01-01

    The neurogenic tumors in the biliary tract are rare and usually are amputation neuroma that occur after cholecystectomy. We describe a case of isolated neurofibroma of the common bile duct in a young man not cholecystectomized. The patient suffered recurrent episodes of abdominal pain, vomiting and weight loss without clinical signs of Von Recklinghausen's disease or jaundice. The hepatogram was normal. The echography indicated a solid formation with obstruction of the proximal common bile duct. In the ERCP the stenosis was found. Surgical excision of the tumor and anastomosis of bilateral hepatic ducts and jejunum were carried out. At microscopic examination intraparietal neurofibroma of the common bile duct was found. As isolated entity, we know of only one reported case. PMID:8731581

  18. Rare bile duct anomaly: B3 duct draining to gallbladder

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    Seung Eun Lee

    2016-01-01

    Full Text Available A 10-year-old girl presented with recurrent right upper abdominal pain and dyspepsia. Magnetic resonance cholangiopancreatography revealed a dilated common channel of intrahepatic bile duct of segment 3 (B3 and segment 4 (B4 drained into the gallbladder directly. The patient underwent laparoscopic cholecystectomy and Roux-en Y hepaticojejunostomy (B3-jejunostomy. Among the anatomical variability of the biliary system, the cholecystohepatic ducts are controversial in existence and incidence. We report a very rare variant of a cholecystohepatic duct in which the B3 duct drained into gallbladder directly and to the best of our knowledge this is the first report.

  19. Double common bile duct: A case report

    Institute of Scientific and Technical Information of China (English)

    Srdjan P Djuranovic; Milenko B Ugljesic; Nenad S Mijalkovic; Viktorija A Korneti; Nada V Kovacevic; Tamara M Alempijevic; Slaven V Radulovic; Dragan V Tomic; Milan M Spuran

    2007-01-01

    Double common bile duct (DCBD) is a rare congenital anomaly in which two common bile ducts exist. One usually has normal drainage into the papilla duodeni major and the other usually named accessory common bile duct (ACBD) opens in different parts of upper gastrointestinal tract (stomach, duodenum, ductus pancreaticus or septum). This anomaly is of great importance since it is often associated with biliary lithiasis, choledochal cyst, anomalous pancreaticobiliary junction (APBJ) and upper gastrointestinal tract malignancies. We recently recognized a rare case of DCBD associated with APBJ with lithiasis in better developed common bile duct. The opening site of ACBD was in the pancreatic duct. The anomaly was suspected by transabdominal ultrasonography and finally confirmed by endoscopic retrograde cholangiopancreatography (ERCP) followed by endoscopic sphincterotomy and stone extraction. According to the literature, the existence of DCBD with the opening of ACBD in the pancreatic duct is most frequently associated with APBJ and gallbladder carcinoma. In case of DCBD, the opening site of ACBD is of greatest clinical importance because of its close implications with concomitant pathology. The adequate diagnosis of this rare anomaly is significant since the operative complications may occur in cases with DCBD which is not recognized prior to surgical treatment.

  20. 腹腔镜胆管探查1273例报告%A 1273 cases report of laparoscopic common bile duct exploration

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    田刚; 陈安平; 尹思能; 龙飞伍; 肖宏; 陈先林; 孙科

    2011-01-01

    Objective To summarized clinical experience of laparoscopic common bile duct exploration.Methods Retrospective analysis clinical data of 1273 samples which were performed laparoscopic exploration of common bile duct in our institution from 1992 to 2007.Results 1260 cases were successful performed laparoscopic common bile duct exploration.13 cases were diverted open operation because of unruly bleeding, liver or bile duct neoplasma, blie duct injuries, Mirizzi syndrome, refractory huge stones, anatomical variation of duodenohepatic ligament, tiny diameter of common bile duct, abortive laparoscopic biliary-intestinal tract internal drainage, et al.operative achievement ratio was 98.97% (1260/1273).In all 1260 cases, 564 cases were implanted tee-pipe, 690 cases were performed primary bile duct suture, 6 cases were executed laparoscopic biliary-intestinal tract internal drainage.Bile leakage was detected in 42 cases postoperative, in which 5 cases were implanted tee-pipe again because of exodus of tee-pipe or severe peritonitis, the others were cured by perseverative drainage and conservative therapy.No one patient died during operation and 7 senile patient died in one month after operation.Mortality was 0.54% (7/1273).Negative morbid change was detected in 85 cases, and negative exploration rate was 6.75 % (85/1260).Mean of hemorrhage was 30.7ml,and average of operative time was 147 minute, and average length of stay was 9.1 days.Recovery rate was 99.44% (1253/1260)in operative achievement.Conclusion Indication of laparoscopic common bile duct exploration of bile duct stones was extensive,which was a safety and effective therapeutic method, and which can be preferred method to treat bile duct stone, especially extrahepatic bile duct stone, in salty institute.%目的 总结腹腔镜胆管探查术的临床应用经验.方法 回顾性分析1992~2007年我院已开展的腹腔镜胆管探查(LCBDE)1273例的临床资料.结果 1273例中有1260例成功施

  1. Bile Duct Exploration

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  2. The "flying" bile duct: avulsion of the common bile duct in a plane crash survivor.

    LENUS (Irish Health Repository)

    Mohan, H

    2012-02-01

    Blunt trauma is an unusual cause of extrahepatic bile duct injury. This is a case of a 51-year-old gentleman who sustained a significant seatbelt injury in a plane crash. Laparotomy, performed due to persistent abdominal pain, revealed that the common bile duct (CBD) was completely avulsed from the duodenum. Following insertion of drains and transfer to a hepatobiliary centre, the devascularised CBD was excised and replaced with a roux-en-y hepaticojejunostomy. Necrotic tissue was debrided from the pancreatic head. A persistent bile leak developed from the sub-hepatic drain. Repeat laparotomy revealed a bile leak from small ducts on the liver surface. Ligation of the ducts and bioglue sealing of the area were successfully performed. Subsequent to this a pancreatic fistula developed from the main pancreatic duct, which has since resolved. This unusual case illustrates the need for prompt recognition and early repair to optimise outcomes in traumatic CBD injury.

  3. Classiifcation of iatrogenic bile duct injur y

    Institute of Scientific and Technical Information of China (English)

    Wan-Yee Lau; Eric C.H. Lai

    2007-01-01

    BACKGROUND: Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. This article reviews the various classiifcation systems of bile duct injury. DATA SOURCES: A Medline, PubMed database search was performed to identify relevant articles using the keywords"bile duct injury", "cholecystectomy", and “classiifcation”. Additional papers were identiifed by a manual search of the references from the key articles. RESULTS: Traditionally, biliary injuries have been classiifed using the Bismuth's classiifcation. This classiifcation, which originated from the era of open surgery, is intended to help the surgeons to choose the appropriate technique for the repair, and it has a good correlation with the ifnal outcome after surgical repair. However, the Bismuth's classiifcation does not encompass the whole spectrum of injuries that are possible. Bile duct injury during laparoscopic cholecystectomy tends to be more severe than those with open cholecystectomy. Strasberg’s classiifcation made Bismuth’s classiifcation much more comprehensive by including various other types of extrahepatic bile duct injuries. Our group, Bergman et al, Neuhaus et al, Csendes et al, and Stewart et al have also proposed other classiifcation systems to complement the Bismuth's classiifcation. CONCLUSIONS:None of the classiifcation system is universally accepted as each has its own limitation. Hopefully, a universally accepted comprehensive classiifcation system will be published in the near future.

  4. Laparoscopic common bile duct exploration: A clinic analysis of 1273 case%1273例腹腔镜胆管探查临床分析

    Institute of Scientific and Technical Information of China (English)

    田刚; 陈安平; 尹思能; 龙飞伍; 肖宏; 陈先林; 孙科; 王征夏; 王一平

    2011-01-01

    目的 探讨腹腔镜胆管探查(LCBDE)的手术适应证、术前诊断、术式选择、并发症的防治及其临床 应用的安全性和价值.方法 结合文献,回顾性分析1992年~2007年该院1 273例腹腔镜胆管探查的临床资料.结果 1 273例患者中有肝外胆管结石1 148例,占90.18%(1 148/1 273),程度不同的急性胆管炎188例,占14.76%(188/1273),60岁以上老年患者549例,占43.12%(549/1 273);共有1260例成功施行了LCBDE,因 各种原因放弃LCBDE或改为开腹手术13例,手术成功率98.97%(1 260/1 273).在成功实施LCBDE的1 260例中,安放T管564例,一期缝合690例,腹腔镜下胆肠内引流术6例.术后漏胆42例,除重置T管5例外,余经持续引流保守治愈.没有术中死亡,术后1个月内死亡7例,均为老年患者.手术死亡率0.54%(7/1 273).胆管阴性探查85例,阴性探查率6.75%(85/1 260).术中平均失血30.7 mL,平均手术时间147 min,术后平均住院时间9.1 d.治愈好转率99.44%(1 253/1 260).结论 LCBDE是一种有效、安全、适应证广泛的胆管结石的微创治疗方法.若能把控好手术相关细节,可以作为胆管结石,尤其是肝外胆管结石的首选术式.%[Objective] To investigate diagnosis, technique, operative indication and complication, and reliability of laparoscopic common bile duct exploration (LCBDE). [Method] Retrospective analysis of clinical data of 1273 samples were performed of laparoscopic exploration of common bile duct in our institution from 1992 to 2007. [Result] Extrahepatic bile duct stone was 1148 cases, 90.18% (1148/1273). Acute cholangitis was 188 cases, 14.67% (188/1273). Over 60 year's patient was 549 cases, 43.12% (549/1273). 1260 cases were successful performed laparoscopic common bile duct exploration. 13 cases were diverted open operation or given up to continue executing laparoscopic common bile duct exploration for different reason. Operative achievement ratio was 98.97% (1260/1273). In all 1260 cases, 564

  5. A case of fascioliasis in common bile duct

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    Ham, Soo Youn; Park, Cheol Min; Chung, Kyu Byung; Lee, Chang Hong; Park, Seung Chul; Choi, Sang Yong; Lim, Han Jong [Korea University College of Medicine, Seoul (Korea, Republic of)

    1989-10-15

    A case of Fascioliasis of common bile duct is confirmed by visualization of adult fluke. Fascioliasis caused by Fasciola hepatica, is common parasitic disease in cattle and sheep. Human is an accidental host. ERCP demonstrated irregular linear conglomerated filling defects in common bile duct. Through surgical intervention, we found adult flukes of F. hepatica and adenomatous hyperplasia of common bile duct.

  6. Percutaneous treatment of benign bile duct strictures

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    Koecher, Martin [Department of Radiology, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic)]. E-mail: martin.kocher@seznam.cz; Cerna, Marie [Department of Radiology, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Havlik, Roman [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Kral, Vladimir [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Gryga, Adolf [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Duda, Miloslav [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic)

    2007-05-15

    Purpose: To evaluate long-term results of treatment of benign bile duct strictures. Materials and methods: From February 1994 to November 2005, 21 patients (9 men, 12 women) with median age of 50.6 years (range 27-77 years) were indicated to percutaneous treatment of benign bile duct stricture. Stricture of hepatic ducts junction resulting from thermic injury during laparoscopic cholecystectomy was indication for treatment in one patient, stricture of hepaticojejunostomy was indication for treatment in all other patients. Clinical symptoms (obstructive jaundice, anicteric cholestasis, cholangitis or biliary cirrhosis) have appeared from 3 months to 12 years after surgery. Results: Initial internal/external biliary drainage was successful in 20 patients out of 21. These 20 patients after successful initial drainage were treated by balloon dilatation and long-term internal/external drainage. Sixteen patients were symptoms free during the follow-up. The relapse of clinical symptoms has appeared in four patients 9, 12, 14 and 24 months after treatment. One year primary clinical success rate of treatment for benign bile duct stricture was 94%. Additional two patients are symptoms free after redilatation (15 and 45 months). One patient is still in treatment, one patient died during secondary treatment period without interrelation with biliary intervention. The secondary clinical success rate is 100%. Conclusion: Benign bile duct strictures of hepatic ducts junction or biliary-enteric anastomosis are difficult to treat surgically and endoscopically inaccessible. Percutaneous treatment by balloon dilatation and long-term internal/external drainage is feasible in the majority of these patients. It is minimally invasive, safe and effective.

  7. Benign disease of the common bile duct.

    Science.gov (United States)

    Saxena, R; Pradeep, R; Chander, J; Kumar, P; Wig, J D; Yadav, R V; Kaushik, S P

    1988-08-01

    The incidence of common bile duct (CBD) pathology in a group of patients with benign biliary disease (n = 505) was found to be 23.2 per cent. The spectrum included 111 patients (90.2 per cent) with CBD stones, 37 of whom (33.3 per cent) had no symptoms or findings pre-operatively indicating CBD involvement. Five patients had papillary stenosis, three had postoperative CBD strictures, one had a choledochal cyst and one had an external biliary fistula. Of the 100 CBDs measuring more than 10 mm in diameter, 90 harboured calculi. In the remaining 23 CBDs measuring less than 10 mm, calculi were present in 21. The presence of CBD calculi was demonstrated by intra-operative cholangiography in 49 patients. In the remaining patients (n = 74), the diagnosis of CBD pathology was made either by percutaneous transhepatic cholangiography, endoscopic retrograde cholangio-pancreatography, T-tube cholangiography or peroperative palpation. The surgical procedures performed included choledochotomy and T-tube drainage (n = 74), transduodenal sphincteroplasty (n = 27) and choledochoduodenostomy (n = 18). The overall mortality and morbidity of CBD exploration was 3.3 per cent and 24.4 per cent respectively, which was significantly greater than that for cholecystectomy alone (0.3 per cent and 8.6 per cent respectively). Transduodenal sphincteroplasty carried a much higher mortality (11 per cent) and morbidity (52 per cent) when compared with other procedures. PMID:3167536

  8. [Liver, bile ducts and pancreatic diseases].

    Science.gov (United States)

    Kanno, T

    1995-06-01

    A fundamental guideline for the use of test results concerning liver, bile duct and pancreatic diseases was proposed in 1991 from the Japan Society of Clinical Pathology (JSCP). This guideline was principally based on the document of 1988 from the Committee on liver function tests of the Japanese Society of Gastroenterology (JSG). The document from the JSG was revised in May, 1994. Also a guideline for selection of markers of hepatitis virus in hepatic disorders, was proposed in January, 1994 from the same Committee of JSG. Here, we reevaluated and discussed the JSCP guideline as taking into consideration the two 1994 JSG documents. PMID:7602802

  9. Aberrant bile ducts, 'remnant surface bile ducts,' and peribiliary glands: descriptive anatomy, historical nomenclature, and surgical implications.

    Science.gov (United States)

    El Gharbawy, Ramadan M; Skandalakis, Lee J; Heffron, Thomas G; Skandalakis, John E

    2011-05-01

    The term "aberrant bile ducts" has been used to designate three heterogeneous groups of biliary structures: (1) bile ducts degenerating or disappearing (unknown etiology, diverse locations); (2) curious biliary structures in the transverse fissure; and (3) aberrant right bile ducts draining directly into the common hepatic duct. We report our observations on these three groups. Twenty-nine fresh human livers of stillborns and adults were injected differentially with colored latex and dissected. Adult livers showed portal venous and hepatic arterial branches, and bile ducts not associated with parenchyma, subjacent to and firmly adherent with the liver capsule: elements of ramifications of normal sheaths were present on the liver's surface. These ramifications, having lost parenchyma associated with them, then sequentially lost their portal branches, bile ducts and arterial branches. This process affected the ramifications of the sheaths in the left triangular ligament, adjacent to the inferior vena cava, in the gallbladder bed and anywhere else on the liver's surface and resulted in the presence of bile ducts accompanied by portal venous and/or hepatic arterial branches and not associated with parenchyma for a period of time. This first group represented normal bile ducts that do not meet the criteria of aberration and could be appropriately designated "remnant surface bile ducts." Such changes were not found in the transverse fissures and review of the literature revealed that the curious biliary structures are the microscopic peribiliary glands. The third group met the criteria of aberration and the anatomy of a representative duct is described.

  10. Clinical research on primary closure of common bile duct after choledochal exploration%胆总管探查一期缝合的临床研究

    Institute of Scientific and Technical Information of China (English)

    张鸿涛; 崔云峰; 苗彬; 李忠廉

    2011-01-01

    目的 探讨胆总管探查后一期缝合的可行性和指征.方法 对近3年间胆总管结石患者行胆总管探查后一期缝合149例与T管引流356例的临床资料进行比较.结果 一期缝合组和T管引流组术后分别有2例和13例术后腹腔引流液含胆汁,均未作特殊处理,持续引流3~7 d后消失.一期缝合组术后平均输液量5.2 L,平均正常进食时间2.2 d,平均住院时间7.2 d;与T管引流组的术后平均输液量(11.1 L),平均正常进食时间(6 d),平均住院时间(16.7 d)相比,差异均有统计学意义(均P<0.05).术后随访1~3年,胆管一期缝合组无胆管狭窄及胆管结石发生,T管引流组有5例在随访过程中发现胆管狭窄,狭窄部位为T管引流处,均经再次行手术治疗.结论 在经过严格选择的胆总管结石行择期胆总管探查病例中,经术中胆道镜排除残石后,一期缝合是一种安全有效的术式.%Objective To investigate the feasibility and indications of primary closure of the common bile duct ( CBD ) after choledochal exploration. Methods From January 2006 to January 2009, 149 patients with CBD stone(s) received primary closure of the common bile duct (group A) and were compared with 356 patients with CBD stone (s) who received T-tube drainage (group B ) after choledochal exploration.Intraoperative choledochoscopy was performed routinely to rule out the possibility of retained stones. The CBD was meticulously stitched using 5-0 monocryl absorbent sutures for primary closure. Following primary closure of the CBD, a drainage tube was placed in the subhepatic space. Results Postoperative bile leakage was observed in 2 patients in group A and 13 in group B respectively ( P > 0. 05 ) , but no reoperations were necessary. After surgery, the average volume of transfusion, normal eating time and postoperative hospital stay was 5.2 liters, 2.2 days and 7.2 days, respectively, in group A, versus 11. 1 liters, 6 days and 16.7 days, respectively

  11. What Are the Risk Factors for Bile Duct Cancer?

    Science.gov (United States)

    ... What are the risk factors for bile duct cancer? A risk factor is anything that affects your chance of getting ... to top » Guide Topics What Is Bile Duct Cancer? Causes, Risk Factors, and Prevention Early Detection, Diagnosis, and Staging Treating ...

  12. Do We Know What Causes Bile Duct Cancer?

    Science.gov (United States)

    ... Topic Can bile duct cancer be prevented? Do we know what causes bile duct cancer? We don’t know the exact cause of most ... genes – the instructions for how our cells function. We usually look like our parents because they are ...

  13. Hepatobiliary Scan in Infantile Spontaneous Perforation of Common Bile Duct

    Energy Technology Data Exchange (ETDEWEB)

    Zeon, Seok Kil; Ryu, Jong Gul; Lee, Eun Young [Keimyung University School of Medicine, Taegu (Korea, Republic of); Lee, Jong Gil [Taegu Fatima Hospital, Taegu (Korea, Republic of)

    1996-03-15

    Spontaneous perforation of CBD in infant is a rare but fatal disease. We report a case of bile leakage from common bile duct in 11 months old girl with progressive abdominal distension and vomiting, preoperatively diagnosed by hepatobiliary scan with Tc-99m-DISIDA, which was confirmed by surgery. Operative cholangiogram showed a small perforation at the confluence of cystic duct and common bile duct with mild fusiform dilatation, and no definite abnormality in confluence of the common bile duct and pancreatic duct. Simple drainage of the free peritoneal bilous fluid and T-tube drainage were performed without any evidence of the complication. Patient was inevitable for 6 months OPD follow-up examination.

  14. Role of endoscopic ultrasound in common bile duct stones

    Directory of Open Access Journals (Sweden)

    Aljebreen Abdulrahman

    2007-01-01

    Full Text Available When the clinical features strongly suggest the presence of bile duct stones, management is fairly straightforward; diagnostic and therapeutic endoscopic retrograde cholangiography (ERC may in some cases constitute the entire strategy. Unfortunately, the clinical picture is often equivocal or uncertain. Although stones are unlikely to be present in the bile duct when the clinical index of suspicion is low, their presence can never be completely ruled out based on clinical and biochemical parameters. Thus, an accurate, noninvasive, reliable, and safe method for bile duct imaging would be highly advantageous. Low-risk tests, such as endoscopic ultrasound (EUS, are emerging as reliable substitutes for diagnostic ERC. This review highlights the technical aspects of examining the extra-hepatic biliary duct system and the performance and results of EUS in diagnosing patients who present with possible common bile duct stones.

  15. Bile Duct Diseases - Multiple Languages: MedlinePlus

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Bile Duct Diseases URL of this page: https://medlineplus.gov/languages/bileductdiseases.html Other topics A-Z A B ...

  16. Pancreatitis complicating mucin-hypersecreting common bile duct adenoma

    Institute of Scientific and Technical Information of China (English)

    Panagiotis Katsinelos; George Basdanis; Grigorios Chatzimavroudis; Giorgia Karagiannoulou; Taxiarchis Katsinelos; George Paroutoglou; Basilios Papaziogas; George Paraskevas

    2006-01-01

    Villous adenomas of the bile ducts are extremely uncommon. We describe a 58-year-old man presenting with clinical signs and laboratory findings of acute pancreatitis and obstructive jaundice. Preoperative investigation demonstrated a dilated papillary orifice with mucus exiting (fish-mouth sign) and a filling defect in the distal common bile duct. He underwent a modified Whipple operation and histological examination of the surgical specimen showed villous adenoma with rich secretion of mucus.

  17. A case of peribiliary cysts accompanying bile duct carcinoma

    Institute of Scientific and Technical Information of China (English)

    Fumihiko Miura; Tadahiro Takada; Hodaka Amano; Masahiro Yoshida; Takahiro Isaka; Naoyuki Toyota; Keita Wada; Kenji Takagi; Kenichiro Karo

    2006-01-01

    A rare case of peribiliary cysts accompaying bile duct carcinoma is presented. A 54-year-old man was diagnosed as having lower bile duct carcinoma and peribiliary cysts by diagnostic imaging. He underwent pylorus preserving pancreatoduodenectomy. As for the peribiliary cysts, a course of observation was taken.Over surgery due to misdiagnosis of patients with biliary malignancy accompanied by peribiliary cysts should be avoided.

  18. In vivo multiphoton imaging of bile duct ligation

    Science.gov (United States)

    Liu, Yuan; Li, Feng-Chieh; Chen, Hsiao-Chin; Chang, Po-shou; Yang, Shu-Mei; Lee, Hsuan-Shu; Dong, Chen-Yuan

    2008-02-01

    Bile is the exocrine secretion of liver and synthesized by hepatocytes. It is drained into duodenum for the function of digestion or drained into gallbladder for of storage. Bile duct obstruction is a blockage in the tubes that carry bile to the gallbladder and small intestine. However, Bile duct ligation results in the changes of bile acids in serum, liver, urine, and feces1, 2. In this work, we demonstrate a novel technique to image this pathological condition by using a newly developed in vivo imaging system, which includes multiphoton microscopy and intravital hepatic imaging chamber. The images we acquired demonstrate the uptake, processing of 6-CFDA in hepatocytes and excretion of CF in the bile canaliculi. In addition to imaging, we can also measure kinetics of the green fluorescence intensity.

  19. Ursodeoxycholic acid treatment of vanishing bile duct syndromes

    Institute of Scientific and Technical Information of China (English)

    Thomas Pusl; Ulrich Beuers

    2006-01-01

    Vanishing bile duct syndromes (VBDS) are characterized by progressive loss of small intrahepatic ducts caused by a variety of different diseases leading to chronic cholestasis, cirrhosis, and premature death from liver failure. The majority of adult patients with VBDS suffer from primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). Ursodeoxycholic acid (UDCA), a hydrophilic dihydroxy bile acid, is the only drug currently approved for the treatment of patients with PBC, and anticholestatic effects have been reported for several other cholestatic syndromes. Several potential mechanisms of action of UDCA have been proposed including stimulation of hepatobiliary secretion, inhibition of apoptosis and protection of cholangiocytes against toxic effects of hydrophobic bile acids.

  20. Surgical versus endoscopic management of common bile duct stones.

    Science.gov (United States)

    Miller, B M; Kozarek, R A; Ryan, J A; Ball, T J; Traverso, L W

    1988-01-01

    The charts of all patients with common bile duct (CBD) stones admitted to Virginia Mason Medical Center between January 1, 1981 and July 31, 1986 were reviewed to define current methods of management and results of operative versus endoscopic therapy. Two hundred thirty-seven patients with CBD stones were treated. One hundred thirty patients had intact gallbladders. Of these patients, 76 (59%) underwent cholecystectomy and common bile duct exploration (CBDE) while 54 (41%) underwent endoscopic papillotomy (EP) only. Of the 107 patients admitted with recurrent stones after cholecystectomy, all but five were treated with EP. The overall mortality rate was 3.0%. Complications, success, and death rates were all similar for CBDE and EP, but the complications of EP were often serious and directly related to the procedure (GI hemorrhage, 6; duodenal perforation, 5; biliary sepsis, 4; pancreatitis, 1). Patients undergoing EP required significantly shorter hospitalization than those undergoing CBDE. Multivariate analysis showed that age greater than 70 years, technical failure, and complications increased the risk of death, regardless of procedure performed. Twenty-one per cent of those undergoing EP with gallbladders intact eventually required cholecystectomy. The conclusion is that the results of EP and CBDE are similar, and the use of EP has not reduced the mortality rates of this disease. PMID:3341812

  1. Common bile duct obstruction due to fibrous pseudotumor of pancreas associated with retroperitoneal fibrosis:A case report

    Institute of Scientific and Technical Information of China (English)

    Mei-Fen Zhao; Yu Tian; Ke-Jian Guo; Zhi-Gang Ma; Hai-Hui Liao

    2004-01-01

    One 63-year-old woman, who presented with cholestatic jaundice due to common bile duct compression produced by primary retroperitoneal fibrosis, is studied. The patient was operated six years ago because of hydronephrosis,when the disease was first diagnosed. Magnetic resonance cholangiopancreatography (MRCP) revealed the presence of extrahepatic bile duct obstruction, which once was considered to be pathognomonic of pancreatic cancer. CTscan demonstrated the change of retroperitoneal fibrosis around left kidney, atrophy of right kidney, and obstruction of extrahepatic bile duct (pancreatic head). An explorative laparotomy was performed, and the retroperitoneum and pancreas were grayish-white and hard, the fibrotic pancreatic head compressed the common bile duct. Bile duct stricture was managed by Rouxen-Y hepatocholangio-jejunostomy.To the best of our knowledge, few similar cases of retroperitoneal fibrosis have been reported.

  2. The Human Umbilical Cord: A Novel Substitute for Reconstruction of the Extrahepatic Bile Duct

    Directory of Open Access Journals (Sweden)

    Jiong Lu

    2012-01-01

    Full Text Available Reconstruction of the extrahepatic bile duct following bile duct injury or defect is one of the most common challenges for hepatobiliary surgeons. There are currently a number of surgical strategies such as biliary-enteric anastomosis, end-to-end anastomosis and autologous tissue substitute. However, sphincter of Oddi dysfunction as well as biliary stricture may occur after surgical anastomosis. Also, insufficient tissue quantity remains a problem associated with the application of tissue substitute. Therefore, considerable attention has been attracted to explore a new replacement material of the bile duct for biliary reconstruction. The human umbilical cord (HUC is abundant in resource and is convenient to collect, including two arteries and one vein, whose diameters are close to that of the common bile duct. In order to reduce immunogenicity (foreign-body reaction, cells and major histocompatibility complex (MHC antigens can be removed from the HUC and the remaining tissue (extracellular matrix, ECM can be used as a scaffold. The HUC provides a rich source of mesenchymal stem cells (MSCs. A current study has demonstrated that MSCs are able to differentiate into biliary epithelial cells in vivo and in vitro with low immunogenicity, which can be used as seed cells. The HUC might be a promising composite material of a scaffold (ECM and seed cells (biliary epithelial cells, for bile duct replacement in situ without removal of sphincter of Oddi, or biliary stricture. In addition, the patients’ own umbilical cord without any foreign-body reaction can be directly banked for possible future use in bile duct reconstruction. Therefore, we hypothesise that the HUC may be a novel substitute for reconstruction of the extrahepatic bile duct.

  3. The Surgical Management of Concomitant Gallbladder and Common Bile Duct Stones.

    Science.gov (United States)

    Darrien, J H; Connor, K; Janeczko, A; Casey, J J; Paterson-Brown, S

    2015-01-01

    Background. The management of choledocholithiasis has evolved from open common bile duct exploration (OCBDE) to therapeutic endoscopic retrograde cholangiopancreatography (ERCP) to laparoscopic common bile duct exploration (LCBDE). Each entails a degree of difficulty. Aim. To review 5-year results of bile duct exploration in an UGI unit. Methods. Common bile duct explorations (CBDEs) performed between January 2008 and January 2013 were identified from a prospectively collected clinical audit system and results reviewed retrospectively. Results. 216 CBDEs were performed, 119 (55%) as an emergency and 52 (24%) following failed ERCP. Open CBDE (OCBDE) was performed primarily in 34/216 (16%) patients and attempted laparoscopically in 182 (84%). Fifty nine (32%) Laparoscopic CBDEs (LCBDEs) were converted to OCBDE. Of the remaining 123 LCBDEs, 51 (41%) primary choledochotomies and 72 (59%) primary transcystic CBDEs (TC-CBDEs) were performed. Forty nine (68%) TC-CBDEs were considered successful and 23 (32%) failed. Fifteen failed TC-CBDEs were converted to a successful laparoscopic choledochotomy. Ductal clearance was achieved in 187/216 (87%) patients and retained stones were identified in 20/123 (16%) LCBDEs. Complications occurred in 52/216 (24%) patients. There were 8/216 (4%) bile leaks requiring further intervention. Postoperative ERCP was carried out in 32/216 (15%) patients and 9/216 (4%) required relaparoscopy/laparotomy. No patient died. Conclusions. Successful management of choledocholithiasis requires a breadth of laparoscopic and endoscopic expertise. PMID:26420916

  4. The Surgical Management of Concomitant Gallbladder and Common Bile Duct Stones

    Directory of Open Access Journals (Sweden)

    J. H. Darrien

    2015-01-01

    Full Text Available Background. The management of choledocholithiasis has evolved from open common bile duct exploration (OCBDE to therapeutic endoscopic retrograde cholangiopancreatography (ERCP to laparoscopic common bile duct exploration (LCBDE. Each entails a degree of difficulty. Aim. To review 5-year results of bile duct exploration in an UGI unit. Methods. Common bile duct explorations (CBDEs performed between January 2008 and January 2013 were identified from a prospectively collected clinical audit system and results reviewed retrospectively. Results. 216 CBDEs were performed, 119 (55% as an emergency and 52 (24% following failed ERCP. Open CBDE (OCBDE was performed primarily in 34/216 (16% patients and attempted laparoscopically in 182 (84%. Fifty nine (32% Laparoscopic CBDEs (LCBDEs were converted to OCBDE. Of the remaining 123 LCBDEs, 51 (41% primary choledochotomies and 72 (59% primary transcystic CBDEs (TC-CBDEs were performed. Forty nine (68% TC-CBDEs were considered successful and 23 (32% failed. Fifteen failed TC-CBDEs were converted to a successful laparoscopic choledochotomy. Ductal clearance was achieved in 187/216 (87% patients and retained stones were identified in 20/123 (16% LCBDEs. Complications occurred in 52/216 (24% patients. There were 8/216 (4% bile leaks requiring further intervention. Postoperative ERCP was carried out in 32/216 (15% patients and 9/216 (4% required relaparoscopy/laparotomy. No patient died. Conclusions. Successful management of choledocholithiasis requires a breadth of laparoscopic and endoscopic expertise.

  5. [Postoperative handling in biliodigestive derivation by iatrogenic bile duct injury].

    Science.gov (United States)

    Domínguez, I; Mercado, M A

    2008-01-01

    Bile duct injury is a severe complication related to cholecystectomy, impacting in the long-term quality of life and functional status. Bile duct repair is the first-line treatment for complex injuries. During short-term and long-term postoperative care, it is important to bear in mind the diagnostic tools, both laboratory and imaging, that will be useful to evaluate a possible surgical complication and to plan an adequate therapeutic strategy. In addition, post-surgical classification describes patients according to their complications and clinical course. In this review we describe the principal issues of postoperative care after bile duct repair, highlighting the diagnosis, severity classification and therapeutic approach of acute cholangitis.

  6. Percutaneous lithotripsy for removing difficult bile duct stones using endoscopy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, See Hyung; Sohn, Chul Ho; Kim, Young Hwan [Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2008-03-15

    To describe efficacy of percutaneous lithotripsy for removing difficult bile duct stones using endoscopy. A total of 88 patients with difficulties for the removal of bile duct stones using endoscopy (an impacted stone, stone size > 15 mm, intrahepatic duct (IHD) stone, stone size to bile duct diameter ratio > 1.0), were enrolled in this study. A 12 Fr sheath was inserted through the percutaneous transhepatic biliary drainage (PTBD) tract, and then nitrol stone baskets and a 0.035' snare wire were used to capture, fragment and remove the stones. The technical and clinical success rates were analyzed, together with an analysis of any complications. The overall technical success rate of stone removal was achieved in 79 of 88 patients (89.8%). In five of nine patients with failed stone removal, small residual IHD stones were noted on a cholangiogram. Even if stone removal failed in these cases, cholangitic symptoms were improved and the drainage catheter was successfully removed. Therefore, clinical success was achieved in 84 of 88 patients (95.5%). There were no significant procedure-related complications, except for sepsis in one case. Billiary stone removal using the stone basket and guide-wire snare technique through the PTBD tract is a safe and effective procedure that can be used as a primary method in patients with difficulties for the removal of bile duct stones using endoscopy.

  7. Ultrasonographic findings of intrahepatic bile duct stone

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yoon Suk; Na, Hae Kyung; Yoon, Chong Hyun [National Medical Center, Seoul (Korea, Republic of)

    1989-10-15

    The intrahepatic duct stones are prevalent in East Asia and pose serious health problem because of the frequent recurrence and often associated suppurative cholangitis. Accurate diagnosis and localization of intrahepatic duct stones are essential to good prognosis and selection of adequate therapeutic method. We studied 112 cases of intrahepatic duct stones diagnosed with ultrasound and confirmed by operation or other radiologic studies for recent 3 years from May 1986 to May 1989 at Department Of Radiology, National Medical Center, and analysed ultrasonographic findings. The results were as follows: 1. Among 112 cases, 73 (65%) were female, 39 (35%) were male with predominancy in 5th decade. 2. The most common location of intrahepatic duct stones was left intrahepatic duct in 48 cases (43%), followed by right intrahepatic duct in 42 cases (37.5%) and both intrahepatic ducts in 22 cases (19.5%). In respect of segmental distribution, left lateral segment is the most common location (53 cases, 34%), followed by right posterior segment (43 cases, 27%). 3. Ultrasonographic findings were as follows: Nodular pattern is the most common (59 cases, 53%), followed by tubular or linear impacted pattern (23 cases, 20%), irregular heterogenous conglomerated mass (13 cases, 12%), smooth homogenous single mass (10 cases, 9%) and mixed (7 cases, 6%) in orders. Ductal dilatations were classified by diffuse dilatation (16 cases, 14%), localized dilatation (50 case, 45%) and no dilatation (46 cases, 41%). Many of the tubular impacted stones showed no ductal dilatation and single mass showed ductal dilatations in all cases. 4. In 53 cases (47%), combined extrahepatic duct stones were present. 5. As associated findings, liver cirrhosis in 11 cases (10%), cholangitis in 9 cases (8%), cholecystitis in 7 cases (6%), hepatic and pericholangitic abscess in 3 cases(3%) and CBD cancer, GB cancer, acute pancreatitis in 2 cases (2%) respectively.

  8. Current perspective in the treatment of bile duct injuries

    Directory of Open Access Journals (Sweden)

    Juan Jos and eacute; Granados-Romero

    2016-03-01

    Full Text Available The laparoscopic cholecystectomy is considered the gold standard for the treatment of benign gallbladder disease, which is associated with an increased incidence of biliary injuries. These types of injuries are multicausal, and anatomical variations or anatomical perception errors are the most common risk factors. The objective of this study is to describe the evolution in the management of bile duct injuries and actual, diagnostic tools, incidence, prognosis and treatment. A literature research about diagnosis and treatment of iatrogenic bile duct injuries as well as their impact on the incidence of morbidity and mortality, based on a 30-year period, was performed on Medline, Cochrane, Embase, MedScape and PubMed database, for all studies that met the eligibility criteria. A thorough quality assessment of all included studies was performed. Synthesis of the results was achieved by narrative review. The bile duct injury is a complication that requires a complex therapy and multidisciplinary management. Reconstruction and treatment techniques have been evolving. The selection of adequate treatment will impact on the patient and acute;s quality of life. The results of the existing studies reporting on iatrogenic bile duct injuries are useful; because the iatrogenic bile duct injuries are complex alterations and constitute one of the most serious complications of a cholecystectomy and require a comprehensive approach, immediate repair, proper drainage and timely referral to adequate treatment to improve long-term prognosis. According to the literature review, currently there better treatments such as absorbable prosthesis, which improve the prognosis and patient and acute;s quality of life, and represent less risk of complications in short/long term. [Int J Res Med Sci 2016; 4(3.000: 677-684

  9. Reference values of MRI measurements of the common bile duct and pancreatic duct in children

    International Nuclear Information System (INIS)

    Magnetic resonance imaging/cholangiopancreatography (MRI/MRCP) is now an essential imaging modality for the evaluation of biliary and pancreatic pathology in children, but there are no data depicting the normal diameters of the common bile duct (CBD) and pancreatic duct. Recognition of abnormal duct size is important and the increasing use of MRCP necessitates normal MRI measurements. To present normal MRI measurements for the common bile duct and pancreatic duct in children. In this retrospective study we searched all children ages birth to 10 years in our MR urography (MRU) database from 2006 until 2013. We excluded children with a history of hepatobiliary or pancreatic surgery. We stratified 204 children into five age groups and retrospectively measured the CBD and the pancreatic duct on 2-D axial and 3-D coronal T2-weighted sequences. We performed statistical analysis, using logistic and linear regressions to detect the age association of the visibility and size of the duct measurements. We used non-parametric tests to detect gender and imaging plane differences. Our study included 204 children, 106 (52%) boys and 98 (48%) girls, with a median age of 33 months (range 0-119 months). The children were distributed into five age groups. The common bile duct was visible in all children in all age groups. The pancreatic duct was significantly less visible in the youngest children, group 1 (54/67, 80.5%; P = 0.003) than in the oldest children, group 5 (22/22, 100%). In group 2 the pancreatic duct was seen in 19/21 (90.4%), in group 3 52/55 (94.5%), and in group 4 39/39 (100%). All duct measurements increased with age (P < 0.001; r-value > 0.423), and the incremental differences between ages were significant. The measurement variations between the axial and coronal planes were statistically significant (P < 0.001); however these differences were fractions of millimeters. For example, in group 1 the mean coronal measurement of the CBD was 2.1 mm and the axial

  10. Reference values of MRI measurements of the common bile duct and pancreatic duct in children

    Energy Technology Data Exchange (ETDEWEB)

    Gwal, Kriti; Bedoya, Maria A.; Patel, Neal; Darge, Kassa; Anupindi, Sudha A. [University of Pennsylvania Perelman School of Medicine, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Rambhatla, Siri J. [Beth Israel Medical Center, Department of Pediatrics, Newark, NJ (United States); Sreedharan, Ram R. [University of Pennsylvania, Departments of Gastroenterology, Hepatology and Nutrition, The Children' s Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (United States)

    2015-08-15

    Magnetic resonance imaging/cholangiopancreatography (MRI/MRCP) is now an essential imaging modality for the evaluation of biliary and pancreatic pathology in children, but there are no data depicting the normal diameters of the common bile duct (CBD) and pancreatic duct. Recognition of abnormal duct size is important and the increasing use of MRCP necessitates normal MRI measurements. To present normal MRI measurements for the common bile duct and pancreatic duct in children. In this retrospective study we searched all children ages birth to 10 years in our MR urography (MRU) database from 2006 until 2013. We excluded children with a history of hepatobiliary or pancreatic surgery. We stratified 204 children into five age groups and retrospectively measured the CBD and the pancreatic duct on 2-D axial and 3-D coronal T2-weighted sequences. We performed statistical analysis, using logistic and linear regressions to detect the age association of the visibility and size of the duct measurements. We used non-parametric tests to detect gender and imaging plane differences. Our study included 204 children, 106 (52%) boys and 98 (48%) girls, with a median age of 33 months (range 0-119 months). The children were distributed into five age groups. The common bile duct was visible in all children in all age groups. The pancreatic duct was significantly less visible in the youngest children, group 1 (54/67, 80.5%; P = 0.003) than in the oldest children, group 5 (22/22, 100%). In group 2 the pancreatic duct was seen in 19/21 (90.4%), in group 3 52/55 (94.5%), and in group 4 39/39 (100%). All duct measurements increased with age (P < 0.001; r-value > 0.423), and the incremental differences between ages were significant. The measurement variations between the axial and coronal planes were statistically significant (P < 0.001); however these differences were fractions of millimeters. For example, in group 1 the mean coronal measurement of the CBD was 2.1 mm and the axial

  11. Detection of markers of hepatitis viral infection in the tissue of bile duct carcinoma

    Institute of Scientific and Technical Information of China (English)

    LIU Hou-bao; QIAN Zhen-yu; WANG Bing-sheng; TONG Sai-xiong

    2008-01-01

    @@ Hepatitis B virus (HBV) is an admitted oncogenic virus. Many epidemiological and molecular biological studies have demonstrated that chronic infection with HBV is a major risk factor associated with the development of hepatocellular carcinoma (HCC) and intrahepatic bile duct cancer.1-4 Compared with hepatocytes and intrahepatic bile duct epithelial cells,extrahepatic bile duct epithelial cells have autoploid in embryogenesis,continuity in anatomy and a similar internal environment.The question arises whether extrahepatic bile duct epithelial cells can receive HBV infection or not? The role of hepatitis viral infection in the pathogenesis of bile duct carcinoma has not yet been clarified.although a causative relationship between HBV or HCV infection and extrahepatic bile duct carcinoma has been reported in the literature.5,6 In this study,we focused on the evidence of hepatitis viral infection in tissue of bile duct carcinoma.

  12. Treatment of bile duct carcinoma using photodynamic therapy (PDT)

    International Nuclear Information System (INIS)

    Full text: Biliary papillomatosis, is a rare, benign tumour characterised by extensive mucosal involvement of the bile duct with carcinoma in 30% of cases. Treatment has been largely limited to surgical resection and is often accompanied by tumour recurrence. Photodynamic therapy (PDT) was used to treat a 64 year old man with mucous-secreting papillomatosis of the common bile hepatic duct which presented with obstructive jaundice and recurrent cholangitis. The successful use of PDT in treating a case of cholangiocarcinoma and the treatment of similar colonic villous tumours encourage the use of PDT in this patient. Porfimer Sodium (Photofrin), 2 mg/kg was given intravenously 64 hours prior to light exposure. A Spectra Physics argon-ion pumped dye laser was used to provide 50 mW of 630 nm wavelength light at a 3 cm long diffusing tip attached to a 3 m optical fibre. A power density of approximately 15 mW.cm-2 was provided at the tissue surface under illumination at a radial distance of approximately 1.8 mm from the diffusing tip. The dose was designed to give a necrosis depth of 3 mm. A transparent 3.6 mm outer diameter catheter was placed in the duct using fluoroscopy and the fibre and diffusing tip then manoeuvred into position. The transparent catheter was left in place during the treatment and forced a minimum inner diameter on the duct of 3.6 mm and also helped to centre the diffuser within the duct. Repeat endoscopy, 48 hours after treatment revealed little duct mucous; necrosed tissue was removed with a balloon catheter with significant increase in size of the duct lumen. Since then, the patient's bilirubin has remained normal. Repeat endoscopic cholangiography one month later has shown no diminution in the diameter of the bile duct. The use of Photodynamic Therapy in the biliary tree using endoscopic retrograde placement of light source is feasible and the results in this patient encourage a trial of its use in operable bile duct carcinoma

  13. Application of fast track surgery in laparoscopic common bile duct exploration%快速康复外科在腹腔镜胆总管探查取石术中的应用

    Institute of Scientific and Technical Information of China (English)

    谭黄业; 樊献军; 肖咏梅; 张立峰; 龙游; 廖斌

    2011-01-01

    Objective To study the value and feasibility of fast track surgery ( FTS ) in laparoscopic common bile duct exploration.Methods Sixty cases undergoing simple laparoscopic common bile duct exploration were selected for the perioperative therapy of fast track surgery ( n = 28 ) or conventional surgery ( n = 32 ).The time for bowel flatus and food intake and ambulation, hospital stay and cost, and incidence of complications after operation were compared.Results After operation, the time of bowel flatus, food intake, ambulation and hospital stay in fast track surgery group were significantly shorter than those in conventional surgery group ( P < 0.05 ).Hospital cost was also less( P < 0.05 ) in FTS group; while the postoperative complications of the two groups showed no significant difference ( P > 0.05 ).Conclusions Fast track surgery in laparoscopic common bile duct exploration patients is safe, economical, effective, and has very high clinical value.%目的 探讨快速康复外科理念在腹腔镜胆总管探查取石术(LCBDE)中的应用价值.方法 对60例择期行LCBDE患者,采用快速康复外科理念指导下的围术期处理方法 (n=28)和传统的围术期处理方法 (n=32),比较两组术后下床活动时间、进食时间、排气排便时间、住院天数及住院费用、并发症的差异.结果 快速康复外科组术后进食时间、排便排气时间、下床活动时间、住院天数明显缩短、住院费用明显减少(P0.05).结论 快速康复外科理念在LCBDE患者中的应用安全、经济、有效,具有较高的临床应用价值.

  14. Adenoma of the distal common bile duct -a case report-

    Energy Technology Data Exchange (ETDEWEB)

    Do, Young Soo; Lee, Hyun Gon; Han, Ho Seong; Ko, Gyung Hyuck; Kim, Jae Hyoung; Kim, Hyung Jin; Chung, Sung Hoon [College of Medicine, Gyeongsang National University, Jinju (Korea, Republic of)

    1991-05-15

    On rare occasions, Obstructive Jaundice may be caused by a benign tumor of the biliary tract. We describe a patient in whom the diagnosis of an adenoma of the distal common bile duct (CBD) was established. The CT showed a soft tissue density mass in the distal CBD and diffuse dilatation of the intrahepatic duct, gall the bladder, and CBD. Endoscopic retrograde cholangiopnacreatography showed an irregularly marginated polypoid mass in the distal CBD. The clinical, radiological, and histological features of this neoplasm are reviewed. The clinical, radiological and histological features of this neoplasm are reviewed.

  15. Primary sclerosing cholangitis – The arteriosclerosis of the bile duct?

    Directory of Open Access Journals (Sweden)

    Trauner Michael

    2007-01-01

    Full Text Available Abstract Primary sclerosing cholangitis (PSC is a chronic inflammatory disease of unknown aetiology affecting the large bile ducts and characterized by periductal fibrosis and stricture formation, which ultimately result in biliary cirrhosis and liver failure. Arteriosclerosis involves the accumulation of altered lipids and lipoproteins in large arteries; this drives inflammation and fibrosis and ultimately leads to narrowing of the arteries and hypoperfusion of dependent organs and tissues. Knowledge of the causative factors is crucial to the understanding of disease mechanisms and the development of specific treatment. Based on pathogenetic similarities between PSC and arteriosclerosis, we hypothesize that PSC represents "arteriosclerosis of the bile duct" initiated by toxic biliary lipids. This hypothesis is based on common molecular, cellular, and morphological features providing the conceptual framework for a deeper understanding of their pathogenesis. This hypothesis should stimulate translational research to facilitate the search for novel treatment strategies for both diseases.

  16. 13.7.Gallbladder and bile duct

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    950323 CT in predicting the efficacy of oralcholelitholysis with bile acids.FU Xianbo (傅贤波),et al.Dept Surg,3rd Teach Hosp,BeijingMed Univ,Beijing,100083.Natl Med J China1993;73(2):81—83.The efficacy of oral cholelitholytic therapywith chenodeoxycholic acid (CDCA) and ur-sodeoxycholic acid (UDCA) in 137 patients withgallstones was compared with their CT pat-terns.The best dissolving results were obtainedfrom patients with the stones in isodense andfaint category (<50Hu) on CT.All the stoneswith high density or heterogeneous calcificationon CT were insoluble.Therefore,they were con-traindicated for oral cholelitholytie therapy.Ac-cording to the abovr,criteria,the rates for disso-lution ranged from 27.7%(38/137).to 66.7%(38/57),and those for complete dissolutionranged from 9.49%(13/137) to 40.7%(11/

  17. Lower Rate of Major Bile Duct Injury and Increased Intraoperative Management of Common Bile Duct Stones after Implementation of Routine Intraoperative Cholangiography

    NARCIS (Netherlands)

    Buddingh, K. Tim; Weersma, Rinse K.; Savenije, Rolf A. J.; van Dam, Gooitzen M.; Nieuwenhuijs, Vincent B.

    2011-01-01

    BACKGROUND: Our university medical center is the only center in The Netherlands that has adopted a policy of routine intraoperative cholangiography (IOC) during cholecystectomy. This study aimed to describe the rate of bile duct injury (BDI) and management of common bile duct (CBD) stones before and

  18. Iatrogenic bile duct injuries from biliar y tract surger y

    Institute of Scientific and Technical Information of China (English)

    Umar Ali; Zhen-Hua Ma; Cheng-En Pan; Qing-Yong Ma

    2007-01-01

    BACKGROUND:Cholecystectomy is the most commonly performed procedure in general surgery. However, bile duct injury is a rare but still one of the most common complications. These injuries sometimes present variably after primary surgery. Timely detection and appropriate management decrease the morbidity and mortality of the operation. METHODS:Five cases of iatrogenic bile duct injury (IBDI) were managed at the Department of Surgery, First Afifliated Hospital, Xi'an Jiaotong University. All the cases who underwent both open and laparoscopic cholecystectomy had persistent injury to the biliary tract and were treated accordingly. RESULTS: Recovery of the patients was uneventful. All patients were followed-up at the surgical outpatient department for six months to three years. So far the patients have shown good recovery. CONCLUSIONS:In cases of IBDI it is necessary to perform the operation under the supervision of an experienced surgeon who is specialized in the repair of bile duct injuries, and it is also necessary to detect and treat the injury as soon as possible to obtain a satisfactory outcome.

  19. Profile of hepatocyte apoptosis and bile lakes before and after bile duct decompression in severe obstructive jaundice patients

    Institute of Scientific and Technical Information of China (English)

    ToarJMLalisang; RadenSjamsuhidajat; NurjatiCSiregar; AkmalTaher

    2010-01-01

    BACKGROUND: Excessive hepatocyte apoptosis and bile lakes in severe obstructive jaundice might impair liver functions. Although decompression of the bile duct has been reported to improve liver functions in animal studies, the mechanism of obstruction differs from that in humans. This study aimed to determine the profiles of hepatocyte apoptosis and bile lakes following bile duct decompression in patients with severe obstructive jaundice in the clinical setting. METHODS: We conducted a "before and after study" on severe obstructive jaundice patients as a model of inhibition of the excessive process by bile duct decompression. Specimens of liver biopsies were taken before and after decompression of the bile duct and then stained by terminal deoxynucleotide transferase-mediated dUTP nick end-labeling (TUNEL) to identify hepatocyte apoptosis and by hematoxilin-eosin (HE) to identify bile lakes. All measurements were independently done by 2 observers. RESULTS: Twenty-one severe obstructive jaundice patients were included. In all patients, excessive hepatocyte apoptosis and bile lakes were apparent. After decompression, the hepatocyte apoptosis index decreased from 53.1 (SD 105) to 11.7 (SD 13.6) (P CONCLUSION: Bile duct decompression improves hepatocyte apoptosis and bile lakes in cases of severe obstructive jaundice, similar to the findings in animal studies.

  20. Prevention of common bile duct injury during laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Zhi-Bing Ou; Jian-Ping Gong; Sheng-Wei Li; Chang-An Liu; Bing Tu; Chuan-Xin Wu; Xiong Ding; Zuo-Jin Liu; Ke Sun; Hu-Yi Feng

    2009-01-01

    BACKGROUND: Since the widespread adoption of laparoscopic cholecystectomy (LC) in the late 1980s, a rise in common bile duct (CBD) injury has been reported. We analyzed the factors contributing to a record of zero CBD injuries in 10 000 consecutive LCs. METHODS: The retrospective investigation included 10 000 patients who underwent LC from July 1992 to June 2007. LC was performed by 4 teams of surgeons. The chief main surgeon of each team has had over 10 years of experience in hepatobiliary surgery. Calot's triangle was carefully dissected, and the relationship of the cystic duct to the CBD and common hepatic duct was clearly identiifed. A clip was applied to the cystic duct at the neck of the gallbladder and the duct was incised with scissors proximal to the clip. The cystic artery was dissected by the same method. Then, the gallbladder was dissected from its liver bed. A drain was routinely left at the gallbladder bed for 1-2 days postoperatively. RESULTS: No CBD injuries occurred in 10 000 consecutive LCs, and there were 16 duct leaks (0.16%). Among these, there were 10 Luschka duct leaks (0.1%) and 6 cystic duct leaks (0.06%). Four hundred thirty cases were converted to open cholecystectomy (OC), giving a conversion rate of 4.3%. After a mean follow-up of 17.5 months (range 6-24 months), no postoperative death due to LC occurred, and good results were observed in 95% of the patients. CONCLUSIONS: In our 10 000 LCs with zero CBD injuries, the techniques used and practices at our department have been successful. Surgeon's expertise in biliary surgery,preoperative imaging, precise operative procedures, and conversion from LC to OC when needed are important measures to prevent CBD injuries.

  1. Novel Approach to Bile Duct Damage in Primary Biliary Cirrhosis: Participation of Cellular Senescence and Autophagy

    Directory of Open Access Journals (Sweden)

    Motoko Sasaki

    2012-01-01

    Full Text Available Primary biliary cirrhosis (PBC is characterized by antimitochondrial autoantibodies (AMAs in patients' sera and histologically by chronic nonsuppurative destructive cholangitis in small bile ducts, eventually followed by extensive bile duct loss and biliary cirrhosis. The autoimmune-mediated pathogenesis of bile duct lesions, including the significance of AMAs, triggers of the autoimmune process, and so on remain unclear. We have reported that cellular senescence in biliary epithelial cells (BECs may be involved in bile duct lesions and that autophagy may precede the process of biliary epithelial senescence in PBC. Interestingly, BECs in damaged bile ducts show characteristicsof cellular senescence and autophagy in PBC. A suspected causative factor of biliary epithelial senescence is oxidative stress. Furthermore, senescent BECs may modulate the microenvironment around bile ducts by expressing various chemokines and cytokines called senescence-associated secretory phenotypes and contribute to the pathogenesis in PBC.

  2. Intraductal papillary mucinous neoplasm of the bile duct with gastric and duodenal fistulas

    OpenAIRE

    Hong, Man Yong; Yu, Dong Wook; Hong, Seung Goun

    2014-01-01

    Intraductal papillary mucinous neoplasm (IPMN) of the bile duct is still rare and not yet understood despite of its increased incidence and similar clinicopathologic characteristics compared with IPMN of the pancreas. The fistula formation into other organs can occur in IPMN, especially the pancreatic type. To our knowledge, only two cases of IPMN of the bile duct with a choledochoduodenal fistula were reported and we have recently experienced a case of IPMN of the bile duct penetrating into ...

  3. Imaging Findings of Intrahepatic Bile Duct Adenoma (Peribiliary Gland Hamartoma): a Case Report and Literature Review

    Energy Technology Data Exchange (ETDEWEB)

    Kim, You Sung; Rha, Sung Eun; Oh, Soon Nam; Jung, Seung Eun; Shin, Yu Ri; Choi, Byung Gil; Byun, Jae Young; Jung, Eun Sun; Kim, Dong Goo [Catholic University of Korea, Seoul St.Mary' s Hospital, Seoul (Korea, Republic of)

    2010-10-15

    Intrahepatic bile duct adenoma is a rare benign epithelial hepatic tumor derived from bile duct cells. We report the imaging findings of a patient with bile duct adenoma, which appeared as a small heterogeneously enhancing mass with focal small cystic change on CT and MRI. Follow-up images at seven months showed a slight increase in tumor size, which could be partly explained by intratumoral hemorrhage on pathologic examination. Although rare, bile duct adenoma should be considered as a differential diagnosis of a small hypervascular tumor located in the periphery of liver. Focal cystic change and intratumoral hemorrhage may occur

  4. Malignant carcinoid tumor of the cystic duct:a rare cause of bile duct obstruction

    Institute of Scientific and Technical Information of China (English)

    Evangelos Felekouras; Athanasios Petrou; Konstantinos Bramis; Evangelos Prassas; Ioannis Papaconstantinou; Nikoleta Dimitriou; Anastasia Pazaiti; Christos Tsigris; Athanasios Giannopoulos

    2009-01-01

    BACKGROUND: Carcinoid tumors of the extrahepatic biliary tree are extremely rare malignancies, accounting for 0.2%-2%of all gastrointestinal carcinoid tumors, while carcinoids of the cystic duct are an uncommon entity and an extremely unusual cause of bile duct obstruction. METHODS: After an extensive literature review, we retrospectively analysed 61 cases of carcinoid tumor of the biliary tree as well as one additional case of a 60-year-old female with symptoms and laboratory/imaging examination ifndings compatible with those of a malignant biliary tract obstruction. At laparotomy, resection of the gallbladder and common bile duct was performed. Histological study revealed a well-differentiated neuro-endocrine carcinoma of the cystic duct. The patient remained disease-free at 16 months. RESULTS: Our presentation is the seventh case reported in the world literature. Compared to cholangiocarcinoma, analysis of the reviewed group indicates an increased incidence of extrahepatic carcinoid tumors in younger persons along with a slight female predominance. Statistically, the most common anatomic location is the common bile duct, followed by the perihilar region and the cystic duct. Jaundice is the most common ifnding. Curative surgery was realized in the majority of cases and long-term disease-free survival was achieved when surgery was curative. CONCLUSIONS: Carcinoid tumors obstructing the biliary tree are extremely dififcult to diagnose preoperatively, and nearly impossible to differentiate from non-neuroendocrine tumors. As surgery offers the only potential cure for both biliary carcinoids and cholangiocarcinoma, we recommend aggressive surgical therapy as the treatment of choice in every case of potentially resectable biliary tumor.

  5. Telmisartan attenuates hepatic fibrosis in bile duct-ligated rats

    Institute of Scientific and Technical Information of China (English)

    En-tong YI; Rui-xia LIU; Yan WEN; Cheng-hong YIN

    2012-01-01

    Aim: To evaluate the antifibrotic effect of telmisartan,an angiotensin Ⅱ receptor blocker,in bile duct-ligated rats.Methods: Adult Sprague-Dawley rats were allocated to 3 groups: sham-operated rats,model rats underwent common bile duct ligation (BDL),and BDL rats treated with telmisartan (8 mg/kg,po,for 4 weeks).The animals were sacrificed on d 29,and liver histology was examined,the Knodell and Ishak scores were assigned,and the expression of angiotensin-converting enzyme (ACE) and ACE2 was evaluated with immunohistochemical staining.The mRNAs and proteins associated with liver fibrosis were evaluated using RTQ-PCR and Western blot,respectively.Results: The mean fibrosis score of BDL rats treated with telmisartan was significantly lower than that of the model rats (1.66±0.87 vs 2.13±0.35,P=0.015).However,there was no significant difference in inflammation between the two groups,both of which showed moderate inflammation.Histologically,treatment with telmisartan significantly ameliorated BDL-caused the hepatic fibrosis.Treatment with telmisartan significantly upregulated the mRNA levels of ACE2 and MAS,and decreased the mRNA levels of ACE,angiotensin Ⅱ type 1 receptor (AT1-R),collagen type Ⅲ,and transforming growth factor β1 (TGF-β1).Moreover,treatment with telmisartan significantly increased the expression levels of ACE2 and MAS proteins,and inhibited the expression levels of ACE and AT1-R protein.Conclusion: Telmisartan attenuates liver fibrosis in bile duct-ligated rats via increasing ACE2 expression level.

  6. Carcinoid tumor of the common bile duct: A rare complication of von Hippel-Lindau syndrome

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Van Hippel-Lindau syndrome (VHL) is a rare autosomal dominant, inherited familial cancer syndrome. Hemangioblastomas, pheochromocytomas and renal carcinoma are the frequent reported VHL tumors. Neuroendocrine tumors have also been described, mostly in the pancreas and rarely in the biliary trees. We report the second case of bile duct carcinoid in a 31-year-old VHL woman. She underwent right adrenalectomy for a pheochromocytoma in the past. She also had a positive family history of phenotypic expression of VHL syndrome. The patient presented with biliary colic. Endoscopic retrograde cholangio-pancreatography showed intra luminal bile duct mass. Surgical exploration identified a beige nodular lesion that was a carcinoid tumor on histology. This new association should be clarified by further genetic investigations.

  7. Development of hepatorenal syndrome in bile duct ligated rats

    Institute of Scientific and Technical Information of China (English)

    Regina M Pereira; Ana Cristina Sim(o)es e Silva; Robson AS dos Santos; Eduardo A Oliveira; Virg(i)nia HR Leite; Filipi LC Dias; Alysson S Rezende; Lincoln P Costa; Luciola S Barcelos; Mauro M Teixeira

    2008-01-01

    AIM: To evaluate in bile duct ligated rats whether there were progressive alterations of renal function without changes in histopathology.METHODS: Male Wistar rats were submitted to sham-surgery or bile duct ligation (BDL) and divided according to the post-procedure time (2, 4 and 6-wk).To determine renal function parameters, rats were placed in metabolic cages and, at the end of the experiment, blood and urine samples were obtained.Histology and hydroxyproline content were analyzed in liver and renal tissue.RESULTS: Rats with 2 wk of BDL increased free water clearance (P = 0.02), reduced urinary osmolality (P =0.03) and serum creatinine (P = 0.01) in comparison to the sham group. In contrast, rats at 6 wk of BDL showed features of HRS, including significant increase in serum creatinine and reductions in creatinine clearance,water excretion and urinary sodium concentration. Rats with 4 wk of BDL exhibited an intermediate stage of renal dysfunction. Progressive hepatic fibrosis according to post-procedure time was confirmed by histology.The increased levels of liver hydroxyproline contrasted with the absence of structural changes in the kidney, as assessed by histology and unchanged hydroxyproline content in renal tissue.CONCLUSION: Our data show that BDL produced progressive renal dysfunction without structural changes in the kidney, characterizing HRS. The present model will be useful to understand the pathophysiology of HRS.

  8. Histological Changes in the Bile Duct after Long-Term Placement of a Fully Covered Self-Expandable Metal Stent within a Common Bile Duct: A Canine Study

    OpenAIRE

    Lee, Sang Soo; Song, Tae Jun; Joo, Mee; Park, Do Hyun; Seo, Dong Wan; Lee, Sung Koo; Kim, Myung-Hwan

    2014-01-01

    Background/Aims To date, it has been difficult to determine the optimal stenting duration of a fully covered self-expandable metal stent (FCSEMS) in a benign biliary stricture. The purpose of this study was to identify the histopathological changes in a bile duct resulting from long-term placement of a FCSEMS. Methods An FCSEMS was inserted into the common bile duct of 12 canines, and the animals were divided into four groups. Posteuthanasia, necropsy was performed to examine the histopatholo...

  9. Radiologic approach to bile duct cysts in adults

    International Nuclear Information System (INIS)

    Radiologic findings in 7 adult patients with bile duct cysts were reviewed. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 6 patients, percutaneous transhepatic cholangiography (PTC) in 4, CT and ultrasonography (US) in 4, and angiography in 6. ERCP and PTC were the only methods which exactly showed the extent of the cysts and the anomalous pancreatico-biliary junction present in 5 patients. ERCP and PTC were mandatory for surgical and treatment. Pancreas divisum was revealed in 3 patients, all of whom had suffered from acute pancreatis. Intracystic adenocarcinoma was depicted at cholangiography in 2 patients. US and CT were valuable in showing cystic masses between the pancreatic head and the hilum of the liver, but in no patient was the diagnosis made by any of these methods. Angiography was performed for preoperative vascular mapping. (orig.)

  10. Mycophenolate mofetil for drug-induced vanishing bile duct syndrome

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Amoxicillin/clavulanate is associated with liver injury,mostly of a cholestatic pattern. While outcomes are usually benign, progression to cirrhosis and death has been reported. The role of immunosuppressive therapy for patients with a protracted course is unclear. We report the case of an elderly patient who developed prolonged cholestasis secondary to amoxicillin/clavulanate. Vanishing bile duct syndrome was confirmed by sequential liver biopsies. The patient responded to prednisone treatment,but could not be weaned off corticosteroids, even when azathioprine was added. Complete withdrawal of both prednisone and azathioprine was possible by using mycophenolate mofetil, an inosine monophosphate dehydrogenase inhibitor. Sustained remission has been maintained for more than 3 years with low-dose mycophenolate mofetil.

  11. Iatrogenic bile duct injury with loss of confluence

    Institute of Scientific and Technical Information of China (English)

    Miguel-Angel; Mercado; Mario; Vilatoba; Alan; Contreras; Pilar; Leal-Leyte; Eduardo; Cervantes-Alvarez; Juan-Carlos; Arriola; Bruno-Adonai; Gonzalez

    2015-01-01

    AIM: To describe our experience concerning the surgical treatment of Strasberg E-4(Bismuth Ⅳ) bile duct injuries. METHODS: In an 18-year period, among 603 patients referred to our hospital for surgical treatment of complex bile duct injuries, 53 presented involvement of the hilar confluence classified as Strasberg E4 injuries. Imagenological studies, mainly magnetic resonance imaging showed a loss of confluence. The files of these patients were analyzed and general data were recorded, including type of operation and postoperative outcome with emphasis on postoperative cholangitis, liver function test and quality of life. The mean time of follow-up was of 55.9 ± 52.9 mo(median = 38.5, minimum = 2, maximum = 181.2). All other patients with Strasberg A, B, C, D, E1, E2, E3, or E5 biliary injuries were excluded from this study.RESULTS: Patients were divided in three groups: G1(n = 21): Construction of neoconfluence + Roux-en-Y hepatojejunostomy. G2(n = 26): Roux-en-Y portoenterostomy. G3(n = 6): Double(right and left) Rouxen-Y hepatojejunostomy. Cholangitis was recorded in two patients in group 1, in 14 patients in group 2, and in one patient in group 3. All of them required transhepatic instrumentation of the anastomosis and six patients needed live transplantation.CONCLUSION: Loss of confluence represents a surgicalchallenge. There are several treatment options at different stages. Roux-en-Y bilioenteric anastomosis(neoconfluence, double-barrel anastomosis, portoenterostomy) is the treatment of choice, and when it is technically possible, building of a neoconfluence has better outcomes. When liver cirrhosis is shown, liver transplantation is the best choice.

  12. Intraductal papillary neoplasm of the bile duct in liver cirrhosis with hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Jing Xu; Yasunori Sato; Kenichi Harada; Norihide Yoneda; Teruyuki Ueda; Atsushi Kawashima; Akishi Ooi; Yasuni Nakanuma

    2011-01-01

    A case of intraductal papillary neoplasm of the bile duct (IPNB) arising in a patient with hepatitis B-related liver cirrhosis with hepatocellular carcinoma (HCC) is reported.A 76-year-old man was admitted to our hospital with recurrent HCC.Laboratory data showed that levels of carcinoembryonic antigen and carbohydrate antigen 19-9 were elevated.He died of progressive hepatic failure.At autopsy, in addition to HCCs, an intraductal papillary proliferation of malignant cholangiocytes with fibrovascular cores was found in the dilated large bile ducts in the left lobe, and this papillary carcinoma was associated with an invasive mucinous carcinoma (invasive IPNB).Interestingly, extensive intraductal spread of the cholangiocarcinoma was found from the reactive bile ductular level to the interlobular bile ducts and septal bile ducts and to the large bile ducts in the left lobe.Neural cell adhesion molecule, a hepatic progenitor cell marker, was detected in IPNB cells.It seems possible in this case that hepatic progenitor cells located in reactive bile ductules in liver cirrhosis may have been responsible for the development of the cholangiocarcinoma and HCC, and that the former could have spread in the intrahepatic bile ducts and eventually formed grossly visible IPNB.

  13. Common Bile Duct Obstruction Secondary to a Periampullary Diverticulum

    Directory of Open Access Journals (Sweden)

    Anastasios J. Karayiannakis

    2012-07-01

    Full Text Available Periampullary duodenal diverticula are not uncommon and are usually asymptomatic although complications may occasionally occur. Here, we report the case of a 72-year-old woman who presented with painless obstructive jaundice. Laboratory tests showed abnormally elevated serum concentrations of total and direct bilirubin, of alkaline phosphatase, of γ-glutamyl transpeptidase, and of aspartate and alanine aminotransferases. Serum concentrations of the tumor markers carbohydrate antigen 19-9 and carcinoembryonic antigen were normal. Abdominal ultrasonography showed dilatation of the common bile duct (CBD, but no gallstones were found either in the gallbladder or in the CBD. The gallbladder wall was normal. Computed tomography failed to detect the cause of CBD obstruction. Magnetic resonance imaging and magnetic resonance cholangiopancreatography revealed a periampullary diverticulum measuring 2 cm in diameter and compressing the CBD. The pancreatic duct was normal. Hypotonic duodenography demonstrated a periampullary diverticulum with a filling defect corresponding to the papilla. CBD compression by the diverticulum was considered as the cause of jaundice. The patient was successfully treated by surgical excision of the diverticulum. In conclusion, the presence of a periampullary diverticulum should be considered in elderly patients presenting with obstructive jaundice in the absence of CBD gallstones or of a tumor mass. Non-interventional imaging studies should be preferred for diagnosis of this condition, and surgical or endoscopic interventions should be used judiciously for the effective and safe treatment of these patients.

  14. Experimental study on inhibitory effect of bridgy duct of hepatic artery on apoptosis of liver and bile duct cells

    Institute of Scientific and Technical Information of China (English)

    Hongwei Lu; Yiming Li; Hong Ji; Jinkai Xu

    2006-01-01

    Objective: To investigate whether the method of bridgy duct established between the recipient's spleen artery and the donor's gastroduodenal artery could inhibit the apoptosis of liver and bile duct cells caused by hepatic artery ischemia.Methods: Twenty-four mongrel dogs from Xi'an area were used to establish simplified models of dog orthotopic liver transplantation and divided into three groups randomly: HAI group (hepatic artery ischemia group),BBB group (bypassing the blood by a bridgy duct) and control group. After cold perfusion, The samples were collected from liver and bile duct in each group at different time and fixed in glutaraldehyde and 4% polyformaldehyde respectively. At last, the apoptosis of liver and bile duct cells were observed and the apoptotic indexes were calculated. Results: Two hours after cold perfusion, apoptotic phenomenon was common in HAI group, rare in BBB group, while no apoptotic phenomenon was observed in control group. TUNEL staining showed that there was no significant difference in apoptotic index among the three groups immediately after cold perfusion. However, with time going, the apoptotic cells were increased in three groups, and the difference in apoptotic index was significant among three groups (P < 0.01 ). Conclusion: Bridgy duct of hepatic artery can inhibit the apoptosis of liver and bile duct cells caused by HAI significantly.

  15. Detection of bile duct leaks using MR cholangiography with mangfodipir trisodium (Teslascan).

    Science.gov (United States)

    Vitellas, K M; El-Dieb, A; Vaswani, K; Bennett, W F; Fromkes, J; Steinberg, S; Bova, J G

    2001-01-01

    Mangafodipir trisodium (Teslascan), a hepatobiliary contrast agent, has the potential of providing functional biliary imaging similar to hepatobiliary scintigraphy. To our knowledge. the potential role of this biliary contrast agent in the detection of bile duct leaks has not been reported. In this case report, we report the first case of a bile duct leak diagnosed with enhanced MRI with mangafodipir trisodium in a patient following laparoscopic cholecystectomy. Our case illustrates that functional MR cholangiography images can be successfully acquired by using a post-mangafodipir fat-suppressed GRE technique and that bile duct leaks can be detected.

  16. A case of asymptomatic intraductal papillary neoplasm of the bile duct without hepatolithiasis

    Institute of Scientific and Technical Information of China (English)

    Junpei Hayashi; Hisao Kanou; Takatsugu Oida; Mitsuhiko Moriyama; Shyun-ichi Matsuoka; Makiko Inami; Shu Ohshiro; Akiyasu Ishigami; Hirotoshi Fujikawa; Masahide Miyagawa; Kenji Mimatsu; Youichi Kuboi

    2008-01-01

    A 65-year-old woman was found to have dilatation of the intrabepatic bile duct in the right anterior segment during a general health.Laboratory data were within normal ranges and no solid mass was detected in her abdominal computer tomography (CT) or nuclear magnetic resonance imaging (MRI).However,endoscopic retrograde cholangiopancreatography (ERCP) demonstrated an obstruction of the right bile duct.Intraoperative cholangiography showed stenosis of the intrahepatic bile duct in the anterior inferior segment (B5) and narrowness of the intrahepatic bile duct in the anterior superior segment (B8),so that we strongly suspected intrahepatic cholangiocarcinoma (ICC).Histologically,surgically resected liver specimens,without tumor mass by macroscopic observation,showed intraductal papillary proliferation with fibrovascular cores and intraductal spreading of carcinoma in situ throughout a considerable area,especially in bile ductules around the peripheral small portal area.Furthermore,the immunohistochemical profile of the tumor (MUC5AC+/CK7+) was compatible with an intraductal papillary neoplasm of the bile duct (IPN-B).Consequently,this case was diagnosed as IPN-B with spreading CIS,stage I (pT1,pN0,P0,H1,M0).We report a case of IPN-B with interesting histopathological findings and emphasize that cholangiography is especially helpful for the diagnosis of bile duct dilatation due to infiltration of carcinoma cells.

  17. Changing patterns of traumatic bile duct injuries: a review of forty years experience

    Institute of Scientific and Technical Information of China (English)

    Zhi-Qiang Huang; Xiao-Qiang Huang

    2002-01-01

    AIM: To summarize the experiences of treating bile ductinjuries in 40 years of clinical practice.METHODS: Based on the experience of more than 40 yearsof clinical work, 122 cases including a series of 61 bile ductinjuries of the Southwest Hospital, Chongqing, and 42cases (1989-1997) and 19 cases (1998-2001) of the GeneralHospital of PLA, Beijing, cases were reviewed with specialreference to the pattern of injury. A series of cases of theliver and the biliary tract injuries following interventionaltherapy for hepatic tumors, most often hemangioma of theliver, were collected. Chinese medical literature from 1995 to1999 dealing with 2742 traumatic bile duct strictures werereviewed.RESULTS: There was a changing pattern of the bile ductinjury. Although most of the cases of bile duct injuriesresulted from open cholecystectomy. Other types of traumasuch as laparoscopic cholecystectomy (LC) and hepaticsurgery were increased in recent years. Moreover, serioushepato-biliary injuries following HAE using sclerotic agentssuch as sodium morrhuate and absolute ethanol for thetreatment of hepatic hemangiomas were encountered inrecent years. Experiences in how to avoid bile duct injuryand to treat traumatic biliary strictures were presented.CONCLUSION: Traumatic bile duct stricture is one of theserious complications of hepato-biliary surgery, itsprevalence seemed to be increased in recent years. Thepattern of bile duct injury was also changed and has becomemore complicated. Interventional therapy with sclerosingagents may cause serious hepatobiliary complications andshould be avoided.

  18. Assessment of Chronological Effects of Irreversible Electroporation on Hilar Bile Ducts in a Porcine Model

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jae Woong, E-mail: cooljay@korea.ac.kr; Lu, David S. K., E-mail: dlu@mednet.ucla.edu; Osuagwu, Ferdnand, E-mail: fosuagwu@mednet.ucla.edu; Raman, Steven, E-mail: sraman@mednet.ucla.edu [David Geffen School of Medicine at UCLA, Department of Radiology (United States); Lassman, Charles, E-mail: classman@mednet.ucla.edu [David Geffen School of Medicine at UCLA, Department of Pathology (United States)

    2013-11-07

    PurposeTo evaluate the chronological effects of irreversible electroporation (IRE) on large hilar bile ducts in an in vivo porcine model correlated with computed tomography (CT) cholangiography and histopathology.Materials and MethodsTwelve IRE zones were made along hilar bile ducts intraoperatively under ultrasound (US)-guidance in 11 pigs. Paired electrodes were placed either on opposing sides of the bile duct (straddle [STR]) or both on one side of the bile duct (one-sided [OSD]). The shortest electrode-to-duct distance was classified as periductal (≤2 mm) or nonperiductal (>2 mm). CT cholangiography and laboratory tests were performed before IRE and again at 2 days, 4 weeks, and 8 weeks after IRE. Degree of bile duct injury were graded as follows: grade 0 = no narrowing; grade 1 = ≤50 % duct narrowing; grade 2 = >50 % narrowing without proximal duct dilatation; grade 3 = grade 2 with proximal duct dilatation; and grade 4 = grade 3 with enzyme elevation. Pigs were selected for killing and histopathology at 2 days, 4, and 8 weeks.ResultsNonperiductal electrode placement produced no long-term strictures in 5 of 5 ducts. Periductal electrode placement produced mild narrowing in 6 of 7 ducts: 5 grade 1 and 1 grade 2. None showed increased enzymes. There was no significant difference between STR versus OSD electrode placement. Histopathology showed minor but relatively greater ductal mural changes in narrowed ducts.ConclusionIn the larger hilar ducts, long-term patency and mural integrity appear resistant to IRE damage with the energy deposition used, especially if the electrode is not immediately periductal in position.

  19. Metastatic melanoma to the common bile duct causing obstructive jaundice: A case report

    Institute of Scientific and Technical Information of China (English)

    Radoje B Colovic; Nikica M Grubor; Miodrag D Jovanovic; Marjan T Micev; Natasa R Colovic

    2007-01-01

    Metastatic melanoma to the common bile duct is very rare with only 18 cases reported so far. We report a 46 year old women who, 18 mo after excision of a skin melanoma, developped a painless progressive obstructive jaundice. At operation a melanoma within the distal third of the common bile duct was found. There were no other secondaries within the abdomen. The common bile duct, including the tumor, was resected and anastomosed with Roux-en-Y jejunal limb. The patient survived 31 mo without any sign of local recurrence and was submitted to three other operations for axillar and brain secondaries, from which she finally died. Radical resection of metastatic melanoma to the common bile duct may result in lifelong relief of obstructive jaundice.It is safe and relatively easy to perform. In other cases, a less aggressive approach, stenting or bypass procedures,should be adopted.

  20. MR-assisted bile duct drainage: a study of passive catheter visualization in an animal model

    International Nuclear Information System (INIS)

    Purpose: To investigate interactive MR-assisted bile duct drainage in pigs with the passive visualization technique using near real-time imaging. Methods: 8 bile duct drainages were placed in an open low-field MR system (0.2 Tesla) in 4 pigs with surgically induced cholestasis. After planning the intervention with magnetic resonance cholangiography (MRC), both the puncture and catheter placement were interactively guided using a fast T2-weighted true FISP sequence. Results: MRC enabled interventional planning in all puncture attempts. Punctures were unproblematic in all attempts, the bile ducts were punctured 6 times after the first and twice after the second attempt. Placement of the passively visible catheter was successful in all animals. The applied sequence enables interactive fluoroscopy-like positioning of the devices. Conclusion: The procedure introduced here enables reliable and fast placement of a bile duct drainage in an animal model using a low-field MR system. (orig.)

  1. Relief of common bile duct obstruction during the course of hepatobiliary scintigraphy.

    Science.gov (United States)

    Jacobson, A F

    1995-10-01

    Hepatobiliary scintigraphy performed in a patient suspected of having common bile duct obstruction showed persistence of the hepatic parenchymal phase and no bile duct or gallbladder activity during the first hour of imaging. On endoscopic retrograde cholangiopancreatography examination several hours later, an obstructing gallstone was identified in the common bile duct, and the stone was extracted in conjunction with a papillotomy. Delayed scintigraphic images at 6 hours were unchanged from the earlier views, but imaging at 24 hours showed tracer activity in the small bowel and colon along with persistent hepatic parenchymal activity. These results demonstrate that hepatobiliary radiopharmaceuticals remain in an excretable form in the liver in patients with complete common duct obstruction, but that resumption of bile flow and tracer excretion does not occur until a number of hours after relief of the obstruction. PMID:8616993

  2. Vanishing bile duct syndrome in human immunodeficiency virus: Nevirapine hepatotoxicity revisited

    Institute of Scientific and Technical Information of China (English)

    Rajan; Kochar; Moises; I; Nevah; Frank; J; Lukens; Michael; B; Fallon; Victor; I; Machicao

    2010-01-01

    Vanishing bile duct syndrome (VBDS) refers to a group of disorders characterized by prolonged cholestasis as a result of destruction and disappearance ofintrahepatic bile ducts. Multiple etiologies have been indentifi ed including infections, neoplastic disorders, autoimmune conditions and drugs. The natural history of this condition is variable and may involve resolution of cholestasis or progression with irreversible damage. VBDS is extremely rare in human immunodeficiency virus (HIV)-infected patients an...

  3. The Regulating Effect of CCK and Gastrin on Apoptosis of Bile Duct Carcinoma Cells

    Institute of Scientific and Technical Information of China (English)

    MAKuansheng; ZHANGFengshen; HEZhenping; DONGJiahong

    2002-01-01

    Objective:Probe into the influence and the mechanisms of CCK and gastrin on the apoptosis of bile duct carcinoma cells. Methods:By taking beauvericin as the revulsant to the apoptosis of bile duct carcinoma cells, the influence of CCK and gastrin on the apoptosis of bile duct carcinoma cells was investigated by using the teehniques such as TUNEL fluorescent staining, stream mode cell detecting instrument and reverse bcl-2 oligonucleotide. Techifiques of immunohistochemistry, in situ hybridization,flow cytometry(FCM),RT-PCR were used to study the roles of apoptosis-related genes bcl-2 and bax Results:After beauvericin 40 μM worked for 12 h, the survival rate of QBC939 bile duct carcinoma cells was decreased by 35%-40%.About 80% of the bile duct carcinoma cells showed various degrees of apoptosis.CCK and gastrin could upregulate the threshold value of the apoptosis of bile duct carcinoma cells, which could be inhibited by L60,L18 and reverse bcl-2 oligonucleotide. In terms of both transcription and translating levels,CCK and gastrin could obviously promote the genetic expression of bel-2,but had no influence on the genetic expression of bax. Addition of CCK-A receptor or CCK-B/gastr in receptor antagonist could remarkably inhibit the expression of bel-2 boosted by gastrin-17 and CCK-8S. Conclusion:CCK and gastrin inhibited the apoptosis of bile duct carcinoma cells through upregulating the genetic expression of bcl-2.Theoretically, this research has expanded our understanding to the mechanism of CCK and gastrin in controlling the growth of tumors, enriched our view to the mechanism of apoptosis of alimentary tract tumors, and has provided a new thinking for the assistant treatment to bile duct carcinoma cells as well.

  4. Does Computed Tomography (CT) Overestimate Common-Bile-Duct Diameter in the Evaluation of Gallstone Pancreatitis?

    OpenAIRE

    Hadia Maqsood; Naeem Goussous; Madhumithaa Parthasarathy; Charlotte Horne; Guneet Kaur; Lisa Setiawan; Amanda Sautter; Stephanie James; Hamid Ferdosi; Anne Sill; Gopal C. Kowdley; Steven C Cunningham

    2016-01-01

    Background Acute pancreatitis is a common reason for inpatient admissions in the United States with around 300,000 admissions annually. Gallstones are the most common etiology for acute pancreatitis, and may be associated with a dilated common bile duct. The diameter of the common bile duct is commonly assessed with ultrasound, computed tomography and magnetic resonance imaging. Methods A retrospective analysis of a database of patients who underwent cholecystectomy at our institution from 20...

  5. Intrahepatic Bile Duct Regeneration in Mice Does Not Require Hnf6 or Notch Signaling through Rbpj

    OpenAIRE

    Walter, Teagan J.; Vanderpool, Charles; Cast, Ashley E.; Huppert, Stacey S.

    2014-01-01

    The potential for intrahepatic bile duct (IHBD) regeneration in patients with bile duct insufficiency diseases is poorly understood. Notch signaling and Hnf6 have each been shown to be important for the morphogenesis of IHBDs in mice. One congenital pediatric liver disease characterized by reduced numbers of IHBDs, Alagille syndrome, is associated with mutations in Notch signaling components. Therefore, we investigated whether liver cell plasticity could contribute to IHBD regeneration in mic...

  6. Primary Patency of Wallstents in Malignant Bile Duct Obstruction: Single vs. Two or More Noncoaxial Stents

    International Nuclear Information System (INIS)

    The purpose of this study was to determine the primary patency of two or more noncoaxial self-expanding metallic Wallstents (Boston Scientific, Natick, MA) and to compare this with the primary patency of a single stent in malignant bile duct obstruction. From August 2002 to August 2004, 127 patients had stents placed for malignant bile duct obstruction. Forty-five patients were treated with more than one noncoaxial self-expanding metallic stents and 82 patients had a single stent placed. Two patients in the multiple-stent group were lost to follow-up. The primary patency period was calculated from the date of stenting until the first poststenting intervention for stent occlusion, death, or the time of last documented follow-up. The patency of a single stent was significantly different from that of multiple stents (P = 0.0004). In the subset of patients with high bile duct obstruction, the patency of a single stent remained significantly different from that of multiple stents (P = 0.02). In the single-stent group, there was no difference in patency between patients with high vs. those with low bile duct obstruction (P = 0.43). The overall median patency for the multistent group and the single-stent group was 201 and 261 days, respectively. In conclusion, the patency of a single stent placed for malignant low or high bile duct obstruction is similar, and significantly longer than, that of multiple stents placed for malignant high bile duct obstruction. Given the median patency of 201 days, when indicated, percutaneous stenting of multiple bile ducts is an effective palliative measure for patients with malignant high bile duct obstruction.

  7. Triple non-invasive diagnostic test for exclusion of common bile ducts stones before laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To evaluate the impact of a preoperative "triple non-invasive diagnostic test" for diagnosis and/or exclusion of common bile duct stones.METHODS: All patients with symptomatic gallstone disease, operated on by laparoscopic cholecystectomy from March 2004 to March 2006 were studied retrospectively. Two hundred patients were included and reviewed by using a triple diagnostic test including:patient's medical history, routine liver function tests and routine ultrasonography. All patients were followed up 2-24 mo after surgery to evaluate the impact of triple diagnostic test.RESULTS: Twenty-five patients were identified to have common bile duct stones. Lack of history of stones,negative laboratory tests and normal ultrasonography alone was proven to exclude common bile duct stones in some patients. However, a combination of these three components (triple diagnostic), was proven to be the most statistically significant test to exclude common bile duct stones in patients with gallstone disease.CONCLUSION: Using a combination of routinely used diagnostic components as triple diagnostic modality would increase the diagnostic accuracy of common bile duct stones preoperatively. This triple non-invasive test is recommended for excluding common bile duct stones and to identify patients in need for other investigations.

  8. Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepatic bile ducts

    International Nuclear Information System (INIS)

    Percutaneous transhepatic biliary drainage (PTBD) have been described as an effective technique to obtain biliary access. Between January 1996 and December 2006, a total of 419 consecutive patients with endoscopically inaccessible bile ducts underwent PTBD. The current retrospective study evaluated success and complication rates of this invasive technique. PTBD was successful in 410/419 patients (97%). The success rate was equal in patients with dilated and nondilated bile ducts (p = 0.820). In 39/419 patients (9%) procedure related complications could be observed. Major complications occurred in 17/419 patients (4%). Patients with nondilated intrahepatic bile ducts had significantly higher complication rates compared to patients with dilated intrahepatic bile ducts (14.5% vs. 6.9%, respectively [p = 0.022]). Procedure related deaths were observed in 3 patients (0.7%). In conclusion, percutaneous transhepatic biliary drainage is an effective procedure in patients with dilated and nondilated intrahepatic bile ducts. However, patients with nondilated intrahepatic bile ducts showed a higher risk for procedure related complications.

  9. Cholestasis progression effects on long-term memory in bile duct ligation rats

    Directory of Open Access Journals (Sweden)

    Nasrin Hosseini

    2014-01-01

    Full Text Available Background : There is evidence that cognitive functions are affected by some liver diseases such as cholestasis. Bile duct ligation induces cholestasis as a result of impaired liver function and cognition. This research investigates the effect of cholestasis progression on memory function in bile duct ligation rats. Materials and Methods: Male Wistar rats were randomly divided into five groups, which include: control group for BDL-7, control group for BDL-21, sham group (underwent laparotomy without bile duct ligation, BDL-7 group (7 days after bile duct ligation, and BDL-21 group (21 days after bile duct ligation. Step-through passive avoidance test was employed to examine memory function. In all groups, short-term (7 days after foot shock and long-term memories (21 days after foot shock were assessed. Results: Our results showed that liver function significantly decreased with cholestasis progression (P < 0.01. Also our findings indicated BDL-21 significantly impaired acquisition time (P < 0.05. Memory retrieval impaired 7 (P < 0.05 and 21 days (P < 0.001 after foot shock in BDL-7 and BDL-21 groups, respectively. Conclusion: Based on these findings, liver function altered in cholestasis and memory (short-term and long-term memory impaired with cholestasis progression in bile duct ligation rats. Further studies are needed to better insight the nature of progression of brain damage in cholestatic disease.

  10. REVERSIBILITY OF CHOLESTATIC CHANGES FOLLOWING EXPERIMENTAL COMMON BILE-DUCT OBSTRUCTION - FACT OR FANTASY

    NARCIS (Netherlands)

    ARONSON, DC; CHAMULEAU, RAFM; FREDERIKS, WM; GOOSZEN, HG; HEIJMANS, HSA; JAMES, J

    1993-01-01

    In 36 male Wistar rats extrahepatic cholestasis was induced by ligation and transsection of the common bile duct. After 1, 2 and 3 weeks of cholestasis the bile flow was restored by means of a Roux-en-Y choledochojejunostomy. Plasma levels of bilirubin, alkaline phosphatase, GOT and clotting factor

  11. Predictors of common bile duct lithiasis in laparoscopic era

    Institute of Scientific and Technical Information of China (English)

    George Sgourakis; Georgia Dedemadi; Athanasios Stamatelopoulos; Emmanuel Leandros; Dionysius Voros; Konstantinos Karaliotas

    2005-01-01

    AIM: To analyze retrospectively the records of 294 conse-cutive patients operated upon for gallbladder stones, to determine the predictive factors of synchronous common bile duct (CBD) stones and validate prospectively the generated model. METHODS: The prognostic estimation of a biochemical test and ultrasonography alone to differentiate between the absence and presence of choledocholithiasis was assessed using receiver operating characteristics curve analysis. Multivariate analysis was employed using discriminant analysis for establishment of a best model. Prospective validation of the model was made.RESULTS: Discriminant forward stepwise analysis disclosed that high values (≥ 2×normal) of SGOT, ALP, conjugated bilirubin and CBD diameter on ultrasound ≥ 10 mm were all prognostic factors of CBD lithiasis in univariate and multivariate analysis, P<0.01. History was not included in the model. Prospective validation of the model was performed by multivariate analysis using Visual General Stepwise Regression. Positive predictive value,when considering all these predictors, was 93.3%, while the negative predictive value was 88.8%. Sensitivity of the model was 96.5% and specificity 80%.CONCLUSION: The above model can be objectively applied to predict the presence of CBD stones.

  12. Imaging of common bile duct by linear endoscopic ultrasound

    Institute of Scientific and Technical Information of China (English)

    Malay; Sharma; Amit; Pathak; Abid; Shoukat; Chittapuram; Srinivasan; Rameshbabu; Akash; Ajmera; Zeeshn; Ahamad; Wani; Praveer; Rai

    2015-01-01

    Imaging of common bile duct(CBD) can be done by many techniques. Endoscopic retrograde cholangiopancreaticography is considered the gold standard for imaging of CBD. A standard technique of imaging of CBD by endoscopic ultrasound(EUS) has not been specifically described. The available descriptions mention different stations of imaging from the stomach and duodenum. The CBD lies closest to duodenum and choice of imaging may be restricted to duodenum for many operators. Generally most operators prefer multi station imaging during EUS and the choice of selecting the initial station varies from operator to operator. Detailed evaluation of CBD is frequently the main focus of imaging during EUS and in such situations multi station imaging with a high-resolution ultrasound scanner may provide useful information. Examination of the CBD is one of the primary indications for doing an EUS and it can be done from five stations:(1) the fundus of stomach;(2) body of stomach;(3) duodenal bulb;(4) descending duodenum; and(5) antrum. Following down the upper 1/3rd of CBD can do imaging of entire CBD from the liver window and following up the lower 1/3rd of CBD can do imaging of entire CBD from the pancreatic window. This article aims at simplifying the techniques of imaging of CBD by linear EUS.

  13. Radiotherapy of bile duct carcinoma; Effectiveness of external irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Shiina, Takeki; Itami, Jun; Uno, Takashi; Kato, Hajime; Tani, Masanao; Kawai, Saburou (National Medical Center of Hospital, Tokyo (Japan))

    1992-10-01

    Twenty-six patients with cholangiocarcinoma and nineteen patients with carcinoma of the gallbladder treated with external radiotherapy were analyzed. Of the twenty-six patients, eighteen had cancer of the hepatic hilus (Klatskin), four intrahepatic and the remaining four extrahepatic cholangiocarcinoma. All but two of the patients had advanced disease. Thirty-three patients received primary irradiation for unresectable tumors, ten patients adjuvant irradiation after non-curative gross tumor resection, and two patients preoperative radiotherapy. Patients with cholangiocarcinoma who underwent radiotherapy with relatively small radiation field tolerated the treatment well, but there was no significant difference in survival according to field size or radiation doses (TDF). On the other hand, patients with carcinoma of gallbladder were treated with larger field size and lower dose. In the patients without gross tumor resection, those receiving radiation doses[>=]90 TDF had significantly longer survival than <90 TDF (p<0.05). Regarding to the field size, patients irradiated by smaller field size ([<=]100 cm[sup 2]) had longer survival (p=0.07). The patients with gross tumor resection had significantly longer survival than that without resection in both cholangiocarcinoma and carcinoma of gallbladder. Postmortem examination revealed tumor recurrence even in the patients with gross tumor resection, but widespread distant metastases were present simultaneously. Cholangitis and liver abscess were special and lethal conditions related to these carcinomas, and intensive therapy must be developed for these conditions. External radiotherapy may be effective in the treatment of bile duct carcinoma in terms of palliation and survival. (author).

  14. Iatrogenic bile duct injuries: Etiology, diagnosis and management

    Institute of Scientific and Technical Information of China (English)

    Beata Jab(l)o(n)ska; Pawe(l) Lampe

    2009-01-01

    Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI isvery important for surgeons and gastroenterologists,because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death.Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popularand simple classification of IBDI is the Bismuth scale.Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered.Different surgical reconstructions are performed in patients with IBDI. According to the literature, Rouxen-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors.In the opinion of some authors, a more physiological and equally effective type of reconstruction is endto-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI;the Terblanche scale, based on clinical biliary symptoms,is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.

  15. Obstructed Bile Duct as a Trigger for Microbe's Translocation?

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    To assess the potential mechanisms of bacterial translocation in a murine model of obstructive jaundice. Methods: Adult rats were randomized to be operated on for ligation or sham-ligation of the common bile duct. Bacterial translocation to the mesenteric lymph nodes (MLNs), liver, spleen, portal blood and systemic circulation and bacterial population levels in the ceca were quantitated after 7 and 14 days. The terminal ilea were histologically examined by light and transmission electron microscopy. Results: Bacterial translocation to the MNLs was seen in both 7 (10/17) and 14 (11/18) day ligated animals, but not found in their corresponding controls (both 0/8). No significant difference in the cecal bacterial population levels was found between the ligated groups and their corresponding control groups, also between the two subgroups that were set up within each ligated group according to the presence or absence of bacteria in the MLNs. In the ligated rats, light microscopy demonstrated subepithelial edema in association with infiltration of flammatory cells and, transmission electron microscopy showed that the enterocytes were injured with abnormal microvilli, swollen mitochondria, unclear endoplasmic reticulum and cytoplasm with bubble degeneration. However, the ilea from the controls appeared normal. Conclusions: Obstructive jaundice promotes bacterial translocation in rats. The gut mucosal damage rather than the intestinal bacterial overgrowth may play a crucial role in bacterial translocation.

  16. CT characterization of bile duct dilatation: Differential diagnosis of obstructive jaundice

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Jae Hoon; Yoon, Hyp; Ko, Young Tae; Lee, Dong Ho; Yang, Ik [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1992-07-15

    Each disease affecting the bile ducts tends to produce characteristic pattern of biliary dilatation: recurrent pyogenic cholangitis causes dilatation and straightening of the larger (central) intrahepatic ducts: clonorchiasis causes dilatation of the smaller (peripheral) intrahepatic ducts; and carcinoma along the extrahepatic ducts causes (proportional) dilatation and tortuosity of both larger and smaller intrahepatic ducts. To evaluate the specificity of the pattern and morphology of the dilated biliary tree on CT scans (CT characterization) three independent radiologists who were unifamiliar with the cases were asked to classify 62 CT scans in patients with obstructive jaundice. The case population consisted of 14 cases with recurrent pyogenic cholangitis, 18 cases with clonorchiasis and 30 cases with carcinoma along the extrahepatic ducts, which were intermixed randomly. Classification was made only on the basis of CT characterization: those scans showing primary lesions, i.t., stone , aggregate of flukes, or tumor mass were excluded or masked. All the scans of every cases showing the extrahepatic bile duct were masked . Radiologists correctly classified 54 of the 62 cases (87%): ten of the 14 patients with recurrent pyogenic cholangitis (71%). 17 of the 18 patients with clonorchiasis (94%) and 27 of the 30 patients with carcinoma along the extrahepatic bile ducts (90%). We believe that CT characterization of bile dust dilatation is useful in the differential diagnosis of obstructive jaundice, especially when a primary pathologic lesion is not depicted in CT scans.

  17. Lack of Methylene Blue Staining in Superficial Epithelia as a Possible Marker for Superficial Lateral Spread of Bile Duct Cancer

    OpenAIRE

    Maetani, I.; Ogawa, S.; Sato, M.; Igarashi, Y.; Sakai, Y.; Shibuya, K

    1996-01-01

    Longitudinal cancer spread is very important for staging of resectability in bile duct cancer. We verified the difference in methylene blue staining properties between cancerous and noncancerous epithelia that are usually observed by cholangioscopy. We obtained 45 biopsy specimens from the common bile duct of 20 patients with bile duct disease using percutaneous transhepatic cholangioscopy (PTCS) after staining with 0.05% methylene blue. We compared the microscopic staining properties with th...

  18. Effects of cholesterol on the phenotype of rabbit bile duct fibroblasts

    Institute of Scientific and Technical Information of China (English)

    Bao-Ying Chen; Jing-Guo Wei; Yao-Cheng Wang; Chun-Mei Wang; Jun Yu; Xiang-Xin Yang

    2003-01-01

    AIM: To investigate how cholesterol (Ch) can affect thephenotype of bile duct fibroblasts of New Zealand rabbits.METHODS: 16 rabbits were divided randomly into twogroups: the control group and the experiment group. Therabbits in experiment group were fed with hypercholesteroldiet for 8 weeks. Bile duct was dissociated from rabbits andprepared for transmission electron microscopy. The purifiedbile duct fibroblasts were cultured and divided randomlyinto there groups: control group, Ch smiddle concentrationgroup (0.6 g/L), Ch high concentration group (1.2 g/L). Afterincubated for 72 h, the fibroblasts were made into specimensfor transmission electron microscopy. The expression of α-actin in bile duct fibroblasts was measured by means oflaser scanning confocal microscopy.RESULTS: With the transmission electron microscopy, thenormal bile duct fibroblasts were shuttle-shaped, and therewere abundant rough endoplasmic reticulums (RER), butfew mitochondria or microfilaments in cytoplasm. This isthe typical phenotype of fibroblasts. Bile duct fibroblasts ofhypercholesterolemic rabbits were observed, by thetransmission electron microscopy Rough endoplasmicreticulums were significantly reduced, with a lot ofmicrofilament bundles or stress fibers appeared in cytoplasm,especially under plasma membrane. Dense bodies werescattered within these bundles. Macula densas anddiscontinuous sarcolemma were found under plasmamembrane. It suggested that the bile duct fibroblasts ofhypercholesterolemic rabbits presented the phenotype ofsmooth muscle cell. The cultured bile duct fibroblasts alsohad typical phenotype of fibroblasts. After stimulated bymiddle concentration cholesterol (0.6 g/L) for 72 h, thereappeared lots of microfilaments in cytoplasm, but withoutdense body, macula densa and discontinuous sarcolemma.Observed with confocal microscopy, there were many regularbundles of microfilaments in fibroblasts treated with middleconcentration ch (0.6 g/L) and the expression of

  19. Pancreatitis following bile duct sphincter of Oddi manometry: utility of the aspirating catheter.

    Science.gov (United States)

    Sherman, S; Hawes, R H; Troiano, F P; Lehman, G A

    1992-01-01

    The aspirating sphincter of Oddi manometry (SOM) catheter was shown to reduce the frequency of post-procedure pancreatitis from 31% to 4% following a pancreatic duct evaluation. This study was designed to prospectively evaluate the utility of the aspirating manometry catheter in reducing the frequency of pancreatic enzyme elevation and clinical pancreatitis following isolated bile duct manometry. Thirty-eight patients were randomly assigned to undergo bile duct SOM with the standard perfusion (infused group) catheter or the aspirating catheter (aspirated group). Overall, the frequency of both amylase and lipase level elevation at least two times the upper limits of normal was 30% at 2 hours, 25% at 6 hours, and 18% at 18 hours after the procedure and was similar for the aspirated and infused groups. No episodes of clinical pancreatitis occurred in either group. The SOM catheter was perfused with full-strength contrast in 12 consecutive patients undergoing a bile duct evaluation. Only one patient had any contrast material identified in the pancreatic duct. The results of this study support the theory that increased pancreatic duct hydrostatic pressure is the major cause for post-SOM pancreatitis and suggests that SOM evaluation of the bile duct alone appears to be safe.

  20. Electron microscopical studies of the common bile duct in reindeer

    Directory of Open Access Journals (Sweden)

    Timo Rahko

    1990-08-01

    Full Text Available In a previous publication the authors have described some ultrastructural characteristics of granulated cells in the common bile duct of the reindeer. On the basis of the same material, electron microscopic observations on other tissue elements of bile duct wall are now reported. The surface and glandular epithelium were composed of tall columnar epithelial cells with villous structures on the luminal surfaces. The parietal cytoplasmic membranes of epithelial cells were equipped with intercellular desmosomes while intraepithelial globule leucocytes did not form any junctional complex with other cells. Apical cytoplasmic areas of superficial epithelial cells showed electron-dense small bodies possibly consisting of mucinous substances. The goblet and deep glandular cells, on the other hand, contained numerous large mucin granules with less electron-dense matrices. It appears that their secretions are more abundant than those in superficial epithelial cells which obviously are absorptive as their main function. The nuclei and other cytoplasmic organelles showed profiles similar to those in epithelial cells generally. The lumen of the bile ducts was usually empty or contained fine-granular or amorphous material. An unusual feature was the presence of parts of globule leucocytes or even almost whole cells occurring freely in ductal secretions.Elektronimikroskooppinen tutkimus yhteisen sappikäytävän rakenteesta porolla.Abstract in Finnish / Yhteenveto: Aikaisemmassa julkaisussa tekijät kuvasivat poron yhteisen sappikäytävän (ductus hepaticus communis seinämän jyväsellisten solujen hienorakennetta. Tässä artikkelissa selostetaan saman aineiston perusteella (6 tervettä teurasporoa elektronimikroskooppisia havaintoja sappikäytäväseinämän muista kudosrakenteista. Sappikäytäväseinämän pinta- ja rauhasepiteeli koostuu korkeista epiteelisoluista. Pinnallisia epiteelisoluja kattavat säännölliset mikrovillukset, ja niillä on vain v

  1. A new method of preventing bile duct injury in laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Fang Xu; Cheng-Gang Xu; De-Zheng Xu

    2004-01-01

    AIM: Of all the complications of laparoscopic cholectecystomy,bile duct injury (BDI) is the most serious complication.The prevention of injury to the common bile duct (CBD) remains a significant concern in laparoscopic cholecystectomy (LC).Different kinds of methods have been advanced to avoid this injury but no single method has gained wide acceptance.Because of various limitations of current methodologies we began a study using cold light illumination of the extrahepatic biliary system (light cholangiography LCP) to better visualize this area and thereby reduce the risk of bile duct injury.METHODS: Thirty-six patients with cholelithiasis were divided into two groups.Group Ⅰ (16 cases) received LCP and group Ⅱ (20 cases) received methelenum coeruleum cholangiography (MCCP).In group Ⅰ cold light was used to illuminate the common bile duct by leading an optical fiber into the common duct with a duodenoscope at the time of LC.The light coming from the fiber in the CBD could clearly illuminate the location of CBD and hepatic duct establishing its location relative to the cystic duct.This method was compared with the dye injection technique using methelenum coeruleum.RESULTS: In group Ⅰ thirteen cases were successfully illuminated and three failed.The cause of three failed cases was due to the difficulty in inserting the fiber into the ampulla of Vater.No complications occurred in the thirteen successful cases.In each of these successful cases the location of the common and hepatic ducts was clearly seen differentiating the ductal system from surrounding anatomy.In ten cases both the left and right hepatic ducts could be seen and in three only the right hepatic ducts were seen.In four of the thirteen cases,cystic ducts were also seen.In group Ⅱ,eighteen of the twenty cases were successful.The location of extrahepatic ducts became blue differentiating the ductal system from surrounding anatomy.Two cases failed due to a stone obstructing the cystic duct

  2. Experimental investigation of the flow of bile in patient specific cystic duct models.

    Science.gov (United States)

    Al-Atabi, Mushtak; Chin, S B; Luo, X Y

    2010-04-01

    Three-dimensional scaled-up transparent models of three human cystic ducts were prepared on the basis of anatomical specimens. The measurement of pressure drop across the cystic duct models and visualization of the flow structures within these ducts were performed at conditions replicating the physiological state. The flow visualization study confirmed the laminar nature of the flow of bile inside the cystic duct and values of pressure drop coefficient (Cp) decreased as the Reynolds number (Re) increased. The three tested models showed comparable behavior for the curve of Reynolds number versus the pressure drop coefficient. The results show that the tested cystic ducts have both increased pressure drop and complicated flow structures when compared with straight conduits. High resistance in a cystic duct may indicate that the gallbladder has to exert large force in expelling bile to the cystic duct. For patients with diseased gallbladder, and even in healthy persons, gallbladder is known to stiffen with age and it may lose its compliance or flexibility. A high resistance cystic duct coupled with a stiffened gallbladder may result in prolonged stasis of bile in the gallbladder, which is assumed to encourage the formation of gallstones.

  3. Beneficial effects of autologous bone marrow mononuclear cell transplantation against ischemic bile duct in rats

    Institute of Scientific and Technical Information of China (English)

    LI Li-xin; CHEN DA-zhi; HE Qiang

    2011-01-01

    Background Bone marrow cell transplantation has been shown to induce angiogenesis and thus improve ischemic disease.This study evaluated the effect of bone marrow mononuclear cell (BM-MNCs) implantation on neovascularization in rats with ischemic bile duct.Methods We established an animal model for ischemic biliary stenosis by clamping manipulation.There were 10 rats in each group:BM-MNCs implantation group,control group and normal group.Rat femur BM-MNCs were isolated using density gradient centrifugation.BM-MNCs or phosphate buffered saline were injected into three points around bile duct tissue in the three groups (25 μl/point).Control rats received injections of saline under similar conditions.At the 21 days after operation,cholangiography was performed.Differentiation of the engrafted cells and capillary density in the bile duct were analyzed by immunohistochemical staining.Results Engrafted cells could differentiate into endothelial cells.The stricture rate in the implantation group was 40%,significantly lower than that in the control group (100%).The capillary density in the implantation group was significantly higher than in the control group or the normal group.Conclusions The implantation of BM-MNCs induced neovascularization in the ischemic bile duct.It improved the blood supply of the ischemic bile duct to prevent or decrease biliary ischemic stricture.

  4. Development of bile duct bezoars following cholecystectomy caused by choledochoduodenal fistula formation: a case report

    Directory of Open Access Journals (Sweden)

    Adibnejad Soheil

    2006-01-01

    Full Text Available Abstract Background The formation of bile duct bezoars is a rare event. Its occurrence when there is no history of choledochoenteric anastomosis or duodenal diverticulum constitutes an extremely scarce finding. Case presentation We present a case of obstructive jaundice, caused by the concretion of enteric material (bezoars in the common bile duct following choledochoduodenal fistula development. Six years after cholecystectomy, a 60-year-old female presented with abdominal pain and jaundice. Endoscopic retrograde cholangiopancreatography demonstrated multiple filling defects in her biliary tract. The size of the obstructing objects necessitated surgical retrieval of the stones. A histological assessment of the objects revealed fibrinoid materials with some cellular debris. Post-operative T-tube cholangiography (9 days after the operation illustrated an open bile duct without any filling defects. Surprisingly, a relatively long choledochoduodenal fistula was detected. The fistula formation was assumed to have led to the development of the bile duct bezoar. Conclusion Bezoar formation within the bile duct should be taken into consideration as a differential diagnosis, which can alter treatment modalities from surgery to less invasive methods such as more intra-ERCP efforts. Suspicions of the presence of bezoars are strengthened by the detection of a biliary enteric fistula through endoscopic retrograde cholangiopancreatography. Furthermore, patients at a higher risk of fistula formation should undergo a thorough ERCP in case there is a biliodigestive fistula having developed spontaneously.

  5. THE ACTUALLY PRINCIPLES IN THE TREATMENT OF BILIARY OBSTRUCTION FROM EXTRAHEPATIC BILE DUCTS CANCER

    Directory of Open Access Journals (Sweden)

    A. Vasilescu

    2009-02-01

    Full Text Available The most common type of extrahepatic bile ducts cancer is the proximal segment which include the bifurcation of common hepatic duct (Klatskin’s tumors. The diagnosis of these kinds of tumors is always challenging. Magnetic resonance cholangiopancreatography (MRCP is the best imagistic procedure also for diagnosis and for staging. Surgical resection provides the best chance for cure in patients with biliary malignancy; unfortunately only 30% from patients with Klatskin’s tumors are diagnosed in resectable stages. The type and extension of the resection depends of the tumor stage and site. Resection of the biliary duct associated with hepatectomy and/or pancreaticoduodenectomy (performed especially for limphadenectomy has good results, from point of view of disease-free survival. In selected cases, the extrahepatic bile duct resection alone and hepatico-jejunal anastomosis is also considered as curative resection. Portal vein resection may be performed and can improve the prognosis. Palliative procedures of nonresectable bile ducts cancer consist in surgical by-pass, percutaneous biliary drainage and endoscopic endoprosthesis. Because long-term relief of jaundice is difficult without using biliary stenting, a combination of radiation therapy and stent placement is commonly used. As radiation therapy, external-beam radiotherapy is usually performed, but combined use of intraluminal brachytherapy with external beam radiation therapy is more useful for making the treatment more effective. Radiation therapy can be associated with chemotherapy (gemcitabine in unresectable bile duct cancer to extend survival and improve quality of life.

  6. Radiographic diagnosis of bile duct cysts. Retrospective analysis of thirteen cases

    Energy Technology Data Exchange (ETDEWEB)

    Paeivaensalo, M.; Merikanto, J.; Laehde, S.; Hietala, S.O.; Leinonen, A.; Jouppila, P.; Lohela, P.; Lanning, P.

    Twelve patients and a foetus with congenital bile duct cysts suggested in the majority of cases at routine upper abdominal sonography were examined by two or more of the following investigations: Ultrasonography (10 patients), computed tomography (5 patients), CT-cholangiography (2 patients), oral cholecystography (7 patients), intravenous cholangiography (4 patients), endoscopic retrograde cholangiopancreatography (ERCP) (6 patients) and cholescintigraphy (2 patients). The sensitivity of each investigation for the diagnosis of bile duct cysts was: Ultrasound 40%, computed tomography 20%, CT-cholangiography 100%, oral cholecystography 17%, intravenous cholangiography 75%, ERCP 83% and cholescintigraphy 50%. When a bile duct cyst has been suggested by ultrasonography or other examinations, without a conclusive diagnosis being made, CT-cholangiography is recommended as the next examination. In patients with impaired biliary excretion of contrast medium, ERCP may be required to achieve the diagnosis.

  7. Spontaneous Rupture of the Bile Duct Associated with Pancreatitis. A Rare Presentation

    Directory of Open Access Journals (Sweden)

    Mahesh K Goenka

    2011-03-01

    Full Text Available Context Spontaneous rupture of the bile duct, although rare, has been described as a known surgical cause of jaundice in infancy after biliary atresia. Case report This article describes a four-year-old girl who presented with severe abdominal pain and features suggestive of acute pancreatitis, who developed gradual distension of the abdomen, and was found to have a ruptured bile duct, producing biliary peritonitis. She was managed with laparoscopic drainage of the peritoneal cavity. However, in view of the persistent biliary drainage, an ERCP was performed followed by stent placement for a bile duct leak. She was subsequently diagnosed as having a choledochal cyst. Conclusion A high index of suspicion, appropriate investigation, such as MRCP, combined with early drainage can help in reaching an early diagnosis, and reduced morbidity and mortality in this rare disorder.

  8. [Acute cholangitis in interstenosis space accompanied by two-component unit of the main bile duct].

    Science.gov (United States)

    Yurchenko, V V

    2016-02-01

    Palliative treatment of obstructive jaundice with the help of biliary endoprosthesis due to the possible complication of post-intervention in the form of insolvency stent deformation or dislocation. The study features in the postoperative period of the main bile duct endoprosthesis about their two-component unit, described the syndrome of the closed space of the bile ducts. On the basis of observation of 14 patients with the given anatomical feature of endoscopic, who were underwent stenting, was assessed frequency of the syndrome and possibilities of its prevention. Interstenosis space expansion of the main bile duct can be a reason for local cholangitis. For the prevention of cholangitis, it should be carried out a separate drainage of interstenosis space with the help of endoprosthesis or by proximal supra-stenotic extension of two or more stents. PMID:27263209

  9. Biliary drainage of the common bile duct with an enteral metal stent

    OpenAIRE

    dek, I.M.; Elzen, van den, CMJ; Fockens, P.; Rauws, E A J

    2009-01-01

    In this case report we present an elderly patient who was referred to our hospital with recurrent episodes of cholangitis that persisted after placement of five metal stents for a distal common bile duct (CBD) stenosis. All metal stents were endoscopically removed from the CBD by forceps after balloon dilatation of the papilla. A profoundly dilated CBD with sludge and concrements was seen. To ensure adequate bile drainage an enteral metal stent was inserted in the CBD. This case shows that pr...

  10. Cylindrical dilatation of the choledochus: a special type of congenital bile duct dilatation.

    Science.gov (United States)

    Todani, T; Watanabe, Y; Fujii, T; Toki, A; Uemura, S; Koike, Y

    1985-11-01

    Cylindrical dilatation of the choledochus develops in 20% of patients with congenital bile duct dilatation and usually has acute-angled unions of the pancreatobiliary ductal system. Symptoms generally develop in patients over 1 year of age. The patients frequently complain of abdominal pain, vomiting, and fever as in those with acute pancreatitis. Ultrasonography and infusion cholangiography are the most useful tools in making a correct diagnosis. A high amylase level in the bile caused by the refluxing of pancreatic juice through anomalous ductal unions is commonly observed. This is responsible for biliary perforation in infancy and possibly carcinoma arising in the bile duct. The amylase concentration in the serum at the time of epigastric pain often is high, which leads to the diagnosis of acute pancreatitis. However, evidence of pancreatic inflammation is seldom noted. Accordingly, amylase in the bile may enter the circulating blood through the denuded epithelium or sinusoids of the liver. Excision of the whole extrahepatic duct along with hepaticoenterostomy would be essential for the treatment of cylindrical dilatation of the bile duct, especially when an anomalous ductal union is present.

  11. Regulation of bile duct motility by vagus and sympathetic nerves in the pigeon.

    Directory of Open Access Journals (Sweden)

    Neya,Toshiaki

    1990-04-01

    Full Text Available Effects of stimulation of the vagus and sympathetic nerves on bile duct peristalses were studied in pigeons anesthetized with urethane. Vagus stimulation increased the frequency of peristalses. Atropine, hexamethonium and tetrodotoxin abolished this excitatory effect. After atropine, inhibition of peristalses sensitive to tetrodotoxin was produced. Stimulation of sympathetic area in the spinal cord inhibited peristalses. Propranolol converted this effect into an excitatory one, which was abolished by phentolamine. The results suggest that vagal and sympathetic innervations of the bile duct in pigeons are similar to those of the sphincter of Oddi in mammalian species.

  12. Main Bile Duct Stricture Occurring After Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the clinical course of main bile duct stricture at the hepatic hilum after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Among 446 consecutive patients with HCC treated by TACE, main bile duct stricture developed in 18 (4.0%). All imaging and laboratory data, treatment course, and outcomes were retrospectively analyzed. All patients had 1 to 2 tumors measuring 10 to 100 mm in diameter (mean ± SD 24.5 ± 5.4 mm) near the hepatic hilum fed by the caudate arterial branch (A1) and/or medial segmental artery (A4) of the liver. During the TACE procedure that caused bile duct injury, A1 was embolized in 8, A4 was embolized in 5, and both were embolized in 5 patients. Nine patients (50.0%) had a history of TACE in either A1 or A4. Iodized oil accumulation in the bile duct wall was seen in all patients on computed tomography obtained 1 week later. Bile duct dilatation caused by main bile duct stricture developed in both lobes (n = 9), in the right lobe (n = 3), in the left lobe (n = 4), in segment (S) 2 (n = 1), and in S3 (n = 1). Serum levels of alkaline phosphatase and γ-glutamyltranspeptidase increased in 13 patients. Biloma requiring drainage developed in 2 patients; jaundice developed in 4 patients; and metallic stents were placed in 3 patients. Complications after additional TACE sessions, including biloma (n = 3) and/or jaundice (n = 5), occurred in 7 patients and were treated by additional intervention, including metallic stent placement in 2 patients. After initial TACE of A1 and/or A4, 8 patients (44.4%), including 5 with uncontrollable jaundice or cholangitis, died at 37.9 ± 34.9 months after TACE, and 10 (55.6%) have survived for 38.4 ± 37.9 months. Selective TACE of A1 and/or A4 carries a risk of main bile duct stricture at the hepatic hilum. Biloma and jaundice are serious complications associated with bile duct strictures.

  13. Impairment of the organization of locomotor and exploratory behaviors in bile duct-ligated rats

    DEFF Research Database (Denmark)

    Leke, Renata; de Oliveira, Diogo L; Mussulini, Ben Hur M.;

    2012-01-01

    female Wistar rats underwent common bile duct ligation (BDL rats) or the manipulation of common bile duct without ligation (control rats). Six weeks after surgery, control and BDL rats underwent open-field, plus-maze and foot-fault behavioral tasks. The BDL rats developed chronic liver failure...... from the control rats for the elevated plus-maze and foot-fault tasks. Therefore, the BDL rats demonstrated disturbed spontaneous locomotor and exploratory activities as a consequence of altered spatio-temporal organization of behavior....

  14. Repair of bile duct defect with degradable stent and autologous tissue in a porcine model

    Institute of Scientific and Technical Information of China (English)

    Yue-Long Liang; Yi-Chen Yu; Kun Liu; Wei-Jia Wang; Jiang-Bo Ying; Yi-Fan Wang; Xiu-Jun Cai

    2012-01-01

    AIM:To introduce and evaluate a new method to repair bile duct defect with a degradable stent and autologous tissues.METHODS:Eight Ba-Ma mini-pigs were used in this study.Experimental models with common bile duct (CBD) defect (0.5-1.0 cm segment of CBD resected) were established and then CBD was reconstructed by duct to duct anastomosis with a novel degradable stent made of poly [sebacic acid-co-(1,3-propanediol)-co-(1,2-propanediol)].In addition,a vascularized greater omentum was placed around the stent and both ends of CBD.Cholangiography via gall bladder was performed for each pig at postoperative months 1 and 3 to rule out stent translocation and bile duct stricture.Complete blood count was examined pre-and post-operatively to estimate the inflammatory reaction.Liver enzymes and serum bilirubin were examined pre-and post-operatively to evaluate the liver function.Five pigs were sacrificed at month 3 to evaluate the healing of anastomosis.The other three pigs were raised for one year for long-term observation.RESULTS:All the animals underwent surgery successfully.There was no intraoperative mortality and no bile leakage during the observation period.The white blood cell counts were only slightly increased on day 14 and month 3 postoperatively compared with that before operation,the difference was not statistically significant (P =0.652).The plasma level of alanine aminotransferase on day 14 and month 3 postoperatively was also not significantly elevated compared with that before operation (P =0.810).Nevertheless,the plasma level of γ-glutamyl transferase was increased after operation in both groups (P =0.004),especially 2 wk after operation.The level of serum total bilirubin after operation was not significantly elevated compared with that before operation (P =0.227),so did the serum direct bilirubin (P =0.759).By cholangiography via gall bladder,we found that the stent maintained its integrity of shape and was still in situ at month 1,and it disappeared

  15. Percutaneous transhepatic biliary drainage through the normal duct in patients with post-operative bile leakage

    International Nuclear Information System (INIS)

    To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic biliary drainage (PTBD) through the normal duct in patients with post-operative bile leakage. From January 1998 to December 2003, fourteen patients (male: 12, female: 2, mean age: 56) with biliary leak after laparoscopic cholecystectomy (n = 5), T-tube removal (n = 5), choledochojejunostomy due to small bowel perforation (n = 1), right lobectomy (n = 1), laparoscopic adrenalectomy (n = 1), and subtotal gastrectomy (n = 1) were treated by means of PTBD; this was performed with the two-step approach. The central bile duct was cannulated using a 21-G Chiba needle to map the intrahepatic biliary tree. An 8.5-F drainage catheter tip was positioned at the CBD after puncturing peripheral bile duct with an additional Chiba needle. We evaluated the technical feasibility, the procedure-related complications, clinical efficacy and the duration of catheter placement. PTBD of the normal duct with the two-step approach was successful in all but two cases. In these two cases, the two-step approach was failed due to the rapid disappearance of the targeted peripheral duct, and this was the result caused by biloportal fistula. PTBD was performed through the central bile duct in one patient, and through the remnant cystic duct in one patient. There were no procedure-related complications except for mild abdominal pain in seven patients. Bile leakage was demonstrated on cholangiogram in 10 of 14 patients; this occurred at the T-tube exit site (n = 4), cystic duct stump (n = 2), choledochojejunostomy site (n = 1), resection margin of liver (n = 1), caudate lobe (n = 1), and GB bed (n = 1). In 13 patients, the biliary leak stopped after drainage (mean duration: 32.1 days). In one patient, surgical management was performed one day after PTBD due to the excessive amount of bile leakage. PTBD is a technically feasible and clinically efficacious treatment for post-operative bile leakage, and it can

  16. Immunoexpression of intermediate filaments and morphological changes in the liver and bile duct of rats infected with Fasciola hepatica.

    Science.gov (United States)

    Kolodziejczyk, L; Laszczyńska, M; Masiuk, M; Grabowska, M; Skrzydlewska, E

    2015-01-01

    We investigated the immunoexpression of the intermediate filament proteins, cytokeratin and desmin, and the morphological changes in the liver of rats during experimental fasciolosis at 4, 7 and 10 weeks post-infection. Rats were infected with 30 Fasciola hepatica metacercariae. Paraffin sections of the liver were stained using H & E, PAS and azan stains. Immunohistochemical reactions were performed using antibodies against cytokeratin and desmin. The experimental F. hepatica infection led to fibrosis and cirrhosis of the liver, and to inflammation of the common bile ducts. The expression of cytokeratin was increased in the epithelial cells of both the liver bile ductules at 4, 7 and 10 weeks post-infection and in the common bile ducts at 7 and 10 weeks post-infection compared to uninfected rats; expression in the common bile ducts was more intense. The myofibroblasts of the liver and smooth myocytes of the interlobular bile ducts and common bile ducts, showed a slight increase in desmin expression compared to the uninfected rats. The increased expression of cytokeratins in the hyperplastic rat common bile duct epithelium during the biliary phase of fasciolosis at 7 and 10 weeks post-infection may be explained by mechanical irritation by the parasite and an inflammatory reaction in the bile duct epithelium and in periductal fibrous tissue. PMID:25923046

  17. Immunoexpression of intermediate filaments and morphological changes in the liver and bile duct of rats infected with Fasciola hepatica.

    Science.gov (United States)

    Kolodziejczyk, L; Laszczyńska, M; Masiuk, M; Grabowska, M; Skrzydlewska, E

    2015-01-01

    We investigated the immunoexpression of the intermediate filament proteins, cytokeratin and desmin, and the morphological changes in the liver of rats during experimental fasciolosis at 4, 7 and 10 weeks post-infection. Rats were infected with 30 Fasciola hepatica metacercariae. Paraffin sections of the liver were stained using H & E, PAS and azan stains. Immunohistochemical reactions were performed using antibodies against cytokeratin and desmin. The experimental F. hepatica infection led to fibrosis and cirrhosis of the liver, and to inflammation of the common bile ducts. The expression of cytokeratin was increased in the epithelial cells of both the liver bile ductules at 4, 7 and 10 weeks post-infection and in the common bile ducts at 7 and 10 weeks post-infection compared to uninfected rats; expression in the common bile ducts was more intense. The myofibroblasts of the liver and smooth myocytes of the interlobular bile ducts and common bile ducts, showed a slight increase in desmin expression compared to the uninfected rats. The increased expression of cytokeratins in the hyperplastic rat common bile duct epithelium during the biliary phase of fasciolosis at 7 and 10 weeks post-infection may be explained by mechanical irritation by the parasite and an inflammatory reaction in the bile duct epithelium and in periductal fibrous tissue.

  18. Role of interventional therapy in hepatic artery stenosis and non-anastomosis bile duct stricture after orthotopic liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Da-Bing Zhao; Jie-Sheng Qian; Hong Shan; Zai-Bo Jiang; Ming-Sheng Huang; Kang-Shun Zhu; Gui-Hua Chen; Xiao-Chun Meng; Shou-Hai Guan; Zheng-Ran Li

    2007-01-01

    AIM: To analyze the clinical manifestations and the effectiveness of therapy in patients with orthotopic liver transplantation (OLT)-associated hepatic artery stenosis (HAS) and non-anastomosis bile duct stricture.METHODS: Nine cases were diagnosed as HAS and non-anastomosis bile duct stricture. Percutaneous transluminal angioplasty (PTA) was performed in four HAS cases, and expectant treatment in other five HAS cases; percutaneous transhepatic bile drainage, balloon dilation, stent placement were performed in all nine cases.RESULTS: Diffuse intra- and extra-bile duct stricture was observed in nine cases, which was associated with bile mud siltation and biliary infection. Obstruction of the bile duct was improved obviously or removed. Life span/ follow-up period was 13-30 mo after PTA of four HAS cases, 6-23 mo without PTA of other five cases.CONCLUSION: Progressive, non-anastomosis, and diffuse bile duct stricture are the characteristic manifestations of HAS and non-anastomosis bile duct stricture after OLT. These are often associated with bile mud siltation, biliary infection, and ultimate liver failure. Interventional therapy is significantly beneficial.

  19. Biliary Metal Stent as a Nidus for Bile Duct Stone

    OpenAIRE

    Cheon, Young Koog; Moon, Jong Ho; Cho, Young Deok; Kim, Yun Soo; Lee, Moon Sung; Shim, Chan Sup

    2002-01-01

    Several cases of recurrent stone formation caused by a surgical material as a nidus have been reported. Recently, we experienced one case in which a migrated metal stent might have been served as a nidus for common duct stone formation. The diagnosis was confirmed by ERCP, the stone was successfully removed with endoscopic therapy. Six years ago, she had undergone a lithotripsy using a percutaneous cholangioscopy (PTCS) because of intrahepatic cile duct stoes. Six years later, she developed a...

  20. Metachronous bile duct cancer nine years after resection of gallbladder cancer

    Institute of Scientific and Technical Information of China (English)

    Hye Jin Joo; Gi Hyun Kim; Won Joong Jeon; Hee Bok Chae; Seon Mee Park; Sei Jin Youn; Jae Woon Choi; Rohyun Sung

    2009-01-01

    We report a rare case of a 74-year-old man with metachronous gallbladder cancer and bile duct cancer who underwent curative resection twice, with the operations nine years apart. At the age of 65 years,the patient underwent a cholecystectomy and resection of the liver bed for gallbladder cancer. This was a welldifferentiated adenocarcinoma, with negative resection margins (T2N0M0, stage ⅠB). Nine years later,during a follow-up examination, abdominal computed tomography and MRCP showed an enhanced 1.7 cm mass in the hilum that extended to the second branch of the right intrahepatic bile duct. We diagnosed this lesion as a perihilar bile duct cancer, Bismuth type Ⅲ a, and performed bile duct excision, right hepatic lobectomy and Roux-en-Y hepaticojejunostomy.The histological diagnosis was a well-differentiated adenocarcinoma with one regional lymph node metastasis (T1N1M0, stage ⅡB). Twelve months after the second operation, the patient is well, with no signs of recurrence. This case is compared with 11 other cases of metachronous biliary tract cancer published in the world medical literature.

  1. Surgical management in biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To discuss the surgical method and skill of biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury.METHODS: From November 2005 to December 2006,eight patients with biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury were admitted to our hospital. Their clinical data were analyzed retrospectively.RESULTS: Bile duct injury was caused by cholecystectomy in the eight cases, including seven cases with laparoscopic cholecystectomy and one with miniincision choleystectomy. According to the classification of Strasberg, type E1 injury was found in one patient,type E2 injury in three, type E3 injury in two and type E4 injury in two patients. Both of the type E4 injury patients also had a vascular lesion of the hepatic artery. Six patients received Roux-en-Y hepaticojejunostomy for the second time, and one of them who had type E4 injury with the right hepatic artery disruption received right hepatectomy afterward. One patient who had type E4 injury with the proper hepatic artery lesion underwent liver transplantation, and the remaining one with type E3 injury received external biliary drainage. All the patients recovered fairly well postoperatively.CONCLUSION: Roux-en-Y hepaticojejunostomy is still the main approach for such failed surgical cases with bile duct injury. Special attention should be paid to concomitant vascular injury in these cases. The optimal timing and meticulous and excellent skills are essential to the success in this surgery.

  2. Radiation injury of canine bile duct induced by 103Pd metal stent

    International Nuclear Information System (INIS)

    Objective: To assess radiation injury of dog bile duct induced by 103Pd metal stent. Methods: Hybrid dogs with body weight form 15 to 20 kg were used. 103Pd metal stent was implanted into the common bile duct under anaesthesia, and the irradiation doses by 103Pd were 12.5 x 104 kBq, 16.6 x 104 kBq, 22.2 x 104 kBq, 25.9 x 104 kBq, 29.6 x 104 kBq and 3.7 x 105 kBq, respectively. Results: Radiation injury on the mucosa of the bile duct was observed in 12.5 x 104 kBq group, and the damage extended to the muscular layer in 22.2 x 104 kBq group. Perforation of the bile duct was observed in 3.7 x 105 kBq group. The dose-response curve of radiation injury at different doses of intra-biliary metal stent 103Pd showed the effective dose (ED50) to be 28.2 x 104 kBq. Conclusion: There is an obvious dose response relationship for in the 103Pd metal stent. The result is unimportant theoretical basis for application of 103Pd metal stent to clinical treatment of biliary cancer

  3. Chronic Extrahepatic Bile Duct Dilatation: Sonographic Screening in the Patients with Opioid Addiction

    Energy Technology Data Exchange (ETDEWEB)

    Farahmand, H.; PourGholami, M.; Fathollah, Sheikh [Rafsanjan University of Medical Sciences, Rafsanjan (Iran, Islamic Republic of)

    2007-06-15

    One of the best known side effects of using opium is spasm of the sphincter of Oddi, which may increase the diameter of the extrahepatic bile ducts. Ultrasound is the first imaging modality used for evaluating the biliary system because it is commonly available and noninvasive. The principal objective of this study was to measure the common bile duct (CBD) diameter via ultrasonography in opium addicts and to evaluate the relation between the CBD diameter and the period of addiction. This research was an analytical-cross sectional study that was done on 110 opium addicts that were admitted to a drug treatment center. The diameter of the CBD in these cases was measured by ultrasonography and the results were analyzed with other factors like age, the period of addiction and the laboratory findings. According to the findings, there is a significant increase in the range of the CBD diameter in comparison with normal bile ducts. Also, the mean diameter of the CBD in the different age groups showed a significant difference (p < 0.0001) and there was a significant relation between the CBD diameter and the period of addiction (p < 0.001, r = 0.74); so, with the increased length of the addiction period, the mean CBD diameter increases. Opium addiction is one of the factors that causes extrahepatic bile duct dilatation, so in these cases, if no obstructing lesion was found on ultrasound examination and the serum bilirobine and alkaline phosphatase levels are normal, then further evaluation is not needed.

  4. Poor agreement among expert witnesses in bile duct injury malpractice litigation: an expert panel survey.

    NARCIS (Netherlands)

    Reuver, PR de; Dijkgraaf, M.G.; Gevers, S.K.; Gouma, D.J.; Bleichrodt, R.P.; Cuesta, M.A.; Erp, W.F. van; Gerritsen, J.; Hesselink, E.J.; Laarhoven, C.J.H.M. van; Lange, J. de; Obertop, H.; Stassen, L.P.; Terpstra, O.T.; Tilanus, H.W.; Vroonhoven, T.J.; Wit, L. de

    2008-01-01

    OBJECTIVE: To determine the inter-rater agreement of expert witness testimonies in bile duct injury malpractice litigation. BACKGROUND DATA: Malpractice litigation is an increasing concern in modern surgical practice. As most of the lawyers are not educated in medicine, expert witnesses are asked to

  5. Calpain system protein expression in carcinomas of the pancreas, bile duct and ampulla

    International Nuclear Information System (INIS)

    Pancreatic cancer, including cancer of the ampulla of Vater and bile duct, is very aggressive and has a poor five year survival rate; improved methods of patient stratification are required. We assessed the expression of calpain-1, calpain-2 and calpastatin in two patient cohorts using immunohistochemistry on tissue microarrays. The first cohort was composed of 68 pancreatic adenocarcinomas and the second cohort was composed of 120 cancers of the bile duct and ampulla. In bile duct and ampullary carcinomas an association was observed between cytoplasmic calpastatin expression and patient age (P = 0.036), and between nuclear calpastatin expression and increased tumour stage (P = 0.026) and the presence of vascular invasion (P = 0.043). In pancreatic cancer, high calpain-2 expression was significantly associated with improved overall survival (P = 0.036), which remained significant in multivariate Cox-regression analysis (hazard ratio = 0.342; 95% confidence interva l = 0.157-0.741; P = 0.007). In cancers of the bile duct and ampulla, low cytoplasmic expression of calpastatin was significantly associated with poor overall survival (P = 0.012), which remained significant in multivariate Cox-regression analysis (hazard ratio = 0.595; 95% confidence interval = 0.365-0.968; P = 0.037). The results suggest that calpain-2 and calpastatin expression is important in pancreatic cancers, influencing disease progression. The findings of this study warrant a larger follow-up study

  6. Chronic Extrahepatic Bile Duct Dilatation: Sonographic Screening in the Patients with Opioid Addiction

    International Nuclear Information System (INIS)

    One of the best known side effects of using opium is spasm of the sphincter of Oddi, which may increase the diameter of the extrahepatic bile ducts. Ultrasound is the first imaging modality used for evaluating the biliary system because it is commonly available and noninvasive. The principal objective of this study was to measure the common bile duct (CBD) diameter via ultrasonography in opium addicts and to evaluate the relation between the CBD diameter and the period of addiction. This research was an analytical-cross sectional study that was done on 110 opium addicts that were admitted to a drug treatment center. The diameter of the CBD in these cases was measured by ultrasonography and the results were analyzed with other factors like age, the period of addiction and the laboratory findings. According to the findings, there is a significant increase in the range of the CBD diameter in comparison with normal bile ducts. Also, the mean diameter of the CBD in the different age groups showed a significant difference (p < 0.0001) and there was a significant relation between the CBD diameter and the period of addiction (p < 0.001, r = 0.74); so, with the increased length of the addiction period, the mean CBD diameter increases. Opium addiction is one of the factors that causes extrahepatic bile duct dilatation, so in these cases, if no obstructing lesion was found on ultrasound examination and the serum bilirobine and alkaline phosphatase levels are normal, then further evaluation is not needed

  7. Three-dimensional reconstructions of intrahepatic bile duct tubulogenesis in human liver

    DEFF Research Database (Denmark)

    Vestentoft, Peter S; Jelnes, Peter; Hopkinson, Branden M;

    2011-01-01

    BACKGROUND: During liver development, intrahepatic bile ducts are thought to arise by a unique asymmetric mode of cholangiocyte tubulogenesis characterized by a series of remodeling stages. Moreover, in liver diseases, cells lining the Canals of Hering can proliferate and generate new hepatic...

  8. Sarcoma botryoides of the common bile duct: Preoperative diagnosis by coronal CT and PTC

    Energy Technology Data Exchange (ETDEWEB)

    Verstandig, A.; Bar-Ziv, J. (Hadassah Hospital, Jerusalem (Israel). Dept. of Radiology); Abu-Dalu, K.I.; Schiller, M. (Hadassah Hospital, Jerusalem (Israel). Dept. of Pediatric Surgery); Granot, E. (Hadassah Hospital, Jerusalem (Israel). Dept. of Pediatrics)

    1991-02-01

    Sarcoma botryoides of the extrahepatic bile ducts is a rare cause of obstructive jaundice in the pediatric population. It is rarely diagnosed preoperatively. We present a case of this tumor which was diagnosed by ultrasound, computerised tomography and PTC. Coronal CT sections were particularly useful in demonstrating the relationship of the tumor to the porta hepatis, pancreas and duodenum. (orig.).

  9. Blunt Dissection: A Solution to Prevent Bile Duct Injury in Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Xiu-Jun Cai; Han-Ning Ying; Hong Yu; Xiao Liang; Yi-Fan Wang; Wen-Bin Jiang; Jian-Bo Li

    2015-01-01

    Background: Laparoscopic cholecystectomy (LC) has been a standard operation and replaced the open cholecystectomy (OC) rapidly because the technique resulted in less pain, smaller incision, and faster recovery.This study was to evaluate the value of blunt dissection in preventing bile duct injury (BDI) in laparoscopic cholecystectomy (LC).Methods: From 2003 to 2015, LC was performed on 21,497 patients, 7470 males and 14,027 females, age 50.3 years (14-84 years).The Calot's triangle was bluntly dissected and each duct in Calot's triangle was identified before transecting the cystic duct.Results: Two hundred and thirty-nine patients (1.1%) were converted to open procedures.The postoperative hospital stay was 2.1 (0-158) days, and cases (46%) had hospitalization days of 1 day or less, and 92.8% had hospitalization days of 3 days or less;BDI was occurred in 20 cases (0.09%) including 6 cases of common BDI, 2 cases of common hepatic duct injury, 1 case of right hepatic duct injury, 1 case of accessory right hepatic duct, 1 case of aberrant BDI 1 case ofbiliary stricture, 1 case of biliary duct perforation, 3 cases ofhemobilia, and 4 cases of bile leakage.Conclusion: Exposing Calot's triangle by blunt dissection in laparoscopic cholecystectomy could prevent intraoperative BDI.

  10. The role of radiotherapy in the treatment of bile duct carcinoma.

    Science.gov (United States)

    Veeze-Kuijpers, B; Meerwaldt, J H; Lameris, J S; van Blankenstein, M; van Putten, W L; Terpstra, O T

    1990-01-01

    Forty-two patients with irresectable bile duct carcinoma (n = 31) or with microscopic evidence of tumor rest after aggressive surgery for bile duct carcinoma (n = 11) were given radiotherapy consisting intentionally of external-beam therapy and intraluminal 192Iridium (192Ir) wire application(s) following bile drainage procedures. The treatment was well tolerated; complications were mainly infectious and related to the success of the drainage. A median survival of 10 months was achieved for the group as a whole. Patients treated following microscopically incomplete resection survived longer than patients with an irresectable tumor (15 vs 8 months median survival, p = 0.06). Gross lymph node involvement also proved to be a prognostic factor.

  11. The role of radiotherapy in the treatment of bile duct carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Veeze-Kuijpers, B.; Meerwaldt, J.H.; Lameris, J.S.; van Blankenstein, M.; van Putten, W.L.; Terpstra, O.T. (Dr. Daniel den Hoed Cancer Center, Rotterdam (Netherland))

    1990-01-01

    Forty-two patients with irresectable bile duct carcinoma (n = 31) or with microscopic evidence of tumor rest after aggressive surgery for bile duct carcinoma (n = 11) were given radiotherapy consisting intentionally of external-beam therapy and intraluminal 192Iridium ({sup 192}Ir) wire application(s) following bile drainage procedures. The treatment was well tolerated; complications were mainly infectious and related to the success of the drainage. A median survival of 10 months was achieved for the group as a whole. Patients treated following microscopically incomplete resection survived longer than patients with an irresectable tumor (15 vs 8 months median survival, p = 0.06). Gross lymph node involvement also proved to be a prognostic factor.

  12. Incidental microscopic bile duct tumor thrombi in hepatocellular carcinoma after curative hepatectomy: a matched study.

    Science.gov (United States)

    Kim, Jong M; Kwon, Choon H D; Joh, Jae-Won; Sinn, Dong H; Park, Jae B; Lee, Joon H; Kim, Sung J; Paik, Seung W; Park, Cheol K; Yoo, Byung C

    2015-02-01

    In patients with hepatocellular carcinoma (HCC), the presence of bile duct tumor thrombi (BDTT) in the major bile ducts indicates poor prognosis compared with that of HCC patients without BDTT. However, the prognostic significance of incidental microscopic BDTT in the peripheral bile ducts after curative liver resection is not known. We compared the outcomes of HCC patients with and without microscopic BDTT in the peripheral bile ducts who underwent hepatectomy.The electronic medical records of 31 patients with microscopic BDTT (BDTT group) were retrospectively reviewed. To compare the surgical outcomes, 62 patients (No BDTT group) were randomly chosen from the remaining HCC patients without BDTT based on age, sex, etiology of HCC, tumor size, tumor number, and modified Union for International Cancer Control T staging.The 1-year, 2-year, and 3-year disease-free survival rates and overall survival rates were 54.8%, 34.0%, 34.0% and 90.1%, 69.2%, 61.0% in the BDTT group and 66.8%, 59.2%, 42.3% and 86.4%, 84.4%, 84.4% in the No BDTT group (P = 0.089 and P = 0.014, respectively). The overall survival curve in the No BDTT group was higher than that in the BDTT group. Multivariate analysis revealed that predisposing factors for tumor recurrence after curative liver resection included increased levels of the protein induced by vitamin K antagonist-II (PIVKA-II), tumor grades 3 and 4, and the presence of BDTT.This study demonstrates that HCC prognosis is worse in patients with incidental microscopic BDTT in the peripheral bile ducts than it is in those without BDTT. The presence of BDTT should therefore be considered when evaluating a patient's HCC prognosis after curative hepatectomy. PMID:25674733

  13. Outcome of simple use of mechanical lithotripsy of difficult common bile duct stones

    Institute of Scientific and Technical Information of China (English)

    Wen-Hsiung Chang; Cheng-Hsin Chu; Tsang-En Wang; Ming-Jen Chen; Ching-Chung Lin

    2005-01-01

    AIM: The usual bile duct stone may be removed by means of Dormia basket or balloon catheter, and results are quite good. However, the degree of difficulty is increased when stones are larger. Studies on the subject reported many cases where mechanical lithotripsy is combined with a second technique, e.g. electrohydraulic lithotripsy (EHL),where stones are crushed using baby-mother scope electric shock. The extracorporeal shock-wave lithotripsy (ESWL)or laser lithotripsy also yields an excellent success rate of greater than 90%. However, the equipment for these techniques are very expensive; hence we opted for the simple mechanical lithotripsy and evaluated its performance.METHODS: During the period from August 1996 to Decemberz 2002, Mackay Memorial Hospital treated 304 patients suffering from difficult bile duct stones (stone >1.5 cm or stones that could not be removed by the ordinary Dormia basket or balloon catheter). These patients underwent endoscopic papillotomy (EPT) procedure, and stones were removed by means of the Olympus BML-4Q lithotripsy. A follow-up was conducted on the post-treatment conditions and complications of the patients.RESULTS: Out of the 304 patients, bile duct stones were successfully removed from 272 patients, a success rate of about 90%. The procedure failed in 32 patients, for whom surgery was needed. Out of the 272 successfully treated patients, 8 developed cholangitis, 21 developed pancreatitis,and 10 patients had delayed bleeding, and no patient died.Among these 272 successful removal cases, successful bile duct stone removal was achieved after the first lithotripsy in 211 patients, whereas 61 patients underwent multiple sessions of lithotripsy. As for the 61 patients that underwent multiple sessions of mechanical lithotripsy, 6 (9.8%) had post-procedure cholangitis, 12 (19.6%) had pancreatitis,and 9 patients (14.7%) had delayed bleeding. Compared with the 211 patients undergoing a single session of mechanical lithotripsy, 3 (1

  14. Percutaneous Transhepatic Removal of Bile Duct Stones: Results of 261 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Ozcan, Nevzat, E-mail: nevzatcan@yahoo.com; Kahriman, Guven, E-mail: guvenkahriman@hotmail.com; Mavili, Ertugrul, E-mail: ertmavili@yahoo.com [Erciyes University, Department of Radiology, Medical Faculty (Turkey)

    2012-08-15

    Purpose: To determine the effectiveness of percutaneous transhepatic removal of bile duct stones when the procedure of endoscopic therapy fails for reasons of anatomical anomalies or is rejected by the patient. Methods: Between April 2001 and May 2010, 261 patients (138 male patients and 123 female patients; age range, 14-92 years; mean age, 64.6 years) with bile duct stones (common bile duct [CBD] stones = 248 patients and hepatolithiasis = 13 patients) were included in the study. Percutaneous transhepatic cholangiography was performed, and stones were identified. Percutaneous transhepatic balloon dilation of the papilla of Vater was performed. Then stones were pushed out into the duodenum with a Fogarty balloon catheter. If the stone diameter was larger than 15 mm, then basket lithotripsy was performed before balloon dilation. Results: Overall success rate was 95.7%. The procedure was successful in 97.5% of patients with CBD stones and in 61.5% of patients with hepatolithiasis. A total of 18 major complications (6.8%), including cholangitis (n = 7), subcapsular biloma (n = 4), subcapsular hematoma (n = 1), subcapsular abscess (n = 1), bile peritonitis (n = 1), duodenal perforation (n = 1), CBD perforation (n = 1), gastroduodenal artery pseudoaneurysm (n = 1), and right hepatic artery transection (n = 1), were observed after the procedure. There was no mortality. Conclusion: Our experience suggests that percutaneous transhepatic stone expulsion into the duodenum through the papilla is an effective and safe approach in the nonoperative management of the bile duct stones. It is a feasible alternative to surgery when endoscopic extraction fails or is rejected by the patient.

  15. A case of methicillin-resistant Staphylococcus aureus infection following bile duct stenting

    Institute of Scientific and Technical Information of China (English)

    Markus K Diener; Alexis Ulrich; Theresia Weber; Moritz N Wente; Markus W Büchler; Helmut Friess

    2005-01-01

    AIM: To present a case of methicillin-resistant Staphylococcus aureus (MRSA) infection following bile duct stenting in a patient with malignant biliary obstruction.METHODS: A 78-year-old male patient was admitted to a community hospital with progredient painless jaundice lasting over two weeks, weight loss and sweating at night.Whether a stent should be implanted pre-operatively in jaundiced patients or whether these patients should directly undergo surgical resection, was discussed.RESULTS: ERC and a biopsy from the papilla of Vater revealed an adenocarcinoma. In addition, a 7-Ch plastic stent was placed into the common bile duct. Persistent abdominal pain, increasing jaundice, weakness and indigestion led to the transfer of the patient to our hospital.A pylorus-preserving pancreatoduodenectomy wasperformed. Intraoperatively, bile leaked out of the transected choledochus andthe stent was found to be dislocated in the duodenum. A smear of the bile revealed an infection with MRSA, leading to post-operative isolation of the patient.CONCLUSION:As biliary stents can cause severe infection of the bile, the need for pre-operative placement of biliary stents should be carefully evaluated in each individual case.

  16. [Pancreato-biliary maljunctions and congenital cystic dilatation of the bile ducts in adults].

    Science.gov (United States)

    Kianmanesh, R; Régimbeau, J M; Belghiti, J

    2001-08-01

    Pancreato-biliary maljunctions (PBM) in adults are defined by the presence of an abnormally long common pancreato-biliary duct (more than 15 mm long) formed outside the duodenal wall and/or by high amylase level in the bile. The high amylase level in the bile is the functional expression of a chronic toxic reflux of pancreatic juices into the biliary tree. The presence of the PBM have two basic consequences: (i) formation of congenital cystic dilatations of the bile duct (CCBD) during embryogenesis and (ii) cancerous degeneration of extrahepatic bile ducts including the gall bladder. CCBD are commonly found in Southeast of Asia and in Japan where more than two-thirds of the worldwide cases are reported. Women are more frequently touched. The main manifestations are pain, cholangitis and acute pancreatitis. Cancerous degeneration mainly due to chronic pancreatico-biliary reflux consecutive to the presence of PBM is the most serious complication of CCBD. Its global incidence is about 16% and increases by age and after cysto-digestive derivations widely performed in the past. In 80% of the cases a cholangiocarcinoma involving the extrahepatic portion of the biliary tree including dilated segments such as the gall bladder and/or cystic wall is found. The treatment of choice of most common types of CCBD with PMD is complete excision of most of the sites where cancer may arise and should interrupt the pancreato-biliary reflux. This treatment significantly reduces the incidence of bile duct cancer to 0.7%. However, despite the absence of mortality, the overall morbidity rates reach from 20% to 40%. In the complete excision, the entire common bile duct from porta hepatis to the intrapancreatic portion of the choledochus and the gall bladder are resected. The bile continuity is assured by a hepatico-jejunal Y anastomosis. When there is no CCBD, the high risk of gall bladder cancer in the presence of a PBM justifies by itself a preventive cholecystectomy even if no biliary

  17. Repair and reconstruction of common bile duct by poly(lactide stent

    Directory of Open Access Journals (Sweden)

    Xiaoyi Xu

    2010-01-01

    Full Text Available To investigate the effect of repair of bioabsorbable poly(lactide (PLA biliary stent in common bile duct (CBD transection injury in canine prior to the clinical application. Circular tubing CBD stent was prepared by melt extraction technique using PLA. A transection incision was made on CBD of the normal canine, and then closed the incision with laser welding followed the implantation of PLA tubular stent into it. The stent was obtained to determine degradation of PLA in vivo at postoperative week 1, 4, and 12, respectively. The changes of outer diameter and burst pressure of CBD were investigated. Furthermore, serum liver enzyme values and CBD histopathological analysis were examined in the animals. The results noted that the polymer stent exhibited the same biomedical functions as T tubes and no significant tissue response. Therefore, biodegradable PLA stent matches the requirements in repair and reconstruction of CBD to support the duct, guide bile drainage and reduce T-tube-related complications.

  18. [Eosinophilic cholangitis from almost normal appearance to the bile duct sclerosis similar to primary sclerosing cholangitis].

    Science.gov (United States)

    Kimura, Yoshito; Yamashita, Yukimasa; Mikami, Sakae; Ono, Hiroshi; Itai, Ryosuke; Matsumoto, Yoshihide; Yamada, Satoshi; Takada, Mariko; Sumitomo, Yasuhiko

    2013-02-01

    A 48-year-old man was admitted to our hospital because of eosinophilia and liver dysfunction. Initial abdominal CT and MRI (MRCP) finding showed almost normal liver and bile duct. Liver biopsy demonstrated mild portal infiltration of lymphocytes and eosinophils. Definitive diagnosis was difficult, but we suspected autoimmune disease. Oral steroid administration was started, which led to a rapid improvement of eosinophilia and liver dysfunction. Dose reduction of steroid administration resulted in exacerbation of eosinophilia and liver dysfunction. Follow-up MRCP and ERCP study revealed biliary strictures similar to primary sclerosing cholangitis (PSC). A second liver biopsy revealed dense infiltration composed of lymphocytes and eosinophils in the portal area. Therefore we diagnosed eosinophilic cholangitis. This is the first case of eosinophilic cholangitis, observed after changes of the bile duct from an almost normal appearance to diffuse sclerosing and narrowing similar to PSC by imaging and pathological studies.

  19. The local spread of lower bile duct cancer: evaluation by thin-section helical CT

    Energy Technology Data Exchange (ETDEWEB)

    Ochotorena, I.J.L.; Kiyosue, H.; Hori, Yuko; Mori, H. [Department of Radiology, Oita Medical University, Hasama-machi, Oita 879-5593 (Japan); Yokoyama, S. [First Department of Pathology, Oita Medical University, Hasama-machi, Oita 879-5593 (Japan); Yoshida, T. [First Department of Surgery, Oita Medical University, Hasama-machi, Oita 879-5593 (Japan)

    2000-07-01

    This study illustrates the local spread of lower bile duct cancer with thin-section helical CT in correlation with the surgical and pathological findings. Pathologically, 16 patients had pancreatic invasion, 4 had small bowel mesentery invasion, 7 had extrapancreatic nerve plexus invasion, and 3 patients had vascular invasion. On thin-section helical CT, pancreatic invasion was correlated to the clarity or non-clarity of the bile duct mass-pancreas border and the presence of an intrapancreatic mass. Cases with small bowel mesentery and extrapancreatic nerve plexus invasion showed mass or stranding around the superior mesenteric artery and/or inferior pancreatoduodenal artery. Vascular invasion was seen as tumor contiguity to these vessels. (orig.)

  20. [Experimental results after acute and chronic ligation of bile duct (author's transl)].

    Science.gov (United States)

    Kirchner, R; Hartung, H; Trendelenburg, C

    1980-08-01

    The bile duct was ligated in 14 bastard dogs. Bilirubine, alcaline phosphatase, GOT, GPT, GLDH, and gamma GT were measured pre- and postoperatively. On the 8th postoperative day stenosis of the choledochus was eliminated using a patch plasty for dilatation in 7 dogs, whereas the occlusion remained in the other 7 dogs. Laboratory and histological results were characteristic for cholestasis 8 days after occlusion; these changes disappeared within 4 weeks after patch plastic surgery. In the controls these parameters normalized as well within 8 weeks, in spite of the persisting occlusion. These results show, that pathological changes after short term cholestasis are fully reversible; they demonstrate as well, that there are compensatory mechanisms operating in dogs with permanent occlusion of the bile duct.

  1. Mechanical lithotripsy and/or stenting in management of difficult common bile duct stones

    Institute of Scientific and Technical Information of China (English)

    Adem Akcakaya; Orhan Veli Ozkan; Gurhan Bas; Atilla Karakelleoglu; Orhan Kocaman; Ismail Okan; Mustafa Sahin

    2009-01-01

    BACKGROUND: Mechanical lithotripsy and/or stent insertion is the alternative therapeutic approach in difficult endoscopic retrograde cholangiopancreatography (ERCP) case. This study was designed to investigate the appropriate treatment for extraction of bile duct stones in difficult cases of ERCP. METHODS: Between 2000 and 2008, 744 ERCP procedures were performed in 592 patients with choledocholithiasis in our endoscopy unit. The demographic features, and clinical and laboratory findings were collected from a prospectively held database. Bile duct calculi were extracted by basket and/or balloon catheter following ERCP and sphincterotomy. Patients with retained stones were regarded as difficult cases. These patients were treated with mechanical lithotripsy and those with incomplete clearance of stones underwent stent placement. RESULTS: Two hundred and forty-five patients (41%) were male and 347 (59%) were female with a mean age of 58 years (range 19-95 years). Stones were impacted in 27 patients (5%). Stone extraction was performed by basket and/or balloon catheter in 610 ERCP procedures, and lithotripsy was performed in 70 ERCP procedures. Forty-four patients underwent stent insertion, and 20 underwent stent replacement. Morbidity occurred in 39 patients (5%), with no mortality associated with the procedure. Hemorrhage occurred in 9 patients and basket impaction in 4. Mild pancreatitis and cholangitis developed in 12 and 11 patients, respectively. CONCLUSION: Difficult cases of bile duct stones can be treated successfully with lithotripsy, and a stent should be applied when the common bile duct cannot be cleared completely.

  2. ESWL for difficult bile duct stones:A 15-year single centre experience

    Institute of Scientific and Technical Information of China (English)

    Rosangela; Muratori; Francesco; Azzaroli; Federica; Buonfiglioli; Flavio; Alessandrelli; Paolo; Cecinato; Giuseppe; Mazzella; Enrico; Roda

    2010-01-01

    AIM:To evaluate the efficacy of extracorporeal shock wave lithotripsy(ESWL)for the management of refractory bile duct cholelithiasis in a third level referral centre.METHODS:The clinical records of all patients treated with a second generation electromagnetic lithotripter (Lithostar Plus,SIEMENS)from October 1990 to April 2005 were evaluated.All patients were monitored during the procedure and antibiotics were administered in case of cholangitis.Theχ 2 test and logistic regression analysis were performed as...

  3. Dose-related effects of dexamethasone on liver damage due to bile duct ligation in rats

    Institute of Scientific and Technical Information of China (English)

    Halil Eken; Hayrettin Ozturk; Hulya Ozturk; Huseyin Buyukbayram

    2006-01-01

    AIM: To evaluate the effects of dexamethasone on liver damage in rats with bile duct ligation. METHODS: A total of 40 male Sprague-Dawley rats,weighing 165-205 g, were used in this study. Group 1 (sham-control, n = 10) rats underwent laparotomy alone and the bile duct was just dissected from the surrounding tissue. Group 2 rats (untreated, n = 10)were subjected to bile duct ligation (BDL) and no drug was applied. Group 3 rats (low-dose dexa, n = 10)received a daily dose of dexamethasone by orogastric tube for 14 d after BDL. Group 4 rats (high-dose dexa,n = 10) received a daily dose of dexamethasone by orogastric tube for 14 d after BDL. At the end of the twoweek period, biochemical and histological evaluations were processed.RESULTS: The mean serum bilirubin and liver enzyme levels significantly decreased, and superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSHPx) values were significantly increased in low-dose dexa and high-dose dexa groups when compared to the untreated group. The histopathological score was significantly less in the low-dose and high-dose dexa groups compared to the untreated rats. In the low-dose dexa group, moderate liver damage was seen, while mild liver damage was observed in the high-dose dexa group.CONCLUSION: Corticosteroids reduced liver damage produced by bile duct obstruction. However, the histopathological score was not significantly lower in the high-dose corticosteroid group as compared to the lowdose group. Thus, low-dose corticosteroid provides a significant reduction of liver damage without increased side effects, while high dose is associated not with lower fibrosis but with increased side effects.

  4. A special recurrent pattern in small hepatocellular carcinoma after treatment: Bile duct tumor thrombus formation

    Institute of Scientific and Technical Information of China (English)

    Qing-Yu Liu; Dong-Ming Lai; Chao Liu; Lei Zhang; Wei-Dong Zhang; Hai-Gang Li; Ming Gao

    2011-01-01

    AIM: To investigate the clinicopathologic features of bile duct tumor thrombus (BDTT) occurrence after treatment of primary small hepatocellular carcinoma (sHCC).METHODS: A total of 423 patients with primary sHCC admitted to our hospital underwent surgical resection or local ablation. During follow-up, only six patients were hospitalized due to obstructive jaundice, which occurred 5-76 mo after initial treatment. The clini-copathologic features of these six patients were re-viewed.RESULTS: Six patients underwent hepatic resection (n = 5) or radio-frequency ablation (n = 1) due to prima-ry sHCC. Five cases had an R1 resection margin, and one case had an ablative margin less than 5.0 mm. No vascular infiltration, microsatellites or bile duct/cana-liculus affection was noted in the initial resected speci-mens. During the follow-up, imaging studies revealed a macroscopic BDTT extending to the common bile duct in all six patients. Four patients had a concomi-tant intrahepatic recurrent tumor. Surgical re-resection of intrahepatic recurrent tumors and removal of BDTTs (n = 4), BDTT removal through choledochotomy (n = 1), and conservative treatment (n = 1) was performed. Microscopic portal vein invasion was noted in three of the four resected specimens. All six patients died, with a mean survival of 11 mo after BDTT removal or con-servative treatment.CONCLUSION: BDTT occurrence is a rare, special re-current pattern of primary sHCC. Patients with BDTTs extending to the common bile duct usually have an un-favorable prognosis even following aggressive surgery. Insufficient resection or ablative margins against pri-mary sHCC may be a risk factor for BDTT development.

  5. Common Bile Duct (CBD) diameter in opium-addicted men: Comparison with non-addict controls

    OpenAIRE

    Zahedi-Nejad, Nina; Narouei, Shahin; Fahimy, Farnaz

    2010-01-01

    Summary Background: Opium and its derivatives are widely abused throughout the world. Recent case reports and a few limited studies have suggested that opiates cause dilation of the common bile duct of the abusers. Material/Methods: Our case-control study, lasting 7.5 months, investigated 121 male adult addicts and 142 non-addicted controls for biliary tract diameters, using ultrasonography. The study was conducted in Bahonar Hospital in Kerman. Neither the addiction cases nor the non-addict ...

  6. Impaction of a lithotripsy basket during endoscopic lithotomy of a common bile duct stone

    Institute of Scientific and Technical Information of China (English)

    Nobutada; Fukino; Takatsugu; Oida; Atsushi; Kawasaki; Kenji; Mimatsu; Youichi; Kuboi; Hisao; Kano; Sadao; Amano

    2010-01-01

    The treatments for common bile duct (CBD) stones are being continually developed. Impaction of the lithotripsy basket during endoscopic removal of CBD stones was seen in 5.9% patients. We report the case of a 66-yearold woman who underwent surgery for the removal of an impacted biliary basket. She was admitted to our hospital with a complaint of right upper abdominal pain. Magnetic resonance cholangiopancreatography revealed a CBD stone (20 mm × 15 mm). We diagnosed her with choledocholithiasis and performe...

  7. Metabolic Alterations in Obstructive Jaundice: Effect of Duration of Jaundice and Bile-Duct Decompression

    OpenAIRE

    R.N. Younes; Vydelingum, N. A.; Derooij, P.; Scognamiglio, F.; Andrade, L.; Posner, M. C.; Brennan, M. F.

    1991-01-01

    We examined the effect of prolonged bile duct obstruction, and subsequent biliary decompression, on biochemical and metabolic parameters, using a reversible jaundice model in male Fischer 344 rats. The animals were studied after biliary obstruction for varying periods (4 days, one week, and two weeks) and following decompression. They were sacrificed one or two weeks following decompression. All the rats were compared to sham operated, pair-fed, controls. Obstructive jaundice rapidly increase...

  8. Metastatic Breast Cancer to the Common Bile Duct Presenting as Obstructive Jaundice

    OpenAIRE

    Cochrane, Justin; Schlepp, Greg

    2015-01-01

    Metastatic breast cancer is typically identified in the bones, lymph nodes, lungs and liver. Rarely does metastatic breast cancer involve the common bile duct (CBD) without direct extension from liver metastasis into the CBD. We present a woman diagnosed with metastatic breast cancer in the CBD after presenting with obstructive jaundice. Patients with a history of primary breast cancer who present with obstructive jaundice secondary to CBD mass need identification of the mass in order to prov...

  9. Management of hilar bile duct carcinoma with high-dose radiotherapy and expandable metallic stent placement

    International Nuclear Information System (INIS)

    This article describes our experience with high-dose radiotherapy in combination with the placement of expandable metallic stents (EMS) in the management of hilar bile duct carcinoma. Between 1988 and 1999, 107 consecutive patients with hilar bile duct carcinoma were treated with EMS placement either alone or in combination with high-dose radiotherapy. External beam radiotherapy (EBRT) was indicated in 101 patients, and in 86 this was combined with intraluminal 192Ir irradiation (ILRT, 59-98 Gy) EMS were placed after the completion of radiotherapy. The 1-, 2-, 3-, and 5-year actuarial survival rates for the radiotherapy group were 66.4%, 23.4%, 15.6%, 7.8%, respectively, and the 1- and 2-year actuarial survival rates for the nonradiotherapy group were 66.4% and 0%, respectively. The placement of EMS was useful for the early establishment of an internal bile passage in radically irradiated patients and the 1-, 2-, 3-, and 5-year actuarial patency rates for the radiotherapy group were 56.3%, 45.3%, 35.2%, and 23.4%, respectively, and the 1- and 2-year actuarial patency rates for the non radiotherapy group were 50.0% and 0% respectively. High-dose radiotherapy, consisting of ILRT and EBRT, appears to be feasible in the management of hilar bile duct carcinoma, and it offers a survival advantage for patients no suited for surgical resection. The placement of EMS assists the internal bile flow and lengthens survival after high-dose radiotherapy. (author)

  10. Antioxidant Effect of Sepia Ink Extract on Extrahepatic Cholestasis Induced by Bile Duct Ligation in Rats

    Institute of Scientific and Technical Information of China (English)

    Hanan Saleh; Amel M Soliman; Ayman S Mohamed; Mohamed-Assem S Marie

    2015-01-01

    Objective The aim of our study was to assess the complications of hepatic fibrosis associated with bile duct ligation and the potential curative role of sepia ink extract in hepatic damage induced by bile duct ligation. Methods Rattus norvegicus rats were divided into 3 groups: Sham-operated group, model rats that underwent common bile duct ligation (BDL), and BDL rats treated orally with sepia ink extract (200 mg/kg body weight) for 7, 14, and 28 d after BDL. Results There was a significant reduction in hepatic enzymes, ALP, GGT, bilirubin levels, and oxidative stress in the BDL group after treatment with sepia ink extract. Collagen deposition reduced after sepia ink extract treatment as compared to BDL groups, suggesting that the liver was repaired. Histopathological examination of liver treated with sepia ink extract showed moderate degeneration in the hepatic architecture and mild degeneration in hepatocytes as compared to BDL groups. Conclusion Sepia ink extract provides a curative effect and an antioxidant capacity on BDL rats and could ameliorate the complications of liver cholestasis.

  11. Intraluminal brachytherapy after metallic stent placement in primary bile duct carcinoma

    International Nuclear Information System (INIS)

    To determine the effect of intraluminal brachytherapy on stent patency and survival after metallic stent placement in patients with primary bile duct carcinoma. Twenty-seven patients with primary bile duct carcinoma underwent metallic stent placement; in 16 of the 27 intraluminal brachytherapy with an iridium-192 source (dose, 25 Gy) was the performed. Obstuction was due to either hilar (n=14) or non-hilar involvement (n=13). For statistical comparison of patients who underwent/did not undergo intraluminal brachytherapy, stent patency and survival were calculated using the Kaplan-Meier method and an independent t test. The mean durations of stent patency and survival were 9.1 and 10.0 months respectively in patients who underwent intraluminal brachytherapy, and 4.2 and 5.0 months in those who did not undergo this procedure (ρ<0.05). The mean durations of stent patency and survival among the 22 patients who died were 7.6 (range, 0.8-16.1) and 8.3 (range, 0.8-17.3) months, respectively, in the eleven patients who underwent intraluminal brachytherapy, and 4.2 (range, 0.9-8.0) and 5.0 (range, 0.9-8.4) months in those whom the procedure was not performed (ρ<0.05). Intraluminal brachytherapy after stent placement extended both stent patency and survival in patients with primary bile duct carcinoma

  12. TOP1 gene copy numbers are increased in cancers of the bile duct and pancreas

    DEFF Research Database (Denmark)

    Grunnet, Mie; Calatayud, Dan; Schultz, Nicolai Aa.;

    2015-01-01

    ) poison. Top1 protein, TOP1 gene copy number and mRNA expression, respectively, have been proposed as predictive biomarkers of response to irinotecan in other cancers. Here we investigate the occurrence of TOP1 gene aberrations in cancers of the bile ducts and pancreas. Material and methods. TOP1......Abstract Background. Bile duct and pancreatic cancer (PC) have poor prognoses and treatment options for inoperable patients are scarce. In order to improve outcome for these patients, there is an urgent need for biomarkers predictive of treatment effect. Irinotecan is a topoisomerase 1 (Top1...... was included to distinguish between chromosomal and gene amplifications. Results. In PC, 29.8% had an increased TOP1 copy number (≥3.5n gene copies per cell) and 10.8% had a TOP1/CEN-20 ratio >1.5. In bile duct cancer, 12.8 % had an increased TOP1 copy number and 6.4% had a TOP1/CEN-20 ratio >1.5. Neither...

  13. Cholangiocarcinoma and malignant bile duct obstruction: Areview of last decades advances in therapeutic endoscopy

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    In the last decades many advances have been achievedin endoscopy, in the diagnosis and therapy ofcholangiocarcinoma,however blood test, magneticresonance imaging, computed tomography scan mayfail to detect neoplastic disease at early stage, thus thediagnosis of cholangiocarcinoma is achieved usuallyat unresectable stage. In the last decades the roleof endoscopy has moved from a diagnostic role toan invaluable therapeutic tool for patients affectedby malignant bile duct obstruction. One of the majorissues for cholangiocarcinoma is bile ducts occlusion,leading to jaundice, cholangitis and hepatic failure.Currently, endoscopy has a key role in the work upof cholangiocarcinoma, both in patients amenable tosurgical intervention as well as in those unfit for surgeryor not amenable to immediate surgical curative resectionowing to locally advanced or advanced disease, withpalliative intention. Endoscopy allows successful biliarydrainage and stenting in more than 90% of patientswith malignant bile duct obstruction, and allows rapidreduction of jaundice decreasing the risk of biliary sepsis.When biliary drainage and stenting cannot be achievedwith endoscopy alone, endoscopic ultrasound-guidedbiliary drainage represents an effective alternativemethod affording successful biliary drainage in morethan 80% of cases. The purpose of this review is tofocus on the currently available endoscopic managementoptions in patients with cholangiocarcinoma.

  14. Intraductal tubulopapillary neoplasm of the bile duct: A case report and review of the published work.

    Science.gov (United States)

    Nakagawa, Takashi; Arisaka, Yoshifumi; Ajiki, Tetsuo; Fujikura, Kohei; Masuda, Atsuhiro; Takenaka, Mamoru; Shiomi, Hideyuki; Okabe, Yoshihiro; Fukumoto, Takumi; Ku, Yonson; Azuma, Takeshi; Zen, Yoh

    2016-06-01

    Recent studies have suggested that a peculiar tumor mimicking intraductal tubulopapillary neoplasms (ITPN) of the pancreas can develop in the bile duct. Here, we present a similar case and review the published work on the newly proposed biliary neoplasm. A 68-year-old woman was referred to us for further evaluation of a liver mass. On imaging, the tumor was 40 mm in size and intraductal in location, and was enhanced slightly on the contrast-enhanced computed tomography. No mucin overproduction was found. She underwent right hepatectomy for suspected intraductal papillary neoplasm of the bile duct. The tumor histologically consisted of the biliary-type epithelium arranged in a tubular architecture within the dilated bile duct. Tumor cells had features of high-grade dysplasia but no stroma invasion. No expressions of MUC2 and MUC5AC were noted. On molecular studies, KRAS and GNAS appeared to be wild-type genotypes. These features were in keeping with ITPN. In the published work review, "biliary ITPN" described in four manuscripts were characterized by predominantly intrahepatic/hilar in location, histological tubular architecture, negative expressions of MUC2 and MUC5AC, and uncommon alterations of KRAS, GNAS and BRAF. Although invasive malignancy was present in 71%, the outcome was favorable with the 5-year survival expected to be approximately 90%. Biliary ITPN are supposedly uncommon, but a greater awareness of this condition may give more chance to diagnose the underrecognized neoplasm. PMID:26459784

  15. Diagnostic value of maspin in distinguishing adenocarcinoma from benign biliary epithelium on endoscopic bile duct biopsy.

    Science.gov (United States)

    Chen, Lihong; Huang, Kevin; Himmelfarb, Eric A; Zhai, Jing; Lai, Jin-Ping; Lin, Fan; Wang, Hanlin L

    2015-11-01

    Histopathologic distinction between benign and malignant epithelia on endoscopic bile duct biopsy can be extremely challenging due to small sample size, crush artifact, and a propensity for marked inflammatory and reactive changes after stent placement. Our previous studies have shown that the insulin-like growth factor II mRNA-binding protein 3, S100P, and the von Hippel-Lindau gene product (pVHL) can help the distinction. This study analyzed 134 endoscopic bile duct biopsy specimens (adenocarcinoma 45, atypical 31, and benign 58) by immunohistochemistry for the expression of maspin, a serine protease inhibitor. The results demonstrated that (1) maspin expression was more frequently detected in malignant than in benign biopsies; (2) malignant biopsies frequently showed diffuse, strong/intermediate, and combined nuclear/cytoplasmic staining patterns for maspin, which were much less commonly seen in benign biopsies; (3) the malignant staining patterns for maspin observed in atypical biopsies were consistent with follow-up data showing that 67% of these patients were subsequently diagnosed with adenocarcinoma; (4) a maspin+/S100P+/pVHL- staining profile was seen in 75% of malignant biopsies but in none of the benign cases. These observations demonstrate that maspin is a useful addition to the diagnostic immunohistochemical panel (S100P, pVHL, and insulin-like growth factor II mRNA-binding protein 3) to help distinguish malignant from benign epithelia on challenging bile duct biopsies. PMID:26362203

  16. A six-microRNA set as prognostic indicators for bile duct cancer.

    Science.gov (United States)

    Wang, Ming; Wen, Tian-Fu; He, Lin-Hai; Li, Chuan; Zhu, Wen-Jiang; Trishul, Narasimha Murthy

    2015-01-01

    MicroRNAs (miRNAs) play important roles in cancer progression by altering transcriptional control. The purpose of this study is to identify and explore specific miRNAs as prognostic and predictive biomarkers for bile duct cancer (BDC) by analyzing Next-generation data. miRNA expression profiles and corresponding clinical information of BDC samples were extracted from The Cancer Genome Atlas (TCGA). The differentially expressed miRNAs were determined by SAMR package in R software. Target genes of those miRNAs were predicted by Targetscan. Functional enrichment analysis and hypergeometric test analysis of target genes were performed. Then, diagnosis accuracy of miRNAs was judged by ROC Curves analysis. Total 120 differentially expressed miRNAs were obtained, of which six important miRNAs were selected and predicted as prognosis and predicting biomarkers in BDC. Besides, functional analysis showed that both enriched pathways were significantly related with ion binding, which might involve in the carcinogenesis of BDC. Moreover, top 3 important pathways sharing the most influence were noted. Our results demonstrated that hsa-miR-483-5p, hsa-miR-675, hsa-miR-139-3p, hsa-miR-598, hsa-miR-625 and hsa-miR-187 could serve as prognostic and predictive markers for survival of BDC patients and could potentially be provided as targets for future therapy. PMID:26770318

  17. [Common channel for bile and pancreatic ducts. Presentation of 12 cases and discussion].

    Science.gov (United States)

    Gauthier, F; Brunelle, F; Valayer, J

    1986-01-01

    Between 1978 and 1985, 11 girls and one boy underwent an elective operation for a congenital choledochal dilatation associated with an anomalous biliopancreatic junction. In 10 out of these 12 cases the children suffered several episodes of abdominal pain, and the diagnosis was missed since a jaundice appeared. The ultrasonographic examination demonstrated in all cases a dilatation of both extra- and intrahepatic bile ducts. The preoperative diagnosis was always established by the mean of a transhepatic cholangiography (8 cases) or a percutaneous cholecystography (4 cases), which showed in every case a dilated choledochus, and a common biliopancreatic channel, 15 to 35 mm long. A high amylase level was found in the bile in 10/10 cases when it was measured. A cholecystokinin test was performed in 4 cases, resulting in each case in a considerable increase of amylase and lipase levels in bile. All children were treated by excision of the dilated choledochus and gallbladder, followed by an hepaticojejunostomy with a Roux en Y loop. The follow-up is 6 months to 5 years for 9 children: 8 are cured, and on girl, who had a major dilatation of the left intrahepatic bile ducts, suffered from episodic abdominal pain and an episode od cholangitis 6 years after the operation. The role of such a common channel in the pathogeny of congenital choledochal cysts, acute pancreatitis in children, and biliary carcinomas in young adults is discussed according to the literatures of the last 10 years.

  18. A small solitary non-parasitic hepatic cyst causing an intra-hepatic bile duct stricture: a case report

    Directory of Open Access Journals (Sweden)

    Hong Taeho

    2010-08-01

    Full Text Available Abstract Introduction We report an unusual presentation of a small hepatic cyst causing cholangitis. Case presentation A 70-year-old Asian man was hospitalized for aggravated chronic pain in the right upper portion of his abdomen. Fever developed after admission. Laboratory tests revealed elevated hepatobiliary enzymes, inflammatory markers and carbohydrate antigen 19-9 without hyperbilirubinemia. Ultrasound and computed tomography demonstrated dilatation of the left intra-hepatic bile ducts. Endoscopic retrograde cholangiopancreatography showed that the right intra-hepatic bile ducts were normally filled with contrast medium, but the left intra-hepatic bile ducts were not seen in the confluence. A left hepatectomy was performed because a hidden malignancy could not be excluded. The surgical findings showed no tumor around the bile duct but rather a 2 cm cyst in segment four of Couinaud's category of the liver around the hilum. The pathology report was a solitary non-parasitic hepatic cyst compressing the bile duct. Conclusion A very small solitary hepatic cyst might cause hepatic duct stricture if it is located near the hepatic hilum, and should be considered in the differential diagnosis of a hepatic duct stricture.

  19. Endoscopic ultrasound in common bile duct dilatation withnormal liver enzymes

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    In recent years, the description of isolated bile ductdilatation has been increasingly observed in subjectswith normal liver function tests and nonspecific abdominalsymptoms, probably due to the widespread useof high-resolution imaging techniques. However, thereis scant literature about the evolution of this conditionand the impact of endoscopic ultrasound (EUS) in thediagnostic work up. When noninvasive imaging tests(transabdominal ultrasound, computed tomography ormagnetic resonance cholangiopancreatography) fail toidentify the cause of dilatation and clinical or biochemicalalarm signs are absent, the probability of having biliarydisease is considered low. In this setting, using EUS,the presence of pathologic findings (choledocholithiasis,strictures, chronic pancreatitis, ampullary or pancreatictumors, cholangiocarcinoma), not always with a benigncourse, has been observed. The aim of this review hasbeen to evaluate the prevalence of disease among nonjaundicedpatients without signs of cytolysis and/orcholestasis and the assessment of EUS yield. Datapoint out to a promising role of EUS in the identificationof a potential biliary pathology. EUS is a low invasivetechnique, with high accuracy, that could play a doublecost-effective role identifying pathologic conditionswith dismal prognosis, in asymptomatic patients withnegative prior imaging tests, and excluding pathologicconditions and further follow-up in healthy subjects.

  20. Feasibility and effectiveness of chemical bile duct embolization for chemical hepatectomy:a preliminary study

    Institute of Scientific and Technical Information of China (English)

    Fu-Yu Li; Ning Li; Li-Sheng Jiang; Jing-Qiu Cheng; Nan-Sheng Cheng; Xing-Wu Wu; Sheng He

    2006-01-01

    BACKGROUND: The high operative risk of hepatectomy for specially located intrahepatic stones is still a problem to be solved. This study was undertaken to investigate the feasibility and effectiveness of chemical bile duct embolization for chemical hepatectomy. METHODS: Oxybenzene or absolute ethanol plus N-butyl-cyanoacrylate was employed for embolization. The feasibility, effectiveness and mechanism of chemical hepatectomy were preliminarily analyzed histologically or by Fas, TIMP-1, TGF-β1, and collagenⅠ. RESULTS:Oxybenzene plus cyanonacrylate can preferably destroy and embolize the intrahepatic biliary duct, leading to the disappearance of hepatocytes in the periphery of embolized lobe and the achievement of effective chemical hepatectomy. The expressions of Fas, TIMP-1 and TGF-β1 in oxybenzene embolism group (88.90±38.10, 619.43± 183.42, 185.22±70.39) and ethanol embolism group (72.39± 29.51, 407.55±134.74, 163.56±51.75) were higher than those of biliary duct-ligated group (26.31±12.07, 195.31±107.67, 74.84±40.73) (P CONCLUSION: The effect of chemical hepatectomy may be achieved by chemical bile duct embolization.

  1. Intraductal Papillary-Mucinous Neoplasm of the Pancreas Penetrating to the Stomach and the Common Bile Duct

    OpenAIRE

    Norihiro Goto; Masahiro Yoshioka; Motohito Hayashi; Toshinao Itani; Jun Mimura; Kimio Hashimoto

    2012-01-01

    Context Intraductal papillary mucinous neoplasm (IPMN) of the pancreas occasionally penetrates to others organs. We present a case of IPMN penetrating to the stomach and the common bile duct. Case report A 75-year-old man was admitted to the hospital because of epigastric pain. Computed tomography (CT) showed a papillary tumor protruding into the markedly dilated main pancreatic duct and splenic vein obstruction. The tumor was diagnosed as IPMN arising in the main duct, but he rejected surger...

  2. Common and Uncommon Anatomical Variants of Intrahepatic Bile Ducts in Magnetic Resonance Cholangiopancreatography and its Clinical Implication

    Science.gov (United States)

    Sarawagi, Radha; Sundar, Shyam; Raghuvanshi, Sameer; Gupta, Sanjeev Kumar; Jayaraman, Gopal

    2016-01-01

    Summary Background Preoperative knowledge of intrahepatic bile duct (IHD) anatomy is critical for planning liver resections, liver transplantations and complex biliary reconstructive surgery. The purpose of our study was to demonstrate the imaging features of various anatomical variants of IHD using magnetic resonance cholangio-pancreatography (MRCP) and their prevalence in our population. Material/Methods This observational clinical evaluation study included 224 patients who were referred for MRCP. MRCP was performed in a 1.5-Tesla magnet (Philips) with SSH MRCP 3DHR and SSHMRCP rad protocol. A senior radiologist assessed the biliary passage for anatomical variations. Results The branching pattern of the right hepatic duct (RHD) was typical in 55.3% of subjects. The most common variant was right posterior sectoral duct (RPSD) draining into the left hepatic duct (LHD) in 27.6% of subjects. Trifurcation pattern was noted in 9.3% of subjects. In 4% of subjects, RPSD was draining into the common hepatic duct (CHD) and in 0.8% of subjects into the cystic duct. Other variants were noted in 2.6% of subjects. In 4.9% of cases there was an accessory duct. The most common type of LHD branching pattern was a common trunk of segment 2 and 3 ducts joining the segment 4 duct in 67.8% of subjects. In 23.2% of subjects, segment 2 duct united with the common trunk of segment 3 and 4 and in 3.4% of subjects segment 2, 3, and 4 ducts united together to form LHD. Other uncommon branching patterns of LHD were seen in 4.9% of subjects. Conclusions Intrahepatic bile duct anatomy is complex with many common and uncommon variations. MRCP is a reliable non-invasive imaging method for demonstration of bile duct morphology, which is useful to plan complex surgeries and to prevent iatrogenic injuries. PMID:27298653

  3. Clinical observation of laparoscopic common bile duct exploration to treat cholecystolithiasis combined with choledocholithiasis%腹腔镜胆道探查术治疗胆囊结石合并胆总管结石的临床观察

    Institute of Scientific and Technical Information of China (English)

    王福荣; 邵文生; 黄小玲; 陈果; 李伟

    2013-01-01

    目的 探讨腹腔镜胆道探查术治疗胆囊结石合并胆总管结石的临床疗效.方法 将128例胆囊结石合并胆总管结石患者随机分为观察组和对照组各64例,两组患者均行全身麻醉,观察组患者接受腹腔镜胆道探查术治疗胆囊结石合并胆总管结石,对照组患者接受传统手术治疗胆囊结石合并胆总管结石,两组患者术后常规抗感染治疗.比较两组患者的手术情况、术后恢复情况、住院时间及费用、术后并发症情况以及术后残石率等情况.结果 与对照组比较,观察组患者切口显著缩小(P<0.01),手术时间、下床时间、术后通气时间、肠鸣音恢复时间、导尿管留置时间、术后住院时间及住院总时间显著缩短(均P<0.01),术中失血量显著减少(P<0.01),而住院总费用增加(P<0.01).观察组切口感染显著低于对照组(P<0.05),但是两组术后并发症整体比较差异无统计学意义(P>0.05).两组患者术后残留结石差异无统计学意义(P>0.05).结论 腹腔镜胆道探查术治疗胆囊结石合并胆总管结石创伤小,恢复快,安全可靠,疗效确切,值得临床推广应用.%Objective To explore the clinical effect of laparoscopic common bile duct exploration to treat cholecystolithiasis combined with choledocholithiasis.Methods A total of 128 patients with cholecystolithiasis combined with choledocholithiasis,who visited the General Surgery department of our hospital in January 2010~ December 2011,were divided randomly into Observation Group and Control Group.Cases in Observation Group received laparoscopic common bile duct exploration,and cases in Control Group received traditional operation.Cases in both groups received traditional anti-infection treatment after operation.The operation conditions,recovery of operation,hospital stays and expense,as well as complication after operation and residual bile duct stones were compared in both groups.Results he cut size was

  4. Septicemia with Streptococcus pseudopneumoniae: report of three cases with an apparent hepatic or bile duct association.

    Science.gov (United States)

    Fuursted, Kurt; Littauer, Pia Jeanette; Greve, Thomas; Scholz, Christian F P

    2016-08-01

    Streptococcus pseudopneumoniae was described in 2004 as a new human pathogen, acknowledged in a range of clinical infections typically associated to the respiratory tract. This report demonstrates that S. pseudopneumoniae has the potential to cause invasive infection. In blood cultures from three patients, growth of an atypical Streptococcus pneumoniae (non-capsular, non-serotypeable, optochin susceptible under ambient atmosphere and bile-intermediately soluble) was recovered. All three patients had a history of a haematological disease (myelodysplastic syndrome and multiple myeloma) and an apparent origin of infection related to the liver or bile duct. All isolates were genome sequenced and subsequently identified as S. pseudopneumoniae by multi-locus sequence analysis (MLSA). Multi-locus sequence typing (MLST) based on the S. pneumoniae scheme revealed unknown sequence types and the antibiogram and resistome revealed no antibiotic resistance. PMID:27100044

  5. Biliary drainage of the common bile duct with an enteral metal stent

    Institute of Scientific and Technical Information of China (English)

    Irene M Dek; Bram DJ van den Elzen; Paul Fockens; Erik AJ Rauws

    2009-01-01

    In this case report we present an elderly patient who was referred to our hospital with recurrent episodes of cholangitis that persisted after placement of five metal stents for a distal common bile duct (CBD) stenosis. All metal stents were endoscopically removed from the CBD by forceps after balloon dilatation of the papilla. A profoundly dilated CBD with sludge and concrements was seen. To ensure adequate bile drainage an enteral metal stent was inserted in the CBD. This case shows that proximally migrated uncovered metal stents in the CBD can be safely removed endoscopically under certain circumstances. We suggest that in the case of a CBD drainage problem due to an extremely dilated CBD, placement of an enteral metal stent in the CBD could be considered, especially in patients who are unfit for surgery.

  6. The influence of the metallic stent for irradiation. Experimental study by phantom and normal bile duct of the dogs

    International Nuclear Information System (INIS)

    A phantom experiment using a film method to evaluate the radiation dose near an EMS (Expandable Metallic Stent) when the EMS was exposed to irradiation and an animal experiment using mongrel dogs to investigate the histological influence of irradiation and EMS on the normal bile duct were studied. In the phantom experiment, when a single portal of 60Coγ irradiation was delivered to the stainless steel wire, in the portion in contact with the wire as compared to the non-wire portion a maximum 17.2% increase in the radiation dose due to back scattering was found. In the experimental study using mongrel dogs, the degree of fibrosis of the bile duct was most marked in the case of external irradiation after EMS placement, followed by EMS placement after external irradiation, external irradiation alone, and EMS placement alone in descending order, suggesting that the influence of secondary electrons and scattering, the period of EMS placement and relative difference between the diameter of the bile duct and EMS. However, neither occlusion of the bile duct, nor necrosis of the bile duct wall was observed, and so the safety of the combined use of a conventional total dose of 50-60 Gy external irradiation after EMS placement was confirmed. (author)

  7. Carcinoma in situ arising in a tubulovillous adenoma of the distal common bile duct: A case report

    Institute of Scientific and Technical Information of China (English)

    Bum-Soo Kim; Sun-Hyung Joo; Kwang-Ro Joo

    2008-01-01

    Tubulovillous adenomas are common in the colon and rectum, but are rare in the common bile duct. Biliary adenomas may produce obstructive jaundice, which can be easily confused with a malignant neoplasm or stone. We report a case of a carcinoma in situ arising in a tubulovillous adenoma of the distal common bile duct causing obstructive jaundice. A 55-year-old male presented with a 10-d history of pruritus and progressive jaundice. Abdominal sonography and computed tomography showed a mass in the distal common bile duct. Endoscopic retrograde cholangiopancreatography showed luminal narrowing of the bile duct due to a polypoid mass. Positron emission tomography demonstrated no abnormal uptake. It was thoughtthat this mass was a malignant tumor, thus a pylorus-preserving panceaticoduodenectomy was performed.The final pathology showed a tubulovillous adenoma with carcinoma in situ of the distal common bile duct. At follow-up 8 mo later, endoscopy showed multiple polypsin the rectum, colon and stomach. The polyps were removed by endoscopic mucosal resection and shown to be tubular adenomas with high grade dysplasia. Biliary adenomas require careful follow-up for early detection of recurrence and malignant transformation.

  8. Transarterial Chemoembolization for Hepatocellular Carcinomas with Central Bile Duct Invasion: Safety, Prognosis, and Predictive Factors

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin Woo; Chung, Jin Wook, E-mail: chungjw@snu.ac.kr [Seoul National University Hospital, Department of Radiology (Korea, Republic of); Cho, Yun Ku [VHS Medical Center, Department of Radiology (Korea, Republic of); Kim, Yoon Jun; Yoon, Jung-Hwan [Seoul National University Hospital, Department of Internal Medicine (Korea, Republic of); Kim, Hyo-Cheol; Jae, Hwan Jun [Seoul National University Hospital, Department of Radiology (Korea, Republic of)

    2015-08-15

    PurposeTo assess the safety and effectiveness of transarterial chemoembolization (TACE) of patients who have hepatocellular carcinomas (HCCs) with central bile duct invasion.Materials and MethodsThe institutional review board approved this retrospective study and waived informed consent. Fifty-three patients, initially treated with TACE for HCCs with central bile duct invasion from January 1999 to September 2012, were included. Clinical, laboratory, and survival data were reviewed. Complications and hospitalization length were evaluated using the χ{sup 2} test, Fisher’s exact test, and logistic regression analysis. Survival was analyzed using the Kaplan–Meier method with log-rank test and Cox proportional hazard model.ResultsSeven patients experienced TACE-related major complications (severe post-embolization syndrome in 3, non-fatal sepsis in 3, and secondary bacterial peritonitis in 1). The overall major complication rate was 13.2 %, but there were no permanent adverse sequelae or deaths within 30 days. Serum total bilirubin ≥3.0 mg/dL was the only significant risk factor for long hospitalization [hazard ratio (HR) = 4.341, p = .022]. The median survival was 12.2 months. Extrahepatic metastasis (HR = 6.145, p < .001), international normalized ratio (PT-INR) ≥1.20 (HR = 4.564, p < .001), vascular invasion (HR = 3.484, p = .001), and intermediate tumor enhancement (HR = 2.417, p = .019) were significantly associated with shorter survival.ConclusionTACE can be a safe and effective treatment for patients who have HCCs with central bile duct invasion. In particular, long-term survival can be expected if patients have strongly enhancing tumors without poor prognostic factors such as extrahepatic metastasis, PT-INR prolongation, and vascular invasion.

  9. Transarterial Chemoembolization for Hepatocellular Carcinomas with Central Bile Duct Invasion: Safety, Prognosis, and Predictive Factors

    International Nuclear Information System (INIS)

    PurposeTo assess the safety and effectiveness of transarterial chemoembolization (TACE) of patients who have hepatocellular carcinomas (HCCs) with central bile duct invasion.Materials and MethodsThe institutional review board approved this retrospective study and waived informed consent. Fifty-three patients, initially treated with TACE for HCCs with central bile duct invasion from January 1999 to September 2012, were included. Clinical, laboratory, and survival data were reviewed. Complications and hospitalization length were evaluated using the χ2 test, Fisher’s exact test, and logistic regression analysis. Survival was analyzed using the Kaplan–Meier method with log-rank test and Cox proportional hazard model.ResultsSeven patients experienced TACE-related major complications (severe post-embolization syndrome in 3, non-fatal sepsis in 3, and secondary bacterial peritonitis in 1). The overall major complication rate was 13.2 %, but there were no permanent adverse sequelae or deaths within 30 days. Serum total bilirubin ≥3.0 mg/dL was the only significant risk factor for long hospitalization [hazard ratio (HR) = 4.341, p = .022]. The median survival was 12.2 months. Extrahepatic metastasis (HR = 6.145, p < .001), international normalized ratio (PT-INR) ≥1.20 (HR = 4.564, p < .001), vascular invasion (HR = 3.484, p = .001), and intermediate tumor enhancement (HR = 2.417, p = .019) were significantly associated with shorter survival.ConclusionTACE can be a safe and effective treatment for patients who have HCCs with central bile duct invasion. In particular, long-term survival can be expected if patients have strongly enhancing tumors without poor prognostic factors such as extrahepatic metastasis, PT-INR prolongation, and vascular invasion

  10. Trends of surgical treatment of hilar bile duct cancer: clinical andexperimental perspectives

    Institute of Scientific and Technical Information of China (English)

    Zhi Qiang Huang; Ning Xin Zhou; Da Dong Wang; Jian Guo Lu; Ming Yi Chen

    2000-01-01

    AIM To summarize the experience of surgical treatment of hilar cholangiocarcinoma and the results of aseries of experiments.METHODS AND RESULTS Personal perspectives of surgical treatment of hilar cholangiocarcinoma werebased on the experience of a series of patients with hilar bile duct cancer treated in the General Hospital ofPLA, Beijing from 1986 to 1999. A total of 157 cases were treated surgically, with 106 (67.5%) resections ofthe tumor , 37.6% of the resections was proved to be radical. The 1-, 2-, 3-, and 5-year survival rate of theradical resection group was 96.7%, 40.0%, 23.3% and 13.3%, respectively. No patient of the palliativeresection group lived beyond 3 years postoperatively. The recent trends of surgical management of hilar bileduct cancer were discussed. Experiments were carried out for cooperative clinicopathological study toevaluate the perineural space involvement, the neural cell adhesion molecule expression, p16 geneexpression, and the 3-dimensional reconstruction of the bile duct cancer specimens. The pathogeneticrelationship of HBV and HCV with extrahepatic cholangiocarcinoma was evaluated by histochemical and IS-PCR methods. And an inquiry into the possibility of gene therapy was made.CONCLUSION Hilar bile duct cancer rarely runs a “benign” course. It is a regional disease rather than alocal affection and may be related to HBV and HCV infection in China. It possesses the metastasing abilityalong the perineural space by a “jumping” fashion, therefore, in most cases, conventional surgical excision isbound to be unradical in the region of the porta hepatis for anatomical reasons.

  11. Endoscopic sphincterotomy for common bile duct stones during laparoscopic cholecystectomy is safe and effective

    DEFF Research Database (Denmark)

    Jakobsen, Henrik Loft; Vilmann, Peter; Rosenberg, Jacob

    2011-01-01

    Management strategy for common bile duct (CBD) stones is controversial with several treatment options if stones in the CBD are recognized intraoperatively. The aim of this study was to report our experience with same-session combined endoscopic-laparoscopic treatment of gallbladder and CBD stones....... We retrospectively evaluated 31 patients with cholecystolithiasis and CBD stones undergoing same-session combined endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and endoscopic stone extraction and laparoscopic cholecystectomy. Same-session ERCP and sphincterotomy were...... pancreatitis postoperatively and no other morbidity or mortality. In conclusion, same-session ERCP with stone extraction and laparoscopic cholecystectomy seems to be a safe and effective treatment strategy for CBD stones....

  12. Diffusion weighted MRI in intrahepatic bile duct adenoma arising from the cirrhotic liver

    Energy Technology Data Exchange (ETDEWEB)

    An, Chansik [Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Park, Sumi; Choi, Yoon Jung [National Health Insurance Corporation Ilsan Hospital, Goyang (Korea, Republic of)

    2013-10-15

    A 64-year-old male patient with liver cirrhosis underwent a CT study for hepatocellular carcinoma surveillance, which demonstrated a 1.4-cm hypervascular subcapsular tumor in the liver. On gadoxetic acid-enhanced MRI, the tumor showed brisk arterial enhancement and persistent hyperenhancement in the portal phase, but hypointensity in the hepatobiliary phase. On diffusion-weighted MRI, the tumor showed an apparent diffusion coefficient twofold greater than that of the background liver parenchyma, which suggested that the lesion was benign. The histologic diagnosis was intrahepatic bile duct adenoma with alcoholic liver cirrhosis.

  13. Vanishing bile duct and Stevens-Johnson syndrome associated with ciprofloxacin treated with tacrolimus

    Institute of Scientific and Technical Information of China (English)

    Gokhan Okan; Serpil Yaylaci; Onder Peker; Sabahattin Kaymakoglu; Murat Saruc

    2008-01-01

    Stevens-Johnson syndrome (SJS) is a serious and potentially life-threatening disease. Vanishing bile duct syndrome (VBDS) is a rare cause of progressive cholestasis. Both syndromes are mostly related with drugs. We report a case of a patient withciprofloxacin-induced SJS and acute onset of VBDS,and reviewed the related literature. It is the first case of ciprofloxacin-induced VBDS successfully treatedwith tacrolimus. This case reminds physicians of the importance of drug reactions, their severity, techniques for diagnosis and methods of management.

  14. Sequential changes of attenuation values of bile duct and gallbladder on CT after oral contrast ingestion

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Hee; Suh, Chang Hae; Lim, Myung Kwan; Chung, Won Kyun [Inha University College of Medicine, Sungnam (Korea, Republic of)

    1995-10-15

    The purpose of this study is to evaluate that sequential CT scans after oral contrast ingestion can show morphological and functional status of the biliary tree, especially for the gallbladder and assess whether the CT scans demonstrate other radiological information than conventional oral cholecystography. Thirty volunteers in third decades and eight patients with hepatobiliary disease were included for the study. CT scans were obtained 3, 6, 9, 12 hours after oral contrast ingestion and thirty minutes after fat meal in thirty volunteers. Conventional oral cholecystography was also obtained in all volunteers at 12 hours after oral contrast ingestion and after fat meal. We evaluate opacification of gallbladder, biliary tree, and duodenum by contrast media on CT scans and attenuation values of gallbladder, common hepatic duct and common bile duct in each anatomic area on CT and its sequential change. CT scans were performed 6 hours after oral contrast ingestion in eight patients with hepatobiliary disease. And gallbladder function was evaluated by opacification of gallbladder by contrast media in all patients. In thirty volunteers, opacified gallbladder by contrast media was seen in all cases in all sequential periods of time on CT scans, but in 22 cases on conventional oral cholecystography. Contrast-filled intrahepatic ducts were demonstrated in 3 cases at 3 hours after oral contrast ingestion and 11 cases at 6 hours and were not seen thereafter. Contrast-filled common hepatic duct was noted in 28, 18 and 4 cases respectively at 3, 6 and 9 hours after oral contrast ingestion and the CT attenuation values of common hepatic ducts had become progressively decreased. Contrast-filled common bile duct was noted in 28, 18 and 4 cases respectively at 3, 6 and 9 hours and the CT attenuation values of common bile ducts were not changed until 9 hours but slightly increased at 12 hours. Contrast media was noted in 7, 5, 6 and 5 cases at 3, 6, 9 and 12 hours in cystic duct and

  15. Sequential changes of attenuation values of bile duct and gallbladder on CT after oral contrast ingestion

    International Nuclear Information System (INIS)

    The purpose of this study is to evaluate that sequential CT scans after oral contrast ingestion can show morphological and functional status of the biliary tree, especially for the gallbladder and assess whether the CT scans demonstrate other radiological information than conventional oral cholecystography. Thirty volunteers in third decades and eight patients with hepatobiliary disease were included for the study. CT scans were obtained 3, 6, 9, 12 hours after oral contrast ingestion and thirty minutes after fat meal in thirty volunteers. Conventional oral cholecystography was also obtained in all volunteers at 12 hours after oral contrast ingestion and after fat meal. We evaluate opacification of gallbladder, biliary tree, and duodenum by contrast media on CT scans and attenuation values of gallbladder, common hepatic duct and common bile duct in each anatomic area on CT and its sequential change. CT scans were performed 6 hours after oral contrast ingestion in eight patients with hepatobiliary disease. And gallbladder function was evaluated by opacification of gallbladder by contrast media in all patients. In thirty volunteers, opacified gallbladder by contrast media was seen in all cases in all sequential periods of time on CT scans, but in 22 cases on conventional oral cholecystography. Contrast-filled intrahepatic ducts were demonstrated in 3 cases at 3 hours after oral contrast ingestion and 11 cases at 6 hours and were not seen thereafter. Contrast-filled common hepatic duct was noted in 28, 18 and 4 cases respectively at 3, 6 and 9 hours after oral contrast ingestion and the CT attenuation values of common hepatic ducts had become progressively decreased. Contrast-filled common bile duct was noted in 28, 18 and 4 cases respectively at 3, 6 and 9 hours and the CT attenuation values of common bile ducts were not changed until 9 hours but slightly increased at 12 hours. Contrast media was noted in 7, 5, 6 and 5 cases at 3, 6, 9 and 12 hours in cystic duct and

  16. Thiazolidinedione treatment inhibits bile duct proliferation and fibrosis in a rat model of chronic cholestasis

    Institute of Scientific and Technical Information of China (English)

    Fabio Marra; Carlo Spirli; Mario Strazzabosco; Massimo Pinzani; Maurizio Parola; Raffaella DeFranco; Gaia Robino; Erica Novo; Eva Efsen; Sabrina Pastacaldi; Elena Zamara; Alessandro Vercelli; Benedetta Lottini

    2005-01-01

    AIM: To investigate the effects of troglitazone (TGZ), an anti-diabetic drug which activates peroxisome proliferatoractivated receptor-γ (PPAR-γ), for liver tissue repair, and the development of ductular reaction, following common bile duct ligation (BDL) in rats.METHODS: Rats were supplemented with TGZ (0.2% w/w in the pelleted food) for 1 wk before BDL or sham operation.Animals were killed at 1, 2, or 4 wk after surgery.RESULTS: The development of liver fibrosis was reduced in rats receiving TGZ, as indicated by significant decreases of procollagen type Ⅰ gene expression and liver hydroxyproline levels. Accumulation of α-smooth-muscle actin (SMA)-expressing cells surrounding newly formed bile ducts following BDL, as well as total hepatic levels of SMA were partially inhibited by TGZ treatment, indicating the presence of a reduced number and/or activation of hepatic stellate cells (HSC) and myofibroblasts. Development of the ductular reaction was inhibited by TGZ, as indicated by histochemical evaluation and hepatic activity of γ-glutamyltransferase (GGT).CONCLUSION: Treatment with thiazolidinedione reduces ductular proliferation and fibrosis in a model of chronic cholestasis, and suggests that limiting cholangiocyte proliferation may contribute to the lower development of scarring in this system.

  17. Intraluminal brachytherapy with metallic stenting in the palliative treatment of malignant obstruction of the bile duct

    International Nuclear Information System (INIS)

    The purpose of this study was to describe the outcome of intraluminal high-dose-rate (HDR) brachytherapy with metallic stenting in patients with obstructing extrahepatic cholangiocarcinoma. Eight patients with inoperable and/or unresectable extrahepatic bile duct carcinomas were treated with intraluminal brachytherapy (ILBT) followed by self-expandable metallic stent placement. Following percutaneous transhepatic drainage, ILBT was delivered by an HDR-Ir-192 source using the Micro-Selectron afterloading device. Two treatments were planned one week apart, with each treatment consisting of a single 10 Gy fraction. Biliary patency and palliative effect were assessed by serial labs (including bilirubin/alkaline phosphatase), symptomatic improvement, and/or cholangiography. All eight patients tolerated the first application of ILBT well, and five of them completed two-intraluminal treatments. Six of eight had satisfactory control of jaundice until death. Pain relief was observed in four of five (80%) and pruritis in six of seven (86%) patients experiencing such symptoms. The mean and median times of stent patency were 6.9 and 5 months (range, 4-14), respectively. Gastrointestinal bleeding and/or cholangitis occurred in three patients. HDR ILBT with metallic stenting for patients with obstructive jaundice from extrahepatic bile duct carcinoma appears to be feasible and associated with acceptable toxicity. These treatments may lead to an improved quality of life in these patients. (author)

  18. Honey prevents hepatic damage induced by obstruction of the common bile duct

    Institute of Scientific and Technical Information of China (English)

    B Imge Erguder; Sibel S Kilicoglu; Mehmet Namuslu; Bulent Kilicoglu; Erdinc Devrim; Kemal Kismet; Ilker Durak

    2008-01-01

    AIM: To examine the possible effects of honey supplementation on hepatic damage due to obstruction of the common bile duct in an experimental rat model.METHODS: The study was performed with 30 male rats divided into three groups: a sham group, an obstructive jaundice group, and an obstructive jaundice plus honey group. At the end of the study period, the animals were sacrificed, and levels of nitric oxide (NO), and NO synthase (NOS) activities were measured in liver tissues, and levels of adenosine deaminase (ADA) and alanine transaminase (ALT) activities were measured in serum.RESULTS: Blood ALT and ADA activities were significantly elevated in the jaundice group as compared to those of the sham group. In the obstructive jaundice plus honey group, blood ALT and ADA activities were significantly decreased as compared to those of the jaundice group. In erythrocytes and liver tissues, NO levels were found to be significantly higher in the obstructive jaundice plus honey group compared to those of the sham group. Additionally, NO levels were found to be significantly higher in liver tissues from the animals in the obstructive jaundice plus honey group than those of the jaundice group.CONCLUSION: Honey was found to be beneficial in the prevention of hepatic damage due to obstruction of the common bile duct.

  19. [Gallstone obstruction of the common bile duct, a severe form of biliary lithiasis. Choice of treatment].

    Science.gov (United States)

    Le Neel, J C; Guiberteau, B; Kohen, M; Borde, L; Sartre, J Y; Bourseau, J C

    1992-01-01

    Collection of 10 or more stones in the extrahepatic common bile duct causes lithiasic obstruction of the CBD, a fairly rare entity observed in less than 10% of cases of bile duct lithiasis. This study is based on 35 cases recorded over 10 years, including 60% in patients aged more than 75 years. Endoscopic treatment was attempted in 28% of patients and was totally successful in one case our of four only because of insufficient removal of obstruction after sphincterotomy. Surgery, either necessary (8 cases) or systematic (25 cases) combines cholecystectomy, choledocotomy and biliary fiberendoscopy for a complete treatment minimizing the risks of residual lithiasis. While biliodigestive anastomoses prevailed (58%) during the first years of this study, external biliary drainage was most often chosen during the last 5 years. This surgery in aged patients still entails high morbidity (25%) and considerable mortality (9%). Better efficacy may be provided in the future by the combination of fiberendoscopic means and of lithotrity for aged subjects at high surgical risks.

  20. Detection of common bile duct stones before laparoscopic cholecystectomy. Evaluation with MR cholangiography

    International Nuclear Information System (INIS)

    Purpose: To assess the diagnostic value of MR cholangiography (MRC) for detecting common bile duct (CBD) stones in candidates for laparoscopic cholecystectomy (LC). Material and Methods: A series of 95 selected patients with gallstones and suspected CBD lithiasis (abnormal serum liver tests and/or CBD size 6.5 mm at US) were referred to our institution for MRC, before LC. MRC was performed on a 0.5 T magnet through a non-breath-hold, respiratory-triggered, fat-suppressed, thin-slab, heavily T2-weighted fast spin-echo sequence and through a breath-hold, thick-slab, single-shot T2-weighted sequence in the coronal plane. Axial T1- and T2-weighted sequences were first obtained. Two observers in conference reviewed source images and maximum intensity projections to determine the presence or absence of choledocholithiasis. MR findings were compared with endoscopic retrograde cholangiography and intraoperative cholangiography (IOC); IOC was always performed during LC. Results: CBD calculi (single or multiple) were identified in 41 out of 95 patients (43%). Two false-positive and 4 false-negative cases were found on MRC. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MRC for choledocholithiasis were 90%, 96%, 94%, 95%, and 93%, respectively. Conclusion: MRC is a highly effective diagnostic modality for evaluation of patients with risk factors for CBD stones prior to LC Bile ducts gallbladder calculi stenosis or obstruction MR imaging

  1. Common Bile Duct (CBD) diameter in opium-addicted men: Comparison with non-addict controls

    International Nuclear Information System (INIS)

    Background: Opium and its derivatives are widely abused throughout the world. Recent case reports and a few limited studies have suggested that opiates cause dilation of the common bile duct of the abusers. Material/Methods: Our case-control study, lasting 7.5 months, investigated 121 male adult addicts and 142 non addicted controls for biliary tract diameters, using ultrasonography. The study was conducted in Bahonar Hospital in Kerman. Neither the addiction cases nor the non-addict controls revealed any hepatobiliary tract symptoms. The subjects were asked to fill in a questionnaire. After the exclusion of the symptomatic cases, ultrasound examinations were carried out and the findings from questionnaires and US examinations were recorded. Results: The mean ± SD diameter of the common bile duct was 4.78 ± 2.58 for addicts and 3.37 ± 2.25 for non-addicts. CBD wall thickness was 1.969 ± 0.61 mm in addicts versus 1.73 ± 0.631 in non-addicts. The differences were statistically significant. According to the multivariate analysis, the duration of opium abuse was a significant factor. Conclusions: We concluded that CBD dilation and increased CBD wall thickness can be expected in people with a prolonged history of opiate addiction. (authors)

  2. Novel endoscopic management for pancreatic pseudocyst with fistula to the common bile duct

    Institute of Scientific and Technical Information of China (English)

    Stefano; Francesco; Crinò; Giuseppe; Scalisi; Pierluigi; Consolo; Doriana; Varvara; Antonio; Bottari; Sebastiano; Pantè; Socrate; Pallio

    2014-01-01

    Pancreatic pseudocyst formation is a well-known complication of pancreatitis. It represents about 75% of the cystic lesions of the pancreas and might be located within or surrounding the pancreatic tissue. Sixty percent of the occurrences resolve spontaneously and only persistent, symptomatic or complicated cysts need to be treated. Complications include infection, hemorrhage, gastric outlet obstruction, splenic infarction and rupture. The formation of fistulas to other viscera is rare and most commonly occurs within the stomach, duodenum or colon. We report a case of a patient with a pancreatic pseudocyst in communication with the common bile duct. There have been only few cases reported in the literature. We successfully managed our case by performing an endoscopicultrasound-guided drainage of the pancreatic collection and a contemporaneous stenting of the common bile duct. Performed independently, both drainages are effective, safe and well-coded and the expertise on these procedures is widespread. By our knowledge this therapeutic approach was never reported in literature but we retain this is the most correct treatment for this very rare condition.

  3. [Gallstone obstruction of the common bile duct, a severe form of biliary lithiasis. Choice of treatment].

    Science.gov (United States)

    Le Neel, J C; Guiberteau, B; Kohen, M; Borde, L; Sartre, J Y; Bourseau, J C

    1992-01-01

    Collection of 10 or more stones in the extrahepatic common bile duct causes lithiasic obstruction of the CBD, a fairly rare entity observed in less than 10% of cases of bile duct lithiasis. This study is based on 35 cases recorded over 10 years, including 60% in patients aged more than 75 years. Endoscopic treatment was attempted in 28% of patients and was totally successful in one case our of four only because of insufficient removal of obstruction after sphincterotomy. Surgery, either necessary (8 cases) or systematic (25 cases) combines cholecystectomy, choledocotomy and biliary fiberendoscopy for a complete treatment minimizing the risks of residual lithiasis. While biliodigestive anastomoses prevailed (58%) during the first years of this study, external biliary drainage was most often chosen during the last 5 years. This surgery in aged patients still entails high morbidity (25%) and considerable mortality (9%). Better efficacy may be provided in the future by the combination of fiberendoscopic means and of lithotrity for aged subjects at high surgical risks. PMID:1342650

  4. Bile duct-duodenal fistula caused by AIDS/HIV-associated tuberculosis

    Directory of Open Access Journals (Sweden)

    Patino Carlos

    2003-01-01

    Full Text Available Allthough infrequent, digestive fistulae in HIV/AIDS patients have been reported throughout the digestive tract from the esophagus to the anus, with predominance of esophageal fistulae. AIDS/HIV-associated opportunistic infections may invade the digestive system and lead to fistula formation. Tuberculosis is the most common infection associated with these esophageal fistulae. We report here one case of bile duct-duodenal fistula in a female AIDS patient with associated abdominal Mycobacterium tuberculosis infection compromising lymphnodes of the hepatic pedicle where the fistula was found. According to the reviewed literature, this is the third case of bile duct-duodenal fistula associated with abdominal tuberculosis in AIDS patient, and the first where both the fistula and the tuberculosis infection were diagnosed at laparotomy for acute abdomen. Whether the AIDS patient with abdominal pain needs or not a laparotomy to treat an infectious disease is often a difficult matter for the surgeon to decide, as most of the times appropriate medical treatment will bring more benefit.

  5. Fatal Bile Duct Necrosis: A Rare Complication of Transcatheter Arterial Chemoembolization in a Patient with Endocrine Hepatic Metastasis

    Directory of Open Access Journals (Sweden)

    Anne-Laure Pelletier

    2008-11-01

    Full Text Available We report the first case of fatal bile duct necrosis following transcatheter arterial chemoembolization (TACE in a 58-year-old woman. The patient underwent two TACEs to treat hepatic metastases from an ileal endocrine tumor. Persistent cholestasis occurred after the second procedure, leading to the diagnosis of bile duct necrosis confirmed by liver biopsy. The patient died of liver failure with encephalopathy six months after the second TACE. Even though this complication is very rare, physicians should consider this diagnosis in patients who develop chronic, marked cholestasis following a TACE procedure.

  6. Benign nontraumatic inflammatory stricture of mid portion of common bile duct mimicking malignant tumor:Report of two cases

    Institute of Scientific and Technical Information of China (English)

    Chiu-Yung Ho; Tseng-Shing Chen; Full-Young Chang; Shou-Dong Lee

    2004-01-01

    Benign nontraumatic inflammatory stricture of the common bile duct (CBD) may result in obstructive jaundice, which can be misdiagnosed as a malignant tumor of the CBD preoperatively. Two cases with strictures of the mid portion of the common bile duct presenting with obstructive jaundice are reported herein. Preoperative radiological studies prompted us to confidently make the diagnosis of cholangiocarcinoma. However, the postoperative diagnosis on histological examination of the resected lesions was chronic inflammation and fibrosis. The complications of chronic duodenal ulcer are considered as the etiology of these two disorders.

  7. Mixed Large Cell Neuroendocrine Carcinoma and Adenocarcinoma with Spindle Cell and Clear Cell Features in the Extrahepatic Bile Duct

    Directory of Open Access Journals (Sweden)

    John Wysocki

    2014-01-01

    Full Text Available Mixed adenoneuroendocrine carcinomas, spindle cell carcinomas, and clear cell carcinomas are all rare tumors in the biliary tract. We present the first case, to our knowledge, of an extrahepatic bile duct carcinoma composed of all three types. A 65-year-old man with prior cholecystectomy presented with painless jaundice, vomiting, and weight loss. CA19-9 and alpha-fetoprotein (AFP were elevated. Cholangioscopy revealed a friable mass extending from the middle of the common bile duct to the common hepatic duct. A bile duct excision was performed. Gross examination revealed a 3.6 cm intraluminal polypoid tumor. Microscopically, the tumor had foci of conventional adenocarcinoma (CK7-positive and CA19-9-postive surrounded by malignant-appearing spindle cells that were positive for cytokeratins and vimentin. Additionally, there were separate areas of large cell neuroendocrine carcinoma (LCNEC. Foci of clear cell carcinoma merged into both the LCNEC and the adenocarcinoma. Tumor invaded through the bile duct wall with extensive perineural and vascular invasion. Circumferential margins were positive. The patient’s poor performance status precluded adjuvant therapy and he died with recurrent and metastatic disease 5 months after surgery. This is consistent with the reported poor survival rates of biliary mixed adenoneuroendocrine carcinomas.

  8. Congenital dilatation of the large and segmental intrahepatic bile ducts (Caroli's disease in two Golden retriever littermates : clinical communication

    Directory of Open Access Journals (Sweden)

    R.D. Last

    2006-06-01

    Full Text Available Two, sibling, male Golden retriever puppies, 13 weeks of age, were presented with congenital biliary cysts of the liver involving both hepatic and segmental bile ducts, as well as bilateral polycystic kidney disease. Ultrasonography of the livers of both pups demonstrated segmental cystic lesions that were contiguous with the bile ducts. Histopathology revealed cystic ectatic bile duct hyperplasia and dysplasia with variable portal fibrosis in the liver, while in the kidneys there were radially arranged, cylindrically dilated cysts of the collecting ducts, which extended through the medulla and cortex. This pathology was compatible with that of congenital dilatation of the large and segmental bile ducts (Caroli's disease described in humans, dogs and rats. In humans Caroli's disease has an autosomal recessive inheritance pattern, while in rats activation of the MEK5/ERK cascade initiates the biliary dysgenesis of Caroli's disease in this species. However, the exact mode of inheritance and pathogenesis of Caroli's disease in dogs is as yet unknown. Previous reports on congenital hepatic cystic diseases of the dog have described Caroli's disease like lesions in various breeds, but these are believed to be the 1st reported cases in the Golden retriever breed.

  9. Poorly expandable common bile duct with stones on endoscopic retrograde cholangiography

    Institute of Scientific and Technical Information of China (English)

    Chi-Liang Cheng; Yung-Kuan Tsou; Cheng-Hui Lin; Jui-Hsiang Tang; Chien-Fu Hung; Kai-Feng Sung; Ching-Song Lee

    2012-01-01

    AIM:To describe characteristics of a poorly expandable (PE) common bile duct (CBD) with stones on endoscopic retrograde cholangiography.METHODS:A PE bile duct was characterized by a rigid and relatively narrowed distal CBD with retrograde dilatation of the non-PE segment.Between 2003 and 2006,endoscopic retrograde cholangiography (ERC) images and chart reviews of 1213 patients with newly diagnosed CBD stones were obtained from the computer database of Therapeutic Endoscopic Center in Chang Gung Memorial Hospital.Patients with characteristic PE bile duct on ERC were identified from the database.Data of the patients as well as the safety and technical success of therapeutic ERC were collected and analyzed retrospectively.RESULTS:A total of 30 patients with CBD stones and characteristic PE segments were enrolled in this study.The median patient age was 45 years (range,20 to 92 years); 66.7% of the patients were men.The diameters of the widest non-PE CBD segment,the PE segment,and the largest stone were 14.3 ± 4.9 mm,5.8 ± 1.6 mm,and 11.2 ± 4.7 mm,respectively.The length of the PE segment was 39.7±15.4 mm (range,12.3 mm to 70.9 mm).To remove the CBD stone(s) completely,mechanical lithotripsy was required in 25 (83.3%) patients even though the stone size was not as large as were the difficult stones that have been described in the literature.The stone size and stone/PE segment diameter ratio were associated with the need for lithotripsy.Post-ERC complications occurred in 4 cases:pancreatitis in 1,cholangitis in 2,and an impacted Dormia basket with cholangitis in 1.Two (6.7%)of the 28 patients developed recurrent CBD stones at follow-up (50 ± 14 mo) and were successfully managed with therapeutic ERC.CONCLUSION:Patients with a PE duct frequently require mechanical lithotripsy for stones extraction.To retrieve stones successfully and avoid complications,these patients should be identified during ERC.

  10. Long-Term Palliative Treatment of Hepatocellular Carcinoma Extending into the Portal Vein and Bile Duct by Chemoembolization and Metallic Stenting

    International Nuclear Information System (INIS)

    We present a patient with hepatocellular carcinoma accompanied by portal vein and bile duct tumor thrombi. The patient was treated with a spiral Z-stent covered by a polyethylene sheet placed in the bile duct, a Wallstent placed in the portal vein, chemoembolization, and external radiation therapy. The patient is alive with patency of both endoprostheses 18 months later

  11. Protective effect of gastrodin on bile duct ligation-induced hepatic fibrosis in rats.

    Science.gov (United States)

    Zhao, Shuangshuang; Li, Naren; Zhen, Yongzhan; Ge, Maoxu; Li, Yi; Yu, Bin; He, Hongwei; Shao, Rong-Guang

    2015-12-01

    Gastrodin has been showed to possess many beneficial physiological functions, including protection against inflammation and oxidation and apoptosis. Studies showed inflammation and oxidation play important roles in producing liver damage and initiating hepatic fibrogenesis. However, it has not been reported whether gastrodin has a protective effect against hepatic fibrosis or not. This is first ever made attempts to test gastrodin against liver fibrosis in bile duct ligation (BDL) rats. The aim of the present study is to evaluate the effect of gastrodin on BDL-induced hepatic fibrosis in rats. BDL rats were divided into two groups, BDL alone group, and BDL-gastrodin group treated with gastrodin (5 mg/ml in drinking water). The effects of gastrodin on BDL-induced hepatic injury and fibrosis in rats were estimated by assessing serum, urine, bile and liver tissue biochemistry followed by liver histopathology (using hematoxylin & eosin and sirius red stain) and hydroxyproline content measurement. The results showed that gastrodin treatment significantly reduced collagen content, bile duct proliferation and parenchymal necrosis after BDL. The serum alanine aminotransferase (ALT) and serum aspartate aminotransferase (AST) decreased with gastrodin treatment by 15.1 and 23.6 percent respectively in comparison to BDL group did not receive gastrodin. Gastrodin also significantly increased the level of serum high density lipoprotein (HDL) by 62.5 percent and down-regulated the elevated urine total bilirubin (TBIL) by 56.5 percent, but had no effect on total bile acid (TBA) in serum, bile and liver tissues. The immunohistochemical assay showed gastrodin remarkably reduced the expressions of CD68 and NF-κB in BDL rats. Hepatic SOD levels, depressed by BDL, were also increased by gastrodin by 8.4 percent. In addition, the increases of hepatic MDA and NO levels in BDL rats were attenuated by gastrodin by 31.3 and 38.7 percent separately. Our results indicate that gastrodin

  12. Demonstration of caudate lobe bile ducts using 3D-CT cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Shinohara, Yasushi [Chiba Univ. (Japan). School of Medicine

    1995-02-01

    The aim of this study is to make precise analysis of bile ducts of the caudate, lobe using 3D-CT cholangiography. Seventy obstructive jaundiced patients without lesions at the hilar duct level were included in this study. According to Kumon`s study, I divided the caudate lobe into three areas: spiegel lobe (sp), caudate process portion (cp) and paracaval portion (pc), and set the range for these three areas in cholangio CT. In 70 cases, 191 caudate branches were detected and those draining areas and confluence patterns were analysed. 3D-CT cholangiography could be obtained from randomized angles. In set up the 8 angles from 0deg to 330deg in sagittal plane to demonstrate intrahepatic bile ducts and investigate the suitable angles for detecting caudate lobe branches in each drainaing area. Suitable angles for detecting the branches of Sp group (104 branches) were 180deg, 210deg, 150deg and 330deg (detectabilities were 89.4%, 61.5%, 51.0% and 47.1% respectively). Suitable angles for detecting the branches of Pc group (80 branches) were 180deg, 210deg, 150deg, 330deg and 0deg (detectabilities were 91.3%, 65.0%, 57.5%, 48.8% and 41.3% respectively). Suitable angles for detecting the branches of Cp group (67 branches) were 210deg, 180deg, 330deg, 150deg and 0deg (detectabilities were 80.1%, 73.1%, 50.7%, 49.3% and 47.8% respectively). The images from 150deg, 180deg, 210deg were necessary to demonstrate the caudate lobe branches in 3D-CT cholangiography. (author).

  13. Poorly Differentiated Adenocarcinoma with Signet-ring Cell Carcinoma of the Extrahepatic Bile Duct in a 42-year-old Japanese Female: A Case Report

    Directory of Open Access Journals (Sweden)

    Nakanishi,Kuniaki

    2010-02-01

    Full Text Available Poorly differentiated adenocarcinoma without papilla or tubule formation of the extrahepatic bile duct is rare. Here we present a case (a 42-year-old Japanese woman without either pancreatobiliary maljunction or liver disease. The patient had obstructive jaundice. Imaging studies revealed a bile duct tumor obstructing the common bile duct and invading the surrounding tissues. Pathologic examination revealed a dense periductal growth of poorly differentiated adenocarcinoma containing signet-ring cells, but without papilla or tubule formation in the extrahepatic bile duct. The tumor cells directly invaded the pancreatic parenchyma and the portal vein. In the extrahepatic bile duct, poorly differentiated adenocarcinoma may be established as a distinct clinicopathologic entity if the tumors are characterized by:1 the absence of papilla or tubule formation, 2 Asian preponderance, 3 occurrence at a younger age than is usual for patients with biliary cancers, and 4 an aggressive mural invasiveness.

  14. Intestinal absorption and postabsorptive metabolism of linoleic acid in rats with short-term bile duct ligation

    NARCIS (Netherlands)

    Minich, DM; Havinga, R; Stellaard, F; Vonk, RJ; Kuipers, F; Verkade, HJ

    2000-01-01

    We investigated in bile duct-ligated (BDL) and sham-operated control rats whether the frequent presence of essential fatty acid deficiency in cholestatic liver disease could be related to linoleic acid malabsorption, altered linoleic acid metabolism, or both. In plasma of BDL rats, the triene-to-tet

  15. Short-Term Biliary Stent Placement Contributing Common Bile Duct Stone Disappearance with Preservation of Duodenal Papilla Function

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    Tatsuki Ueda

    2016-01-01

    Full Text Available Aims. To investigate the effect of biliary stent placement without endoscopic sphincterotomy (EST on common bile duct stones (CBDS disappearance and the contribution of preserving the duodenal papilla function to reduce recurrence of CBDS. Methods. Sixty-six patients admitted for acute obstructive cholangitis due to CBDS who underwent biliary stent placement without EST for 2 years from March 2011 were evaluated retrospectively. The second endoscopic retrograde cholangiopancreatography (ERCP was performed for treatment of CBDS 3 to 4 months after the first ERCP. We estimated the rate of stone disappearance at the time of second ERCP. Results. CBDS disappearance was observed in 32 (48.5% of 66 patients. The diameter of the bile ducts and the diameter of CBDS in patients with CBDS disappearance were significantly smaller than in those with CBDS requiring extraction (p=0.007 and p<0.001, resp.. Stone disappearance was evident when the diameter of bile ducts and that of CBDS were <10 and 7 mm, respectively (p=0.002. Conclusions. Short-term stent placement without EST eliminates CBDS while preserving duodenal papilla function and may be suitable for treating CBDS in patients with nondilated bile ducts and small CBDS.

  16. Clinical usefulness of transpapillary removal of common bile duct stones by frequency doubled double pulse Nd: YAG laser

    Institute of Scientific and Technical Information of China (English)

    Tae Hyeon Kim; Hyo Jeong Oh; Chang-Soo Choi; Dong Han Yeom; Suck Chei Choi

    2008-01-01

    AIM: To study the efficacy and the safety of laser lithotripsy without direct visual control by using a balloon catheter in patients with bile duct stones that could not be extracted by standard technique.METHODS: The seventeen patients (7 male and 10 female; mean age 67.8 years) with difficult common bile duct (CBD) stones were not amenable for conventional endoscopic maneuvers such as sphincterotomy and mechanical lithotripsy were included in this study. Laser wavelengths of 532 nm and 1064 nm as a double pulse were applied with pulse energy of 120 mJ. The laser fiber was advanced under fluoroscopic control through the ERCP balloon catheter. Laser lithotripsy was continued until the fragment size seemed to be less than 10 mm.Endoscopic extraction of the stones and fragments was performed with the use of the Dormia basket and balloon catheter.RESULTS: Bile duct clearance was achieved in 15 of 17 patients (88%). The mean number of treatment sessions was 1.7 ± 0.6. Endoscopic stone removal could not be achieved in 2 patients (7%). Adverse effects were noted in three patients (hemobilia, pancreatitis, and cholangitis).CONCLUSION: The Frequency Doubled Double Pulse Nd:YAG (FREDDY) laser may be an effective and safe technique in treatment of difficult bile duct stones.

  17. Effects of dexamethasone on small bowel and kidney oxidative stress and histological alterations in bile duct-ligated rats.

    Science.gov (United States)

    Ozturk, Hayrettin; Eken, Halil; Ozturk, Hulya; Buyukbayram, Huseyin

    2006-09-01

    Oxidative stress plays an important role in the pathogenesis of toxic liver diseases and other hepatic alterations including obstruction of bile flow. It has been shown that the gastrointestinal tract and renal tissue is particularly affected during obstruction of bile flow. In this study, we aimed to evaluate the effects of dexamethasone on small bowel and kidney oxidative stress and histological alterations in bile duct-ligated (BDL) rats. A total of 40 male Sprague-Dawley rats weighing 200-240 g were used in this study. Group 1 (Sham-control, n = 10) rats underwent laparotomy and bile duct was dissected from the surrounding tissue. Group 2 (Dexa-control, n = 10) rats underwent laparotomy and bile duct was dissected from the surrounding tissue. The rats received daily dexamethasone. Group 3 (BDL/Untreated, n = 10) rats were subjected to bile duct ligation and no drug was applied. Group 4 (BDL/Dexa, n = 10) rats received daily dexamethasone by orogastric tube for 14 days after BDL. At the end of the 2-week period, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), and malondialdehyde (MDA) were measured and biochemical and histological evaluation were processed. The mean serum bilirubin, liver enzymes, MDA level, and histopathological score significantly decreased and SOD, CAT, and GSH-Px values were significantly increased in group 4 when compared to group 3. Group 3 presented a significant increase in caecal count of E. coli and in aerobe/anaerobe ratio. In group 4, liver was moderately damaged. Ileal biopsies from group 4 demonstrated a significant increase in villus height, total mucosal thickness, and villus density when compared to group 3. Glomerular injury scores (GIS) and arterial injury scores (AIS) in group 3 rats were increased in the juxtamedullary region. In contrast to group 4, tubulo-interstitial lesions were diffuse in group 3 animals. Dexamethasone reduced small bowel and kidney oxidative stress and histological

  18. Common bile duct schwannoma: A case report and review of literature

    Institute of Scientific and Technical Information of China (English)

    Luigi Fenoglio; Rodolfo Brizio; Felice Borghi; Sara Severini; Paola Cena; Elena Migliore; Christian Bracco; Fulvio Pomero; Sergio Panzone; Giovan Battista Cavallero; Alberto Silvestri

    2007-01-01

    Schwannoma is a myelin sheath tumor complicated with neurofibroma, neurofibromatosis and neurogenic sarcoma. Peripheral nerve sheath tumors represent 2%-6% of gastrointestinal tract stromal tumors (GIST),but there are deficient data about location of neurogenic tumors in the biliary system and only nine cases of schwannoma of the extrahepatic biliary tract have been reported. These tumors are clinically non-specific. They are usually symptomatic by compressing the close or adjacent structures when being retroperitoneal, and their preoperative diagnosis is extremely difficult. This paper reviews the literature data and describes a case of schwannoma of the common bile duct associated with cholestasis in a healthy young woman, diagnosed and treated in our department. This case is of interest on account of the complexity of its diagnosis and the atypical macroscopic growth pattern of the tumor.

  19. Endopancreatic Bile Duct Cholangiocarcinoma in a Patient with Peutz-Jeghers Syndrome

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    Alexandros K. Charalabopoulos

    2011-01-01

    Full Text Available Peutz-Jeghers syndrome is a rare autosomal dominant inherited disease characterized by a special type of hamartomatous gastrointestinal polyps combined with mucocutaneous melanin pigmentations. Patients with the syndrome have a high risk of developing neoplasia, with colon, small bowel, and stomach being the most common gastrointestinal sites. Herein, we present the occurrence of a rare tumor in patients with Peutz-Jeghers syndrome; a cholangiocarcinoma of the endopancreatic bile duct. A minireview is also presented. It can be concluded that cholangiocarcinoma remains a possible diagnosis in PJS patients, as in others that present with biliary obstruction. PJS patients may be at higher risk than others in view of their propensity for malignancy.

  20. Effect of glutamine synthetase inhibition on brain and interorgan ammonia metabolism in bile duct ligated rats

    DEFF Research Database (Denmark)

    Fries, Andreas W; Dadsetan, Sherry; Keiding, Susanne;

    2014-01-01

    Ammonia has a key role in the development of hepatic encephalopathy (HE). In the brain, glutamine synthetase (GS) rapidly converts blood-borne ammonia into glutamine which in high concentrations may cause mitochondrial dysfunction and osmolytic brain edema. In astrocyte-neuron cocultures and brains...... of healthy rats, inhibition of GS by methionine sulfoximine (MSO) reduced glutamine synthesis and increased alanine synthesis. Here, we investigate effects of MSO on brain and interorgan ammonia metabolism in sham and bile duct ligated (BDL) rats. Concentrations of glutamine, glutamate, alanine......, and aspartate and incorporation of (15)NH4(+) into these amino acids in brain, liver, muscle, kidney, and plasma were similar in sham and BDL rats treated with saline. Methionine sulfoximine reduced glutamine concentrations in liver, kidney, and plasma but not in brain and muscle; MSO reduced incorporation...

  1. Granular cell tumor of the common bile duct: A Japanese case

    Institute of Scientific and Technical Information of China (English)

    Junko Saito; Michiko Kitagawa; Hiroshi Kusanagi; Nobuyasu Kano; Eiji Ishii; SO Nakaji; Nobuto Hirata

    2012-01-01

    Granular cell tumor (GCT) of the biliary system is rare.It is reported that it occurs more commonly in young black women.We report here our seldom experience of a Japanese case in whom icterus was found as a first symptom just after a caesarean operation.A 36-year-old Japanese woman developed icterus after delivery by the Caesarean operation.A surgical operation was performed without can deny that there was a tumor-related change in a bile duct as a result of examination for various images.As a result of pathological evaluation,GCT was diagnosed.By the preoperative organization biomicroscopy result,it was not able to be attachd a right diagnosis.It was thought that this tumor,although rare,should be considered as one of the causes of biliary stenosis in the younger population.

  2. Treatment of bile ducts injury in cholecystectomy%胆囊切除致胆管损伤的诊治

    Institute of Scientific and Technical Information of China (English)

    何宗全; 叶显道

    2013-01-01

    Objective To investigate the reasons and preventive measures and treatments of bile ducts injury in cholecystectomy. Methods Clinical data of 27 cases of bile ducts injury caused by cholecystectomy during 7 years were retrospectively analyzed. These 27 cases received a total of 34 sessions procedures, choledochojejunal Roux-en-Y anastomosis in 19 sessions procedures, abdominal cavity drainage in 2 sessions procedures, bile duct neoplasty in 2 sessions procedures, end-to-end anastomosis of bile duct with T-tube pedestal drainage in 3 sessions procedures, bile duct neoplasty with T tube pedestal drainage in 3 sessions procedures, ENBD in 1 case, bile duct reconstruction with pedicled umbilical vain graft in 1 case. Results In short-term,20 cases( 74. 1% )achieved good effect,fair in 6 cases ( 22.2% ),died in 1 case( 3. 7% ). In 20 cases undergoing average 3-year follow-up, achieved good 15 cases( 75. 0% ),fair 4 cases (20.0% )and bad 1 case( 5.0% ). In non-death cases of illness, choledochojejunal Roux-en-Y anastomosis 15 cases, good 11 cases ( 73. 3% ) ,fair 3 cases( 20. 0% ) ,bad 1 case( 6. 7% ). Conclusions Iatrogenic dile duct injury is prone to occur during cholecystectomy. The main reason of bile duct damage is unsuitable modus operandi for three basic factors including pathology, anatomy and human factor. Bile duct damages will obtain good treatment results, the key to is which prompt discovery and correct and timely treatment. Choledochojejunal Roux-en-Y anastomosis technique is an effective method for most of the injury of bile duct and biliary stricture cases.%目的 探讨胆囊切除致胆管损伤的原因及防治措施.方法 回顾性分析近7年收治27例胆囊切除致胆管损伤的临床资料.27例胆囊切除致胆管损伤中,实施手术34例次.胆肠Roux-en-Y吻合术19例次,腹腔引流术2例次,胆管修补术2例次,胆管对端吻合、T管支撑引流术3例次,胆管修补、T管支撑引流术3例

  3. Intraductal Papillary-Mucinous Neoplasm of the Pancreas Penetrating to the Stomach and the Common Bile Duct

    Directory of Open Access Journals (Sweden)

    Norihiro Goto

    2012-01-01

    Full Text Available Context Intraductal papillary mucinous neoplasm (IPMN of the pancreas occasionally penetrates to others organs. We present a case of IPMN penetrating to the stomach and the common bile duct. Case report A 75-year-old man was admitted to the hospital because of epigastric pain. Computed tomography (CT showed a papillary tumor protruding into the markedly dilated main pancreatic duct and splenic vein obstruction. The tumor was diagnosed as IPMN arising in the main duct, but he rejected surgery and he was followed without treatment. One year later, gastroduodenoscopy revealed gastropancreatic fistula and we were able to pass an endoscope through the fistula and directly examine the lumen of the main pancreatic duct and the papillary tumor adjacent to the fistula. Absence of malignant cells on histopathology suggested mechanical penetration rather than invasive penetration. CT showed splenic vein reperfusion due to decreased inner pressure of the main pancreatic duct. Two and a half years later, CT revealed biliopancreatic fistula formation. Endoscope biliary drainage was performed but failed. Despite jaundice, he is still ambulatory and seen in the clinic three years after the first admission. Conclusions We have experienced a case of IPMN penetrating to the stomach and the common bile duct that has taken a slow course. It represents the importance of distinguishing mechanical penetration from invasive penetration as well as mechanical splenic vein obstruction from splenic vein invasion.

  4. Patterns of failure and prognostic factors in resected extrahepatic bile duct cancer: implication for adjuvant radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Koo, Tae Ryool; Eom, Keun Yong; Kim, In Ah; Cho, Jai Young; Yoon, Yoo Seok; Hwang, Dae Wook; Han, Ho Seong; Kim, Jae Sung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2014-06-15

    To find the applicability of adjuvant radiotherapy for extrahepatic bile duct cancer (EBDC), we analyzed the pattern of failure and evaluate prognostic factors of locoregional failure after curative resection without adjuvant treatment. In 97 patients with resected EBDC, the location of tumor was classified as proximal (n = 26) and distal (n = 71), using the junction of the cystic duct and common hepatic duct as the dividing point. Locoregional failure sites were categorized as follows: the hepatoduodenal ligament and tumor bed, the celiac artery and superior mesenteric artery, and other sites. The median follow-up time was 29 months for surviving patients. Three-year locoregional progression-free survival, progression-free survival, and overall survival rates were 50%, 42%, and 52%, respectively. Regarding initial failures, 79% and 81% were locoregional failures in proximal and distal EBDC patients, respectively. The most common site was the hepatoduodenal ligament and tumor bed. In the multivariate analysis, perineural invasion was associated with poor locoregional progression-free survival (p = 0.023) and progression-free survival (p = 0.012); and elevated postoperative CA19-9 (> or =37 U/mL) did with poor locoregional progression-free survival (p = 0.002), progression-free survival (p < 0.001) and overall survival (p < 0.001). Both proximal and distal EBDC showed remarkable proportion of locoregional failure. Perineural invasion and elevated postoperative CA19-9 were risk factors of locoregional failure. In these patients with high risk of locoregional failure, adjuvant radiotherapy could be considered to improve locoregional control.

  5. Management of traumatic bile duct injury%外伤性胆道损伤的处理

    Institute of Scientific and Technical Information of China (English)

    张剑; 王剑明; 杨彦; 刘颜; 何俊闯; 齐卫鹏; 钱亚伟; 付阳

    2014-01-01

    患者发生迟发性胆汁漏及再发胆道狭窄.结论 外伤性胆道损伤的部位隐蔽,易漏诊,常于术中确诊.患者常合并休克和腹腔其他脏器损伤,治疗上应在抗休克治疗的同时尽早行剖腹探查术,并基于损伤程度和部位选择最佳的胆道重建手术.%Objective To investigate the management of traumatic bile duct injury.Methods The clinical data of 26 patients with traumatic bile duct injury were retrospectively analyzed.All the patients were admitted to the Tongji Hospital of the Huazhong University of Science and Technology from July 2009 to May 2014.All the 26 patients had the history of trauma.The trauma of the patients were typed according to the Mattox injury typing system.Besides anti-shock treatment,cholecystectomy,bile duct repair,end-to-end anastomosis of bile duct,choledochojejunostomy and quadrate lobectomy + hilar bile duct reshaping + hepaticojejunostomy were selected according to the site and degree of the injury.Symptomatic treatment was applied to patients who were combined with other organs injury.Patients were followed up via out-patient examination and telephone interview till October 2014.Results Twenty-six patients received exploratory laparotomy,and gallbladder injury was detected in 15 patients,common bile duct injury in 5 patients,common hepatic duct injury in 3 patients,left hepatic duct injury in 2 patients,right hepatic duct in 1 patient.Eleven patients were combined with hepatic rupture,1 with splenic rupture,5 with renal rupture,4 with small intestinal rupture.Eleven patients were with type Ⅰ bile duct injury,4 with type Ⅱ bile duct injury,8 with type Ⅳ bile duct injury and 3 with type Ⅴ bile duct injury.Of the 15patients with gallbladder injury,5 patients with slight bruise of the gallbladder did not receive cholecystectomy.Six patients and 4 patients with type Ⅰ and Ⅱ bruise of the gallbladder received cholecystectomy.Of the 11 patients with hepatic and bile duct injury,5

  6. A comparative study of the systemic inflammatory response syndrome after the laparoscopic exploration of common bile duct versus open surgical procedure%腹腔镜与开腹胆道探查术后全身炎症反应综合征情况对比研究

    Institute of Scientific and Technical Information of China (English)

    汪新天; 吴金术; 陈晨; 蒋波

    2012-01-01

    目的 探讨腹腔镜与开腹胆总管探查手术创伤与术后全身炎症反应综合征(SIRS)发生的关系.方法 收集腹腔镜胆总管探查术患者(腔镜组,n=32)和开腹胆总管探查术患者(开腹组,n=43)临床资料,分析不同手术方式与患者术后SIRS发生率的关系.结果 与开腹组相比,腔镜组患者术后SIRS发生率明显降低、SIRS持续时间缩短(P<0.05),术后住院时间缩短(P<0.01).两组患者手术时间、麻醉时间及失血量差异无显著性(P>0.05).结论 腹腔镜胆总管探查术患者术后SIRS发生率低,手术创伤小.%[Objective] To compare the influence of the laparoscopic exploration of common bile duct and open surgical procedure on the systemic inflammatory response syndrome. [Methods] 75 cases with cholecystolithiasis and choledocholithiasis were divided into laparoscopic group (32 cases) and open surgery group (43 cases). The clinical data of the two groups were compared and analyzed retrospectively. [ Results ] The incidence rate and persistence time of SIRS were lower on the laparoseopic group. The postoperative hospital stay was longer in the open group than that in the laparoscopic group. [Conclusion] The patient who performed LCBDE have lesser surgical trauma and lower incidence of SIRS.

  7. A study of impact of stent implantation in distal common bile duct on duodenal-biliary reflux

    International Nuclear Information System (INIS)

    Objective: This study aimed to investigate the incidence and the cause for duodenal- biliary reflux and reflux cholangitis after metallic stent placement in distal common bile duct. Methods: After percutaneous transhepatic bile duct puncture and biliary outside drainage was performed, 16 cases with malignant distal biliary stricture underwent metallic stent placement in distal common bile duct. Before stent placement, the routine laboratory studies including leukocyte, neutrophil percentage and the levels of total bilimbin and direct bilirubin in blood were performed for all patients. Two to five days [an average of (3.3±0.9) days] after stent implantation, the above indexes were tested again, and 1 ml of water containing 185 MBq of 99Tcm-DTPA was given orally before extubation, then 99Tcm radioactivity in the bile was detected 2 hours later. For the measurement data obtained from the experiment, t test or Wilcoxon signed rank test was adopted to compare them, and P9/L, and the median of neutrophil percentage was 0.74. Compared with those before stent implantation, the difference did not reach statistical significance (t=0.423, Z=1.036, P>0.05). After stent implantation, the median of total bilirubin and direct bilirubin were significantly lower, which were 92.2 and 74.3 μmol/L. Compared with those before stenting, the difference was statistically significant (Z=-3.170, -3.170, P<0.05). Conclusions: There is a high incidence of duodenal-biliary reflux after stent implantation in distal common bile duct in the early stage. However, there is no simultaneous cholangitis caused by duodenal-biliary reflux. (authors)

  8. Chronic bile duct hyperplasia is a chronic graft dysfunction following liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Jian-Wen Jiang; Zhi-Gang Ren; Guang-Ying Cui; Zhao Zhang; Hai-Yang Xie; Lin Zhou

    2012-01-01

    AIM:To investigate pathological types and influential factors of chronic graft dysfunction (CGD) following liver transplantation (LT) in rats.METHODS:The whole experiment was divided into three groups:(1) normal group (n =12):normal BN rats without any drug or operation; (2) syngeneic transplant group (SGT of BN-BN,n =12):both donors and recipients were BN rats; and (3) allogeneic transplant group (AGT of LEW-BN,n =12):Donors were Lewis and recipients were BN rats.In the AGT group,all recipients were subcutaneously injected by Cyclosporin A after LT.Survival time was observed for 1 year.All the dying rats were sampled,biliary tract tissues were performed bacterial culture and liver tissues for histological study.Twenty-one day after LT,8rats were selected randomly in each group for sampling.Blood samples from caudal veins were collected for measurements of plasma endotoxin,cytokines and metabonomic analysis,and faeces were analyzed for intestinal microflora.RESULTS:During the surgery of LT,no complications of blood vessels or bile duct happened,and all rats in each group were still alive in the next 2 wk.The long term observation revealed that a total of 8 rats in the SGT and AGT groups died of hepatic graft diseases,5 rats in which died of chronic bile duct hyperplasia.Compared to the SGT and normal groups,survival ratio of rats significantly decreased in the AGT group (P< 0.01).Moreover,liver necrosis,liver infection,and severe chronic bile duct hyperplasia were observed in the AGT group by H and E stain.On 21 d after LT,compared with the normal group (25.38 ± 7.09 ng/L)and SGT group (33.12 ± 10.26 ng/L),plasma endotoxin in the AGT group was remarkably increased (142.86± 30.85 ng/L) (both P < 0.01).Plasma tumor necrosis factor-α and interleukin-6 were also significantly elevated in the AGT group (593.6 ± 171.67 pg/mL,323.8 ± 68.30 pg/mL) vs the normal (225.5 ± 72.07pg/mL,114.6 ± 36.67 pg/mL) and SGT groups (321.3± 88.47 pg/mL,205.2 ± 53.06 pg/mL) (P

  9. Evaluation of Real-time Ultrasound Imaging US Prompt Bile Pancreatic Duct Confluence Type the Value of the Relationship between Bile Pancreatic System Disease Onset%评价超声显像US诊断胆胰管汇合分型与胆胰系统疾病发病关系的价值

    Institute of Scientific and Technical Information of China (English)

    杨付云

    2015-01-01

    目的总结胆胰管汇合不同分型的胆胰系统疾病的超声表现,探讨超声(US)对胆胰管汇合分型与临床胆胰系疾病发病关系的诊断价值和临床指导作用。方法收集2010年5月~2013年5月200例胆胰系疾病患者的超声资料,分为病例组与对照组,回顾性分析探讨超声对胆胰管合流不同分型与胆胰系疾病发病关系诊断价值的意义。结果胆胰管汇合不同分型与胆道胰腺疾病的发病关系密切相关,其中I型胆道系统疾病发病率高于I 型;I 型胰腺疾病发病率高于I型。结论胆胰管合流异常与胆胰系疾病关系密切,超声对于提示胆胰管合流异常不同分型与胆胰系疾病的关系有很高的诊断价值及临床指导作用。%Objective To summarize the biliary pancreatic duct confluence the sonographic appearances of the dif erent types of bile pancreatic system diseases, explore ultrasonography (US) in bile pancreatic duct confluence types and clinical department of bile pancreatic disease diagnostic value and clinical guidance. Methods Col ect data in May 2010 to May 2010, 200 cases of biliary pancreatic disease in patients with ultrasound data, divided into the case group and control group, were retrospectively analyzed to explore the bile pancreatic duct confluence type and bile pancreatic disease relations significance of diagnostic value. Results The gal bladder pancreatic duct confluence type is closely related to the relationship between the onset of biliary pancreatic diseases, including type B-p biliary disease incidence rate is higher than P-type B;P-type B pancreatic disease incidence rate is higher than B-P type. Conclusion Abnormal bile pancreatic duct confluence and bile pancreatic is closely related to disease, ultrasound for prompt bile pancreatic duct confluence exception type relationship with the department of bile pancreatic disease has a high diagnostic value and clinical guidance.

  10. Intraductal neoplasm of the intrahepatic bile duct:Clinicopathological study of 24 cases

    Institute of Scientific and Technical Information of China (English)

    Yoshiki Naito; Hironori Kusano; Osamu Nakashima; Eiji Sadashima; Satoshi Hattori; Tomoki Taira; Akihiko Kawahara

    2012-01-01

    AIM:To investigate the clinicopathological features of intraductal neoplasm of the intrahepatic bile duct (INihB).METHODS:Clinicopathological features of 24 cases of INihB,which were previously diagnosed as biliary papilIomatosis or intraductal growth of intrahepatic biliary neoplasm,were reviewed.Mucin immunohistochemistry was performed for mucin (MUC)1,MUC2,MUC5AC and MUC6.Ki-67,P53 and β-catenin immunoreactivity were also examined.We categorized each tumor as adenoma (low grade),borderline (intermediate grade),and malignant (carcinoma in situ,high grade including tumors with microinvasion).RESULTS:Among 24 cases of INihB,we identified 24 tumors.Twenty of 24 tumors (83%) were composed of a papillary structure; the same feature observed in intraductal papillary neoplasm of the bile duct (IPNB).In contrast,the remaining four tumors (17%) showed both tubular and papillary structures.In three of the four tumors (75%),macroscopic mucin secretion was limited but microscopic intracellular mucin was evident.Histologically,16 tumors (67%) were malignant,three (12%) were borderline,and five (21%) were adenoma.Microinvasion was found in four cases (17%).Immunohistochemical analysis revealed that MUC1 was not expressed in the borderline/adenoma group but was expressed only in malignant lesions (P =0.0095).Ki-67 labeling index (LI) was significantly higher in the malignant group than in the borderline/adenoma group (22.2± 15.5 vs 7.5 ± 6.3,P < 0.01).In the 16 malignant cases,expression of MUC5AC showed borderline significant association with high Ki-67 LI (P =0.0622).Nuclear expression of β-catenin was observed in two (8%)of the 24 tumors,and these two tumors also showed MUC1 expression.P53 was negative in all tumors.CONCLUSION:Some cases of INihB have a tubular structure,and are subcategorized as IPNB with tubular structure.MUC1 expression in INihB correlates positively with degree of malignancy.

  11. Endoscopic ultrasonography is a valuable diagnostic tool in patients with incidental findings in the pancreas or bile ducts

    DEFF Research Database (Denmark)

    Al-Najami, Issam; Ainsworth, Alan Patrick

    2015-01-01

    evaluation (n = 27), referred for new EUS or other imaging procedures (n = 14) and referred for surgery/endoscopic retrograde cholangiopancreatography (n = 6). In total, 6 patients proved to have neoplastic diseases in the pancreas. None of the patients who were stopped from further evaluation following EUS...... later proved to have a malignant disease in the pancreas. CONCLUSION: EUS is a valuable diagnostic tool in patients with incidental findings in the pancreas/bile duct noted at a CT. Many patients can be stopped from further diagnostic work-up after EUS with a minimal risk of overlooking a malignant......INTRODUCTION: Incidental findings are often seen at computed tomographies (CT). This study describes patients who had an endoscopic ultrasonography (EUS) because of an incidental finding in the pancreas/bile duct. METHODS: Patients referred for EUS between September 2012 and September 2013 because...

  12. Microvessel density at different levels of normal or injured bile duct in dogs and its surgical implications

    Institute of Scientific and Technical Information of China (English)

    LinGeng; DingLuo; Hao-ChunZhang; Liang-SongZhao; De-KeQing

    2011-01-01

    BACKGROUND: Ischemic recurrent stricture after surgical repair for iatrogenic bile duct injury (BDI) remains a challenge in clinical practice. The present study was designed to investigate whether ischemia is universal and of varied severity at different levels of the proximal bile duct after BDI. METHODS: A total of 30 beagle dogs were randomly divided into control, BDI, and BDI-repaired groups. The BDI animal model was established based on the classic pattern of laparoscopic cholecystectomy-related BDI. The animals were sacrificed on postoperative day 15, and bile duct tissue was harvested to assess microvessel density (MVD) at selected levels of the normal, post-BDI and BDI-repaired bile duct with the CD34 immunohistochemistry technique. RESULTS:  In the control group, MVD at level H (high level) was remarkably higher than that at level L (low level). No significant difference was found between MVDs at levels H and M (middle level), as well as at levels M and L. However, the tendency was noted that the closer the level to the hilus, the greater the MVD at that level. In both the BDI and BDI-repaired groups, MVDs at level H were generally greater than those at level L, despite the unremarkable differences between MVDs at neighboring levels. In these two groups, a similar tendency of MVD distribution to that in the control group was found; the closer the level to the injury site, the lower was the MVD at that level. Moreover, compared with the MDVs at the levels M and L in the control group, MVDs at the corresponding levels in the BDI and BDI-repaired groups were all remarkably reduced (P CONCLUSIONS: After BDI, universal ischemic damage in the injured proximal bile duct develops close to the injury site, while close to the hilus, ischemia is relatively slight. High hepaticojejunostomy, rather than low biloenterostomy or end-to-end duct anastomosis, should be recommended for BDI repair. Great care should be taken to protect the peribiliary plexus during

  13. Cystic dilatation of the common bile duct in adults: report of five cases and review of literature

    OpenAIRE

    Arruda Pedro Carlos Loureiro de; Coelho Antonio Roberto Barros; Lima Filho José Falcão Corrêa; Machado Ricardo José Caldas; Souza Ayrton Ponce de; Mathias Carlos Augusto de Carvalho; Ferraz Álvaro Antônio Bandeira; Ferraz Edmundo Machado

    2000-01-01

    The authors report five cases of cystic dilatation of the common bile duct Type I (Todani?s classification) in adults patients, in Division of General Surgery of a University Hospital, treated over a- 25-year- period from 1974 to 1999, among 16.057 operations, and not previously published. Diagnosis was obtained by operative cholangiogram (OC) in the first case, percutaneous transhepatic cholangiogram on the second one (PTHC) and by ultrasonography (US), endoscopic retrograde cholangiopancrea...

  14. Triplex Forming Oligonucleotides against Type α 1(I) Collagen attenuates Liver Fibrosis induced by Bile Duct ligation

    OpenAIRE

    Panakanti, Ravikiran; Pratap, Akshay; Yang, Ningning; JACKSON, JOHN S.; Mahato, Ram I.

    2010-01-01

    Liver fibrosis is a consequence of chronic liver disorders which lead to the accumulation of extracellular matrix (ECM). Particularly, there is an increased accumulation of collagen in the fibrotic liver. We have therefore used a triplex forming oligonucleotide (TFO) against the type α 1 (I) collagen and evaluated, whether it can attenuate liver fibrosis induced by common bile duct ligation (CBDL) in rats. There was a significant decrease in hydroxyproline levels and Masson’s trichrome staini...

  15. Lack of Methylene Blue Staining in Superficial Epithelia as a Possible Marker for Superficial Lateral Spread of Bile Duct Cancer

    Directory of Open Access Journals (Sweden)

    I. Maetani

    1996-01-01

    epithelia. The cancerous epithelia stained significantly less often than either the normal (p = 0.000005 or the metaplastic (p = 0.001 epithelia. Evaluation of methylene blue staining during PTCS revealed that this stain was absorbed by the cholangial epithelia, not superficially stuck to it. The difference in methylene blue staining properties between the cancerous and normal epithelia could be helpful to clarify the boundary of superficial lateral spread of bile duct cancer.

  16. Amylase level in extrahepatic bile duct in adult patients with choledochal cyst plus anomalous pancreatico-biliary ductal union

    Institute of Scientific and Technical Information of China (English)

    In-Ho Jeong; Jin-Hong Kim; Jae-Ho Han; Wook-Hwan Kim; Yong-Sik Jung; Hong Kim; Bong-Wan Kim; Jung-Woon Kim; Jeong Hong; Hee-Jung Wang; Myung-Wook Kim; Byung-Moo Yoo

    2005-01-01

    AIM: To investigate the relationship between pancreatic amylase in bile duct and the clinico-pathological features in adult patients with choledochal cyst and anomalous pancreatico-biliary ductal union (APBDU).METHODS: From 39 patients who underwent surgery for choledochal cyst between March 1995 and March 2003,we selected 15 adult patients who had some symptoms and were radiologically diagnosed as APBDU, and their clinico-pathological features were subsequently evaluated retrospectively. However, we could not obtain biliary amylase in all the patients because of the surgeon's slip.Therefore, we measured the amylase level in gall bladder of 10 patients and in common bile duct of 11 patients.RESULTS: Levels of amylase in common bile duct and gall bladder ranged from 11 500 to 212 000 IU/L, and the younger the patients, the higher the biliary amylase level (r= -0.982, P<0.01). Pathologically, significant correlation was found between the size of choledochal cyst and the grade of inflammation (r= 0.798,P<0.01). And, significant correlation was found between the level of amylase in gall bladder and the grade of hyperplasia. On the other hand, there was no correlation to the age of symptomatic onset or inflammatory grade (r = 0.743, P<0.05). Level of lipase was elevated from 6 000 to 159 000 IU/L in bile duct and from 14 400 to 117 000 IU/L in the gall bladder;however, there was no significant correlation with age or clinico-pathological features.CONCLUSION: The results support the notion that amylase has a particular role in the onset of symptoms, and suggest that a large amount of biliary amylase induces early onset of symptom, thereby making early diagnosis possible.

  17. Bile duct carcinoma associated with congenital biliary dilatation in a 16-year-old female: a case report and literature review.

    Science.gov (United States)

    Izumi, Hideki; Yazawa, Naoki; Furukawa, Daisuke; Masuoka, Yoshihito; Yamada, Misuzu; Mashiko, Taro; Kawashima, Yohei; Ogawa, Masami; Kawaguchi, Yoshiaki; Mine, Tetsuya; Hirabayashi, Kenichi; Nakagohri, Toshio

    2016-12-01

    We encountered a very rare case of bile duct carcinoma associated with congenital biliary dilatation (CBD) in a 16-year-old female who was admitted to our hospital because of right upper abdominal pain and vomiting. Abdominal computed tomography demonstrated a cystic dilatation of the common bile duct measuring 7 cm in diameter and two enhanced tumors 4 cm in diameter located in the inferior bile duct and middle bile duct. Magnetic resonance cholangiopancreatography clearly demonstrated a cystic dilatation of the extrahepatic bile duct (Todani's CBD classification: type 4-A). Endoscopic retrograde cholangiopancreatography also revealed two tumors. Biopsy results of one of the tumors confirmed adenocarcinoma. Excision of the perihilar bile duct and subtotal stomach-preserving pancreaticoduodenectomy with dissection of the major lymph nodes were performed. A postoperative histopathologic examination revealed a well-differentiated tubular adenocarcinoma, which remained within the mucosal layer, and no lymph node metastasis was found. The postoperative course was uneventful, and the patient was discharged 10 days after surgery and has remained disease-free for 21 months. PMID:26943681

  18. Recurrence of inflammatory pseudotumor in the distal bile duct: Lessons learned from a single case and reported cases

    Institute of Scientific and Technical Information of China (English)

    EM López-Tomassetti Fernández; H Díaz Luis; A Martín Malagón; I Arteaga González; A Carrillo Pallarés

    2006-01-01

    Inflammatory myofibroblastic tumors (IMTs) or inflammatory pseudotumors (IPs) have been extensively discussed in the literature. They are usually found in the lung and upper respiratory tract. However, reporting of cases involving the biliopancreatic region has increased over recent years. Immunohistochemical study of these lesions limited to the pancreatic head or distal bile duct seems to be compatible with those observed in a new entity called autoimmune pancreatitis, but usually intense fibrotic reaction (zonation) predominates producing a mass. When this condition is limited to the pancreatic head, the common bile duct might be involved by the inflammatory process and jaundice may occur often resembling adenocarcinoma of the pancreas. We have previously reported a case of IMT arising from the bile duct associated with autoimmune pancreatitis which is an extremely rare entity. Four years after Kaush-Whipple resection, radiological examination on routine followup revealed a tumor mass, suggesting local recurrence.Ultrasound-guided FNA confirmed our suspicious diagnosis. This present case, as others, suggests that persistent follow-up is necessary in order to prevent irreversible liver damage at this specific location.

  19. 胆管结石治疗进展%The Treatment Progress of Calculus of Bile Duct

    Institute of Scientific and Technical Information of China (English)

    卢树乾

    2015-01-01

    Calculus of bile duct is a common biliary tract disease, which is characterized by high morbidity and frequent recur-rence. At present, the clinical treatment of calculus of bile duct is difficult and the common treatment methods have non surgical therapy and surgical therapy. The text has summarized therapeutic effect, application situation and research development of the two methods on calculus of bile duct.%胆管结石是一种常见的胆道系统疾病,具有发病率高且反复发作的特点。目前胆管结石的临床处理较为困难,常见治疗方法有非手术治疗和手术治疗。该文综述了这两种治疗方法在胆管结石中的疗效,使用状况及研究进展。

  20. Bile duct sensitivity to high-dose-rate afterloading irradiation with iridium 192. Experimental investigations in pigs. Strahlenempfindlichkeit des gesunden Gallengangs bei High-dose-rate-Afterloadingbestrahlung mit Iridium 192. Experimentelle Untersuchungen am Schwein

    Energy Technology Data Exchange (ETDEWEB)

    Brambs, H.J. (Abt. Roentgendiagnostik und Roentgen- und Strahlentherapie, Universitaetsklinik Freiburg (Germany) Pathologisches Inst., Freiburg Univ. (Germany) Tierhygienisches Inst., Freiburg Univ. (Germany)); Freund, U. (Abt. Roentgendiagnostik und Roentgen- und Strahlentherapie, Universitaetsklinik Freiburg (Germany) Pathologisches Inst., Freiburg Univ. (Germany) Tierhygienisches Inst., Freiburg Univ. (Germany)); Bruggmoser, G. (Abt. Roentgendiagnostik und Roentgen- und Strahlentherapie, Universitaetsklinik Freiburg (Germany) Pathologisches Inst., Freiburg Univ. (Germany) Tierhygienisches Inst., Freiburg Univ. (Germany)); Laaff, H. (Abt. Roentgendiagnostik und Roentgen- und Strahlentherapie, Universitaetsklinik Freiburg (Germany) Pathologisches Inst., Freiburg Univ. (Germany) Tierhygienisches Inst., Freiburg Univ. (Germany)); Kluger, U.W. (Abt. Roentgendiagnostik und Roentgen- und Strahlentherapie, Universitaetsklinik Freiburg (Germany) Pathologisches Inst., Freiburg Univ. (Ger

    1993-12-01

    This animal study was designed to assess the tolerance of the normal bile duct to a single intraluminal high-dose-rate afterloading irradiation. This information is essential for treatment recommendations in irradiation therapy of malignant bile duct stenoses. In 16 pigs bile duct catheters were inserted surgically. Over these devices single intraductal doses of 7.5 Gy and 15 Gy were applied using an iridium-192 source. After a period of two to three months the bile ducts and the surrounding structures were investigated by means of cholangiography, angiography, and macropathological and histological investigations. A single intraductal dose of 7.5 Gy leads to a slightly scarred shrinkage of the bile duct with sclerosis and obliteration of the capillary vessels. Vasculitis and necrosis of the bile duct wall are still evident three months after irradiation. A single dose of 15 Gy leads to severe lesions with widespread necroses of the bile duct wall which tend to bleed, and result in a high degree of shrinkage of the bile duct. The radiation damage is most prevalent near the papilla and in the narrow segments near the liver. Single intraluminal high-dose-rate afterloading doses of 7.5 and 15 Gy cause significant lesions and complications at the bile ducts. As the intact bile duct is the Achilles heel of intraductal therapy, considerably lower single doses are recommended for a fractioned treatment. (orig.)

  1. Simultaneous bile duct and portal venous branch ligation in two-stage hepatectomy

    Institute of Scientific and Technical Information of China (English)

    Hiroya Iida; Chiaki Yasui; Tsukasa Aihara; Shinichi Ikuta; Hidenori Yoshie; Naoki Yamanaka

    2011-01-01

    Hepatectomy is an effective surgical treatment for multiple bilobar liver metastases from colon cancer; however, one of the primary obstacles to completing surgical resection for these cases is an insufficient volume of the future remnant liver, which may cause postoperative liver failure. To induce atrophy of the unilateral lobe and hypertrophy of the future remnant liver, procedures to occlude the portal vein have been conventionally used prior to major hepatectomy. We report a case of a 50-year-old woman in whom two-stage hepatectomy was performed in combination with intraoperative ligation of the portal vein and the bile duct of the right hepatic lobe. This procedure was designed to promote the atrophic effect on the right hepatic lobe more effectively than the conventional technique, and to the best of our knowledge, it was used for the first time in the present case. Despite successful induction of liver volume shift as well as the following procedure, the patient died of subsequent liver failure after developing recurrent tumors. We discuss the first case in which simultaneous ligation of the portal vein and the biliary system was successfully applied as part of the first step of two-stage hepatectomy.

  2. Heme oxygenase-1 overexpression increases liver injury after bile duct ligation in rats

    Institute of Scientific and Technical Information of China (English)

    Matthias Froh; Ronald G Thurman; Lars Conzelmann; Peter Walbrun; Susanne Netter; Reiner Wiest; Michael D Wheeler; Mark Lehnert; Takehiko Uesugi; Jurgen Scholmerich

    2007-01-01

    AIM: To investigate the effects of heme oxygenase-1(HO-1) against oxidant-induced injury caused by bile duct ligation (BDL).METHODS: Either cobalt protoporphyrin (CoPP), a HO-1 inducer, or saline were injected intraperitoneally in male SD-rats. Three days later, BDL or sham-operations were performed. Rats were sacrificed 3 wk after BDL and livers were harvested for histology. Fibrosis was evaluated by sirius red staining and image analysis.Alpha-smooth muscular actin, which indicates activation of stellate cells, was detected by immunohistochemical staining, and cytokine and collagen- Ⅰα (Col- Ⅰα) mRNA expression was detected using RNase protection assays.RESULTS: Serum alanine transaminase increased 8-fold above normal levels one day after BDL. Surprisingly,enzyme release was not reduced in rats receiving CoPP.Liver fibrosis was evaluated 3 wk after BDL and the sirius red-positive area was found to be increased to about 7.8%. However, in CoPP pretreated rats sirius redpositive areas were increased to about 11.7% after BDL.Collagen- Ⅰα and TGF-β mRNA increased significantly by BDL. Again, this effect was increased by HO-1overexpression.CONCLUSION: Hepatic fibrosis due to BDL is not reduced by the HO-1 inducer CoPP. In contrast, HO-1overexpression increases liver injury in rats under conditions of experimental chronic cholestasis.

  3. Risk Factors for Recurrence of Symptomatic Common Bile Duct Stones after Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Ju Hyun Oak

    2012-01-01

    Full Text Available Purpose. The recurrence of CBD stone is still observed in a considerable number of patients. The study was to evaluate the risk factors for recurrence of symptomatic CBD stone in patients who underwent cholecystectomy after the removal of CBD stone. Methods. The medical records of patients who underwent removal of CBD stone with subsequent cholecystectomy were reviewed. The risk factors for the recurrence of symptomatic CBD stone were compared between the recurrence and the nonrecurrence group. Results. The mean follow-up period was 40.6 months. The recurrence of symptomatic CBD stones was defined as the detection of bile duct stones no sooner than 6 months after complete clearance of CBD stones, based on symptoms or signs of biliary complication. 144 patients (68 males, 47.2% were finally enrolled and their mean age was 59.8 (range: 26~86 years. The recurrence of CBD stone occurred in 15 patients (10.4%. The mean period until first recurrence was 25.9 months. The presence of type 1 or 2 periampullary diverticulum and multiple CBD stones were the independent risk factors. Conclusion. For the patients with type 1 or 2 periampullary diverticulum or multiple CBD stones, careful followup is needed for the risk in recurrence of symptomatic CBD stone.

  4. Quality of life after iatrogenic bile duct injury: a case control study.

    LENUS (Irish Health Repository)

    Hogan, Aisling M

    2012-02-01

    OBJECTIVE: To compare quality of life (QOL) of patients following iatrogenic bile duct injuries (BDI) to matched controls. SUMMARY BACKGROUND DATA: BDI complicate approximately 0.3% of all cholecystectomy procedures. The literature regarding impact on quality of life is conflicted as assessment using clinical determinants alone is insufficient. METHODS: The medical outcomes study short form 36 (SF-36), a sensitive tool for quantification of life quality outcome, was used. The study group of iatrogenic BDI was compared with an age- and sex-matched group who underwent uncomplicated cholecystectomy. Telephone questionnaire using the SF-36 quality of life tool was administered to both groups at a median postoperative time of 12 years 8 months (range, 2 months -20 years). RESULTS: Seventy-eight patients were referred with BDI but due to mortality (n = 10) and unavailability (n = 6) 62 participated. The age- and sex-matched control cohort had undergone uncomplicated cholecystectomy (n = 62). Comparison between groups revealed that 7 of 8 variables examined were statistically similar to those of the control group (physical functioning, role physical, bodily pain, general health perceptions, vitality and social functioning, and mental health index). Mean role emotional scores were slightly worse in the BDI group (46 vs. 50) but the significance was borderline (P = 0.045). Subgroup analysis by method of intervention for BDI did not demonstrate significant differences. CONCLUSION: Quality of life of surviving patients following BDI compares favorably to that after uncomplicated laparoscopic cholecystectomy.

  5. Molecular biomarkers in extrahepatic bile duct cancer patients undergoing chemoradiotherapy for gross residual disease after surgery

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Hyeon Kang; Kim, Kyu Bo; Chie, Eui Kyu; Ha, Sung W. [Seoul National University College of Medicine, Seoul (Korea, Republic of); Park, Hae Jin [Dept. of Radiation Oncology, Soonchunhyang University Hospital, Seoul (Korea, Republic of)

    2012-12-15

    To analyze the outcomes of chemoradiotherapy for extrahepatic bile duct (EHBD) cancer patients who underwent R2 resection or bypass surgery and to identify prognostic factors affecting clinical outcomes, especially in terms of molecular biomarkers. Medical records of 21 patients with EHBD cancer who underwent R2 resection or bypass surgery followed by chemoradiotherapy from May 2001 to June 2010 were retrospectively reviewed. All surgical specimens were re-evaluated by immunohistochemical staining using phosphorylated protein kinase B (pAKT), CD24, matrix metalloproteinase 9 (MMP9), survivin, and {beta}-catenin antibodies. The relationship between clinical outcomes and immunohistochemical results was investigated. At a median follow-up of 20 months, the actuarial 2-year locoregional progression-free, distant metastasis-free and overall survival were 37%, 56%, and 54%, respectively. On univariate analysis using clinicopathologic factors, there was no significant prognostic factor. In the immunohistochemical staining, cytoplasmic staining, and nuclear staining of pAKT was positive in 10 and 6 patients, respectively. There were positive CD24 in 7 patients, MMP9 in 16 patients, survivin in 8 patients, and {beta}-catenin in 3 patients. On univariate analysis, there was no significant value of immunohistochemical results for clinical outcomes. There was no significant association between clinical outcomes of patients with EHBD cancer who received chemoradiotherapy after R2 resection or bypass surgery and pAKT, CD24, MMP9, survivin, and {beta}-catenin. Future research is needed on a larger data set or with other molecular biomarkers.

  6. Macroscopical and microscopical studies of the common bile duct in reindeer (Rangifer tarandus tarandus L

    Directory of Open Access Journals (Sweden)

    Timo Rahko

    1990-08-01

    Full Text Available The histological structure and secretory function of the common bile duct (ductus hepaticus communis has not been previously described in reindeer. Macroscopical studies were thus performed in 25 reindeer to reveal the morphology and topography of the ductus hepaticus communis and adjoining organs. Histologic structure of the common bile duct was investigated in 20 animals. Our studies showed that the ductus hepaticus communis and pancreaticus join about 2 cm before the duodenal opening to form the common duct. The common bile duct is an elastic tube about 3 to 5 cm long and 2 to 3 mm thick partly surrounded by fat and pancreatic tissues. The wall of the duct, being about 1 mm thick by light microscopy, consisted of folded mucosa surrounded by connective tissue fibres and a serosal layer. Distally, also muscular bands were seen. In some areas separate leucocytes and even lymphatic nodules were present. Surprisingly pancreatic acini occurred in certain areas of the wall, even in close contact to subepithelial tissues. Mucosal epithelium consisted of surface and glandular epithelial cells with mucous secretion. Numerous intraepithelial globule leucocytes were identifiable within the lamina epithelialis.Tutkimus yhteisen sappikäytävän rakenteesta porolla.Abstract in Finnish / Yhteenveto: Yhteisen sappikäytävän (ductus hepaticus communis histologista rakennetta ja eritystoimintaa ei ole aikaisemmin kuvattu porolla. Makroskooppisia tutkimuksia suoritettiin 25 porolla yhteisen sappikäytävän rakenteen ja topografian selvittämiseksi. Seinämän histologinen rakenne selvitettiin 20 porolla. Tutkimukset osoittivat, että porolla ductus hepaticus communis ja ductus pancreaticus yhtyvät noin 2 cm ennen ohutsuolta muodostaakseen yhteisen tiehyeen. Ductus hepaticus communis on noin 3-5 cm pitkä ja 2-3 mm:n läpimittainen käytävä. Se on elastinen ja osit-tain rasva- ja haimakudoksen ympäröimä. Seinämä on mikroskooppisesti noin 1 mm paksu

  7. Clinical significance of magnetic resonance cholangiopancreatography utilizing half-Fourier acquisition single-shot fast spin-echo in diagnosing bile duct diseases

    Institute of Scientific and Technical Information of China (English)

    张雪林; 颜志平; 邱士军

    2003-01-01

    Objective: To investigate the clinical significance of magnetic resonance cholangiopancreatography (MRCP) utilizing half-Fourier acquisition single-shot fast spin-echo (HASTE) in the diagnosis of bile duct diseases. Methods: Forty-three patients with obstructive jaundice and 4 without were enrolled in this study. The underlying diseases included bile duct calculi (13 cases), chronic cholangitis (14 cases) malignant tumors (18 cases) and congenital biliary cysts (2 cases). All patients underwent examinations with magnetic resonance imaging (MRI) and MRCP, and 39 were also examined with B-type ultrasonography, 33 with CT and 25 with ERCP and PTC. Three-dimensional image reconstruction was performed using volume-rendered technique (VRE) on the basis of the data obtained by MRCP. Results: The biliary calculi were displayed as circular filling defects in MRCP images, with the proximal end of dilated bile duct taking the form of the mouth of a cup. The bile duct of patients with chronic cholangitis showed distal end dilation and thinner proximal end without discontinuity. Interception of the bile ducts was most frequent (72.2%) in cases of malignant bile duct obstruction, in which the ducts may also be mastoid or resembling rat tails. 72.2% of the cases had severe dilation of the bile ducts, which occur in only 16.0% of the benign cases, with significant difference between them (P<0.01). In images of intrahepatic biliary cyst, intrahepatic duct dilated in the shape of a bursa in connection with the duct. By MRCP, 20 malignant obstructions of the bile ducts were identified with 2 misdiagnoses, and in 25 cases of benign obstructions identified by MRCP, only 1 misdiagnoses occurred. Thus MRCP had the sensitivity, specificity and accuracy of 90.0%, 96.3% and 93.6% respectively in discriminating benign and malignant diseases of the bile ducts, showing a total diagnostic accuracy of 94.0% that was similar to that of ERCP (92.0%) but significantly higher than those of both CT

  8. A CASE OF FRANK INTRABILIARY RUPTURE OF HEPATIC HYDATID CYST VIA FISTULA TO THE COMMON BILE DUCT

    Directory of Open Access Journals (Sweden)

    Rahele Mehraeen

    2012-05-01

    Full Text Available Hydatid disease primarily affects the liver and typically demonstrates characteristic imaging findings.There are many potential local complications as intrahepatic complications, exophytic growth, transdiaphragmatic thoracic involvement, perforation into hollow viscera, peritoneal seeding, biliary communication, portal vein involvement and abdominal wall invasion. Rupture of a hydatid cyst into the biliary tract is the most common complication of hepatic hydatid cyst. This is due to the incorporation of biliary radicles into the pericyst. Itmay occur in three routes; namely, contained,communicating and direct. When the cyst contents escape via biliary or bronchial radicles, the rupture is communicating. Cysto-biliary communications can either be occult or frank and the frank CBC accounts for only 5%-15% of the cases. It occurs in the right duct in 55-60% of cases, in the left duct in 25- 30%, and rarely in the confluence or gallbladder. Although communication with the intrahepatic bile ducts is common, its occurrence between a hepatic hydatid cyst and the common bile duct is rare. We present an unusual case of a fistulous communication between a hepatic hydatid cyst and CBD and frank cyst evacuation in a 42-year-old man. The sonographic, abdominal CT scan and MR cholangiopancreatography (MRCP features have been discussed. The purpose of this report is to draw attention to this rare occurrence and to highlight the presentation and the imaging features of it.

  9. Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment

    Directory of Open Access Journals (Sweden)

    Oguz Dilek

    2007-07-01

    Full Text Available Abstract Background Anomalous biliary opening especially the presence of the ampulla of Vater in the duodenal bulb is a very rare phenomenon. We report clinical implications, laboratory and ERCP findings and also therapeutic approaches in 53 cases. Methods The data were collected from the records of 12.158 ERCP. The diagnosis was established as an anomalous opening of the common bile duct (CBD into the duodenal bulb when there is an orifice observed in the bulb with the absence of a papillary structure at its normal localization and when the CBD is visualized by cholangiography through this orifice without evidence of any other opening. Results A total of 53 cases were recruited. There was an obvious male preponderance (M/F: 49/4. Demographic data and ERCP findings were available for all, but clinical characteristics and laboratory findings could be obtained from 39 patients with full records. Thirty – seven of 39 cases had abdominal pain (95% and 23 of them (59% had cholangitis as well. Elevated AP and GGT were found in 97.4% (52/53. History of cholecystectomy was present in 64% of the cases, recurrent cholangitis in 26% and duodenal ulcer in 45%. Normal papilla was not observed in any of the patients and a cleft-like opening was evident instead. The CBD was hook shaped at the distal part that opens to the duodenal bulb. Pancreatic duct (PD was opening separately into the bulb in all the cases when it was possible to visualize. Dilated CBD in ERCP was evident in 94% and the CBD stone was demonstrated in 51%. PD was dilated in four of 12 (33% cases. None of them has a history of pancreatitis. Endoscopically, Papillary Balloon Dilatation instead of Sphincterotomy carried out in 19 of 27 patients (70% with choledocholithiazis. Remaining eight patients had undergone surgery (30%. Clinical symptoms were resolved with medical treatment in 16(32% patients with dilated CBD but no stone. Perforation and bleeding were occurred only in two patients

  10. The long-term results of benign bile duct strictures reconstruction

    Directory of Open Access Journals (Sweden)

    Čolović Radoje B.

    2003-01-01

    Full Text Available Over 27 year period (1.01.1974-31.12.2001 a 168 patients (pts were operated on for benign bile duct strictures of types I to IV according to Bismuth,s classification. Reconstruction of fresh lesions and lesions and strictures of sectoral or segmental ducts were not taken into account. The later are to be the subject of separate publication. There were 107(63,7% women and 61(36,3% men of average age of 46 years (ranging from 14 to 76 years. The average time from injury to our reconstruction was 8,2 years. In 162 pts (96,4% an operative injury was the cause of the stricture, in 150 (89,3% during cholecystectomy, in 8 (4,76% during distal gastrectomy for duodenal ulcer and in 4 (2,38% during surgery of the central hydatid cyst of the liver. In 112 (66,66% pts 1 to 6 previous attempts of reconstructions had been performed elsewhere. According to the Bismuth,s classification there were 27 (16,07% strictures of type I, 46 (27,38% of type II, 66 (39,28% of type III and 29 (17,26% of type IV. The most frequent preoperative complications were intrahepatic lithiasis (34%, fibrosis or cirrhosis of the liver in 9,5%, liver abscesses in 6%, bilioduodenal fistula in 4,16% biliary peritonitis in 4,16% and incisional hernia in 8,9% of pts. Suture mucosa-to-mucosa hepaticojejunostomy with 75 cm long Roux-en-Y jejunal limb described by Blumgart was performed in 161 (95,8%, choledochoduodenostomy in 3 (1,8% and strictureplasty in 2 (1,2% while in 2 pts the reconstruction was not technically possible. Three pts died during the first 6 months, 2 in whom the reconstruction was not possible and 1 with chronic endemic nephropathy. Eight of the rest 165 pts were lost from follow up being from Bosnia and Croatia due to well known war events. Six out of the 157 pts died in the mean time, 2 due to variceal bleeding (they had cirrhosis and portal hypertension at the time of reconstruction an 4 due to unrelated causes (2 due to pancreatic carcinoma, 1 due to myocardial

  11. Anomalies of the bile ducts: a case report of direct drain of the cystic duct into the papilla of Vater.

    Directory of Open Access Journals (Sweden)

    Watanabe,Akiharu

    1983-10-01

    Full Text Available Direct drain of the cystic duct and drain of the biliary tract through an internal fistula into the duodenum in a 81-year-old man were endoscopically diagnosed without an operation.

  12. Surgical operation and re-operation for hepatocellular carcinoma with bile duct thrombosis

    Institute of Scientific and Technical Information of China (English)

    WANG Ya-dong; XUE Huan-zhou; JIANG Qing-feng; SHEN Quan; WANG Lian-cai; ZHANG Xiao; LU Bing; YU Miao; LI Ke

    2010-01-01

    Background Few reports have evaluated the efficacy of re-operation for relapse after initial surgery for hepatocellular carcinoma (HCC) with bile duct thrombosis (BDT).The aim of this study was to investigate the efficacy of initial surgery and subsequent re-operation for HCC with BDT, and their effects on prognosis.Methods The clinical data of 880 patients with HCC, including 28 patients with BDT, who underwent radical hepatectomy between 1998 and 2008 in our hospital, were reviewed.The effects of BDT and re-operation on prognosis were retrospectively analyzed.Results The 1-, 3- and 5-year survival rates were 89.3%, 46.4% and 21.4%, respectively, in 28 patients with BDT versus 91.4%, 52.9% and 20.9% in 852 patients without BDT (P >0.05).Six patients with BDT underwent re-operation after disease relapse, and their survival time was significantly longer than those who did not undergo re-operation (P <0.05).Multivariate analysis indicated that portal vein invasion and tumor size were independently associated with tumor relapse and prognosis (P<0.05).Univariate analysis and multivariate analyses showed that obstructive jaundice was not significantly correlated with tumor relapse or prognosis (P >0.05).Conclusions Hepatectomy plus BDT removal is an effective treatment option for HCC with BDT.Obstructive jaundice is not a contraindication for surgery.Re-operation after relapse can provide good outcomes if the cases are appropriately selected.

  13. Sphincter of Oddi dysfunction and bile duct microlithiasis in acute idiopathic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Grace H Elta

    2008-01-01

    Although there are numerous causes of acute pancreatitis,an etiology cannot always be found.Two potential etiologies,microlithiasis and sphincter of Oddi dysfunction,are discussed in this review.Gallbladder microlithiasis,missed on transcutaneous ultrasound,is reported as the cause of idiopathic acute pancreatitis in a wide frequency range of 6%-80%.The best diagnostic technique for gallbladder microlithiasis is endoscopic ultrasound although biliary crystal analysis and empiric cholecystectomy remain as reasonable options.In contrast,in patients who are post-cholecystectomy,bile duct microlithiasis does not appear to have a role in the pathogenesis of acute pancreatitis.Sphincter of Oddi dysfunction is present in 30%-65% of patientswith idiopathic acute recurrent pancreatitis in whom other diagnoses have been excluded.It is unclear if this sphincter dysfunction was the original etiology of the first episode of pancreatitis although it appears to have a causative role in recurring episodes since sphincter ablation decreases the frequency of recurrent attacks.Unfortunately,this conclusion is primarily based on small retrospective case series;larger prospective studies of the outcome of pancreatic sphincterotomy for SOD-associated acute pancreatitis are sorely needed.Another problem with this diagnosis and its treatment is the concern over potential procedure related complications from endoscopic retrograde cholangiopancreatography (ERCP),manometry and pancreatic sphincterotomy.For these reasons,patients should have recurrent acute pancreatitis,not a single episode,and have a careful informed consent before assessment of the sphincter of Oddi is undertaken.

  14. Postoperative radiotherapy dose correlates with locoregional control in patients with extra-hepatic bile duct cancer

    Energy Technology Data Exchange (ETDEWEB)

    Im, Jung Ho; Seong, Jinsil; Lee, Jeong Shim; Kim, Yong Bae; Kim, Kyung Sik; Lee, Woo Jung [Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Lee, Ik Jae; Park, Jun Sung; Yoon, Dong Sup [Sangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2013-12-15

    To evaluate the results of postoperative radiotherapy in patients with extra-hepatic bile duct cancer (EHBDC) and identify the prognostic factors for local control and survival. Between January 2001 and December 2010, we retrospectively reviewed the cases of 70 patients with EHBDC who had undergone curative resection and received postoperative radiotherapy. The median radiation dose was 50.4 Gy (range, 41.4 to 54 Gy). The resection margin status was R0 in 30 patients (42.9%), R1 in 25 patients (35.7%), and R2 in 15 patients (21.4%). The 5-year rates of overall survival (OS), event-free survival (EFS), and locoregional control (LRC) for all patients were 42.9%, 38.3%, and 61.2%, respectively. The major pattern of failure was distant relapses (33 patients, 47.1%). A multivariate analysis showed that the postradiotherapy CA19-9 level, radiation dose (≥50 Gy), R2 resection margins, perineural invasion, and T stage were the significant prognostic factors for OS, EFS, and LRC. OS was not significantly different between the patients receiving R0 and R1 resections, but was significantly lower among those receiving R2 resection (54.6%, 56.1%, and 7.1% for R0, R1, and R2 resections, respectively). In patients with EHBDC who had undergone curative resection, a postoperative radiotherapy dose less than 50 Gy was suboptimal for OS and LRC. Higher radiation doses may be needed to obtain better LRC. Further investigation of novel therapy or palliative treatment should be considered for patients receiving R2 resection.

  15. Aqueous garlic extract alleviates liver fibrosis and renal dysfunction in bile-duct-ligated rats.

    Science.gov (United States)

    Mahmoud, Mona F; Zakaria, Sara; Fahmy, Ahmed

    2014-01-01

    There is accumulating evidence that the renin-angiotensin system (RAS) is involved in hepatic inflammation and fibrogenesis. Garlic was found to lower the activity of the angiotensin converting enzyme (ACE) in the serum of rats in a diabetic model. We examined the effect of an aqueous garlic extract (AGE) on the ACE activity, cholestasis-induced liver fibrosis, and associated renal dysfunction in comparison with the effect of the standard drug enalapril. Both AGE and enalapril were administered orally for six weeks starting from the third day after bile duct ligation (BDL). BDL significantly increased the serum activities of liver enzymes, serum lactate dehydrogenase (LDH) activity, an indicator of liver cell death, serum total bilirubin (TB) level, liver myeloperoxidase (MPO) activity, and liver malondialdehyde (MDA) content. BDL was associated with elevation of serum urea and creatinine levels indicating renal dysfunction. BDL also caused an increase in the transcript levels of the genes coding for tumour necrosis factor alpha (TNF-alpha), transforming growth factor beta-1 (TGF-beta1), and matrix metalloproteinase-13 (MMP-13), a collagenase, in liver tissues. A significant decrease in hepatic reduced glutathione (GSH) was observed in BDL rats, while serum ACE activity was increased. Both AGE and enalapril counteracted all these deleterious changes, with the exception that only AGE reduced the MPO activity. These findings suggest that AGE possesses hepato- and renoprotective properties, similar to enalapril, probably by modulating the levels of proteins such as TNF-alpha, TGF-beta1 and MMP-13, and involving a reduction of ACE and of oxidative stress. PMID:24873034

  16. Dietary glycine blunts liver injury after bile duct ligation in rats

    Institute of Scientific and Technical Information of China (English)

    Matthias Froh; Juirgen Scholmerich; Ronald G Thurman; Zhi Zhong; Peter Walbrun; Mark Lehnert; Susanne Netter; Reiner Wiest; Lars Conzelmann; Erwin Gaibele; Claus Hellerbrand

    2008-01-01

    AIM: To investigate the effects of (dietary) glycine against oxidant-induced injury caused by bile duct ligation (BDL).METHODS: Either a diet containing 5% glycine or a standard diet was fed to male Sprague-Dawley (SD) rats. Three days later, BDL or sham-operation was performed. Rats were sacrificed 1 to 3 d after BDL. The influence of deoxycholic acid (DCA) in the presence or absence of glycine on liver cells was determined by measurement of calcium and chloride influx in cultivated Kupffer cells and lactate dehydrogenase (LDH) activity was determined in the supernatant of cultivated hepatocytes.RESULTS: Serum alanine transaminase levels increased to about 600 U/L 1 d after BDL. However, enzyme release was blunted by about two third in rats receiving glycine. Release of the alkaline phosphatase and aspartate aminotransferase was also blocked significantly in the group fed glycine. Focal necrosis was observed 2 d after BDL. Glycine partially blocked the histopathological changes. Incubation of Kupffer cells with DCA led to increased intracellular calcium that could be blocked by incubation with glycine. However, systemic blockage of Kupffer cells with gadolinium chloride had no effects on transaminase release. Incubation of isolated hepatocytes with DCA led to a significant release of LDH after 4 h. This release was largely blocked when incubation with glycine was performed.CONCLUSION: These data indicate that glycine significantly decreased liver injury, most likely by a direct effect on hepatocytes. Kupffer cells do not appear to play an important role in the pathological changes caused by cholestasis.

  17. Bile duct ligation in rats: A reliable model of hepatorenal syndrome?

    Institute of Scientific and Technical Information of China (English)

    Stelios F Assimakopoulos; Constantine E Vagianos

    2009-01-01

    The two most widely used experimental models of advanced liver disease are the administration of carbon tetrachloride, and common bile duct ligation (BDL), however, neither has been systematically evaluated as a model of hepatorenal syndrome (HRS). The BDL model in rats, studied at diverse time points, induced a progressive renal dysfunction without structural changes in the kidney. The authors concluded that BDL is a good model for further studies of HRS and its treatment. However, the renal impairment observed at the acute phase of the BDL model is based on a different pathophysiology than that of HRS. Specifically, in acute obstructive jaundice, cholemia predominates over parenchymal liver disease (reversible at this stage without portal hypertension or cirrhosis) and independently induces negative inotropic and chronotropic effects on the heart,impaired sympathetic vasoconstriction response and profound natriuresis and diuresis that might lead to volume depletion. In addition, systemic endotoxemia contributes to the prerenal etiology of renal impairment and promotes direct nephrotoxicity and acute tubular necrosis. On the other hand, the renal failure observed in the chronic BDL model (with development of biliary cirrhosis, portal hypertension and ascites) shares pathophysiological similarities with HRS, but the accordance of the chronic BDL model to the diagnostic criteria of HRS (e.g. absence of spontaneous bacterial peritonitis, no renal function improvement after plasma volume expansion) should have been confirmed. In conclusion, we think that the BDL model is not suitable for the study of the natural history of HRS, but the chronic BDL model might be valid for the study of established HRS and its potential therapies.

  18. Comparison of murine cirrhosis models induced by hepatotoxin administration and common bile duct ligation

    Institute of Scientific and Technical Information of China (English)

    Ming-Ling Chang; Chau-Ting Yeh; Pei-Yeh Chang; Jeng-Chang Chen

    2005-01-01

    AIM: To build up the research models of hepatic fibrosis in mice.METHODS: Inbred wild-type FVB/N mice were either treated with alpha-naphthyl-isothiocyanate (ANIT), allyl alcohol (AA),carbon tetrachloride (CCl4), 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC), and silica, or subjected to common bile duct ligation (CBDL) to induce hepatic injury. Liver biopsies were performed every 4 wk to evaluate hepatic fibrosis over a period of 6 mo. Cumulative cirrhosis and survival curves were constructed by life table method and compared with Wilcoxon test.RESULTS: Under the dosages used, there was neither mortality nor cirrhosis in AA and silica-treated groups. DDC and ANIT caused cirrhosis within 4-12 and 12-24 wk, respectively.Both showed significantly faster cirrhosis induction at high dosages without significant alteration of survival. The duration for cirrhosis induction by CCl4 ranged from 4 to 20 wk, mainly dependent upon the dosage. However, the increase in CCl4dosage significantly worsened survival. Intraperitoneal CCl4administration resulted in better survival in comparison with gavage administration at high dosage, but not at medium and low dosages. After CBDL, all the mice developed liver cirrhosis within 4-8 wk and then died by the end of 16 wk.CONCLUSION: CBDL and administrations of ANIT, CCl4, and DDC ensured liver cirrhosis. CBDL required the least amount of time in cirrhosis induction, but caused shortened lives of mice. It was followed by DDC and ANIT administration with favorable survival. As for CCl4, the speed of cirrhosis induction and the mouse survival depended upon the dosages and the administration route.

  19. Antiarrhythmic agents and the risk of malignant neoplasm of liver and intrahepatic bile ducts.

    Directory of Open Access Journals (Sweden)

    Yun-Ping Lim

    Full Text Available The objective of this study was to determine the association between the use of antiarrhythmic agents and the risk of malignant neoplasm of liver and intrahepatic bile ducts (MNLIHD.We used the research database of the Taiwan National Health Insurance Program to conduct a population-based, case-control study. We identified 9944 patients with antiarrhythmic history who were first diagnosed as having MNLIHD between 2005 and 2010. We identified an additional 19,497 patients with antiarrhythmic history in the same period who did not develop MNLIHD and were frequency-matched using age, sex, and index year to form a control group. Five commercially available antiarrhythmic agents, amiodarone, mexiletine, propafenone, quinidine, and procainamide, were analyzed.The adjusted odds ratio (OR of MNLIHD was 1.60 (95% confidence interval [CI], 1.45-1.77 for amiodarone users versus nonamiodarone users. In subgroup analysis, amiodarone use was significantly associated with an increased risk of MNLIHD with an adjusted OR of 18.0 (95% CI, 15.7-20.5 for patients with comorbidities compared to an OR of 2.43 (95% CI, 1.92-3.06 for those without comorbidities. After adjustment for age, sex, statins, anti-diabetes medications, non-steroidal antiinflammatory drugs, propafenone use, quinidine use, and comorbidities, the ORs were 1.49, 1.66, and 1.79 for MNLIHD associated with annual mean defined daily doses of ≤ 30, 31-145, and >145, respectively.The results of the present study indicated that amiodarone might be associated with the development of MNLIHD in a dose-dependent manner, particularly among patients with comorbidities.

  20. Composition of common bile duct stones in Chinese patients during and after endoscopic sphincterotomy

    Institute of Scientific and Technical Information of China (English)

    Wei-Lun Tsai; Kwok-Hung Lai; Chiun-Ku Lin; Hoi-Hung Chan; Ching-Chu Lo; Ping-I Hsu; Wen-Chi Chen; Jin-Shiung Cheng; Gin-Ho Lo

    2005-01-01

    AIM: Endoscopic sphincterotomy (ES) is a well-established therapeutic modality for the removal of common bile duct (CBD) stones. After ES there are still around 10% of patients that experience recurrent CBD stones. The aim of this study is to investigate the composition of CBD stones before and after ES and its clinical significance in Chinese patients.METHODS: From January 1996 to December 2003, 735Veterans General Hospital and stone specimens from 266patients were sent for analysis. Seventy-five patients had recurrent CBD stones and stone specimens from 44patients were sent for analysis. The composition of the stones was analyzed by infrared (IR) spectrometry and they were classified as cholesterol or bilirubinate stones according to the predominant composition. Clinical data were analyzed.RESULTS: In the initial 266 stone samples, 217 (82%)were bilirubinate stones, 42 (16%) were cholesterol stones,3 were calcium carbonate stones, 4 were mixed cholesterol and bilirubinate stones. Patients with bilirubinate stones were significantly older than patients with cholesterol stones (66±13 years vs 56±17 years, P= 0.001). In the 44 recurrent stone samples, 38 (86%) were bilirubinate stones, 3 (7%) were cholesterol stones, and 3 were mixed cholesterol and bilirubinate stones. In 27 patients, bothinitial and recurrent stone specimens can be obtained,23 patients had bilirubinate stones initially and 2 became cholesterol stones in the recurrent attack. In the four patients with initial cholesterol stones, three patients had bilirubinate stones and one patient had a cholesterol stone in the recurrent attack.CONCLUSION: Bilirubinate stone is the predominant composition of initial or recurrent CBD stone in Chinese patients. The composition of CBD stones may be different from initial stones after ES.

  1. Pathophysiology of lung injury induced by common bile duct ligation in mice.

    Directory of Open Access Journals (Sweden)

    Fumiaki Shikata

    Full Text Available BACKGROUND: Liver dysfunction and cirrhosis affect vasculature in several organ systems and cause impairment of organ functions, thereby increasing morbidity and mortality. Establishment of a mouse model of hepatopulmonary syndrome (HPS would provide greater insights into the genetic basis of the disease. Our objectives were to establish a mouse model of lung injury after common bile duct ligation (CBDL and to investigate pulmonary pathogenesis for application in future therapeutic approaches. METHODS: Eight-week-old Balb/c mice were subjected to CBDL. Immunohistochemical analyses and real-time quantitative reverse transcriptional polymerase chain reaction were performed on pulmonary tissues. The presence of HPS markers was detected by western blot and microarray analyses. RESULTS: We observed extensive proliferation of CD31-positive pulmonary vascular endothelial cells at 2 weeks after CBDL and identified 10 upregulated and 9 down-regulated proteins that were associated with angiogenesis. TNF-α and MMP-9 were highly expressed at 3 weeks after CBDL and were less expressed in the lungs of the control group. CONCLUSIONS: We constructed a mouse lung injury model by using CBDL. Contrary to our expectation, lung pathology in our mouse model exhibited differences from that of rat models, and the mechanisms responsible for these differences are unknown. This phenomenon may be explained by contrasting processes related to TNF induction of angiogenic signaling pathways in the inflammatory phase. Thus, we suggest that our mouse model can be applied to pulmonary pathological analyses in the inflammatory phase, i.e., to systemic inflammatory response syndrome, acute lung injury, and multiple organ dysfunction syndrome.

  2. Tetrathiomolybdate protects against bile duct ligation-induced cholestatic liver injury and fibrosis.

    Science.gov (United States)

    Song, Ming; Song, Zhenyuan; Barve, Shirish; Zhang, Jingwen; Chen, Theresa; Liu, Marcia; Arteel, Gavin E; Brewer, George J; McClain, Craig J

    2008-05-01

    Tetrathiomolybdate (TM), a potent copper-chelating drug, was initially developed for the treatment of Wilson's disease. Our working hypothesis is that the fibrotic pathway is copper-dependent. Because biliary excretion is the major pathway for copper elimination, a bile duct ligation (BDL) mouse model was used to test the potential protective effects of TM. TM was given in a daily dose of 0.9 mg/mouse by means of intragastric gavage 5 days before BDL. All the animals were killed 5 days after surgery. Plasma liver enzymes and total bilirubin were markedly decreased in TM-treated BDL mice. TM also inhibited the increase in plasma levels of tumor necrosis factor (TNF)-alpha and transforming growth factor (TGF)-beta1 seen in BDL mice. Cholestatic liver injury was markedly attenuated by TM treatment as shown by histology. Hepatic collagen deposition was significantly decreased, and it was paralleled by a significant suppression of hepatic smooth muscle alpha-actin and fibrogenic gene expression in TM-treated BDL mice. Although the endogenous antioxidant ability was enhanced, oxidative stress as shown by malondialdehyde and 4-hydroxyalkenals, hepatic glutathione/oxidized glutathione ratio, was not attenuated by TM treatment, suggesting the protective mechanism of TM may be independent of oxidative stress. In summary, TM attenuated BDL-induced cholestatic liver injury and fibrosis in mice, in part by inhibiting TNF-alpha and TGF-beta1 secretion. The protective mechanism seems to be independent of oxidative stress. Our data provide further evidence that TM might be a potential therapy for hepatic fibrosis.

  3. Application study of regular hepatectomy with choledochoscope in treatment of intrahepatic bile duct stones

    Institute of Scientific and Technical Information of China (English)

    LU De-Bin; LI Qiao-Lin

    2016-01-01

    Objective:To study the clinical effect of regular hepatectomy with choledochoscope in treatment of intrahepatic bile duct stones (IBDS);Methods:A total of 76 cases of patients with complex IBDS treated in our hospital from August 2014 to July 2015 were selected and divided into experimental group (n=38) and control group (n=38) according to random number table, and baseline information of two groups was without statistical significance. Experimental group received regular hepatectomy with choledochoscope and control group received multiple hepatolobectomy. Hepatolobectomy as well as TBIL (total bilirubin), ALB (albumin), ALT (alanine aminotransferase), AST (aspartate aminotransferase), APTT (activated partial thromboplastin time), postoperative complications, recurrence, clinical effect and other indexes of two groups 1 d before operation and 7 d after operation were observed;Results:left hemihepatectomy, left lateral lobectomy, right hemihepatectomy, right posterior lobectomy as well as left lateral and right posterior lobectomy rates of experimental group were not statistically different from those of control group. TBIL, ALB, ALT, AST and APTT of experimental group 7d after operation were not statistically different from those of control group. Excellent and good rate of treatment of experimental group (97.37%) was significantly higher than that of control group (76.32%), incidence of postoperative complications (15.79%) was significantly lower than that of control group (44.74%), stone residue rate of experimental group (5.26%) was significantly lower than that of control group (23.68%), and comparison between groups showed statistical significance;Conclusion:Regular hepatectomy with choledochoscope treatment of IBDS has higher excellent and good rate, more stable liver function indexes as well as lower rate of stone residue and incidence of postoperative complications, and it’s worth application in clinical practice.

  4. [Animal experiments with 99mTc-diethyl-HIDA in acute complete bile duct occlusion (author's transl)].

    Science.gov (United States)

    Bähre, M; Biersack, H J; Breuel, H P; Degen, H; Busch, F; Grouls, V; Lindstaedt, H; Thelen, M

    1979-10-01

    In order to establish whether a complete obstructive jaundice can abolish the accumulation of diethyl-HIDA (EHIDA) in the liver parenchyma, the common bile duct was ligated in 14 mongrel dogs. Before as well as at regular intervals after ligature of the common bile duct, a sequence scintigraphy was performed with 2 mCi 99mTc-EHIDA. For evaluation, time-activity curves (Tmax, T1/2), and analogue scintigrams as well as laboratory parameters were used for assessment. Up to seven weeks after ligation of the common bile duct, there was a marked accumulation of EHIDA in the liver parenchyma. The relative liver uptake (liver/background ratio) fell from 8.9 to 2.7, whereas conversely the cholestasis indicators aP and bilirubine rose markedly. Tmax did not show any significant alterations, whereas T1/2 was prolonged from about one week after ligation. Because of the duct ligation, there was no excretion of activity into the intestines. Immediately after ligation of the common bile duct, the gallbladder was shown up as a "hot" area in which the majority of the applied activity appeared from about one hour p.i. Begining with the fifth to the seventh day after ligation, the gallbladder was seen as a "cold" area in the liver paraenchyma. Bilirubine and aP were raised by about 50 times the initial value. With longer lasting cholestasis, the scintigram no longer altered whereas bilirubine and aP rose further. Histological examination after ligation for more than five weeks showed slight alterations as a whole. Gamma-GT and in particular GPT were likewise slightly raised compared to bilirubine and aP. The conclusion was drawn from this that the good accumulation of EHIDA in the liver parenchyma which is to be observed without exception even in cholestasis lasting for several weeks could be explained by a relatively slight hepatocellular damage. Only when there is a consecutive parenchymal damage in extrahepatic jaundice, accumulation of EHIDA in the liver can be abolished.

  5. Site-characteristic expression and induction of trefoil factor family 1, 2 and 3 and malignant brain tumor-1 in normal and diseased intrahepatic bile ducts relates to biliary pathophysiology

    DEFF Research Database (Denmark)

    Sasaki, Motoko; Tsuneyama, Koichi; Saito, Takahito;

    2004-01-01

    in normal and diseased livers. MATERIALS AND METHODS: Expression of TFF1,2,3 and DMBT1 were examined immunohistochemically in primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), chronic viral hepatitis (CVH), extrahepatic biliary obstruction (EBO), and normal livers. RESULTS: In normal...... livers, TFF1,3 and DMBT1 were infrequently detectable in large and rarely in small bile ducts, respectively. TFF2 was not detectable in large bile ducts. In large bile duct diseases (PSC and EBO), expression of TFF3 and DMBT1 were increased. In small bile duct diseases (PBC and CVH), expression of TFF2...

  6. Effectiveness of ultrasound, computed tomography, hepatobiliary scintigraphy and nuclear magnetic resonance in diseases of the gallbladder and bile ducts

    Energy Technology Data Exchange (ETDEWEB)

    Fiegler, W.; Schoerner, W.; Felix, R.

    1984-09-01

    The effectiveness of ultrasound, computed tomography, hepatobiliary scintigraphy and nuclear magnetic resonance in diseases of the biliary tract is described. Ultrasound should be the first examination in clinical suspicion of cholelithiasis and has a higher accuracy than oral cholecystography. Computed tomography is very expensive and should be carried out in suspected gallbladder carcinoma, cholecystitis with abscess formation, tumour in the porta hepatis and pancreatic head and in sonographically unclear cases. Nuclear magnetic resonance can determine the ability of the gallbladder to concentrate bile. Ultrasound can distinguish with high accuracy between obstructive and inflammatory jaundice. In clinical suspicion of bile duct lesions an infusion cholangiogram must be carried out, if bilirubin is lower than 5 mg%; if bilirubin is higher, an ERC or PTC should be performed. If in biliary obstruction a suspicion of tumour in porta hepatis or head of the pancreas is present, computed tomography should be effected.

  7. Utility of MR cholangiography for follow-up examination after metallic stent placement in the bile duct

    International Nuclear Information System (INIS)

    To evaluate the efficacy of MR cholangiography for follow-up examination after metallic stent placement in the bile duct. Between December 1999 and June 2000, 15 patients with biliary obstruction in whom metallic biliary stents had been placed underwent MR cholangiography during follow-up examination. The causes of obstruction were hilar cholangiocarcinoma (n=6), common bile duct cancer (n=5), gall bladder cancer (n=1) and pancreatic cancer (m=3). The types of self-expandable metallic stent employed were the nitinol stent (n=2), the endocoil nitinol stent (n=3), the ultraflexed diamond stent (n=5), and the wallstent (n=5). Using MR cholangiography, we measured the diameter of that part of the biliary stent which showed high signal intensity, assigning one point if this was less than one third of the stent diameter, two points of between one third and two thirds, and three points if more than two thirds. We decided that a higher score indicated fewer artifacts. The score was 1.7-3 (mean, 2.3) points for the endocoil nitinol stent, 1.7-2.3 (mean, 2) for the nitinol stent, and 1-3 (mean, 1.7) for the ultraflex diamond stent. In most cases, two thirds of the stent diameter was observed. For the wallstent, the score was 1-1.7 (mean, 1.3) points and the inner portion of the stent was almost invisible. MR cholangiography is not useful for follow-up examination after the placement of wallstents and three other types of nitinol stent in the bile duct

  8. Etiology and treatments of re-stenosis of bile duct after surgical repair for iatrogenic bile duct injury%医源性胆管损伤修复后再狭窄原因及治疗

    Institute of Scientific and Technical Information of China (English)

    李绍强; 梁力建

    2011-01-01

    胆管损伤(BDI)是胆囊切除术后常见的严重并发症.BDI首次手术修复后胆道再狭窄的原因是多方面的,影响因素主要包括:BDI的类型、手术修复的时机、手术修复的方法、合并肝动脉损伤和术者经验.BDI首次手术后胆道再狭窄的治疗十分棘手,手术难度大.术前详细的影像学特别是胆道树的直接影像检查评估对手术方案的选择十分重要.具体的治疗措施视病人的全身状况、肝功能及其储备功能、胆管狭窄的部位和有无合并肝内胆管结石、胆汁性肝硬化等因素而定.胆道金属支架植入术只适用于高龄、不能耐受手术或预测生存期不超过2年的病人.狭窄段胆管切除、肝门部胆管空肠Roux-en-Y吻合术是最常用的手术方式,效果良好.对左、右肝管或以上胆管狭窄合并肝内胆管结石或肝叶萎缩,健侧肝无肝硬化、肝功能良好的病人,应行肝切除术.%Iatrogenic bile duct injury (IBDI) is a severe complication of cholecystectomy. The major factors related to re-stenosis of bile duct after initial surgical repair includes type of IBDI, timing of initial surgical repair, initial surgical procedures, being accompanied by hepatic arterial injury and performed operation. The treatment for re-stenosis of bile duct is difficult. Preoperat imaging studies especially the cholangiogram of the whole biliary tree are critical important for surgical planning. The treatment modality adopted should comprehensively depend on the general condition of patient, liver function and liver function reserve, the site of biliary stricture, with or without intrahepatic stones and biliary cirrhosis. Metal stent placement is only indicated for patients who are intolerance of operation, or whose life expectancy are less than 2 years. Removal of the biliary stricture and hilar bile duct-jejunum Roux-en-Y anastomosis is the common used procedure for re-stenosis of bile duct after initial surgical repair

  9. Relationship between the GH-IGFs axis and the proliferation of bile duct cancer cell line QBC939 in vitro

    Institute of Scientific and Technical Information of China (English)

    Hui-Hua Cai; Yue-Ming Sun; Jian-Feng Bai; Yi Shi; Han-Lin Zhao; Yi Miao

    2008-01-01

    BACKGROUND:In recent years, recombined human growth hormone (rhGH) has been increasingly used in patients to help them recover from operation. But GH, as a mitogen, can promote cell renewal and increase malignant transformation. In the current study, we assessed the proliferation of a bile duct cancer cell line (QBC939) in vitro with GH and explored the possible relationship with the axis of GH-IGFs (insulin-like growth factors). METHODS:QBC939 cells in the exponential growth stage were harvested and divided into an experimental group (GH group) and a control group (NS group). The GH group was divided into four sub-groups according to the dose of GH and culture time (50μg/L for 2 hours, 50μg/L for 24 hours, 100μg/L for 2 hours, 100μg/L for 24 hours). The NS group was divided into two sub-groups (NS for 2 hours and NS for 24 hours). After 2 or 24 hours, IGF-1 and IGF-2 were detected using the enzyme-linked immunosorbent assay. The QBC939 cells cultured for 24 hours with two GH concentrations were made into single cell suspensions and samples underwent subsequent cell cycle evaluation. Messenger RNA of IGF-1 and IGF-2 receptor (IGF-1RmRNA and IGF-2RmRNA) were tested with the method of in situ hybridization. RESULTS:There was no statistically signiifcant difference between the GH and NS groups after 2 hours of culture (P>0.05). But after 24 hours of culture, GH stimulated cell growth in vitro and also elevated the percentage in S phase and the proliferation index (P CONCLUSION:GH can stimulate QBC939 cell growth and proliferation in vitro and the mechanism is most likely by the GH-IGF-1-IGF-1R axis.

  10. Spontaneous Perforation of Common Bile Duct in a Child with a Clinical Manifestation of Acute Abdominal Distension: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Hee Rok; Namkyung Sook; Kim, Heung Cheol; Hong, Myung Sun [Dept. of Radiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon (Korea, Republic of)

    2011-09-15

    Spontaneous perforation of common bile duct (CBD) is extremely rare in children, but potentially a fatal disorder that requires an emergency laparotomy. Most of the patients present with insidious symptoms including slowly progressive abdominal distension with accumulation of the ascites, fluctuating mild jaundice, and clay-colored stools. We report a case of surgically confirmed spontaneous perforation of the CBD in a 3-year-old girl who presented with acute abdominal distension with no biliary symptoms or signs, and who showed imaging findings consistent with anomalous pancreaticobiliary ductal union with a focal stenosis in the CBD.

  11. Hepatitis C and B Virus Infection in Chinese Patients with Extrahepatic Bile Duct Carcinoma

    Institute of Scientific and Technical Information of China (English)

    CHENMingyi; HUANGZhiqiang; CHENLezhen; GAOYabing; PENGRuiyun; WANGDewen

    2002-01-01

    Objective:In China, the incidence of extrahepatic bile duct carcinoma (EBDC) tends to increase over the past decades. The etiology of the noted increase in EBDC is not identified. Approximately, in a half of the overall Chinese patients with EBDC, the causative factors in the development of EBDC have not been demonstrated. There is a high prevalence of hepatitis C virus (HCV) or hepatitis B virus (HBV)in China, both of which can induce malignant transformation of infected cells and strongly associated with hepatocellular carcinoma (HCC).In this study,EBDC tissues from Chinese patients were examined for the presence of HCV and HBV infection to investigate further the potential causes of EBDC. Methods:HCV NS5 protein and HBsAg were detected by labeled streptavidin biotin (LSAB) method; HCV RNA and HBV DNA were detected by in situ polymerase chain reaction (IS-PCR) in formalin fixed, paraffin embedded specimens from 51 Chinese patients with EBDC. HCV RNA and HBV DNA were detected by IS-PCR in 34 Chinese patients with specimens of benign lesions of hepatobiliary tract(control group). Results:In 51 case tissue sections of EBDC, NS5 protein was detected in 14 (27.5%), and HBsAg in 5 (9.8%), HCV RNA in 18(35.4%) and HBV DNA in 8 (15.9%), respectively, of which HCV and HBV co-infection was detected in 2 (3.9%). In 34 case tissue sections of the control group, HCV RNA was detected in 2 (5.9%), and HBV DNA in 3 (8.8%).Conclusion:In this study using standard histochemical and PCR techniques,HCV and HBV and HBV presence in EBDC tissues than would be expected on serologic grounds.The detectable rate of HCV RNA in EBDC tissues was significantly higher than in control group(x2=9.808,P=0.002).As a result ,this study indicates that there is a correlation between the presence of HCV infection and EBDC,and HCV infection has possible ctiologic significance in the development of EBDCin China.While HBV DNA was detecled in EBDC tissues with the difference in the detectable rate of HBV

  12. Efficient and Controlled Generation of 2D and 3D Bile Duct Tissue from Human Pluripotent Stem Cell-Derived Spheroids.

    Science.gov (United States)

    Tian, Lipeng; Deshmukh, Abhijeet; Ye, Zhaohui; Jang, Yoon-Young

    2016-08-01

    While in vitro liver tissue engineering has been increasingly studied during the last several years, presently engineered liver tissues lack the bile duct system. The lack of bile drainage not only hinders essential digestive functions of the liver, but also leads to accumulation of bile that is toxic to hepatocytes and known to cause liver cirrhosis. Clearly, generation of bile duct tissue is essential for engineering functional and healthy liver. Differentiation of human induced pluripotent stem cells (iPSCs) to bile duct tissue requires long and/or complex culture conditions, and has been inefficient so far. Towards generating a fully functional liver containing biliary system, we have developed defined and controlled conditions for efficient 2D and 3D bile duct epithelial tissue generation. A marker for multipotent liver progenitor in both adult human liver and ductal plate in human fetal liver, EpCAM, is highly expressed in hepatic spheroids generated from human iPSCs. The EpCAM high hepatic spheroids can, not only efficiently generate a monolayer of biliary epithelial cells (cholangiocytes), in a 2D differentiation condition, but also form functional ductal structures in a 3D condition. Importantly, this EpCAM high spheroid based biliary tissue generation is significantly faster than other existing methods and does not require cell sorting. In addition, we show that a knock-in CK7 reporter human iPSC line generated by CRISPR/Cas9 genome editing technology greatly facilitates the analysis of biliary differentiation. This new ductal differentiation method will provide a more efficient method of obtaining bile duct cells and tissues, which may facilitate engineering of complete and functional liver tissue in the future. PMID:27138846

  13. Non-functioning well-differentiated neuroendocrine tumor of the extrahepatic bile duct:an unusual suspect?

    Institute of Scientific and Technical Information of China (English)

    Harsheet Sethi; Mansoor Madanur; Parthi Srinivasan; Bernard Portmann; Nigel Heaton; Mohamed Rela

    2007-01-01

    BACKGROUND: Neuroendocrine tumors (NETs) arising in the biliary tree are extremely rare, and 37 cases were identiifed in the English literature. METHODS: A well-differentiated NET was found arising from the junction of the cystic and common hepatic ducts, in a 51-year-old male presenting with pedal edema and weight loss with abnormal liver enzymes and a normal serum bilirubin level. No mass was seen on radiological imaging and biopsy of the liver was suggestive of an early cholangiopathy. A bile leak complicating the liver biopsy led to an ERCP that demonstrated a iflling defect suggestive of a mass in the common bile duct (CBD). RESULTS: He underwent a successful excision of the tumor with a Roux-en-Y hepaticojejunostomy. The diagnosis of NET was made on histological and immunohistochemical analysis of the resected specimen. He remains well and disease free 22 months after surgery. CONCLUSIONS: Recognition of biliary NET continues to be a challenge and an increased awareness of these tumors in rare sites will result in optimal management of these tumors.

  14. End-ischemic machine perfusion reduces bile duct injury in donation after circulatory death rat donor livers independent of the machine perfusion temperature.

    Science.gov (United States)

    Westerkamp, Andrie C; Mahboub, Paria; Meyer, Sophie L; Hottenrott, Maximilia; Ottens, Petra J; Wiersema-Buist, Janneke; Gouw, Annette S H; Lisman, Ton; Leuvenink, Henri G D; Porte, Robert J

    2015-10-01

    A short period of oxygenated machine perfusion (MP) after static cold storage (SCS) may reduce biliary injury in donation after cardiac death (DCD) donor livers. However, the ideal perfusion temperature for protection of the bile ducts is unknown. In this study, the optimal perfusion temperature for protection of the bile ducts was assessed. DCD rat livers were preserved by SCS for 6 hours. Thereafter, 1 hour of oxygenated MP was performed using either hypothermic machine perfusion, subnormothermic machine perfusion, or with controlled oxygenated rewarming (COR) conditions. Subsequently, graft and bile duct viability were assessed during 2 hours of normothermic ex situ reperfusion. In the MP study groups, lower levels of transaminases, lactate dehydrogenase (LDH), and thiobarbituric acid reactive substances were measured compared to SCS. In parallel, mitochondrial oxygen consumption and adenosine triphosphate (ATP) production were significantly higher in the MP groups. Biomarkers of biliary function, including bile production, biliary bicarbonate concentration, and pH, were significantly higher in the MP groups, whereas biomarkers of biliary epithelial injury (biliary gamma-glutamyltransferase [GGT] and LDH), were significantly lower in MP preserved livers. Histological analysis revealed less injury of large bile duct epithelium in the MP groups compared to SCS. In conclusion, compared to SCS, end-ischemic oxygenated MP of DCD livers provides better preservation of biliary epithelial function and morphology, independent of the temperature at which MP is performed. End-ischemic oxygenated MP could reduce biliary injury after DCD liver transplantation.

  15. Percutaneous removal of foreign bodies by gooseneck snare technique in the common bile duct T-tube tract: a report of two cases

    International Nuclear Information System (INIS)

    Although the presence of foreign bodies in the common bile duct and T-tube tract in uncommon, it is because of recent developments in endoscopic biliary intervention and percutaneous choledochoscopic procedures that they are found with increasing frequency in the biliary tree. We report two cases in which foreign bodies in the biliary tree were successfully removed using the percutaneous gooseneck snare technique. In one patient a plastic biliary stent was malfunctioning and could not be removed under endoscopic guidance, while in the other, a plastic guidewire had been inserted into the T-tube tract during percutaneous choledochoscopy for the treatment of a common bile duct stone

  16. Extraordinary elevated CA19-9 in patient with common bile duct stones and cholangitis Case report

    Directory of Open Access Journals (Sweden)

    Ali Mokhtarifar

    2012-05-01

    Full Text Available Serum Carbohydrate Antigen, CA19-9, is a carbohydrate antigen whose usage -as a tumor marker- in pancreatic and bile ducts malignancies is commonly increasing. Sensitivity and specificity of this antigen in the diagnosis of malignancies is 70-90% and 68-91%, respectively. CA19-9 can also rise in other disorders and in few of benign conditions including cholangitis, due to other causes, e.g. choledocholithiasis. However, in such cases the increase is not significant and it is usually below 1000 u/ml. Values more than 10000 u/ml are limited to few case reports in articles. The case under study was a 66 year old man hospitalized because of epigastric and right upper quadrant pain, fever, jaundice, acholic stool, weight loss of about 6 kg, and hyperchromic urine. Physical examination revealed that the case was icteric and febrile with a mild RUQ tenderness on percussion. Laboratory tests showed marked elevation of bilirubin and CA19-9 (Total bilirubin: 36 mg/dl, Direct: 19.5 mg/dl CA19-9 :44777u/ml, Normal: 0-40 u/ml, but the enzymes of the liver and alkaline phosphatase only increased to two times the normal level. Sonography showed dilated common bile duct with four stones within it. Four weeks after stones extraction and renewal of bile current CA19-9 fell to 60 u/ml and returned to normal range (0-40 2 months later and during this period the patient was totally asymptomatic. As a result, in patients with biliary obstruction, a diagnosis of malignancy cannot be made solely on the basis of increased concentration of CA19-9, even in case of high clinical suspicion and the interpretation of this increase must be done with more caution and after lab follow-up following removal of the obstruction.

  17. Fully covered self-expanding metal stents placed temporarily in the bile duct: safety profile and histologic classification in a porcine model

    Directory of Open Access Journals (Sweden)

    Schmitt Timothy

    2011-06-01

    Full Text Available Abstract Background Fully covered Self-Expanding metal stents (FCSEMS have been shown efficacious in palliating malignant biliary obstructions. There is little data analyzing mucosal response to their temporary placement in the bile duct. Methods Ten mini pigs underwent endoscopic placement of a FCSEMS (Wallflex, Boston Scientific. FCSEMS were kept in place for three months. At the end of the 3 months, FCSEMS were removed endoscopically. Five pigs were euthanized and their bile ducts harvested. The other five were kept alive for another month post removal. A single pathologist, created a scoring system (to determine degree of inflammation, fibrosis, and epithelial injury, examined all specimens in a blinded fashion. Results Four FCSEMS spontaneously migrated in the duodenum. On post mortem examination, mild mucosal thickness was noted in three bile duct specimens while superficial inflammation of the bile duct was noted in five animals. Histologic examination of the bile duct revealed focal acute inflammation in both groups. For the 5 animals euthanized immediately after stent removal, there was a tendency to have superficial mucosal erosion and fibrosis. In contrast, increased chronic inflammation was more commonly seen in the animals 1 month post stent removal, with all animals in this group showing moderate degrees of mononuclear inflammatory cell mucosal infiltrates. No severe inflammatory or fibrotic duct injury was observed in any of the study animals, with degree of injury graded as mild to moderate. Conclusion FCSEMS appear to induce minimal tissue overgrowth or fibrosis post placement. Ease of removability and no significant histologic injury are advantages noted with FCSEMS., however, further studies are needed to evaluate treating benign biliary strictures with FCSEMS in humans.

  18. Ectopic drainage of the common bile duct into the lesser curvature of the gastric antrum in a newborn with pyloric atresia, annular pancreas and congenital short bowel syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Scheida, Nicola; Amaral, Joao G. [Hospital for Sick Children, Department of Diagnostic Imaging, Division of Image Guided Therapy, Toronto (Canada); Wales, Paul W. [Hospital for Sick Children, Department of Surgery, Toronto (Canada); Krishnamurthy, Ganesh [Hospital for Sick Children, Department of Diagnostic Imaging, Division of Image Guided Therapy, Toronto (Canada); Children' s Hospital of Philadelphia, Department of Diagnostic Imaging, Philadelphia, PA (United States); Chait, Peter G. [Ellesmere X-Ray and Associates, Scarborough (Canada)

    2009-01-15

    We report a newborn with bilious vomiting and the rare combination of pyloric atresia, annular pancreas and ectopic drainage of the common bile duct into the lesser curvature of the gastric antrum. Radiologic, sonographic and percutaneous transhepatic transcholecystic cholangiographic (PTTC) findings, with surgical correlation, are presented. (orig.)

  19. Diagnostic performance of CT and MRI in distinguishing intraductal papillary neoplasm of the bile duct from cholangiocarcinoma with intraductal papillary growth

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Yubao; Zhong, Xiaomei; Yan, Lifen; Zheng, Junhui; Liu, Zaiyi; Liang, Changhong [Guangdong Academy of Medical Sciences, Department of Radiology, Guangdong General Hospital, Guangzhou (China)

    2015-07-15

    We aimed to evaluate the diagnostic performance of CT and MRI for distinguishing intraductal papillary neoplasm of the bile duct (IPNB) from cholangiocarcinoma (CC) with intraductal papillary growth (IPG). Forty-two patients with either IPNB or CC with IPG proven by histopathology were independently reviewed in retrospect. Strict criteria for diagnosis of IPNB included presence of the designated imaging features as follows: local dilatation of the bile duct, nodule within the dilated bile duct, growing along the interior wall of bile duct. Any lesion that was not consistent with the criteria was classified as CC with IPG. Sensitivity, specificity, positive and negative predictive values for characterization of IPNB were calculated, and k test was used to assess the level of agreement. Two imaging reviewers correctly identified 21 of 26 (80.8 %) and 22 of 26 (84.6 %) IPNB cases, respectively. Alternatively, they correctly identified 14 of 16 (87.5 %) and 15 of 16 (93.8 %) CC with IPG, respectively. Agreement between the two reviewers was perfect (k = 0.81) for the diagnosis of IPNB and differentiation from CC with IPG. By using our designated diagnostic criteria of CT and MRI, IPNB can be accurately identified and possible to be distinguished from CC with IPG. (orig.)

  20. Decline in CA19-9 during chemotherapy predicts survival in four independent cohorts of patients with inoperable bile duct cancer

    DEFF Research Database (Denmark)

    Grunnet, Mie; Christensen, Ib J; Lassen, Ulrik;

    2015-01-01

    BACKGROUND: Carbohydrate associated antigen (CA19-9) has been approved by the FDA as a biomarker for monitoring treatment effect in pancreatic cancer. However, the value of serum CA19-9 as a biomarker of response to chemotherapy in bile duct cancer is unclear. The aim of this study was to determi...

  1. [The effect of berberine administration of evaluation of the functional state of rat liver after ligation of common bile duct].

    Science.gov (United States)

    Zverinskiĭ, I V; Mel'nichenko, N G; Poplavskiĭ, V A; Sut'ko, I P; Telegin, P G; Shliakhtun, A G

    2013-01-01

    On the eighth day after ligation of the common bile duct in rats a significant increase in the serum content of total lipids, cholesterol bilirubin and ALT, alkaline phosphatase, and gamma-glutamyltransferase was observed. In the microsomal fraction there was a marked decrease in the content and activity of microsomal monooxygenases. Introperitoneal injection of berberine (10 mg/kg) for 6 days caused a partial normalization of permeability of hepatocytes plasma membranes and activity microsomal flavin-containing monooxygenases. It is suggested that berberine is a substrate and inducer of flavin-containing monooxygenases. Membrane-stabilizing effect of berberine is probably realized at the level of inhibition of prooxidant status of liver cells. PMID:23650726

  2. Trends in cancer of the liver, gall bladder, bile duct, and pancreas in elderly in Denmark, 1980-2012

    DEFF Research Database (Denmark)

    Bjerregaard, Jon Kroll; Mortensen, Michael Bau; Pfeiffer, Per

    2016-01-01

    Background Cancers of the liver, bile duct, gall bladder and pancreas (HPB-c) are a heterogeneous group, united almost exclusively by a poor prognosis. As the number of elderly in the Western world continues to rise and HPB-c are associated with age, we wanted to examine changes in incidence......, mortality, prevalence and relative survival for these cancers.Materials and methods HBP-c was defined as ICD-10 codes C22 (liver), C23-24 (gall bladder), and C25 (pancreas). Data derived from the NORDCAN database with comparable data on cancer incidence, mortality, prevalence and relative survival...... in the Nordic countries, where the Danish data were delivered from the Danish Cancer Registry and the Danish Cause of Death Registry with follow-up for death or emigration until the end of 2013.Results The incidence and mortality rates of cancer of the liver and pancreas increased over time while the rates...

  3. CT and MR Findings of Multiple Bile Duct Hamartomas%胆管错构瘤的CT、MRI表现

    Institute of Scientific and Technical Information of China (English)

    冯廷越; 陈天忠; 唐建桥

    2015-01-01

    Objective To summarize computed tomography (CT) and magnetic resonance (MR) imaging features of multiple bile duct hamartomas (BDH) and analysis changes of lesions with concurrent infection before and after treatment on MRI and CT to improve understanding of the imaging findings of the disease.Methods This retrospective study reviewed CT and MR imaging findings of ten patients with multiple bile duct hamartomas in our hospital and compared the difference of imaging findings before and after therapy in those with infection.Results Non-contrasted enhanced CT images of multiple bile duct hamartomas showed scattered or diffuse low density lesions with no enhancement; T2 weighted imaging (T2WI) was sensitivity to detect cystic lesion with significantly higher signal. Diffuse liver disease could be well displayed by Magnetic Resonance Cholangiopancreatography (MRCP), and all lesions were without intrahepatic biliary communication and have irregular borders when concurrent infection.Conclusion CT examination is limited in the diagnosis of biliary hamartomas, and conventional non-contrasted MRI and MRCP examinations have great value and show some advantages in the diagnosis of multiple bile duct hamartomas compared to CT, while we should pay more attention to the change of imaging findings of those with concurrent infection.%目的:总结胆管错构瘤的CT及MRI表现,对比分析并发感染病例病灶的治疗前后改变,以提高对该病影像检查及诊断的认识。方法回顾性研究我院诊治的10例胆管错构瘤患者的资料,分析胆管错构瘤病变的CT、MRI表现特点,对并发感染病例的治疗前后变化进行对比分析。结果胆管错构瘤的CT平扫表现为散在或弥漫性分布的低密度灶,增强扫描无强化;MRI平扫T2WI序列能敏感的显示呈明显高信号的囊性病变;MRCP立体的显示弥漫性病变,所有病变与肝内胆管树不相通;并发感染后病灶边界变模糊。结论单

  4. Differential regional responsiveness of astroglia in mild hepatic encephalopathy: An Immunohistochemical approach in bile duct ligated rat.

    Science.gov (United States)

    Hiba, Omar El; Elgot, Abdeljalil; Ahboucha, Samir; Gamrani, Halima

    2016-05-01

    Hepatic encephalopathy (HE) is a neuropsychiatric disorder that occurs in both acute and chronic liver failure. However, the pathomechanisms of the disease remains obscure. Neuropathological studies have demonstrated a primary gliopathy in humans as well as in animal models of chronic and acute liver failure. Here, we have investigated in an animal model of mild HE: the bile duct ligated rat (BDL) at the cirrhotic stage (4 weeks after surgery), the expression of the key marker of mature astrocytes; the glial fibrillary acidic protein (GFAP) in different brain areas such as: Substantia nigra pars compacta (SNc), Ventral tegmental area (VTA), hippocampus, dorsal striatum and brain cortex by means of immunohistochemistry. The immunohistochemical study showed, in BDL compared to the operated controls (shams), a diminished astrocyte reactivity corresponding to a loss of GFAP expression within SNc, VTA, hippocampus and dorsal striatum (phepatic encephalopathy. PMID:26995310

  5. Cystic dilatation of the common bile duct in adults: report of five cases and review of literature

    Directory of Open Access Journals (Sweden)

    Arruda Pedro Carlos Loureiro de

    2000-01-01

    Full Text Available The authors report five cases of cystic dilatation of the common bile duct Type I (Todani?s classification in adults patients, in Division of General Surgery of a University Hospital, treated over a- 25-year- period from 1974 to 1999, among 16.057 operations, and not previously published. Diagnosis was obtained by operative cholangiogram (OC in the first case, percutaneous transhepatic cholangiogram on the second one (PTHC and by ultrasonography (US, endoscopic retrograde cholangiopancreatography (ERCP, and operative cholangiogram (OC, respectively, on the last three cases. The second patient had an adenocarcinoma arising in the cystic wall associated with peritoneal metastasis. The first two cases were treated by internal drainage and the last three by excision of the cysts and bilioenteric anastomoses. Classification, incidence, etiology, diagnosis, malignization and surgical treatment of biliary cystic disease (BCD were revised, with the conclusion that resection must be the preferable method of treatment, when possible, especially due to the concern of malignization.

  6. 腹腔镜下胆总管末端狭窄支撑术117例报告%Laparoscopicstents Supporting for the Stenosis of the Common Bile Duct Termination Region:A Report of 117 Ca-ses

    Institute of Scientific and Technical Information of China (English)

    曹云; 陈安平

    2014-01-01

    Objective To summarize the experience on laparoscopic stents supporting for stenosis of the common bile duct termination region (LCBDS). Methods It was used of laparoscopic common bile duct exploration, net stone or electrohydraulic lithotripsy to take a clean of extrahepatic bile duct stones. It was dilated that the Annular stenosis or tubular stricture of the com-mon bile duct termination region by dilatable catheter, the balloon and zebra guidewire in laparoscopic common bile duct explora-tion. After that, laparoscopic stents supporting for the stenosis of the common bile duct termination region by Plastic stent or serf-expandable metallic stents. Results In 109 cases(93. 2% ) had completed successful the dilatation of the stenosis and biliary drainage to reach the preestablished object in total 117 patients of the terminal CBD stenosis of stones and metastatic periampulla carcinoma. One patient changed laparoscopic operation into open abdominal operation. Two patients had leaked the bile juice. One patient had a large number of residual stones in the left intrahepatic duct . The Wallstent of 2 patients is fail. Two patients had died of the functional failure of the liver and the kidneys operated 15 days later ( the general incidence of complications 6. 8% ). Conclusion If patients are suitable, LCBDS is feasible, simple and safety that the stents supporting of the terminal CBD stenosis of benign and malignancy.%目的:总结运用腹腔镜下胆总管末端狭窄支撑术的治疗经验。方法采用腹腔镜胆总管切开探查、取石网取石或液电碎石直至取净肝外胆管结石,在斑马导丝引导下用逐级扩张导管和(或)球囊导管对胆总管末端狭窄进行扩张,并对胆总管末端梗阻为主的良恶性狭窄病人有选择地放置塑料支架或自膨式金属胆管支架。结果本组117例患者中109例(93.2%)手术获成功,即术后无胆漏、支架位置正确、引流通畅、黄疸减轻或消退。1

  7. The role of B/D ratio and A/D ratio to defferentiate malignancy from benignancy in distal extrahepatic bile duct obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Rhim, Hyun Chul; Baek, JUng Hwan; Jeon, Eui Yong; Koh, Byung Hee; Cho, On Koo [Hanyang University College of Medicine, Seoul (Korea, Republic of); Kim, Young Hwan [Ulsan University College of Medicine, Ulsan (Korea, Republic of)

    1994-12-15

    To determine wheter bilirubin/extrahepatic bile duct diameter ratio(B/D ratio) or alkalinephosphatase/extrahepatic bile duct diameter ratio (A/D ratio) can be used to differentiate malignant from benigndisease in distal extrahepatic bile duct obstruction during ultrasonographic examination. We retrospectively reviewed the sonograms and laboratory data of 100 patients with obstructive jaundice (benign : n=50, malignant: : n=50). The diagnosis was confirmed either surgically (n=66) or clinically (n=34). The B/D ratio and A/D radio were calculated by means of dividing total bilirubin (mg/dl) and alkaline phosphatase (I.U.)respectively by maximum extrahepatic bile duct diameter(mm) on ultrasonogram. Significant difference in B/D ratio was found between the benignancy (0.28+0.25) and malignancy (0.98+0.84) groups (P<0.001). Significant difference in A/D ratio was also found between the benignancy (15.00+10.22) and malignancy (32.44+30.28) groups(P<0.001) Accuracies to predict malignancy according to criteria of B/D and A/D ratios were less than 75% and 65%respectively. On the other hand, the positive predictive value and specificity were relatively high. The B/D ratio and A/D ratio calculated from ultrasonograms can be used as a valuable screening index todifferentiate malignancy from benignacy in patients with distal extrahepatic bile duct obstruction, especially when the sonography is difficult because of the interposition of bowel gas or obesity

  8. Diagnosis and surgical treatments of hepatocellular carcinoma with tumor thrombosis in bile duct:Experience of 34 patients

    Institute of Scientific and Technical Information of China (English)

    Lun-Xiu Qin; Zeng-Chen Ma; Zhi-Quan Wu; Jia Fan; Xin-Da Zhou; Hui-Chuan Sun; Qing-Hai Ye; Lu Wang; Zhao-You Tang

    2004-01-01

    AIM: Hepatocellular carcinoma (HCC) with bile duct tumor thrombosis (BDT) is a rare event. The prognosis of this type of patients is very dismal. The aim of this study was to share the experience in the diagnosis and treatment of HCC with BDT, to further improve the prognosis of these patients.METHODS: Thirty-four patients of HCC with BDT received surgical treatment in authors' institute from July 1987 to January 2003 were reviewed retrospectively. The experience in the diagnosis and treatment, and the outcome of this type of HCC patients were summarized.RESULTS: Thirty of the 34 patients (88.2%) were positive for alpha-fetoprotein (AFP) (>20 μg/L), and 12 patients (35.3%) were found having obstructive jaundice before operation, 18 cases were suspected of "obstruction of bile duct" preoperatively. The primary tumors were frequently located at the left medial (13 cases) or right anterior lobe (14 cases). Thirty-one patients received liver resections and removal of BDT, while the other 3 patients received removal of BDT combined with hepatic artery ligation and cannulation (HAL+HAI), or only removal of BDT because their liver function reservation and general condition could not tolerate the primary tumor resection. The 1-year survival rate was 71.4%(20/28). The longest disease-free survival was over 15 years. The intrahepatic tumor recurrence within 1 year after operation was found in 14 patients (14/28, 50.0%).CONCLUSION: Surgical removal of primary tumors and BDTis safe and beneficial to the HCC patients with BDT. Early detection, diagnosis, and surgical treatment are the key points to prolong the survival time of patients.

  9. Recommendation to Exclude Bile-Duct-Cannulated Rats with Hyperbilirubinemia for Proper Conduct of Biliary Drug Excretion Studies.

    Science.gov (United States)

    Kato, Koji; Hasegawa, Yoshitaka; Iwata, Katsuya; Ichikawa, Takuya; Yahara, Tohru; Tsuji, Satoshi; Sugiura, Masayuki; Yamaguchi, Jun-Ichi

    2016-08-01

    Hyperbilirubinemia (HB) is sometimes encountered following bile-duct cannulation in rats. It possibly originates from the reduced functioning of multidrug resistance-associated protein 2 (Mrp2) and subsequent adaptive alterations in the expression of Mrp3 and the organic anion transporting polypeptides (Oatps). Our aim was to clarify the importance of excluding bile-duct-cannulated (BDC) rats with HB for proper conduct of drug excretion studies. We detected HB [serum total bilirubin concentration (TBIL) ≥0.20 mg/dl] in 16% of all BDC rats prepared. The serum activities of aspartate aminotransferase, alanine aminotransferase, leucine aminopeptidase, and alkaline phosphatase were within the respective normal ranges in the BDC rats with mild HB (TBIL, 0.20-0.79 mg/dl), indicating the absence of hepatic failure. In the pharmacokinetics of pravastatin, an Oatps/Mrp2 probe drug in the BDC rats, the apparent volume of distribution and the clearance were smaller in the mild HB group as compared with the normal group, suggesting the reduction of apparent hepatic uptake and hepatobiliary elimination. The biliary excretion (percentage of dose) was significantly reduced by 54%, suggesting that the biliary efflux activity via Mrp2 was reduced to a greater extent relative to metabolic activity in hepatocytes. The serum γ-glutamyltransferase (GGT) activity correlated with TBIL and inversely correlated with biliary excretion of pravastatin, a finding which could serve as a clue to uncover the regulatory system involving cooperation between GGT and Mrp2. In conclusion, BDC rats with HB, however mild, should be excluded from drug excretion studies to avoid the risk of underestimation of the biliary excretion of drugs. PMID:27208382

  10. Downregulation of AQP2 and AQP2 mRNA expression in kidney medulla of rats with bile duct ligation

    Institute of Scientific and Technical Information of China (English)

    Yong Wang; Jin-Gang Liu; Ji-Long Han

    2007-01-01

    BACKGROUND:Obstructive jaundice is a common disease. Acute renal injury, secondary to obstructive jaundice, is one of the main causes of postoperative multiple system failure. This investigation evaluated renal function and renal aquaporin 2 (AQP2) expression changes in obstructive jaundice. METHODS:Forty male Wistar rats were equally randomized into two groups. Twenty in the obstructive jaundice group were subjected to common bile duct ligation, and then were subdivided into 7- and 14-day obstruction groups, and the other 20 sham-operated rats were also subdivided into 7- and 14-day groups. At the end of each experiment, rats were sacriifced, venous blood was collected from the inferior vena cava, and serum creatinine and urine nitrogen concentrations were measured. At the same time, the medulla of the right kidney was separated and AQP2 expression was assessed. The RT-PCR technique was used to detect AQP2 mRNA expression. RESULTS:Ligation of the common bile duct caused signiifcant rises in serum bilirubin, creatinine clearance and urine nitrogen. AQP2 expression in the medulla decreased mere signiifcantly (38.35±2.08) in the 7-day ligation group than in the sham-operated group (41.06± 1.04), as did that in the 14-day ligation group, even more than (31.89±1.57). The expression of AQP2 mRNA also decreased more signiifcantly in the 14-day group (0.5429± 0.1107) than in the 7-day group (0.6071±0.1328).CONCLUSION:AQP2 expression is inhibited in obstructive jaundice, and so is its gene expression.

  11. Stepwise approach to curative surgery using percutaneous transhepatic cholangiodrainage and portal vein embolization for severe bile duct injury during laparoscopic cholecystectomy: a case report.

    Science.gov (United States)

    Honmyo, Naruhiko; Kuroda, Shintaro; Kobayashi, Tsuyoshi; Ishiyama, Kohei; Ide, Kentaro; Tahara, Hiroyuki; Ohira, Masahiro; Ohdan, Hideki

    2016-12-01

    Laparoscopic cholecystectomy (LC) has been recently adapted to acute cholecystitis. Major bile duct injury during LC, especially Strasberg-Bismuth classification type E, can be a critical problem sometimes requiring hepatectomy. Safety and definitive treatment without further morbidities, such as posthepatectomy liver failure, is required. Here, we report a case of severe bile duct injury treated with a stepwise approach using (99m)Tc-galactosyl human serum albumin ((99m)Tc-GSA) single-photon emission computed tomography (SPECT)/CT fusion imaging to accurately estimate liver function.A 52-year-old woman diagnosed with acute cholecystitis underwent LC at another hospital and was transferred to our university hospital for persistent bile leakage on postoperative day 20. She had no jaundice or infection, although an intraperitoneal drainage tube discharged approximately 500 ml of bile per day. Recorded operation procedure showed removal of the gallbladder with a part of the common bile duct due to its misidentification, and each of the hepatic ducts and right hepatic artery was injured. Abdominal enhanced CT revealed obstructive jaundice of the left liver and arterial shunt through the hilar plate to the right liver. Magnetic resonance cholangiopancreatography revealed type E4 or more advanced bile duct injury according to the Bismuth-Strasberg classification. We planned a stepwise approach using percutaneous transhepatic cholangiodrainage (PTCD) and portal vein embolization (PVE) for secure right hemihepatectomy and biliary-jejunum reconstruction and employed (99m)Tc-GSA SPECT/CT fusion imaging to estimate future remnant liver function. The left liver function rate had changed from 26.2 % on admission to 26.3 % after PTCD and 54.5 % after PVE, while the left liver volume rate was 33.8, 33.3, and 49.6 %, respectively. The increase of liver function was higher than that of volume (28.3 vs. 15.8 %). On postoperative day 63, the curative operation, right

  12. EUS diagnosis of ectopic opening of the common bile duct in the duodenal bulb: A case report

    Institute of Scientific and Technical Information of China (English)

    Miodrag Krstic; Bojan Stimec; Radmilo Krstic; Milenko Ugljesic; Srbislav Knezevic; Ivan Jovanovic

    2005-01-01

    Among the various congenital anomalies of the biliary system,an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male was admitted to hospital for severe right upper quadrant abdominal pain,followed by fever, chills, elevated body temperature and mild icterus. The diagnosis of ectopic opening of CBD in the duodenal bulb was established on endoscopic ultraso-nography (EUS),which clearly demonstrated dilated CBD, with multiple stones and air in the lumen, draining into the bulb. A normal pancreatic duct, which did not drain into the bulb, was also observed. This finding was confirmed on ERCP and surgery.As far as we know, this is the first case of this anomaly diagnosed by EUS. Ectopic opening of the CBD in the duodenal bulb is not an incidental finding, but a pathologic condition which can be associated with clinical entities such as recurrent or intractable duodenal ulcer, recurrent biliary pain,choledocholithiasis or acute cholangitis. Endoscopic ultrasonography features allow preoperative diagnosis of this anomaly and can replace ERCP as a first diagnostic tool in such clinical circumstances. Embryology of the anomalies of the extrahepatic biliary tree has been also reviewed.

  13. [Common bile duct distomatosis managed by coelioscopic aproach. One case report].

    Science.gov (United States)

    Khelifi, Slim; Bouhafa, Ahmed; Ouertani, Fethi; Ben Maamer, Anis; Hedfi, Mohamed; Cherif, Abderraouf; Ghorbel, Abdeljabbar; Letaief, Abdelmajid

    2006-06-01

    Biliary distomatosis is caused by a parasitis of trematode family: the fascialo hepatica. It is a rare affection in Tunisia. The diagnostic is often done in the status phase. Adult parasite stay preferentially at biliary ducts, cause obstruction and cholangitis. The authors report a case of biliary treated successfully by laparoscopic procedure. PMID:17042216

  14. Effect of sirolimus on renal injury induced by bile duct ligation in rats Efeito do sirolimo na lesão renal induzida pela ligadura do ducto biliar em ratos

    OpenAIRE

    Hulya Ozturk; Akan Terzi; Hayrettin Ozturk; Aysel Kukner

    2010-01-01

    PURPOSE: To evaluate the effects of sirolimus (SRL) on renal injury in rats with bile duct ligation. METHODS: A total of 21 male Sprague-Dawley rats weighing 220-260g were used. Group 1 (Sham-control, n=7) rats were undergone laparotomy alone and bile duct was just dissected from the surrounding tissue. Group 2 rats (BDL/Untreated, n=7) were subjected to bile duct ligation and no drug was applied. Group 3 rats (BDL/SRL, n =7) received a daily dose of sirolimus (0.5 mg·day-1xkg-1 dissolved 1 m...

  15. 胆总管内乳头状瘤1例报告%Report of 1 case common bile duct papilloma

    Institute of Scientific and Technical Information of China (English)

    刘钰檩; 李光一; 偰光华

    2016-01-01

    Bile duct papilloma is a benign tumor originating from the epithelium of bile duct.It is rare in clinic.Its etiology and pathogenesis are still not very clear,and it is generally believed that the long-term stimulation of the bile duct stones and inflammation.Because of the lack of specificity of the clinical manifestations of the disease,it is more difficult to diagnose before operation,and it is easy to be misdiagnosed,and there is no uniform standard for treatment.The clinical manifestations,laboratory data,auxiliary examination and diagnosis and treatment of 1 case of common bile duct papilloma were reported in this paper,in order to provide clinical data for the clinical study of intrahepatic duct papilloma.%胆管内乳头状瘤是起源于胆管黏膜上皮的良性肿瘤,临床上较为罕见。其病因及发病机制仍不十分清楚,现普遍认为与胆道结石和炎症的长期刺激有关。因此病临床表现缺乏特异性,故术前诊断较为困难,容易误诊,且目前治疗方法无统一的标准。本文报告1例胆总管内乳头状瘤患者的临床表现、辅助检查资料及诊疗过程,为胆管内乳头状瘤的临床研究提供临床资料。

  16. Pathological changes of bile duct injury after orthotopic liver transplantation%原位肝移植后胆管损伤的病理学改变

    Institute of Scientific and Technical Information of China (English)

    谭文翔; 杨玉龙; 王晓光; 付维利

    2008-01-01

    背景:肝移植术后胆道损伤引起的并发症是临床上诊治的难点,是抑制肝移植发展的瓶颈.目的:在成功应用胆道内镜治疗肝移植术后胆道并发症的同时,对胆管的损伤进行观察记录并取活检病理,分析不同胆管损伤、组织病理学类型与肝移植术后胆管并发症的关系.设计、时间及地点:病例分析,于2001-07/2005-10在大连市肝胆外科研究所,友谊医院肝胆外科完成.对象:将19例肝移植术后患者根据胆管并发症发生情况分为3组:正常组4例,胆管损伤组12例,肝动脉损伤组3例.方法:利用内镜技术,分别对3组患者进行胆管观察、记录.内镜下取活检进行病理分析.对于无T管者,应用子母胆道镜观察、取活检.主要观察指标:应用胆道内镜观察T管造影、肝内外胆管黏膜外观及病理学检查结果、供-受体胆管吻合口的愈合情况.胆管损伤组经内镜取石、狭窄扩张治疗后行上述指标的复查.结果:①正常组患者肝内外胆管解剖正常,无狭窄、瘢痕,胆管黏膜颜色正常,供-受体胆管吻合口愈合佳.病理学检查均可见修复性的黏膜组织,被覆上皮完整.②胆管损伤组患者胆管内有各种类型的单发、多发及铸型结石,胆管均有不同程度损伤,经内镜取净结石、解除梗阻后,胆管黏膜均有不同程度的修复,造影检查胆树恢复正常.⑨肝动脉损伤组患者胆管壁缺血坏死,丧失胆管的组织结构,明显充血,胆泥和结石完全灌满供体胆树,Ⅲ级胆管间断具有胆管的组织结构;病理学检查发现胆管壁弥漫坏死,结构不清,大量胆汁渗入,可见增生的肉芽组织和化脓灶.结论:在原位肝移植中胆管均有不同程度的损伤,冷保存/再灌注损伤是导致胆管树损害最重要的始动因素,胆管周围血管丛的损伤和微循环障碍可能是胆管损伤的途径之一.%BACKGROUND: Complications, caused by bile duct injury after liver

  17. Protective effect of low dose of melatonin against cholestatic oxidative stress after common bile duct ligation in rats

    Institute of Scientific and Technical Information of China (English)

    Mukaddes Esrefoglu; Mehmet Gül; Memet Hanifi Emre; Alaattin Polat; Mukadder Ayse Selimoglu

    2005-01-01

    AIM: To investigate the role of oxidative injury and the effect of exogenous melatonin administration on liver damage induced by bile duct ligation (BDL), and second,to evaluate the role of nitric oxide (NO), a free oxygen radical, in oxidative injury.METHODS: Thirty-two Sprague-Dawley rats were assigned to four groups: sham operation (SO), BDL, BDL+melatonin,and BDL+vehicle. Cholestasis was achieved by double ligature of the common bile duct. Melatonin was injected intraperitoneally 500 μg/(kg.d) for 8 d. Hepatic oxidative stress markers were evaluated by changes in the amount of lipid peroxides, measured as malondialdehyde (MDA),and reduced GSH. Total nitrite (NOx) concentrations were determined in hepatic homogenates. Histopathological examination was performed using a histological scoring system.RESULTS: The histopathological changes including portal inflammation, necrosis, apoptosis, focal inflammation and fibrosis were severe in the BDL and BDL+vehicle groups. There were numerous large areas of coagulation necrosis. Histological Activity Index scores of these groups were significantly higher than that of the SO group. Treatment with melatonin reduced these alterations significantly. The degree of necro-infiammation and fibrosis showed significant difference between the BDL and BDL+melatonin groups. BDL was accompanied by a significant increase in MDA and NOx, and a significant decrease in GSH levels. Mean±SE values of MDA, GSH and NOx levels of SO group were 147.47±6.69, 0.88±0.33 μmol/g and 180.70±6.58 nm/g, respectively. The values of BDL group were 200.14±21.30, 0.65±0.02 μmol/g, and 400.46±48.89 nm/g, respectively, whereas the values of BDL+melatonin group were 115.93±6.8, 0.74±0.02 μmol/g,and 290.38±32.32 nm/g, respectively. Melatonin treatment was associated with a significant recovery of MDA, GSH and NOx levels.CONCLUSION: We have concluded that oxidative stress is associated with the pathogenesis of cholestatic liver damage and NO

  18. Percutaneous drainage and stenting for palliation of malignant bile duct obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Delden, Otto M. van; Lameris, Johan S. [Academic Medical Center of the University of Amsterdam, Department of Radiology, Amsterdam (Netherlands)

    2008-03-15

    Percutaneous biliary drainage and stenting (PTBD) for palliation of malignant obstructive jaundice has evolved to a safe and effective technique. PTBD is equally effective for treatment of distal and proximal bile obstruction. Metal self-expandable stents have proved superior to plastic stents and should therefore be used. Technical success is >90% en clinical success is >75% in all major series. There are a considerable number of complications, but most can be treated conservatively and procedure-related mortality is <2% in most series. Thirty-day mortality after PTBD is >10% in many series, but this is largely due to the underlying disease. About 10-30% of patients will have recurrent jaundice at some point in their disease after PTBD and require re-intervention. (orig.)

  19. Routine magnetic resonance cholangiography compared to intra-operative cholangiography in patients with suspected common bile duct stones

    Institute of Scientific and Technical Information of China (English)

    Fariborz Eshghi; Roohollah Abdi

    2008-01-01

    BACKGROUND:Magnetic resonance cholangiography (MRC) is a non-invasive method for imaging biliary ducts. When used to exclude common bile duct (CBD) stones, MRC may obviate the need for intra-operative cholangiography (IOC). In this prospective study, MRC and IOC were compared for the diagnosis of suspected stones of the CBD. METHODS:Thirty patients with gallstones and suspected CBD lithiasis (abnormal serum liver tests and CBD>7 mm on ultrasound) had MRC followed by open cholecystectomy and IOC. MR imaging was done using a 1.5-T whole body scanner (Signa, General Electric Medical Systems). A torso phased-array coil with a 4-channel receiver was used for data acquisition. RESULTS:Over a period of 18 months, 30 patients (average age 53.9±13.3 years; range 38-76 years) were enrolled in this study. Eleven patients were male (36.7%) and 19 female (63.3%). MRC revealed CBD stones in 19 patients, while IOC revealed CBD stones in 22. The sensitivity of MRC in detecting CBD stones was 81.8%, and the speciifcity was 87.5%. The positive predictive value was 94.7%, and the negative predictive value was 63.3%. CONCLUSIONS:Pre-operative MRC may obviate the need for IOC. MRC reduces operative time, is less invasive, and may also alleviate damage to the CBD that can occur during IOC. MRC can identify CBD stones pre-operatively and can help surgeons plan safe procedures. Pre-operative MRC should be done routinely in patients whose clinical or biochemical ifndings suggest the possibility of CBD stones.

  20. Design and development of artificial substitute for bile duct%人工胆管替代物的设计与发展

    Institute of Scientific and Technical Information of China (English)

    刘凯; 刘松阳; 王广义

    2008-01-01

    学术背景:胆道手术后易发生胆管狭窄、反复胆道逆行感染乃至胆汁性肝硬化等并发症,人们一直在寻求一种人工胆管替代物来解决胆道修复与重建的难题.目的:对长期以来的相关研究及文献进行回顾,综合人工胆管设计和应用的最新进展,以期设计出最合理的人工胆管替代物.检索策略:作者通过计算机检索PubMed数据库(http://www.pubmed.gov/)1950-01/2007-12有关人工胆管的文献,检索词为"atticial bile duct,stem cell,tissue engineering",限定语言种类为English.同时检索中国全文期刊数据库(http://www.cnki.net)1994-01/2007-12有关人工胆管的文献,检索词为"人工胆管,干细胞,组织工程",限定语言种类为中文.纳入标准:①有关人工胆管的实验与临床研究.②有关干细胞临床应用的研究.③有关组织工程生物相容性材料的研究.排除标准:重复研究.对资料进行初审,并查找全文.共收集到相关文献414篇,纳入37篇.文献评价:37篇文献中人工胆管研究背景10篇,自体移植5篇,干细胞技术5篇,纳米技术、机械胆管结构及高分子材料5篇,最新进展12篇.资料综合:通过对入选文献进行分析整理,将人工胆管替代物从生物相容性材料和生物医学工程方面进行分析.人工胆管替代物在自体移植、机械结构、纳米技术、干细胞技术和组织工程高分子材料等方面分别取得了各自进展,目前更加倾向于组织工程高分子材料.更合理的人工胆管替代物有待进一步研究.结论:人工胆管的设计研究虽然在多个方面获得进展,但因自体移植、机械结构、纳米技术以及干细胞技术各自存在难以克服的弊端和限制,使其无法获得突破性成果.组织工程高分子材料成为目前人工胆管设计的主要方向.%BACKGROUND:The operation of bile duet has always been the most difficult part in the general surgery.The Patients have a high morbidity

  1. Three-dimensional visualization of the microvasculature of bile duct ligation-induced liver fibrosis in rats by x-ray phase-contrast imaging computed tomography

    OpenAIRE

    Xuan, Ruijiao; Zhao, Xinyan; Hu, Doudou; Jian, Jianbo; Wang, Tailing; HU, CHUNHONG

    2015-01-01

    X-ray phase-contrast imaging (PCI) can substantially enhance contrast, and is particularly useful in differentiating biological soft tissues with small density differences. Combined with computed tomography (CT), PCI-CT enables the acquisition of accurate microstructures inside biological samples. In this study, liver microvasculature was visualized without contrast agents in vitro with PCI-CT using liver fibrosis samples induced by bile duct ligation (BDL) in rats. The histological section e...

  2. A Unique Use of a Double-Pigtail Plastic Stent: Correction of Kinking of the Common Bile Duct Due to a Metal Stent

    OpenAIRE

    Kuwatani, Masaki; Kawakami, Hiroshi; Abe, Yoko; Kawahata, Shuhei; Kawakubo, Kazumichi; Kubo, Kimitoshi; Sakamoto, Naoya

    2015-01-01

    A 72-year-old man with jaundice by ampullary adenocarcinoma was treated at our hospital. For biliary decompression, a transpapillary, fully covered, self-expandable metal stent (FCSEMS) was deployed. Four days later, the patient developed acute cholangitis. Endoscopic carbon dioxide cholangiography revealed kinking of the common bile duct above the proximal end of the FCSEMS. A 7-F double-pigtail plastic stent was therefore placed through the FCSEMS to correct the kink, straightening the comm...

  3. Comparative evaluation of angiography and computed tomography in 34 cases with malignant neoplasm of the liver, bile duct, gallbladder and pancreas

    International Nuclear Information System (INIS)

    In 34 cases with malignant neoplasm of the liver, bile duct, gallbladder and pancreas, angiographic and CT finding were studied. 1) As CT findings, the margin of many hepatomas and almost all liver metastasis were able to be found except for some hepatomas. In many hepatomas, it was also found that there were lower parts in low density area. These lesions are seemed due to necrosis or hemorrhage. Metastatic carcinomas which had angiographic finding of much diffuse hypervasculature were seen as uniform low density area. On the other hand, those which had peripheral hypervasculature and of which the angiographic findings were some ring-like tumor stains were shown as the more obvious low density areas. These lesions became smaller by contrast enhancement, because the peripheral part of the lesion was changed to isodensity as normal liver. This phenomenon was not seen in the large a vasculer liver metastasis. 2) The dilatation of the partial intrahepatic bile duct was found in many intrahepatic cholangiomas (hiler type), but rare in hepatoma and liver metastasis. At the same time, CT showed low density areas which had ill-defined margin and did not coincide with tumor location. The low density area may suggest inflammatory change but it was not certified why these area did not coincide with tumor location. 3) In most extrahepatic bile duct carcinoma, the encasement of portal vein was shown on angiography. CT showed bile duct dilatation in all patient. These two findings might be rarely found in gallbladder carcinoma because of its location. 4) Unresectable pancreas carcinomas were easily diagnosed by CT and angiography, but it is impossible to find early pancreas carcinoma by conventional second generation CT examination. (author)

  4. CT findings of intraductal papillary neoplasm of the bile duct: Assessment with multiphase contrast-enhanced examination using multi-detector CT

    Energy Technology Data Exchange (ETDEWEB)

    Ogawa, H., E-mail: ogawa.hiroshi@h.mbox.nagoya-u.ac.jp [Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Itoh, S. [Department of Radiology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya (Japan); Nagasaka, T. [Department of Medical Technology, Nagoya University School of Health Sciences, Nagoya (Japan); Suzuki, K. [Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Ota, T. [Department of Radiology, Aichi Medical University Hospital, Nagakute Aichi (Japan); Naganawa, S. [Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya (Japan)

    2012-03-15

    Aim: To evaluate multi-detector computed tomography (MDCT) findings of intraductal papillary neoplasm of the bile duct (IPNB), a neoplasm that is considered to be the biliary counterpart of pancreatic intraductal papillary mucinous neoplasm. Materials and methods: Two radiologists retrospectively evaluated multiphase contrast-enhanced CT images with 0.5 or 1 mm collimation in 37 consecutive patients with resected IPNB diagnosed by a single pathologist. The CT findings were correlated with the pathological findings concerning invasion of the surrounding organs and vessels. Results: All patients showed bile duct dilatation. An intraductal mass was detected in 36 patients and the following findings were observed: extensive infiltration along the bile duct more than 20 mm (n = 32), compared with normal hepatic parenchyma, isodense or hyperdense during the late arterial phase (n = 31), not hyperdense during the portal-venous and delayed phases (n = 36), and intense enhancement rim at the base of the mass during the portal-venous or delayed phase (n = 27). Parenchymal invasion of the surrounding organs was seen in eight of 16 tumours showing irregular or bulging margins. Vascular invasion was false positive in four of eight tumours. Conclusions: IPNB exhibits relatively characteristic findings with multiphase contrast-enhanced examination using MDCT. A tendency to overestimate invasion of the surrounding organs and vessels was seen.

  5. Effect of preoperative biliary drainage on surgical results after pancreaticoduodenectomy in patients with distal common bile duct cancer:Focused on the rate of decrease in serum bilirubin

    Institute of Scientific and Technical Information of China (English)

    Yun Mee Choi; Seok-Hwan Shin; Kyung Rae Kim; Ze-Hong Woo; Eung-Ho Cho; Keon-Young Lee; Seung-Ik Ahn; Sun Keun Choi; Sei Joong Kim; Yoon Seok Hut; Young Up Cho; Kee-Chun Hang

    2008-01-01

    AIM:To examine if the rate of decrease in serum bilirubin after preoperative biliary drainagecan be used as a predicting factor for surgical complications and postoperative recovery after pancreaticoduodenectomy in patients with distal common bile duct cancer.METHODS:A retrospective study was performed in 49 consecutive patients who underwent pancreaticoduodenectomy for distal common bile duct cancer.Potential risk factors were compared between the complicated and uncomplicated groups.Also,the rates of decrease in serum bilirubin were compared pre-and postoperatively.RESULTS:Preoperative biliary drainage (PBD) was performed in 40 patients (81.6%).Postoperative morbidity and mortality rates were 46.9% (23/49) and 6.1% (3/49),respectively.The presence or absence of PBD was not different between the complicated and uncomplicated groups.In patients with PBD,neither the absolute level nor the rate of decrease in serum bilirubin was significantly different.Patients with rapid decrease preoperatively showed faster decrease during the first postoperative week (5.5±4.4 μmol/L vs-1.7±9.9μmol/L,P=0.004).CONCLUSION:PBD does not affect the surgical outcome of pancreaticoduodenectomy in patients with distal common bile duct cancer.There is a certain group of patients with a compromised hepatic excretory function,which is represented by the slow rate of decrease in serum bilirubin after PBD.

  6. Swertianlarin, an Herbal Agent Derived from Swertia mussotii Franch, Attenuates Liver Injury, Inflammation, and Cholestasis in Common Bile Duct-Ligated Rats

    Directory of Open Access Journals (Sweden)

    Liangjun Zhang

    2015-01-01

    Full Text Available Swertianlarin is an herbal agent abundantly distributed in Swertia mussotii Franch, a Chinese traditional herb used for treatment of jaundice. To study the therapeutic effect of swertianlarin on cholestasis, liver injury, serum proinflammatory cytokines, and bile salt concentrations were measured by comparing rats treated with swertianlarin 100 mg/kg/d or saline for 3, 7, or 14 days after bile duct ligation (BDL. Serum alanine aminotransferase (ATL and aspartate aminotransferase (AST levels were significantly decreased in BDL rats treated with swertianlarin for 14 days (P<0.05. The reduced liver injury in BDL rats by swertianlarin treatment for 14 days was further confirmed by liver histopathology. Levels of serum tumor necrosis factor alpha (TNFα were decreased by swertianlarin in BDL rats for 3 and 7 days (P<0.05. Moreover, reductions in serum interleukins IL-1β and IL-6 levels were also observed in BDL rats treated with swertianlarin (P<0.05. In addition, most of serum toxic bile salt concentrations (e.g., chenodeoxycholic acid (CDCA and deoxycholic acid (DCA in cholestatic rats were decreased by swertianlarin (P<0.05. In conclusion, the data suggest that swertianlarin derived from Swertia mussotii Franch attenuates liver injury, inflammation, and cholestasis in bile duct-ligated rats.

  7. Antiproliferation and apoptosis induced by tamoxifen in human bile duct carcinoma QBC939 cells via upregulated p53 expression

    Energy Technology Data Exchange (ETDEWEB)

    Han, Peng; Kang, Jin-He; Li, Hua-Liang [Key Laboratory of Ministry of Education for Cell Biology and Tumor Cell Engineering, School of Life Sciences, Xiamen University, Xiamen 361005 (China); Hu, Su-Xian [First Hospital Attached to Fujian Medical University, Xiamen 361004 (China); Lian, Hui-Hui; Qiu, Ping-Ping; Zhang, Jian [Key Laboratory of Ministry of Education for Cell Biology and Tumor Cell Engineering, School of Life Sciences, Xiamen University, Xiamen 361005 (China); Li, Wen-Gang, E-mail: lwg11861@163.com [First Hospital Attached to Fujian Medical University, Xiamen 361004 (China); Chen, Qing-Xi, E-mail: chenqx@xmu.edu.cn [Key Laboratory of Ministry of Education for Cell Biology and Tumor Cell Engineering, School of Life Sciences, Xiamen University, Xiamen 361005 (China); Key Laboratory for Chemical Biology of Fujian Province, Xiamen University, Xiamen 361005 (China)

    2009-07-24

    Tamoxifen (TAM) is a nonsteroidal antiestrogen that has been used in the treatment of breast cancer for over 30 years. Recently, it was shown that TAM also has efficacy on gastrointestinal neoplasms such as hepatocarcinoma and pancreatic carcinoma, and that the chemopreventive activities of TAM might be due to its abilities to inhibit cell growth and induce apoptosis. In the present study, we investigated the effects of tamoxifen on growth and apoptosis in the human bile duct carcinoma (BDC) cell line QBC939 using MTT assay, inverted microscopy, fluorescence microscopy, transmission electron microscopy, classic DNA fragmentation agarose gel electrophoresis assay, PI single- and FITC/PI double-staining flow cytometry, and Western blotting. Our data revealed that TAM could significantly inhibit growth and induce apoptosis in QBC939 cells. Increased expression of p53 was observed in TAM-treated cells, indicating that p53 might play an important role in TAM-induced apoptosis in QBC939 cells. These results provide significant insight into the anticarcinogenic action of TAM on BDC.

  8. Antiproliferation and apoptosis induced by tamoxifen in human bile duct carcinoma QBC939 cells via upregulated p53 expression

    International Nuclear Information System (INIS)

    Tamoxifen (TAM) is a nonsteroidal antiestrogen that has been used in the treatment of breast cancer for over 30 years. Recently, it was shown that TAM also has efficacy on gastrointestinal neoplasms such as hepatocarcinoma and pancreatic carcinoma, and that the chemopreventive activities of TAM might be due to its abilities to inhibit cell growth and induce apoptosis. In the present study, we investigated the effects of tamoxifen on growth and apoptosis in the human bile duct carcinoma (BDC) cell line QBC939 using MTT assay, inverted microscopy, fluorescence microscopy, transmission electron microscopy, classic DNA fragmentation agarose gel electrophoresis assay, PI single- and FITC/PI double-staining flow cytometry, and Western blotting. Our data revealed that TAM could significantly inhibit growth and induce apoptosis in QBC939 cells. Increased expression of p53 was observed in TAM-treated cells, indicating that p53 might play an important role in TAM-induced apoptosis in QBC939 cells. These results provide significant insight into the anticarcinogenic action of TAM on BDC.

  9. Oleanolic acid attenuates obstructive cholestasis in bile duct-ligated mice, possibly via activation of NRF2-MRPs and FXR antagonism.

    Science.gov (United States)

    Chen, Pan; Li, Jingjie; Fan, Xiaomei; Zeng, Hang; Deng, Rongrong; Li, Dongshun; Huang, Min; Bi, Huichang

    2015-10-15

    Obstructive cholestasis is characterized by impairment of hepatic canalicular bile efflux and there are no clinically effective drugs to cure except surgeries. Previously we revealed that oleanolic acid (OA) protected against lithocholic acid (LCA)-induced intrahepatic cholestasis in mice. Cholestasis caused by LCA is characterized by segmental bile duct obstruction, whether OA possesses the beneficial effect on completed obstructive cholestasis induced by bile duct ligation (BDL) remains unknown. In this study, we demonstrated that BDL-induced mice liver pathological change, and increase in serum levels of ALT, AST and ALP were all significantly reduced by OA (20 mg/kg, i.p.). Meanwhile, OA also lowered total bilirubin and total bile acids levels in serum, as well as total bile acids level in liver, in contrast, urinary total bile acids output was remarkably up-regulated by OA. Gene expression analysis showed that OA caused significant increased mRNA expression of MRP3 and MRP4 located at hepatic basolateral membrane, and restoration of MRP2 and BSEP located at hepatic cannalicular membrane. Furthermore, significant NRF2 protein accumulation in nucleus was also observed in OA treated mice. In mice primary cultured hepatocytes, the effects of OA on MRP2, MRP3 and MRP4 expression were directly proved to be mediated via NRF2 activation, and BSEP downregulation induced by OA was in part due to FXR antagonism. Luciferase assay performed in Hep G2 cells also illustrated that OA was a partial FXR antagonist. Taken together, we conclude that OA attenuates obstructive cholestasis in BDL mice, possibly via activation of NRF2-MRPs and FXR antagonism. PMID:26297978

  10. The Effect Observe of Hepatic Left Lateral Lobectomy Big Cholangiojejunostomy in Treatment of Intrahepatic Bile Duct Stones With Bile Duct Stricture%肝内胆管结石合并胆管狭窄采用肝左外叶切除大口胆肠内引流治疗的效果观察

    Institute of Scientific and Technical Information of China (English)

    敖文革

    2015-01-01

    目的:探讨肝内胆管结石合并胆管狭窄采用肝左外叶切除大口胆肠内引流治疗的临床疗效。方法对我院接收的38例行肝左外叶切除大口胆肠内引流治疗的肝内胆管结石合并胆管狭窄患者的临床资料进行回顾性分析。结果本组38例患者中优良35例,其优良率为92.1%,术后肺部感染1例,切口感染1例,经针对性处理后均痊愈。结论肝内胆管结石合并胆管狭窄采用肝左外叶切除大口胆肠内引流治疗可取得较好的效果,临床价值较高。%Objective To investigate the effect observe of hepatic left lateral lobectomy big cholangiojejunostomy in treatment of intrahepatic bile duct stones with bile duct stricture.Methods Retrospectively analyses the clinical data of 38 cases of patients in left liver with big cholangiojejunostomy in treatment of hepatolithiasis with bile duct stricture in our hospital. Results35 cases were excelent in this group of 38 cases,the excelent rate was 92.1%,1 case of postoperative pulmonary infection,1 case of incision infection,al of patients were cured with targeted treatment.Conclusion The intrahepatic bile duct stones with bile duct stenosis with left lateral lobectomy of liver in big cholangiojejunostomy in treatment can achieve good effect,the higher clinical value.

  11. The Application of Damage Control Operation in Ultrasound interventional treatment of Bile Duct Injury%超声介入行损伤控制性手术在胆道损伤中的临床分析

    Institute of Scientific and Technical Information of China (English)

    黄明; 孙锋; 唐波; 孙琰; 张庶; 寸冬云

    2011-01-01

    Objective To explore the application of damage control operation ( DCO) in ultrasound interventional treatment of bile duct injury. Methods Clinical data of 19 cases with severe bile duct injury from December 2003 to December 2009 were selected as the object of this study, which Ultrasound interventional method was used in the damage control operation. DCO was performed in all 19 patients. PTCD was performed in 13 patients. Abdominal paracentesis drainage and/or hepatophyma and biloma drainage was performed in 6 patients. Results Among 19 patients, 17 patients underwent reoperation after patient's condition were ameliorated by drainage, symptomatic and supportive treatment, and no complications such as stricture of bile duct occurred during 24 months of median follow-up. Cholestasis hepatic cirrhosis was found in 1 patients who was waiting for liver transplantation. 1 patient died of severe pulmonary infection. Conclusion To reduce complications and increase survival rate, severe trauma patients with bile duct injury should be made positively under DCO and choose appropriate ultrasound interventional method.%目的 分析探讨超声介入方法行损伤控制性手术(DCO)在治疗胆道损伤中的应用.方法 回顾分析2003年12月至2009年12月期间超声介入方法实现DCO治疗19例胆道损伤患者的临床资料;19例胆道损伤患者均按DCO原则治疗:13例行PTCD引流胆汁,6例行腹腔穿刺引流和/或肝脓肿及胆汁瘤引流.结果19例病人中17例(89.5%)通过引流、对症、支持治疗,病情稳定接受再次确定性手术,中位随访期24个月,无术后胆管狭窄等并发症;1例病人胆汁淤积性肝硬化,等待肝移植,1例死于严重地肺部感染.结论 胆道损伤严重的患者,积极按照DCO原则,选用超声介入方式恰当处理,可以达到减少并发症和提高存活率的目的.

  12. The study between the dynamics and the X-ray anatomy and regularizing effect of gallbladder on bile duct sphincter of the dog

    Institute of Scientific and Technical Information of China (English)

    Jing-Guo Wei; Yao-Cheng Wang; Guo-Min Liang; Wei Wang; Bao-Ying Chen; Jia-Kuan Xu; Li-Jun Song

    2003-01-01

    AIM: To study the relationship between the radiological anatomy and the dynamics on bile duct sphincter in bile draining and regulatory effect of gallbladder.METHODS: Sixteen healthy dogs weighing 18 kg to 25 kg were divided randomly into control group and experimental group (cholecystectomy group). Cineradiography, manometry with perfusion, to effect of endogenous cholecystokinin and change of ultrastructure were employed.RESULTS: According to finding of the choledochography and manometry, in control group the intraluminal basal pressure of cephalic cyclic smooth muscle of choledochal sphincter cCS was 9.0+2.0 mmHg and that of middle oblique smooth muscle of choledochal sphincter (mOS) was 16.8+0.5 mmHg,the intraluminal basal pressure of cCS segment was obviously lower than that of mOS (P<0.01) in the interval period of bile draining, but significant difference of intraluminal basal pressure of the mOS segment was not found between the interval period of bile draining (16.8+0.5 mmHg) and the bile flowing period (15.9±0.9 mmHg) (P>0.05). The motility of cCS was mainly characterized by rhythmically concentric contraction, just as motility of cCS bile juice was pumped into the mOS segment in control group. And motility of mOS segment showed mainly diastolic and systolic activity of autonomically longitudinal peristalsis. There was spasmodic state in cCS and mOS segment and reaction to endogenous cholecystokinin was debased after cholecystectomy. The change of ultrastructure of cCS portion showed mainly that the myofilaments of cell line in derangement and mitochondria is swelling.CONCLUSION: During fasting, the cCS portion has a function as similar cardiac "pump" and it is main primary power source in bile draining, and mOS segment serves mainly as secondary power in bile draining. The existence of the intact gallbladder is one of the important factors in guaranteeing the functional coordination between the cCS and mOS of bile duct sphincter. There is

  13. A meta-analysis for the effect of prophylactic GTN on the incidence of post-ERCP pancreatitis and on the successful rate of cannulation of bile ducts

    Directory of Open Access Journals (Sweden)

    Wang Chun-hui

    2010-07-01

    Full Text Available Abstract Background Glyceryl trinitrate (GTN has been shown to be able to relax the sphincter of Oddi (SO both in animals and humans. Theoretically, the use of these compounds during and after endoscopic retrograde cholangiopancreatgraphy (ERCP could relax the biliary and pancreatic sphincters, facilitating cannulation of common bile duct (CBD during the procedure, or minimizing potential pancreatic outflow obstruction after the procedure. However, clinical trials evaluating the protective effect of GTN on the post-endoscopic retrograde cholangiopancreatgraphy pancreatitis (PEP have yielded inconclusive results. This meta-analysis is to systematically assess the effect of prophylactic administration of glyceryl trinitrate (GTN on the prevention of PEP and the effect on the cannulation of bile ducts. Methods By searching PubMed (1966 to September 2009, CENTRAL (Cochrane Controlled trials Register; issue 3, 2009 and EMBASE.com (1984 to September 2009, two independent reviewers systematically identified prospective randomized controlled trials (RCTs detecting the effect of prophylactic GTN on the incidence of PEP and on the cannulation of bile ducts. A meta-analysis of these clinical trials was then performed. Results There are 55/899(6.1% patients suffering PEP in the treatment group versus 95/915(10.4% patients in the placebo group. The overall pooled risk of PEP was significantly lower in the GTN group than in the placebo group (OR 0.56, 95% CI: 0.40 to 0.79, p = 0.001. Subgroup analyses suggested that GTN administered by the sublingual form (OR 0.34,95% CI:0.16 to 0.75, p = 0.007 is more effective than transdermal route(OR 0.64,95% CI:0.40 to 1.01, p = 0.05, and the protective effect of GTN was far more obvious in the centers with high incidence of PEP (OR 0.40, 95% CI:0.24 to 0.67, p = 0.0006 than those centers with a low incidence of PEP (OR 0.75, 95% CI: 0.47 to 1.20, p = 0.22. Additionally, the meta-analysis suggests that GTN was not

  14. Effects of plastic stenting in commom bile duct of rats: a quantitative reaction analysis using collagen and elastin morphometry Efeitos de prótese plástica em hepatocolédoco de ratos: uma análise quantitativa utilizando morfometria do colágeno e elastina

    OpenAIRE

    Everson Luiz de Almeida Artifon; Fabio Pinatel Lopasso; Gustavo Brazuna Moura; Fernando Augusto Mardiros Herbella Fernandes; Paulo Sakai; Flair José Carrilho; Elia Tamaso Espin Garcia Caldini; Orlando de Castro e Silva Junior

    2010-01-01

    PURPOSE: To evaluate the effects of biliary stenting in rats through analysis of collagen and elastin deposition in the bile ducts. METHODS: Twenty male rats underwent midline laparotomy, duodenotomy and transampullary stenting of the common bile duct with a 22Fr plastic stent. Animals were randomized in 4 groups, with 5 components in each: (I) control, (II) biliary stenting for 7 days, (III) biliary stenting for 14 days, and (IV) biliary stenting for 30 days. Sections of the common bile duct...

  15. A frequent PNPLA3 variant is a sex specific disease modifier in PSC patients with bile duct stenosis.

    Directory of Open Access Journals (Sweden)

    Kilian Friedrich

    Full Text Available BACKGROUND AIMS: Primary sclerosing cholangitis predominantly affects males and is an important indication for liver transplantation. The rs738409 variant (I148M of the PNPLA3 gene is associated with alcoholic and non-alcoholic liver disease and we evaluated its impact on the disease course of PSC. METHODS: The I148M polymorphism was genotyped in 121 German PSC patients of a long-term prospective cohort and 347 Norwegian PSC patients. RESULTS: In the prospective German cohort, actuarial survival free of liver transplantation was significantly reduced for I148M carriers (p = 0.011 compared to wildtype patients. This effect was restricted to patients with severe disease, as defined by development of dominant stenosis (DS requiring endoscopic intervention. DS patients showed markedly decreased survival (p = 0.004 when carrying the I148M variant (I148M: mean 13.8 years; 95% confidence interval: 11.6-16.0 vs. wildtype: mean 18.6 years; 95% confidence interval: 16.3-20.9 while there was no impact on survival in patients without a DS (p = 0.87. In line with previous observations of sex specific effects of the I148M polymorphism, the effect on survival was further restricted to male patients (mean survival 11.9 years; 95% confidence interval: 10.0-14.0 in I148M carriers vs. 18.8 years; 95% confidence interval: 16.2-21.5 in wildtype; p<0.001 while female patients were unaffected by the polymorphism (p = 0.65. These sex specific findings were validated in the Norwegian cohort (p = 0.013. CONCLUSIONS: In male PSC patients with severe disease with bile duct stenosis requiring intervention, the common I148M variant of the PNPLA3 gene is a risk factor for reduced survival.

  16. Cost-effectiveness analysis of endoscopic ultrasound versus magnetic resonance cholangiopancreatography in patients with suspected common bile duct stones.

    Directory of Open Access Journals (Sweden)

    Stephen Morris

    Full Text Available Patients with suspected common bile duct (CBD stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP, an invasive procedure with risk of significant complications. Using endoscopic ultrasound (EUS or Magnetic Resonance CholangioPancreatography (MRCP first to detect CBD stones can reduce the risk of unnecessary procedures, cut complications and may save costs.This study sought to compare the cost-effectiveness of initial EUS or MRCP in patients with suspected CBD stones.This study is a model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs per patient from the perspective of the UK National Health Service (NHS over a 1 year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources, including one-way and probabilistic sensitivity analyses.Using MRCP to select patients for ERCP was less costly than using EUS to select patients or proceeding directly to ERCP ($1299 versus $1753 and $1781, respectively, with similar QALYs accruing to each option (0.998, 0.998 and 0.997 for EUS, MRCP and direct ERCP, respectively. Initial MRCP was the most cost-effective option with the highest monetary net benefit, and this result was not sensitive to model parameters. MRCP had a 61% probability of being cost-effective at $29,000, the maximum willingness to pay for a QALY commonly used in the UK.From the perspective of the UK NHS, MRCP was the most cost-effective test in the diagnosis of CBD stones.

  17. The balloon dilatation and large profile catheter maintenance method for the management of the bile duct stricture following liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Choo, Sung Wook; Shin, Sung Wook; Do, Young Soo; Park, Kwang Bo; Sung, Yon Mi; Choo, In Wook [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Liu, Wei Chiang [Sungae General Hospital, Seoul (Korea, Republic of)

    2006-03-15

    We wanted to evaluate the therapeutic efficacy of the percutaneous balloon dilatation and large profile catheter maintenance method for the management of patients with anastomotic biliary strictures following liver transplant. From May 1999 to June 2003, 12 patients with symptomatic benign biliary stricture complicated by liver transplantation were treated with the percutaneous balloon dilatation and large profile catheter maintenance method (1-6 months). The patients were eight males and four females, and their ages ranged from 20 to 62 years (mean age: 44 years). Ten patients underwent living donor liver transplantation and two underwent cadaveric liver transplantation. Postoperative biliary strictures occurred from two to 21 months (mean age: 18 months) after liver transplantation. The initial technical success rate was 92%. Patency of the bile duct was preserved for eight to 40 months (mean period: 19 months) in 10 of 12 (84%) patients. When reviewing two patients (17%), secondary balloon dilatations were needed for treating the delayed recurrence of biliary stricture. In one patients, no recurrent stenosis was seen during the further 10 months follow-up after secondary balloon dilatation. Another patient did not response to secondary balloon dilatation, and he was treated by surgery. Eleven of 12 patients (92%) showed good biliary patency for 8-40 months (mean period: 19 months) of follow-up. The percutaneous balloon dilatation and large profile catheter maintenance method is an effective therapeutic alterative for the treatment of most biliary strictures that complicate liver transplantation. It has a high success rate and it should be considered before surgery.

  18. Hemodynamic and antifibrotic effects of a selective liver nitric oxide donor V-PYRRO/NO in bile duct ligated rats

    Institute of Scientific and Technical Information of China (English)

    Frédéric Moal; Dominique Bonnefont-Rousselot; Marie Christine Rousselet; Paul Calès; Nary Veal; Eric Vuillemin; Eric Barrière; Jianhua Wang; Lionel Fizanne; Frédéric Oberti; Olivier Douay; Yves Gallois

    2006-01-01

    AIM: To assess whether a liver specific nitric oxide (NO)donor (V-PYRRO/NO) would prevent the development of portal hypertension and liver fibrosis in rats with bile duct ligation (BDL).METHODS: Treatment (placebo or V-PYRRO/NO0.53 μmol/kg per hour) was administered i.v. to rats 2 d before BDL (D-2) and maintained until the day of hemodynamic measurement (D26). Intra-hepatic NO level was estimated by measuring liver cGMP level. Effects of V-PYRRO/NO on liver fibrosis and lipid peroxidation were also assessed.RESULTS: Compared to placebo treatment, V-PYRRO/NO improved splanchnic hemodynamics in BDL rats:portal pressure was significantly reduced by 27% (P< 0.0001) and collateral circulation development was almost completely blocked (splenorenal shunt blood flow by 74%, P = 0.007). Moreover, V-PYRRO/NO significantly prevented liver fibrosis development in BDL rats (by 30% in hepatic hydroxyproline content and 31% in the area of fibrosis, P < 0.0001 respectively), this effect being probably due to a decrease in lipid peroxidation by 44% in the hepatic malondialdehyde level (P =0.007). Interestingly, we observed a significant and expected increase in liver cGMP, without any systemic hemodynamic effects (mean arterial pressure, vascular systemic resistance and cardiac output) in both shamoperated and BDL rats treated with V-PYRRO/NO. This result is in accordance with studies on V-PYRRO/NOmetabolism showing a specific release of NO in the liver.CONCLUSION: Continuous administrations of V-PYRRO/NO in BDL rats improved liver fibrosis and splanchnic hemodynamics without any noxious systemic hemodynamic effects.

  19. A survey on concomitant common bile duct stone and symptomatic gallstone and clinical values in Shiraz, Southern Iran

    Science.gov (United States)

    Hosseini, Seyed Vahid; Ayoub, Abbass; Rezaianzadeh, Abbas; Bananzadeh, Ali Mohammad; Ghahramani, Leila; Rahimikazerooni, Salar; Khazraei, Hajar

    2016-01-01

    Background: Common bile duct stone (CBDS) as a result of gallstone is one of the gastrointestinal disorders. In this study, the incidence of CBDS and symptomatic gallstone in Shiraz were investigated, and their management suggested. Materials and Methods: This is a retrospective study that enrolled among 560 patients. The incidence of gallstone together with CBDS was evaluated using an ultrasonography studyand clinical data in the period between March 2014 and 2014 in Shiraz. Comparison between data was done using Student’s t-test or Chi-square test. Results: Of these patients, 18.6% were male, and 81.4% were female with a mean age of 47.67 ± 0.74 years. The concomitant rate of gallstone and CBDS was 8.6%. 6.8% of patients with concomitant of gallstone and CBDS showed symptoms while 1.8% had not been diagnosed before the operation. The mean of serum alkaline phosphatase level in patients with the only gallstone was 255.80 IU/L and patients with concomitant gallstone, and CBDS was 580.88 IU/L with a significant difference between two groups (P < 0.001). Furthermore, liver function tests (aspartate aminotransferase, alanine transaminase) showed a significant difference between two groups of patients (P < 0.01, P < 0.001). Conclusions: Clinical variables such as tenderness, fever, and Morphy sign were more severein patients with concomitant gallstone and CBDS. The concomitant rate of gallstone and CBDS in our society is less that Western countries and asymptomatic patients showed fewer ratios than other countries. We think the approach for asymptomatic CBDS patients with gallstone can be affected by our results. PMID:27656616

  20. Activation of the renin-angiotensin system stimulates biliary hyperplasia during cholestasis induced by extrahepatic bile duct ligation.

    Science.gov (United States)

    Afroze, Syeda H; Munshi, Md Kamruzzaman; Martínez, Allyson K; Uddin, Mohammad; Gergely, Maté; Szynkarski, Claudia; Guerrier, Micheleine; Nizamutdinov, Damir; Dostal, David; Glaser, Shannon

    2015-04-15

    Cholangiocyte proliferation is regulated in a coordinated fashion by many neuroendocrine factors through autocrine and paracrine mechanisms. The renin-angiotensin system (RAS) is known to play a role in the activation of hepatic stellate cells and blocking the RAS attenuates hepatic fibrosis. We investigated the role of the RAS during extrahepatic cholestasis induced by bile duct ligation (BDL). In this study, we used normal and BDL rats that were treated with control, angiotensin II (ANG II), or losartan for 2 wk. In vitro studies were performed in a primary rat cholangiocyte cell line (NRIC). The expression of renin, angiotensin-converting enzyme, angiotensinogen, and angiotensin receptor type 1 was evaluated by immunohistochemistry (IHC), real-time PCR, and FACs and found to be increased in BDL compared with normal rat. The levels of ANG II were evaluated by ELISA and found to be increased in serum and conditioned media of cholangiocytes from BDL compared with normal rats. Treatment with ANG II increased biliary mass and proliferation in both normal and BDL rats. Losartan attenuated BDL-induced biliary proliferation. In vitro, ANG II stimulated NRIC proliferation via increased intracellular cAMP levels and activation of the PKA/ERK/CREB intracellular signaling pathway. ANG II stimulated a significant increase in Sirius red staining and IHC for fibronectin that was blocked by angiotensin receptor blockade. In vitro, ANG II stimulated the gene expression of collagen 1A1, fibronectin 1, and IL-6. These results indicate that cholangiocytes express a local RAS and that ANG II plays an important role in regulating biliary proliferation and fibrosis during extraheptic cholestasis.

  1. Gardenia jasminoides attenuates hepatocellular injury and fibrosis in bile duct-ligated rats and human hepatic stellate cells

    Institute of Scientific and Technical Information of China (English)

    Ying-Hua Chen; Tian Lan; Jing Li; Chun-Hui Qiu; Teng Wu; Hong-Ju Gou; Min-Qiang Lu

    2012-01-01

    AIM:To investigate the anti-hepatofibrotic effects of Gardenia jasminoides in liver fibrosis.METHODS:Male Sprague-Dawley rats underwent common bile duct ligation (BDL) for 14 d and were treated with Gardenia jasminoides by gavage.The effects of Gardenia jasminoides on liver fibrosis and the detailed molecular mechanisms were also assessed in human hepatic stellate cells (LX-2) in vitro.RESULTS:Treatment with Gardenia jasminoides decreased serum alanine aminotransferase (BDL vs BDL +100 mg/kg Gardenia jasminoides,146.6 ± 15 U/L vs 77± 6.5 U/L,P =0.0007) and aspartate aminotransferase (BDL vs BDL + 100 mg/kg Gardenia jasminoides,188 ± 35.2 U/L vs 128 ± 19 U/L,P =0.005) as well as hydroxyproline (BDL vs BDL + 100 mg/kg Gardenia jasminoides,438 ± 40.2 μg/g vs 228 ± 10.3 μg/g liver tissue,P =0.004) after BDL.Furthermore,Gardenia jasminoides significantly reduced liver mRNA and/or protein expression of transforming growth factor β1(TGF-β1),collagen type Ⅰ (Col Ⅰ) and α-smooth muscle actin (α-SMA).Gardenia jasminoides significantly suppressed the upregulation of TGF-β1,Col Ⅰ and α-SMA in LX-2 exposed to recombinant TGF-β1.Moreover,Gardenia jasminoides inhibited TGF-β1-induced Smad2 phosphorylation in LX-2 cells.CONCLUSION:Gardeniajasminoides exerts antifibrotic effects in the liver fibrosis and may represent a novel antifibrotic agent.

  2. Distant Metastasis Risk Stratification for Patients Undergoing Curative Resection Followed by Adjuvant Chemoradiation for Extrahepatic Bile Duct Cancer

    International Nuclear Information System (INIS)

    Purpose: To analyze the prognostic factors predicting distant metastasis in patients undergoing adjuvant chemoradiation for extrahepatic bile duct (EHBD) cancer. Methods and Materials: Between January 1995 and August 2006, 166 patients with EHBD cancer underwent resection with curative intent, followed by adjuvant chemoradiation. There were 120 males and 46 females, and median age was 61 years (range, 34–86). Postoperative radiotherapy was delivered to tumor bed and regional lymph nodes (median dose, 40 Gy; range, 34–56 Gy). A total of 157 patients also received fluoropyrimidine chemotherapy as a radiosensitizer, and fluoropyrimidine-based maintenance chemotherapy was administered to 127 patients. Median follow-up duration was 29 months. Results: The treatment failed for 97 patients, and the major pattern of failure was distant metastasis (76 patients, 78.4%). The 5-year distant metastasis-free survival rate was 49.4%. The most common site of distant failure was the liver (n = 36). On multivariate analysis, hilar tumor, tumor size ≥2 cm, involved lymph node, and poorly differentiated tumor were associated with inferior distant metastasis-free survival (p = 0.0348, 0.0754, 0.0009, and 0.0078, respectively), whereas T stage was not (p = 0.8081). When patients were divided into four groups based on these risk factors, the 5-year distant metastasis-free survival rates for patients with 0, 1, 2, and 3 risk factors were 86.4%, 59.9%, 32.5%, and 0%, respectively (p < 0.0001). Conclusion: Despite maintenance chemotherapy, distant metastasis was the major pattern of failure in patients undergoing adjuvant chemoradiation for EHBD cancer after resection with curative intent. Intensified chemotherapy is warranted to improve the treatment outcome, especially in those with multiple risk factors.

  3. Meta-analysis of the diagnostic accuracy of laparoscopic ultrasonography and intraoperative cholangiography in detection of common bile duct stones.

    Science.gov (United States)

    Jamal, K N; Smith, H; Ratnasingham, K; Siddiqui, M R; McLachlan, G; Belgaumkar, A P

    2016-04-01

    Introduction During laparoscopic cholecystectomy, intraoperative cholangiography (IOC) is currently regarded as the gold standard in the detection of choledocholithiasis. Laparoscopic ultrasonography (LUS) is an attractive alternative with several potential advantages. Methods A systematic review was undertaken of the published literature comparing LUS with IOC in the assessment of common bile duct (CBD) stones. Results Twenty-one comparative studies were analysed. There were 4,566 patients in the IOC group and 5,044 in the LUS group. The combined sensitivity and specificity of IOC in the detection of CBD stones were 0.87 (95% confidence interval [CI]: 0.83-0.89) and 0.98 (95% CI: 0.98-0.98) respectively with a pooled area under the curve (AUC) of 0.985 and a diagnostic odds ratio (OR) of 260.65 (95% CI: 160.44-423.45). This compares with a sensitivity and specificity for LUS of 0.90 (95% CI: 0.87-0.92) and 0.99 (95% CI: 0.99-0.99) respectively with a pooled AUC of 0.982 and a diagnostic OR of 765.15 (95% CI: 450.78-1,298.76). LUS appeared to be more successful in terms of coming to a clinical decision regarding CBD stones than IOC (random effects, risk ratio: 0.95, 95% CI: 0.93-0.98, df=20, z=-3.7, pIOC in the detection of CBD stones. The main advantages of LUS are that it does not involve ionising radiation, is quicker to perform, has a lower failure rate and can be repeated during the procedure as required. PMID:26985813

  4. Carefully investigate the biomechanics of bile duct and focus on the functional preservation of biliary and pancreas%认真研习胆道生物力学重视保护胆胰结构和功能

    Institute of Scientific and Technical Information of China (English)

    刘永雄

    2012-01-01

    半个多世纪以来,我国胆道外科在基础研究和临床诊治方面都取得了巨大的发展和进步.探索、认知了以肝胆管结石病及相关课题为中心的高位胆管(肝门和肝内胆管)为中心的阻塞性病变的临床救治以及相关的严重并发症,制定了系统、配套的临床诊疗策略和共同的治疗原则,取得了高水平的治疗效果,形成了有中国特色的胆道外科:肝胆管外科.本系列研究获得了2000年国家科学技术进步一等奖.胆树是一个封闭的充盈液相碱性内容的肝胰分泌入肠的通道,是实现和保证有效消化功能的主要构成,以往的研究和认识积累主要侧重在结构和疾病的生物化学变化方面,而对胆道的生物力学(流体力学)和所涉及的基础与临床方面的观察,研究显得滞后,致在这方面的临床思维和决策方面存在着相应的片面性、盲目性乃至随意性.也提示了在这方面开展探索和研究的迫切性.本文简介了相关胆道生物力学功能的资料,介绍了与此相关的诸多生理与病理学因素,并从临床认识和诊疗角度提出了明确的诸多重要视点.%During the past half century,the great development and progress has been achieved in basic research and clinical management of biliary surgery in our country.The clinical treatment and relative complications of bile duct obstructive disease based on the central of hilar cholangiocarcinoma caused by hepatolithiasis has been explored and recognized.The systemic and supporting clinical strategy and joint treatment principle has been made,which resulted in qualified clinical outcome and formed hepatobiliary surgerythe bile duct surgery with Chinese characteristics.This series of studies had been honored as The National Science and Technology Progress Award in 2000. Bile duct tree is a closed tract full of alkaline liquid secreted by liver and pancreas to ensure the effective digestions.Previous studies had been

  5. Laparoscopic stents supporting for the stenosis of the common bile duct termination region:a report of 117 cases%腹腔镜胆总管末端狭窄支撑术临床应用117例报告

    Institute of Scientific and Technical Information of China (English)

    陈安平; 王佳牧; 索运生; 刘安; 易斌; 孙科; 张胜龙

    2014-01-01

    Objective To summarize the experience on laparoscopic stents supporting for stenosis of the common bile duct termination region (LCBDS). Methods There were used of laparoscopic common bile duct exploration,net stone or electrohydraulic lithotripsy to take a clean of extrahepatic bile duct stones. It was dilated that the annular stenosis or tubular stricture of the common bile duct termination region by dilatable catheter,the balloon and zebra guidewire in laparoscopic common bile duct exploration. After that, laparoscopic stents supported for the stenosis of the common bile duct termination region by plastic stent or serf-expandable metallic stents. Results 109 cases had completed successful the dilatation of the stenosis and biliary drainage to reach the preestablished object (success rate: 93.2%),in total 117 patients of the terminal common bile duct stenosis of stones and metastatic periampulla carcinoma. 1 patient changed laparoscopic operation into open abdominal operation. 2 patients had leaked the bile juice. 1 patient had a large number of residual stones in the left intrahepatic duct. The wallstent of 2 patients was fail. 2 patients had died of the functional failure of the liver and the kidneys. The general incidence of complications was 6.8%. Conclusions If patients are suitable,LCBDS is feasible,simple and safety that the stents supporting of the terminal common bile duct stenosis of benign and malignancy.%目的:总结运用腹腔镜胆总管末端狭窄支撑术的临床治疗经验。方法采用腹腔镜胆总管切开探查、取石网取石或液电碎石直至取净肝外胆管结石,在斑马导丝引导下用逐级扩张导管和(或)球囊导管对胆总管末端狭窄进行扩张,然后对胆总管末端梗阻为主的良恶性狭窄患者有选择地放置塑料支架或自膨式金属胆管支架。结果本组117例患者中109例手术获成功,成功率93.2%,术后无胆漏、支架位置正确、引流通畅、

  6. The evaluation value of contrast-enhanced CT with bile duct reconstruction before surgery%CT 增强联合胆道重建技术在胆总管癌术前评估中的价值

    Institute of Scientific and Technical Information of China (English)

    施剑斐

    2015-01-01

    目的:探讨CT增强扫描联合胆道重建技术在胆总管癌诊断中的价值,提高CT 对胆总管术前评估的准确性。方法回顾性分析30例经病理证实为胆总管癌的CT 增强图像,并对胆总管进行M PR和CPR ,总结胆总管癌的CT表现特点并用统计学方法分析两种重建技术对胆总管癌术前评估的准确性。结果 CPR对胆总管癌的诊断符合率和分型符合率均高于M PR ,且差异具有统计学意义( P分别为0.010和0.021),两种重建方式对定位的符合率差异不明显( P =0.317)。胆总管癌的C T主要表现为胆总管管壁的增厚或形成软组织肿块,胆总管、肝内胆管及胆囊明显扩张,增强后胆总管管壁或软组织肿块呈中度以上强化。结论 CT增强扫描可以作为胆总管癌术前的常规检查,胆道重建技术明显提高了胆总管癌术前评估的准确性。%Objective To explore the value of contrast‐enhanced CT with bile duct reconstruction in diagnosing cholan‐giocarcinoma ,and improve the evaluation accuracy of CT before surgery .Methods The contrast‐enhanced CT images of 30 cases proven cholangiocarcinoma by pathology ,and the common bile ducts were reconstructed by multi‐planar reforma‐tion (MPR) and curved multi‐plain reconstruction (CPR) .The CT findings of Cholangiocarcinoma were concluded and the evaluation accuracy of MPR and CPR were analyzed by statistical methods .Results The compliance rates of CPR in the diagnosis and typing of cholangiocarcinoma were both higher than MPR ,and the differences were significant (p‐value was 0 .010 and 0 .021 respectively) ,but there was no difference between the CPR and MPR in the location of cholangiocarcino‐ma .The thickening wall and the soft tissue masses enhanced moderately or severely with expansion of common bile duct , intrahepatic bile duct and gallbladder were the main CT finding in diagnosing Cholangiocarcinoma .Conclusion Contrast

  7. Intestinal metaplasia in gallbladder correlates with high amylase levels in bile in patients with a morphologically normal pancreaticobiliary duct.

    Science.gov (United States)

    Sakamoto, Hirotsugu; Mutoh, Hiroyuki; Ido, Kenichi; Satoh, Shin; Kumagai, Machio; Hayakawa, Hiroko; Tamada, Kiichi; Sugano, Kentaro

    2009-12-01

    We reported previously that intestinal metaplasia in the gallbladder is strongly associated with expression of caudal-related homeobox transcription factor Cdx2. It has been documented that occult pancreatobiliary reflux, even in the absence of pancreaticobiliary maljunction, is associated with elevated risk of biliary malignancy. We ascertained the correlation between intestinal metaplasia in the gallbladder and occult pancreatobiliary reflux. In 196 patients with a normal pancreaticobiliary ductal arrangement who had undergone laparoscopic cholecystectomy, we performed intraoperative cholangiography and measured amylase levels in bile sampled from the gallbladder. The cutoff value for high cystic amylase was defined as a biliary amylase level higher than the normal upper limit of serum amylase (215 IU/L). We also retrospectively reviewed the cholecystectomized tissue specimens to investigate the presence of intestinal metaplasia and expression of Cdx2. Then, we explored the relationship between intestinal metaplasia in the gallbladder and occult choledocho-pancreatic reflux. Intestinal metaplasia was found in 16.8% (33/196) of the gallbladders. The prevalence of choledocho-pancreatic reflux revealed by intraoperative cholangiography was not significantly different between cases with intestinal metaplasia (5/33, 15.2%) and those without (25/163, 15.3%; P = .81). However, in cases with intestinal metaplasia, the rate of high cystic amylase (13/33, 39.4%) was significantly higher compared with cases without intestinal metaplasia (26/163, 16.0%, P = .005). In conclusion, intestinal metaplasia in the gallbladder is significantly correlated with high amylase levels in bile in patients with a morphologically normal pancreaticobiliary ductal arrangement.

  8. Temporary Placement of a Newly Designed, Fully Covered, Self-Expandable Metal Stent for Refractory Bile Leaks

    OpenAIRE

    Hwang, Jae Chul; Kim, Jin Hong; Yoo, Byung Moo; Lim, Sun-Gyo; Kim, Jin Hun; Kim, Wook Hwan; Kim, Myung Wook

    2011-01-01

    Bile leaks remain a significant cause of morbidity for patients undergoing laparoscopic cholecystectomy. Leakage from an injured duct of Luschka (subvesical duct) follows the cystic duct as the most common cause of postcholecystectomy bile leaks. Although endoscopic sphincterotomy, plastic-stent placement, or nasobiliary-drain placement are effective in healing biliary leaks, in patients in whom leakage persists and the symptoms worsen despite conventional endoscopic treatment, re-exploration...

  9. Characterization of two novel cell lines with distinct heterogeneity derived from a single human bile duct carcinoma.

    Directory of Open Access Journals (Sweden)

    Jinghan Wang

    Full Text Available BACKGROUND: Intratumoral heterogeneity reflects subclonal diversity and accounts for a variety of clinically defined phenotypes including the development of drug resistance and recurrence. However, intratumoral heterogeneity of bile duct carcinoma (BDC is rarely studied. METHODS: Two highly heterogeneous cell lines named EH-CA1a and EH-CA1b were established from a primary tumor tissue of a pathologically proven BDC. Distinct heterogeneity and underlying mechanisms of two cell lines in karyotype, colony formation, tumorgenicity, and sensitivity to chemoradiotherapy were intensively studied. RESULTS: Both cell lines showed typical morphology of cancer cells. EH-CA1a cells grew as free-floating aggregates, while EH-CA1b cells grew adherently as a monolayer. EH-CA1a cells had higher cloning efficiencies and were able to keep proliferating under hypoxic condition. Coincidentally, hypoxia-induced factor-1α (HIF1α and vascular endothelial growth factor (VEGF mRNA were significantly higher in EH-CA1a cells than in EH-CA1b cells. Both cell lines were tumorigenic in nude mouse, however, EH-CA1a cells showed more aggressive characteristics. Most importantly, the EH-CA1a cells showed much more resistance against radiation and chemotherapy with gemcitabine. Metastasis-related genes including matrix metalloproteinase 2 (MMP-2, MMP-9, epithelial-mesenchymal transition (EMT markers such as Vimentin, Snail, and Twist, are more highly expressed in EH-CA1a cells than in EH-CA1b cells. Moreover, the percentage of cells expressing cancer stem cell-like marker, CD133, in EH-CA1a cells is much higher than that in EH-CA1b cells. Moreover, knockdown of CD133 in both EH-CA1a and EH-CA1b cells significantly reduced their invasive potential and increased their sensitivities to radiation and gemcitabine, suggesting the differential expression of CD133 protein may partially account for the difference in malignancy between these two cancer cells. CONCLUSION: Establishment

  10. Effect of All-trans Retinoic Acid on Liver Fibrosis Induced by Common Bile Duct Ligation in Rats

    Institute of Scientific and Technical Information of China (English)

    Hui WANG; Zili DAN; Haiyan JIANG

    2008-01-01

    Summary: The aim of this study was to investigate the effect and possible mechanism of all-trans retinoic acid (ATRA) on liver fibrosis induced by common bile duct ligation (CBDL) in rats. Fifty-three female Wistar rats were randomly divided into 5 groups: sham operation group (group J, 5 animals) and groups A, B, C and D (12 animals in each group). The rats in groups A, B, C and D were subjected to CBDL to induce liver fibrosis, while those in group J to sham operation. From the 3rd week the rats in groups B, C and D respectively received daily administration of ATRA via gastric tube at three different doses [0.1, 1.5 and 7.5 mg/kg body weight (BW)]. Animals were sacrificed at 6th week. Rats' liver tissues were observed for pathologic changes under a light microscope. The protein levels of type Ⅰ collagen (COL Ⅰ), matrix metalloproteinase-2 (MMP2), MMP13 and tissue inhibitors of metalloproteinase-1 (TIMP-1) in liver tissues were determined by immunohistochemical techniques. The expression levels of TGF-β1 and CTGF mRNA in liver tissues were detected by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR). The results showed that loss of normal hepatic architecture and formation of obvious fibrosis were observed in group A, while ATRA treatment for 4 weeks notably alleviated the pathological changes of hepatocytes. The expression of COL Ⅰ and TIMP-1 proteins in group A was increased, while decreased in ATRA-treated CBDL groups (P<0.05). ATRA (1.5 and 7.5 mg/kg BW) reduced the expression levels of COL Ⅰprotein more greatly than that of 0.1 mg/kg BW (P<0.05). ATRA treatment increased the protein levels of MMP2 and MMP13. The expression levels of TGF-β1 and CTGF mRNA in group A were increased. In comparison with group A, the mRNA levels of TGF-β1 and CTGF in ATRA-treated CBDL groups were significantly decreased (P<0.05). It was concluded that ATRA could inhibit CBDL-induced liver fibrosis in rats by suppressing the expression of TGF

  11. Gallbladder and bile duct

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008457 Relationship between pigment gallstone and intestinal barrier function: experiment with guinea pigs and clinical observations. WU Shuodong(吴硕东), et al.1st Dept Micro-invasive Bili Surg, Shengjing Hosp, China Med Univ, Shenyang 110004, Natl Med J China 2008;88(21):1498-1502. Objective To investigate the relationship between the intestinal barrier function and pigment gallstone formation.

  12. Differential diagnosis of sclerosing cholangitis with autoimmune pancreatitis and periductal infiltrating cancer in the common bile duct at dynamic CT, endoscopic retrograde cholangiography and MR cholangiography

    International Nuclear Information System (INIS)

    To compare findings at dynamic computed tomography (CT), endoscopic retrograde cholangiography (ERC) and magnetic resonance cholangiography (MRC) in patients with sclerosing cholangitis with autoimmune pancreatitis (SC-AIP) and periductal infiltrating cancer in the common bile duct (CBD), and to evaluate the diagnostic performance of ERC and MRC in differentiating between the two diseases. Bile duct changes at dynamic CT, ERC and MRC were compared in 58 patients with SC-AIP and CBD involvement and 93 patients with periductal infiltrating CBD cancer. Two radiologists rated their confidence in differentiating between the two diseases and the diagnostic performances of ERC and MRC were compared. At CT, SC-AIP was more frequently associated with intrapancreatic CBD involvement, thinner CBD walls, concentric wall thickening, smooth outer margins, and lower degrees of upstream ductal dilatation and contrast enhancement (P ≤ 0.05) than CBD cancer. At ERC and MRC, SC-AIP was more frequently associated with smooth margins, gradual and symmetric narrowing, multifocal involvement and hourglass appearance (P ≤ 0.027) than CBD cancer. MRC showed good diagnostic performance comparable to ERC. Dynamic CT, ERC and MRC can be helpful in distinguishing SC-AIP from periductal infiltrating CBD cancer. MRC may be a useful diagnostic alternative to ERC in differentiating between the two diseases. (orig.)

  13. Differential diagnosis of sclerosing cholangitis with autoimmune pancreatitis and periductal infiltrating cancer in the common bile duct at dynamic CT, endoscopic retrograde cholangiography and MR cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Hee; Byun, Jae Ho; Lee, So Jung; Park, Seong Ho; Kim, Hyoung Jung; Lee, Seung Soo; Lee, Moon-Gyu [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Asanbyeongwon-gil 86, Songpa-Gu, Seoul (Korea, Republic of); Kim, Myung-Hwan [University of Ulsan College of Medicine, Asan Medical Center, Department of Internal Medicine, Asanbyeongwon-gil 86, Songpa-Gu, Seoul (Korea, Republic of); Kim, Jihun [University of Ulsan College of Medicine, Asan Medical Center, Department of Diagnostic Pathology, Asanbyeongwon-gil 86, Songpa-Gu, Seoul (Korea, Republic of)

    2012-11-15

    To compare findings at dynamic computed tomography (CT), endoscopic retrograde cholangiography (ERC) and magnetic resonance cholangiography (MRC) in patients with sclerosing cholangitis with autoimmune pancreatitis (SC-AIP) and periductal infiltrating cancer in the common bile duct (CBD), and to evaluate the diagnostic performance of ERC and MRC in differentiating between the two diseases. Bile duct changes at dynamic CT, ERC and MRC were compared in 58 patients with SC-AIP and CBD involvement and 93 patients with periductal infiltrating CBD cancer. Two radiologists rated their confidence in differentiating between the two diseases and the diagnostic performances of ERC and MRC were compared. At CT, SC-AIP was more frequently associated with intrapancreatic CBD involvement, thinner CBD walls, concentric wall thickening, smooth outer margins, and lower degrees of upstream ductal dilatation and contrast enhancement (P {<=} 0.05) than CBD cancer. At ERC and MRC, SC-AIP was more frequently associated with smooth margins, gradual and symmetric narrowing, multifocal involvement and hourglass appearance (P {<=} 0.027) than CBD cancer. MRC showed good diagnostic performance comparable to ERC. Dynamic CT, ERC and MRC can be helpful in distinguishing SC-AIP from periductal infiltrating CBD cancer. MRC may be a useful diagnostic alternative to ERC in differentiating between the two diseases. (orig.)

  14. Cholecystokinin acts as an essential factor in the exacerbation of pancreatic bile duct ligation-induced rat pancreatitis model under non-fasting condition.

    Science.gov (United States)

    Yoshinaga, K; Washizuka, M; Segawa, Y

    2000-09-01

    We examined the influence of 2 gut hormones involved in the enhancement of pancreatic exocrine secretion, secretin and cholecystokinin (CCK), in the exacerbation of pancreatitis. We also examined the role of the vagal system, which was considered to be a transmission route for these hormones. Our model of pancreatitis in the rat was prepared by pancreatic bile duct ligation (PBDL), which simultaneously ligated the pancreatic duct and the common bile duct. Serum amylase activity and histopathological changes in the pancreas were used as indices of pancreatitis. We also measured the volume of pancreatic juice, as well as the amylase activity and protein level of the pancreatic juice, as indices of increased pancreatic exocrine secretion. Two gut hormones were given 6 times at 1-h intervals. Administration of secretin (1-3 microg/kg, s.c.) did not influence serum amylase activity in rats with PBDL-induced pancreatitis. However, food stimulation and administration of CCK-8 (1 microg/kg, s.c.) increased serum amylase activity and promoted vacuolation of the pancreatic acinar cells in rats with PBDL-induced pancreatitis. Administration of atropine (3 mg/kg, s.c.) or a CCK1-receptor antagonist, Z-203 (0.1 mg/kg, i.v.), inhibited food-stimulated or CCK-8-induced (1 microg/kg, s.c.) enhancement of pancreatic exocrine secretion and exacerbation after the development of PBDL-induced pancreatitis. These results suggest that not secretin, which regulates the volume of pancreatic juice, but CCK, which regulates the secretion of pancreatic enzymes via the vagal system, plays an essential role in food-stimulated exacerbation after the development of pancreatitis.

  15. Dynamic expression of desmin, α-SMA and TGF-β1 during hepatic fibrogenesis induced by selective bile duct ligation in young rats

    Energy Technology Data Exchange (ETDEWEB)

    Gonçalves, J.O.; Tannuri, A.C.A.; Coelho, M.C.M.; Bendit, I.; Tannuri, U. [Laboratório de Pesquisa em Cirurgia Pediátrica (LIM-30), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil)

    2014-08-15

    We previously described a selective bile duct ligation model to elucidate the process of hepatic fibrogenesis in children with biliary atresia or intrahepatic biliary stenosis. Using this model, we identified changes in the expression of alpha smooth muscle actin (α-SMA) both in the obstructed parenchyma and in the hepatic parenchyma adjacent to the obstruction. However, the expression profiles of desmin and TGF-β1, molecules known to be involved in hepatic fibrogenesis, were unchanged when analyzed by semiquantitative polymerase chain reaction (RT-PCR). Thus, the molecular mechanisms involved in the modulation of liver fibrosis in this experimental model are not fully understood. This study aimed to evaluate the molecular changes in an experimental model of selective bile duct ligation and to compare the gene expression changes observed in RT-PCR and in real-time quantitative PCR (qRT‐PCR). Twenty-eight Wistar rats of both sexes and weaning age (21-23 days old) were used. The rats were separated into groups that were assessed 7 or 60 days after selective biliary duct ligation. The expression of desmin, α-SMA and TGF-β1 was examined in tissue from hepatic parenchyma with biliary obstruction (BO) and in hepatic parenchyma without biliary obstruction (WBO), using RT-PCR and qRT‐PCR. The results obtained in this study using these two methods were significantly different. The BO parenchyma had a more severe fibrogenic reaction, with increased α-SMA and TGF-β1 expression after 7 days. The WBO parenchyma presented a later, fibrotic response, with increased desmin expression 7 days after surgery and increased α-SMA 60 days after surgery. The qRT‐PCR technique was more sensitive to expression changes than the semiquantitative method.

  16. Noninvasive study of anatomic variations of the bile and pancreatic duct using magnetic resonance cholangiopancreatography; Estudio no invasivo de variantes anatomicas de la via biliar y pancreatica mediante colangiopancreatografia por resonancia magnetica (CPRM)

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez, E.; Falco, J.; Campo, R.; Martin, J.; Brullet, E. [SDI-UDIAT Corporacio Sanitaria Parc Tauli. Sabadell (Spain); Espinos, J. [Hospital Mutua de Tarrasa (Spain)

    1999-07-01

    To identify anatomic variations of the bile duct and pancreatic duct and papillary anomalies by means of magnetic resonance cholangiopancreatography (MRCP) and determine their correlation with endoscopic retrograde cholangiopancreatography (ERCP) findings. Eighty-five patients were selected by means of a prospective study comparing MRCP and ERCP. Coronal and axial HASTE images and coronal and oblique coronal RARE images were acquired in all the patients. Four of the studies (6%) were excluded because of poor technical quality. Anatomic variations were observed in 26 cases (30.5%), including trifurcation (n=7; 27%), right hepatic duct draining into left hepatic duct (n=2, 7.7%), right hepatic duct draining into common bile duct (n=4; 15.4%), extrahepatic confluence (n=2; 7.7%), medial cystic duct (n=2; 7.7%), parallel cystic duct (n=3; 11.5%), juxtapapillary duodenal diverticulum (n=3; 11.5%) and pancreas divisum (n=3; 11.5%). A good correlation was observed between the MRCP and ERCP findings. The introduction of MRCP into the noninvasive study of biliary disease may be useful in the detection of anatomic variations relevant to laparoscopic surgery and other endoscopic and interventional techniques. (Author) 11 refs.

  17. Pull-in small bile duct's choledochojejunostomy in rabbits%兔细小胆管拖入式胆肠吻合的实验研究

    Institute of Scientific and Technical Information of China (English)

    黄东东; 邱宝安

    2013-01-01

    Objective To investigate the effect of Pull in choledochojejunostomy which apllied in rabbits' Small bile duct construction on prevention of anastomosis stenosis and potential mechanisms.Methods A total of 21 rabbits were randomly assigned to three groups(n=7).Group A underwent a simple laparotomy (SL),group B biliary-enteric sutured by mucosa to mucosa Choledochojejunostomy (CJ) and group C Pull-in Choledochojejunostomy(PCJ).TBil and DBil were test in 2,4,8 weeks.The tissue of bile duct and anastomotic stoma were collected after Rabbits was killed in 8 weeks.The diameter of bile duct lumen,anastomotic stoma and the thickness of bile duct were measured respectively.Pathological changes of anastomotic stoma were observed and ki67 expression was studied by Immunohistochemical staining.Results (1)Bilirubin level was nomal in group A and C,but significantly higher in group B(P<0.01).(2)Anastomotic stoma in group C was larger than that in group A and even more than that(completely closed) in group B.There was also statistically significant difference in the diameter of anastomotic stoma,C>A>B(P<0.01).The diameter of bile duct lumen and the thickness of bile duct showed the similar results,B>C>A(P<0.01).(3) As for the inflammatory studies,Group B was observed with significant infiltrated neutrophils compared with group C.Furthermore,cytokine studies showed that the expression of Ki67 index around anastomosis was significantly difference among three groups,B>C>A(P<0.01).Conclusions The studies suggested that pull-in choledochojejunostomy which apllied in rabbits' small bile duct reconstruction could offer some beneficial effect in preventing anastomotic stoma stenosis.The mechanism might be through reducing the inflammatory reaction and restraining excessive hyperplasia in the area around anastomotic stoma.%目的 观察拖入式胆肠吻合术预防细小胆管胆肠吻合口狭窄的效果并初步探讨其机制.方法 21只新西兰大耳兔随机

  18. CCK、Gastrin对胆管癌细胞凋亡的调控%The Regulating Effect of CCK and Gastrin on Apoptosis of Bile Duct Carcinoma Cells

    Institute of Scientific and Technical Information of China (English)

    马宽生; 张丰深; 何振平; 董家鸿

    2002-01-01

    目的探讨CCK、Gastrin对胆管癌细胞凋亡的影响及其机理.方法以beauvericin为凋亡诱导剂,应用TUNEL荧光染色、流式细胞仪检测和反义bcl-2寡核苷酸技术初步探讨了CCK、Gastrin对胆管癌细胞凋亡阈值的影响,及用免疫组化、原位杂交、流式细胞术、RT-PCR等技术,研究了凋亡相关基因bcl-2和bax在其中的作用.结果发现beauvericin40μM、作用12h,QBC939胆管癌细胞的存活率降低35%~40%,80%左右的胆管癌细胞出现不同程度的凋亡;CCK、Gastrin对胆管癌细胞凋亡阈值有上调作用;CCK/Gastrin受体拈抗剂L60和L18及反义bcl-2寡核苷酸可抑制它们的作用.CCK、Gastrin在转录和翻译水平对bcl-2基因表达均有显著的促进作用,而对bax基因无明显影响;CCK-A受体或CCK-B/Gastrin受体拮抗剂则明显抑制Gastrin-17和CCK-8S对bcl-2基因的促表达作用.结论CCK和Gastrin通过对bcl-2基因表达的上调,抑制了胆管癌细胞的凋亡.本研究在理论上扩展了CCK/Gastrin对肿瘤生长调控的机理、丰富了消化道肿瘤凋亡调控的机制,也为胆管癌的辅助治疗提供了新的思路.%Objective Probe into the influence and the mechanisms of CCK and gastrin on the apoptosis of bile duct carcinoma cells.Methods By taking beauvericin as the revulsant to the apoptosis of bile duct carcinoma cells, the influence of CCK and gastrin on theapoptosis of bile duct carcinoma cells was investigated by using the techniques such as TUNEL fluorescent staining, stream mode cell de-tecting instrument and reverse bcl-2 oligonucleotide. Techniques of immunohistochemistry, in situ hybridization, flow cytometry (FCM),RT-PCR were used to study the roles of apoptosis-related genes bcl-2 and baxResults After beauvericin 40μM worked for 12 h, the survival rate of QBC939 bile duct carcinoma cells was decreased by 35% - 40%.About 80% of the bile duct carcinoma cells showed various degrees of apoptosis. CCK and gastrin could

  19. [Correction of hepatic dysfunction as pre-treatment before systemic chemotherapy in patients with bile duct neoplasms].

    Science.gov (United States)

    Iakovlev, A Iu; Chichkanova, A S; Ulitin, D N; Mokrov, K V; Akulenko, S V

    2012-01-01

    This prospective randomized study incorporates 141 surgical department patients with hepatobiliary tumors. The 1st group patients received 800 ml/day of remaxol. The 2nd1 group patients received Ringer solution and 10% glucose at 1:1 ratio. The subgroups included: 1 subgroup-with pre-operative cholecysto- or choledochostomia and B-subgroup-without pre-operative interventions. The combined surgical and pharmaceutical correction of bile passage, bilirubinemia, cholestasis and cytolysis by remaxole leads to better hepatic dysfunction correction and allows better timing of chemotherapy in bile passage tumors. PMID:23607215

  20. Percutaneous diagnosis and treatment in disease conditions of the bile ducts and the gallbladder. Possibilities and relative value. Perkutane Diagnostik und Therapie an Gallenwegen und Gallenblase. Moeglichkeiten und Stellenwert

    Energy Technology Data Exchange (ETDEWEB)

    Hauenstein, K.H.; Wimmer, B. (Freiburg Univ. (Germany, F.R.). Abt. Roentgendiagnostik); Salm, R.; Farthmann, E.H. (Freiburg Univ. (Germany, F.R.). Abt. Allgemeinchirurgie mit Poliklinik)

    1991-03-01

    Percutaneous transhepatic access to the bile duct has opened up new possibilities not only for diagnosis by means of cholangiography and cholangioscopy with endoscopically guided biopsy by small-bore equipment, but also for the treatment of benign and malignant obstructive jaundice. In malignant disease recanalization of the obstruction is possible by means of laser, intracavitary irritation, internal bile drainage in Klatskin tumors, large-diameter endoprostheses (e.g., a Y-shaped prosthesis) or metal stents. In benign disease, balloon dilatation of inflammatory stenoses, stone extractions from the bile duct or gallbladder by means of Dormia baskets, ultrasound or pezo electric shockwave-contact lithotripsy and chemical litholysis are possible very often percutaneous access is a real alternative to surgical intervention. (orig.).

  1. Spironolactone lowers portal hypertension by inhibiting liver fibrosis, ROCK-2 activity and activating NO/PKG pathway in the bile-duct-ligated rat.

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    Wei Luo

    Full Text Available OBJECTIVE: Aldosterone, one of the main peptides in renin angiotensin aldosterone system (RAAS, has been suggested to mediate liver fibrosis and portal hypertension. Spironolactone, an aldosterone antagonist, has beneficial effect on hyperdynamic circulation in clinical practice. However, the mechanisms remain unclear. The present study aimed to investigate the role of spionolactone on liver cirrhosis and portal hypertension. METHODS: Liver cirrhosis was induced by bile duct ligation (BDL. Spironolactone was administered orally (20 mg/kg/d after bile duct ligation was performed. Liver fibrosis was assessed by histology, Masson's trichrome staining, and the measurement of hydroxyproline and type I collagen content. The activation of HSC was determined by analysis of alpha smooth muscle actin (α-SMA expression. Protein expressions and protein phosphorylation were determined by immunohistochemical staining and Western blot analysis, Messenger RNA levels by quantitative real time polymerase chain reaction (Q-PCR. Portal pressure and intrahepatic resistance were examined in vivo. RESULTS: Treatment with spironolactone significantly lowered portal pressure. This was associated with attenuation of liver fibrosis, intrahepatic resistance and inhibition of HSC activation. In BDL rat liver, spironolactone suppressed up-regulation of proinflammatory cytokines (TNFα and IL-6. Additionally, spironolactone significantly decreased ROCK-2 activity without affecting expression of RhoA and Ras. Moreover, spironolactone markedly increased the levels of endothelial nitric oxide synthase (eNOS, phosphorylated eNOS and the activity of NO effector-protein kinase G (PKG in the liver. CONCLUSION: Spironolactone lowers portal hypertension by improvement of liver fibrosis and inhibition of intrahepatic vasoconstriction via down-regulating ROCK-2 activity and activating NO/PKG pathway. Thus, early spironolactone therapy might be the optional therapy in cirrhosis and

  2. Bile duct evaluation of potential living liver donors with Gd-EOB-DTPA enhanced MR cholangiography: Single-dose, double dose or half-dose contrast enhanced imaging

    International Nuclear Information System (INIS)

    Introduction: Detailed knowledge of the biliary anatomy is essential to avoid complications in living donor liver transplantation. The aim of this study was to determine the optimal dosage of Gd-EOB-DTPA for contrast-enhanced magnetic resonance cholangiography (ce-MRC) with reference to contrast-enhanced CT cholangiography (ce-CTC). Materials and methods: 30 potential living liver donors (PLLD) underwent both ce-CTC and ce-MRC. Ten candidates each received single, double or half-dose Gd-EOB-DTPA. Ce-MRC images with and without inversion recovery pulses (T1w ± IR) were acquired 20–30 min after intravenous contrast injection. Image data was quantitatively and qualitatively reviewed by two radiologists based on a on a 5-point scale. Data sets were compared using a Mann–Whitney-U-test or Wilcoxon-rank-sum-test. Kappa values were also calculated. Results: All image series provided sufficient diagnostic information both showing normal biliary anatomy and variant bile ducts. Ce-CTC showed statistically significant better results compared to all ce-MRC data sets. T1w MRC with single dose Gd-EOB-DTPA proved to be superior to half and double dose in subjective and objective evaluation without a statistically significant difference. Conclusions: Ce-MRC is at any dosage inferior to ce-CTC. As far as preoperative planning of bile duct surgery is focused on the central biliary anatomy, ce-MRC can replace harmful ce-CTC strategies, anyway. Best results were seen with single dose GD-EOB-DTPA on T1w MRC+IR

  3. Bile duct evaluation of potential living liver donors with Gd-EOB-DTPA enhanced MR cholangiography: Single-dose, double dose or half-dose contrast enhanced imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kinner, Sonja, E-mail: Sonja.Kinner@uni-due.de [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (Germany); Steinweg, Verena [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (Germany); Maderwald, Stefan [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (Germany); Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); Radtke, Arnold; Sotiropoulos, Georgios [Department of General Surgery, University Hospital Essen (Germany); Forsting, Michael; Schroeder, Tobias [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (Germany)

    2014-05-15

    Introduction: Detailed knowledge of the biliary anatomy is essential to avoid complications in living donor liver transplantation. The aim of this study was to determine the optimal dosage of Gd-EOB-DTPA for contrast-enhanced magnetic resonance cholangiography (ce-MRC) with reference to contrast-enhanced CT cholangiography (ce-CTC). Materials and methods: 30 potential living liver donors (PLLD) underwent both ce-CTC and ce-MRC. Ten candidates each received single, double or half-dose Gd-EOB-DTPA. Ce-MRC images with and without inversion recovery pulses (T1w ± IR) were acquired 20–30 min after intravenous contrast injection. Image data was quantitatively and qualitatively reviewed by two radiologists based on a on a 5-point scale. Data sets were compared using a Mann–Whitney-U-test or Wilcoxon-rank-sum-test. Kappa values were also calculated. Results: All image series provided sufficient diagnostic information both showing normal biliary anatomy and variant bile ducts. Ce-CTC showed statistically significant better results compared to all ce-MRC data sets. T1w MRC with single dose Gd-EOB-DTPA proved to be superior to half and double dose in subjective and objective evaluation without a statistically significant difference. Conclusions: Ce-MRC is at any dosage inferior to ce-CTC. As far as preoperative planning of bile duct surgery is focused on the central biliary anatomy, ce-MRC can replace harmful ce-CTC strategies, anyway. Best results were seen with single dose GD-EOB-DTPA on T1w MRC+IR.

  4. Acellular dermal matrix for repair of porcine bile duct defects:to promote vascular and bile duct epithelial regeneration%脱细胞真皮基质修复猪胆管缺损:促进血管及胆管上皮再生

    Institute of Scientific and Technical Information of China (English)

    陈刚; 白建华; 朱新锋; 曹俊; 刘其雨; 赵英鹏; 李立

    2015-01-01

    BACKGROUND:Acelular dermal matrix is a cel-free natural tissue scaffold similar to human soft tissue, which is easy to shape and has non-toxic side effects. It has been used to repair the urethra and ureter. OBJECTIVE:To investigate the effect of acelular dermal matrix on the repair of bile duct injury. METHODS:Thirty Diannan miniature pigs were randomly divided into three groups: in blank group, the bile duct was resected folowed by end to end anastomosis; in experimental group, bile duct defect model was made folowed by repair with acelular dermal matrix; in control group, bile duct defect model was made folowed by repair with expanded polytetrafluoroethylene. At 6 and 24 weeks after repair, bile duct patches and surrounding tissues were taken for immunohistochemical observation and RT-PCR detection. RESULTS AND CONCLUSION: Compared with the control and blank group, the expression of cytokeratin was higher, but the expression of transforming growth factor β1 was lower in the experimental group. Within 24 weeks after repair, the total mRNA level of transforming growth factor β1 was lower in the experimental group than the other two groups (P < 0.05), but the total mRNA levels of insulin-like growth factor 2 and vascular endothelial growth factor were higher in the experimental group (P < 0.05). These findings indicate that the acelular dermal matrix for repair of bile duct injury can promote angiogenesis and bile duct epithelial regeneration, but not increase the formation of scars.%背景:脱细胞真皮基质是无细胞的天然组织支架,与人体软组织十分相近,易于塑形,无毒副作用,已被用于修补尿道与输尿管。目的:观察脱细胞基质修补胆管损伤的效果。方法:将30头滇南小耳猪随机均分为3组,空白对照组切断胆管后行端端吻合,实验组人为制作胆管缺损后以脱细胞真皮基质修补,对照组人为制作胆管缺损后以膨体聚四氟乙烯修补。修补后6,24

  5. Biliary cystadenoma with bile duct communication depicted on liver-specific contrast agent-enhanced MRI in a child

    International Nuclear Information System (INIS)

    Biliary cystadenoma is a benign, but potentially malignant, cystic neoplasm of the biliary ducts occurring most commonly in middle-aged females and very rarely in children. We present a 9-year-old boy with biliary cystadenoma, diagnosed by MRI using a new liver-specific contrast agent (gadoxetic acid) that is eliminated by the biliary system. The images clearly demonstrate the communication between the multiloculated cystic mass and the biliary tree, suggesting the possibility of biliary cystadenoma. Due to the malignant potential of a cystadenoma, the lesion was resected. The resection was complete and the postoperative course was uneventful. (orig.)

  6. 不同浓度氢氧化钠消融胆道的研究%Preliminary screening of sodium hydroxide for selective bile duct ablation and embolization

    Institute of Scientific and Technical Information of China (English)

    杨爱军; 董家鸿

    2010-01-01

    Objective To observe the pathological changes after ablation with sodium hydroxide in intrahepatic bile ducts in rabbits. Methods Twenty-four rabbits were divided into group A (5% sodium hydroxide,n=6) , group B (2. 5% sodium hydroxide,n =6), group C (1.5% sodium hydroxide,n =6) , group D (1% sodium hydroxide,n=6). The hepatic histopathology and the survival rate of the rabbits were observed. Results No rabbits were dead after the ablation. In the group A, right external lobe liver was totally necrotized after ablation with 5% sodium hydroxide (6/6). In the group B, right external lobe liver was barely completely necrotized after ablation with 2. 5% sodium hydroxide (5/6). In the group C, liver tissues were massively necrotized (1/6). In the group D, portal areas were necrotized(0/6). The biliary tracts were necrotized at the edge of lobe and there was no obvious necrosis in hepatic tissues. Conclusion 1% is the proper concentration of sodium hydroxide for selective bile duct ablation.%目的 观察氢氧化钠溶液消融家兔胆道后肝脏病理及肝功能改变.方法 观察家兔右外叶胆道于5%至1%浓度氢氧化钠溶液消融后肝脏功能状态、组织病理改变和术后存活情况.结果 动物存活率100%(24/24).各组间肝功能改变差异无统计学意义(P>0.05),但均与术前比较差异有统计学意义(P<0.05).5%氢氧化钠溶液组右外叶肝脏完全坏死(6/6).2.5%氢氧化钠组右外叶肝脏几乎完全坏死(5/6).1.5%氢氧化钠组右外叶以汇管区为中心的大片坏死(1/6).1%氢氧化钠组右外叶以汇管区为中心的点片状坏死,肝叶边缘仅胆管坏死(0/6).结论 1%为氢氧化钠溶液消融胆道的较理想浓度.

  7. Therapeutic experience ofendoscopic biliarydrainage for malignant bile duct obstruction%恶性胆道梗阻内镜治疗体会

    Institute of Scientific and Technical Information of China (English)

    屠继军; 毛伯能; 张学俭; 曹惠明

    2015-01-01

    目的:探讨经内镜胆道内支架置入术对各种恶性胆道梗阻的治疗效果。方法31例患者均行经内镜逆行胰胆管造影术( ERCP),根据不同情况分别置入金属或塑料支架引流,并随访观察。结果31例均一次成功置入支架,其中金属支架14例,塑料支架17例,总胆红素从(321.82±40.63)umol/L一周后下降到(120.51±18.76),直接胆红素从(251.27±38.74) umol/L一周后下降到(101.49±16.38) umol/L(P<0.01)。结论通过十二指肠镜进行胆道支架置入术是姑息治疗恶性胆道梗阻的有效方法。%Objective To investigate the therapeutic effect ofERBD ( Endoscopic retrograde biliary drainage ) or EMBE ( Endoscopic metal biliary endoprothesis ) in the treatment of malignant bile duct obstruction . Methods 31 patients with malignant biliary obstruct firstly received ERCP ( Endoscopic retrograde cholangiopancreatography ) examination.Appropriate methods ( EMBD or EMBE ) were performed on them according to the patients'conditions.After that, outcomes were performed and evaluated .Results 31 patients underwent ERCP and embedded with biliary stents successfully .31 cases of bile duct obstruction were drained with EMBE (14cases) and ERBD (17cases) respectively.The total bilirubin dropped significantly from (321.82 ±40.63) μmol/l to (120.51 ±18.76) μmol/l.The direct bilirubin was also reduced dramatically from (251. 27 ±38.74)μmol/l to (101.49 ±16.38) μmol/l (P <0.01).Conclusions These results indicate that endoscopic biliary drainage could provide adequate relief and have definite therapeutic effect of various malignant biliary obstruct .

  8. 多序列MRI和MSCT诊断胆道结石对照研究%The comparative study of multi-sequence MRI and MSCT in the diagnosis of calculus of bile duct

    Institute of Scientific and Technical Information of China (English)

    潘仲林; 朱友志; 廖文彬; 陈东; 曹慧贤

    2013-01-01

    Objective To evaluate comparatively the value of multi-sequence magnetic resonance imaging (MRI) and multislice computed tomography (MSCT) in the diagnosis of bile duct stones. Methods Between July 2011 to July 2012, a total of 58 patients who were diagnosed as cholangiolithiasis were subjucted to unenhanced MSCT and multi-sequence MRI. MRI scan sequences included axial T2 WI, axial T2 WI-fatsat, axial T1 WI, coronal T2 WI, and the examination time interval was not more than 2 days. All the cases were certified by the surgery and pathology results. According to the locations, stones were segmented into the intrahepatic bile duct stones, the superior common bile duct stones, the inferior common bile duct stones and gallbladder stones. A 2 × 2 table for Chi-square test was used for statistics analysis. Results There were 102 segments existing stones, 30 with gallbladder stones, 9 with the superior common bile duct stones, 36 with the inferior common bile duct stones, and 27 with the intrahepatic bile duct stones. One hundred segments were diagnosed by multi-sequence MRI; sixty-six segments were diagnosed by MSCT. The diagnostic accuracy of multi-sequence MRI and MSCT were 98. 03% (100/102) and 64. 7% (66/102) , there was significant difference (χ2 =40. 0, P <0. 01). Conclusion Multi-sequence MRI diagnoses of bile duct stones is significantly higher than that of MSCT, and provides a reliable diagnosis for the surgeon.%目的 对比探讨多序列磁共振成像(MRI)及多层螺旋CT (MSCT)诊断胆道系统结石的价值.方法 抽取2011年7月~2012年7月共58例胆道结石病例,均行MSCT平扫和多序列MRI检查,MRI检查序列包括:轴位T2 WI、轴位T2WI压脂、轴位T1WI、冠状位T2WI、厚层块MRCP和薄层MRCP.2种检查时间间隔不超过2天,所有病例均经手术和病理证实.按结石所在部位分成肝内胆管结石、上段胆总管结石、下段胆总管结石及胆囊结石进行统计.将MSCT和多序列MRI诊断结果进行

  9. Clinical application of precise hepatectomy techniques in right intrahepatic bile duct stones%精准肝切除技术在治疗右侧肝胆管结石中的应用

    Institute of Scientific and Technical Information of China (English)

    朱卫东; 谭兴国; 邓如岗; 刘科; 吴明祥

    2013-01-01

    目的:探讨精准肝切除治疗右侧肝内胆管结石的临床应用价值.方法:回顾性分析2005年5月-2010年8月43例精准肝切除与32例非规则性肝切除治疗右肝内胆管结石的病例资料,比较两组患者的手术时间、术中出血量、术后并发症、住院时间、结石清除率和住院时间等.结果:与非规则性肝切除组相比,精准肝切除组患者手术时间长(P<0.01),但术中出血量少(P<0.01),术后并发症少(P<0.01),结石清除率高(P<0.01),患者住院时间短(P<0.05).结论:右肝叶(段)精准切除是提高右肝胆管结石手术治疗效果、减少并发症的有效途径.%Objective:To explore the curative effect of precise hepatectomy techniques in bile duct stone.Methods:Totally 43 patients underwent precise hepatectomy and32 patients underwent irregular hepatectomy were retrospectively analyzed,and the intraoperative and postoperative indexes such as operation time,blood loss,postoperative complications,hospitalization time,clearance rate of calculus were analyzed.Results:Compared with the patients in irregular hepatectomy group.although the operative time was longer in precise hepatectomy group (P<0.01),the patients in precise hepatectomy group had less blood loss(P<0.01),less postoperative complications(P<0.01),and higher clearance rate of calculus (P<0.01)Thus.the patients in precise hepateclomy group had shorter hospital stay(P<0.05).Conclusions:Precise hepatectomy was the effective measures to increase the therapeutic effect and decrease complications for bile duct stone of right lobe liver.

  10. Selection criteria for preoperative endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy and endoscopic treatment of bile duct stones:Results of a retrospective,single center study between 1996-2002

    Institute of Scientific and Technical Information of China (English)

    Gabor Mester; Gyorgy Reti; Attila Nagy; Peter Laszlo Lakatos

    2004-01-01

    AIM: The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiopancreatography (ERCP).METHODS: Patients undergoing preoperative ERCP (≤90 dbefore laparoscopic cholecystectomy) were evaluated in this retrospective study from the 1st of January 1996 to the 31st of December 2002. The indications for ERCP were elevated serum bilirubin, elevated liver function tests (LFT), dilated bile duct (≥8 mm) and/or stone at US examination, coexisting acute pancreatitis and/or acute pancreatitis or jaundice in patient's history. Suspected prognostic factors and the combination of factors were compared to the result of ERCP.RESULTS: Two hundred and six preoperative ERCPs were performed during the observed period. The rate of successful cannulation for ERC was (97.1%). Bile duct stones were detected in 81 patients (39.3%), and successfully removed in 79 (97.5%). The number of prognostic factors correlated with the presence of bile duct stones. The positive predictive value for one prognostic factor was 1.2%, for two 43%,for three 72.5%, for four or more 91.4%.CONCLUSION: Based on our data preoperative ERCP is highly recommended in patients with three or more positive factors (high risk patients). In contrast, ERCP is not indicated in patients with zero or one factor (low risk patients).Preoperative ERCP should be offered to patients with two positive factors (moderate risk patients), however the practice should also be based on the local conditions (e.g.skill of the endoscopist, other diagnostic tools).

  11. Biliary sphincterotomy dilation for the extraction of difficult common bile duct stones Dilatación de la esfinterotomía biliar para la extracción de coledocolitiasis difíciles

    Directory of Open Access Journals (Sweden)

    J. García-Cano

    2009-08-01

    Full Text Available Background and aim: endoscopic retrograde cholangiopancreatography (ERCP with biliary sphincterotomy (BS is the usual method for extracting common bile duct stones. However, following BS and by means of extraction balloons and Dormia baskets a complete bile duct clearance cannot be achieved in all cases. We present a study on the impact that hydrostatic balloon dilation of a previous BS (BSD may have in the extraction rate of choledocholithiasis. Patients and methods: a prospective study which included 91 consecutive patients diagnosed with choledocholithiasis who underwent ERCP. For stone removal, extraction balloons and Dormia baskets were used, and when necessary BSD was employed. Results: complete bile duct clearance was achieved in 86/91 (94.5% patients. BSD was used in 30 (33% cases. In these cases, extraction was complete in 29/30 (97%; 23 (76% patients in the BSD group had anatomic difficulties or bleeding disorders. The most frequently used hydrostatic balloon diameter was 15 mm (60%. There were 7 (7.6% complications: two self-limited hemorrhage episodes in the BSD group and one episode of cholangitis, one of pancreatitis, and three of bleeding in the group in which BSD was not used. Conclusions: BSD is a very valuable tool for extracting common bile duct stones. In our experience, there has been an increase in the extraction rate from 73% (Rev Esp Enferm Dig 2002; 94: 340-50 to 94.5% (p = 0.0001, OR 0.1, CI 0.05-0.45, with no increase in complications.

  12. Nomogram Prediction of Survival and Recurrence in Patients With Extrahepatic Bile Duct Cancer Undergoing Curative Resection Followed by Adjuvant Chemoradiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Song, Changhoon [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Kyubo, E-mail: kyubokim@snu.ac.kr [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Chie, Eui Kyu [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul (Korea, Republic of); Kim, Jin Ho [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Jang, Jin-Young; Kim, Sun Whe [Department of Surgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Han, Sae-Won; Oh, Do-Youn; Im, Seock-Ah; Kim, Tae-You; Bang, Yung-Jue [Department of Internal Medicine, Seoul National University College of Medicine, Seoul (Korea, Republic of); Ha, Sung W. [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul (Korea, Republic of)

    2013-11-01

    Purpose: To develop nomograms for predicting the overall survival (OS) and relapse-free survival (RFS) in patients with extrahepatic bile duct cancer undergoing adjuvant chemoradiation therapy after curative resection. Methods and Materials: From January 1995 through August 2006, a total of 166 consecutive patients underwent curative resection followed by adjuvant chemoradiation therapy. Multivariate analysis using Cox proportional hazards regression was performed, and this Cox model was used as the basis for the nomograms of OS and RFS. We calculated concordance indices of the constructed nomograms and American Joint Committee on Cancer (AJCC) staging system. Results: The OS rate at 2 years and 5 years was 60.8% and 42.5%, respectively, and the RFS rate at 2 years and 5 years was 52.5% and 38.2%, respectively. The model containing age, sex, tumor location, histologic differentiation, perineural invasion, and lymph node involvement was selected for nomograms. The bootstrap-corrected concordance index of the nomogram for OS and RFS was 0.63 and 0.62, respectively, and that of AJCC staging for OS and RFS was 0.50 and 0.52, respectively. Conclusions: We developed nomograms that predicted survival and recurrence better than AJCC staging. With caution, clinicians may use these nomograms as an adjunct to or substitute for AJCC staging for predicting an individual's prognosis and offering tailored adjuvant therapy.

  13. Nomogram Prediction of Survival and Recurrence in Patients With Extrahepatic Bile Duct Cancer Undergoing Curative Resection Followed by Adjuvant Chemoradiation Therapy

    International Nuclear Information System (INIS)

    Purpose: To develop nomograms for predicting the overall survival (OS) and relapse-free survival (RFS) in patients with extrahepatic bile duct cancer undergoing adjuvant chemoradiation therapy after curative resection. Methods and Materials: From January 1995 through August 2006, a total of 166 consecutive patients underwent curative resection followed by adjuvant chemoradiation therapy. Multivariate analysis using Cox proportional hazards regression was performed, and this Cox model was used as the basis for the nomograms of OS and RFS. We calculated concordance indices of the constructed nomograms and American Joint Committee on Cancer (AJCC) staging system. Results: The OS rate at 2 years and 5 years was 60.8% and 42.5%, respectively, and the RFS rate at 2 years and 5 years was 52.5% and 38.2%, respectively. The model containing age, sex, tumor location, histologic differentiation, perineural invasion, and lymph node involvement was selected for nomograms. The bootstrap-corrected concordance index of the nomogram for OS and RFS was 0.63 and 0.62, respectively, and that of AJCC staging for OS and RFS was 0.50 and 0.52, respectively. Conclusions: We developed nomograms that predicted survival and recurrence better than AJCC staging. With caution, clinicians may use these nomograms as an adjunct to or substitute for AJCC staging for predicting an individual's prognosis and offering tailored adjuvant therapy

  14. Detection of Autoantibodies to Vascular Endothelial Growth Factor Receptor-3 in Bile Duct Ligated Rats and Correlations with a Panel of Traditional Markers of Liver Diseases

    Science.gov (United States)

    Duval, Florent; Cruz-Vega, Delia Elva; González-Gamboa, Ivonne; González-Garza, María Teresa; Ponz, Fernando; Sánchez, Flora; Alarcón-Galván, Gabriela; Moreno-Cuevas, Jorge E.

    2016-01-01

    There is a need for new noninvasive biomarkers (NIBMs) able to assess cholestasis and fibrosis in chronic cholestatic liver diseases (CCLDs). Tumorigenesis can arise from CCLDs. Therefore, autoantibodies to tumor-associated antigens (TAA) may be early produced in response to abnormal self-antigen expression caused by cholestatic injury. Vascular endothelial growth factor receptor-3 (VEGFR-3) has TAA potential since it is involved in cholangiocytes and lymphatic vessels proliferations during CCLDs. This study aims to detect autoantibodies directed at VEGFR-3 during bile duct ligation- (BDL-) induced cholestatic injury in rat sera and investigate whether they could be associated with traditional markers of liver damage, cholestasis, and fibrosis. An ELISA was performed to detect anti-VEGFR-3 autoantibodies in sera of rats with different degree of liver injury and results were correlated with aminotransferases, total bilirubin, and the relative fibrotic area. Mean absorbances of anti-VEGFR-3 autoantibodies were significantly increased from week one to week five after BDL. The highest correlation was observed with total bilirubin (R2 = 0.8450, P = 3.04e − 12). In conclusion, anti-VEGFR-3 autoantibodies are early produced during BDL-induced cholestatic injury, and they are closely related to cholestasis, suggesting the potential of anti-VEGFR-3 autoantibodies as NIBMs of cholestasis in CCLDs and justifying the need for further investigations in patients with CCLD. PMID:27212785

  15. Dihydroartemisinin alleviates bile duct ligation-induced liver fibrosis and hepatic stellate cell activation by interfering with the PDGF-βR/ERK signaling pathway.

    Science.gov (United States)

    Chen, Qin; Chen, Lianyun; Kong, Desong; Shao, Jiangjuan; Wu, Li; Zheng, Shizhong

    2016-05-01

    Liver fibrosis represents a frequent event following chronic insult to trigger wound healing responses in the liver. Activation of hepatic stellate cells (HSCs), which is a pivotal event during liver fibrogenesis, is accompanied by enhanced expressions of a series of marker proteins and pro-fibrogenic signaling molecules. Artemisinin, a powerful antimalarial medicine, is extracted from the Chinese herb Artemisia annua L., and can inhibit the proliferation of cancer cells. Dihydroartemisinin (DHA), the major active metabolite of artemisinin, is able to attenuate lung injury and fibrosis. However, the effect of DHA on liver fibrosis remains unclear. The aim of this study was to investigate the effect of DHA on bile duct ligation-induced injury and fibrosis in rats. DHA improved the liver histological architecture and attenuated collagen deposition in the fibrotic rat liver. Experiments in vitro showed that DHA inhibited the proliferation of HSCs and arrested the cell cycle at the S checkpoint by altering several cell-cycle regulatory proteins. Moreover, DHA reduced the protein expressions of a-SMA, α1 (I) collagen and fibronectin, being associated with interference of the platelet-derived growth factor β receptor (PDGF-βR)-mediated ERK pathway. These data collectively revealed that DHA relieved liver fibrosis possibly by targeting HSCs via the PDGF-βR/ERK pathway. DHA may be a therapeutic antifibrotic agent for the treatment of hepatic fibrosis. PMID:27038258

  16. Serum oxidative stress is increased in patients with post cholecystectomy bile duct injury Aumento del estrés oxidativo en el suero de pacientes con lesiones de vías biliares postcolecistectomía

    Directory of Open Access Journals (Sweden)

    A. G. Miranda-Díaz

    2010-06-01

    Full Text Available Background: post-cholecystectomy bile duct injuries are identified by the onset of jaundice as well as elevated bilirubin and alkaline phosphatase levels during the peri-operative period. It is unknown how serum oxidative stress markers are modified in patients with post-cholecystectomy bile duct injuries. Objective: to determine serum oxidative stress marker levels (lipid peroxidation by-products, nitrites/nitrates and total antioxidant capacity in patients with post-cholecystectomy bile duct injuries. Patients and methods: a prospective, transversal and analytical study was designed with two groups. Group 1: 5 healthy volunteer subjects. Group 2: 52 patients with post-cholecystectomy bile duct injuries (43 female and 9 male. An elective bilio-digestive reconstruction was performed at week 8. The serum oxidative stress marker levels were quantified by colorimetric method. Results: patients with bile duct injuries had a significant increased serum lipid peroxides (malondialdehyde and 4-hydroxy-alkenals and nitric oxide metabolites (nitrites/nitrates levels compared to the control group. In contrast, total antioxidant capacity in patients with bile duct injuries remained similar compared to healthy controls. Conclusions: the results show that oxidative stress is usually associated to bile duct injury.Introducción: las lesiones de las vías biliares postcolecistectomía se establecen por la aparición de ictericia, elevación de las bilirrubinas y de la fosfatasa alcalina durante el periodo perioperatorio. Se desconoce cómo se modifican los marcadores de estrés oxidativo en el suero de los pacientes con lesiones de las vías biliares postcolecistectomía. Objetivo: determinar los marcadores de estrés oxidativo (productos de peroxidación de lípidos, catabolitos del óxido nítrico y capacidad antioxidante total en el suero de pacientes con lesiones de las vías biliares. Pacientes y métodos: se realizó un estudio prospectivo transversal

  17. 防御素2在肝内胆管结石病中的抗菌作用%Anti-bacterial Effects of HBD2 in Intrahepatic Bile Duct of Calculus

    Institute of Scientific and Technical Information of China (English)

    陈辉星; 洪海杰; 朱金海; 韩圣华; 周良艺; 唐南洪; 陈燕凌

    2012-01-01

    Objective To investigate the function of the Human β-defensin 2 (HBD2) in human intrahepatic bile duct of calculus. Methods HBD2 expression was studied by immunohistochemistry and RT-PCR in 60 cases of human intrahepatic bile duct of calculus. Mean-while, the bile bacterial culture profiles for each patient were documented, and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score for each case at the time of diagnosis of intrahepatic bile duct of calculus was recorded. Result The expression of HBD2 in patients with Gram-negative bacteria culture was stronger than patients with Gram-positive bacteria culture. The difference was statistically significant (17/36 : 4/24,P <0. 05). HBD2 expression level -was higher in the left part of liver. Patients -with high APACHE II score showed stronger HBD2 expression than those -with low APACHE II score and the difference -was statistically significant. Conclusion HBD2 is expressed in the tissue of human intrahepatic bile duct of calculus, and its expression level strongly correlates with Gram-negative bacteria found and a high APACHE II score.%目的 探讨人防御素2(HBD2)在肝胆管结石病中的抗菌作用.方法 应用免疫组织化学方法和RT-PCR检测肝内胆管结石患者手术切除肝组织标本HBD2的表达情况.比较胆汁培养为革兰阴性及阳性菌组的HBD2表达的强弱,左右肝组织HBD2表达的强弱,分析HBD2表达与急性生理功能和慢性健康状况评分系统(ARACHEⅡ)评分的关系.结果 HBD2在部分肝内胆管结石的胆管间质细胞胞浆中表达,革兰阴性菌组的肝组织HBD2表达强于革兰阳性菌组,左肝部位HBD2的表达强于右肝部位,ARACHEⅡ高分组的HBD2表达强于低分组.结论 HBD2在肝胆管结石病肝组织中起到抗菌作用,其表达强度与革兰阴性菌和ARACHEⅡ评分正相关.

  18. Conditional loss of heparin-binding EGF-like growth factor results in enhanced liver fibrosis after bile duct ligation in mice

    Energy Technology Data Exchange (ETDEWEB)

    Takemura, Takayo; Yoshida, Yuichi [Department of Gastroenterology and Hepatology, Osaka University, Graduate School of Medicine, Osaka (Japan); Kiso, Shinichi, E-mail: kiso@gh.med.osaka-u.ac.jp [Department of Gastroenterology and Hepatology, Osaka University, Graduate School of Medicine, Osaka (Japan); Kizu, Takashi; Furuta, Kunimaro; Ezaki, Hisao; Hamano, Mina; Egawa, Mayumi; Chatani, Norihiro; Kamada, Yoshihiro [Department of Gastroenterology and Hepatology, Osaka University, Graduate School of Medicine, Osaka (Japan); Imai, Yasuharu [Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Osaka (Japan); Higashiyama, Shigeki [Department of Biochemistry and Molecular Genetics, Ehime University, Graduate School of Medicine and Department of Cell Growth and Tumor Regulation, Proteo-Medicine Research Center (ProMRes), Ehime University, Shitsukawa, Toon, Ehime (Japan); Iwamoto, Ryo; Mekada, Eisuke [Department of Cell Biology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka (Japan); Takehara, Tetsuo [Department of Gastroenterology and Hepatology, Osaka University, Graduate School of Medicine, Osaka (Japan)

    2013-07-26

    Highlights: •HB-EGF expression was increased during the development of liver fibrosis. •Conditional HB-EGF knockout mouse showed enhanced experimental liver fibrosis. •HB-EGF antagonized TGF-β-induced activation of hepatic stellate cells. •We report a possible protective role of HB-EGF in cholestatic liver fibrosis. -- Abstract: Our aims were to evaluate the involvement of heparin-binding EGF-like growth factor (HB-EGF) in liver fibrogenesis of humans and mice and to elucidate the effect of HB-EGF deficiency on cholestatic liver fibrosis using conditional HB-EGF knockout (KO) mice. We first demonstrated that gene expression of HB-EGF had a positive significant correlation with that of collagen in human fibrotic livers, and was increased in bile duct ligation (BDL)-induced fibrotic livers in mouse. We then generated conditional HB-EGF knockout (KO) mice using the interferon inducible Mx-1 promoter driven Cre recombinase transgene and wild type (WT) and KO mice were subjected to BDL. After BDL, KO mice exhibited enhanced liver fibrosis with increased expression of collagen, compared with WT mice. Finally, we used mouse hepatic stellate cells (HSCs) to examine the role of HB-EGF in the activation of these cells and showed that HB-EGF antagonized TGF-β-induced gene expression of collagen in mouse primary HSCs. Interestingly, HB-EGF did not prevent the TGF-β-induced nuclear accumulation of Smad3, but did lead to stabilization of the Smad transcriptional co-repressor TG-interacting factor. In conclusion, our data suggest a possible protective role of HB-EGF in cholestatic liver fibrosis.

  19. Combined intraperitoneal and intrathecal etanercept reduces increased brain tumor necrosis factor-alpha and asymmetric dimethylarginine levels and rescues spatial deficits in young rats after bile duct ligation

    Directory of Open Access Journals (Sweden)

    Jiunn-Ming Sheen

    2016-06-01

    Full Text Available Background: Rats subjected to bile duct ligation (BDL exhibit increased systemic oxidative stress and brain dysfunction characteristic of hepatic encephalopathy, including fatigue, neurotransmitter alterations, cognitive and motor impairment, and brain inflammation. The levels of tumor necrosis factor-alpha (TNF-α and asymmetric dimethylarginine (ADMA are both increased in plasma and brain in encephalopathy induced by chronic liver failure. This study first determined the temporal profiles of TNF-α and ADMA in the plasma, brain cortex, and hippocampus in young BDL rats. Next, we examined whether etanercept was beneficial in preventing brain damage.Methods: Young rats underwent sham ligation or BDL at day 17 ± 1 for 4 weeks. Treatment group rats were administered etanercept (10 mg/kg intraperitoneally (IP three times per week with or without etanercept (100 µg intrathecally (IT three times in total.Results: We found increased plasma TNF-α, soluble tumor necrosis factor receptor 1, soluble tumor necrosis factor receptor 2, and ADMA levels, increased cortical TNF-α mRNA and protein and ADMA, and hippocampal TNF-α mRNA and protein, and spatial defects in young BDL rats. The increase in cortex TNF-α mRNA and ADMA were reduced by IP etanercept or combined IP and IT etanercept. Dually IP/IT etanercept administration reduced the increased cortical and hippocampal TNF-α mRNA and protein level as well as spatial deficits.Conclusions: We conclude that combined intraperitoneal and intrathecal etanercept reduce increased brain TNF-α and ADMA levels and rescues spatial deficits in young rats after BDL.

  20. Systematic review and meta-analysis of outcomes after liver resection in patients with hepatocellular carcinoma (HCC) with and without bile duct thrombus

    Science.gov (United States)

    Navadgi, Suresh; Chang, Chi-Chun; Bartlett, Adam; McCall, John; Pandanaboyana, Sanjay

    2016-01-01

    Introduction This meta-analysis aimed to compare perioperative and survival outcomes in patients who underwent hepatectomy with and without Bile Duct Tumour Thrombus (BDTT). Methods A comprehensive search of Cochrane Library, PubMed, MEDLINE and EMBASE was performed to identify relevant articles. The perioperative, postoperative and long term outcomes were compared. Results Eleven studies including 6051 patients met the inclusion criteria. The perioperative outcomes were comparable between the 2 groups. The BDTT group had higher proportion poorly differentiated tumours (OR = 1.87, X2 = 10.00, df = 6, p = 0.002, I2 = 40%), Lymphovascular invasion (LVI) (OR = 4.85, X2 = 28.21, df = 9, p = <0.001, I2 = 68%) and Macrovascular invasion (MVI) (OR = 5.41, X2 = 8.73, df = 9, p = <0.001, I2 = 0%). There was no difference in 1 and 3 year survival, however 5-yr survival was poorer in the BDTT group (OR = 0.37, X2 = 37.04, df = 7, p = <0.001, I2 = 81%). The mean difference (MD) in overall survival in the BDTT group was −20 months [−32.31, −7.06], p = 0.002, I2 = 95%. Conclusion Patients with HCC with BDTT had more advanced stage HCC with adverse histological features including higher rates of MVI, LVI and poor differentiation. Hepatectomy in this group of patients offers similar survival at 3 years but inferior long-term survival and should be considered when feasible. PMID:27037199

  1. Conditional loss of heparin-binding EGF-like growth factor results in enhanced liver fibrosis after bile duct ligation in mice

    International Nuclear Information System (INIS)

    Highlights: •HB-EGF expression was increased during the development of liver fibrosis. •Conditional HB-EGF knockout mouse showed enhanced experimental liver fibrosis. •HB-EGF antagonized TGF-β-induced activation of hepatic stellate cells. •We report a possible protective role of HB-EGF in cholestatic liver fibrosis. -- Abstract: Our aims were to evaluate the involvement of heparin-binding EGF-like growth factor (HB-EGF) in liver fibrogenesis of humans and mice and to elucidate the effect of HB-EGF deficiency on cholestatic liver fibrosis using conditional HB-EGF knockout (KO) mice. We first demonstrated that gene expression of HB-EGF had a positive significant correlation with that of collagen in human fibrotic livers, and was increased in bile duct ligation (BDL)-induced fibrotic livers in mouse. We then generated conditional HB-EGF knockout (KO) mice using the interferon inducible Mx-1 promoter driven Cre recombinase transgene and wild type (WT) and KO mice were subjected to BDL. After BDL, KO mice exhibited enhanced liver fibrosis with increased expression of collagen, compared with WT mice. Finally, we used mouse hepatic stellate cells (HSCs) to examine the role of HB-EGF in the activation of these cells and showed that HB-EGF antagonized TGF-β-induced gene expression of collagen in mouse primary HSCs. Interestingly, HB-EGF did not prevent the TGF-β-induced nuclear accumulation of Smad3, but did lead to stabilization of the Smad transcriptional co-repressor TG-interacting factor. In conclusion, our data suggest a possible protective role of HB-EGF in cholestatic liver fibrosis

  2. Endosonography with linear array instead of endoscopic retrograde cholangiography as the diagnostic tool in patients with moderate suspicion of common bile duct stones

    Institute of Scientific and Technical Information of China (English)

    Maciej Kohut; Andrzej Nowak; Ewa Nowakowska-Dutawa; Tomasz Marek; Roman Kaczor

    2003-01-01

    AIM: To evaluate the diagnostic efficiency of endoscopic ultrasound (EUS) as the main imaging modality in patients with moderate suspicion of common bile duct stones (CBDS).METHODS: 55 patients with moderate clinical suspicion of CBDS were prospectively included to the study and evaluated with EUS. This study was done in single blind method in the clinical and biochemical data of patients. EUS was done with echo-endoscope Pentax FG 32-UA (f=5-7,5 MHz) and Hitachi EUB 405 ultrasound machine. Patients diagnosed with CBDS by EUS were excluded from this study and treated with ERC. All the other patients were included to the follow up study obtained by mail every 6 months for clinical evaluation (need of ERC or surgery).RESULTS: CBDS was found in 4 patients by EUS. Diagnosis was confirmed in all cases on ERC. The remaining 51 patients without CBDS on EUS were followed up for 6-26 months (meanly 13 months) There were: 40 women, 42cholecystectomized patients, aged: 55 (mean). Biochemical values (mean values) were as follows: bilirubin: 14,9 μmol.L-1,alkaline phosphatase: 95 IU.L-,1 γ-GTP: 131 IU.L-1, ALT: 50IU.L-1, AST: 49 IU.L-1, Only 1 patient was lost for follow up.In the remaining 50 patients with follow up, there was only 1 (2 %) patient with persistent biliary symptoms in whom CBDS was finally diagnosed by ERC with ES. All other patients remained symptoms free on follow up and did not require ERC or biliary surgery.CONCLUSION: Vast majority of patients with moderate suspicion of CBDS and no stones on EUS with linear array can avoid invasive evaluation of biliary tree with ERC.

  3. Evaluation of Intraductal Ultrasonography, Endoscopic Brush Cytology and K-ras, P53 Gene Mutation in the Early Diagnosis of Malignant Bile Duct Stricture

    Institute of Scientific and Technical Information of China (English)

    Ping Huang; Hao Zhang; Xiao-Feng Zhang; Xiao Zhang; Wen Lyu; Zhen Fan

    2015-01-01

    Background:In qualitative diagnosis of bile duct stenosis,single diagnostic measure is difficult to make a correct diagnosis,to combine several diagnostic techniques may be helpful to make an accurate diagnosis.The aim of this study was to evaluate the value of intraductal ultrasonography (IDUS),endoscopic brush cytology and K-ras,P53 gene mutation in the early diagnosis of malignant biliary stricture.Methods:From February 2012 to February 2013,84 patients with suspected malignant biliary stricture were performed IDUS firstly,then endoscopic brush cytology and finally K-ras,P53 gene mutation detection,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of all above ways were evaluated and compared.Results:Of 84 patients,52 cases were ultimately diagnosed malignant biliary stenosis;of which,9 cases had no recurrence or metastasis to other organs after radical operation during the follow-up period.IDUS combined with brush cytology and K-ras + P53 gene mutation detection had obvious advantage in the sensitivity,accuracy and negative predictive value than any other joint detection and single detection (the advantage was more significant compared with IDUS + brush cytology or any single detection P < 0.01).There were obvious statistical significance in the sensitivity and accuracy between IDUS + brush cytology + P53 or IDUS + brush cytology + K-ras and IDUS + brush cytology or IDUS (P < 0.05).There was no statistical significance in the sensitivity,specificity,positive predictive value,negative predictive value and accuracy between IDUS + brush cytology + P53 and IDUS + brush cytology + K-ras (P > 0.05).Conclusions:IDUS combined with brush cytology and K-ras,P53 gene mutation detection is better than the separate detection and contribute to the early diagnosis of malignant biliary stricture.Its more widespread use is recommended.

  4. Feasibility of fluoroelastomer-246B as the substitute of bile duct%氟橡胶246B作为胆管替代物的可行性

    Institute of Scientific and Technical Information of China (English)

    刘凯; 王广义; 刘松阳

    2008-01-01

    BACKGROUND: Fluoroelastomer-246B has better histocompatibility than polyethylene and polypropylene, which is the same as expanded polytetrafiuoroethylene (ePTFE). Besides, fluoroelastomer-246B has better rigidity than ePTFE, so it is hard to deform.OBJECTIVE: To investigate the feasibility of fluoroelastomer-246B as a human implant in vivo and a substitute of human bile duct by the test of bile soak, routine sterilized method, and implantation into rat abdominal cavity.DESIGN: A controlled observation.SETTING: First Hospital of Jilin University & Key Laboratory of Education Ministry for Supramolecular Structure and Material of Jilin University.MATERIALS: This study was performed at the Key Laboratory of Education Ministry for Supramolecular Structure and Material of Jilin University from June 2006 to March 2007. A total of 35 male Wistar rats of clean grade, aged 4-5 weeks,weighing 140-160 g, were provided by Laboratory Animal Center, School of Basic Medical Sciences, Jilin University [Permission No. SCXK (Ji) 2003-0001]. Prior to surgery, the Wistar rats were fasted for 5 hours, but they were allowed to access to water freely. The main materials used in the present study were as follows: fluoroelastomer-246B (Yangzhong Municipal Rubber & Plastics Plant, China), ePTFE(Shanghai Suo-Kang Medical Implants Co.,Ltd., China).METHODS: Rectangular fluoroelastomer-246B thin slices (50 mm×10 mm×0.5 mm) made were placed in a beaker filled with fresh bile, and preserved in a 37 ℃ thermostat container. The tensile strength, thermal decomposition temperature and glass transition temperature of fluoroelastomer-246B were tested after 30 days, and the results were compared to those before soaking to investigate whether the physical-chemical properties of fluoroelastomer-246B slices would change after soaking in the bile environment for a long time. The rectangular fluoroelastomer-246B thin slices made as above were sterilized by boiling method, formaldehyde vapors fumigating

  5. The combination of three endoscopes ( laparoscope, choledochoscope, duodenoscope) in treatment of complicated intra- and extrahepatic bile duct calculi%三镜联合治疗复杂性肝内外胆管结石的体会

    Institute of Scientific and Technical Information of China (English)

    王卫斌

    2012-01-01

    目的:分析复杂肝内外胆管结石的有效治疗方法及三镜(腹腔镜、胆道镜、十二指肠镜)联合治疗的优势.方法:回顾分析2009年8月至2011年8月为100例肝内外胆管结石患者行三镜联合手术的临床资料,并对结果进行随访.结果:79例成功施行胆总管一期缝合术,术后5~8d拔除鼻胆管,患者治愈出院.19例放置T管,12~15 d后带管出院,6~8周经胆道造影检查无特殊发现,遂拔除T管;其中3例发现胆道残留结石,术后经T管胆道镜取石成功,患者治愈出院.2例合并胆管癌,1例中转开腹,1例植入金属支架.术后随访3~6个月,2例胆管癌患者均死亡,余者均无结石复发、胆道狭窄等并发症发生.结论:三镜联合治疗复杂性肝内外胆管结石具有患者创伤小、康复快等特点,可降低并发症发生率及残石率,技术较成熟,值得临床推广应用.%Objective; To analyze the efficiency and superiority of combination of three endoscopes (laparoscope, choledocho-scope,duodenoscope) in treatment of complicated intra- and extrahepatic bile duct calculi. Methods:The clinical data of 100 patients with intra- and extrahepatic bile duct calculi who underwent combined three-microscopic surgery from Aug. 2009 to Aug. 2011 was analyzed retrospectively. Results: Primary suture of common bile duct was successfully performed in 79 patients, the nasobiliary tube was removed 5-8 days later,and these patients were cured. T-tube was placed in 19 patients who were discharged with tube 12-15 days after operation. The T-tube was removed after no special finding was noticed in the eholangiography. Residual calculi in bile duct were found in 3 patients,and the calculi were removed through T-tube sinus by choledochoscope,patients were cured and discharged. 2 cases were combined with bile duct carcinoma, 1 case was converted to laparotomy,and 1 patient was implanted metal stent. During the follow-up of 3-6 months,2 patients with carcinoma

  6. 肝癌TACE术后胆管狭窄致梗阻性黄疸的外科治疗%Surgical Treatment of Obstructive Jaundice Caused by Bile Duct Strictures after Hepatic Transcatheter Arterial Chemoembolization

    Institute of Scientific and Technical Information of China (English)

    蒋振宇; 朱锦辉; 曹利平

    2014-01-01

    Objective To examine the surgical treatments for obstructive jaundice caused by bile duct strictures after hepat-ic transcatheter arterial chemoembolization(TACE).Methods Clinical data were retrospectively analyzed of 9 patients who de-veloped bile duct strictures among 229 patients after TACE between June 1994 and March 2011 in People’s Hospital of Zhe-jiang Provincial and the Second Affiliated Hospital of Zhejiang University.There were 6 cases of primary liver cancer,and 3 ca-ses of metastatic liver cancer.Obstructive jaundice occurred 5 to 16 months after TACE treatment.The median time was 8 months.Results All the nine patients with bile duct strictures suffered different degrees of obstructive j aundice,which was cured after surgical operations or PTC + stenting in 7 patients and significantly relieved by percutaneous transhepatic cholangic drainage(PTCD)in 2 ones.Two patients with obstructive j aundice after TACE for primary liver cancer were followed up for 3 years,and no recurrence of hepatic carcinoma and bile duct obstruction was found.The other 7 patients were followed up for 3 to 13 months,and they all died of deterioration of primary disease.Conclusion Patients with obstructive jaundice caused by bile duct strictures after TACE benefit from surgical operations or intervention treatment.Different surgical strategies are selected based on the characteristics of primary disease,the site and extent of bile duct stricture.%目的:分析肝癌经导管动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)术后胆管狭窄致梗阻性黄疸的外科治疗方法。方法回顾性分析1994年6月至2011年3月在浙江省人民医院及浙江大学医学院附属第二医院229例因肝癌行肝脏TACE治疗后出现胆管狭窄的9例患者的临床资料。6例为原发性肝癌,3例为转移性肝癌。肝癌经TACE治疗后出现梗阻性黄疸的时间为5~16个月,中位时间为8个月。结果9例胆管狭窄病例均出

  7. Amylase activity in human bile.

    Science.gov (United States)

    Donaldson, L A; Joffe, S N; McIntosh, W; Brodie, M J

    1979-03-01

    The mean amylase level in 42 human bile samples was 154 IU/l and there was no significant difference in the amylase activity of 32 paired serum and bile samples. Estimation of the amylase thermolability of bile showed it to be similar to that of serum. This suggests that the amylase activity in bile may have filtered through the liver from the hepatic circulation rather than refluxed from the pancreatic duct. The presence of amylase in human bile provides further evidence that the liver might have a role in the regulation of serum amylase.

  8. Endoscopic ultrasonography versus intraoperative cholangiography in the detection of suspected common bile duct stones%超声内镜与术中胆道造影对可疑胆总管结石的诊断比较

    Institute of Scientific and Technical Information of China (English)

    朱欣; 杨建辉; 鲁葆春; 孙学征

    2015-01-01

    Objective To compare the diagnostic value of endoscopic ultrasonography (EUS) versus intraoperative cholangiography (IOC) for suspected common bile duct stones (CBDS).Methods 324 patients with suspected CBDS who were admitted to the Hepatobiliary Pancreatic Surgery Department of Shaoxing People's Hospital between June 2010 and June 2014 were retrospectively studied.Either EUS or IOC was used and the diagnostic value of these two imaging modalities was compared.Results The sensitivity, specificity, positive predictive value and negative predictive value of IOC in diagnosing suspected CBDS were 90.6%, 98.4%, 9.5% and 97.7% respectively.Its consistency rate was 96.9%.The sensitivity, specificity, positive predictive value and negative predictive value of EUS in diagnosing suspected CBDS were 97.1%, 100%, 100% and 99.1% respectively.Its consistency rate was 99.3%.Conclusions In diagnosing suspected CBDS, the sensitivity, specificity, positive predictive value and negative predictive value of EUS were significantly higher than IOC.When compared with IOC, EUS was more sensitive to detect occult CBDS and avoided unnecessary ERCP or bile duct exploration.Patients with negative EUS were less likely to have retained CBDS.%目的 探讨超声内镜(EUS)和术中胆道造影(IOC)对可疑胆总管结石的诊断价值.方法 搜集2010年6月至2014年6月绍兴市人民医院肝胆胰外科收治的可疑胆总管结石324例,全部行IOC或术前EUS检查.回顾性分析两种诊断方法对可疑胆总管结石的诊断价值.结果 IOC对可疑胆总管结石的敏感性、特异性、阳性预测值、阴性预测值、准确率分别为90.6%、98.4%、93.5%、97.7%、96.9%.EUS对可疑胆总管结石的敏感性、特异性、阳性预测值、阴性预测值、准确率分别为97.1%、100%、100%、99.1%、99.3%.结论 EUS对可疑胆总管结石的敏感性、特异性、阳性预测值、阴性预测值均高于IOC.与IOC相

  9. Effect of L-cysteine on remote organ injury in rats with severe acute pancreatitis induced by bile-pancreatic duct obstruction

    Institute of Scientific and Technical Information of China (English)

    Li-Juan Yang; Rong Wan; Jia-Qing Shen; Jie Shen and Xing-Peng Wang

    2013-01-01

    BACKGROUND: Remote  organ  failure  occurs  in  cases  of acute  pancreatitis  (AP);  however,  the  reports  on  AP  induced by  pancreatic  duct  obstruction  are  rare.  In  this  study  we determined  the  effect  of  L-cysteine  on  pancreaticobiliary inflammation  and  remote  organ  damage  in  rats  after pancreaticobiliary duct ligation (PBDL). METHODS:   AP  was  induced  by  PBDL  in  rats  with  5/0  silk. Sixty  rats  were  randomly  divided  into  4  groups.  Groups  A and  B  were  sham-operated  groups  that  received  injections  of saline  or  L-cysteine  (10  mg/kg)  intraperitoneally  (15  rats  in each group). Groups C and D were PBDL groups that received injections  of  saline  or  L-cysteine  (10  mg/kg)  intraperitoneally (15 rats in each group). The tissue samples of the pancreas and remote organs such as the lung, liver, intestine and kidney were subsequently examined for pathological changes under a light microscope. The samples were also stored for the determination of malondialdehyde and glutathione levels. Blood urea nitrogen (BUN), plasma amylase, ALT and AST levels were determined spectrophotometrically using an automated analyzer. Also, we evaluated  the  effect  of  L-cysteine  on  remote  organ  injury  in rats  with  AP  induced  by  retrograde  infusion  of  3.5%  sodium taurocholate (NaTc) into the bile-pancreatic duct. RESULTS: Varying degrees of injury in the pancreas, lung, liver, intestine and kidney were observed in the rats 24 hours after PBDL. The severity of

  10. 血红素氧合酶-1减轻大鼠胆道缺血再灌注损伤的作用及机制%Effect and mechanism of heme oxygenase-1 alleviating rat bile duct ischemia-reperfusion injury

    Institute of Scientific and Technical Information of China (English)

    黄汉飞; 庞天龙; 许坚吉; 侯美玲; 段键; 李珍; 曾仲; 王昆华

    2013-01-01

    Objective To explore the effect and mechanism of heme oxygenase-1 (HO-1) in rat bile duct ischemia-reperfusion injury.Methods 128 SD rats were randomly divided into a saline group (Saline),empty virus group (Adv),induced group (Adv-HO-1),and inhibition group (HO-1 siR-NA).Rats were injected using 0.5ml of saline,empty adenovirus,HO-1 adenovirus,and siRNA adenovirus (2× 109 TU/rat) via the dorsal penile vein 24 h before surgery.Liver function and bile composition was analyzed at 1 h,24 h,7d,and 14 d after reperfusion.The liver's histopathological changes and infiltration of inflammatory cells to the bile duct were examined,and the expression of HO-1,multidrug resistance protein (Mrp2),sodium taurocholate cotransporting polypeptide (Ntcp),and bile salt export pump (Bsep) protein were detected.Results Liver function was significantly reduced in the induced group after surgery,and hepatocytes and bile duct injury was attenuated.In comparison to the Adv-HO-1 group,abundant inflammatory cells and irregular configuration of bile ducts were seen in liver tissues of the HO-1 siRNA group.The expression of HO-1,Mrp2,Ntcp,and Bsep were significantly higher in the induced group than the suppressed group.However,serum conjugated bile salts,total bilirubin,and bile salt/phospholipid in the suppressed group was significantly higher than that in the induced group.Conclusions HO-1 can prevent biliary ischemia-reperfusion injury and reduce the accumulation of inflammatory cells around the bile duct.The inhibition of HO-1 enhanced the bile salt/phospholipid ratio aggravating cholangitis and cholestasis.%目的 探讨血红素氧合酶-1(HO-1)对大鼠胆道缺血再灌注损伤的影响及其机制.方法 将128只SD大鼠随机分为盐水组、空病毒组、诱导组和抑制组.分别于术前24 h经阴茎背静脉注射生理盐水、空白腺病毒、HO-1腺病毒和siRNA腺病毒0.5 ml.腺病毒注射剂量为2×109 TU/只.于再灌注1h、24 h、7d和14 d检测肝功能、

  11. Physiology of bile secretion

    Institute of Scientific and Technical Information of China (English)

    Alejandro Esteller

    2008-01-01

    The formation of bile depends on the structural and functional integrity of the bile-secretory apparatus and its impairment,in different situations,results in the syndrome of cholestasis.The structural bases that permit bile secretion as well as various aspects related with its composition and flow rate in physiological conditions will first be reviewed.Canalicular bile is produced by polarized hepatocytes that hold transporters in their basolateral (sinusoidal) and apical (canalicular) plasma membrane.This review summarizes recent data on the molecular determinants of this primary bile formation.The major function of the biliary tree is modification of canalicular bile by secretory and reabsorptive processes in bileduct epithelial cells (cholangiocytes) as bile passes through bile ducts.The mechanisms of fluid and solute transport in cholangiocytes will also be discussed.In contrast to hepatocytes where secretion is constant and poorly controlled,cholangiocyte secretion is regulated by hormones and nerves.A short section dedicated to these regulatory mechanisms of bile secretion has been included.The aim of this revision was to set the bases for other reviews in this series that will be devoted to specific issues related with biliary physiology and pathology.

  12. The proliferous rule of bile duct endothelium after the placement of metallic biliary stent: a study in canine%犬胆管金属支架诱导胆管内皮的增殖规律

    Institute of Scientific and Technical Information of China (English)

    毛晓楠; 卢再鸣; 郭启勇; 温锋; 梁宏元; 刘兆玉

    2010-01-01

    目的 探讨胆管金属支架植入后胆管内皮随时间的增殖规律.方法 采用经皮经肝穿刺胆囊的途径于犬胆总管下段植入支架,随机分配入1、3、12、24个月4个时间组,分别取支架上段及支架覆盖段胆管组织,通过免疫组化方法检测各组胆管内皮PCNA和Ki-67的表达情况,并通过HE染色测量支架覆盖段胆管壁厚度,比较不同位置胆管内皮增殖水平的差异,比较相邻时间组支架覆盖段胆管内皮增殖活性及胆管壁厚度的差异,采用两随机样本t检验进行统计学分析.结果 共18只实验犬建模成功.免疫组化及病理结果显示各时间组支架覆盖段胆管内皮的增殖活性明显高于支架上段(P<0.05);支架覆盖段胆管内皮的增殖活性及胆管壁厚度在支架植入后1个月内明显增高(P<0.05),之后经过一个相对的增殖平衡期,在支架植入后3~12个月期间再次逐渐增高并维持高增殖状态(P<0.05).结论 胆管金属支架能够诱导胆管内皮增殖,这种增殖活性在支架植入后3~12个月之间逐渐显现并加强,并在支架植入12个月以后继续维持.%Objective To discuss the proliferous rule of bile duct endothelium after the placement of metallic biliary stent. Methods The metallic biliary stent was placed at the inferior segment of common bile duct of canine after a percutaneous transhepatic puncture at cholecyst. All the stented dogs were assigned randomly to 4 group including A、B、C and D, each group had been under research for 1 month, 3 months, 12 months and 24 months. The expression of PCNA and Ki-67 in bile duct endothelium covered by the stent were calculated on the immunohistochemistry staining images and compared with those uncovered in each group, then the expression of PCNA and Ki-67 in bile duct endothelium covered by the stent were compared between every two adjacent groups. The thickness of bile duct wall covered by the stent were measured on the HE

  13. Clinical and Morphological Study of Junction of Pancreatico-Biliary Ductal System in Congenital Dilatation of Bile Duct%先天性胆管扩张症的胰胆管连接部的形态与临床观察

    Institute of Scientific and Technical Information of China (English)

    金百祥; 周以明

    1985-01-01

    In the years from 1979 to 1984,42 cases of congenital dilatation of bile duct were admitted.In 14 of them,biliary system was examined morphologically during operation by means of ch01angiopancreatography,percutaneous transhepatic cholangiography and endoscopic retrograde pancreatocholangiography which revealed abhormal long intercommunicating channel with an anomalous junction of the pancreatico-biliary ductal system.Clinical analysis was made of the relation betwean symptoms such as abdominal pain.palpable mass and jaundice.Abdominal pain was found related to elevated serum amylase level.Patients presenting abdominal pain of ten tend to show high amylase level in bile.These findings suggest that there is reflux of bile into pancreatic duct and likewise pancreatic juice into the bile duct in such patients.It also suggests that abdominal pain so often accompanying congenital dilatation of bile duct is due to pancreatitis.%@@ 自1969年Babbitt提出胰胆管合流异常的概念之后,由于各种造影的广泛应用,近年来,文献上有诸多报告.现将本院自1979年起积累之14例胰胆管连接部形态的造影所见,结合临床分析如下.

  14. 腹腔镜胆囊切除术后胆总管残余结石的危险因素分析%Risk factors for retained common bile duct stones of laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    崔宏力; 周长宇; 刘建东; 安宏超; 李华志; 徐宏征; 吴永哲

    2014-01-01

    目的 探讨导致腹腔镜胆囊切除术术后胆管残余结石的相关危险因素,为预防术后胆管残余结石提供科学依据.方法 分析2002年1月-2013年6月于北京市垂杨柳医院行腹腔镜胆囊切除术的654例胆囊结石患者,按术后是否存在胆总管结石残留,分为残余结石组(27例)及非残余结石组(627例).分别观察两组的黄疸胰腺炎病史、胆总管内径(B超)≥8 mm、急性胆囊炎、急诊手术、胆囊切除顺序、胆囊三角粘连、泥沙样结石、结石颈部嵌顿、充满型结石、胆囊管增粗、胆囊管保留≥1 cm、结石最小直径≤5 mm、胆囊结石数量≥5个、脓性胆汁等相关指标.采用统计软件IBM SPSS 20.0进行统计学分析.结果 经Logistic回归分析,按照影响度高低排序,本研究发现以下因素为LC术后残余结石的独立危险因素:胆总管内径(B超)≥8 mm、胆囊切除顺序(逆切)、黄疸胰腺炎病史、胆囊管保留长度≥1 cm、泥沙样结石.结论 有黄疸胰腺炎病史、胆总管内径(B超)≥8 mm、胆囊切除顺序(逆切)、泥沙样结石、胆囊管保留长度≥1 cm,是LC术后胆管残余结石的独立危险因素,在行LC术前及术中应特别注意上述因素并采取相应的措施,有助于避免术后胆管残余结石的发生.%Objective To investigate the related risk factors caused the retained common bile duct (CBD)stones after laparoscopic cholecystectomy,to provide the evidence for preventing from retained common bile duct stones of laparoscopic cholecystectomy.Methods Selected 654 cases of laparoscopic cholecystectomy patients as the objects whom hospitalized in Beijing Chuiyongliu Hospital from January 2002 to June 2013.All cases were divided into the group of retained CBD stones (27cases) and the group of non-retained CBD stones (627 cases).Collected the potentially relevant factors of two groups with the retained CBD stones,including medical history of jaundice and pancreatitis

  15. Endoscopic laser lithotripsy for complicated bile duct stones: is cholangioscopic guidance necessary? Litotripsia endoscópica a laser para cálculos difíceis de via biliar: a colangioscopia é necessária?

    Directory of Open Access Journals (Sweden)

    Ralf Jakobs

    2007-06-01

    Full Text Available BACKGROUND: Endoscopic papillotomy is successful in more than 95% of the cases of choledocholithiasis. For patients with difficult bile duct stones not responding to mechanical lithotripsy, different methods for stone fragmentation have been developed. AIM: To compare the results of laser lithotripsy with a stone-tissue recognizing system, when guided by fluoroscopy only or by cholangioscopy. METHODS: Between 1992 and 2002 we have treated 89 patients with difficult bile duct stones by endoscopic retrograde cholangiopancreatography and laser lithotripsy. Unsuccessful extracorporeal shock-wave lithotripsy and electrohydraulic were also performed before laser in 35% and 26% of the cases, respectively. RESULTS: Laser was effective in 79.2% of 72 patients guided by cholangioscopy and in 82.4% of 17 cases steered by fluoroscopy. The median number of impulses in the latter was 4,335 and 1,800 with the former technique. Two parameters influenced the manner of laser guidance. In cases of stones situated above a stricture, cholangioscopic control was more effective (64.7% vs. 31.9%. When the stones were in the distal bile duct, fluoroscopic control was more successful. CONCLUSION: In cases of difficult stones in the distal bile duct, laser lithotripsy under fluoroscopic control is very effective and easily performed. Cholangioscopic guidance should be recommended just in cases of intrahepatic stones or in patients with stones situated proximal to a bile duct stenosis. In these cases, cholangioscopy should be performed either endoscopically or percutaneously.RACIONAL: A papilotomia endoscópica é efetiva em mais de 95% dos casos de coledocolitíase . Para pacientes com cálculos de difícil extração (gigantes ou proximais a uma estenose, que não respondem à litotripsia mecânica, diferentes métodos de fragmentação foram desenvolvidos. OBJETIVO: Comparar os resultados da litotripsia à laser com um sistema de reconhecimento cálculo-tecido, quando

  16. PANCREATITIS AGUDA COMO PRESENTACIÓN DE UN QUISTE DEL CONDUCTO BILIAR EN EL ADULTO: REPORTE DE CASO Acute pancreatitis as a presentation of bile duct cyst in adults: a case report

    Directory of Open Access Journals (Sweden)

    Lenin Enríquez Domínguez

    2009-01-01

    Full Text Available Paciente adulta se presentÓ en la sala de urgencias con un cuadro de pancreatitis aguda como complicaciÓn de un quiste del conducto biliar colédoco tipo IV, el cual fue diagnosticado por ultrasonograma abdominal durante su estancia intrahospitalaria. El diagnÓstico de quiste de colédoco es más difícil en la edad adulta ya que los pacientes raramente se presentan con la triada clásica de dolor abdominal, masa palpable e ictericia, presentándose principalmente con alguna manifestaciÓn de vías biliares o pancreática benigna. Existen pocas publicaciones en Occidente acerca de este tÓpico. La importancia en cuanto al diagnÓstico temprano, la clasificaciÓn del mismo y al tratamiento quirúrgico con la resecciÓn total del quiste radica en su alta incidencia hacia el desarrollo de colangiocarcinoma.An adult female patient who attended an ER with acute pancreatitis as a complication of bile duct cyst disease is described here; she was diagnosed by abdominal ultrasonogram during her hospital stay. A diagnosis of bile duct cysts is difficult to make in adults, since patients rarely present the classic picture of abdominal pain, palpable mass and jaundice; it is mainly presented as a biliary duct or pancreatic tissue complication. There are few publications on this topic in the west. A diagnosis can be made by ultrasound in many cases and is the image study of choice due to its low cost and accessibility. These are only few western publications concerning this subject. The importance of making an early diagnosis, classification and surgical treatment (total resection of the cyst lies in the high risk of malignancy developing.

  17. 体外诱导骨髓间充质干细胞向胆管上皮样细胞分化%In vitro induced differentiation of bone marrow mesenchymal stem cells into bile duct epithelial-like cells

    Institute of Scientific and Technical Information of China (English)

    张诚; 杨玉龙; 林美举; 史力军; 张洪威; 李婧伊

    2013-01-01

    BACKGROUND:Extrahepatic bile duct and gal bladder epithelial cel s are easily isolated and purified, but bile duct epithelial cel s predispose to lose proliferative capacity under in vitro circumstances. Thus, enough amounts of cel s used for basic studies are hardly acquired, which limits the progression of bile duct repair. Bone marrow mesenchymal stem cel s can be differentiated into hepatocytes, but there have been no reports regarding in vitro induced differentiation of bone marrow mesenchymal stem cel s into bile duct epithelial cel s. OBJECTIVE:To discuss the feasibility of inducing bone marrow mesenchymal stem cel s into the bile duct epithelial cel s in vitro, and to find suitable seed cel s for the repair of bile duct injury. METHODS:Rat bone marrow mesenchymal stem cel s were in vitro isolated and purified by whole bone marrow adherent screening in vitro. Passage 3 bone marrow mesenchymal stem cel s were cultured with culture medium containing hepatocyte growth factor and epidermal growth factor. The morphological changes of bone marrow mesenchymal stem cel s were observed under the inverted microscope and CK19 expression was detected by immunofluorescence assay at different time periods. RESULTS AND CONCLUSION:Under the induction by hepatocyte growth factor and epidermal growth factor, bone marrow mesenchymal stem cel s gradual y appeared from shuttle-shaped to polygonal or triangular. Immunofluorescence examination showed that CK19 expression appeared in the cel membrane in the 4th week of induction and it was significantly increased in the 6th week. These findings suggest that bone marrow mesenchymal stem cel s can be induced to differentiate into duct epithelial-like cel s under the combined induction of hepatocyte growth factor and epidermal growth factor, which provides a new thought for bile duct repair with bone marrow mesenchymal stem cel s.%  背景:肝外胆管和胆囊上皮细胞的分离、纯化相对比较容易,但是胆管上

  18. 齐墩果酸对阻塞性胆汁淤积大鼠胆酸转运蛋白OSTα/β和BSEP的调控作用%Oleanolic acid stimulates the expression of bile acids transporters OSTalpha-beta and BSEP in bile duct-ligation rats

    Institute of Scientific and Technical Information of China (English)

    柴进; 向国春; 封欣婵; 张樑君; 程英; 陈文生

    2016-01-01

    Objective To study the function and effect of Oleanolic acid to cholestasis on regulating bile acids transporters. Methods A total of 45 rats were divided into 9 groups,5 rats in each group. The Sham group,Bile duct ligation group and Oleanolic acid group were treated with saline or Oleanolic acid for 3 days,7 days and 14 days. Then the liver and tested bile acids transporters in mRNA and protein lev-els were collected. Results The expression of bile acids transporter OSTβ with Oleanolic acid was increased after 3 days. The expression of OSTβ and BESP in Oleanolic acid group after 7 days were increased than those in Sham group. Fourteen days later,the increasing tendency of OSTα,OSTβ and BSEP were sensiable. Conclusion Oleanolic acid can stimulates the expression of bile acids transporters OSTalpha-beta and BSEP in bile duct-ligation rats.%目的:建立胆道结扎大鼠模型,观察胆道结扎所致肝外胆汁淤积时齐墩果酸对肝细胞表面胆酸转运蛋白OSTα/β和BSEP的调控作用。方法随机将45只SD大鼠分为9组,每组5只。假结扎组( Sham组)、胆道结扎组( BDL组)和齐墩果酸组( BDL+OA组)分别用生理盐水、齐墩果酸处理3 d、7 d、14 d后收集组织样本,提取肝脏RNA和总蛋白,分别在mRNA水平和蛋白水平检测OSTα/β和BSEP的表达变化。结果大鼠胆道结扎后,齐墩果酸干预3 d,胆酸转运蛋白OSTβ在mRNA和蛋白水平均增高,随着齐墩果酸干预时间的延长,在第7天时,胆酸转运蛋白BSEP的表达亦出现增高。第14天时,OSTα、OSTβ、BSEP表达均增高。结论齐墩果酸能够上调阻塞性胆汁淤积胆酸转运蛋白OSTα、OSTβ、BSEP的表达。

  19. 内镜治疗胆总管良性狭窄31例分析%EPBD combined ERBD for benign common bile duct stricture: an analysis of 31 cases

    Institute of Scientific and Technical Information of China (English)

    包海标; 徐毅; 吕宾; 孙翠萍; 许薇薇

    2011-01-01

    Objective To evaluate the efficacy of endoscopy for benign common bile duct stricture. Methods 31 patients with benign common bile duct stricture were retrospectively analyzed. Patients who were hospitalized due to obstructive jaundice, abdominal pain and diagnosed based on medical history, computed tomography (CT) and magnetic resonance imaging (MRI) findings, laboratory test results, were treated by endoscopic papillo - sphincter balloon dilation ( EPBD) and endoscopic retrograde biliary drainage ( ERBD). The patients were e-valuated by the Bismuth criterion. Results 31 patients were underwent EPBD and ERBD, and the effective rate was 96.77%. 30 patients were followed up,among which 27 patients were without recurrence and 3 patients were with recurrence in half a year, of which 2 cases were with chronic pancreatitis and 1 previously underwent resection of the gallbladder. The stent indwelling time of the 3 patients were 6 months. Conclusion EPBD combined ERBD treatment on benign common bile duct stricture is safe and effective. The efficacy is associated with the cause of strictures and the indwelling time of stents.%目的 探讨内镜在胆总管良性狭窄治疗中的作用.方法 回顾性分析31例因梗阻性黄疸、腹痛入院,均据病史、CT和MRI及实验室检查确诊为胆总管良性狭窄患者.狭窄分类对照Bismuth标准分为2型,并评价采用内镜下括约肌气囊扩张术(EPBD)和胆管内支架引流术(ERBD)的治疗效果.结果 31例患者经EPBD和ERBD治疗,有效率为96.77%,随访患者30例,其中27例未复发;3例拔除支架后6月内复发;3例再狭窄患者中2例为慢性胰腺炎,1例为有胆囊切除史者,支架留置时间皆为6个月.结论 EPBD联合ERBD治疗胆总管良性狭窄安全有效,其治疗效果与狭窄的病因和支架留置时间有关.

  20. The combined treatment with laparoscopy and endoscopy for congenital fusiform dilation of bile ducts%腹腔镜联合内镜治疗梭状先天性胆管扩张症

    Institute of Scientific and Technical Information of China (English)

    张军; 李龙; 刘树立; 李颀; 董宁; 张金山

    2013-01-01

    Objective To assess the efficacy of laparoscopy and endoscopy for congenital fusiform dilation of bile ducts in children.Methods From June 2006 to June 2012,the clinical manifestation,radiological features and surgical treatment of 18 cases with congenital fusiform dilation of bile ducts treated with combination of laparoscopy and endoscopy were retrospectively analyzed.Results The protein plugs and/or stones were removed completely under laparoscopy and endoscopy in 18 cases.Patients were followed up for 3 months to 6 years.The biochemical and ultrasound examinations showed no increase in pancreatic amylase or any recurrence of the stones in the common channel of biliary and pancreatic ducts or in the pancreatic duct.The median time of jaundice regression was 5 weeks (ranging from 3 to 8 weeks) postoperatively.Amylase decreased to the normal level after 4 to 9 days postoperatively (median 4.5 d).Transaminase turned to normal after 2 to 5 months postoperatively (median 3.3 months).Conclusions The combination of laparoscopy and endoscopy for treatment of patients with congenital fusiform dilation of bile ducts can effectively clear the protein plugs and/or stones in the common channel of biliary and pancreatic ducts.%目的 探讨梭状先天性胆管扩张症的腹腔镜联合内镜治疗的效果.方法 回顾性分析2006年6月至2012年6月腹腔镜联合内镜(胆道镜、尿道镜)手术治疗18例梭状先天性胆管扩张症患儿的临床症状、生化检查指标和影像检查结果.结果 本组均成功行腹腔镜、内镜(胆道镜、尿道镜)联合胆道探查、冲洗和取石及碎石,直视下解除共同管梗阻,行胆管扩张症根治术.患儿术后随访3个月~6年,无一例术后血和尿胰淀粉酶升高及再发共同管和胰管蛋白栓和(或)结石.黄疸术后3~8周(平均5周),逐渐消退;淀粉酶术后4~9 d(平均4.5d)恢复正常;转氨酶术后2~5个月(平均3.3个月)恢复正常.结论 梭状先天性胆

  1. 真稳态进动快速成像序列在肝内外胆管梗阻诊断中的价值%Value of balanced-FFE sequence in the diagnosis of inside and outside the liver bile duct obstruction

    Institute of Scientific and Technical Information of China (English)

    周永怀; 程和平; 曹若愚

    2009-01-01

    目的 探讨磁共振真稳态进动快速成像(balanced-FFE)序列在肝内外胆管梗阻诊断中的价值.方法 采用相控阵体线圈,对121例胆管疾病患者进行了balanced-FFE冠状位像扫描.结果 Balanced-FFE像对胆管结石定位准确率为96.6%,定性准确率为97.7%;对胆管肿瘤定位准确率为91.3%,定性准确率为82.6%.结论 Balanced-FFE序列不仅较准确地显示胆管内病变,而且能够显示胆管壁及周围组织侵犯情况,在肝内外胆管梗阻性疾病中具有较高的定位和定性诊断价值.%Objective To investigate the value of magnetic resonance balanced fast field echo (ba- lanced-FFE) sequcnce in the diagnosis of inside and outside the liver bile duct obstruction. Meth- ods Phased-array SENSE body coil was used. 121 cases of bile duct obstruction disease patients were scanned by balanced-FFE sequence with coronary scan. Results Balanced-FFE sequence image,showed that accuracy rate of the bile duct stones localization was 96.6%,accuracy rate of quality was 97.7%,accuracy rate of the bile duct tumor localization was 91.3%,accuracy rate of quality was 82.6%. Conclusion Balanced-FFE sequence can show not only the inside bile duct lesions exactly,but also bile duct wall and surrounding tissue invasion. It had more diagnosis ability of localization and quality with inside and outside the liver bile duct obstruction cases.

  2. A study of impact of stent implantation in distal common bile duct on duodenal-biliary reflux%胆总管末端植入金属支架对肠胆反流的影响

    Institute of Scientific and Technical Information of China (English)

    温锋; 卢再鸣; 郭启勇; 杨晓珍; 毛晓楠; 梁宏元

    2010-01-01

    目的 探讨胆总管末端植入金属支架后早期肠胆反流状况和反流性胆管炎的发生机制.方法 16例无胆系感染并排除肠梗阻及肠道、胆道手术病史的恶性低位胆管梗阻患者,通过经皮经肝胆管穿刺及单纯外引流后,于胆总管末端植入金属网状支架.在植入支架前进行血白细胞计数、中性粒细胞百分比和总胆红素、直接胆红素含量的检测.支架植入后2~5 d再次检查上述各项指标,并于拔管前2 h口服含有99锝m-二乙三氨五醋酸(99Tcm-DTPA)的水,2 h后检测胆汁中核素的放射性活度.对研究获得的计量资料,采用配对t检验或秩和检验,P<0.05为差异有统计学意义.结果 支架植入后2~5 d,14例进行了胆汁99Tcm检测,其中12例于拔管前2 h胆汁中检测到99Tcm活度,放射计数占总摄入剂量的1.82%.2例胆汁中未检测到99Tcm.14例进行胆汁核素检测的患者均没有出现高热、寒战、黄疸加重的胆管炎表现,血白细胞计数和中性粒细胞百分比分别为(7.59±2.62)×109/L、0.74,与支架植入前的(7.94±3.84)×109/L和0.68相比,差异均没有统计学意义(分别为t=0.423、Z=1.036,P值均>0.05);而血总胆红素和直接胆红素值的中位数分别为92.2和74.3 μmol/L,明显低于支架植入前的202.6和154.7 μmol/L,差异均具有统计学意义(Z值均为-3.170,P值均<0.05).结论 胆总管末端植入支架后,早期就有较高的肠胆反流发生率,但没有反流性胆管炎的发生.%Objective This study aimed to investigate the incidence and the cause for duodenalbiliary reflux and reflux cholangitis after metallic stent placement in distal common bile duct Methods After percutaneous transhepatic bile duct puncture and biliary outside drainage was performed, 16 cases with malignant distal biliary stricture underwent metallic stent placement in distal common bile duct Before stent placement, the routine laboratory studies including leukocyte

  3. Resultados del drenaje de la vía biliar por CPRE en pacientes con edad geriátrica Outcomes of bile duct drainage by means of ERCP in geriatric patients

    Directory of Open Access Journals (Sweden)

    J. García-Cano

    2007-08-01

    Full Text Available Antecedentes y objetivo: la colangiopancreatografía retrógrada endoscópica (CPRE es habitualmente la técnica de elección para desobstruir la vía biliar. Una gran parte de los pacientes a los que se realiza esta intervención están en edad geriátrica (mayores de 75 años. Nuestro objetivo ha sido valorar la eficacia de la CPRE en este grupo de pacientes, comparado con los de menor edad. Pacientes y métodos: estudio retrospectivo en el que se han incluido los pacientes a quienes se realizó terapéutica biliar endoscópica mediante CPRE en un periodo de cuatro años (2002-2005. Resultados: se realizó CPRE a 178 pacientes en edad geriátrica y a 159 de menor edad. No hubo diferencias en el éxito del drenaje biliar (97,7-98,7%, en el número de complicaciones (11,8-14,4%, ni en la mortalidad (1,1-0,6%. Por el contrario, en el grupo geriátrico hubo más coledocolitiasis (57,3-39,6%, p = 0,004 y se utilizaron más prótesis metálicas autoexpandibles para drenar la ictericia obstructiva tumoral (47-8%, p = 0,0035. En el grupo de menor edad se repitieron más CPRE a los mismos pacientes (4-10%, p = 0,001. Conclusiones: el éxito y la morbimortalidad para drenar la vía biliar mediante CPRE son similares en los pacientes con edad geriátrica y en los de edad inferior. La coledocolitiasis es más frecuente en los pacientes mayores. No se debe excluir a ningún paciente que precise de una CPRE sólo por la edad.Background and objective: endoscopic retrograde cholangiopancreatography (ERCP is usually the procedure of choice for relieving bile duct obstruction. A large number of patients undergoing this intervention are geriatric population (aged 75 years of age and older. Our aim was to assess the efficacy of ERCP in this group of patients as compared to younger ones. Patients and methods: a retrospective study. All patients in whom a therapeutic biliary endoscopy had been performed over a four-year period of time (2002-2005 were included

  4. Management of empyema of gallbladder with percutaneous cholecysto-duodenal stenting in a case of hilar cholangiocarcinoma treated with common bile duct metallic stenting

    Directory of Open Access Journals (Sweden)

    Sheo Kumar

    2011-01-01

    Full Text Available Empyema of the gallbladder develops when the gallbladder neck is obstructed in the presence of infection, preventing pus from draining via the cystic duct. Treatment options include cholecystectomy or, in patients with comorbidities, drainage via percutaneous cholecystostomy, later followed by cholecystectomy. Here, we describe a 59-year-old man who presented with complaints of recurrent hiccups and was found to have cholangiocarcinoma causing obstruction to cystic duct drainage. The patient was managed successfully by percutaneous transhepatic cholecysto-duodenal self-expandable covered metal stent.

  5. 医源性胆道损伤的内镜治疗选择%Endoscopic managements for iatrogenic bile duct injury

    Institute of Scientific and Technical Information of China (English)

    张奇煜; 张磊; 李汛; 周文策; 孟文勃; 朱晓亮; 徐红霞; 王亚晋; 徐冬霞

    2014-01-01

    目的 探讨以经内镜逆行性胰胆管造影(ERCP)为基础的内镜技术在医源性胆道损伤(BDI)中的选择及临床疗效.方法 回顾性分析2010年1月至2013年12月兰州大学第一医院收治的65例医源性BDI患者的临床资料,BDI按照Strasberg等的分型标准进行分型,统计各型BDI的治疗方法及疗效.结果 单纯内镜治疗33例,有效26例;单纯手术治疗16例,有效14例;内镜联合手术治疗16例,均有效.BDI分型A型11例、C型1例、D型6例、E1型21例、E2型14例、E3型7例、E4型5例,单纯内镜治疗有效率分别为7/7、0/0、2/2、12/17、4/4、1/2和0/1,单纯手术治疗有效率分别为1/1、1/1、2/2、2/2、5/5、1/2和2/3,内镜联合手术治疗有效率分别为3/3、0/0、2/2、2/2、5/5、3/3和1/1.有35例行胆道支架置入治疗,塑料支架和覆膜金属支架分别为26例和9例,覆膜金属支架者较塑料支架耐受时间明显增加[(14.80±8.340)个月比(4.85±1.860)个月,P=0.012]、并发症发生率明显降低(1/9比13/26,P=0.045).结论 对于医源性BDI,多数情况下可选择内镜治疗作为一线方案,这也可为之后手术治疗创造条件.对于E1型BDI的狭窄,ERCP放置胆道覆膜金属支架的远期疗效与手术治疗相当.%Objective To evaluate the clinical effects of endoscopic retrograde cholangiopancreaticography (ERCP) in iatrogenic bile duct injury (BDI).Methods Data of 65 patients with iatrogenic BDI who underwent ERCP at The First Affiliated Hospital of Lanzhou University from January 2010 to December 2013 were retrospectively analyzed.All the BDIs were classified by Strasberg-Bismuth classification,and the treatment and effects of all BDI were analysed.Results Of 65 patients,33 were treated by ERCP,16 by srugery,and 16 others by both methods with efficacy being 78.79% (26/33),14/16,16/16 respectively.BDIs were classified by the Strasberg-Bismuth classification into class A (n =11),class C (n =1),class D (n=6),class E1 (n=21

  6. The treatment of obstructive jaundice caused by bile duct strictures after hepatic transcatheter arterial chemoembolization in liver tumor patients%肝脏肿瘤动脉栓塞化疗术后胆管狭窄

    Institute of Scientific and Technical Information of China (English)

    朱锦辉; 刘颖斌

    2011-01-01

    Objective To evaluate the treatment of obstructive jaundice caused by bile duct strictures after hepatic transcatheter arterial chemoembolization in hepatic tumor patients. Methods A retrospective review (Jun 1994 - Mar 2010) of databases at two institutions (Zhejiang Provincial People's Hospital and Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine) identified 15patients with obstructive jaundice caused by liver bile duct stricture after transcatheter arterial chemoembolization. There were 7 cases of primary liver cancer, 5 patients of liver hemangioma, 3 cases of metastatic liver cancer including 2 cases of colonic cancer and one of pancreatic cancer. Obstructive jaundice appeared in a period of 5 months to 16 months after TACE. The median time was 9 months. Results The obstructive jaundice was relieved by surgically constructed hepatobiliary drainage or PTC+stenting treatment in 13 cases and PTCD in 2 cases. All patients of hepatic hemangioma were doing well after treatment. Two cases of primary liver cancer patients with obstructive jaundice after TACE were followed up for 2 years with no recurrence of hepatic carcinoma and bile duct obstruction. The other 8 patients were followed up from 3months to 18 months until to their death from primary disease progress. Conclusions Surgery and or PTCD plus stent can effectively relieve the obstructive jaundice caused by TACE in benign or malignant liver tumors.%目的 分析肝脏经导管动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)术后胆管狭窄致梗阻性黄疸的外科治疗方法.方法 回顾性分析1994年6月至2010年3月在浙江省人民医院及上海交通大学医学院附属新华医院行肝脏TACE治疗后出现胆管狭窄的15例患者的临床资料.7例为原发性肝癌,5例为肝脏血管瘤,3例为转移性肝癌,原发疾病分别为结肠癌2例和胰腺癌1例.肝脏TACE后出现梗阻性黄疸的时间为5~16个月,中位时间为9

  7. 大黄素诱导胆管癌QBC939细胞凋亡的实验研究%Experimental study of emodin inducing apoptosis of bile duct carcinoma cell QBC939

    Institute of Scientific and Technical Information of China (English)

    李新星; 王坚

    2012-01-01

    Objective To investigate the effect and mechanism of emodin inducing the apoptosis of human bile duct carcinoma cell QBC939 in vitro. Methods The inhibition of cell proliferation was detected by MTT. The morphological changes of apoptotic cells were observed under fluorescence microscopy.The apoptosis rates and intracellular reactive oxygen species levels were detected by flow cytometry.The intracellular relative activities of caspase-9 and caspase-3 were tested through colorimetric method.Results Emodin inhibited cell proliferation of human bile duct carcinoma cell QBC939 in time-dose dependent fashion.Apoptotic cells displayed bright,nuclear presented divided leaves,debris and a set of edges under fluorescence microscopy.Treated with 30 μmol/L and 50 μmol/L emodin,the apoptosis rates of 24 hours were respectively 38.9% ± 9.07% and 67.09% ± 4.08% (P < 0.05).The intracellular reactive oxygen species levels after 30 minutes treatment were 1.65 ± 0.08 and 2.28 ± 0.04folds of the control group (P < 0.05). Emodin could activate caspase-9 and caspase-3,leading to elevations of their activities (P < 0.05).Conclusion Emodin inhibites cell proliferation of human bile duct carcinoma cell QBC939 through inducing apoptosis.The mechanism is associated with the elevated levels of reactive oxygen species and the activation of caspase-9 cells and caspase-3.%目的 探讨大黄素在体外诱导人胆管癌QBC939细胞凋亡的作用及机制.方法 采用3-(4,5-二甲基噻唑-2)-2,5-二苯基四氮唑溴盐(MTT)法检测大黄素对细胞增殖的抑制作用;在荧光显微镜下观察凋亡细胞的形态学变化;运用流式细胞技术检测细胞凋亡率和细胞内活性氧水平;通过比色法测定细胞内caspase-9及caspase-3的相对活性.结果 大黄素以时间-剂量的方式抑制胆管癌QBC939细胞的增殖;在荧光显微镜下,凋亡的细胞呈现亮色,或核呈分叶、碎片状,细胞皱缩;QBC939细胞在30 μmol/L和50

  8. Bile acids for liver-transplanted patients

    DEFF Research Database (Denmark)

    Poropat, Goran; Giljaca, Vanja; Stimac, Davor;

    2010-01-01

    Liver transplantation has become a widely accepted form of treatment for numerous end-stage liver diseases. Bile acids may decrease allograft rejection after liver transplantation by changing the expression of major histocompatibility complex class molecules in bile duct epithelium and central vein...

  9. Bile acids for liver-transplanted patients

    DEFF Research Database (Denmark)

    Chen, Weikeng; Gluud, C

    2005-01-01

    Liver transplantation has become a widely accepted form of treatment for numerous end-stage liver diseases. Bile acids may decrease the degree of allograft rejection after liver transplantation by changing the expression of major histocompatibility complex class molecules in bile duct epithelium...

  10. Review of experimental models for inducing hepatic cirrhosis by bile duct ligation and carbon tetrachloride injection Revisão de modelos experimentais de cirrose hepática induzida por ligadura do ducto biliar e por injeção de tetracloreto de carbono

    OpenAIRE

    Thamirys Guimarães Marques; Eleazar Chaib; Juliana Hamati da Fonseca; Ana Cecília Rodrigues Lourenço; Felipe Duarte Silva; Marcelo Augusto Fontenelle Ribeiro Jr; Flavio Henrique Ferreira Galvão; Luiz Augusto Carneiro D'Albuquerque

    2012-01-01

    PURPOSE: To present a review about a comparative study of bile duct ligation versus carbon tetrachloride Injection for inducing experimental liver cirrhosis. METHODS: This research was made through Medline/PubMed and SciELO web sites looking for papers on the content "induction of liver cirrhosis in rats". We have found 107 articles but only 30 were selected from 2004 to 2011. RESULTS: The most common methods used for inducing liver cirrhosis in the rat were administration of carbon tetrachlo...

  11. Cystic dilatation of the common bile duct in adults: report of five cases and review of literature Dilatação cística do ducto biliar comum em adultos: relato de cinco casos e revisão de literatura

    OpenAIRE

    Pedro Carlos Loureiro de Arruda; Antonio Roberto Barros Coelho; José Falcão Corrêa Lima Filho; Ricardo José Caldas Machado; Ayrton Ponce de Souza; Carlos Augusto de Carvalho Mathias; Álvaro Antônio Bandeira Ferraz; Edmundo Machado Ferraz

    2000-01-01

    The authors report five cases of cystic dilatation of the common bile duct Type I (Todani’s classification) in adults patients, in Division of General Surgery of a University Hospital, treated over a- 25-year- period from 1974 to 1999, among 16.057 operations, and not previously published. Diagnosis was obtained by operative cholangiogram (OC) in the first case, percutaneous transhepatic cholangiogram on the second one (PTHC) and by ultrasonography (US), endoscopic retrograde cholangiopancrea...

  12. Ligadura de ducto biliar como modelo de estudo da síndrome hepatopulmonar e estresse oxidativo Common bile duct ligation as a model of hepatopulmonary syndrome and oxidative stress

    Directory of Open Access Journals (Sweden)

    Juliana Tieppo

    2005-12-01

    hepatopulmonary syndrome is characterized by hepatic dysfunction and presence of dilated pulmonary vessels, with alterations in air diffusion that can be demonstrated in the experimental model of common bile duct ligation. AIM: To evaluate the oxidative stress in pulmonary tissue of cirrhotic rats with common bile duct ligation. MATERIAL/METHODS: We used 12 male Wistar rats weighing between 200-300 g divided in two groups: control (Co = 6 and cirrhotic (Ci = 6. We evaluated aminotransferases, arterial gasometry, lipoperoxidation and chemoluminescence, and antioxidant enzymatic activity with superoxide dismutase. The tissues analyzed for hepatopulmonary syndrome were cirrhotic liver and lung. RESULTS: The animals with common bile duct ligation showed alterations in the following aminotransferases: aspartate aminotransferase, Co = 105.3 ± 43/Ci = 500.5 ± 90.3, alanine aminotransferase, Co = 78.75 ± 37.7/Ci = 162.75 ± 35.4, and alkaline phosphatase, Co = 160 ± 20.45/Ci = 373 ± 45.44. The lipoperoxidation and the antioxidant response had significant differences between the groups when evaluated in lung (lipoperoxidation Co = 0.87 ± 0.3/Ci = 2.01 ± 0.9, chemoluminescence Co = 16008.41 ± 1171.45/Ci = 20250.36 ± 827.82 superoxide dismutase Co = 6.66 ± 1.34/Ci = 16.06 ± 2.67. CONCLUSIONS: Our results suggest that in this experimental model of cirrhosis using common bile duct ligation, there is an increase in lipoperoxidation in pulmonary tissue as well as an increase in superoxide dismutase's antioxidant activity, suggesting a pulmonary injury caused by secondary biliary cirrhosis.

  13. 胆道内镜在治疗肝移植术后吻合口狭窄中的应用%Endoscopy in the treatment of bile duct anastomotic strictures after liver transplantation

    Institute of Scientific and Technical Information of China (English)

    张诚; 杨玉龙; 吕毅; 林美举; 吴萍; 马跃峰; 张洪威; 史力军; 李婧伊

    2015-01-01

    Objective To study the role of therapeutic endoscopy in bile duct anastomotic strictures after liver transplantation.Methods 24 cases of bile duct anastomotic strictures after liver transplantation diagnosed by cholangiography underwent choledochoscopy and duodenoscopy.The mode of operation,complication and curative effect were analyzed.Results The bile duct anastomotic strictures were relieved successfully in all the 24 cases.Of 17 cases who were treated by choledochoscopy through a T tube (Group A) including 1 case of type Ⅰ a,1 case of type Ⅰ b,2 cases of type Ⅱ,1 case of type Ⅲa,4 cases of type Ⅲb and 8 cases of type Ⅲ c.There was one case of type Ⅰ b who was treated by percutaneous transhepatic catheter drainage (PTCD) and percutaneous transhepatic cholangioscope (PTCS,Group B).Of the 6 cases who were treated by endoscopic retrograde cholangiopancreatography (ERCP,Group C) there were 2 cases of type Ⅰ a,2 cases of type Ⅱ,1 case of type Ⅲ b and 1 case of type Ⅲ c.There was no postoperative biliary infection,bleeding,bile leakage and other complications in group A or group B.There were 1 case of postoperative hyperamylasemia and 3 cases of biliary infection in group C,of which 1 case of type Ⅲ a and 1 case of type Ⅲ c underwent a second open operation to remove residual biliary casts through choledochoscopy,and balloon dilation of anastomotic stricture at 3 and 6 months,respectively.At a mean follow-up of 72 months,there was no recurrent anastomotic stricture in group A.One case of type Ⅱ in group C relapsed one month after removal of the plastic stent.One case of type Ⅰ b in group B and one case of type Ⅰ c in group C evolved to form a stricture of type Ⅱ at 5 months and 19 months after biliary casts removal respectively.The strictures were not relieved by multiple plastic stenting for 4 to 6 months in the three patients with type Ⅱ strictures,but they were cured using full-covered self-expanding removable metal stents

  14. Estudio por ecoendoscopia de la vía biliar extrahepática en pacientes con pancreatitis aguda biliar Endoscopic ultrasonographic examination of the common bile duct in patients with acute biliary pancreatitis

    Directory of Open Access Journals (Sweden)

    A. Repiso

    2008-06-01

    Full Text Available Objetivo: el objetivo de nuestro estudio fue valorar la utilidad de la ecoendoscopia en el estudio de la vía biliar extrahepática en los pacientes diagnosticados de pancreatitis aguda biliar y determinar los factores clínicos y analíticos relacionados con el resultado de la técnica. Material y métodos: se incluyeron en el estudio de modo consecutivo 73 pacientes (31 varones, 42 mujeres; media de edad 64 ± 15 años con pancreatitis aguda biliar remitidos a nuestro servicio para la realización de ecoendoscopia biliopancreática. En todos los pacientes se realizó la técnica seguida de CPRE con esfinterotomía y técnica endoscópica para la extracción de cálculos cuando se identificó por ecoendoscopia la existencia de coledocolitiasis. Se compararon las características clínico-evolutivas de estos pacientes con respecto al resultado obtenido con la ecoendoscopia. Resultados: la media de tiempo transcurrido desde el ingreso hasta la realización de la ecoendoscopia fue de 7 ± 6 días. En 18 pacientes (24% se observó en la ecoendoscopia la existencia de coledocolitiasis y en 17 de ellos se realizó esfinterotomía endoscópica. La presencia de coledocolitiasis fue más frecuente en aquellos pacientes con dilatación de la vía biliar extrahepática (55 vs. 14%; p 0,05. Tampoco se observó esta diferencia en el subgrupo de pacientes con pancreatitis aguda severa (45 vs. 55%; p > 0,05. Conclusiones: la ecoendoscopia es una técnica útil en la selección de los pacientes con pancreatitis aguda biliar que se beneficiarán de la realización de una esfinterotomía endoscópica.Objective: the objective of our study was to evaluate the usefulness of endoscopic ultrasonography (EUS for the study of the common bile duct in patients diagnosed with acute biliary pancreatitis, and to establish clinical and laboratory factors related to this technique. Materials and methods: seventy-three consecutive patients with acute biliary pancreatitis were

  15. Efficacy and safety of endoscopic papillary balloon dilation for the removal of bile duct stones: Data from a “real-life” multicenter study on Dilation-Assisted Stone Extraction

    Science.gov (United States)

    Di Mitri, Roberto; Mocciaro, Filippo; Pallio, Socrate; Pecoraro, Giulia Maria; Tortora, Andrea; Zulli, Claudio; Attardo, Simona; Maurano, Attilio

    2016-01-01

    AIM To report data on Dilation-Assisted Stone Extraction (DASE) use in clinical practice and its efficacy and safety trough three Italian referral centers for biliopancreatic diseases treatment. METHODS From January 2011 to December 2015 we collected data on 120 patients treated with DASE. Technical success was obtained when the endoscopist was able to place the balloon trough the papilla inflating the balloon until the final diameter for an adequate time (at least 30 s). Clinical success was obtained after complete stone removal (no remaining stones were visible at the cholangiogram). RESULTS Forty-nine male (40.8%) and 71 female (59%) were enrolled. The mean age was 67.8 years ± 15.7. The mean common bile duct (CBD) dilation was 19.2 mm ± 3.9 and the mean size of stones 15.8 ± 2.9. DASE was applied as first approach in 38% (62% after initial failure of stones extraction). Technical and clinical success was of 91% and 87% respectively. In those in which DASE failed alternative treatment were adopted. After DASE 18% of patients experienced a complication (bleeding 9%, pancreatitis 8%, perforation 0.8%). At univariable analysis, elective endoscopic retrograde cholangiopancreatography (P = 0.031), DASE as first approach (P = 0.032), and cannulation of major papilla followed by guidewire insertion (P = 0.004) were related to low risk of complications. Pre-cut was related to an increased risk of complications (P = 0.01). CONCLUSION DASE allowed a higher first-session success rate and can be consider a valid alternative to endoscopic sphincterotomy not only for bigger CBD stones. PMID:27803771

  16. 胆囊切除术后患者胆道Ⅲ型Oddi括约肌功能障碍的治疗%Therapy for patients with bile duct Ⅲ of sphincter of Oddi dysfunction after cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    翁坚军; 关亚萍; 朱峰

    2016-01-01

    Objective To study the therapeutic effect of pinaverium bromid and oryz-aspergillus enzyme and pancreatin tablet on patients with bile duct Ⅲ of sphincter of Oddi dysfunction (SOD) after cholecystectomy.Methods 72 patients who had a diagnosis consistent with bile duct Ⅲ of SOD seen from February 2010 to February 2013 in our hospital were randomly divided into the control group and the treatment group.Patients in the control group were given pinaverium bromid for 3 months while patients in the treatment group were,in addition to pinaverium bromid,given oryz-aspergillus enzyme and pancreatin tablet.Relief of abdominal pain,abdominal distention and recurrence of the above symptoms after drug withdrawal were studied.Results The scores on abdominal pain in the treatment group before and after treatment were 7.5 ± 1.1 and 3.0 ± 1.6 (P < 0.05) while the scores in the control group were 7.4 ± 1.1 and 5.0 ± 1.4 (P < 0.05),respectively.Alleviation of abdominal pain in the treatment group was superior to the control group (P < 0.05).The scores on abdominal distention in the treatment group before and after treatment were 5.4 ± 0.6 and 1.6 ± 0.5 (P < 0.05) while the scores in the control group were 5.2 ± 0.5 and 4.7 ± 0.8 (P > 0.05),respectively.Alleviation of abdominal distention in the treatment group was superior to the control group (P <0.05).The scores of abdominal pain and distention in half year after 3 months' therapy in the treatment group were 3.1 ± 1.7 and 1.7 ± 1.1,respectively,which obviously were lower than the control group (5.4 ± 1.4 and 5.0 ± 0.6,P < 0.05).Conclusions Pinaverium bromid and oryz-aspergillus enzyme and pancreatin tablet could effectively alleviate abdominal pain and distention in patients with bile duct Ⅲ of SOD after cholecystectomy and the recurrence rates of symptoms were significantly lower.%目的 观察匹维溴铵联合米曲菌胰酶片治疗胆囊切除术后患者胆道Ⅲ型Oddi括约肌功能

  17. Suprapapillary needle puncture for common bile duct access: laboratory profile Punção suprapapilar por agulha para acesso ao ducto biliar comum: perfil laboratorial

    Directory of Open Access Journals (Sweden)

    Everson L. A. Artifon

    2006-12-01

    duodenal papilla of normal aspect. The patients with dilation of the suprapapillary fistula showed the fistula continuing to drain clear bile CONCLUSION: Suprapapillary puncture allows investigative and therapeutic procedures without significant increases in amylase, lipase and C-RP. Patients submitted to diagnostic puncture present complete recovery of the papilla, while dilation of the fistula maintains it pervious later on, but without complications.RACIONAL: A cateterização para acesso às vias biliares na colangiopancreatografia retrógrada pode apresentar dificuldades técnicas, sendo necessário freqüentemente efetuar-se papilotomia, procedimento não isento de complicações como perfuração e pancreatite OBJETIVOS: Demonstrar menor incidência de complicações a partir do perfil laboratorial, através de nova técnica desenvolvida, a punção suprapapilar MATERIAL E MÉTODOS: Após aprovação pelo Comitê de Ética em Pesquisa da instituição, 30 pacientes foram selecionados no período de julho de 2003 a agosto de 2004. Preenchidos os critérios de inclusão e exclusão, os pacientes, após explicação do protocolo e a assinatura do consentimento livre e esclarecido, foram submetidos a colangiopancreatografia retrógrada pela técnica de punção suprapapilar. Após o procedimento, foi feito seguimento com o paciente internado para avaliar possíveis complicações, bem como determinação dos níveis séricos da amilase, lipase e proteína C reativa nas 4 h, 12 h e 24 h subseqüentes e reavaliados 60 dias após. O estudo estatístico foi feito por análise de variância para medidas múltiplas e comparações múltiplas foram feitas por meio do teste de Wald RESULTADOS: O sucesso da técnica ocorreu em 93,4% (28/30 dos pacientes. Não foram observadas alterações estatisticamente significantes no perfil laboratorial. Complicações relacionadas à técnica de punção ocorreram em dois pacientes: um pelo não uso do fio guia e em outro por hemorragia

  18. Bile peritonitis due to intra-hepatic bile duct rupture

    Institute of Scientific and Technical Information of China (English)

    R Lochan; BV Joypaul

    2005-01-01

    Generalized biliary peritonitis is a serious intra-abdominal emergency. Most of them occur due to duodenal ulcer perforation and rapidly evolve into bacterial peritonitis due to contamination by gut organisms and food. In this situation, recognition of the pathology and its treatment is straightforward and is usually associated with a good outcome. There are a few unusual causes of biliary peritonitis, of which rupture of the biliary tree is one.We describe a rare case of biliary peritonitis due to rupture of an intra-hepatic biliary radical. Unusual causes of peritonitis do interrupt our daily routine emergency surgical experience. Rapid recognition of the presence of peritonitis, adequate resuscitation, recognition of operative findings, establishment of biliary anatomy, and performance of a meticulous surgical procedure resulted in a good outcome.

  19. 超声影像在诊断病毒性肝炎合并胆道损害中的价值%The value of ultrasound in the diagnosis of viral hepatitis complicated with bile duct injury

    Institute of Scientific and Technical Information of China (English)

    吴淑芬

    2015-01-01

    Objective: To investigate rules and affect factors in virus hepatitis complicated with biliary system damage. Methods: To observe 158 patients with various clinical types of viral hepatitis, gallbladder filling degree of gallbladder wall thickness, the gallbladder bile in the gallbladder situation, through sound situation by ultrasound, and the patients with intrahepatic, extrahepatic bile duct wall thickness were measured, the clarity of cavity were observed. Results:The 158 cases of patients with biliary ultrasonic testing results showed the gallbladder wall thickening, rough bilateral syndrome, sound transparent difference, stones, gallbladder enlargement or smaller, like solid. Severe hepatitis, biliary system in patients and liver cirrhosis was significantly higher than that of the abnormal in patients with acute hepatitis and chronic hepatitis (x2=17.96, x2=16.27; P<0.05). Conclusion: Viral hepatitis complicated with biliary system damage is related to clinical type, course of disease, liver function damage. Observe the change of ultrasonic dynamic biliary system, liver function testing timely, and provide the basis for guiding clinical treatment, to judge the severity and chronicity of hepatitis prediction.%目的:探讨病毒性肝炎合并胆道系统损害的发生规律及影响因素,分析超声影像在诊断病毒性肝炎合并胆道损害中的价值。方法:观察158例各种临床类型病毒性肝炎患者的胆囊充盈程度、胆囊壁厚度、胆囊内胆汁情况以及胆囊内透声等超声影像情况,并对患者肝内、肝外胆管壁的厚度进行测量,对腔内清晰程度进行观察。结果:158例患者胆系超声检测结果表现为胆囊壁粗糙增厚、双边征、透声差、结石、胆囊增大或变小以及类实质样改变等变化。重型肝炎,肝硬化患者的胆道系统异常明显高于急性肝炎及慢性肝炎患者,差异有统计学意义(x2=17.96, x2=16.27;P<0.05)。结论:

  20. 间苯三酚预防胆总管结石ERCP术后胰腺炎的效果%Effect of phloroglucinol on the prevention of postoperative pancreatitis in patients with common bile duct stones after ERCP surgery

    Institute of Scientific and Technical Information of China (English)

    林蕤; 顾卫; 黄慧

    2016-01-01

    Objective To study the value of preoperative application of phloroglucinol in the prevention of postoperative pancreatitis in patients with common bile duct stones undergoing endoscopic retrograde cholangiopancrea-tography (ERCP). Methods Thirty-eight patients with common bile duct stones received ERCP treatment in Depart-ment of Hepatobiliary Surgery in our hospital from June 2014 to June 2015 were selected and randomly divided into the observation group (n=19) and the control group (n=19). The control group received conventional surgery scheme, with diazepam, pethidine and anisodamine applied preoperatively. The observation group additionally applied phloroglucinol preoperatively on the basis of the control group. The adverse reactions, gastric peristalsis times, operation time, the pre-operative, postoperative 6 h, 24 h serum amylase level, as well as the incidence of postoperative hyperamylasemia and acute pancreatitis were compared between the two groups. Results The nausea and vomiting, hypertension and intraopera-tive gastric motility times in observation group were significantly lower than those in the control group [1 case vs 6 cases, 2 cases vs 9 cases, (1.6 ± 0.5) times vs (4.2 ± 0.6) times, P<0.05]. The operation time of observation group was significantly shorter than that in the control group [(34.7±6.7) min vs (48.2±12.1) min, P<0.05]. The serum amylase levels showed no sta-tistically significant difference between the two groups before operation [(55.8±12.5) c·µ-1·L-1 vs (56.3±13.7) c·µ -1·L-1]. The levels in the two groups at postoperative 6 h, 24 h were significantly lower than the preoperative level (P<0.05), and the levels at each postoperative time point of the observation group were significantly lower than those of the control group [(82.5±24.7) c·µ-1·L-1 vs (122.4±44.6) c·µ-1·L-1;(72.1±29.5) c·µ-1·L-1 vs (114.3±58.4) c·µ-1·L-1, P<0.05]. The to-tal incidence rates of postoperative hyperamylasemia and acute

  1. Expression of GalNAc-T3 and its relationships with clinicopathological factors in 61 extrahepatic bile duct carcinomas analyzed using stepwise sections - special reference to its association with lymph node metastases-.

    Science.gov (United States)

    Inoue, Takahiro; Eguchi, Takashi; Oda, Yoshinao; Nishiyama, Kenichi; Fujii, Kei; Izumi, Hiroto; Kohno, Kimitoshi; Yamaguchi, Koji; Tanaka, Masao; Tsuneyoshi, Masazumi

    2007-02-01

    Extrahepatic bile duct carcinomas (EBDCs) still result in an unfavorable prognostic outcome, and little is known about their biological aggressiveness. Recently, UDP-N-acetyl-alpha-D-galactosamine:polypeptide N-acetylgalactosaminyl transferase-3 (GalNAc-T3) was reported to be associated with differentiation and malignant potential of human carcinomas. Here, we investigated 61 EBDCs for their detailed clinicopathological features and GalNAc-T3 expression by immunohistochemistry, and then evaluated the relationships between the clinicopathological features and GalNAc-T3 expression patterns. Most of the EBDCs were massively invasive tumors with frequent vascular or perineural invasion and lymph node metastases. GalNAc-T3 expression was detected in all 61 EBDCs, and the expression patterns could be classified into granular and diffuse types. All four noninvasive or minimally invasive EBDCs were the granular type. Among the 58 minimally or massively invasive EBDCs, the GalNAc-T3 expression pattern at the luminal surface was the granular type in 38 cases (66%) and diffuse type in 20 cases (34%), while the expression pattern at the invasive front was the granular type in 26 cases (45%) and diffuse type in 32 cases (55%). Among the 38 cases with granular-type expression at the luminal surface, 26 cases (68%) remained the granular type and 12 cases (32%) became the diffuse type at the invasive front. All 20 cases with diffuse-type expression at the luminal surface remained the diffuse type at the invasive front. Diffuse-type GalNAc-T3 expression at the invasive front was significantly associated with lymph node metastasis (PGalNAc-T3 expression patterns and other clinicopathological factors, including tumor differentiation, depth of invasion or overall survival. In conclusion, EBDCs alter their GalNAc-T3 expression pattern during tumor growth, and the difference in the GalNAc-T3 expression pattern may be associated with lymph node metastasis. Clinically, preoperative

  2. 胆总管横断加胆肠吻合术治疗复发性胰腺炎46例临床分析%Combined common bile duct transection and choledochojejunostomy for recurrent pancreatitis: A clinical analysis of 46 cases

    Institute of Scientific and Technical Information of China (English)

    闫勇; 闫洪涛; 汪涛; 汤礼军; 张生

    2011-01-01

    目的 探讨复发性胰腺炎的发病机制和手术治疗方法.方法 对确诊为复发性胰腺炎的46例患者,经术前磁共振胰胆管造影(magnetic resonance cholangiopancreatography ,MRCP)、内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)检查,及术中胆汁淀粉酶、胆道压力测定和胆道镜等检查,明确胆胰汇合部异常.以彻底消除胆胰返流为原则进行胆总管横断加胆肠吻合术.结果 患者共同通道长度大于1.0 cm者13例,全组胆汁淀粉酶高于血淀粉酶值2倍以上.术前胆道压力平均值高于术后平均值,术后全组病例症状完全缓解,24例随访52个月无腹痛发作.结论 胆胰汇合部异常致胆汁逆流入胰管引发胰腺炎是复发性胰腺炎的重要原因,根据临床症状、胆总管扩张,共同通道长度、胆汁淀粉酶值可做出诊断.胆总管横断加胆肠吻合术是治疗这类复发性胰腺炎的有效术式.%Objective To study the pathogenesis of recurrent pancreatitis (RP) and its surgical procedure. Methods Diagnosis of abnormal pancreaticobiliary junction was established in 46 patients with RP by magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatog raphy (ERCP) before operation, measurement of bile amylase level and biliary tract pressure during operation, and choledochoscopy, respectively, for bile duct transection to thoroughly eliminate the reflux to biliary tract. Results A more than 1.0 cm long common channel was found in 13 out of the 46 patients. The level of bile amylase was two-fold higher than that of serum amylase. The mean biliary tract pressure was higher before oper ation than after operation. The symptoms of the patients were completely relieved after operation. No abdominal pain occurred in 24 patients during the 52-month follow- up. Conclusion Bile reflux to pancreatic duct due to abnormal pancreaticobiliary junction is the major cause of RP, which can be

  3. Effectiveness of Application of T2WI-MRC and CE-MRC in Diagnosis of Bile Duct Diseases%T2WI-MRC和CE-MRC检查在胆道疾病诊断中的应用价值

    Institute of Scientific and Technical Information of China (English)

    徐立峰

    2015-01-01

    目的:探讨MR胆管水成像(T2WI-MRC)和钆贝葡胺增强后胆管成像(CE-MRC)在胆道疾病诊断中的应用价值。方法选取2012年4月~2014年7月我院收治的78例胆道疾病患者作为研究对象,所有患者均进行T2WI-MRC及CE-MRC检查,以术中胆管造影作为金标准,比较两种检查方法对肝内外胆管的显示情况。结果在肝内三级以上胆管的显示方面,CE-MRC显示68例(87.2%),T2WI-MRC显示41例(52.6%),差异有统计学意义(χ2=27.524,P=0.000);在肝内三级以下胆管、胆总管、胆囊、胆囊管、肝总管的显示方面,差异无统计学意义(P>0.05)。两种方法对解剖变异的诊断符合率均为100%;在肝胆管狭窄、肝胆管扩张的诊断上,差异不具有统计学意义(P>0.05)。结论 T2WI-MRC成像具有成像速度快、成像质量好等优点,但对某些微小的三级以上胆道显示较差。CE-MRC对胆道狭窄具有较高的诊断准确率,可以在一次屏气下完成全肝扫描,呼吸不均匀者也能进行检查,但缺点是引入了造影剂,增加了患者费用,并且潜在增加了过敏反应。临床诊断中,要根据实际需要,合理选择成像方法。%ObjectiveTo discuss the effectiveness of application of T2WI-MRC and CE-MRC in diagnosis of the bile duct diseases.Methods Altogether 78 patients with bile duct diseases who had been treated from April 2012 to July 2014 in our hospital were selected as the research object. All the patients were scanned by T2WI-MRC and CE-MRC. Taking intra-operative cholangiography as the gold standard, the extra-hepatic bile duct images obtained by two different methods were compared. Results CE-MRC diagnosed 68 (87.2%) cases of intra-hepatic bile ducts above Level 3; T2WI-MRC diagnosed 41 (52.6%) cases of intra-hepatic bile ducts above Level 3, which existed statistically signiifcant differences (χ2=27.524,P=0.000). No statistically signiifcant

  4. General Information about Extrahepatic Bile Duct Cancer

    Science.gov (United States)

    ... Español 1-800-4-CANCER Live Chat Publications Dictionary Menu Contact Dictionary Search About Cancer Causes and Prevention Risk Factors ... Contacts Other Funding Find NCI funding for small business innovation, technology transfer, and contracts Training Cancer Training ...

  5. ATP release, generation and hydrolysis in exocrine pancreatic duct cells.

    Science.gov (United States)

    Kowal, J M; Yegutkin, G G; Novak, I

    2015-12-01

    Extracellular adenosine triphosphate (ATP) regulates pancreatic duct function via P2Y and P2X receptors. It is well known that ATP is released from upstream pancreatic acinar cells. The ATP homeostasis in pancreatic ducts, which secrete bicarbonate-rich fluid, has not yet been examined. First, our aim was to reveal whether pancreatic duct cells release ATP locally and whether they enzymatically modify extracellular nucleotides/sides. Second, we wished to explore which physiological and pathophysiological factors may be important in these processes. Using a human pancreatic duct cell line, Capan-1, and online luminescence measurement, we detected fast ATP release in response to pH changes, bile acid, mechanical stress and hypo-osmotic stress. ATP release following hypo-osmotic stress was sensitive to drugs affecting exocytosis, pannexin-1, connexins, maxi-anion channels and transient receptor potential cation channel subfamily V member 4 (TRPV4) channels, and corresponding transcripts were expressed in duct cells. Direct stimulation of intracellular Ca(2+) and cAMP signalling and ethanol application had negligible effects on ATP release. The released ATP was sequentially dephosphorylated through ecto-nucleoside triphosphate diphosphohydrolase (NTPDase2) and ecto-5'-nucleotidase/CD73 reactions, with respective generation of adenosine diphosphate (ADP) and adenosine and their maintenance in the extracellular medium at basal levels. In addition, Capan-1 cells express counteracting adenylate kinase (AK1) and nucleoside diphosphate kinase (NDPK) enzymes (NME1, 2), which contribute to metabolism and regeneration of extracellular ATP and other nucleotides (ADP, uridine diphosphate (UDP) and uridine triphosphate (UTP)). In conclusion, we illustrate a complex regulation of extracellular purine homeostasis in a pancreatic duct cell model involving: ATP release by several mechanisms and subsequent nucleotide breakdown and ATP regeneration via counteracting nucleotide

  6. ATP release, generation and hydrolysis in exocrine pancreatic duct cells.

    Science.gov (United States)

    Kowal, J M; Yegutkin, G G; Novak, I

    2015-12-01

    Extracellular adenosine triphosphate (ATP) regulates pancreatic duct function via P2Y and P2X receptors. It is well known that ATP is released from upstream pancreatic acinar cells. The ATP homeostasis in pancreatic ducts, which secrete bicarbonate-rich fluid, has not yet been examined. First, our aim was to reveal whether pancreatic duct cells release ATP locally and whether they enzymatically modify extracellular nucleotides/sides. Second, we wished to explore which physiological and pathophysiological factors may be important in these processes. Using a human pancreatic duct cell line, Capan-1, and online luminescence measurement, we detected fast ATP release in response to pH changes, bile acid, mechanical stress and hypo-osmotic stress. ATP release following hypo-osmotic stress was sensitive to drugs affecting exocytosis, pannexin-1, connexins, maxi-anion channels and transient receptor potential cation channel subfamily V member 4 (TRPV4) channels, and corresponding transcripts were expressed in duct cells. Direct stimulation of intracellular Ca(2+) and cAMP signalling and ethanol application had negligible effects on ATP release. The released ATP was sequentially dephosphorylated through ecto-nucleoside triphosphate diphosphohydrolase (NTPDase2) and ecto-5'-nucleotidase/CD73 reactions, with respective generation of adenosine diphosphate (ADP) and adenosine and their maintenance in the extracellular medium at basal levels. In addition, Capan-1 cells express counteracting adenylate kinase (AK1) and nucleoside diphosphate kinase (NDPK) enzymes (NME1, 2), which contribute to metabolism and regeneration of extracellular ATP and other nucleotides (ADP, uridine diphosphate (UDP) and uridine triphosphate (UTP)). In conclusion, we illustrate a complex regulation of extracellular purine homeostasis in a pancreatic duct cell model involving: ATP release by several mechanisms and subsequent nucleotide breakdown and ATP regeneration via counteracting nucleotide

  7. A rabbit model for simultaneous recording the electromyography of the gallbladder and sphincter of Oddi and the pressure of gallbladder and common bile duct%同步检测胆囊及Oddi氏括约肌电活动和胆管压力的兔模型

    Institute of Scientific and Technical Information of China (English)

    文辉清; 沈磊; 时鑫; 龙萍; 刘衍民

    2013-01-01

    目的 建立同步检测胆囊及Oddi括约肌肌电活动及胆囊、胆总管压力的动物模型.方法 对6只家兔用7F静脉深穿管分别经肝穿刺进入胆囊腔及经十二指肠腔插入胆总管.将铂金电极缝在胆囊底部浆膜上.以多通道生理仪记录家兔的胆囊及Oddi括约肌肌电信号和胆囊、胆总管压力.结果 Oddi氏括约肌肌电的峰电位>0.05 mV,最大电位为0.26 mV,频率为0~2次/分;而慢波电位≤0.05 mV,频率为8⒍11次/分.胆囊内压力最大为15 cm H2O(6.83~15.00 cm H2O),胆总管最大压力为22 cm H2O(11~22 cm H2O).胆囊肌电活动的波形缺乏规律性.结论 兔可以作为同步检测胆囊及Oddi氏括约肌肌电活动和胆囊、胆总管压力的模型.%Objective To investigate an animal model for recording the electromyography (EMG) of the gallbladder/sphincter of Oddi and the pressure of gallbladder and common bile duct.Methods The animal model was established in 6 rabbits.A 7F central venous catheter was adopted to penetrate into the gallbladder through the liver.A pair bipolar platinum electrode was stitched onto the gallbladder at the serosal side.Another 7F central venous catheter with a pair bipolar platinum electrode was used to insert into the common bile duct near the sphincter of Oddi (SO).The signal of myoelectrical activity of SO and the gallbladder was recorded through a multi-channel physiological instrument.Meanwhile the changes in the pressure of the gallbladder and common bile duct were observed.Results The spike potential of SO in rabbits was above 0.05 mV,and the most value was 0.26 mV.The frequency of the spike potential was 2 times/min.The slow wave potential of SO was below 0.05 mV,and the frequency was 8-11 times/min.The pressure of gallbladder was 15 cm H2O (6.83-15.00 cm H2O).The pressure of common bile duct was 22 cm H2O (11-22 cm H2O).The EMG of gallbladder was unclear.Conclusion Rabbits can be used to establish the animal model recording the

  8. Mutational Characterization of the Bile Acid Receptor TGR5 in Primary Sclerosing Cholangitis

    NARCIS (Netherlands)

    Hov, Johannes R.; Keitel, Verena; Laerdahl, Jon K.; Spomer, Lina; Ellinghaus, Eva; ElSharawy, Abdou; Melum, Espen; Boberg, Kirsten M.; Manke, Thomas; Balschun, Tobias; Schramm, Christoph; Bergquist, Annika; Weismueller, Tobias; Gotthardt, Daniel; Rust, Christian; Henckaerts, Liesbet; Onnie, Clive M.; Weersma, Rinse K.; Sterneck, Martina; Teufel, Andreas; Runz, Heiko; Stiehl, Adolf; Ponsioen, Cyriel Y.; Wijmenga, Cisca; Vatn, Morten H.; Stokkers, Pieter C. F.; Vermeire, Severine; Mathew, Christopher G.; Lie, Benedicte A.; Beuers, Ulrich; Manns, Michael P.; Schreiber, Stefan; Schrumpf, Erik; Haeussinger, Dieter; Franke, Andre; Karlsen, Tom H.

    2010-01-01

    Background: TGR5, the G protein-coupled bile acid receptor 1 (GPBAR1), has been linked to inflammatory pathways as well as bile homeostasis, and could therefore be involved in primary sclerosing cholangitis (PSC) a chronic inflammatory bile duct disease. We aimed to extensively investigate TGR5 sequ

  9. Fully covered self-expanding metal stents in the management of difficult common bile duct stones Prótesis metálicas autoexpandibles totalmente recubiertas en el tratamiento de coledocolitiasis difíciles

    Directory of Open Access Journals (Sweden)

    Jesús García-Cano

    2013-01-01

    Full Text Available Background and objectives: plastic biliary stents are often used after an ERCP session without complete common bile duct stones (CBDS extraction. Sometimes, the volume of biliary drainage with these stents may be insufficient. We present our experience with the use of fully covered self-expanding metal stents (FCSEMS in the setting of incomplete CBDS extraction. Patients and methods: after an ERCP session with difficult CBDS not completely removed, biliary FCSEMS (Wallflex were inserted in some patients when it was deemed that biliary sphincterotomy and a single plastic stent would not provide an adequate drainage. Results: a retrospective study was performed. Biliary FCSEMS were inserted in 29 patients, mean age 81 years. CBDS could not be extracted through a biliary sphincterotomy due to its large size (n = 18 or because of the presence of inflammatory distal strictures (n = 11. The greatest biliary drainage with shortest ERCP time was considered mandatory due to clinical instability of patients and/or poor tolerance to conscious sedation administered by the endoscopist. Successful biliary drainage was obtained in all cases. FCSEMS were removed after a median of 199.5 days in 16 patients with a complete CBDS extraction in 15 (93.7%. FCSEMS were not removed in the remaining 13 patients due to their clinical condition, and a wait-and-see strategy was undertaken. Conclusions: in selected cases, utilization of removable FCSEMS can be a good option for a quick and adequate biliary drainage in the setting of difficult CBDS. Because of the higher cost of these stents its use needs to be individualized.Introducción y objetivos: las prótesis biliares plásticas suelen emplearse tras una sesión de CPRE sin extracción completa de coledocolitiasis. En ocasiones, el calibre de drenaje con estas prótesis puede ser insuficiente. Presentamos nuestra experiencia en la utilización de prótesis metálicas autoexpandibles totalmente recubiertas (PMATR en

  10. 冷保存后肝内胆管跨膜型黏蛋白的表达情况%Expression of mucins in intrahepatic bile duct tissues after cold preservation

    Institute of Scientific and Technical Information of China (English)

    田峰; 程龙; 曾议; 王曙光

    2010-01-01

    目的 探讨冷保存后体外培养的SD大鼠肝内不同节段胆管跨膜型黏蛋白Muc1、Muc3A、Muc4的表达情况.方法 用酶消化辅助机械分离方法获得SD大鼠肝内胆管组织,以非吻合口狭窄好发部位为界分为大、小胆管.胆管片段在鼠尾胶原内培养48 h后进行实验.实验分为对照组、冷保存1 h组、冷保存12 h组.采用RT-PCR和Western blot法检测黏蛋白Muc1、Muc3A、Muc4的表达情况.3组比较采用方差分析,两两比较采用LSD法检验.结果 大、小胆管均表达黏蛋白Muc1、Muc3A、Muc4.随着冷保存时间延长,大胆管Muc1、Muc3A、Muc4 mRNA显著降低,冷保存1 h组分别为0.95±0.14、0.26±0.04、0.24±0.06,冷保存12 h组分别为0.18±0.03、0.14±0.04、0.22±0.07,对照组分别为1.00±0.20、1.00±0.09、1.00±0.21,3组比较差异有统计学意义(F=8.8,57.1,10.8,P<0.05).冷保存12 h组Muc1和Muc3A mRNA显著低于冷保存1 h组(P<0.05).大胆管Muc1、Muc4蛋白表达水平亦随冷保存时间延长而降低,对照组分别为1.05±0.41、1.06±0.38,冷保存1 h组分别为0.82±0.13、0.73±0.10,冷保存12 h组分别为0.56±0.11、0.33±0.04,3组比较差异有统计学意义(F=3.9,12.6,P<0.05).冷保存12 h组Muc1蛋白显著低于对照组(P<0.05).冷保存12 h组Muc4蛋白显著低于冷保存1 h组(P<0.05).而小胆管Muc3A mRNA呈升高趋势,对照组为0.06±0.03,冷保存1 h组为0.15±0.04,冷保存12 h组为0.19±0.05,与大胆管不同.结论 长时间冷保存后肝内非吻合口狭窄好发部位胆管黏蛋白Muc1、Muc3A、Muc4表达显著降低,减弱了其对胆管上皮细胞的保护作用,可加重胆管损伤.%Objective To investigate the expression of Muc1,Muc3A and Muc4 in cultured intrahepatic bile duct(IBD)tissues from different hepatic segments after cold preservation.Methods The IBD tissues of SD rats were obtained by collagen perfusion combining mechanical separation and then were divided into large and small IBD

  11. Small duct primary sclerosing cholangitis without inflammatory bowel disease is genetically different from large duct disease

    Science.gov (United States)

    Næss, Sigrid; Björnsson, Einar; Anmarkrud, Jarl A.; Al Mamari, Said; Juran, Brian D.; Lazaridis, Konstantinos N.; Chapman, Roger; Bergquist, Annika; Melum, Espen; Marsh, Steven G. E.; Schrumpf, Erik; Lie, Benedicte A.; Boberg, Kirsten Muri; Karlsen, Tom H.; Hov, Johannes R.

    2014-01-01

    Background & aims Small duct primary sclerosing cholangitis (PSC) is phenotypically a mild version of large duct PSC, but it is unknown whether these phenotypes share aetiology. We aimed to characterize their relationship by investigating genetic associations in the HLA complex, which represent the strongest genetic risk factors in large duct PSC. Methods Four classical HLA loci (HLA-A, HLA-B, HLA-C, HLA-DRB1) were genotyped in 87 small duct PSC patients, 485 large duct PSC patients and 1117 controls across three geographical regions. Results HLA-DRB1*13:01 (OR=2.0, 95% CI 1.2–3.4, P=0.01) and HLA-B*08 (OR=1.6, 95% CI 1.1–2.4, P=0.02) were significantly associated with small duct PSC compared with healthy controls. Based on the observed frequency of HLA-B*08 in small duct PSC, the strongest risk factor in large duct PSC, an estimated 32% (95% CI 4%–65%) of this population can be hypothesized to represent early stages or mild variants of large duct PSC. This subgroup may be constituted by small duct PSC patients with inflammatory bowel disease (IBD), which greatly resembled large duct PSC in its HLA association. In contrast, small duct PSC without IBD was only associated with HLA-DRB1*13:01(P=0.03) and was otherwise distinctly dissimilar from large duct PSC. Conclusions Small duct PSC with IBD resembles large duct PSC in its HLA association and may represent early stages or mild variants of large duct disease. Different HLA associations in small duct PSC without IBD could indicate that this subgroup is a different entity. HLA-DRB1*13:01 may represent a specific risk factor for inflammatory bile duct disease. PMID:24517468

  12. Successful Endoscopic Therapy of Traumatic Bile Leaks

    Directory of Open Access Journals (Sweden)

    Matthew P. Spinn

    2013-02-01

    Full Text Available Traumatic bile leaks often result in high morbidity and prolonged hospital stay that requires multimodality management. Data on endoscopic management of traumatic bile leaks are scarce. Our study objective was to evaluate the efficacy of the endoscopic management of a traumatic bile leak. We performed a retrospective case review of patients who were referred for endoscopic retrograde cholangiopancreatography (ERCP after traumatic bile duct injury secondary to blunt (motor vehicle accident or penetrating (gunshot trauma for management of bile leaks at our tertiary academic referral center. Fourteen patients underwent ERCP for the management of a traumatic bile leak over a 5-year period. The etiology included blunt trauma from motor vehicle accident in 8 patients, motorcycle accident in 3 patients and penetrating injury from a gunshot wound in 3 patients. Liver injuries were grade III in 1 patient, grade IV in 10 patients, and grade V in 3 patients. All patients were treated by biliary stent placement, and the outcome was successful in 14 of 14 cases (100%. The mean duration of follow-up was 85.6 days (range 54-175 days. There were no ERCP-related complications. In our case review, endoscopic management with endobiliary stent placement was found to be successful and resulted in resolution of the bile leak in all 14 patients. Based on our study results, ERCP should be considered as first-line therapy in the management of traumatic bile leaks.

  13. Atypical Liver Abscess Misdiagnosed as a Bile Duct Carcinoma with Dynamic Enhancement CT Manifestations and Pathology%不典型肝脓肿误诊为胆管细胞癌的CT动态增强表现及病理

    Institute of Scientific and Technical Information of China (English)

    邹建华; 郑巧

    2012-01-01

    目的:探讨不典型肝脓肿的CT动态增强表现及其病理基础,提高对肝脓肿及胆管细胞癌的鉴别诊断水平。方法:回顾性分析经手术病理证实的3例不典型肝脓肿的临床资料及CT表现。结果:不典型肝脓肿的CT表现具有多样性,CT平扫病灶呈均匀或不均匀低密度区,形态呈类圆形,边缘模糊或较清楚。增强扫描动脉期病灶呈轻度强化,门静脉期及延迟扫描病灶呈小环状、蜂窝状及不均匀强化,部分形如"花瓣状"改变,类似肝内胆管细胞癌的影像学表现。结论:螺旋CT动态多期增强扫描对鉴别肝内胆管细胞癌与不典型肝脓肿有一定价值。%Objective:To investigate the atypical liver abscess of dynamic enhancement CT manifestations and pathologic foundation,improve the liver abscess and bile duct carcinoma in the differential diagnosis of level. Methods:retrospective analysis of the operation and pathology in 3 cases of atypical liver abscess clinical data and CT manifestation.Results:the CT manifestations of atypical liver abscess with diversity:unenhanced CT lesions showed homogeneous or inhomogeneous low density area,circular shape,blurred edges or more clearly. Enhanced arterial lesions enhanced slightly,portal venous phase lesions showed a small annular,honeycomb, petaloid,grid,cluster,with no obvious reinforced low density zone,the delay period lesions still strengthen the performance.The imaging manifestation and bile duct cell carcinoma is similar to.Conclusion:spiral CT dynamic multi phase enhanced scan in differential diagnosis of atypical hepatic abscess and bile duct cancer cells have a certain value.

  14. 转化生长因子β1及其受体在正常及损伤性狭窄胆管壁中的表达%Expression of TGF-β1 and TGF-βR1 in normal bile duct and injured biliary stricture lesions

    Institute of Scientific and Technical Information of China (English)

    刘双海; 李浩; 顾红光; 蔡景修

    2001-01-01

    目的 探讨转化生长因子β1(TGF-β1)在损伤性胆管狭窄发生中的作用。 方法 通过免疫组化检测TGF-β1及其Ⅰ型受体(TGF-βR1)在人正常胆管壁中及损伤性狭窄胆管壁中的表达。 结果 正常胆管壁中未检测到TGF-β1及TGF-βR1。在损伤性狭窄胆管壁中,大量炎细胞及少量成纤维细胞高表达TGF-β1,大量炎细胞及大量成纤维细胞高表达TGF-βR1。 结论 胆管损伤后,其中的炎细胞及成纤维细胞产生了TGF-β1;TGF-β1可能由TGF-βR1介导通过自分泌及旁分泌机制,使TGF-β1不断产生,并使成纤维细胞表型改变、活化、增殖,胶原等基质不断合成堆积;TGF-β1可能在损伤性胆管狭窄发生中起了重要作用。%Objective To investigate the role of transforming growth factor-β1 (TGF-β1) in the pathogenesis of injured biliary strictures.  Methods We detected immunohistochemistrily the expression of TGF-β1 and its type I receptor(TGF-βR1) in normal bile duct wall and injured biliary stricture lesions.  Results Neither TGF-β1 nor TGF-βR1 was detected in normal bile duct wall. However, in injured biliary stricture lesions, TGF-β1 was highly expressed by large numbers of inflammatory cells and some fibroblasts. TGF-βR1 was highly expressed by large numbers of inflammatory cells and fibroblasts.  Conclusions Fibroblasts in injured bile duct are activated and proliferated, and then release TGF-β1 through paracrine and autocrine pathways induced by TGF-βR1. TGF-β1 may play a pivotal role in the pathogenesis of injured biliary strictures.

  15. Laparoscopic diagnosis and treatment of cystic duct stones in 86 cases%腹腔镜诊治胆囊管结石86例体会

    Institute of Scientific and Technical Information of China (English)

    李俊彦; 蒋宏

    2012-01-01

    Objective:To explore the method and effect of laparoscopic diagnosis and treatment in calculus of cystic duct. Methods: Reviewed the clinical data that 86 patients received laparoscopic cholecystectomy treatment because of calculus of cystic duct. Results: Before operation 30 cases were diagnosed Calculus of cystic duct By B-ul-trasonography and CT , intraoperative probe found 56 cases diagnosed Calculus of cystic duct. 83 cases were successfully completed laparoscopic cholecystectomy, 3 cases were converted to open, no case was happened serious complications such as bile duct injury, hemorrhage, bile duct leakage and common bile duct calculus and so on. All recoveried. Conclusion : B-ultrasonography combined with CT examination can diagnose Calculus of cystic duct before operation and active application of laparoscopic cholecystectomy plays vital role in diagnosis and treatment of Calculus of cystic duct,if circumstance complicated,Choose laparotomy in order to reduce unnecessary bile duct injury, it is safe and feasible through laparoscopic cholecystectomy, treat Calculus of cystic duct.%目的:探讨腹腔镜诊断和治疗胆囊管结石的方法和效果.方法:对86例胆囊管结石患者采用腹腔镜治疗.结果:经B超、CT术前诊断胆囊管结石30例,术中探查发现胆囊管结石56例.顺利完成腹腔镜胆囊切除术(LC) 83例,3例中转开腹,无一例发生胆管损伤、出血、胆漏、胆总管结石等严重并发症,均痊愈出院.结论:B超结合CT检查可在术前诊断胆囊管结石,灵活运用LC的处理技巧是腹腔镜诊断和治疗胆囊管结石的关键.酌情中转开腹可减少不必要的胆管损伤.

  16. Efficacy analysis of endoscopic sphincterotomy plus endoscopic papillary balloon dilation for remove of common bile duct stons%内镜下乳头小切开联合球囊扩张治疗胆总管结石临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    闫方博; 张健康

    2014-01-01

    Objective To explore the effectiveness and safety of endoscopic sphincterotomy(EST)plus endoscopic pap-illary balloon dilation (EPBD) for the removal of common bile duct stones. Methods One hundred patients who re-ceived endoscopic retrograde pancreatic angiography(ERCP)in the first hospital of shanxi medical university from June 2012 to March 2014 were randomly divided into EST group and ESBD group. ESBD group in advance nipples small in-cision after balloon expansion; EST group used normal operation. The successful rate of stone clear-ance,operation time,the rate of mechanical lithotripsy and related complications were observed.Results After one time,all stones were removed one time from 46 cases(92%) assigned EST and 48 cases(96%) assigned EPBD(P>0.05); Mechanical lithotripsy was used to fragment stones 8 cases(16%) in EST group and 2 cases(4%) in ESBD group(P0.05); Average operation time,respectively (45.3±13.0) min and (30.5±9.2) min(P0.05);使用机械碎石分别有8例(16%)和2例(4%),差异有统计学意义(P0.05);两组平均操作时间分别为(45.3±13.0)min和(30.5±9.2)min,差异有统计学意义(P<0.05)。结论内镜下乳头括<肌小切开联合球囊扩张术取石成功率及术后并发症发生率与常规括<肌切开术相当,但平均操作时间及使用机械碎石的机率与EST相比较低,是治疗胆总管结石安全、有效的方法。

  17. 中下段胆管癌切除后切缘阳性的意义及预后因素分析%Significance of positive ductal margin and prognostic factors of surgical resection in middle and distal bile duct carcinoma

    Institute of Scientific and Technical Information of China (English)

    梁建伟; 赵平; 周志祥; 田艳涛; 赵东兵; 王成锋

    2009-01-01

    目的 分析中下段胆管癌切除术后切缘阳性的意义,研究影响中下段胆管癌切除术后的预后因素.方法 回顾性分析1990年1月至2006年12月收治的79例中下段且日管癌切除患者的临床病理资料.其中男性53例、女性26例,年龄30~79岁,平均61岁.中段胆管癌34例,下段胆管癌45例.行胰十二指肠切除术46例,行根治性胆总管癌切除术25例,行根治性胆总管癌切除联合肝部分切除术6例,行根治性胆总管癌切除联合门静脉部分切除术2例.5例于术后1个月内死亡,对其余74例患者的15项临床病理特征进行单因素及多因素分析.结果 74例患者总的5年生存率为30.7%,中位生存期为36个月.术后病理榆查为镜下切缘阳性(R1切除)16例(20.3%),其中肝脏端胍管切缘阳性6例,远端胆管切缘阳性3例,双侧胆管切缘阳性2例,环周切缘阳性5例.接受R0和Rl切除的患者的5年生存率分别为34.4%和15.5%.10例(17.2%)R0切除的胆管癌出现局部复发,10例(62.5%)R1切除出现复发,差异有统计学意义(X2=13.024,P<0.01).单因素分析显示术前血红蛋白水平、分化程度、肿瘤浸润深度、淋巴结转移、TNM分期及手术切缘为影响预后的因素.多因素分析显示淋巴结转移状况和切缘癌残留是影响预后的独立因素.结论 中下段胆管癌根治术中冰冻病理检查切缘达R0切除是提高长期生存的重要策略,辅助治疗的效果尚待进一步研究.%Objective To discuss the significance of a positive ductal margin and evaluate the prognostic factors related to surgical resection for middle and distal bile duct carcinoma. Methods A retrospective clinicopathological analysis of 79 patients who had undergone surgical resection for middle or distal bile ductal cancer between January 1990 and December 2006 was conducted. The surgical procedures consisted of pancreatoduodenectomy in 46 patients, bile duct resection in 25 patients, bile duct resection

  18. Application of persistent methylene blue dyeing method for anatomic hepatotectomy of hepatocellular carcinoma with bile duct tumor thrombi%持久亚甲蓝染色法在肝细胞癌合并胆管癌栓解剖性肝切除术中的应用

    Institute of Scientific and Technical Information of China (English)

    蔡守旺; 吕文平; 杨世忠; 曾建平; 徐立宁; 张文智; 董家鸿

    2012-01-01

    Objective To evaluate the role of anantomic hepatotectomy of hepatocellular carcinoma with bile duct tumor thrombi by application of persistent methylene blue dyeing method.Methods From January 2009 to February 2011,11 hepatocellular carcinoma patients with bile duct tumor thrombi underwent anantomic hepatotectomy with removal of the biliary tumor thrombus.There were 10 male and 1 female patients.The average age was 49 years ( ranging from 31 to 67 years).The initial symptom of 9 out of the 11 patients was jaundice. After anatomy and ligation of Glissonean pedicle of pre-resection segment,methylene blue was injected into its far-end portal vein in order to dye the segment,Results Persistent methylene blue dyeing method was successful in all patients. Primary foci were found in all patients.Hepatotectomy were performed,including 4 patients of segmentectomy,3 patients of subsegmentectomy,2 patients of hemihepatectomy,and 2 patients of hepatic sectorectomy.The mean operation time and blood loss was 137 minutes and 246 ml respectively.Severe complications such as liver function failure and sub-diaphragm abscess was avoided in all patients.No perioperative death.Post-operation radiotherapy was performed on 2 patients.Over a mean follow-up time of 14.6 months,liver cancer recurrence occured in 2 patients,abdomen seeding metastasis in 1 patient,bile duct tumor thrombi recurrence in 1 case,and 2 patients died.Conclusions Anantomic hepatotectomy of hepatocellular carcinoma with bile duct tumor thrombi by application of persistent methylene blue dyeing method can make resection more precise and improve curative effect.%目的 探讨持久亚甲蓝染色法在肝细胞癌合并胆管癌栓患者的解剖性肝切除术中的应用价值.方法 2009年1月至2011年2月对11例肝细胞癌合并胆管癌栓患者实施解剖性肝切除术和胆管取癌栓术.其中男性10例,女性1例;年龄31~67岁,平均年龄49岁.9例以黄疸为首

  19. Differential expression of cholangiocyte and ileal bile acid transporters following bile acid supplementation and depletion

    Institute of Scientific and Technical Information of China (English)

    N. Sertac Kip; Konstantinos N. Lazaridis; Anatoliy I. Masyuk; Patrick L. Splinter; Robert C. Huebert; Nicholas F. LaRusso

    2004-01-01

    AIM: We have previously demonstrated that cholangiocytes,the epithelial cells lining intrahepatic bile ducts, encode two functional bile acid transporters via alternative splicing of a single gene to facilitate bile acid vectorial transport.Cholangiocytes possess ASBT, an apical sodium-dependent bile acid transporter to take up bile acids, and t-ASBT, a basolateral alternatively spliced and truncated form of ASBT to efflux bile acids. Though hepatocyte and ileal bile acid transporters are in part regulated by the flux of bile acids,the effect of alterations in bile acid flux on the expression of t-ASBT in terminal ileocytes remains unclear. Thus, we tested the hypothesis that expression of ASBT and t-ASBT in cholangiocytes and ileocytes was regulated by bile acid flux. METHODS: Expression of ASBT and t-ASBT message and protein in cholangiocytes and ileocytes isolated from pairfed rats given control (C) and 1% taurocholate (TCA) or 5% cholestyramine (CY) enriched diets, were assessed by both quantitative RNase protection assays and quantitative immunoblotting. The data obtained from each of the control groups were pooled to reflect the changes observed following TCA and CY treatments with respect to the control diets.Cholangiocyte taurocholate uptake was determined using a novel microperfusion technique on intrahepatic bile duct units (IBDUs) derived from C, TCA and CY fed rats.RESULTS: In cholangiocytes, both ASBT and t-ASBT message RNA and protein were significantly decreased in response to TCA feeding compared to C diet. In contrast,message and protein of both bile acid transporters significantly increased following CY feeding compared to C diet. In the ileum, TCA feeding significantly up-regulated both ASBT and t-ASBT message and protein compared to C diet, while CY feeding significantly down-regulated message and protein of both bile acid transporters compared to C diet. As anticipated from alterations in cholangiocyte ASBT expression, the uptake of

  20. 内镜下治疗肝内外胆管结石1478例回顾性分析——对中药联合内镜治疗肝内外胆管结石的研究%Retrospective Analysis of Endoscopy on 1478 Cases with Intra-and Extrahepatic Bile Duct stone-Research of Traditional Chinese Medicine Herb Combination with Endoscopy on Intra-and Extrahepatic Bile Duct Stone

    Institute of Scientific and Technical Information of China (English)

    高文艳; 李昊燃; 王立新; 林一帆; 王长洪; 麻树人; 陈山泉; 陆宇平; 杨卓; 巩阳; 刘杨; 季芳

    2011-01-01

    Objective: To make a retrospective analysis of 1478 cases with intrahepatolithiasis and extrahepatic bile duct stone disease treated with therapeutic endoscopy and the traditional chinese medicin(TCM)on promoting recovery of liver function, reducing the time of hospitalization and preventing stone to recur. Methods: Complete clinical data of 1478 cases were collected from March 2004 to March 2009 in department of traditional chinese medicine of Shenyang military region general hospital. To analysis the information of cases treated with therapeutic endoscopy and combinated with the TCM ,to observe the therapeutic efficacy. The cases that removing calculus succeed and had the history of operation on biliary tract were followed up for 1 year. Results: 1410 cases were removing calculus 1 times ,achievement ratio was 95.40%. 946 cases were combinated with Qingyilidantuihuang Decoction. After treatment, the time of hospitalization in the group of TCM was shorter than the group of non-TCM. The numerus of icteric index decreasing daily in the group of TCM were higher than the group of non-TCM. In 68 cases with refractory stone, 18 cases were ERBD,the other 50 cases injected TCM decoction through nasobiliary drainage and removing calculus succed in the end. The recurrence rate of the group of TCM (2.30%) was lower than the group of nonTCM's (6.36%) significantly. Conclusion: After the treatment of endoscopy,the cases that combinated with TCM can promote the liver function as soon as possible and reduce the time of hospitalization in the near future. It can prevent or delay the recur of calculus in long -time. Injecting TCM decoction through nasobiliary drainage to dissolve stone for refractory stone can increase the achievement ratio of removing stone.%目的 回顾性分析中药联合内镜治疗肝内外胆管结石临床疗效.方法 分析本院既往5年肝内外胆管结石患者.分为中药组及非中药组.比较两组患者黄疸

  1. Observation of the seleno bis-(S-glutathionyl) arsinium anion in rat bile.

    Science.gov (United States)

    George, Graham N; Gailer, Jürgen; Ponomarenko, Olena; La Porte, Paul F; Strait, Karen; Alauddin, Mohammad; Ahsan, Habibul; Ahmed, Selim; Spallholz, Julian; Pickering, Ingrid J

    2016-05-01

    Certain arsenic and selenium compounds show a remarkable mutual cancelation of toxicities, where a lethal dose of one can be voided by an equimolar and otherwise lethal dose of the other. It is now well established that the molecular basis of this antagonism is the formation and biliary excretion of seleno bis-(S-glutathionyl) arsinium anion [(GS)2AsSe](-). Previous work has definitively demonstrated the presence of [(GS)2AsSe](-) in rabbit bile, but only in the presence of other arsenic and selenium species. Rabbits have a gall bladder, which concentrates bile and lowers its pH; it seems likely that this may be responsible for the breakdown of biliary [(GS)2AsSe](-). Since rats have no gall bladder, the bile proceeds directly through the bile duct from the hepatobiliary tree. In the present work we have shown that the primary product of biliary co-excretion of arsenic and selenium in rats is [(GS)2AsSe](-), with essentially 100% of the arsenic and selenium present as this species. The chemical plausibility of the X-ray absorption spectroscopy-derived structural conclusions of this novel arsenic and selenium co-excretion product is supported by density functional theory calculations. These results establish the biomolecular basis to further explore the use of selenium dietary supplements as a possible palliative for chronic low-level arsenic poisoning of human populations.

  2. Cystic dilation of bile duct: new clinical classification and treatment strategy%胆管囊状扩张症:新的临床分型与治疗策略

    Institute of Scientific and Technical Information of China (English)

    董家鸿; 郑秀海; 夏红天; 赵向前; 梁斌; 杨滔; 曾建平; 黄志强

    2013-01-01

    A2型患者采用非手术治疗;13例B型患者中,12例患者行肝切除术,1例患者合并胆管癌,采用非手术治疗;300例C型患者中,286例患者行肝外囊状扩张病变切除+胆管空肠吻合术,14例患者因囊状扩张胆管恶变行胆管癌根治性切除术;96例D型患者中,35例患者行肝外胆管囊状扩张病变切除+肝切除(肝内胆管囊状扩张病变累及的部分肝组织)+胆管空肠吻合术,59例患者仅行肝外囊状扩张病变切除术,1例D1型和1例D2型患者伴有胆管癌,行根治性切除术;1例E型患者行EST治疗.399例患者获得随访,随访时间l~15年,平均随访57个月.33例患者出现胆管空肠吻合口狭窄和(或)结石.24例患者并发胆管癌,其中15例患者于随访期内死亡.46例患者因复发性胆管炎伴有吻合口狭窄或结石、肿瘤实施再次手术治疗(胆管空肠再吻合术、内镜下胆管取石术、胆管癌根治性切除术等).其余患者无相关临床症状或偶发轻度的胆管炎,经对症治疗缓解.D型患者中联合肝切除者与仅行肝外胆管囊状扩张病变切除者的症状缓解率、狭窄和(或)结石复发率、再手术率分别为88.2%(30/34)、8.8% (93/34)、11.8% (4/34)和64.4%(38/59)、28.8%(17/59)、35.6% (21/59),两者比较,差异有统计学意义(P<0.05).结论 新的胆管囊状扩张症分型基于囊状扩张病变累及胆管树的部位及其病理特征,对于不同分型的胆管囊状扩张症选择不同的治疗策略和手术方法具有明确的指导作用.%Objective To suggest a new clinical classification of the cystic dilatation of bile duct (CDBD),and to design the treatment modality according to different classifications.Methods The clinical data of 434 patients with CDBD who were admitted to the Chinese PLA General Hospital from June 1993 to June 2010 were retrospectively analyzed.The data of computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) were

  3. Advances of MRCP in diagnosis of pancreatic duct dilatation

    International Nuclear Information System (INIS)

    Pancreatic duct dilatation is a common sign of pancreaticobiliary diseases and may be seen in pancreatic carcinoma, carcinoma of duodenal papilla, distal common bile duct carcinoma, ampullary carcinoma, intraductal papillary mucinous tumor, pancreatitis, pancreatic pseudocyst, sphincter of oddi dysfunction, pancreatic trauma, pancreas divisum, annular pancreas, pancreatic tuberculosis, abdominal aorta aneurysm, etc. It is possible to make a correct diagnosis and differential diagnosis by analyzing features of shape, extent, and location of dilated pancreatic duct. This article reviews the advances of MRCP in etiological diagnosis of dilatation of the pancreatic duct. (authors)

  4. Postoperative bile leakage managed successfully by intrahepatic biliary ablation with ethanol

    Institute of Scientific and Technical Information of China (English)

    Tetsuya Shimizu; Takashi Tajiri; Hiroshi Yoshida; Yasuhiro Mamada; Nobuhiko Taniai; Satoshi Matsumoto; Yoshiaki Mizuguchi; Shigeki Yokomuro; Yasuo Arima; Koho Akimaru

    2006-01-01

    We report a case of postoperative refractory bile leakage managed successfully by intrahepatic biliary ablation with ethanol. A 75-year-old man diagnosed with hepatocellular carcinoma underwent extended posterior segmentectomy including the caudate lobe and a part of the anterior segment. The hepatic tumor attached to the anterior branch of the bile duct was detached carefully and resected. Fluid drained from the liver surface postoperatively contained high concentrations of total bilirubin, at a constant volume of 150 mL per day. On d 32 after surgery, a fistulogram of the drainage tube demonstrated an enhancement of the anterior bile duct.Endoscopic retrograde cholangiography demonstrated complete obstruction of the proximal anterior bile duct and no enhancement of the peripheral anterior bile duct.On d 46 after surgery, a retrograde transhepatic biliary drainage (RTBD) tube was inserted into the anterior bile duct under open surgery. However, a contrast study of RTBD taken 7 mo post-surgery revealed that the fistula remained patent despite prolonged conservative management, so we decided to perform ethanol ablation of the isolated bile duct. Four mL pure ethanol was injected into the isolated anterior bile duct for ten minutes, the procedure being repeated five times a week. Following 23 attempts, the volume of bile juice reached less than 10 mL per day. The RTBD was clamped and removed two days later. After RTBD removal, the patient had no complaints or symptoms. Follow-up magnetic resonance imaging demonstrated atrophy of the ethanol-injected anterior segment without liver abscess formation.

  5. The clinical value of ENBD in the prevention of post-ERCP pancreatitis and hyperamylasemia in patients with common bile duct stones%ENBD预防胆总管结石ERCP术后急性胰腺炎及高淀粉酶血症的临床价值

    Institute of Scientific and Technical Information of China (English)

    余璐; 邓涛; 占义军; 皮小雨; 李红艳

    2012-01-01

    Objective To investigate the efficacy of endoscopic nasobiliary drainage (ENBD) in the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and hyperamylasemia in patients with common bile duct stones. Methods The clinical data of 367 patients with common bile duct stones, including 309 undergoing ENBD and 58 undergoing routine treatment, were reviewed retrospectively. Serum amylase levels at 2 h and 24 h postoperatively and incidence of pancreatitis and hyperamylasemia were compared between the two groups. Results Serum amylase levels at 2 h and 24 h postoperatively were significantly lower in the ENBD group than those in the routine treatment group (396.6 U/L±240.3 U/L vs 593.9 U/L±470.5 U/L, P<0.05; 620.8 U/L±345.5 U/L vs 1074.0 U/L ±609. 1 U/L, P <0. 01). The incidence of post-ERCP pancreatitis and hyperamylasemia were also significantly lower in the ENBD group than those in the routine treatment group (4. 9% vs 13. 8% , 13. 6% vs 22. 4% , both P < 0.05). Conclusion ENBD can effectively prevent the occurrence of post-ERCP pancreatitis and hyperamylasemia in patients with common bile duct stones.%目的 观察内镜鼻胆管引流术(ENBD)预防内镜逆行胰胆管造影术(ERCP)术后急性胰腺炎及高淀粉酶血症的效果.方法 收集我院胆总管结石行ERCP取石术的患者367例,其中ENBD组309例,对照组58例,比较两组术后2h及24 h血清淀粉酶值、高淀粉酶血症及急性胰腺炎的发生率.结果 ENBD组术后2h、24 h的血清淀粉酶值分别为(396.6±240.3) U/L和(620.8±345.5) U/L,明显低于对照组的(593.9±470.5) U/L和(1 074.0±609.1) U/L(P<0.05);ENBD组有42例发生高淀粉酶血症(13.6%)、15例发生急性胰腺炎(4.9%),对照组则分别为13例(22.4%)和8例(13.8%),两组比较差异均有统计学意义(P<0.05).结论 ENBD能有效预防胆总管结石患者ERCP术后急性胰腺炎及高淀粉酶血症的发生.

  6. The Clinical Efficacy of Domestic Biliary Metallic Stents in the Management of Bile Duct Cancer Combined with Different Anti-cancer Treatments%国产胆道金属支架联合抗肿瘤治疗胆管癌的疗效分析

    Institute of Scientific and Technical Information of China (English)

    李腾飞; 李臻; 韩新巍

    2011-01-01

    Objective To evaluate the clinical efficacy of domestic biliary metallic stents in the management of bile duct cancer combined with different anti-cancer treatments. Materials and Methods Clinic data of 35 bile duct cancer patients that taken both stenting and anti-cancer treatment and 38 patients that only taken single stenting were analyzed and compared to see if there were difference in clinical efficacy between the two groups. Results There was significant difference in survival rate and stent patency rate between the group of combined with different anti-cancer treatments and group of simple stenting( x2 = 12. 141, P = 0. 000 < O. 05; x2 = 12. 792, P = O. 000 < O. 05 ). 17 patients received three-dimensional radiation therapy, 15 patients received chemotherapy and 3 patients were combined with both three-dimensional radiation therapy and chemotherapy. Comparing with the single stenting group, each of the three groups had significant difference in survival rate and stent patency rate ( P < O. 05 ). But there were no significant differences in survival rate and stent patency rate during the three groups(x2 =l.092,P=0.579>O. 05;x2 =0.517,P=0.772 >0.05). Conclusion The domestic biliary metallic stent insertion combined with different anti-cancer treatments can increase survival rate and stent patency rate in the patients with bile duct cancer, it is a safe and effective therapy method.%目的 探讨国产胆道金属支架联合抗肿瘤治疗胆管癌的疗效.资料与方法 回顾性分析35例因胆管癌行国产胆道金属支架置入并联合抗肿瘤治疗的患者临床资料(治疗组)并与38例仅单纯行金属支架治疗者(对照组)行随机对照研究,观察其疗效.结果 在生存时间和支架的通畅时间方面联合抗肿瘤组较对照组均明显延长,差异有统计学意义(χ2=12.141,P=0.0000.05;χ2=0.517,P=0.772>0.05).结论 国产胆道金属支架联合抗肿瘤治疗能显著延长患者生存时间和支架通畅

  7. Effect of indomethacin in preventing post-endoscopic retrograde cannulation pancreatitis in patients undergoing common bile duct cholecystolithotomy%吲哚美辛栓预防内镜逆行胆胰管造影术胆总管取石术后胰腺炎的研究

    Institute of Scientific and Technical Information of China (English)

    翟莉莉; 黄坤; 于久飞

    2016-01-01

    目的 探讨吲哚美辛栓预防内镜逆行胆胰管造影术(ERCP)胆总管取石术后胰腺炎的效果.方法 纳入2014年1-12月于民航总医院住院行ERCP胆总管取石术的胆总管结石患者51例,完全随机分为吲哚美辛组(26例)和对照组(25例).吲哚美辛组于ERCP术前60 min直肠内给予吲哚美辛栓100 mg,对照组不予吲哚美辛栓.比较2组患者术后2、6、24 h血清淀粉酶和ERCP术后胰腺炎(PEP)及高淀粉酶血症发生率.结果 吲哚美辛组术后6和24 h血清淀粉酶水平均低于对照组[(202±41) U/L比(409 ±77) U/L,(111±18) U/L比(264 ±56) U/L],差异均有统计学意义(均P<0.05),术后2h2组间比较差异无统计学意义[(128±20) U/L比(192 ±29) U/L,P>0.05].对照组25例患者中4例(16.0%)出现PEP,吲哚美辛组无一例出现PEP,组间差异有统计学意义(P<0.05);对照组12例(48.0%)、吲哚美辛组7例(26.9%)出现术后高淀粉酶血症,组间差异有统计学意义(P<0.05).结论 直肠应用吲哚美辛栓可以预防ERCP胆总管取石术后胰腺炎和高淀粉酶血症.%Objective To investigate the effect of indomethacin in preventing post-endoscopic retrograde cannulation (ERCP) pancreatitis (PEP) in patients undergoing common bile duct cholecystolithotomy.Methods Totally 51 patients with common bile duct stones who underwent ERCP common bile duct cholecystolithotomy from January 2014 to December 2014 were randomly divided into indomethacin group (26 cases) and control group (25 cases).Indomethacin group was rectally administrated with indomethacin (100 mg) 60 min before operation and control group was not given indomethacin.The serum amylase was detected 2,6 and 24 h after operation,the incidences of PEP and postoperative hyperamylasemia were compared between groups.Results The serum amylase level in indomethacin group was significantly lower than that in control group 6 and 24hafterERCP [(202±41) U/Lvs (409 ±77) U/L,(111±18) U/L vs (264 ±56) U

  8. 内镜下同期胆、肠双金属支架置入治疗胆管及十二指肠恶性梗阻%Simultaneous stenting in bile duct and duodenum under endoscope for treatment of malignant biliary and duodenal obstruction

    Institute of Scientific and Technical Information of China (English)

    潘亚敏; 王田田; 高道键; 吴军; 胡冰

    2013-01-01

    Objective To investigate the therapeutic strategies, methods, safety and efficacy of simultaneous placement of self-expanding metallic stent (SEMS) in the bile duct and duodenum under endoscope for treatment of malignant biliary and duodenal obstruction. Methods The clinical data of patients with obstructive jaundice combined with severe duodenal stricture, who were treated with simultaneous placement of biliary SEMS and duodental SEMS under endoscope during January 2009 to June 2012, were retrospectively analyzed. The success rate of endoscopic management, complications, relief of jaundice and results of gastric outlet obstruction scoring system (GOOSS) were analyzed. Results Totally ten patients meeting the criteria were analyzed in this study. The patients included 5 cases with pancreatic cancer, 2 with gallbladder cancer, 2 with cancer of bile duct and one with duodenal papilla caner. Five patients with type Ⅰ duodenal stricture (without invading duodenal papilla) successfully received biliary stents through endoscopic retrograde cholangiopancreatography (ERCP) after placement of duodenal stents. One patient with type Ⅰ duodenal stricture was implanted with a 9 cm duodenal stent before endoscopic anterograde cholangiopancreatography (EACP) , then a SEMS was implanted in the bile duct through endoscopic ultrasonography-guided biliary drainage (EUS-BD). Three patients with type Ⅱ duodenal stricture (with invading duodenal papilla) underwent EACP and biliary stent placement through EUS-BD, and then the duodenal stent was deployed in duodenum after EACP. The patient with type Ⅲ (away from the duodenal papilla) was implanted with biliary and duodenal stents. The success rate of endoscopic management was 100%. Two patients had self-controlled bleeding of intestinal mucosa, which was caused by endoscope friction when passing through the duodenal stricture, but without any continuous bleeding or perforation. Symptoms of jaundice and gastric outlet obstruction

  9. Nikander's Thesis: Studies on the exocrine ducts of the pancreas and the liver in reindeer (Rangifer tarandus tarandus L

    Directory of Open Access Journals (Sweden)

    Sven Nikander

    1991-10-01

    Full Text Available This thesis is based on the following papers, which will be referred to in the next by their Roman numerals:I Nikander, S. 1990. On the anatomy and topography of the pancreas and the pancreatic duct in reindeer (Rangifer tarandus tarandus L.. Rangifer 10: 25-29.II Rahko, T. & Nikander, S. 1990. Macroscopical and microscopical studies of the common bile duct in reindeer (Rangifer tarandus tarandus L.. Rangifer 10: 3-8.III Rahko, T. & Nikander, S. 1990. Histochemical studies of the common bile duct in reindeer. Rangifer 10: 9-15.IV Rahko, T. & Nikander, S. 1990. Electron microscopical studies of the common bile duct in reindeer. Rangifer 10: 17-23.V Nikander, S. & Rahko, T. 1990. Ultra-structure of granulated cells in the bile duct of reindeer. Rangifer Special Issue No. 3: 363-367.

  10. Endoscopic therapy of periampullary duodenal diverticula combined with common bile duct stones in the 45 aged people%45例老年人十二指肠乳头旁憩室合并胆总管结石的内镜治疗

    Institute of Scientific and Technical Information of China (English)

    汪发勇; 潘宏年; 蒋宇敏; 李婷

    2012-01-01

    Objective To exptore the efficacy of endoscopic therapy of periampullary duodenal diverlicula combined wilh common bile duel stones in the aged people. Methods From June 2006 to May 2011 45 aged people of periampullary duodenal diverlicula combined wilh common bile duel stones were analyzed. Toally 44 palienls underwent endoscopic sphinclerotomy(EST) or combined wilh baltoon dilalalion, endoscopic lilholripsy baskel or/(and) mechanical lilholripsy to remove the common bile duel stones. Results The diagnosis of common bile duel stones was conformed during the successful operalion in all the cases successfully. Diameler of stones between 0. 6 cm and 3. 0 cm, 27 palienls had one stone, 12 had Iwo and 6 had three or more. The stones were removed using baskel direclly in 34 palienls, 7 palienls were selected wilh Endoscopic mechanical lilholripsy(EML) , and plaslic slenl placement without calculus removal in 3 palienls. EST failed in one patient because of small duodenal papilla and huge stone. The stones were removed completely al the first opralion in 34 cases, and the other 6 cases received a second operalion after endoscopic nasobiliary drainage. Errhysis occurred in 3 patients during opralion and was healed by tocally sprinkling noradrenaline or electric coagulation. One patient had hemorrhage from the incision on the duodenal papilla 24 hours after the operalion and was cured by using clipper. 2 patients devetoped mild pancreatitis, 5 patients had a transient increase of serum amylase. They were cured by some medical methods. Thirly-six of the patients were foltowed up for 6 to 12 months, when common bile duct stones didn't reocccur. The stones became smaller in 3 palienls wilh plaslic slent and received endoscopic therapy again. Conclusion In the aged people, endoscopic therapy of periampullary duodenal diverticula combined wilh common bile duct stones is relalivly safe. Proper cut should be choose according to the tocation of diverlicula, the size of the stones

  11. Bile acid and immunosuppressive therapy in primary biliary cirrhosis

    NARCIS (Netherlands)

    F.H.J. Wolfhagen (Franciscus)

    1995-01-01

    textabstractPrimary Biliary Cirrhosis (PBC) is a chronic, cholestatic liver disease characterized by non-suppurative destruction of interlobular and septal bile ducts, with subsequent liver damage and eventually development of cirrhosis. The disease is relatively rare with an estimated annual incide

  12. Successful outcome of sphincterotomy and 7 French pigtail stent insertion in the management of post-cholecystectomy bile leaks.

    LENUS (Irish Health Repository)

    Donnellan, Fergal

    2009-06-01

    BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is widely used to manage post-cholecystectomy bile leaks. However, the best endoscopic intervention remains controversial. We investigated the success of a 7 French double pigtail stent following sphincterotomy in the management of such bile leaks. METHODS: Between July 1998 and June 2008, 48 patients were referred for ERCP for presumed post-cholecystectomy bile leaks. Leaks were confirmed at ERCP and managed by a combination of sphincterotomy and stent insertion unless contraindicated. RESULTS: Bile duct cannulation was successful in 44 (91.7%) patients. A leak of the cystic duct was demonstrated in 19 (43.2%) patients, the duct of Luschka in 11 (25.0%), and the common hepatic duct in 5 (11.4%). Complete transection of the common bile duct occurred in 4 patients. The remaining patients had no cholangiographic evidence of a leak. Sphincterotomy was performed in 34 patients. A 7 French double pigtail plastic stent was placed in all 35 patients with cholangiographic evidence of a bile leak. No bile leaks were demonstrated at a follow-up of 8-16 weeks and all stents were removed successfully. CONCLUSION: The combination of sphincterotomy and insertion of a 7 French double pigtail stent results in excellent outcomes in the management of post-cholecystectomy bile leaks.

  13. Role of bile acids in carcinogenesis of pancreatic cancer: An old topic with new perspective.

    Science.gov (United States)

    Feng, Hui-Yi; Chen, Yang-Chao

    2016-09-01

    The role of bile acids in colorectal cancer has been well documented, but their role in pancreatic cancer remains unclear. In this review, we examined the risk factors of pancreatic cancer. We found that bile acids are associated with most of these factors. Alcohol intake, smoking, and a high-fat diet all lead to high secretion of bile acids, and bile acid metabolic dysfunction is a causal factor of gallstones. An increase in secretion of bile acids, in addition to a long common channel, may result in bile acid reflux into the pancreatic duct and to the epithelial cells or acinar cells, from which pancreatic adenocarcinoma is derived. The final pathophysiological process is pancreatitis, which promotes dedifferentiation of acinar cells into progenitor duct-like cells. Interestingly, bile acids act as regulatory molecules in metabolism, affecting adipose tissue distribution, insulin sensitivity and triglyceride metabolism. As a result, bile acids are associated with three risk factors of pancreatic cancer: obesity, diabetes and hypertriglyceridemia. In the second part of this review, we summarize several studies showing that bile acids act as cancer promoters in gastrointestinal cancer. However, more question are raised than have been solved, and further oncological and physiological experiments are needed to confirm the role of bile acids in pancreatic cancer carcinogenesis. PMID:27672269

  14. A case report of an unusual type of choledochal cyst with choledocholithiasis: Saccular dilatation of the confluent portion of both intrahepatic ducts

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Young; Kim, Hee Jin; Han, Hyun Young [Dept. of Radiology, Eulji University Hospital, Daejeon (Korea, Republic of)

    2015-10-15

    A choledochal cyst is a rare congenital anomaly of the biliary system manifested as the cystic dilatation of bile ducts, usually occurring in the common bile duct. Here, we describe an unusual type of choledochal cyst in a 45-year-old male that did not fit into the most widely accepted Todani classification of these cysts. The lesion mimicked duplication anomalies of the gallbladder and was finally diagnosed as a choledochal cyst involving the confluent portion of both intrahepatic ducts.

  15. Bile acid sequestrants

    DEFF Research Database (Denmark)

    Hansen, Morten; Sonne, David P; Knop, Filip K

    2014-01-01

    Bile acids are synthesized in the liver from cholesterol and have traditionally been recognized for their role in absorption of lipids and in cholesterol homeostasis. In recent years, however, bile acids have emerged as metabolic signaling molecules that are involved in the regulation of lipid...... and glucose metabolism, and possibly energy homeostasis, through activation of the bile acid receptors farnesoid X receptor (FXR) and TGR5. Bile acid sequestrants (BASs) constitute a class of drugs that bind bile acids in the intestine to form a nonabsorbable complex resulting in interruption...... of the enterohepatic circulation. This increases bile acid synthesis and consequently reduces serum low-density lipoprotein cholesterol. Also, BASs improve glycemic control in patients with type 2 diabetes. Despite a growing understanding of the impact of BASs on glucose metabolism, the mechanisms behind their glucose...

  16. 尖吻蝮蛇血凝酶用于肝内胆管结石围手术期止血的疗效观察%Effect observation of agkistrodon hemocoagulase for hemostasis during perioperative period of intrahepatic bile duct calculus

    Institute of Scientific and Technical Information of China (English)

    汪斌; 丁佑铭; 陈晓燕; 聂云贵

    2015-01-01

    目的:评价尖吻蝮蛇血凝酶在胆道手术后的止血疗效及对凝血功能的影响。方法选取2011年1@8月在该科行开腹手术治疗的肝内胆管结石患者80例,随机分为尖吻蝮蛇血凝酶组与巴曲酶制剂组各40例,术前30min 分别静脉滴注尖吻蝮蛇凝血酶2U 和巴曲酶制剂2kU,术后连续用药3d,观察术中手术切口出血量、单位面积出血量、术后腹腔引流管引流量、引流液的血红蛋白浓度以及术前1d,术后30min、1d 和7d 机体凝血功能(PT、APTT、PLT 和 FIB)。结果2组患者术后止血效果及凝血功能各项指标比较差异无统计学意义(P ﹥0.05),2组均无不良反应发生。结论尖吻蝮蛇血凝酶应用于肝内胆管结石围手术期具有较好的止血作用和安全性。%Objective To evaluate the effects of hemocoagulase agkistrodon on its hemostatic and coagulation function on the patients with biliary operation. Methods 80 cases of intrahepatic bile duct calculus patients with biliary operation from January to August 2011 were selected and randomly divided into agkistrodon hemocoagulase group and batroxobin preparation group,each of 40 cases. Before operation for 30 minutes,the 2 groups received intravenous injection with agkistrodon hemo-coagulase 2U and hemocoagulase atrox 2kU respectively,and postoperative continuous administration for 3d. The intraoperative bleeding volume,operation hemorrhagic volume per unit area,postoperative drainage volume of drainage tube,drainage hemo-globin concentration and the coagulation function(PT,APTT,PLT and FIB)in 1d before operation and 30min,1d and 7d after operation were observed. Results There was no significant difference of hemostatic effect and the indexes of blood coagulation function between 2 groups(P ﹥ 0. 05). No adverse event was reported. Conclusion Hemocoagulase Agkistrodon has good he-mostatic function and safety during peri operation period of intrahepatic bile duct

  17. Effect of percutaneous transhepatic biliary drainage combined with metallic stent implantation treatment for biliary obstruction after portoenterostomy of bile duct cancer%经皮肝穿刺胆管引流术联合金属内支架植入术治疗胆管癌胆肠吻合术后梗阻性黄疸的疗效

    Institute of Scientific and Technical Information of China (English)

    谢军; 时启良; 郭长东; 王洪剑; 吕维富

    2015-01-01

    Objective To study the effect of clinical application of percutaneous transhepatic catheter drainage(PTCD)and metallic stents on biliary obstruction after portoenterostomy of bile duct cancer. Methods Form Nov. 2011 to May. 2014,a total of 24 patients with obstructive jaundice after portoenterostomy were admitted to the hospital and their clinical data were retrospectively analyzed. The PTCD or implantation of metallic stents was performed in 24 patients. The change of bilirubin restored,AST,ALT and the survival rate of the patients were documented and analyzed. Results The operation was successful in all 24 patients. Among 14 patients of obstruction of lower biliary tract,stent implantation was carried out in 10 patients. Among 10 patients of obstruction of higher biliary tract,stent implantation was carried out in 3 patients. The difference between the two groups was significant (P<0. 05). After the treatment,relief of jaundice symptoms was a-chieved,and the bilirubin restored to normal or acceptable lever,and hepatic function was improved obviously. The median follow-up time was 120 days. During the follow-up,death occurred in 7 cases among 11 patients while death occurred in 2 cases among 13 patients in com-bined-stents group. The difference in the survival rate between the two groups was significant statistically (P<0. 05). Conclusion PTCD or PTCD combined stents is an effective and advisable therapy for biliary obstruction after portoenterostomy of bile duct cancer. Obstruction of lower biliary tract is easier to implant stent. The technique of PTCD combined stents is superior to PTCD technique in the survival rate.%目的:探讨经皮肝穿刺胆管引流术(PTCD)联合金属内支架植入术治疗胆管癌胆肠吻合术后梗阻性黄疸的临床应用效果。方法回顾性分析24例胆管癌胆肠吻合术后梗阻性黄疸患者临床资料,采用经皮穿刺胆管引流(引流组)或经皮穿刺胆管引流术联合金属内支架植入

  18. Painful Bile Extraction Methods

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    It was only in the past 20 years that countries in Asia began to search for an alternative to protect moon bears from being killed for their bile and other body parts. In the early 1980s, a new method of extracting bile from living bears was developed in North Korea. In 1983, Chinese scientists imported this technique from North Korea. According to the Animals Asia Foundation, the most original method of bile extraction is to embed a latex catheter, a narrow rubber

  19. Aspectos ultra-sonográficos dos hamartomas dos ductos biliares (complexo de von Meyenburg: resultado de uma busca ativa de oito anos Ultrasonography findings in patients with bile duct hamartomas (von Meyenburg complex: result of an active search of eight years

    Directory of Open Access Journals (Sweden)

    Márcio Martins Machado

    2003-06-01

    Full Text Available A correta identificação de tumores hepáticos benignos é importante, pois a maioria não necessita de conduta intervencionista. Os autores relatam os aspectos ultra-sonográficos dos hamartomas de ductos biliares (complexo de von Meyenburg em 16 pacientes estudados prospectivamente, resultados de uma busca ativa de oito anos. Em 14 pacientes foram identificadas múltiplas lesões menores ou iguais a 0,8 cm, e em dois, apenas duas lesões em cada (medindo de 0,4 cm a 1,3 cm. O aspecto ultra-sonográfico que predominou foi o de múltiplas pequenas imagens hiperecogênicas com ou sem reverberação sonora posterior e margens irregulares (14 pacientes. Menos comumente, foi encontrado o aspecto "em alvo", com centro com maior ecogenicidade que a periferia (dois pacientes com duas lesões cada e margens bem definidas.The recognition and identification of benign liver tumors is important since most of these tumors do not require any intervention. The authors report the ultrasonography findings in 16 patients with bile duct hamartomas (von Meyenburg complex that were evaluated prospectively by an active search of eight years. Multiple lesions with size equal or less than 0.8 cm were identified in 14 patients. Two other patients had only two lesions measuring 0.4 cm to 1.3 cm. The most common ultrasonographic pattern was that of multiple small hyperechogenic lesions (with or without posterior acoustic reverberation with irregular margins (14 patients. A less common finding (two patients with two lesions each was the "target" pattern with echogenic center and well defined limits.

  20. 利胆排石汤联合纤维十二指肠镜治疗胆总管结石40例%Lidan Paishi Decoction Combined with Fiber Endoscopic Treatment in 40 Cases with Common Bile Duct Stones

    Institute of Scientific and Technical Information of China (English)

    牛贵义

    2013-01-01

    Objective: To observe clinical curative effect of fiber duodenoscopy combined Lidan Paishi decoction (LPD) in treatment of common bile duct stones. Method: Eighty cases of common bile duct stones were randomly divided into observation group and control group, 40 cases in each. The 2 groups were given anti-infective, maintenance of water, electrolyte, acid-base balance as foundation treatment. The control group was given the fibers treated with endoscopy, based on the control treatment the observation group was given LPD treatment, before and after 1 week of operation daily. Two groups were observed in patients with fever, jaundice, abdominal pain and other clinical symptoms integral improvement and before treatment and after treatment at 3 months total bilirubin ( TBil) , amylase ( AMY) , alanine aminotransferase ( ALT) , aspartate aminotransferase (AST) levels. Result: Jaundice, fever, nausea and vomiting, abdominal pain and other symptoms integral in the observation group after treatment group were (0.75 ±0. 12) , (0.87 ±0.15), (0.81 ±0.18), (0.54±0.26), the control group were (1.57 ±0.22) , (1.43 ±0.37), (1.47 ±0.24), (1. 74 ± 0. 26), the two group were significantly improved (P < 0. 05 ) , and the TBil and Amy of observation group were better than that of the control group (P <0. 05). TBil, AMY, ALT, AST index after treatment in observation group were (12.54 ±2.25) Ixmol·L-1, (48.43 ±18.87), (33. 54 ±6. 42) , (33.34±4.25) U ·L-1, control group were (19. 75 ±6. 25) Ixmol·L-1, (84.53 ±13.57), (34.71 ±6.24), (33.94 ±5.16) U ·L-1, two groups were significantly improved (P <0. 05) , and the TBil and Amg of the observation group were better than that of the control group (P < 0. 05). Conclusion: Fiber duodenoscopy combined LPD for the treatment of common bile duct stones can improve clinical symptoms and serum TBil, AMY levels.%目的:观察纤维十二指肠镜联合利胆排石汤治疗胆总管结石的临床疗效.方法:将80例胆总管结

  1. MRCP在活体肝移植术前供者胆管解剖结构评估中应用价值的荟萃分析%Magnetic resonance cholangiopancreatography classification of the bile duct anatomy of liver transplantation living donor: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    龙淼淼; 刘丽华; 刘铁; 岳建兰; 范文俊; 沈文; 祁吉

    2012-01-01

    目的 评价磁共振胰胆管成像(MRCP)在评估活体肝移植术前供者胆管解剖结构中的应用价值.方法 检索Cochrane图书馆、MEDLINE、EMBASE、中国生物医学文献数据库等文摘数据库收录的中英文文献摘要,辅以Springer、OVID、Sciencedirect等全文数据库,按照Coehrane协作网推荐的诊断试验纳入标准筛选文献,采用循证医学软件包检验纳入文献的异质性,并选择相应的效应量合并模型,对纳入的研究进行加权合并,计算敏感性、特异性、阳性预测值、阴性预测值、诊断比值比,绘制汇总受试者工作特征曲线(SROC),计算曲线下面积,最后进行敏感性分析.结果 符合纳入标准的文献有17篇,共有34项研究,异质性检验发现各研究间存在异质性,进行荟萃回归分析发现异质性来源为MRCP成像方法,按照不同的MRCP成像方法进行亚组分析,各亚组内异质性检验未发现异质性.按照固定效应模型获得厚层MRCP、三维MRCP、厚层MRCP与三维MRCP结合、增强MRCP等亚组的汇总敏感性分别为0.89、0.92、0.95和1.00,特异性分别为0.78、0.80、0.82和0.76,阳性预测值分别为4.1、4.5、5.2和4.1,阴性预测值分别为0.14、0.10、0.06和 0),诊断比值比分别为29、45、85和1228,SROC曲线下面积分别为0.83、0.92、0.96和0.99.结论 厚层MRCP和三维MRCP相结合在评估活体肝移植供者术前胆管解剖结构中具有很高的敏感性和特异性,完全可以满足术前对胆管结构评估的要求.%Objective To systematically evaluate the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) in the investigation of bile duct anatomy of liver transplantation living donors.Methods A search in Cochrane library,MEDLINE,EMBASE,CBMdisc (China Biology Medicine disc) was performed to identify relevant English and Chinese-language abstracts,supplemented by Springer,OVID,Sciencedirect full text database,etc.Criteria for inclusion were

  2. INHIBITION OF BILE ACID ACCUMULATION DECREASED THE EXCESSIVE HEPATOCYTE APOPTOSIS AND IMPROVED THE LIVER SECRETION FUNCTIONS ON OBSTRUCTIVE JAUNDICE PATIENTS

    Directory of Open Access Journals (Sweden)

    Akmal Taher

    2011-06-01

    Full Text Available Excessive hepatocyte apoptosis induced by bile acid accumulation occurred in severe obstructive jaundice, and impair the liver secretion function. The objective of this study is to determine whether the inhibition of bile acid accumulation through bile duct decompression affect the excessive hepatocyte apoptosis and caused improvement the liver secretion functions on human model. In this study we use a before and after study on severe obstructive jaundice patients due to extra hepatic bile duct tumor was decompressed. Bile duct decompression was performed as a model of the role of inhibition of bile acid accumulation inhibition bile acid accumulation and excessive hepatocyte apoptosis. Bile acid and marker of liver secretion functions were serially measured. Liver biopsy pre and post decompression was performed for Hepatocyte apoptosis pathologic examination by TUNEL fluorescing, which measured by 2 people in double blinded system. Total bile acid, and liver secretion functions were measured by automated chemistry analyzer. The result of this study shows that twenty one severe obstructive jaundice patients were included. After decompression the hepatocyte apoptosis index decreased from an average of 53.1 (SD 105 to 11.7 (SD 13.6 (p < 0.05. Average of bile acid serum decreased from 96.4 (SD 53.8 to 19.9 (SD 39.5 until 13.0 (SD 12.6 μmol/L (p < 0.05 Total ilirubin decreased from 20.0 (SD 8.9 to 13.3 (SD 5.0 until 6.2 (SD 4.0 mg/dL (p < 0.05, while the phosphates alkaline (ALP and γ-glutamil transpeptidase (γ-GT activities also decreased ignificantly. In conclusion, bile acids accumulation and excessive hepatocyte poptosis through bile duct decompression improve the liver secretion functions by inhibition mechanism.

  3. 胆胰管隔膜切开法在困难性经内镜逆行胰胆管造影术胆管插管中应用%Endoscopic transpancreatic septotomy as precutting technique for difficult bile duct cannulation

    Institute of Scientific and Technical Information of China (English)

    缪林; 范志宁; 季国忠; 张发明; 张秀华; 蒋国斌; 熊观瀛; 吴萍

    2012-01-01

    [Objective] To evaluate the technique of transpancreatic septum precut for cannulation of inaccessible common bile duct in endoscopic retrograde cholangiopancreatography (ERCP). [Methods] From May 2009 to April 2010, 1074 patients referred to our department for ERCP, excluded 16 patients who had a history of previous Billroth Ⅱ gastrectomy or Roux-en-Y anastomosis or duodenal stenosis or duodenal papula tumor. 1059 patients completed ERCP, 163 patients were difficult billiary cannulation in ERCP- With pancreatic guidewire or pancreatic duct plastic stent assistance, 94 patients completed ERCP successfully. 69 unsuccessfully patients data, of whom 36 underwent transpancreatic septum precut and 33 had needle-knife sphincterotomy, were analyzed retrospectively. [Results] Of 69 patients accepted precut papillotomy, common bile duct cannulation was successfully achieved in 67. The success rates of transpancreatic septum precut group and needle-knife sphincterotomy group were 97.2% (35/36) and 96.9% (32/33) respectively, which was not significantly differenl (P >0.05). Complications occurred in 11 cases, including acute pancreatitis (n=6), bleeding (n=2). cholangitis (n=3). The total frequency of complications of the transpancreatic septum pre-cut group was lower than that of needle-knife sphineterotomy group (8.3% VS 24.2%, P <0.05). [Conclusion] Pancreatic guidewire or pancreatic duct plastic stent assistance improves the success rate of selective billiary cannulation in ERCP. Transpancreatic septum precut and needle-knife sphineterotomy markedly improves the success rate of selective billiary cannulation in ERCP, transpancreatic septum precut was safer compared with needle-knife sphinctemtomy.%目的 探讨经胰管胆胰管隔膜预切开术在困难性经内镜逆行胰胆管造影术(ERCP)胆管插管中的应用价值.方法 2009年5月~2010年4月该院消化医学中心拟行经内镜ERCP患者1074例,除外毕氏Ⅱ式、Roux-en

  4. 胆道术后黄疸病因分析及治疗%Analysis and treatment of jaundice following operation of bile-tract

    Institute of Scientific and Technical Information of China (English)

    朱俊强

    2011-01-01

    Objective To explore the etiology of postoperative jaundice in bile duct and treatment. Methods Retrospective clinical analysis was made in 31 cases in our hospital from 2003 to 2009. Results 6 of 31 cases were non - obstructive jaundice and 25 were obstructive jaundice.The commonest reason included retained calculus and ampullary cancer and the injury of bile- duct.Conclusion A timely diagnoses and effective therapeutic methods were needed for jaundice following postoperative of bile- tract.%目的 探讨胆道术后黄疸发生的原因及治疗措施.方法 回顾性分析2003~2009年31例胆道术后黄疸的临床资料.结果 胆道术后非梗阻性黄疸6例;梗阻性黄疸25例,以残余结石、壶腹部周围癌、胆管损伤致狭窄常见.结论 胆道术后黄疸应及时明确诊断,采用有效的治疗方法.

  5. Ascaris lumbricoides and its invasion of the accessory cystic duct: an unusual presentation.

    Science.gov (United States)

    Majid, Zain; Masood, Irfan; Pirzada, Muhammad Taqi

    2015-04-01

    Around the world, Ascaris lumbricoides is the most common helminthic infection. We describe the case of a 25-year-old woman, known to have had Ascaris infestation, presenting with abdominal pain, constipation and jaundice together with fever and tachycardia. There was tenderness in the right hypochondrium and liver function tests confirmed cholestatic jaundice. An abdominal ultrasound showed multiple linear echogenic foci in the distal small intestine along with cholelithiasis and a thick-walled gall bladder with a single stone compressing the common bile duct (Mirizzi syndrome). The patient underwent exploratory laparotomy; more than 100 worms were found inside the small intestine and they were removed by enterotomy and manual decompression. No worm could be palpated within the common bile duct (CBD). Cholecystectomy was performed, during which an accessory cystic duct was noted opening into the common bile duct superiorly to the main cystic duct. A 10 cm live worm was found coming out of it and was removed via forceps. Later on an endoscopic retrograde cholangio-pancreatogram (ERCP) showed a widened ampulla, a mildly dilated common bile duct, but without any filling defects. The patient made an uneventful postoperative recovery being discharged on the ninth day. Worms in an accessory cystic duct have not been report in the medical literature so far.

  6. Efficacy of HGF carried by ultrasound microbubble-cationic nano-liposomes complex for treating hepatic fibrosis in a bile duct ligation rat model, and its relationship with the diffusion-weighted MRI parameters.

    Science.gov (United States)

    Zhang, Shou-hong; Wen, Kun-ming; Wu, Wei; Li, Wen-yan; Zhao, Jian-nong

    2013-12-01

    Hepatic fibrosis is a major consequence of liver aggression. Finding novel ways for counteracting this damaging process, and for evaluating fibrosis with a non-invasive imaging approach, represent important therapeutic and diagnostic challenges. Hepatocyte growth factor (HGF) is an anti-fibrosis cell growth factor that induces apoptosis in activated hepatic stellate cells, reduces excessive collagen deposition, and stimulates hepatocyte regeneration. Thus, using HGF in gene therapy against liver fibrosis is an attractive approach. The aims of the present study were: (i) to explore the efficacy of treating liver fibrosis using HGF expression vector carried by a novel ultrasound microbubble delivery system; (ii) to explore the diagnostic interest of diffusion-weighted MRI (DWI-MRI) in evaluating liver fibrosis. We established a rat model of hepatic fibrosis. The rats were administered HGF linked to novel ultrasound micro-bubbles. Progression of hepatic fibrosis was evaluated by histopathology, hydroxyproline content, and DWI-MRI to determine the apparent diffusion coefficient (ADC). Our targeted gene therapy produced a significant anti-fibrosis effect, as shown by liver histology and significant reduction of hydroxyproline content. Moreover, using DWI-MRI, the b value (diffusion gradient factor) was equal to 300s/mm(2), and the ADC values significantly decreased as the severity of hepatic fibrosis increased. Using this methodology, F0-F2 could be distinguished from F3 and F4 (Pmicrobubble-cationic nano-liposome complex for gene delivery. The data indicate that, this approach is efficient to counteract the fibrosis process. DWI-MRI appears a promising imaging technique for evaluating liver fibrosis.

  7. Bile culture (image)

    Science.gov (United States)

    ... tract. A specimen of bile is placed in culture media and observed for growth of microorganisms. If there ... no infection. If there is growth in the culture media, the growth is then isolated and identified to ...

  8. Risk Factors for Development of Biliary Stricture in Patients Presenting with Bile Leak after Cholecystectomy

    OpenAIRE

    Lokesh, Hosur Mayanna; Pottakkat, Biju; Prakash, Anand; Singh, Rajneesh Kumar; Behari, Anu; Kumar, Ashok; Kapoor, Vinay Kumar; Saxena, Rajan

    2013-01-01

    Background/Aims This study was aimed at determining the factors associated with the development of benign biliary stricture (BBS) in patients who had sustained a bile duct injury (BDI) at cholecystectomy and developed bile leaks. Methods A retrospective analysis of 214 patients with BDI who were referred to our center between January 1989 and December 2009 was done. Results One hundred fifty-three (71%) patients developed BBS (group I), and 61 (29%) were normal (group II). By univariate analy...

  9. Percutaneous transhepatic cholelithotripsy for difficult common bile duct stones

    DEFF Research Database (Denmark)

    Stage, J G; Moesgaard, F; Grønvall, S;

    1998-01-01

    to endoscopic retrograde cholangiography and extracorporeal shock wave lithotripsy underwent cholelithotripsy, utilizing a new dilation kit with massive teflon dilators covered by "peel-away sheets". RESULTS: Successful lithotripsy was performed in all patients by laser lithotripsy through a...

  10. [Reflexions on carcinomas of the extra-hepatic bile ducts].

    Science.gov (United States)

    Arianoff, A A; Vielle, G; Dewulf, E; Arianoff, V

    1975-01-01

    The authors present 12 cases of true malignant ampulloma and 23 cases of carcinoma of the biliary tract (MBT). They analyze frequency, symptomatology, pathology, radiology, treatment and results. They stress that decreasing malignancy is in the following order: cancer of the MBT, cancer of the gallbladder, and ampulloma. The latter is the least lethal with the most long-term cures. As to cancer of the MBT no cure is to be expected, but palliative surgery (resection or tumor by-pass) will bring temporary cure; consequently this should always be tried when possible despite the high operative mortality. PMID:1114872

  11. Biliary-colonic fistula caused by cholecystectomy bile duct injury

    Institute of Scientific and Technical Information of China (English)

    Francisco Igor B Macedo; Victor J Casillas; James S Davis; Joe U Levi and Danny Sleeman

    2013-01-01

     Biliary-colonic  fistula  is  a  rare  complication after laparoscopic cholecystectomy. We present a case of post-cholecystectomy  iatrogenic  biliary  injury  that  resulted  in  a fistula  between  the  common  hepatic  duct  and  large  bowel. Magnetic  resonance  cholangiopancreatography  provided good  visualization  of  injury  even  with  concurrent  normal level of alkaline phosphatase. Radiologic findings and surgical management of this condition are discussed in detail.

  12. [Bile duct lesions repaired with peritoneal tube grafts].

    Science.gov (United States)

    Lorenzana-Bautista, Ileana; Flores-Plascencia, Aníbal; Barrios-Pineda, Francisco Javier; Alderete-Vázquez, Georgia; Sánchez-Valdivieso, Enrique Alejandro

    2013-01-01

    Antecedentes: un número significativo de individuos sufrirá daño por iatrogenia del colédoco durante colecistectomías laparoscópicas. Las derivaciones bilio-digestivas pueden complicarse con estenosis y sepsis biliar y afectar la calidad y expectativa de vida. Para evitar la derivación se utilizan injertos sintéticos. Objetivo: evaluar el implante autólogo de peritoneo en la reparación de colédoco. Material y métodos: estudio experimental efectuado en 10 conejos Nueva Zelanda adultos a los que se les resecó un segmento del colédoco y para la reparación término-terminal de la vía biliar se construyó un neo-conducto con peritoneo parietal como auto-injerto. Se vigilaron con ontroles semanales de bilirrubinas y transaminasas. A la necropsia programada se estudió el segmento injertado, se realizó biopsia epática durante el procedimiento y la autopsia. Resultados: los animales no mostraron alteraciones en sus hábitos normales, la herida quirúrgica no tuvo complicaciones, no cursaron con ictericia y a la necropsia el segmento injertado se apreció totalmente integrado. En dos animales hubo como complicación un bilioma y un absceso hepático. El daño hepático observado inicialmente fue disminuyendo a lo largo del seguimiento. Discusión: nuestros resultados se equiparan con ventaja con los métodos conocidos de reparación de vías biliares, especialmente en lesiones severas (Bismuth-Strasberg E1-3). Adolece de las complicaciones de las derivaciones bilio-digestivas, no es caro como los injertos intéticos y es de mucho más fácil construcción que el injerto de amnios humano. Conclusiones: el auto-injerto de peritoneo es un procedimiento adecuado como alternativa para tratar lesiones circunferenciales de colédoco.

  13. 综合护理干预对内镜下治疗胆总管结石效果的影响%Effect of comprehensive nursing intervention on the treatment effect of common bile duct stones in patients undergoing endoscopy

    Institute of Scientific and Technical Information of China (English)

    崔梅; 张殿红; 张凤苹; 廉德花

    2011-01-01

    Objective To investigate the effect of comprehensive nursing intervention on the treatment of common bile duct stones undergoing endoscopy.Methods A total of 137 patients with common bile duct stones undergoing the endoscopic treatment were randomly divided into intervention group (n =69 cases) and control group (n =68 patients).All the patients received routine care before and after the endoscopic treatment.In addition,the patients in the intervention group received audio-visual training intervention with preoperative,music therapy with intra-operative and position training intervention with postoperative.The intervention effect was compared between the two groups.Results Breath rate,heart rate,oxygen saturation before treatment were not different in the two groups (P>0.05).Breath frequency in intervention group after treatment was (23.6 ±3.4) time/min,the first bed time was (19.24 ± 3.67)h,extubation rate was 97.10% and complication rate was 4.35% and those in control group were (28.9 ± 3.7) time/min,(24.62 ±4.81 ) h,86.76% and 16.18%respectively,and the differences were significant ( t =8.72,7.35 ; x2 =4.96,5.03 ; P < 0.05 ).Heart rate,blood pressure in experimental group after treatment were reduced and the extubation time and in hospital time were shorten than control group,however,the sleeping time was longer in experimental group (P < 0.05).Conclusions Comprehensive nursing intervention can improve treatment compliance,promote patients' early recovery and achieve the desired effect.%目的 探讨综合护理干预对内镜下治疗胆总管结石效果的影响.方法 将137例内镜下治疗胆总管结石患者随机分为干预组(n=69)和对照组(n=68).对照组接受内镜治疗前后常规护理,干预组在此基础上,给予术前视听训练干预,术中音乐疗法干预及术后体位训练干预.观察比较两组患者干预效果.结果 两组患者治疗前呼吸、心率、血氧饱和度比较差异无统计学意义(P>0

  14. Flagging Drugs That Inhibit the Bile Salt Export Pump.

    Science.gov (United States)

    Montanari, Floriane; Pinto, Marta; Khunweeraphong, Narakorn; Wlcek, Katrin; Sohail, M Imran; Noeske, Tobias; Boyer, Scott; Chiba, Peter; Stieger, Bruno; Kuchler, Karl; Ecker, Gerhard F

    2016-01-01

    The bile salt export pump (BSEP) is an ABC-transporter expressed at the canalicular membrane of hepatocytes. Its physiological role is to expel bile salts into the canaliculi from where they drain into the bile duct. Inhibition of this transporter may lead to intrahepatic cholestasis. Predictive computational models of BSEP inhibition may allow for fast identification of potentially harmful compounds in large databases. This article presents a predictive in silico model based on physicochemical descriptors that is able to flag compounds as potential BSEP inhibitors. This model was built using a training set of 670 compounds with available BSEP inhibition potencies. It successfully predicted BSEP inhibition for two independent test sets and was in a further step used for a virtual screening experiment. After in vitro testing of selected candidates, a marketed drug, bromocriptin, was identified for the first time as BSEP inhibitor. This demonstrates the usefulness of the model to identify new BSEP inhibitors and therefore potential cholestasis perpetrators. PMID:26642869

  15. Detection of bacterial DNA in bile of cats with lymphocytic cholangitis.

    Science.gov (United States)

    Otte, C M A; Gutiérrez, O Pérez; Favier, R P; Rothuizen, J; Penning, L C

    2012-04-23

    In this study, we have successfully used molecular methods based on the amplification of the 16S ribosomal RNA gene on feline bile samples to show that bile of cats with LC is not sterile. This is probably due to the fact that the inflammatory process in the biliary tree causes dilatations. As a result, bacteria can easily migrate from the intestines via the common bile duct. The diversity of species identified and the presence of Helicobacter spp. DNA in both patients and controls suggests that bacteriobilia is secondary to the disease and is not the cause of LC.

  16. Bile acids for viral hepatitis

    DEFF Research Database (Denmark)

    Chen, Weikeng; Liu, J; Gluud, C

    2007-01-01

    Trials have assessed bile acids for patients with viral hepatitis, but no consensus has been reached regarding their usefulness.......Trials have assessed bile acids for patients with viral hepatitis, but no consensus has been reached regarding their usefulness....

  17. Role of nucleation of bile liquid crystal in gallstone formation

    Institute of Scientific and Technical Information of China (English)

    Hai-Ming Yang; Jie Wu; Jin-Yi Li; Lin Gu; Min-Fei Zhou

    2003-01-01

    AIM: To explore the role of bile liquid crystal in the process of gallbladder stone formation and to provide bases for preventing and treating cholelithiasis.METHODS: 46 guinea pigs, half males and half females,were randomly divided into control group and stone-causing group. Normal feed and stoneleading feed were used respectively to raise guinea pigs in the control group and stone-causing group. The guinea pigs were killed in three batches during the raising period. Under polarizing microscope, the pattern changes of bile liquid crystal in the gallbladder biles of the guinea pigs in the control group and stone-causing group were dynamicly observed respectively in single-blind trial.RESULTS: It was found that there were few crystals in the guinea pigs′biles of the control group, and their Malta cross was small and scattered, and existed in single form. With the increase of the feeding days, bile liquid crystals grew and Malta cross became bigger with their distribution densified, denser somewhere, but always existed in single form. While those of the stone-causing group had more bile liquid crystals, Malta cross was big and merged in strings.With the increase of the feeding days, bile liquid crystals grew in amount and strings of Malta cross increased and became bigger. The crosses in strings were arranged more and more regularly and they gradually changed into stone crystals.CONCLUSION: Formation of gallbladder stone is a process of nucleation from different substances, and the causing-stone gallbladder bile is a constantly supersaturated solution, and bile liquid crystal is a nucleation factor in the formation of gallbladder stones. The process of nucleation includes gathering, merging and phase-changing of bile liquid crystals.The process of gathering, merging of bile liquid crystal is the key to nucleation.

  18. Normal and diseased gallbladder biles : spectral analysis by in vivo proton MR spectroscopy

    International Nuclear Information System (INIS)

    To investigate the in vivo proton MR spectra of the bile of human gallbladder in its normal and diseased states and to compare the findings between the two groups. In vivo proton MRS was performed in 88 subjects comprising 33 healthy volunteers, 41 patients with gallstone, and 14 with distal common bile duct obstruction. For this, a clinical 1.5T system with a body coil and STEAM (STipulated Echo-Acquisition Mode) was used. We analyzed the MR spectra of normal and diseased gallbladder biles and tried to categorized the findings according to the significant peaks occurring within consistent ranges of chemical shift. We also compared the spectral patterns between normal and diseased bile. Proton MRS showed four significant major peaks in normal and diseased human bile: peak 1 at 0.8-1.4 ppm, peak 2 at 3.2-3.4 ppm, peak 3 at 3.9-4.1 ppm, and peak 4 at 5.2-5.4 ppm. In each group, peak 1 was most frequent (healthy volunteers, 91%, patients with gallstone, 100%, patients with distal common bile duct obstruction, 93%), but as compared with normal bile (peak 2, 36%, peak 3, 33%), in patients with gallstone, peak 3 was more frequently seen (46%), and in those with distal common bile duct obstruction, peaks 2 (64%) and 3 (64%) were most frequent. According to the significant peak, each MR spectra was categorized as follows: pattern I: peak 1; pattern II: peaks 1 and 2; pattern III: peaks 1 and 3; pattern IV: peaks 1, 2, and 3; pattern V: peaks 1 and 4; pattern VI: peak 3. In normal bile, the common MR spectral patterns were I (36%), II (27%), III, IV, VI, and V, in decreasing order of frequency. In patients with gallstone, however pattern I (44%) and pattern IV (34%) predominated, while in those with distal common bile duct obstruction, pattern IV (57%) was most common. The spectra of normal and diseased gallbladder bile obtained by in vivo proton MR spectroscopy varied, with some differences in spectral patterns between both groups. (author)

  19. Perindopril and losartan attenuate intrahepatic Toll-like receptor 4 protein expression in rats with bile duct ligation-induced hepatic fibrosis%培哚普利和氯沙坦对肝纤维化组织TLR4表达的影响

    Institute of Scientific and Technical Information of China (English)

    倪淑媛; 李煜生; 黄珊; 罗薇; 李翠; 李旭

    2012-01-01

    目的 观察大鼠正常肝脏和肝纤维化(HF)组织Toll样受体4(TLR4)表达差异及培哚普利(Pe)和氯沙坦(Lo)对其的影响.方法 Wistar雄性大鼠随机分为假手术组(Sham组)、胆总管结扎术(BDL组)、Pe 14 d和30 d及Lo 14 d和30 d组,6只/组.BDL组和治疗组均通过BDL制备大鼠HF模型.予Pe(2mg/kg)和Lo(50mg/kg)灌胃,1次/d.14 d和30 d后分别应用Westernblotting检测肝脏TLR4水平.结果 BDL 14 d组大鼠肝脏TLR4为Sham组的(6.53±1.11)倍(P<0.05);Pe 14 d组和Lo 14 d组TLR4分别下降到Sham组的(1.71±0.41)倍(P>0.05)和(0.95±0.38)倍(P>0.05).Pe 30 d组和Lo 30 d组大鼠肝脏TLR4分别回升为Sham组的(6.51±0.87)倍(P<0.05)和(5.64±0.87)倍(P<0.05).结论 大鼠HF后肝脏TLR4水平上升,Pe和Lo可降低实验性HF组织的TLR4水平,但长期服用其抑制TLR4的作用减弱.%Objective To investigate the expression of Toll-like receptor 4 (TLR4) in the liver tissue of rats with bile duct ligation (BDL)-induced hepatic fibrosis and evaluate the inhibitory effects of perindopril and losartan on TLR4 expression. Methods Male Wistar Rats were randomly divided into sham-operated group (n=6), BDL group, perindopril treatment group (2 mg/kg) and losartan treatment group (50 mg/kg) (n=12). Perindopril and losartan groups were further divided into two subgroups for corresponding treatments by gastric lavage once daily for 14 and 30 days. The protein level of TLR4 in the liver tissue was examined by Western blotting. Results In 14-day BDL group, the protein level of TLR4 significantly increased to 6.53±1.11 folds of that in the sham group (P

  20. [Bile acids in the bile in diabetes mellitus].

    Science.gov (United States)

    Slivka, O Ia; Zelinskiĭ, B A; Zelinskiĭ, S Ts

    1979-01-01

    Hepatic and gall bladder bile of healthy persons (8) and of patients with severe form of diabetes mellitus (17) was studied. Paer chromatography was applied for determination of cholic, chenodeoxycholic, deoxycholic bile acids and their conjugates with glycin and taurine. An absolute content and percentage of glycodeoxycholic and glycochenodeoxycholic bile acids were increased, and glycochenodeoxycholic acid content and taurates proportion were decreased in the gall bladder and hepatic bile of diabetic patients. The data obtained pointed to disturbed hepatic function in severe diabetes mellitus; it was expressed in suppression of bile acids synthesis and conjugation, and also in depression of transformation of deoxycholic into cholic acid.

  1. Hepatobiliary Secretion Kinetics of Conjugated Bile Acids Measured in Pigs by 11C-Cholylsarcosine PET

    DEFF Research Database (Denmark)

    Sørensen, M.; Munk, O.L.; Ørntoft, N.W.;

    2016-01-01

    the liver with simultaneous measurements of hepatic blood perfusion and 11C-CSar concentrations in arterial, portal, and hepatic venous blood. In 3 pigs (7 experiments), bile was collected from a catheter in the common hepatic duct. PET data were analyzed with a 2-tissue compartmental model with...

  2. Hepatobiliary Secretion Kinetics of Conjugated Bile Acids Measured in Pigs by 11C-Cholylsarcosine PET

    DEFF Research Database (Denmark)

    Sørensen, Michael; Munk, Ole Lajord; Oerntoft, Nikolaj;

    2016-01-01

    liver with measurements of hepatic blood perfusion and (11)C-CSar concentrations in arterial, portal and hepatic venous blood. In three pigs (seven experiments) bile was collected from a catheter in the common hepatic duct (CHD). PET data were analyzed by a two-tissue compartmental model with...

  3. Bile acid interactions with cholangiocytes

    Institute of Scientific and Technical Information of China (English)

    Xuefeng Xia; Heather Francis; Shannon Glaser; Gianfranco Alpini; Gene LeSage

    2006-01-01

    Cholangiocytes are exposed to high concentrations of bile acids at their apical membrane. A selective transporter for bile acids, the Apical Sodium Bile Acid Cotransporter (ASBT) (also referred to as Ibat; gene name Slc10a2)is localized on the cholangiocyte apical membrane. On the basolateral membrane, four transport systems have been identified (t-ASBT, multidrug resistance (MDR)3,an unidentified anion exchanger system and organic solute transporter (Ost) heteromeric transporter, OstαOstβ. Together, these transporters unidirectionally move bile acids from ductal bile to the circulation. Bile acids absorbed by cholangiocytes recycle via the peribiliaryplexus back to hepatocytes for re-secretion into bile.This recycling of bile acids between hepatocytes and cholangiocytes is referred to as the cholehepatic shunt pathway. Recent studies suggest that the cholehepatic shunt pathway may contribute in overall hepatobiliary transport of bile acids and to the adaptation to chronic cholestasis due to extrahepatic obstruction. ASBT is acutely regulated by an adenosine 3', 5'-monophosphate (cAMP)-dependent translocation to the apical membrane and by phosphorylation-dependent ubiquitination and proteasome degradation. ASBT is chronically regulated by changes in gene expression in response to biliary bile acid concentration and inflammatory cytokines.Another potential function of cholangiocyte ASBT is to allow cholangiocytes to sample biliary bile acids in order to activate intracellular signaling pathways. Bile acids trigger changes in intracellular calcium, protein kinase C (PKC), phosphoinositide 3-kinase (PI3K), mitogenactivated protein (MAP) kinase and extracellular signalregulated protein kinase (ERK) intracellular signals.Bile acids significantly alter cholangiocyte secretion,proliferation and survival. Different bile acids have differential effects on cholangiocyte intracellular signals,and in some instances trigger opposing effects on cholangiocyte secretion

  4. Bile acid effects are mediated by ATP release and purinergic signalling in exocrine pancreatic cells

    DEFF Research Database (Denmark)

    Kowal, Justyna Magdalena; Haanes, Kristian Agmund; Christensen, Nynne;

    2015-01-01

    BACKGROUND: In many cells, bile acids (BAs) have a multitude of effects, some of which may be mediated by specific receptors such the TGR5 or FXR receptors. In pancreas systemic BAs, as well as intra-ductal BAs from bile reflux, can affect pancreatic secretion. Extracellular ATP and purinergic......) and duct cells (Capan-1). Taurine and glycine conjugated forms of CDCA had smaller effects on ATP release in Capan-1 cells. In duct monolayers, CDCA stimulated ATP release mainly from the luminal membrane; the releasing mechanisms involved both vesicular and non-vesicular secretion pathways. Duct cells...... increase [Ca(2+)]i. The TGR5 receptor is not involved in these processes but can play a protective role at high intracellular Ca(2+) conditions. We propose that purinergic signalling could be taken into consideration in other cells/organs, and thereby potentially explain some of the multifaceted effects...

  5. Patent arterial duct

    OpenAIRE

    Martin Robin P; Elmasry Ola A; Forsey Jonathan T

    2009-01-01

    Abstract Patent arterial duct (PAD) is a congenital heart abnormality defined as persistent patency in term infants older than three months. Isolated PAD is found in around 1 in 2000 full term infants. A higher prevalence is found in preterm infants, especially those with low birth weight. The female to male ratio is 2:1. Most patients are asymptomatic when the duct is small. With a moderate-to-large duct, a characteristic continuous heart murmur (loudest in the left upper chest or infraclavi...

  6. ATP release, generation and hydrolysis in exocrine pancreatic duct cells

    DEFF Research Database (Denmark)

    Kowal, Justyna Magdalena; Yegutkin, G.G.; Novak, Ivana

    2015-01-01

    purine homeostasis in a pancreatic duct cell model involving: ATP release by several mechanisms and subsequent nucleotide breakdown and ATP regeneration via counteracting nucleotide-inactivating and nucleotide-phosphorylating ecto-enzymes. We suggest that extracellular ATP homeostasis in pancreatic ducts......Extracellular adenosine triphosphate (ATP) regulates pancreatic duct function via P2Y and P2X receptors. It is well known that ATP is released from upstream pancreatic acinar cells. The ATP homeostasis in pancreatic ducts, which secrete bicarbonate-rich fluid, has not yet been examined. First, our...... aim was to reveal whether pancreatic duct cells release ATP locally and whether they enzymatically modify extracellular nucleotides/sides. Second, we wished to explore which physiological and pathophysiological factors may be important in these processes. Using a human pancreatic duct cell line, Capan...

  7. Therapeutic targeting of bile acids

    Science.gov (United States)

    Gores, Gregory J.

    2015-01-01

    The first objectives of this article are to review the structure, chemistry, and physiology of bile acids and the types of bile acid malabsorption observed in clinical practice. The second major theme addresses the classical or known properties of bile acids, such as the role of bile acid sequestration in the treatment of hyperlipidemia; the use of ursodeoxycholic acid in therapeutics, from traditional oriental medicine to being, until recently, the drug of choice in cholestatic liver diseases; and the potential for normalizing diverse bowel dysfunctions in irritable bowel syndrome, either by sequestering intraluminal bile acids for diarrhea or by delivering more bile acids to the colon to relieve constipation. The final objective addresses novel concepts and therapeutic opportunities such as the interaction of bile acids and the microbiome to control colonic infections, as in Clostridium difficile-associated colitis, and bile acid targeting of the farnesoid X receptor and G protein-coupled bile acid receptor 1 with consequent effects on energy expenditure, fat metabolism, and glycemic control. PMID:26138466

  8. Bile layering: a cause for false-positive cholescintiscans

    Energy Technology Data Exchange (ETDEWEB)

    Rao, B.K.; Lieberman, L.M.

    1980-06-01

    A number of /sup 99m/Tc-labeled pharmaceuticals have been introduced recently for evaluation and diagnosis of hepatobiliary disease. Pyridoxylidene glutamate (PG) and iminodiacetic acid derivatives have evolved as the most useful agents due to excellent biliary excretion with rapid visualization of the gallbladder and the biliary ducts. These radiopharmaceuticals offer substantial advantages over /sup 131/I-rose bengal. In our experience of over 80 patients evaluated for various hepatobiliary disorders with /sup 99m/Tc PG or paraisopropyl acetanilidoiminodiacetic acid (PIPIDA), two patients had early cholescintigrams suggestive of intraluminal defects. These were not confirmed on delayed imaging. The cholescintigrams in these two patients were similar and suggested bile layering. Although demonstration of this phenomenon by oral cholecystography and intravenous cholangiography has been reported, we found no description of bile layering with radiopharmaceuticals.

  9. Exploring the strategies to prevent bile duct injury in laparoscopic cholecystectomy%探讨腹腔镜胆囊切除术中预防胆道损伤的对策

    Institute of Scientific and Technical Information of China (English)

    张建军; 张志勇; 江细民; 徐争朴

    2006-01-01

    目的探讨在腹腔镜胆囊切除术中预防胆道损伤的方法,提高手术的安全性.方法自2004年1月至2005年7月采用以Rouviere's沟或线为导向的胆囊三角区解剖方法结合术中胆道造影,对440例病人进行了腹腔镜胆囊切除术.结果所有病人无一例发生胆道损伤及手术死亡.13例中转开腹(2.9%).4例术后胆漏(0.8%),其中2例经腹腔引流管引流9天治愈;1例在"B"超引导下经皮穿刺抽吸二次治愈;1例经十二指肠内镜鼻胆管引流8天治愈.2例术后腹腔出血再次腹腔镜探查结扎止血而愈.1例因呼吸道并发症于术后一个月死亡.4次胆漏病人术后随访3~6个月无胆道遗留症状.结论以Rouviere's沟或线为导向的胆囊三角区解剖方法结合术中胆道造影可以减少胆道损伤的几率,是值得推广应用的.

  10. 术中胆道造影联合腹腔镜超声诊断胆道结石的临床价值%Clinical evaluation of Intraoperative cholangiography and laparoscopic ultrasound in common bile duct (CBD) stone exploration

    Institute of Scientific and Technical Information of China (English)

    张智明; 王祥林; 钟勇; 吴国池; 魏桂菊; 赖仁展; 陈海亮

    2007-01-01

    目的 探讨腹腔镜胆囊切除(LC)术中胆道造影(IOC)和腹腔镜超声(LUS)诊断胆总管结石的临床价值.方法 对2001年3月~2003年12月行LC手术、有胆总管探查指证、且符合纳入标准的98例住院患者进行临床研究.所有患者在切除胆囊前均先行LUS检查再行IOC检查,统计两种检查方法的操作成功率和操作时间.结果 IOC操作成功率为94.9%,LUS为100%.IOC的操作时间为(11.37±3.53)min,LUS为(7.68±2.14)min.LUS和IOC在操作时间上差异有显著性(P<0.01).IOC的敏感性为85.0%,特异性为96.2%,准确性为91.4%,阳性预测值为94.4%,阴性预测值为89.5%,阳性似然比为22.4,阴性似然比为0.156;LUS的敏感性为82.5%,特异性为98.1%,准确性为91.4%,阳性预测值为97.1%,阴性预测值为88.1%,阳性似然比为43.40,阴性似然比为0.178;LUS联合IOC的敏感性为97.%,特异性为94.3%,准确性为95.7%,阳性预测值为92 9