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Sample records for bile duct injury

  1. Iatrogenic bile duct injuries – clinical problems

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    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.

  2. Clinical implications of bile duct injury after transcatheter arterial chemoembolization

    International Nuclear Information System (INIS)

    Objective: To evaluate the incidence, risk factors , and clinical course of bile duct injury after transcatheter arterial chemoembolization (TACE) for treatment of hepatic malignancy. Methods: A total of 1240 consecutive patients with hepatic malignancies underwent 2680 TACE procedures. None of these patients were found to have any radiographic evidence of biliary abnormalities pre-TACE. Eighteen patients developed bile duct injuries at 3 weeks to 3 months after TACE. A retrospective review of medical records and imaging studies were carried out to evaluate the occurrence of TACE-induced bile duct injury, the clinical outcome, and the statistical significance of potential predisposing factors. Results: The TACE-induced bile duct injuries occurred in 13 of 148 patients with liver metastatic tumors (8.8%), 5 of 1092 patients with HCC (0.5%). Biliary injuries, including focal (n=4) and multiple intrahepatic bile duct dilatation (n=8), and cystic lesion or biloma (n=6), were identified on the follow-up imaging studies after TACE. Three patients with multiple bile duct injuries had mild jaundice at the presentation, two of them responded well to the conservative treatment, one died of irreversible deterioration of liver function at 2 weeks after the onset of jaundice. Four patients with a large biloma had associated serious bacterial infections; 3 of which were treated with percutaneous catheter drainage and antibiotics, 2 of them died of purulent peritonitis due to rupture of the cystic lesions and 1 cured with antibiotic. The remaining 11 patients were asymptomatic. The mortality related to the biliary injury occurred in 3 patients (16.7%). The incidences of bile duct injury were higher in patients with metastatic tumors in non-cirrhotic livers than in patients with hepatocellular carcinoma associated with cirrhosis (P<0.01), higher in patient with hypovascular lesions (P<0.01), and higher in patients using an emulsion of lipiodol-platinum for selective embolization

  3. 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

  4. 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.

  5. The experimental study of radiation injury on bile duct and liver tissue

    International Nuclear Information System (INIS)

    Objective: To investigate the safety, acceptance and the effective extent of 192Ir-internal irradiation, providing theoretical guidelines for HC. Methods: Sixteen male healthy hybrid dogs enrolled in the experiment were divided into 4 groups of 4 each. The brachytherapy applicator was introduced from gall bladder into the convergence of cystic duct with common hepatic duct during the operation and a small chip of 1 cm3 liver tissue was cut off and taken for control later on. The animals in group A-D were irradiated by 192Ir-internal irradiation with 30 Gy, 40 Gy, 50 Gy arid 60 Gy at the correlative dose points respectively. Animals were put to death after 10 days subsequently, with sampling specimens obtained from radiation cystic duct and the in between liver tissue with the distant cystic duct. The radiation injury of the cystic duct and liver tissue near bile ducts were observed and studied by light microscope and transmission election microscope. Results: By the limit of the safest endurance dose(50 Gy) of Bile duct, unreversed injury of the nuclei of liver cells occurred at 0 to 15 mm from bile duct revealed by transmission electron microscope and light microscope. The whole biliary duct wall would be undergone necrosis with irradiation dose over 60 Gy. Conclusions: Normal bile duct possesses good endurance to 192Ir-internal irradiation. Within the safest endurance limit of 50 Gy the effective irradiation field could reach 15 mm from the involved bile duct. (authors)

  6. Is the Age of Patients with Iatrogenic Bile Duct Injuries Increasing?

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    Stankiewicz Rafał

    2015-03-01

    Full Text Available Resection of the gall-bladder is still the most common surgical procedure performed at general surgery departments. The laparoscopic method used in the majority of cases offers considerable benefits but at the same time is associated with an increased rate of bile duct complications. So far, a slim female aged 25-50 years was a typical patient with a iatrogenic bile duct injury.

  7. 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

  8. 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

  9. 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.

  10. A case of amoxicillin-induced hepatocellular liver injury with bile-duct damage

    OpenAIRE

    Kim, Ju Seung; Jang, Young Rock; Lee, Ji Won; Kim, Jin Yong; Jung, Young Kul; Chung, Dong Hae; Kwon, Oh Sang; Kim, Yun Soo; Choi, Duck Joo; Kim, Ju Hyun

    2011-01-01

    Amoxicillin, an antibiotic that is widely prescribed for various infections, is associated with a very low rate of drug-induced liver injury; hepatitis and cholestasis are rare complications. Here we present a case of a 39-year-old woman who was diagnosed with abdominal actinomycosis and received amoxicillin treatment. The patient displayed hepatocellular and bile-duct injury, in addition to elevated levels of liver enzymes. The patient was diagnosed with amoxicillin-induced cholestatic hepat...

  11. Management of Bile Duct Injury at Various Stages of Presentation: Experience from a Tertiary Care Centre.

    Science.gov (United States)

    Ibrarullah, Md; Sankar, S; Sreenivasan, K; Gavini, S R K

    2015-04-01

    The clinical presentation, management and outcome of all patients with bile duct injury who presented to our tertiary care centre at various stages after cholecystectomy were analyzed. The patients were categorized into three groups: group A-patients in whom the injury was detected during cholecystectomy, group B-patients who presented within 2 weeks of cholecystectomy and group C-patients who presented after 2 weeks of cholecystectomy. Our team acted as rescue surgeons and performed 'on-table' repair for injuries occurring in another unit or in another hospital. Strasberg classification of bile duct injury was followed. In group A, partial and complete transections were managed by repair over T-tube and high hepaticojejunostomy, respectively. Patients in group B underwent endoscopic retrograde cholangiogram and/or magnetic resonance cholangiogram to evaluate the biliary tree. Those with intact common bile duct underwent endoscopic papillotomy and stenting in addition to drainage of intra-abdominal collection when present. For those with complete transection, early repair was considered if there was no sepsis. In presence of intra-abdominal sepsis an attempt was made to create controlled external biliary fistula. This was followed by hepatico jejunostomy at least after 3 months. Group C patients underwent hepaticojejunostomy at least 6 weeks after the injury. The outcome was graded into three categories: grade A-no clinical symptoms, normal LFT; grade B-no clinical symptoms, mild derangement of LFT or occasional episodes of pain or fever; grade C-pain, cholangitis and abnormal LFT; grade D-surgical revision or dilatation required. Fifty nine patients were included in the study and the distribution was group A-six patients, group B-33 patients and group C-20 patients. In group A, one patient with complete transection of the right hepatic duct (type C) and partial injury to left hepatic duct (LHD) underwent right hepaticojejunostomy and repair of the LHD over

  12. 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.

  13. 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

  14. 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

  15. 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

  16. 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.

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

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    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.

  18. Platycodin D attenuates bile duct ligation-induced hepatic injury and fibrosis in mice.

    Science.gov (United States)

    Kim, Tae-Won; Lee, Hong-Ki; Song, In-Bae; Lim, Jong-Hwan; Cho, Eun-Sang; Son, Hwa-Young; Jung, Ju-Young; Yun, Hyo-In

    2013-01-01

    Platycodin D (PD) is the major triterpene saponin in the root of Platycodon grandiflorum. The aim of the present study was to evaluate the protective effects of PD on bile duct ligation (BDL)-induced cholestasis in mice. Mice were allocated to five groups: sham, BDL alone, and BDL with PD treatment at 1, 2, and 4mg/kg. PD was administered to the mice for 28 consecutive days after the BDL operation. PD treatment of BDL-operated mice decreased serum alanine aminotransferase, serum aspartate aminotransferase, and total bilirubin levels by up to 37%, 31%, and 41%, respectively, in comparison with the levels in mice that underwent BDL alone. PD treatment attenuated oxidative stress, as evidenced by an increase in anti-oxidative enzyme levels glutathione and superoxide dismutase together with a decrease in lipid peroxidation and oxidative stress indices levels of malondialdehyde and nitric oxide. Histopathological studies further confirmed the protective effects of PD on cholestasis-induced hepatic injury and liver fibrosis in mice. In addition, nuclear factor-kappa B and inducible nitric oxide synthase levels significantly decreased after PD treatment, as did the levels of hepatocyte apoptosis. Taken together, these results suggest that PD treatment might be beneficial in cholestasis-induced hepatotoxicity. PMID:23116642

  19. 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.

  20. Biliary reconstruction with right hepatic lobectomy due to delayed management of laparoscopic bile duct injuries: a case report.

    Directory of Open Access Journals (Sweden)

    Ota T

    2004-06-01

    Full Text Available We report a case requiring biliary reconstruction with right hepatic lobectomy due to biliary strictures caused by continuous cholangitis after laparoscopic bile duct injury. The patient, a 55-year-old woman, underwent laparoscopic cholecystectomy for cholelithiasis at another hospital. Although a bile leakage from the intraabdominal drain was observed several days after the operation, the patient was not given adequate treatment to stop the leakage. Two months after the initial laparoscopic cholecystectomy, she was referred to our hospital. Endoscopic retrograde cholangiopancreatography (ERCP showed complete obstruction of the common hepatic duct, which was caused by clipping during laparoscopic cholecystectomy. Cholangiography from percutaneous transhepatic biliary drainage (PTBD catheters revealed that sections of the secondary branches of the right intrahepatic bile duct had become constricted due to persistent cholangitis. Fortunately, the left hepatic duct was judged to be normal by imaging. Therefore, we elected to perform a right hepatic lobectomy and left hepaticojejunostomy, because we felt that performing a hepaticojejunostomy without hepatic resection would put the patient at risk of continuing to suffer from cholangitis. The patient was discharged on the 55 th postoperative day, and, 5 years after reconstructive surgery, is healthy and has remained free from biliary strictures in the remnant liver. Appropriate decision-making is essential in the treatment of biliary injury after laparoscopic cholecystectomy. Surgeons should not hesitate to perform biliary reconstruction with hepatic resection to reduce the risk of cholangitis or biliary strictures of the remnant liver. More importantly, preoperative clear imaging of the biliary tree and suitable management of any biliary injury which might occur are necessary to avoid having to perform reconstructive surgery.

  1. Bile duct obstruction

    Science.gov (United States)

    ... 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 ...

  2. What's New in Bile Duct Cancer Research and Treatment?

    Science.gov (United States)

    ... bile duct cancer What’s new in bile duct cancer research and treatment? Bile duct cancer is an uncommon ... Doctor After Treatment What`s New in Bile Duct Cancer Research? Other Resources and References Cancer Information Cancer Basics ...

  3. Roentgendiagnostic of the operated bile duct system

    International Nuclear Information System (INIS)

    The roentgendiagnostic after bile duct surgery shall demonstrate postoperative complications, recurrencys of the primary disease and other complications. Planning the diagnostic procedures one has to consider the preceeding operation: surgery of the gall-bladder, the common bile duct, the papilla Vateri, biliodigestive anastomosis, bile duct drainage by plastic tube, and duodenopancreatectomy. (orig.)

  4. Percutaneous treatment of benign bile duct strictures

    Energy Technology Data Exchange (ETDEWEB)

    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.

  5. 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...

  6. 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

  7. Pancreatoduodenectomy for bile duct and ampullary cancer

    OpenAIRE

    Yamaguchi, Koji

    2011-01-01

    Pylorus-preserving pancreatoduodenectomy has become a standard operation for distal and middle bile duct cancers. Bile duct cancer typically extends longitudinally and invades vertically. It frequently metastasizes to the lymph nodes and infiltrates the perineural spaces. The presence of residual cancer in the bile duct stump and lymph node metastases are significant prognostic factors. Negative surgical margins and D2 lymph node dissection are necessary for curative resection. The clinical c...

  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. Congenital double bile duct presenting as recurrent cholangitis in a child

    Directory of Open Access Journals (Sweden)

    K.D. Chakravarty

    2015-12-01

    Full Text Available Double common bile duct (DCBD is a rare congenital anomaly. Most of these bile duct anomalies are associated with bile duct stones, anomalous pancreaticobiliary junction (APBJ, pancreatitis and bile duct or gastric cancers. Early detection and treatment is important to avoid long term complications. Surgical resection of the anomalous bile duct and reconstruction of the biliary enteric anastomosis is the treatment of choice. We report a rare case of DCBD anomaly in a girl, who presented with recurrent cholangitis. She had type Va DCBD anomaly. She underwent successful resection of the bile duct and reconstruction of the biliary enteric anastomosis. Preoperative imaging and diagnosis of the congenital biliary anomaly is very important to avoid intraoperative bile duct injury. Review of the literature shows very few cases of type Va DCBD, presenting with either bile duct stones or APBJ.

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

    Science.gov (United States)

    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

  11. 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.

  12. 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...

  13. Bile Duct Adenoma with Oncocytic Features

    Directory of Open Access Journals (Sweden)

    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.

  14. Spontaneous postoperative choledochoduodenal fistula due to bile duct injury following laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Sezgin Yilmaz

    2016-01-01

    Conclusion: In the present case we have reported a case of Bismuth type 2 (Strasberg type E2 injury in which the biliary drainage was closed spontaneously with the formation of spontaneous biliary-duodenal fistula. It is an extremely interesting case that has not been reported in the literature previously.

  15. The first case of pediatric bile duct adenoma

    OpenAIRE

    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

    Energy Technology Data Exchange (ETDEWEB)

    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. Palliative irradiation of the bile ducts

    Energy Technology Data Exchange (ETDEWEB)

    Kutzner, J.; Klose, K.; Keller, E.

    1985-11-01

    Carcinoma of the common hepatic bile duct or common bile duct were treated by interstitial irradiation with gold seeds using the percutaneous transhepatic drainage partly boosted by external irradiation. The interstitial dose of 50 Gy was given in two applications and 40 Gy by linac. Twice histological examination showed wide tumor destruction of local irradiation, but also much more tumor extension than seen before by diagnostic investigation. Mostly the therapy is only palliative because of the infiltration of liver and lymphnodes. (orig.).

  18. Radiotherapy of bile duct carcinoma

    International Nuclear Information System (INIS)

    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 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)

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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.

  2. What Should You Ask Your Doctor about Bile Duct Cancer?

    Science.gov (United States)

    ... treatment for bile duct cancer? What should you ask your doctor about bile duct cancer? It is ... your own. For instance, you might want to ask about clinical trials for which you may qualify. ...

  3. Solitary intrahepatic bile-duct cyst presenting with Jaundice

    International Nuclear Information System (INIS)

    Caroli's disease is an uncommon condition, and characterized by congenital segmental saccular dilatation of intrahepatic bile ducts. A case of Caroli's disease, manifested by only a large communicating cystic dilatation of left intrahepatic bile duct and causing extrinsic pressure over the extrahepatic bile duct, is presented. The patient was 43-year-old housewife, hospitalized because of abdominal distension and severe jaundice. To relieve jaundice and alleviate surgical intervention, percutaneous drainage of the bile-duct cyst preceded surgery

  4. A case of fascioliasis in common bile duct

    Energy Technology Data Exchange (ETDEWEB)

    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.

  5. A case of fascioliasis in common bile duct

    International Nuclear Information System (INIS)

    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. Pancreatic enzymes in the epithelium of intrahepatic large bile ducts and in hepatic bile in patients with extrahepatic bile duct obstruction.

    OpenAIRE

    Terada, T.; Morita, T; Hoso, M; Nakanuma, Y

    1994-01-01

    AIM--To determine whether pancreatic enzymes are present in hepatic bile and in intrahepatic bile duct epithelium. METHODS--The activity and proteins of pancreatic enzymes (pancreatic alpha-amylase, lipase, trypsin/trypsinogen) in hepatic bile were investigated using biochemical and western blot analyses in 25 patients with extrahepatic bile duct obstruction. Immunolocalization of enzyme proteins was evaluated by immunohistochemistry in 20 necropsy livers with extrahepatic bile duct obstructi...

  7. Solitary intrahepatic bile-duct cyst presenting with Jaundice

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jeong Mi; Chun, Ki Sung; Ha, Hyun Kwon; Shinn, Kyung Sub; Bahk, Yong Whee; Kim, Jun Gi [St. Vincent Hospital, Catholic University Medical College, Seoul (Korea, Republic of)

    1989-08-15

    Caroli's disease is an uncommon condition, and characterized by congenital segmental saccular dilatation of intrahepatic bile ducts. A case of Caroli's disease, manifested by only a large communicating cystic dilatation of left intrahepatic bile duct and causing extrinsic pressure over the extrahepatic bile duct, is presented. The patient was 43-year-old housewife, hospitalized because of abdominal distension and severe jaundice. To relieve jaundice and alleviate surgical intervention, percutaneous drainage of the bile-duct cyst preceded surgery.

  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. Repair of a Post-Hepatectomy Posterior Sectoral Duct Injury Secondary to Anomalous Bile Duct Anatomy Using a Novel Combined Surgical-Interventional Radiologic Approach

    Directory of Open Access Journals (Sweden)

    Beth-Ann Shanker

    2013-01-01

    Full Text Available A 64-year-old woman with a completely transected posterior sectoral duct following extended hepatectomy underwent a combined operative procedure with interventional radiology and surgery to restore biliary-enteric drainage. The anterior and posterior sectoral ducts were identified, and catheters were inserted into both systems. The posterior sectoral catheter was placed intraoperatively through a preoperatively placed sheath, and a new tunnel was created through the regenerated liver surface. Biliary-enteric anastomoses were created over the stents.

  10. 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 ...

  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. Congenital bile duct dilatation (Caroli's disease - Grumbach's disease)

    International Nuclear Information System (INIS)

    Congenital bile duct dilatation is an autosomal recessive inherited disease. Pathologically tortuous dilated, dyplastic intrahepatic bile ducts were found. It may be associated with hepatic fibrosis (Grumbach's disease), or without (Caroli's disease). A common additional finding is an infantile polycystic kidney. Three cases are reported and the radiological and sonographic findings are discussed. (orig.)

  13. 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

  14. Mechanical properties of the porcine bile duct wall

    Directory of Open Access Journals (Sweden)

    Andersen Helle

    2004-07-01

    Full Text Available Abstract Background and Aim The function of the common bile duct is to transport bile from the liver and the gall bladder to the duodenum. Since the bile duct is a distensible tube consisting mainly of connective tissue, it is important to obtain data on the passive mechanical wall properties. The aims of this study were to study morphometric and biomechanical wall properties during distension of the bile duct. Methods Ten normal porcine common bile ducts were examined in vitro. A computer-controlled volume ramp infusion system with concomitant pressure recordings was constructed. A video camera provided simultaneous measurement of outer dimensions of the common bile duct. Wall stresses and strains were computed. Results The common bile duct length increased by 25% from 24.4 ± 1.8 mm at zero pressure to 30.5 ± 2.0 mm at 5 kPa (p (βε - 1. The circumferential stress-strain curve was shifted to the left when compared to the longitudinal stress-strain curve, i.e. the linear constants (α values were different (p 0.5. Conclusion The porcine bile duct exhibited nonlinear anisotropic mechanical properties.

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

    International Nuclear Information System (INIS)

    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

  16. 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.

  17. Common bile duct pathologies at nawabshah

    International Nuclear Information System (INIS)

    To determine the causes, presentation, management and outcome of Common Bile Duct (CBD) pathologies. All patients who presented with CBD pathologies. Data of all the patients with CBD pathologies was collected and entered on a proforma, including their complaints, positive examination findings, investigations, diagnosis, procedure performed and its outcome. During the study period 45 patients presented with CBD pathology. Amongst them 14 were males and the rest females (31), with a mean age of 36.7 years. Around 67% patients had choledocholithiasis as the commonest cause. Exploration of the CBD with T-tube insertion was the commonest procedure, performed in 69% patients. About 4% patients had retained stones and 20% developed wound infection. Mean hospital stay was 13 days. Most common pathology involving the CBD was secondary stones; 95% patients had associated gall stones also. (author)

  18. 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.

  19. Lithocholic acid feeding induces segmental bile duct obstruction and destructive cholangitis in mice.

    Science.gov (United States)

    Fickert, Peter; Fuchsbichler, Andrea; Marschall, Hanns-Ulrich; Wagner, Martin; Zollner, Gernot; Krause, Robert; Zatloukal, Kurt; Jaeschke, Hartmut; Denk, Helmut; Trauner, Michael

    2006-02-01

    We determined the mechanisms of hepatobiliary injury in the lithocholic acid (LCA)-fed mouse, an increasingly used model of cholestatic liver injury. Swiss albino mice received control diet or 1% (w/w) LCA diet (for 1, 2, and 4 days), followed by assessment of liver morphology and ultrastructure, tight junctions, markers of fibrosis and key proteins of hepatobiliary function, and bile flow and composition. As expected LCA feeding led to bile infarcts, which were followed by a destructive cholangitis with activation and proliferation of periductal myofibroblasts. At the ultrastructural level, small bile ducts were frequently obstructed by crystals. Biliary-excreted fluorescence-labeled ursodeoxycholic acid accumulated in bile infarcts, whereas most infarcts did not stain with India ink injected into the common bile duct; both findings are indicative of partial biliary obstruction. Expression of the main basolateral bile acid uptake proteins (sodium-taurocholate cotransporter and organic anion-transporting polypeptide 1) was reduced, the canalicular transporters bile salt export pump and multidrug-related protein 2 were preserved, and the basolateral transporter multidrug-related protein 3 and the detoxifying enzyme sulfotransferase 2a1 were induced. Thus, we demonstrate that LCA feeding in mice leads to segmental bile duct obstruction, destructive cholangitis, periductal fibrosis, and an adaptive transporter and metabolic enzyme response. PMID:16436656

  20. 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 ...

  1. Congenital absence of the common bile duct: A rare anomaly of extrahepatic biliary tract.

    Science.gov (United States)

    Mittal, Tarun; Pulle, Mohan V; Dey, Ashish; Malik, Vinod K

    2016-01-01

    Congenital absence of the common bile duct (CBD) is an extremely rare developmental anomaly with right and left hepatic ducts draining directly into the gallbladder (GB). Other synonyms for this clinical condition are "cholecystohepatic ducts", "transverse lie of the GB" or "interposition of the GB". The potential for iatrogenic injury is high, because of either inadvertent division or ligation of the ducts. Diagnosis is mostly made intraoperatively, and needs some form of biliary reconstruction. Herein, we are reporting a case of congenital absence of the CBD in a 36-year-old lady that was detected intraoperatively. PMID:27279403

  2. 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.

  3. Bile duct cyst in adults: Interventional treatment, resection, or transplantation?

    OpenAIRE

    Herwig Cerwenka

    2013-01-01

    Cystic dilatations of the bile ducts may be found along the extrahepatic biliary tree, within the liver, or in both of these locations simultaneously. Presentation in adults is often associated with complications. The therapeutic possibilities have changed considerably over the last few decades. If possible, complete resection of the cyst(s) can cure the symptoms and avoid the risk of malignancy. According to the type of bile duct cyst, surgical procedures include the Roux-en-Y hepaticojejuno...

  4. 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

  5. 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.

  6. Cluster Hepaticojejunostomy Is a Useful Technique Enabling Secure Reconstruction of Severely Damaged Hilar Bile Ducts.

    Science.gov (United States)

    Ha, Tae-Yong; Hwang, Shin; Song, Gi-Won; Jung, Dong-Hwan; Kim, Myeong-Hwan; Lee, Sung-Goo; Kwon, Dong-Il; Ko, Gi-Young

    2015-08-01

    Secure reconstruction of multiple hepatic ducts severely damaged by tumor invasion or iatrogenic injury is very difficult. If percutaneous or endoscopic biliary stenting fails, one or more percutaneous transhepatic biliary drainage (PTBD) tubes must be maintained in place for the rest of the patient's life. To cope with such difficult situations, we present a surgical technique termed cluster hepaticojejunostomy (HJ), which can be coupled with palliative bile duct resection. The cluster HJ technique consisted of applying multiple internal biliary stents and a single wide porto-enterostomy to surrounding connective tissues. We present a preliminary study with six patients. Five perihilar cholangiocarcinoma patients undergoing palliative bile duct resection received this procedure. Follow-up PTBD tubogram and hepatobiliary scintigraphy were performed at 1-2 weeks after surgery, after which the PTBD tubes were removed. No patient showed surgical complications, and the 6-month patency rate of clustered HJ was 80%. Another patient with laparoscopic cholecystectomy-associated major bile duct injury showed no biliary complications in the 5-year period following this procedure. Based on the results of this study, the cluster HJ technique may be a useful surgical method enabling the secure reconstruction of severely damaged hilar bile ducts. PMID:25956723

  7. [A case of primary neuroendocrine carcinoma of the bile duct].

    Science.gov (United States)

    Hamanaka, Michiko; Nakahira, Shin; Takeda, Yutaka; Kawashima, Hiroshi; Mukai, Yosuke; Kanemura, Takeshi; Uchiyama, Chieko; Okishiro, Masatsugu; Takeno, Atsushi; Suzuki, Rei; Taniguchi, Hirokazu; Egawa, Chiyomi; Nakata, Ken; Miki, Hirofumi; Kato, Takeshi; Nagano, Teruaki; Nakatsuka, Shinichi; Tamura, Shigeyuki

    2012-11-01

    A 74-year-old man presented to a physician with a chief complaint of jaundice. He was diagnosed with bile duct carcinoma and admitted to our hospital. Laboratory data revealed abnormally elevated levels of total bilirubin, serum hepatic transaminase, and CA19-9. Endoscopic retrograde cholangiopancreatography revealed neoplastic stenosis from the hilus hepatis to the common bile duct. Abdominal computed tomography (CT) revealed an enhancing tumor in the hilus hepatis bile duct, and positron emission tomography-CT (PET-CT) revealed abnormal fluorodeoxyglucose accumulation in the tumor. Under a diagnosis of hilar cholangiocarcinoma, the patient underwent an extended right hepatectomy and left hepatico -jejunostomy. Immunohistochemically, the tumor cells were positive for neuroendocrine markers such as chromogranin A, synaptophysin, and CD56. The tumor was diagnosed as primary neuroendocrine carcinoma of the bile duct. The patient exhibited multiple liver metastasis 6 months after the operation. Transcatheter arterial chemoembolization (TACE) was performed for the liver metastasis. Although TACE exerted a cytoreductive effect temporarily, multiple liver abscesses developed. The patient died of liver failure 16 months after the operation. We report this rare case of primary neuroendocrine carcinoma of the bile duct. PMID:23267998

  8. Percutaneous transhepatic biliary drainage in patients with postsurgical bile leakage and nondilated intrahepatic bile ducts

    OpenAIRE

    Jong, Egbert; Moelker, Adriaan; Leertouwer, Trude; Spronk, Sandra; van Dijk, Monique; Eijck, Casper

    2014-01-01

    textabstractObjective and Background: Bile leakage is a serious postoperative complication and percutaneous transhepatic biliary drainage (PTBD) may be an option when endoscopic treatment is not feasible. In this retrospective study, we established technical and clinical success rates as well as the complication rates of PTBD in a large group of patients with postoperative bile leakage. Methods: Data on all patients with nondilated intrahepatic bile ducts who underwent a PTBD procedure for th...

  9. Detection of bile leakage from traumatic right hepatic duct laceration with technetium-99m DISIDA cholescintigraphy.

    Science.gov (United States)

    Salam, M; Glowniak, J V; Vetto, R M; Jarboe, J E; Haines, J E; Krishnamurthy, G T

    1987-08-01

    A woman was admitted to the hospital after blunt abdominal trauma. Initial ultrasound was equivocal but suggested a localized hepatic laceration. The patient was discharged but returned three weeks later with ascites and mild pain in the right upper abdominal quadrant. Hepatobiliary imaging identified a large bile leak originating from the porta hepatis but showed no evidence of parenchymal injury. No hepatic injury was found at surgery, but a laceration of the right hepatic duct was identified. Hepatobiliary imaging is the procedure of choice in diagnosing bile leaks from the extrahepatic biliary system. PMID:3665296

  10. 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.

  11. Endoscopic Ultrasonography Assessment for Ampullary and Bile Duct Malignancy

    OpenAIRE

    Q. L. Zhang; Nian, W. D.; Zhang, L. P.; Liang, J. Y.

    1996-01-01

    From 1989 through 1992, endoscopic ultrasonography (EUS) was undertaken preoperatively to evaluate the extent of primary tumor, involvement of regional lymph nodes, and distant metastases in 22 patients with ampullary carcinoma and 18 patients with bile duct carcinoma. The results were compared with histopathological findings according to the TNM staging system. The accurate rate in assessing the extent of cancer invasion was 82% for ampullary carcinoma, 66% for common hepatic duct carcinoma,...

  12. 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

  13. 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.

  14. 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.

  15. Laparoscopic managment of common bile duct stones: our initial experience.

    Science.gov (United States)

    Aroori, S; Bell, J C

    2002-05-01

    The management of choledocholithiasis has changed radically since the introduction of laparoscopic cholecystectomy. However, perceived technical difficulties have deterred many surgeons from treating common bile duct stones laparoscopically at the time of cholecystectomy. This has lead to reliance on endoscopic retrograde cholangiopancreatography followed by endoscopic sphincterotomy to deal with common bile duct stones. We retrospectively reviewed the charts of patients who had laparoscopic common bile duct exploration at Downe Hospital between December 1999 and August 2001. Among 149 laparoscopic cholecystectomies done by our group in this period, 10 patients (6.7%) underwent laparoscopic CBD exploration, three by the transcystic technique and seven by choledochotomy. Three patients (2%) had unsuspected stones found on routine per- operative cholangiogram. The mean operative time was 2.34hrs (range 1.50-3.30hrs). The mean hospital post- operative stay was 3 days (range 1-6 days). Post-operative morbidity was zero. Stone clearance was achieved in all cases. We conclude, laparoscopic exploration of the common bile duct is relatively safe and straightforward method. The key skill required is the ability to perform laparoscopic suturing with confidence. PMID:12137159

  16. Bile duct cyst in adults: Interventional treatment, resection, or transplantation?

    Directory of Open Access Journals (Sweden)

    Herwig Cerwenka

    2013-01-01

    Full Text Available Cystic dilatations of the bile ducts may be found along the extrahepatic biliary tree, within the liver, or in both of these locations simultaneously. Presentation in adults is often associated with complications. The therapeutic possibilities have changed considerably over the last few decades. If possible, complete resection of the cyst(s can cure the symptoms and avoid the risk of malignancy. According to the type of bile duct cyst, surgical procedures include the Roux-en-Y hepaticojejunostomy and variable types of hepatic resection. However, the diffuse forms of Todani type V cysts (Caroli disease and Caroli syndrome in particular remain a therapeutic problem, and liver transplantation has become an important option. The mainstay of interventional treatment for Todani type III bile duct cysts is via endoscopic retrograde cholangiopancreatography. The diagnostic term “bile duct cyst” comprises quite different pathological and clinical entities. Interventional therapy, hepatic resection, and liver transplantation all have their place in the treatment of this heterogeneous disease group. They should not be seen as competitive treatment modalities, but as complementary options. Each patient should receive individualized treatment after all of the clinical findings have been considered by an interdisciplinary team.

  17. Bile duct cyst in adults: interventional treatment, resection, or transplantation?

    Science.gov (United States)

    Cerwenka, Herwig

    2013-08-28

    Cystic dilatations of the bile ducts may be found along the extrahepatic biliary tree, within the liver, or in both of these locations simultaneously. Presentation in adults is often associated with complications. The therapeutic possibilities have changed considerably over the last few decades. If possible, complete resection of the cyst(s) can cure the symptoms and avoid the risk of malignancy. According to the type of bile duct cyst, surgical procedures include the Roux-en-Y hepaticojejunostomy and variable types of hepatic resection. However, the diffuse forms of Todani type V cysts (Caroli disease and Caroli syndrome) in particular remain a therapeutic problem, and liver transplantation has become an important option. The mainstay of interventional treatment for Todani type III bile duct cysts is via endoscopic retrograde cholangiopancreatography. The diagnostic term "bile duct cyst" comprises quite different pathological and clinical entities. Interventional therapy, hepatic resection, and liver transplantation all have their place in the treatment of this heterogeneous disease group. They should not be seen as competitive treatment modalities, but as complementary options. Each patient should receive individualized treatment after all of the clinical findings have been considered by an interdisciplinary team. PMID:23983423

  18. Clear cell carcinoid tumor of the distal common bile duct

    Directory of Open Access Journals (Sweden)

    Tsukada Katsuhiko

    2007-01-01

    Full Text Available Abstract Background Carcinoid tumors rarely arise in the extrahepatic bile duct and can be difficult to distinguish from carcinoma. There are no reports of clear cell carcinoid (CCC tumors in the distal bile duct (DBD to the best of our knowledge. Herein, we report a CCC tumor in the DBD and review the literature concerning extrahepatic bile duct carcinoid tumors. Case presentation A 73-old man presented with fever and occult obstructive jaundice. Ultrasonography, computed tomography (CT and magnetic resonance cholangiopancreaticography (MRCP demonstrated a nodular tumor projection in the DBD without regional lymph node swelling. Under suspicion of carcinoma, we resected the head of the pancreas along with 2nd portion duodenectomy and a lymph node dissection. The surgical specimen showed a golden yellow polypoid tumor in the DBD (0.8 × 0.6 × 0.5 cm in size. The lesion was composed of clear polygonal cells arranged in nests and a trabecular pattern. The tumor invaded through the wall into the fibromuscular layer. Immunohistochemical stains showed that neoplastic cells were positive for neuron-specific enolase (NSE, chromogranin A, synaptophysin, and pancreatic polypeptide and negative for inhibin, keratin, CD56, serotonin, gastrin and somatostatin. The postoperative course was uneventful and he is living well without relapse 12 months after surgery. Conclusion Given the preoperative difficulty in differentiating carcinoid from carcinoma, the pancreaticoduodenectomy is an appropriate treatment choice for carcinoid tumors located within the intra-pancreatic bile duct.

  19. 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

  20. 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

  1. 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

  2. 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.

  3. 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

  4. 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/

  5. Clonal chromosomal abnormalities in congenital bile duct dilatation (Caroli's disease)

    OpenAIRE

    Parada, L; Hallen, M; Hagerstrand, I; Tranberg, K; Johansson, B

    1999-01-01

    BACKGROUND—Caroli's disease is a rare congenital disorder characterised by cystic dilatation of the intrahepatic bile ducts and an increased risk of cholangiocellular carcinoma. The cause is unknown, but occasional familial clustering suggests that some cases are inherited, in particular when occurring in association with polycystic kidney disease and germline PKD1 gene mutations. To date, no gene responsible for familial isolated Caroli's disease has been identified, and no genetic investiga...

  6. 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.

  7. 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.

  8. Hemodynamic characterization of chronic bile duct-ligated rats: effect of pentobarbital sodium

    International Nuclear Information System (INIS)

    Systemic and splanchnic hemodynamics of the chronic bile duct-ligated rat were characterized by radioactive microspheres. Conscious and pentobarbital sodium-anesthetized, bile duct-ligated and sham-operated rats had cardiac output and regional organ blood flows determined. The conscious bile duct-ligated rat compared with the sham-operated showed a hyperdynamic circulation with an increased cardiac output and portal tributary blood flow. Pentobarbital sodium anesthesia induced marked hemodynamic changes in both sham-operated and bile duct-ligated rats. The latter group was especially sensitive to its effects; thus, comparison of cardiac output and portal tributary blood flow between anesthetized bile duct-ligated and sham-operated rats showed no significant differences. The authors conclude that the rat with cirrhosis due to chronic bile duct ligation is an excellent model for hemodynamic investigations but should be studied in the conscious state, since pentobarbital sodium anesthesia eliminated the hyperdynamic circulation

  9. 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 ...

  10. 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.

  11. 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.

  12. Spiral (Helical) computed tomographic imaging for the diagnosis of bile duct cancer. Vascular and pancreatic invasions

    International Nuclear Information System (INIS)

    The development of several imaging techniques for diagnosing bile duct cancer have improved, however, its diagnosis at the early stage is still difficult. We discuss the significance of the spiral (helical) computed tomography (SCT) imaging for the diagnosis of bile duct cancer at an early stage. We performed, as a preoperative examination, SCT under intravenous angiography (IV-SCT) for all cases, which included 233 cases of benign bile duct diseases, 42 cases of gallbladder cancer and 22 cases of bile duct cancer. The accuracy rate of diagnosis ability of 42 cases of gallbladder cancer by IV-SCT was 91%, and that of portal vein invasion was 91%. In the cases of bile duct cancer, IV-SCT showed destructive images of the bile duct wall and the tumor images invaded into the pancreatic parenchyma, in the cases of invasion at the splenic vein and confluence site of the portal vein, IV-SCT gave clearer 3D images than conventional angiography. The accuracy rate of diagnosing pancreatic invasion in bile duct cancer by IV-SCT was 80%. However, it is still difficult to determine completely the layer structures of the bile duct and the invasion into the walls along the long axis. As the future development of SCT for the diagnosis of bile duct cancer, we expect further progression of diagnosis ability of bile duct cancer and the invasion level by the applying high resolution thin-section CT images or endoscopical images of the luminal organs in examining the bile duct. (K.H.)

  13. 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.

  14. Congenital bile duct dilatation (Caroli's disease - Grumbach's disease)

    Energy Technology Data Exchange (ETDEWEB)

    Lammer, J.; Fotter, R.; Becker, H.

    1984-08-01

    Congenital bile duct dilatation is an autosomal recessive inherited disease. Pathologically tortuous dilated, dyplastic intrahepatic bile ducts were found. It may be associated with hepatic fibrosis (Grumbach's disease), or without (Caroli's disease). A common additional finding is an infantile polycystic kidney. Three cases are reported and the radiological and sonographic findings are discussed.

  15. 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...

  16. Traumatic injury of the thoracic duct.

    Science.gov (United States)

    Guzman, A E; Rossi, L; Witte, C L; Smyth, S

    2002-03-01

    Injuries to the thoracic duct are infrequent but may become life-threatening when chylous leakage persists. This report describes 6 patients with such injuries in whom the leakage resolved spontaneously in one, was corrected using microsurgical lymphatic repair or lymphatic-venous anastomosis in two, successfully treated either by ligation of the thoracic duct or insertion of a peritoneovenous shunt in two, and was eventually controlled after bilateral pleurodesis and thoracic duct ligation by insertion of a peritoneo-venous shunt in one. Conventional lymphography is superior to lymphoscintigraphy and is usually required to document disruption of the thoracic duct. PMID:11939572

  17. 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.)

  18. 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.

  19. Cholescintigraphy with 99mTc-mebrophenin in the detection of patency loss of bile ducts

    International Nuclear Information System (INIS)

    Cholescintigraphy with 99mTc-mebrophenin was done in 85 patients reffered with the diagnosis of cholelithiasis. During operations in 23 cases diseases were demonstrated impairing the patency of bile ducts, in 19 cases gallbladder calculi were found, in the remaining 43 cases clinical observations, extensive laboratory investigations and radiological methods ruled out the presence of bile system diseases. Statistically significant differences were demonstrated in the time of passage of the marker along the bile ducts to the intestine between the patients with occlusion of the bile ducts and patients without this occlusion. The relationship of the specificity and sensitivity of the method to the accepted diagnostic criteria was presented graphically, forming the so called characteristics of perception efficiency (ROC curves). The most useful parameter was the time of radioactivity appearance in the common bile duct. Assuming that the appearance of radioactivity there should be observed within 17 minutes, the sensitivity of the method for the detection of patency disturbances of the bile ducts was 82% and the specificity of the method was 87%. The predictive value of the negative result was 93%. Cholescintigraphy with 99mTc-mebrophenin with measurement of the time of radioactivity appearance in successive parts of the bile ducts was found to be useful in the assessment of their patency. The method is simple, no contradictions and complications are known. It may be used in all cases of suspected obstacle to the passage of bile. 19 refs., 2 figs., 3 tabs

  20. Caroli's disease: hepatic arterial color doppler signals in the communicating dilated bile ducts

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Moon Gyu; Han, Boo Kyung; Baek, Seong Yon; Cho, Kyoung Sik; Auh, Yong Ho; Kim, Myung Hwan; Yu, Eun Sil [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    1992-01-15

    Three siblings with congenital dilatation of the intrahepatic bile ducts (Caroli's disease) are presented. Bile duct pathology was associated with congenital hepatic fibrosis and polycystic renal disease in all three patients. On color Doppler imaging (CD imaging), multiple small color Doppler signals were observed in or near the vascular radicles within the dilated bile ducts, besides other well-known sonographic findings such as bile duct dilatation, biliary calculi. Doppler frequency spectral analysis confirmed all these color Doppler signals as arterial origin in all patients, showing pulsatile wave pattern. Although portal venous radicles are well known in conventional sonograms or computed tomography(CT), continuous wave patterns were not detected in all patients. In addition to previously reported sonographic findings about Caroli's disease, color Doppler signals showing arterial wave pattern in or around the portal venous radicles within dilated ducts are another helpful diagnostic criteria and those findings are easily depicted on routine sonograms with color mapping.

  1. Caroli's disease: hepatic arterial color doppler signals in the communicating dilated bile ducts

    International Nuclear Information System (INIS)

    Three siblings with congenital dilatation of the intrahepatic bile ducts (Caroli's disease) are presented. Bile duct pathology was associated with congenital hepatic fibrosis and polycystic renal disease in all three patients. On color Doppler imaging (CD imaging), multiple small color Doppler signals were observed in or near the vascular radicles within the dilated bile ducts, besides other well-known sonographic findings such as bile duct dilatation, biliary calculi. Doppler frequency spectral analysis confirmed all these color Doppler signals as arterial origin in all patients, showing pulsatile wave pattern. Although portal venous radicles are well known in conventional sonograms or computed tomography(CT), continuous wave patterns were not detected in all patients. In addition to previously reported sonographic findings about Caroli's disease, color Doppler signals showing arterial wave pattern in or around the portal venous radicles within dilated ducts are another helpful diagnostic criteria and those findings are easily depicted on routine sonograms with color mapping

  2. 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.

  3. 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

  4. 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.)

  5. 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

  6. 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.

  7. Cluster hepaticojejunostomy with radial spreading anchoring traction technique for secure reconstruction of widely opened hilar bile ducts.

    Science.gov (United States)

    Hwang, Shin; Ha, Tae-Yong; Song, Gi-Won; Jung, Dong-Hwan

    2016-05-01

    Secure reconstruction of multiple hepatic ducts that are severely damaged by tumor invasion or iatrogenic injury is a challenge. Failure of percutaneous or endoscopic biliary stenting requires lifelong placement of one or more percutaneous transhepatic biliary drainage (PTBD) tubes. For such difficult situations, we devised a surgical technique termed cluster hepaticojejunostomy (HJ), which can be coupled with palliative bile duct resection. The cluster HJ technique consisted of applying multiple internal biliary stents and a single wide porto-enterostomy to the surrounding connective tissues. The technique is described in detail in the present case report. Performing cluster HJ benefits from three technical tips as follows: making the multiple bile duct openings wide and parallel after sequential side-to-side unification; radially anchoring and traction of the suture materials at the anterior anastomotic suture line; and making multiple segmented continuous sutures at the posterior anastomotic suture line. Thus, cluster HJ with radial spreading anchoring traction technique is a useful surgical method for secure reconstruction of severely damaged hilar bile ducts. PMID:27212993

  8. 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...

  9. 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.

  10. 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...

  11. Percutaneous transhepatic removal of common bile duct stone: a case report

    International Nuclear Information System (INIS)

    Percutaneous transhepatic intervention for removal of common bile duct stones is introduced as a secondary choice of treatment in the high-risk patient. Through a percutaneous transhepatic biliary drainage catheter, a Dormia basket was inserted and the stone was entraped. Then the stone was crushed and fragments were passed spontaneously to the duodenum through the Ampulla of Vater. We experienced one case of successful treatment of a common bile duct stone using percutaneous transhepatic insertion of the Dormia basket

  12. Percutaneous transhepatic removal of common bile duct stone: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Yong Moon; Han, Joon Koo; Choi, Byung Ihn; Park, Jae Hyung; Han, Man Chung; Park, Yong Hyun [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1992-01-15

    Percutaneous transhepatic intervention for removal of common bile duct stones is introduced as a secondary choice of treatment in the high-risk patient. Through a percutaneous transhepatic biliary drainage catheter, a Dormia basket was inserted and the stone was entraped. Then the stone was crushed and fragments were passed spontaneously to the duodenum through the Ampulla of Vater. We experienced one case of successful treatment of a common bile duct stone using percutaneous transhepatic insertion of the Dormia basket.

  13. Decompression of malignant biliary obstruction by duodenoscopic intubation of bile duct.

    OpenAIRE

    Laurence, B. H.; Cotton, P B

    1980-01-01

    Interest is increasing in non-operative methods of relieving malignant obstruction of the bile duct, and drainage tubes and prostheses may be placed in the bile duct via the percutaneous transhepatic route. Two cases are described, however, in which a duodenoscope was used and the approach was via the papilla of Vater. This method allows temporary or permanent drainage tubes to be placed through malignant strictures. This endoscopic approach is less invasive and should be safer than that by t...

  14. Clinical application of percutaneous drainage in treating hepatocellular carcinoma with bile duct tumor thrombus

    OpenAIRE

    Lu, Zaiming; Sun, Wei; Wen, Feng; Liang, Hongyuan; Shan, Ming; Guo, Qiyong

    2013-01-01

    Aim of the study This study aimed to evaluate the effect of percutaneous interventional treatment on obstructive jaundice caused by hepatocellular carcinoma with bile duct tumor thrombus. Material and methods A total of 16 patients with bile duct tumor thrombus were included in the current retrospective study. All the patients were subjected to percutaneous transhepatic biliary drainage (PTBD). Treatment included permanent external drainage, internal drainage and routine tube adjustment, and ...

  15. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Weber, Andreas [Department of Gastroenterology, Technical University of Munich (Germany); Gaa, Jochen [Department of Radiology, Technical University of Munich (Germany); Rosca, Bogdan; Born, Peter; Neu, Bruno; Schmid, Roland M. [Department of Gastroenterology, Technical University of Munich (Germany); Prinz, Christian [Department of Gastroenterology, Technical University of Munich (Germany)], E-mail: christian.prinz@lrz.tum.de

    2009-12-15

    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.

  17. 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

  18. 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

  19. 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.

  20. 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.

  1. 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.

  2. 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).

  3. 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.

  4. 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.

  5. High expression of L-type amino acid transporter 1 as a prognostic marker in bile duct adenocarcinomas

    OpenAIRE

    Yanagisawa, Nobuyuki; Hana, Kiyomi; Nakada, Norihiro; Ichinoe, Masaaki; Koizumi, Wasaburo; Endou, Hitoshi; Okayasu, Isao; Murakumo, Yoshiki

    2014-01-01

    Oncocytic L-type amino acid transporter (LAT) 1 may be a prognostic indicator and target of new molecular therapeutic agents against malignancies. To investigate whether LAT1 expression influence the outcomes of patients with bile duct cancer, the expression of LAT1, LAT2, CD98, and Ki-67 was investigated immunohistochemically in 134 surgically resected bile duct adenocarcinomas, including 84 distal extrahepatic bile duct adenocarcinomas, 21 hilar cholangiocarcinomas, 15 intrahepatic cholangi...

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

    OpenAIRE

    Last, R D; Hill, J M; Roach, M; T. Kaldenberg

    2006-01-01

    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 radial...

  7. 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...

  8. 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

  9. 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

  10. 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.

  11. 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.

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

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    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.

  13. 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.

  14. Vanishing bile duct syndrome in the context of concurrent temozolomide for glioblastoma.

    Science.gov (United States)

    Mason, Matthew; Adeyi, Oyedele; Fung, Scott; Millar, Barbara-Ann

    2014-01-01

    Temozolomide, an oral alkylating agent, is used in the treatment of glioblastoma. We describe a case of a 62-year-old woman developing jaundice with significant derangement of liver function tests on day 17 of focal radiotherapy with concomitant temozolomide. There was no structural abnormality on imaging and liver biopsy was performed. Pathology revealed absence of small terminal bile ducts affecting up to 60% of sampled portal tracts and senescence of many of the remaining small bile ducts, in keeping with a diagnosis of acute vanishing bile duct syndrome. This is a rare syndrome. It has been documented in association with Hodgkin's lymphoma and viral causes. Drugs implicated as precipitating this condition include antiseizure medications, some antibiotics, ibuprofen and antifungals. Temozolomide was stopped. The patient received supportive care, ursodeoxycholic acid 750 mg daily and cholestyramine 4 g twice daily. She was otherwise asymptomatic and her blood results returned to normal by day 129. PMID:25432915

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

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    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.

  16. [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

  17. 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、

  18. 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...

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

    OpenAIRE

    Darío Martínez-Baena; Pablo Parra-Membríves; Daniel Díaz-Gómez; José Manuel Lorente-Herce

    2013-01-01

    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 compar...

  20. Urosodeoxycholic Acid Therapy in a Child with Trimethoprim-Sulfamethoxazole-induced Vanishing Bile Duct Syndrome

    OpenAIRE

    Cho, Hyun Jeong; Jwa, Hye Jeong; Kim, Kyu Seon; Gang, Dae Yong; Kim, Jae Young

    2013-01-01

    We present a case of a 7-year-old boy who had cholestasis after trimethoprim-sulfamethoxazole combination therapy. Liver biopsy was performed 36 days after the onset of jaundice because of no evidence of improving cholestasis. Liver histology revealed portal inflammation, bile plug, and biliary stasis around the central vein with the loss of the interlobular bile ducts. Immunohistochemical stains for cytokeratin 7 and 19 were negative. These findings were consistent with those of vanishing bi...

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

    Directory of Open Access Journals (Sweden)

    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.

  2. 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

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

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    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.

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

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    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.

  5. Bile duct cyst type V (Caroli's disease): surgical strategy and results

    OpenAIRE

    Lendoire, Javier; Schelotto, Pablo Barros; Rodríguez, Juan Alvarez; Duek, Fernando; Quarin, Carlos; Garay, Verónica; Amante, Marcelo; Cassini, Eduardo; Imventarza, Oscar

    2007-01-01

    Background. Caroli's disease (CD) is a benign congenital disorder characterized by segmental cystic dilatation of the intrahepatic biliary ducts. Therapeutic strategy includes medical treatment, percutaneous, endoscopic or surgical drainage of the affected bile ducts, liver resection or transplantation. The aim of this study was to analyse the results and long-term follow-up of a consecutive series of patients who underwent surgical treatment for CD. Patients and methods. Between 1995 and 200...

  6. 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.

  7. 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

  8. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun [School of Medicine, Kyungpook National University, Daegu (Korea, Republic of); Kim, Young Hwan [Keimyung University College of Medicine, Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andong (Korea, Republic of)

    2004-10-15

    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

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

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    Hadia Maqsood

    2016-03-01

    Full Text Available 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 2000 to 2013 was performed. Patients with a diagnosis of gallstone pancreatitis were identified. A paired-samples T-test was used to compare measurements of commonbile- duct diameter by ultrasound, computed tomography, and magnetic resonance imaging. A P-value <0.05 was regarded as significant. Results Among 6,876 patients undergoing cholecystectomy, 738 (11% were diagnosed with acute gallstone pancreatitis. Of those with acute gallstone pancreatitis, most (600; 81% had an ultrasound documented in the medical record, while just less than half (344; 47% had a computed tomography, and a third (217; 29% a magnetic resonance imaging. Of the 600 who underwent a preoperative ultrasound, 281 (47% also underwent computed tomography and 183 (30% also underwent magnetic resonance imaging. The diameter of common bile duct was significantly larger by computed tomography compared to ultrasound (11.2 vs. 8.7, P=0.022 in patients imaged with both modalities. Common-bile-duct diameter was similar by magnetic resonance imaging and ultrasound (7.0 vs. 7.1, respectively, P=0.859, and by magnetic resonance imaging and computed tomography (10.5 vs. 13.9, respectively, P=0.059. Conclusion Computed tomography scan may overestimate the diameter of the common bile duct compared to magnetic resonance imaging and ultrasound in the setting of acute gallstone pancreatitis, and should therefore be interpreted with caution.

  11. 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

  12. 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...

  13. Adenosquamous Carcinoma of Extrahepatic Bile Duct: A Case Report

    OpenAIRE

    Lim, Sin Hyung; Yang, Hyeon Woong; Kim, Anna; Cha, Sang Woo; Jung, Sung Hee; Go, Hoon; Lee, Woong Chul

    2007-01-01

    Most malignant tumors originating from the biliary tract are adenocarcinomas, and adenosqamous carcinoma of Klatskin's tumor is a very rare finding. An 83-yr-old man was admitted to our hospital because of jaundice. The abdominal computed tomography and magnetic resonance cholangiopancreatography revealed wall thickening and luminal stenosis of both the intrahepatic duct confluent portion and the common hepatic duct. These findings were compatible with Klatskin's tumor, Bismuth type III. Cons...

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

    Directory of Open Access Journals (Sweden)

    Storr Sarah J

    2012-11-01

    Full Text Available Abstract Background 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. Methods 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. Results 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. Conclusion 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.

  15. 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.

  16. Serum markers of the extracellular matrix remodeling reflect antifibrotic therapy in bile-duct ligated rats

    DEFF Research Database (Denmark)

    Schierwagen, Robert; Leeming, Diana Julie; Klein, Sabine; Granzow, Michaela; Nielsen, Mette J; Sauerbruch, Tilman; Krag, Aleksander; Karsdal, Morten A; Trebicka, Jonel

    reflect the stage of liver fibrosis and may allow monitoring of anti-fibrotic therapies. Here we analyzed these neo-epitopes as read-out for a liver directed therapy with statins. Methods: Bile duct ligation (BDL) was performed on wild type rats, which received atorvastatin (15 mg/kg(*)d) for 1 week...

  17. 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...

  18. 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.

  19. 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

  20. Hepatic scintigraphy in Caroli's disease. [Technetium-99m sulfur colloid; bile duct malformations

    Energy Technology Data Exchange (ETDEWEB)

    Sty, J.R.; Sullivan, P.; Wagner, R.; Starshak, R.J.

    1978-06-01

    Caroli's disease (communicating cavernous ectasia of the intrahepatic bile ducts) is manifested on the /sup 99m/Tc-sulfur colloid images as multiple focal defects in the liver. Since several other conditions have a similar presentation, intravenous or transhepatic cholangiography may be of assistance in reaching the correct diagnosis.

  1. 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

  2. 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.).

  3. Granular cell myoblastoma of the common bile duct treated by biliary drainage and surgery.

    OpenAIRE

    Dewar, J; Dooley, J S; Lindsay, I.; George, P; Sherlock, S

    1981-01-01

    A young Caucasian woman is described in whom obstructive jaundice was caused by a granular cell myoblastoma of the common bile duct. She was treated by percutaneous transhepatic biliary drainage for 10 days, before radical removal. Granular cell myoblastomas are benign lesions of disputed histogenesis, rare among biliary neoplasms, the excision of which is curative.

  4. Lithocholic Acid Feeding Induces Segmental Bile Duct Obstruction and Destructive Cholangitis in Mice

    OpenAIRE

    Fickert, Peter; Fuchsbichler, Andrea; Marschall, Hanns-Ulrich; Wagner, Martin; Zollner, Gernot.; Krause, Robert; Zatloukal, Kurt; Jaeschke, Hartmut; Denk, Helmut; Trauner, Michael

    2006-01-01

    We determined the mechanisms of hepatobiliary injury in the lithocholic acid (LCA)-fed mouse, an increasingly used model of cholestatic liver injury. Swiss albino mice received control diet or 1% (w/w) LCA diet (for 1, 2, and 4 days), followed by assessment of liver morphology and ultrastructure, tight junctions, markers of fibrosis and key proteins of hepatobiliary function, and bile flow and composition. As expected LCA feeding led to bile infarcts, which were followed by a destructive chol...

  5. Comparison of thymidine phosphorylase expression and prognostic factors in gallbladder and bile duct cancer

    Directory of Open Access Journals (Sweden)

    You Young

    2010-10-01

    Full Text Available Abstract Background Biliary tract cancers have limitations in information about different location-related pathogenesis and clinico-pathological characteristics. The goal of this study was to investigate anatomical site-related similarities and differences in biliary tract cancers and to assess the expression and clinical significance of functional proteins such as p53, cyclin D1, survivin, thymidine phosphorylase, and ERCC1. Methods One hundred and sixty-one patients with biliary tract adenocarcinomas, who underwent curative or palliative surgery in a single institution between October 1994 and December 2003 were evaluated, retrospectively. The level of protein expression of p53, cyclin D1, survivin, thymidine phosphorylase, and ERCC1 was assessed by immunohistochemistry. Results With respect to clinico-pathological characteristics, gallbladder cancer was more frequent in women, and bile duct cancer was more common in men. Perineural invasion was more common in bile duct cancer. Recurrence as a distant metastasis was more common in gallbladder cancer. Immunohistochemical analysis revealed that thymidine phosphorylase expression was significantly higher in gallbladder cancer than in bile duct cancer. Positive thymidine phosphorylase and p53 staining were associated with an advanced stage. Differentiation, vascular invasion, perineural invasion, lymphatic invasion, lymph node metastasis, and TNM stage independently predicted poor prognosis in biliary tract cancer. These correlations were seen more clearly in gallbladder cancer. The immunohistochemical staining patterns of p53, cyclin D1, survivin, thymidine phosphorylase, and ERCC1 showed no prognostic significance in biliary tract cancers. Conclusions We concluded that gallbladder and bile duct cancers are considered to be separate diseases with different clinico-pathological characteristics and prognostic factors. In addition, we hypothesize that high expression of thymidine phosphorylase by

  6. 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

  7. Choledochal cyst with bile duct dilatation: sonography and 99mTc IDA cholescintigraphy

    International Nuclear Information System (INIS)

    Three cases of choledochal cyst associated with intrahepatic biliary dilatation are presented. Findings on sonography included a large cystic mass in the porta hepatis separate from the gallbladder; a dilated common hepatic or common bile duct entering directly into the cyst; the smaller cystic masses of dilated central intrahepatic ducts. The dilatation of the central intrahepatic bile ducts was moderate in two patients and massive in one patient. All three patients underwent operation with intraoperative cholangiography. Two patients had 99mTc IDA cholescintigraphy which confirmed the diagnosis of choledochal cyst by demonstrating filling of the cyst with stasis and delayed intestinal activity. The accurate preoperative diagnosis of choledochal cyst, made by sonography combined with 99mTc IDA cholescintigraphy, obviated invasive studies

  8. Ultrasound in the diagnosis of roundworms in gallbladder and common bile duct. Report of four cases.

    Science.gov (United States)

    Gomez, N A; Leon, C J; Ortiz, O

    1993-01-01

    Four patients who complained of symptoms and signs compatible with biliary tract disease and in whom the diagnosis of gallbladder (three cases) and common bile duct ascariasis (one case) was made sonographically are reported. In two patients with gallbladder ascariasis, cholecystectomy corroborated the presence of the round-worms, and was curative. The third patient was a pregnant woman (32nd gestational week) who took piperazine citrate, and a second sonogram performed 29 days later was completely normal. The fourth patient with common bile duct ascariasis underwent choledochotomy with extraction of one ascaris lumbricoides from the common duct, and a T tube was left in place for 15 days. All patients received antiparasitics and had a favorable outcome. Ultrasonography is an important noninvasive diagnostic procedure in the work-up of these patients, who usually describe a clinical picture suggesting gallstone disease: this is especially true in the presence of pregnancy. PMID:8351609

  9. 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:

  10. 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.

  11. Effects on Bacterial Translocation of High-Fat Enteral Nutrition in Bile Duct Ligated Rats

    OpenAIRE

    Nihat Zafer Utkan; Tufan Elipek

    2012-01-01

    Objective: Bacterial Translocation (BT) from the gastrointestinal system is at the center of current sepsis theories. In patients with obstructive jaundice, the absence of intraluminal bile flow causes some alterations and mucosal damage in the gut. In the present study, it was aimed to investigate the effects on BT of high-fat enteral nutrition in bile duct ligated rats.Material and Methods: In this study, a total of 28 healthy Spraque-Dawley rats, weighing 230-300 gr, were grouped into fou...

  12. Percutaneous transhepatic biliary drainage with anterior approach to the left bile ducts

    International Nuclear Information System (INIS)

    In 28 selected cases (right hepatic lobe lobectomy or atrophy; prevalent dilatation of the left bile ducts; necessary double drainage in the obstruction of the right and left hepatic ducts confluence; etc.) the percutaneous transhepatic cholangiography and the biliary drainage were performed by a left-lobe subxiphoid approach, rather than the currently popular right-lobe approach. By means of this technique some treatments (biliary endoprosthesis insertion, gallstones removal or dissolution, bilioplasty) were executed; these treatments were impossible or very hard to realize by the right-lobe approach. No failures or complications occurred

  13. Synchronous Presentation of Ampullary Adenocarcinoma and Common Bile Duct Cancer: Report of a Case and Review of Literature

    Directory of Open Access Journals (Sweden)

    Max V Wohlauer

    2012-09-01

    Full Text Available Context Ampullary adenocarcinomas and bile duct cancers represent a very small minority of all gastrointestinal malignancies. Synchronous presentation of both malignancies is extremely rare. Case report We report a case of a 76-year-old male who presented with painless jaundice. His work-up showed an ampullary mass and a separate common bile duct stricture. Attempted endoscopic resection established the diagnosis of ampullary adenocarcinoma. Pathologic examination of the Whipple specimen identified a separate focus of bile duct cancer. Conclusion Synchronous presentation of an ampullary mass and separate distal bile duct stricture, especially in elderly patients, should raise concern for both lesions representing malignancies. In the absence of conclusive evidence for survival advantage in resected early stage ampullary and biliary cancers, close observation should be considered a valid alternative to adjuvant chemotherapy and radiation.

  14. Duplication common bile duct. Case report and review

    International Nuclear Information System (INIS)

    The anatomical variations of the biliary duct are so common that they can considered to be rather like normal and not as congenital malformations, nevertheless inside these rare enough subtypes exist as the duplication of the choledocho. In this article the clinical case appears of patient of 27 years who had presented multiple episodes of biliary colic the last one of them associated with jaundice and to whom during the ERCP document this anatomical infrequent enough variation. A review of the literature appears besides brings over of this anomaly.

  15. 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

  16. 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.)

  17. 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.

  18. Accuracy of MRCP compared to ERCP in the diagnosis of bile duct disorders

    Directory of Open Access Journals (Sweden)

    Delmé Hurter

    2008-05-01

    Full Text Available AIM: To determine the accuracy of Magnetic Resonance Cholangiopancreatography compared to the gold standard Endoscopic Retrograde Cholangiopancreatography in the diagnosis of bile duct disorders at our institution. PATIENTS AND METHODS: 52 patients with suspected pancreatobiliary pathology were included in this prospective observational study. MRCP was performed in the 24-hour period prior to the ERCP. RESULTS: MRCP had sensitivity, specificity, positive and negative predictive values of 87%, 80%, 83.3% and 84.2% respectively for choledocholitiasis which correlates well with results obtained in other parts of the world. CONCLUSION: At our institution, MRCP has high diagnostic accuracy for bile duct calculi. Due to a small study population, results for other biliary pathology were inconclusive

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

    OpenAIRE

    John Wysocki; Rishi Agarwal; Laura Bratton; Jeremy Nguyen; Mandy Crause Weidenhaft; Nathan Shores; Kimbrell, Hillary Z.

    2014-01-01

    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 c...

  20. Synchronous Presentation of Ampullary Adenocarcinoma and Common Bile Duct Cancer: Report of a Case and Review of Literature

    OpenAIRE

    Max V Wohlauer; Martine C McManus; Brian Brauer; Jeremy Hedges; Csaba Gajdos

    2012-01-01

    Context Ampullary adenocarcinomas and bile duct cancers represent a very small minority of all gastrointestinal malignancies. Synchronous presentation of both malignancies is extremely rare. Case report We report a case of a 76-year-old male who presented with painless jaundice. His work-up showed an ampullary mass and a separate common bile duct stricture. Attempted endoscopic resection established the diagnosis of ampullary adenocarcinoma. Pathologic examination of the Whipple specimen iden...

  1. Diagnosis of Cancer Spread Using Percutaneous Transhepatic Biliary Cholangioscopy-guided Ultrasonography for Malignant Bile Duct Stenosis

    OpenAIRE

    Hirokazu Inoue

    2001-01-01

    The characteristics of sites of intramural cancer spread were examined by comparing the intraductal ultrasonography (IDUS) and wall thickening findings at sites of intramural cancer spread and non-spread, in patients with malignant bile duct stenosis who had undergone percutaneous transhepatic biliary drainage (PTBD). The subjects were ten patients with extrahepatic bile duct cancer, two with pancreatic cancer, one with cancer of the gallbladder, and one with cancer of the papilla of Vater wh...

  2. The role of hepatobiliary scintigraphy and MR cholangiography in the assessment of bile duct obstruction after biliary surgery

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Seung; Moon, Dae Hyuk; Lee, Moon Gyu; Lee, Sung Gyu; Lee, Hee Kyung [Asan Medical Center, Seoul (Korea, Republic of)

    1998-07-01

    The aim of our study was to determine the role of MR cholangiography (MRC) and hepatobiliary scintigraphy (HBS) in the assessemtn of recurrent bile duct obstruction after biliary surgery. Twenty-three patients (15 men and 8 women: mean age 49.8) with post-biliary operation state (16 biliary-enteric anastomoses and seven cholecystectomy) underwent a total of 28 MRC and 28 HBS using Tc-99m DISIDA within 3 days of each other. Interval between surgery and MRC or HBS ranged from 2 wk to 15 yr (median: 14 mon). MRC and HBS were analyzed for the presence of bile duct obstruction. The final diagnoses were cofirmed by percutaneous transhepatic biliary drainage or surgical operation in 11 of 28 cases and by the follow-up clinical course in the rests. Of 14 instances with bile duct obstruction (13 intrahepatic bile duct obstruction and 1 common bile duct obstruction), HBS showed complete intrahepatic bile duct (IHD) obstruction in 7, incomplete IHD obstruction in 5, parenchymal dysfuction in 1, and IHD dilation without obstructon in 1, resulting in sensitivity of 86% (12/14). MRC showed stone in 6, stricture in 4, IHD dilatation in 3, and normal in 1. The sensitivity of MRC was 71% (10/14). Fourteen instances were without obstruction. HBS showed no evidence of obstruction in all 14 instances (specificity 100%). However, stricture on MRC was found in 4 instances, resulting in specificity of 71% (10/14). HBS is useful in the diagnosis of recurrent bile duct obstruction after surgery. MRC is a useful modality for assessing the diagnosis of obstruction itself as well as the cause and location of bile duct obstruction. However, the specificity of MRC appears to be lower because of possible overestimation of stricture.

  3. Anesthetic management of a patient with sickle cell disease for common bile duct exploration

    Directory of Open Access Journals (Sweden)

    Sarika Subhash Ingle

    2011-01-01

    Full Text Available Patients with sickle cell disease (SCD may present to the anesthetist in different clinical settings like perioperative care, management of acute painful crisis and intensive therapy for acute respiratory failure. We describe the successful management of a 34-year-old female patient with SCD, posted for cholecystectomy with common bile duct exploration under general and epidural anesthesia. The importance of preoperative stabilization and careful anesthetic strategy is emphasized.

  4. Multiple bile duct hamartomas: US, CT, and MR findings. A case report

    International Nuclear Information System (INIS)

    We report ultrasound, CT and MR findings in a patient with multiple bile duct hamartomas (BDH) which were associated with disseminated peritoneal leiomyomatosis, a coincidence not previously reported. At MR imaging, the multiple hepatic nodules of BDH were hypointense in T1-weighted images and moderately hyperintense in T2-weighted images, which is in agreement with the findings in the 2 previously reported cases examined with this modality. (orig.)

  5. Multiple bile duct hamartomas: US, CT, and MR findings. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Gallego, J.C. [Dept. of Radiology, Hospital Arquitecto Marcide, Ferrol (Spain)]|[Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Suarez, I. [Dept. of Radiology, Hospital Arquitecto Marcide, Ferrol (Spain)]|[Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Soler, R. [Dept. of Radiology, Hospital Arquitecto Marcide, Ferrol (Spain)]|[Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain)

    1995-05-01

    We report ultrasound, CT and MR findings in a patient with multiple bile duct hamartomas (BDH) which were associated with disseminated peritoneal leiomyomatosis, a coincidence not previously reported. At MR imaging, the multiple hepatic nodules of BDH were hypointense in T1-weighted images and moderately hyperintense in T2-weighted images, which is in agreement with the findings in the 2 previously reported cases examined with this modality. (orig.).

  6. Utility of endoscopic ultrasonography in the evaluation of dilated common bile duct of undetermined etiology

    OpenAIRE

    Sotoudehmanesh, R.; N Nejati; Farsinejad, M.; Kolahdoozan, S; Rahimi, R.

    2014-01-01

    Introduction: Occasionally, common bile duct (CBD) dilatation is discovered while working up patients for various causes. Not infrequently, the usual imaging modalities fail to identify the cause and endoscopic ultrasonography (EUS) becomes necessary. The aim of this study is to assess the value of EUS in identifying the cause of CBD dilatation undiagnosed by transabdominal ultrasonography. Patients and Methods: During 1 year, 152 consecutive patients who were referred for evaluation of dilat...

  7. Altered expression of thioredoxin reductase-1 in dysplastic bile ducts and cholangiocarcinoma in a hamster model

    OpenAIRE

    Yoon, Byung-Il; Kim, Dae-Yong; Jang, Ja-June; Han, Jeong-Hee

    2006-01-01

    Thioredoxin reductase 1 (TrxR) is a homodimeric selenoenzyme catalyzing thioredoxin (Trx) in an NADPH-dependent manner. With regard to carcinogenesis, these redox proteins have been implicated in cell proliferation, transformation and anti-apoptosis. In the present study, using a hamster cholangiocarcinoma (ChC) model, we evaluated the immunohistochemical expression pattern of TrxR in precancerous lesions and ChCs as well as in normal bile ducts. The goal of this study was to determine the po...

  8. 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...

  9. 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 ...

  10. Caroli's disease misdiagnosed as intraductal papillary neoplasm of the bile duct

    OpenAIRE

    Gu, Dae Hoe; Park, Min Seon; Jung, Chang Ho; Yoo, Yang Jae; Cho, Jae Young; Lee, Yun Ho; Seo, Yeon Seok; Yim, Hyung Joon; Um, Soon Ho; Ryu, Ho Sang

    2015-01-01

    Caroli's disease is a rare autosomal-recessive disorder caused by malformation of the ductal plate during embryonic development. Although it is present at birth, Caroli's disease is typically not diagnosed until between the second and fourth decades of life, as it was in the present patient. Here we report a rare case of Caroli's disease limited to one liver segment, which was initially misdiagnosed as an intraductal papillary neoplasm of the bile duct. The asymptomatic patient was treated wi...

  11. 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.

  12. CD24 expression predicts distant metastasis in extrahepatic bile duct cancer

    OpenAIRE

    Kyubo Kim; Hye Sook Min; Eui Kyu Chie; Jin-Young Jang; Sun Whe Kim; Sae-Won Han; Do-Youn Oh; Seock-Ah Im; Tae-You Kim; Yung-Jue Bang; Ja-June Jang; Sung W Ha

    2013-01-01

    AIM: To evaluate the prognostic significance of CD24 expression in patients undergoing adjuvant chemoradiotherapy for extrahepatic bile duct (EHBD) cancer. METHODS: Eighty-four patients with EHBD cancer who underwent curative resection followed by adjuvant chemoradiotherapy were enrolled in this study. Postoperative radiotherapy was delivered to the tumor bed and regional lymph nodes up to a median of 40 Gy (range: 40-56 Gy). All patients also received fluoropyrimidine chemotherapy for radios...

  13. 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...

  14. 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...

  15. Usefulness of Percutaneous Transhepatic Cholangioscopic Lithotomy for Removal of Difficult Common Bile Duct Stones

    OpenAIRE

    Lee, Jae Hyung; Kim, Hyung Wook; Kang, Dae Hwan; Choi, Cheol Woong; Park, Su Bum; Kim, Suk Hun; Jeon, Ung Bae

    2013-01-01

    Background/Aims Approximately 5% to 10% of common bile duct (CBD) stones are difficult to remove by conventional endoscopic methods. Percutaneous transhepatic cholangioscopic lithotomy (PTCSL) can be an alternative method for this condition, but is not well established yet. The aim of this study was to evaluate the clinical efficacy and safety of PTCSL for removal of difficult CBD stones. Methods This study is a retrospective review of 34 consecutive patients who underwent unsuccessful remova...

  16. 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)

  17. 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.

  18. 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

  19. 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

  20. Synchronous carcinoma of the gallbladder in a patient with intrahepatic bile duct carcinoma.

    Science.gov (United States)

    Taniai, N; Onda, M; Tajiri, T; Yoshida, H; Naitou, Z

    2000-01-01

    An 83-year-old woman, diagnosed as having cholelithiasis, was admitted to the Department of Surgery, Nippon Medical School, with right hypochondrial pain. Ultrasonography and computed tomography revealed a mass in the gallbladder fundus and a hypovascular tumor in the anterior segment of the liver. Magnetic resonance imaging showed stenosis of the intrahepatic bile duct and dilatation of its proximal portion. She was diagnosed as having intrahepatic bile duct carcinoma combined with gallbladder carcinoma. At laparotomy, there was evidence of multiple peritoneal metastases and intraoperative histological examination of the gallbladder tumor revealed adenocarcinoma. Accordingly, only cholecystectomy and needle biopsy of the liver tumor was performed. Histological examination of the gallbladder revealed papillary adenocarcinoma invading the muscularis propria with medullary growth or intermediate stroma. There was no microvessel invasion, no perineural invasion and no lymph node involvement. On the other hand, the liver tumor was a cholangiocarcinoma with a well-differentiated tubular pattern. Therefore, this was a rare case of synchronous carcinoma of the gallbladder associated with intrahepatic bile duct carcinoma. PMID:10690592

  1. 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.

  2. 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

  3. 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.

  4. 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.

  5. 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...

  6. 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.

  7. 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

  8. 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)

  9. High expression of L-type amino acid transporter 1 as a prognostic marker in bile duct adenocarcinomas

    International Nuclear Information System (INIS)

    Oncocytic L-type amino acid transporter (LAT) 1 may be a prognostic indicator and target of new molecular therapeutic agents against malignancies. To investigate whether LAT1 expression influence the outcomes of patients with bile duct cancer, the expression of LAT1, LAT2, CD98, and Ki-67 was investigated immunohistochemically in 134 surgically resected bile duct adenocarcinomas, including 84 distal extrahepatic bile duct adenocarcinomas, 21 hilar cholangiocarcinomas, 15 intrahepatic cholangiocarcinomas, and 14 ampullary adenocarcinomas. LAT1 expression was weakly correlated with CD98 expression and Ki-67 labeling index (LI). Kaplan–Meier analysis showed a significant difference in prognosis between patients with bile duct adenocarcinomas having LAT1-high and -low scores, whereas LAT2 and CD98 expression and Ki-67 LI were not predictive of poor prognosis. Prognosis tended to be worse in patients having tumors with LAT1-high/LAT2-low than LAT1-low/LAT2-high scores (P = 0.0686). Multivariable analyses revealed that LAT1 expression, surgical margin, pT stage were independent prognostic factors. In conclusion, aberrant overexpression of LAT1 in bile duct adenocarcinoma predicts poor prognosis, suggesting that LAT1 may be a potential target of anticancer therapy

  10. 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.

  11. Clinical application of percutanously interventional therapeusis in patients with hepatocellular carcinoma accompanied with bile duct thrombosis

    International Nuclear Information System (INIS)

    Objective: To explore the method and value of percutanously interventional therapeusis for treatment of obstructive jaundice caused by hepatocellular carcinoma accompanied with bile duct thrombosis. Methods: Sixteen cases bile duct thrombosis proved by pathology and imaging examinations were retrospectively analyzed. According to the clinical symptoms, all the patients received percutaneous transhepatic biliary drainage (PTBD) including permanent external drainage, temporary internal drainage and implantation of covered stents. Serum total bilirubin (TBIL) after the interventional therapeusis were measured and compared with that before the treatments by t test to evaluate the efficacy of these treatments. The relief of clinical symptoms was also reviewed to evaluate the efficacy of these treatments. The relief of clinical symptoms was also reviewed to evaluate the efficacy of these treatments. The patients were followed up within 2 years. Results: The PTBD was successfully performed in 16 cases. Permanent external drainage, temporary internal drainage and imalantation of covered stents were performed in 2 patients, 7 patients and 7 patients respectively. TBIL after the interventional therapy decreased significantly (t=7.366, P<0.01) to (161.2 ± 80.5) μmol/L averagely from (261.9 ± 77.2) μmol/L before the treatments. All the patients died before the end of followed-up. The average survival time was 204 days (30 to 391 d) and the median survival time was 200 days. Bleeding and infection were the main complications, which could be controlled successfully by routine treatments. Conclusion: With high achievement ratio and good efficacy, percutanously interventional therapeusis are good choices for the treatments of obstructive jaundice due to bile duct thrombosis. (authors)

  12. 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

  13. 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.

  14. 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....

  15. 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.

  16. Caroli's disease misdiagnosed as intraductal papillary neoplasm of the bile duct.

    Science.gov (United States)

    Gu, Dae Hoe; Park, Min Seon; Jung, Chang Ho; Yoo, Yang Jae; Cho, Jae Young; Lee, Yun Ho; Seo, Yeon Seok; Yim, Hyung Joon; Um, Soon Ho; Ryu, Ho Sang

    2015-06-01

    Caroli's disease is a rare autosomal-recessive disorder caused by malformation of the ductal plate during embryonic development. Although it is present at birth, Caroli's disease is typically not diagnosed until between the second and fourth decades of life, as it was in the present patient. Here we report a rare case of Caroli's disease limited to one liver segment, which was initially misdiagnosed as an intraductal papillary neoplasm of the bile duct. The asymptomatic patient was treated with liver segmentectomy. PMID:26157755

  17. 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.

  18. 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.

  19. 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

  20. 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

  1. A huge intraductal papillary mucinous carcinoma of the bile duct treated by right trisectionectomy with caudate lobectomy

    Directory of Open Access Journals (Sweden)

    Jo Sungho

    2009-12-01

    Full Text Available Abstract Background Because intraductal papillary mucinous neoplasm of the bile duct (IPMN-B is believed to show a better clinical course than non-papillary biliary neoplasms, it is important to make a precise diagnosis and to perform complete surgical resection. Case presentation We herein report a case of malignant IPMN-B treated by right trisectionectomy with caudate lobectomy and extrahepatic bile duct resection. Radiologic images showed marked dilatation of the left medial sectional bile duct (B4 resulting in a bulky cystic mass with multiple internal papillary projections. Duodenal endoscopic examination demonstrated very patulous ampullary orifice with mucin expulsion and endoscopic retrograde cholangiogram confirmed marked cystic dilatation of B4 with luminal filling defects. These findings suggested IPMN-B with malignancy potential. The functional volume of the left lateral section was estimated to be 45%. A planned extensive surgery was successfully performed. The remnant bile ducts were also dilated but had no macroscopic intraluminal tumorous lesion. The histopathological examination yielded the diagnosis of mucin-producing oncocytic intraductal papillary carcinoma of the bile duct with poorly differentiated carcinomas showing neuroendocrine differentiation. The tumor was 14.0 × 13.0 cm-sized and revealed no stromal invasiveness. Resection margins of the proximal bile duct and hepatic parenchyma were free of tumor cell. The patient showed no postoperative complication and was discharged on 10th postoperative date. He has been regularly followed at outpatient department with no evidence of recurrence. Conclusion Considering a favorable prognosis of IPMN-B compared to non-papillary biliary neoplasms, this tumor can be a good indication for aggressive surgical resection regardless of its tumor size.

  2. Bilateral ovarian metastasis from distal common bile duct carcinoma developing after choledochal cyst excision.

    Science.gov (United States)

    Lee, Seung Eun; Choi, Yoo Shin; Kim, Mi Kyung; Oh, Hyoung-Chul; Do, Jae Hyuk

    2015-05-01

    Ovarian metastases represent about 3-5% of all ovarian malignancies. Most of these tumors originate in the digestive tract and cholangiocarcinoma rarely involves the ovary. A 60-year-old woman was admitted for the investigation of abdominal distension that had lasted 1 week. One and a half years prior, the patient had undergone choledochal cyst excision, Roux-en Y hepaticojejunostomy and cholecystectomy. Computed tomography scans of the abdomen revealed a papillary mass in the remnant distal common bile duct and enlargement of both ovaries with a huge amount of ascites. An explorative laparotomy disclosed no peritoneal seeding with resectable cholangiocarcinoma and bilateral ovarian mass. Pylorus-preserving pancreatoduodenectomy and bilateral salphingo-oophorectomy with hysterectomy were performed. Histologically, it was a well-differentiated adenocarcinoma and all surgical margins were free of tumor. Both ovarian masses were consistent with metastatic adenocarcinoma from the common bile duct. The patient received six cycles of postoperative adjuvant systemic chemotherapy, dying after 10 months due to pulmonary embolism. PMID:26155281

  3. 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)

  4. 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

  5. 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)

  6. 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.

  7. 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.

  8. 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.

  9. Visual characteristics of the papilla to estimate cannulation of the common bile duct - A pilot study

    Directory of Open Access Journals (Sweden)

    Ina Zuber-Jerger

    2009-01-01

    Full Text Available Objectives : Performance of endoscopic retrograde cholangiography (ERC depends mainly on the skills of the examiner, but also on anatomical variants. The aim of the study was to investigate patient- and papilla-related factors for the successful selective cannulation of the common bile duct (CBD. Patients and methods : 50 patients with a papilla with no prior sphincterotomy needing an ERC were enrolled. From a standardized description given by the endoscopist, criteria to characterize the papilla were analyzed. Results : Success was achieved in 92%. Cannulation time was 460 +/- 561 seconds on average. 70% of the papillae were mastered in 300 seconds or less. Concordance between endoscopists concerning descriptive variables was between 86% and 100%. The judgment of the endoscopist concerning expected difficulty was not significantly related to success, demonstrating the necessity of predictive parameters. Typical position of the duodenoscope and performance of precut were significantly related to success. The joint presence of a visible orifice and a typical position of the duodenoscope had a positive predictive value (PPV of 96%. Conclusions : Endoscopists can rely on the joint presence of a visible orifice of the papilla and a typical position of the duodenoscope in X-ray to predict the success of ERC. ( Zuber-Jerger I, Gelbmann CM, Kullmann F. Visual characteristics of the papilla to estimate cannulation of the common bile duct - a pilot study.

  10. [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

  11. Diagnostic Value of 99mTc-DISIDA hepatobiliary Scintigraphy in Patients with Acute or Intermittent Common Bile Duct Obstruction

    International Nuclear Information System (INIS)

    We examined patients with suspected acute or intermittent biliary obstruction using hepatobiliary scintigraphy, ultrasonography and contrast cholangiography. Of 16 patients with confirmed common bile duct obstruction, sonography and scintigraphy disagreed in 8(50%). Scintigraphy revealed partial or complete common bile duct obstruction in 13 patients (81.3%) and 6 of them had no evidence of dilated biliary trees. It is concluded that disagreement between sonography and scintigraphy is not rare in patients with acute or intermittent biliary obstruction and hepatobiliary scintigraphy is useful in diagnosing obstruction prior to ductal dilatation.

  12. 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.

  13. Fish bone as a nidus for stone formation in the common bile duct: report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Hwan; Lee, Sang Kwon; Kwon, Jung Hyeok; Woo, Seong Ku [Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andong (Korea, Republic of); Park, Won Kyu [Youngnam University Hospital, Daegu (Korea, Republic of)

    2004-09-15

    We report two cases of common bile duct stone formed around a fish bone which migrated from the intestinal tract, along with their characteristic imaging findings. Two patients who had no history of previous operation were admitted because of cholangitis. Percutaneous transhepatic biliary drainage (PTBD) was performed and the cholangiogram showed filling defects with an unusually elongated shape in the common bile duct. After improvement of the cholangitic symptoms, the stones were removed through the PTBD tract under fluoroscopic guidance. A nidus consisting of a 1.5 cm sized fish bone was found in each stone removed.

  14. 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

  15. 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.

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

    Directory of Open Access Journals (Sweden)

    Chi-Liang Cheng

    2012-01-01

    Full Text Available 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.

  17. 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.

  18. Disseminated eosinophilic infiltration of a newborn infant, with perforation of the terminal ileum and bile duct obstruction.

    OpenAIRE

    Murray, S. M.; Woods, C. J.

    1981-01-01

    A preterm boy died 4 days after delivery from septicaemia which at necropsy was found to be due to perforation of an eosinophilic lesion of the terminal ileum. Eosinophilic infiltration was also found in kidney, lymph node, bone marrow, portal tracts of liver, gall bladder, and bile duct with associated obstruction of the cystic duct and mucocele of the gall bladder. No allergic cause for the infiltrate was found in either the infant or his mother. Eosinophilic infiltration of neonatal spleen...

  19. 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).

  20. Endoscopic papillary large balloon dilation alone without sphincterotomy for the treatment of large common bile duct stones

    Directory of Open Access Journals (Sweden)

    Chen Wen-Chi

    2011-06-01

    Full Text Available Abstract Background Lethal pancreatitis has been reported after treatment for common bile duct stones using small endoscopic papillary balloon dilation. Methods We retrospectively evaluated the safety and efficacy of using large balloon dilation alone without the use of sphincterotomy for the treatment of large common bile duct stones in Kaohsiung Veterans General Hospital. Success rate of stone clearance, procedure-related adverse events and incidents, frequency of mechanical lithotripsy use, and recurrent stones were recorded. Results A total of 247 patients were reviewed in the current study. The mean age of the patients was 71.2 years. Most of them had comorbidities. Mean stone size was 16.4 mm. Among the patients, 132 (53.4% had an intact gallbladder and 121 (49% had a juxtapapillary diverticulum. The mean size of dilating balloon used was 13.2 mm. The mean duration of the dilating procedure was 4.7 min. There were 39 (15.8% patients required the help of mechanical lithotripsy while retrieving the stones. The final success rate of complete retrieval of stones was 92.7%. The rate of pancreatic duct enhancement was 26.7% (66/247. There were 3 (1.2% adverse events and 6 (2.4% intra-procedure bleeding incidents. All patients recovered completely after conservative and endoscopic treatment respectively, and no procedure-related mortality was noted. 172 patients had a follow-up duration of more than 6 months and among these, 25 patients had recurrent common bile duct stones. It was significantly correlated to the common bile duct size (p = 0.036 Conclusions Endoscopic papillary large balloon dilation alone is simple, safe, and effective in dealing with large common bile duct stones in relatively aged and debilitated patients.

  1. 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

  2. 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.

  3. 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

  4. High dose internal radiotherapy of bile duct carcinoma with sup(60)Co wire placed inside a percutaneous transhepatic drainage catheter

    International Nuclear Information System (INIS)

    A new method for relieving biliary obstruction due to malignant tumours is described. The procedure consists of percutaneous transhepatic cannulation of the obstructed bile duct by means of a Ring biliary drainage catheter and sup(60)Co wire built in a nylon tube, placed inside the catheter for 23 hours. First results are reported. (author)

  5. Obstructive jaundice due to a textiloma mimicking a common bile duct stone.

    Science.gov (United States)

    Cimsit, Bayindir; Keskin, M; Ozden, I; Alper, A

    2006-01-01

    A foreign body is a rare cause of obstructive jaundice. We report a 19-year-old woman with jaundice caused by a surgical gauze in the common bile duct (CBD). Four yours earlier, she had undergone a cholecystectomy and drainage for hydatid disease of the liver. Her postoperative course was complicated by a biliary fistula that healed after 50 days. She now presented with obstructive jaundice of 2 weeks' duration. Magnetic resonance cholangiopancreatography (MRCP) showed a signal-void mass, consistent with a CBD stone. Surgical exploration of the CBD revealed a surgical gauze as the cause of the obstruction. To the best of our knowledge, this is the first case of a surgical gauze obstructing the CBD requiring surgical removal. PMID:16547681

  6. 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 of...

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

    Directory of Open Access Journals (Sweden)

    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.

  8. 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

    Hepatic encephalopathy (HE) arises from acute or chronic liver diseases and leads to several problems, including motor impairment. Animal models of chronic liver disease have extensively investigated the mechanisms of this disease. Impairment of locomotor activity has been described in different...... rat models. However, these studies are controversial and the majority has primarily analyzed activity parameters. Therefore, the aim of the present study was to evaluate locomotor and exploratory behavior in bile duct-ligated (BDL) rats to explore the spatial and temporal structure of behavior. Adult...... exhibited a decrease in total distance traveled, increased total immobility time, smaller number of rearings, longer periods in the home base area and decreased percentage of time in the center zone of the arena, when compared to the control rats. Moreover, the performance of the BDL rats was not different...

  9. Percutaneous treatment of extrahepatic bile duct stones assisted by balloon sphincteroplasty and occlusion balloon

    International Nuclear Information System (INIS)

    To describe the technical feasibility and usefulness of extrahepatic biliary stone removal by balloon sphincteroplasty and occlusion balloon pushing. Fifteen patients with extrahepatic bile duct stones were included in this study. Endoscopic stone removal was not successful in 13 patients, and two patients refused the procedure due to endoscopy phobia. At first, all patients underwent percutaneous transhepatic biliary drainage (PTBD). A few days later, through the PTBD route, balloon assisted dilatation for common bile duct (CBD) sphincter was performed, and then the stones were pushed into the duodenum using an 11.5 mm occlusion balloon. Success rate, reason for failure, and complications associated with the procedure were evaluated. Eight patients had one stone, five patients had two stones, and two patients had more than five stones. The procedure was successful in 13 patients (13/15). In 12 of the patients, all stones were removed in the first trial. In one patients, residual stones were discovered on follow-up cholangiography, and were subsequently removed in the second trial. Technical failure occurred in two patients. Both of these patients had severely dilated CBD and multiple stones with various sizes. Ten patients complained of pain in the right upper quadrant and epigastrium of the abdomen immediately following the procedure, but there were no significant procedure-related complications such as bleeding or pancreatitis. Percutaneous extrahepatic biliary stone removal by balloon sphincteroplasty and subsequent stone pushing with occlusion balloon is an effective, safe, and technically feasible procedure which can be used as an alternative method in patients when endoscopic extrahepatic biliary stone removal was not successful

  10. Treatment of Common Bile Duct Obstruction by Pancreatic Cancer Using Various Stents: Single-Center Experience

    International Nuclear Information System (INIS)

    Purpose: To compare the effectiveness of various means of stenting in patients with biliary obstruction caused by pancreatic cancer in a retrospective analysis. Methods: Sixty-two patients with biliary obstruction due to unresectable pancreatic cancer underwent biliary stenting. On the basis of the findings obtained by percutaneous transhepatic cholangiography(10 patients) and endoscopic retrograde cholangiography (52 patients),the site of obstruction was distal to the hilar confluence,predominantly especially in the middle to lower third of the common bile duct. Polyurethane-covered Wallstents (9 mm in diameter) we reinserted in 13 patients, while uncovered Wallstents (10 mm in diameter)were used in 10 patients and plastic stents (10 Fr and 12 Fr) were used in 39 patients. Results: Stenting was successful in 34 patients (87.2%) treated with plastic stents and in 22 patients(95.7%) treated with Wallstents. Effective biliary drainage was achieved in 32 out of 34 patients (94.1%) treated with plastic stents and in 21 out of 22 patients (95.5%) treated with Wallstents. The cumulative patency rate was significantly higher for the uncovered and covered Wallstents compared to plastic stents, but was not significantly higher for covered than for uncovered Wallstents. Stentocclusion occurred in 23 patients (70%; all by clogging) from the plastic stent group, in two patients (22%; by tumor ingrowth) from the uncovered Wallstent group, and in one patient (9%; by clogging) from the covered Wallstent group. The survival rate showed no significant difference among the three stent groups. Conclusion: The Wallstent is effective for long-term palliation in patients with obstruction caused by pancreatic cancer invading the middle to lower part of the common bile duct. The covered Wallstent can prevent tumor ingrowth, a problem with the uncovered Wallstent. However, it may be necessary to take measures to prevent the migration or clogging of covered Wallstents

  11. Percutaneous treatment of extrahepatic bile duct stones assisted by balloon sphincteroplasty and occlusion balloon

    Energy Technology Data Exchange (ETDEWEB)

    Park, Yong Sung; Kim, Ji Hyung; Choi, Young Woo; Lee, Tae Hee; Hwang, Cheol Mog; Cho, Young Jun; Kim, Keum Won [Konyang University Hospital, Daejeon (Korea, Republic of)

    2005-12-15

    To describe the technical feasibility and usefulness of extrahepatic biliary stone removal by balloon sphincteroplasty and occlusion balloon pushing. Fifteen patients with extrahepatic bile duct stones were included in this study. Endoscopic stone removal was not successful in 13 patients, and two patients refused the procedure due to endoscopy phobia. At first, all patients underwent percutaneous transhepatic biliary drainage (PTBD). A few days later, through the PTBD route, balloon assisted dilatation for common bile duct (CBD) sphincter was performed, and then the stones were pushed into the duodenum using an 11.5 mm occlusion balloon. Success rate, reason for failure, and complications associated with the procedure were evaluated. Eight patients had one stone, five patients had two stones, and two patients had more than five stones. The procedure was successful in 13 patients (13/15). In 12 of the patients, all stones were removed in the first trial. In one patients, residual stones were discovered on follow-up cholangiography, and were subsequently removed in the second trial. Technical failure occurred in two patients. Both of these patients had severely dilated CBD and multiple stones with various sizes. Ten patients complained of pain in the right upper quadrant and epigastrium of the abdomen immediately following the procedure, but there were no significant procedure-related complications such as bleeding or pancreatitis. Percutaneous extrahepatic biliary stone removal by balloon sphincteroplasty and subsequent stone pushing with occlusion balloon is an effective, safe, and technically feasible procedure which can be used as an alternative method in patients when endoscopic extrahepatic biliary stone removal was not successful.

  12. 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.

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

    International Nuclear Information System (INIS)

    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.

  14. 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.

  15. 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)

  16. 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.

  17. Percutaneous Transhepatic Bile Duct Ablation with n-Butyl Cyanoacrylate in the Treatment of a Biliary Complication after Split Liver Transplantation

    OpenAIRE

    Vincenzo Pirotta; Mohammed Al Kofahi; Plamen Mihaylov; Iacopo Mangoni; Rocco Corso; Stefano Di Sandro; Alessandro Giacomoni; Paolo Aseni; Abdallah Slim; Andrea Lauterio; Luciano De Carlis

    2009-01-01

    Biliary complications continue to be a major cause of morbidity after split-liver transplantation (SLT). In this report we describe an uncommon late biliary complication. One year after SLT the patient showed an intrahepatic bile dicy dilatation with severe cholangitis episodes. The segmentary bile duct of hepatic segment VI-VII draining in the left duct was unidentified and tied at the time of the in situ split-liver procedure. We perform a permanent obliteration of the dilated intrahepatic ...

  18. 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

    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 becaus...... malignant disease. FUNDING: not relevant. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency via Region of Southern Denmark (case no. 13/27,321)....

  19. 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...

  20. 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...

  1. MRI, CT, US and ERCP in the evaluation of bile duct hamartomas (von Meyenburg complex): a case report

    Energy Technology Data Exchange (ETDEWEB)

    Wohlgemuth, W.A.; Boettger, J.; Bohndorf, K. [Klinik fuer Diagnostische Radiologie und Neuroradiologie, Zentralklinikum Augsburg (Germany)

    1998-12-01

    A case of multiple bile duct hamartomas (von Meyenburg complex) of the liver accompanied by exudative and in part necrotizing pancreatitis is presented. Magnetic resonance imaging (fat suppressed, T2-weighted images with prolonged echo time) could exclude diffuse tumor infiltration of the liver, which had not been possible with CT, sonography, or ERCP. To our knowledge, no comparable case has been reported. (orig.) With 6 figs., 16 refs.

  2. Case report: Retroperitoneal biliary fluid collections secondary to common bile duct rupture - an unusual complication of choledocholithiasis in a child

    International Nuclear Information System (INIS)

    Rupture of the common bile duct (CBD) in a child secondary to choledocholithiasis is a rare event. In this article, the authors describe a child who presented with an acute abdomen due to CBD rupture, with subsequent acute retroperitoneal fluid collections, all diagnosed preoperatively on CT scan. The aim of this article is to show the pathways that such collections can take in the retroperitoneum

  3. 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.

  4. 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

  5. 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.)

  6. Intrapancreatic bile duct metastasis from colon cancer after resection of liver metastasis with intrabiliary growth: a case report.

    Science.gov (United States)

    Kawakatsu, Shoji; Kaneoka, Yuji; Maeda, Atsuyuki; Takayama, Yuichi; Fukami, Yasuyuki; Onoe, Shunsuke

    2015-01-01

    An extremely rare case of intrapancreatic bile duct metastasis from sigmoid colon adenocarcinoma is herein presented. Sigmoid colon cancer (T3, N0, M0, stage IIA) had been diagnosed and treated by sigmoidectomy in October 1993. In December 2002, a liver metastasis with intrabiliary growth was found, and this was treated by extended right hepatic lobectomy and caudate lobectomy with extrahepatic bile duct resection. In February 2014, intrapancreatic bile duct metastasis was found, and this was treated by subtotal stomach-preserving pancreatoduodenectomy. The intrapancreatic metastasis was judged to have arisen from cancer cell implantation, either by spontaneous shedding of cancer cells or as a complication of percutaneous transhepatic biliary drainage. Twelve months have passed since the last surgical intervention, and there has been no sign of local recurrence or distant metastasis. Differential diagnosis between intrahepatic cholangiocarcinoma and intrabiliary growth of a liver metastasis originating from colorectal adenocarcinoma is difficult but very important for determining the therapeutic strategy. Careful examination is needed to diagnose intrahepatic biliary dilatation, especially for patients with a history of carcinoma in the digestive tract and even if years have passed since curative resection of the digestive tract cancer. Aggressive surgical management for localized recurrence of a hepatic metastasis from colorectal adenocarcinoma may improve patient survival. PMID:26293132

  7. 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.

  8. 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.

  9. Recent progress and future perspective of medical examination and treatment for bile duct carcinoma

    International Nuclear Information System (INIS)

    Explained are the progress during the past decade of medicare of bile duct carcinoma (BDC) leading to current status and the future perspective, from aspects of diagnosis, biliary drainage and treatment. The greatest progress in diagnosis is the introduction of multi-detector raw CT (MD-CT) with high time/space resolution resulting in, as well as of tumor site, the detection of extension, vascular invasion, remote metastasis, ascites and anatomical vascular running state essential for therapeutic planning. Advances in MD-CT image processing have also greatly contributed to the diagnostic progress. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT and peroral cholangioscopy can cover the diagnostic defect of MD-CT for detecting small lymphatic metastasis and horizontal extension on superficies, respectively. Preoperative biliary drainage is common in Japan and this modality is negative in Western countries, which may be due to the difference in their surgical procedures of BDC. Endoscopic naso-biliary drainage through duodenal papilla is becoming popular because of its safety and low risk of dissemination. As for treatment, resection is a gold standard for BDC. Results are awaited of recent trials like the postoperative chemotherapy with gemcitabine, and neoadjuvant radio-chemotherapy with 45 Gy radiation+gemcitabine. A systematic scheme for current diagnosis and treatment of BDC is proposed in this paper. (T.T.)

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

    Institute of Scientific and Technical Information of China (English)

    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.

  11. 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

  12. 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

  13. 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

  14. 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.

  15. 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.

  16. 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

  17. Safe laparoscopic clearance of the common bile duct in emergently admitted patients with choledocholithiasis and cholangitis

    Science.gov (United States)

    Plaudis, Haralds; Fokins, Vladimirs; Mukans, Maksims; Pupelis, Guntars

    2016-01-01

    Backgrounds/Aims Laparoscopic treatment of patients with choledocholithiasis and cholangitis is challenging due to mandatory recovery of the biliary drainage and clearance of the common bile duct (CBD). The aim of our study was to assess postoperative course of cholangitis and biliary sepsis after laparoscopic clearance of the CBD in emergently admitted patients with choledocholithiasis and cholangitis. Methods Emergently admitted patients who underwent laparoscopic clearance of the CBD were included prospectively and stratified in 2 groups i.e., cholangitis positive (CH+) or negative (CH-) group. Patient demographics, comorbidities, preoperative imaging data, inflammatory response, surgical intervention, complication rate and outcomes were compared between groups. Results Ninety-nine of a total 320 patients underwent laparoscopic clearance of the CBD, of which, 60 belonged to the acute cholangitis group (CH+) and 39 to the cholangitis negative group (CH-). Interventions were done on average 4 days after admission, operation duration was 95-105 min, and the conversion rate was 3-7% without differences in the groups. Preoperative inflammatory response was markedly higher in the CH+ group. Inflammation signs on intraoperative choledochoscopy were more evident in patients with cholangitis. Postoperative inflammatory response did not differ between the groups. The overall complication rate was 8.3% and 5.1%, respectively. Laparoscopic clearance of the CBD resulted in 1 lethal case (CH+ group), resulting in 1% mortality rate and a similar 12-month readmission rate. Conclusions Single-stage laparoscopic intraoperative US and choledochoscopy-assisted clearance of the CBD is feasible in emergently admitted patients with choledocholithiasis and cholangitis. PMID:27212991

  18. Comparison of long-term results of laparoscopic and endoscopic exploration of common bile duct

    Science.gov (United States)

    Rai, S S; Grubnik, V V; Kovalchuk, O L; Grubnik, O V

    2006-01-01

    Background: To compare long term results of laparoscopic and endoscopic exploration of common bile duct, to assess post-procedure quality of life. Materials and Methods: From September 1992 to August 2003, we performed 4058 cholecystectomies, out of which 479 (11.80%) patients had choledocholithiasis. There were 163 males and 316 females. Mean age was 63.65 ± 5.5 years. These patients were put in two groups. In the first group of 240 patients, a majority of patients underwent two-stage procedures. ERCP/ES was performed in 210 (87.50%) cases. In the second group of 239 patients, a majority of patients underwent single-stage procedures. ERCP/ES was done in 32 (13.38%) cases. Results: Mortality was zero in both groups. Morbidity was 15.1% in first group and 7.5% in second group. Mean hospital stay was 11.7 ± 3.2 days in first group and 6.2 ± 2.1 days in second group. Average operative time was 95.6 ± 20 minutes in first group and 128.4 ± 32 minutes in second group. Completed questionnaires received from 400 (83.50%) patients revealed better long-term results in the second group. Clinical features of low-grade cholangitis were seen in 20% of patients who underwent ES. Hence the post-procedure quality of life in patients who underwent single-stage procedures was definitely much better, because of minimal damage of sphincter of Oddi. Conclusions: Single-stage laparoscopic operations provide better results and shorter hospital stay. Damage to sphincter of Oddi should be minimal, to avoid long-term low-grade cholangitis. In young patients, the operation of choice should be single-stage laparoscopic procedure with absolutely no damage to sphincter of Oddi. PMID:21170222

  19. Comparison of long-term results of laparoscopic and endoscopic exploration of common bile duct

    Directory of Open Access Journals (Sweden)

    Rai Sarabjit

    2006-01-01

    Full Text Available Background: To compare long term results of laparoscopic and endoscopic exploration of common bile duct, to assess post-procedure quality of life. Materials and Methods: From September 1992 to August 2003, we performed 4058 cholecystectomies, out of which 479 (11.80% patients had choledocholithiasis. There were 163 males and 316 females. Mean age was 63.65 ± 5.5 years. These patients were put in two groups. In the first group of 240 patients, a majority of patients underwent two-stage procedures. ERCP/ES was performed in 210 (87.50% cases. In the second group of 239 patients, a majority of patients underwent single-stage procedures. ERCP/ES was done in 32 (13.38% cases. Results: Mortality was zero in both groups. Morbidity was 15.1% in first group and 7.5% in second group. Mean hospital stay was 11.7 ± 3.2 days in first group and 6.2 ± 2.1 days in second group. Average operative time was 95.6 ± 20 minutes in first group and 128.4 ± 32 minutes in second group. Completed questionnaires received from 400 (83.50% patients revealed better long-term results in the second group. Clinical features of low-grade cholangitis were seen in 20% of patients who underwent ES. Hence the post-procedure quality of life in patients who underwent single-stage procedures was definitely much better, because of minimal damage of sphincter of Oddi. Conclusions: Single-stage laparoscopic operations provide better results and shorter hospital stay. Damage to sphincter of Oddi should be minimal, to avoid long-term low-grade cholangitis. In young patients, the operation of choice should be single-stage laparoscopic procedure with absolutely no damage to sphincter of Oddi.

  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. 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.

  2. Epidemiology of cancer of the liver and intrahepatic bile ducts in an Australian population.

    Science.gov (United States)

    Luke, Colin; Price, Timothy; Roder, David

    2010-01-01

    The incidence of liver and intrahepatic bile duct cancer in Australia is low at about one third the world average but increases are evident. South Australian registry data have been used to describe: age-standardized incidence and mortality trends; and disease-specific survivals, using Kaplan-Meier estimates and Cox proportional hazards regression. The study included 1,220 incident cancers (901 hepatocellular carcinomas; 201 cholangiocarcinomas; 118 other types) and 983 deaths. Incidence and mortality rates increased by 2-3 fold during 1977-2007. Incidence increases affected males, females and all ages. There was a strong: male predominance (3 to 1); and age gradient (70+ year old incidence >30 times under 50 year old incidence). Compared with hepatocellular carcinomas, cholangiocarcinomas and other histology types more often affected females and older ages and less often the Asian born. All histology types showed similar incidence increases. Apart from recognized risk factors (e.g., hepatitis B/C infection and aflatoxins for hepatocellular carcinoma; liver-fluke infection for cholangiocarcinomas, etc.), common risk factors may include excess alcohol consumption and possibly obesity and diabetes mellitus. Five-year disease-specific survival in 1998-2007 was 16%, with higher fatalities applying for earlier periods, older patients, males, lower socio-economic groups, and cholangiocarcinomas. Aboriginal patients tended to have higher case fatalities (p=0.054). Survival increases may be due to earlier diagnosis from alpha feta protein testing and diagnostic imaging, plus more aggressive treatment of localized disease. Mortality increases require a preventive response, including hepatitis B vaccination, prevention of viral infection though contaminated blood and other body fluids, early detection initiatives for high-risk patients, aggressive surgery for localized disease, and experimentation with new systemic therapies. PMID:21338184

  3. Extrahepatic bile duct atresia from the pathologist’s perspective: pathological features and differential diagnosis

    Directory of Open Access Journals (Sweden)

    Peter Van Eyken

    2014-06-01

    Full Text Available Extrahepatic biliary atresia (EHBA refers to stenosis or atresia of the extrahepatic biliary tree. It accounts for 25-30% of cases of neonatal cholestasis. If left untreated, EHBA progresses to biliary cirrhosis and is universally fatal within the first 2 years of life. Early diagnosis is crucial since surgical treatment (Kasai procedure is the only treatment option. Histopathologic examination of liver biopsy specimens is a key element in the diagnostic work-up of infants with suspected EHBA. Pathologic diagnosis aims at excluding non-surgically correctable causes of neonatal cholestasis thereby leading to surgical exploration for confirmation of the diagnosis. All published data indicate that pathologists can diagnose EHBA with high sensitivity, high specificity and reasonable interobserver agreement. The most useful histologic features in the diagnosis of EHBA are portal tract changes including ductular proliferation and bile plugs in ducts and ductules. These lesions are not pathognomonic but can be seen in extrahepatic obstruction of any cause. Total parenteral nutrition (TPN-associated cholestasis and alpha1-antitrypsin (A1AT deficiency cannot be differentiated from EHBA without access to clinical data and may lead to false-positive diagnosis. False-negative interpretation may be caused by early age at diagnosis or by small/indequate specimens. The pathologist also plays a role in the examination of the resected fibrotic segment and of explant specimens. Histopathology can yield prognostic information, being also an indispensable tool in research for the possible pathogenesis of this disease. A well-coordinated, multidisciplinary approach is required in the assessment of suspected cases of EHBA.  Proceedings of the International Course on Perinatal Pathology (part of the 10th International Workshop on Neonatology · October 22nd-25th, 2014 · Cagliari (Italy · October 25th, 2014 · The role of the clinical pathological dialogue in

  4. Anisodamine accelerates spontaneous passage of single symptomatic bile duct stones ≤ 10 mm

    Science.gov (United States)

    Gao, Jun; Ding, Xue-Mei; Ke, Shan; Zhou, Yi-Ming; Qian, Xiao-Jun; Ma, Rui-Liang; Ning, Chun-Min; Xin, Zong-Hai; Sun, Wen-Bing

    2013-01-01

    AIM: To investigate the rate of spontaneous passage of single and symptomatic common bile duct (CBD) stones ≤ 10 mm in diameter in 4 wk with or without a 2-wk course of anisodamine. METHODS: A multicenter, randomized, placebo-controlled trial was undertaken. A total of 197 patients who met the inclusion criteria were enrolled. Ninety-seven patients were assigned randomly to the control group and the other 100 to the anisodamine group. The anisodamine group received intravenous infusions of anisodamine (10 mg every 8 h) for 2 wk. The control group received the same volume of 0.9% isotonic saline for 2 wk. Patients underwent imaging studies and liver-function tests every week for 4 wk. The rate of spontaneous passage of CBD stones was analyzed. RESULTS: The rate of spontaneous passage of CBD stones was significantly higher in the anisodamine group than that in the control group (47.0% vs 22.7%). Most (87.2%, 41/47) stone passages in the anisodamine group occurred in the first 2 wk, and passages in the control group occurred at a comparable rate each week. Factors significantly increasing the possibility of spontaneous passage by univariate logistic regression analyses were stone diameter (< 5 mm vs ≥ 5 mm and ≤ 10 mm) and anisodamine therapy. Multivariate logistic regression analyses revealed that these two factors were significantly associated with spontaneous passage. CONCLUSION: Two weeks of anisodamine administration can safely accelerate spontaneous passage of single and symptomatic CBD stones ≤ 10 mm in diameter, especially for stones < 5 mm. PMID:24151390

  5. 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.

  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. Preoperative assessment of longitudinal extent of bile duct cancers using MDCT with multiplanar reconstruction and minimum intensity projections: Comparison with MR cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Ryoo, Inseon, E-mail: isryoo@gmail.com [Department of Radiology, Seoul National University Hospital, 110-744, Seoul (Korea, Republic of); Lee, Jeong Min, E-mail: leejm@radcom.snu.ac.kr [Department of Radiology, Seoul National University Hospital, 110-744, Seoul (Korea, Republic of); Park, Hee Sun, E-mail: heesun@radiol.snu.ac.kr [Department of Radiology, Konkuk University Hospital, 143-729, Seoul (Korea, Republic of); Han, Joon Koo, E-mail: hanjk@radcom.snu.ac.kr [Department of Radiology, Seoul National University Hospital, 110-744, Seoul (Korea, Republic of); Choi, Byung Ihn, E-mail: choibi@radcom.snu.ac.kr [Department of Radiology, Seoul National University Hospital, 110-744, Seoul (Korea, Republic of)

    2012-09-15

    Objective: To compare the performance of MDCT, including multiplanar reformation (MPR) and minimum intensity projection (MinIP) images, with that of transaxial MDCT with MR cholangiography (MRC) in the preoperative evaluation of the longitudinal extent of bile duct cancer. Methods: Twenty-seven patients with surgically proven bile duct cancer, who had undergone preoperative multiphasic MDCT and MRC, were included. Two radiologists evaluated the MDCT set with MPR and MinIP images and the image set of transaxial MDCT with MRC, regarding the longitudinal extent of bile duct cancer. The results were compared with the surgical and pathology findings. Results: The area under the receiver operating characteristic curves of the MDCT set with MPR and MinIP images and the image set of transaxial MDCT with MRC for predicting the longitudinal extent of bile duct cancer, were 0.938, 0.923 and 0.839, 0.836 for both reviewers. The differences were not statistically significant for either image set or either reviewer. The sensitivity and specificity of the MDCT image set for detecting tumor involvement of the biliary second confluences or intrapancreatic segment were similar for both reviewers to those of transaxial MDCT with MRC. Conclusions: MDCT with MPR and MinIP images showed comparable diagnostic performance to that of transaxial MDCT with MRC for predicting the longitudinal extent of bile duct cancer.

  8. Percutaneous Transhepatic Biliary Drainage in the Management of Postsurgical Biliary Leaks in Patients with Nondilated Intrahepatic Bile Ducts

    International Nuclear Information System (INIS)

    Purpose. To assess the feasibility of percutaneous transhepatic biliary drainage (PTBD) for the treatment of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts, its efficacy in restoring the integrity of bile ducts, and technical procedures to reduce morbidity. Methods. Seventeen patients out of 936 undergoing PTBD over a 20-year period had a noncholestatic liver and were retrospectively reviewed. All patients underwent surgery for cancer and suffered a postsurgical biliary leak of 345 ml/day on average; 71% were in poor condition and required permanent nutritional support. An endoscopic approach failed or was excluded due to inaccessibility of the bile ducts. Results. Established biliary leaks and site of origin were diagnosed an average of 21 days (range 1-90 days) after surgery. In all cases percutaneous access to the biliary tree was achieved. An external (preleakage) drain was applied in 7 cases, 9 patients had an external-internal fistula bridging catheter, and 1 patient had a percutaneous hepatogastrostomy. Fistulas healed in an average of 31 days (range 3-118 days ) in 15 of 17 patients (88%) following PTBD. No major complications occurred after drainage. Post-PTBD cholangitis was observed in 6 of 17 patients (35%) and was related to biliary sludge formation occurring mostly when drainage lasted >30 days and was of the external-internal type. Median patient survival was 17.7 months and in all cases the repaired biliary leaks remained healed. Conclusions. PTBD is a feasible, effective, and safe procedure for the treatment of postsurgical biliary leaks. It is therefore a reliable alternative to surgical repair, which entails longer hospitalization and higher costs

  9. 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

  10. Late effects of intraoperative radiation therapy on retroperitoneal tissues, intestine, and bile duct in a large animal model

    International Nuclear Information System (INIS)

    The late histopathological effects of intraoperative radiotherapy (IORT) on retroperitoneal tissues, intestine, and bile duct were investigated in dogs. Fourteen adult foxhounds were subjected to laparotomy and varying doses (0-45 Gy) of IORT (11 MeV electrons) delivered to retroperitoneal tissues including the great vessels and ureters, to a loop of defunctionalized small bowel, or to the extrahepatic bile duct. One control animal received an aortic transection and reanastomosis at the time of laparotomy; another control received laparotomy alone. This paper describes the late effects of single-fraction IORT occurring 3-5 years following treatment. Dogs receiving IORT to the retroperitoneum through a 4 X 15 cm portal showed few gross or histologic abnormalities at 20 Gy. At doses ranging from 30-45 Gy, radiation changes in normal tissues were consistently observed. Retroperitoneal fibrosis with encasement of the ureters and great vessels developed at doses ≥30 Gy. Radiation changes were present in the aorta and vena cava at doses ≥40 Gy. A 30 Gy dog developed an in-field malignant osteosarcoma at 3 years which invaded the vertebral column and compressed the spinal cord. A 40 Gy animal developed obstruction of the right ureter with fatal septic hydronephrosis at 4 years. Animals receiving IORT through a 5 cm IORT portal to an upper abdominal field which included a defunctionalized loop of small bowel, showed few gross or histologic abnormalities at a dose of 20 Gy. At 30 Gy, hyaline degeneration of the intestinal muscularis layer of the bowel occurred. At a dose of 45 Gy, internal intestinal fistulae developed. One 30 Gy animal developed right ureteral obstruction and hydronephrosis at 5 years. A dog receiving 30 Gy IORT through a 5 cm portal to the extrahepatic bile duct showed diffuse fibrosis through the gastroduodenal ligament. These canine studies contribute to the area of late tissue tolerance to IORT. 7 refs., 3 figs., 5 tabs

  11. Molecular mechanisms of cholangiocarcinogenesis: are biliary intraepithelial neoplasia and intraductal papillary neoplasms of the bile duct precursors to cholangiocarcinoma?

    Science.gov (United States)

    Bickenbach, Kai; Galka, Eva; Roggin, Kevin King

    2009-04-01

    Cholangiocarcinoma (CC) is a rare, malignant neoplasm that can develop from any site within the intrahepatic or extrahepatic biliary tree. Although the key steps of cholangiocarcinogenesis remain unknown, it has been hypothesized that CC may develop through two key premalignant precursor lesions: biliary intraepithelial neoplasia (BilIN) and intraductal papillary neoplasm of the bile duct (IPNB). These lesions probably are analogous to pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasm, respectively. This article outlines the molecular basis of cholangiocarcinogenesis through the BilIN and IPNB pathways. It highlights the genetic mutations that alter cellular proliferation, tumor suppression, and impairment of critical mucinous, cell-adhesion, and matrix proteins. PMID:19306808

  12. 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.

  13. 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

  14. Surgical management of Stenson’s duct injury by using double J stent urethral catheter

    Directory of Open Access Journals (Sweden)

    Suha N. Aloosi

    2015-01-01

    Conclusions: Herein, we described an easy yet efficient technique in management of parotid duct injury using a JJ stent which is often used for urethra. We think that use of JJ stent is a valuable technique to be used in the diagnosis and surgical repair of the parotid duct during traumatic facial and/or parotid injuries.

  15. 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.

  16. 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

  17. The use of the liver-spleen-scan for the diagnosis of congenital intrahepatic cysts of the bile duct (M. Caroli)

    International Nuclear Information System (INIS)

    After a short review of the pathogenesis, diagnosis and therapy for congenital intrahepatic cysts of the bile-duct (morbus Caroli), reference was made to the diagnostic significance of liver scintigraphy on the basis of two casuistic reports. Liver scintigraphy permits an exact localization of intrahepatic cysts as well as information regarding the course of the hepatopathy connected with morbus Caroli. In addition, 131-J-bromsulfon scintigraphy of the liver is a simple method for controlling the patency of the bile ducts. Our observations tend to indicate that preoperative and postoperative scintigraphic controls of the liver are practical for this disease. (orig.)

  18. 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...... confirmed in all three validation cohorts. CONCLUSIONS: CA19-9 response is a robust predictor of survival in patients with inoperable bile duct cancer in four independent data sets....... if a decline in CA19-9 (CA19-9 response) during chemotherapy is predictive of survival in patients with inoperable bile duct cancer. METHODS: Consecutive patients with inoperable bile duct cancer treated at a University Hospital were retrospectively included in an investigational cohort (n = 212......). Three validation cohorts were established including patients 1) participating in phase I/II trials at a Danish Hospital (n = 71), 2) identified retrospectively in a Canadian cohort (n = 196) and 3) randomized in the ABC-02 trial (n = 410). Patients with a baseline CA19-9 and at least one CA19-9 value...

  19. Laparoscopic exploration of the common bile duct and removal of dead worm in a patient of cholangitis after endoscopic retrograde cholangiopancreatography failure

    Directory of Open Access Journals (Sweden)

    Chalkoo Mushtaq

    2009-01-01

    Full Text Available We describe a dead ascaris-induced extrahepatic bilary obstruction in a young female who presented with acute cholangitis. The dead ascaris was removed by laparoscopic exploration of common bile duct after endoscopic retrograde cholangiopancreatography failure. Patient had an uneventful hospital course after the procedure and was discharged afebrile after 3 days of hospital stay.

  20. 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.)

  1. Transpapillary selective bile duct cannulation technique: Review of Japanese randomized controlled trials since 2010 and an overview of clinical results in precut sphincterotomy since 2004.

    Science.gov (United States)

    Kawakami, Hiroshi; Kubota, Yoshimasa; Kawahata, Shuhei; Kubo, Kimitoshi; Kawakubo, Kazumichi; Kuwatani, Masaki; Sakamoto, Naoya

    2016-04-01

    In 1970, a Japanese group reported the first use of endoscopic retrograde cholangiopancreatography (ERCP), which is now carried out worldwide. Selective bile duct cannulation is a mandatory technique for diagnostic and therapeutic ERCP. Development of the endoscope and other devices has contributed to the extended use of ERCP, which has become a basic procedure to diagnose and treat pancreaticobiliary diseases. Various techniques related to selective bile duct cannulation have been widely applied. Although the classical contrast medium injection cannulation technique remains valuable, use of wire-guided cannulation has expanded since the early 2000s, and the technique is now widely carried out in the USA and Europe. Endoscopists must pay particular attention to a patient's condition and make an attendant choice about the most effective technique for selective bile duct cannulation. Some techniques have the potential to shorten procedure time and reduce the incidence of adverse events, particularly post-ERCP pancreatitis. However, a great deal of experience is required and endoscopists must be skilled in a variety of techniques. Although the development of the transpapillary biliary cannulation approach is remarkable, it is important to note that, to date, there have been no reports of transpapillary cannulation preventing post-ERCP pancreatitis. In the present article, selective bile duct cannulation techniques in the context of recent Japanese randomized controlled trials and cases of precut sphincterotomy are reviewed and discussed. PMID:26825609

  2. [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

  3. 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.

  4. Pancreas-Preserving Duodenal Resections with Bile and Pancreatic Duct Replantation for Duodenal Dystrophy. Two Case Reports

    Directory of Open Access Journals (Sweden)

    Viacheslav Ivanovich Egorov

    2010-09-01

    Full Text Available Context Duodenal dystrophy is a rare disease, characterized by the chronic inflammation of the aberrant pancreatic tissue in the duodenal wall. Case reports Two middle-aged men were admitted with upper abdominal pain of several months duration, periodic nausea and vomiting after meals, intermittent jaundice and weight loss. A diagnosis of cystic dystrophy of the vertical part of the duodenum without chronic inflammation of the orthotopic pancreas was established in both cases by multi-detector computed tomography, magnetic resonance imaging and endosonography. Both patients were successfully treated by two modifications of pancreas-preserving duodenal resections with reimplantation of the bile and pancreatic ducts into the neoduodenum. Conclusion These cases are a good example of a pancreas-preserving approach to duodenal dystrophy treatment and can be an alternative to the Whipple procedure in cases of mild changes of the orthotopic gland

  5. 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

  6. 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...

  7. Radiofrequency Ablation of the Main Lesion of Hepatocellular Carcinoma and Bile Duct Tumor Thrombus as a Radical Therapeutic Alternative

    Science.gov (United States)

    Gao, Jun; Zhang, Qingshuai; Zhang, Jun; Kong, Jian; Wang, Shaohong; Ding, Xuemei; Ke, Shan; Sun, Wenbing

    2015-01-01

    Abstract Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) formation is a rare entity found microscopically in 1% to 9.2% of resected specimens. The ideal treatment for HCC is surgical resection. However, because of poor hepatic functional reserve in patients with HCC, most tumors are unresectable. Here, we report 2 cases of HCC with BDTT type III accompanied by hepatic dysfunction that were successfully treated with radiofrequency (RF) ablation. We used RF ablation as both a radical therapeutic method and an efficient way to control bleeding from the origin of BDTT after BDTT removal. At the time of writing, the 2 patients have been disease-free for 16 and 12 months, respectively. Our results show that RF ablation may be used as a radical therapeutic alternative for HCC with BDTT in patients with liver cirrhosis and obstructive jaundice. PMID:26166111

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

    International Nuclear Information System (INIS)

    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

  9. 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

  10. 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

  11. 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.

  12. Ethyl acetate fraction of Amomum xanthioides improves bile duct ligation-induced liver fibrosis of rat model via modulation of pro-fibrogenic cytokines

    Science.gov (United States)

    Kim, Hyeong-Geug; Han, Jong-Min; Lee, Jin-Seok; Suk Lee, Jong; Son, Chang-Gue

    2015-01-01

    We investigated anti-hepatofibrotic effects of ethyl acetate fraction of Ammomum xanthoides (EFAX) using bile duct ligation (BDL)-induced hepatic fibrosis in a rat model. Male SD rats (6 weeks old) underwent BDL followed by 15 days of orall administration of EFAX (12.5, 25 or 50 mg/kg) or ursodeoxycholic acid (25 mg/kg). BDL caused animal death, ascites formation, alterations in serum biochemistries, and severe hepatic injury with excessive collagen deposition, whereas EFAX treatment significantly attenuated these effects. BDL markedly increased the pro-fibrogenic cytokines (TGF-β, PDGF-β, and CTGF) and the extracellular matrix indicators α-SMA, TIMP-1 and collagen type 1 in hepatic proteins and gene expression levels, which were notably normalized by EFAX treatment. EFAX also markedly normalized pro-fibrogenic signaling molecules including Smad2/3, Smad7, Akt, p44/42, and p38. We further explored EFAX mechanisms of actions using LX-2 cells (human derived hepatic stellate cell line). Pre-treatment with EFAX drastically attenuated the activation of α-SMA and Smad2/3, which are downstream molecules of TGF-β. These findings suggest that EFAX may be a potent anti-hepatofibrotic agent, and its corresponding mechanisms primarily involve the modulation of pro-fibrogenic cytokines. PMID:26412144

  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. Magnetic Resonance-Assisted Imaging of Slow Flow in the Pancreatic and Common Bile Duct in Healthy Volunteers

    International Nuclear Information System (INIS)

    Background: Magnetic resonance cholangiopancreaticography (MRCP) is commonly used to evaluate the pancreatic (PD) and common bile duct (CBD), and the addition of secretin is used to obtain functional information (S-MRCP). Neither method gives any information on flow velocities within the ducts. Purpose: To evaluate a new, MRI diffusion-based, slow-flow-sensitive sequence for the detection of slow flow changes in the PD and CBD. Material and Methods: Seven healthy volunteers were examined. A modified single-shot turbo spin-echo sequence was used to detect slow flow changes. Three b factors (0, 6, and 12 s/mm2) were used. The flow sensitivity was applied in two directions, vertically and horizontally. Scanning was performed before and after glucagon was given, and again after an intravenous injection of secretin. The sequence gives signal loss from a duct when flow increases, and such changes were recorded. Results: All images showed the PD with b = 0 (no flow sensitization). After administration of glucagon, artifacts from bowel movements were reduced and visibility of the PD was improved at both b = 6 and b 12. Significant reduction of the visibility of the PD, indicating increased flow, was recorded both at b = 6 and b = 12 after the administration of secretin. There were no changes in the visibility of the CBD. Conclusion: This study shows that MRI-based detection of slow flow changes inside the PD is possible. Due to the sequence's high sensitivity to any motion, further studies are required before adopting the method for clinical use

  15. Stensen's duct injuries: the role of sialendoscopy and adjuvant botulinum toxin injection

    OpenAIRE

    Kopeć, Tomasz; Wierzbicka, Małgorzata; Szyfter, Witold

    2013-01-01

    Introduction Stensen's duct injuries are uncommon but troublesome sequelae of facial surgery or other external traumas. Aim To investigate the feasibility of sialendoscopic control of Stensen's duct in iatrogenic injuries and the efficiency of botulinum toxin adjuvant therapy. Material and methods In 2008 and 2010, 5 patients with parotid sialoceles or fistulas, infrequent complications after plastic surgery or trauma, were treated in a single institution, Poznan University of Medical Science...

  16. Role of bile acids in liver injury and regeneration following acetaminophen overdose.

    Science.gov (United States)

    Bhushan, Bharat; Borude, Prachi; Edwards, Genea; Walesky, Chad; Cleveland, Joshua; Li, Feng; Ma, Xiaochao; Apte, Udayan

    2013-11-01

    Bile acids play a critical role in liver injury and regeneration, but their role in acetaminophen (APAP)-induced liver injury is not known. We tested the effect of bile acid modulation on APAP hepatotoxicity using C57BL/6 mice, which were fed a normal diet, a 2% cholestyramine (CSA)-containing diet for bile acid depletion, or a 0.2% cholic acid (CA)-containing diet for 1 week before treatment with 400 mg/kg APAP. CSA-mediated bile acid depletion resulted in significantly higher liver injury and delayed regeneration after APAP treatment. In contrast, 0.2% CA supplementation in the diet resulted in a moderate delay in progression of liver injury and significantly higher liver regeneration after APAP treatment. Either CSA-mediated bile acid depletion or CA supplementation did not affect hepatic CYP2E1 levels or glutathione depletion after APAP treatment. CSA-fed mice exhibited significantly higher activation of c-Jun N-terminal protein kinases and a significant decrease in intestinal fibroblast growth factor 15 mRNA after APAP treatment. In contrast, mice fed a 0.2% CA diet had significantly lower c-Jun N-terminal protein kinase activation and 12-fold higher fibroblast growth factor 15 mRNA in the intestines. Liver regeneration after APAP treatment was significantly faster in CA diet-fed mice after APAP administration secondary to rapid cyclin D1 induction. Taken together, these data indicate that bile acids play a critical role in both initiation and recovery of APAP-induced liver injury. PMID:24007882

  17. Percutaneous Transhepatic Bile Duct Ablation with n-Butyl Cyanoacrylate in the Treatment of a Biliary Complication after Split Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Andrea Lauterio

    2009-01-01

    Full Text Available Biliary complications continue to be a major cause of morbidity after split-liver transplantation (SLT. In this report we describe an uncommon late biliary complication. One year after SLT the patient showed an intrahepatic bile dicy dilatation with severe cholangitis episodes. The segmentary bile duct of hepatic segment VI-VII draining in the left duct was unidentified and tied at the time of the in situ split-liver procedure. We perform a permanent obliteration of the dilated intrahepatic ducts by a percutaneous embolization using an n-butyl cyanoacrylate (NABC. The management of biliary complications after SLT requires a multidisciplinary approach. The use of NBCA in obliteration of a dilated bile duct seems to be a safe procedure with good results providing a less invasive option than hepatic resection and decreasing the morbidity associated with chronic external biliary drainage. Further studies are needed to determine whether this approach is effective and safe and whether it could reduce hospital stay and cost.

  18. 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。

  19. A case report of an ampullary tumor presenting with spontaneous perforation of an aberrant bile duct and treated with total laparoscopic pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    Kaplan Mehmet

    2012-07-01

    Full Text Available Abstract Background This case report discusses a patient who presented with bile peritonitis due to spontaneous perforation of an aberrant bile duct that originated in the triangular ligament of the liver. It was associated with an ampullary tumor and treated with total laparoscopic pancreaticoduodenectomy (TLPD. Case report A 58-year-old male patient was admitted to the emergency department of Medical Park Gaziantep Hospital in September 2009 with acute abdominal findings. He underwent an urgent laparoscopy, and, interestingly, bile peritonitis due to the rupture of an aberrant bile duct in the triangular ligament was noted. After laparoscopic treatment of the acute conditions, the follow-up examinations of the patient showed the finding of obstructive jaundice. Endoscopic retrograde cholangio-pancreatography revealed a 1-cm polypoid mass located at the ampulla of Vater (duodenal papilla with possible extension to the ampullary sphincter. A stent was inserted for temporary biliary drainage, and subsequent endoscopic biopsy showed the pathological finding of adenocarcinoma. After waiting for a 1-month period for the peritonitis to heal, the patient underwent pylorus-preserving TLPD and was discharged without any major complications on postoperative day 7. Conclusion In patients with bile peritonitis, it should be considered that the localization of the perforation may be in an aberrant bile duct localized at the triangular ligament and the etiology may be associated with an obstructing periampullary tumor. Laparoscopic pancreaticoduodenectomy is a feasible operative procedure in carefully selected patients. This technique can achieve adequate margins and follows oncological principles. Randomized comparative studies are needed to establish the superiority of minimally invasive surgery over traditional open surgery.

  20. Tratamento laparoscópico de coledocolitíase Laparoscopic treatment of common bile duct lithiasis

    Directory of Open Access Journals (Sweden)

    Marcel Autran C. MACHADO

    2000-07-01

    Full Text Available Paciente com história de 18 meses de emagrecimento e icterícia foi encaminhado ao Serviço de Cirurgia Abdominal do Hospital do Câncer, São Paulo, SP., com hipótese diagnóstica de câncer de cabeça de pâncreas. Exames laboratoriais mostraram elevação de bilirrubinas e de enzimas canaliculares. Ultra-sonografia abdominal revelou dilatação de via biliar intra e extra-hepática. Tomografia computadorizada mostrou árvore biliar dilatada com presença de cálculo de cerca de 3 cm em colédoco distal. O paciente foi submetido a colecistectomia com coledocotomia, retirada do cálculo e anastomose colédoco-duodenal por laparoscopia. Evoluiu sem intercorrências, recebendo alta no sexto dia de pós-operatório. Conclui-se que o tratamento laparoscópico da coledocolitíase é factível em alguns pacientes, especialmente naqueles com dilatação de via biliar. A retirada de cálculos deve ser seguida de procedimento de drenagem da via biliar com dreno de Kehr. Em alguns pacientes com colédoco cronicamente dilatado, como o do presente caso, a anastomose colédoco-duodenal é o procedimento de escolha.With the advances of videolaparoscopic surgery, this approach had become the treatment of choice for cholelithiasis. However, about 5% to 10% may present common bile duct lithiasis. Most surgeons have still difficulties to deal with this situation and do prefer resolve with open surgery or with further endoscopic approach. We present a case of a 60-year-old man, with 18 months history of right upper quadrant pain, weight loss and jaundice. He was referred with diagnostic of pancreatic cancer. Laboratory investigation showed increased bilirrubin (10 mg/dL, alkaline phosphatase and GGT. Abdominal ultrasound showed atrophic gallbladder with dilated intra and extrahepatic biliary tree. Computerized tomography scan disclosed enlarged biliary tree with 3 cm stone in the distal common bile duct. The patient underwent a laparoscopic cholecystectomy

  1. A rare combination of an endocrine tumour of the common bile duct and a follicular lymphoma of the ampulla of Vater: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Ryzman-Louloudis Charlotte

    2011-01-01

    Full Text Available Abstract Carcinoid tumours of the common bile duct represent an extremely rare entity. Similarly, primary follicular lymphomas of the ampulla of Vater constitute an infrequent neoplasia. Herein, we report the first case of a synchronous development of a carcinoid tumour of the common bile duct and an ampullary follicular lymphoma that was treated surgically with a Whipple's procedure, due to inability to establish definitive preoperative diagnosis despite the extensive diagnostic investigation.

  2. 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.)

  3. 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...

  4. Ischemia reperfusion of the hepatic artery induces the functional damage of large bile ducts by changes in the expression of angiogenic factors.

    Science.gov (United States)

    Mancinelli, Romina; Glaser, Shannon; Francis, Heather; Carpino, Guido; Franchitto, Antonio; Vetuschi, Antonella; Sferra, Roberta; Pannarale, Luigi; Venter, Julie; Meng, Fanyin; Alpini, Gianfranco; Onori, Paolo; Gaudio, Eugenio

    2015-12-01

    Liver transplantation and cholangiocarcinoma induce biliary dysfunction following ischemia reperfusion (IR). The function of the intrahepatic biliary tree is regulated by both autocrine and paracrine factors. The aim of the study was to demonstrate that IR-induced damage of cholangiocytes is associated with altered expression of biliary angiogenic factors. Normal and bile duct ligation rats underwent 24-h sham or hepatic reperfusion after 30 min of transient occlusion of the hepatic artery (HAIR) or portal vein (PVIR) before collecting liver blocks and cholangiocyte RNA or protein. We evaluated liver histology, biliary apoptosis, proliferation and expression of VEGF-A/C, VEGFR-2/3, Ang-1/2, and Tie-1/2 in liver sections and isolated small and large cholangiocytes. Normal rat intrahepatic cholangiocyte cultures (NRICC) were maintained under standard conditions in normoxic or under a hypoxic atmosphere for 4 h and then transferred to normal conditions for selected times. Subsequently, we measured changes in biliary proliferation and apoptosis and the expression of VEGF-A/C and VEGFR-2/3. In vivo, HAIR (but not PVIR) induced damage of large bile ducts and decreased proliferation and secretin-stimulated cAMP levels. HAIR-induced damage of large bile ducts was associated with increased expression of VEGF-A/C, VEGFR-2/3, Ang-1/2, and Tie-1/2. In vitro, under hypoxic conditions, there was increased apoptosis and reduced proliferation of NRICC concomitant with enhanced expression of VEGF-A/C and VEGFR-2/3. The functional damage of large bile ducts by HAIR and hypoxia is associated with increased expression of angiogenic factors in small cholangiocytes, presumably due to a compensatory mechanism in response to biliary damage. PMID:26451003

  5. 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...

  6. Endoscopic papillary balloon dilatation may preserve sphincter of Oddi function after common bile duct stone management: evaluation from the viewpoint of endoscopic manometry

    OpenAIRE

    Sato, H; Kodama, T; Takaaki, J; Tatsumi, Y.; Maeda, T; Fujita, S; Fukui, Y.; H. Ogasawara; Mitsufuji, S

    1997-01-01

    Background—Endoscopic papillary balloon dilatation (EPBD) has been reported as a safe and effective alternative to endoscopic sphincterotomy in the management of common bile duct (CBD) stones; its effect on papillary function has yet to be elucidated. 
Aim—To investigate sphincter of Oddi (SO) motility before and after EPBD to determine its effect on SO function. 
Patients and methods—The papillary function of 10 patients with CBD stones was studied using endoscopic manometry befo...

  7. Biliary tree stem/progenitor cells in glands of extrahepatic and intraheptic bile ducts: an anatomical in situ study yielding evidence of maturational lineages

    OpenAIRE

    Carpino, Guido; Cardinale, Vincenzo; Onori, Paolo; Franchitto, Antonio; Berloco, Pasquale Bartolomeo; Rossi, Massimo; Wang, Yunfang; Semeraro, Rossella; Anceschi, Maurizio; Brunelli, Roberto; Alvaro, Domenico; Reid, Lola M.; Gaudio, Eugenio

    2011-01-01

    Stem/progenitors have been identified intrahepatically in canals of Hering and extrahepatically in glands of the biliary tree. Glands of the biliary tree (peribiliary glands: PBGs) are tubulo-alveolar glands with mucinous and serous acini, located deep within intrahepatic and extrahepatic bile ducts. We have shown that biliary tree stem/progenitors (BTSCs) are multipotent, giving rise in vitro and in vivo to hepatocytes, cholangiocytes or pancreatic islets. Cells with the phenotype of BTSCs a...

  8. 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)

  9. Roles of myofibroblasts and notch and hedgehog signaling pathways in the formation of intrahepatic bile duct lesions in polycystic kidney rats.

    Science.gov (United States)

    Furubo, Shinichi; Sato, Yasunori; Harada, Kenichi; Nakanuma, Yasuni

    2013-01-01

    Polycystic kidney (PCK) rats, an animal model of Caroli's disease, show a dilatation of intrahepatic bile ducts (IHBD) called "ductal plate malformation." Mesenchymal cells and the Notch and Hedgehog signaling pathways in portal tracts are reportedly involved in the normal development of IHBD, although there have been no studies on the roles of these signaling pathways in PCK rats. We immunohistochemically examined the expression of the molecules related to these signaling pathways in portal tracts. All molecules related to these signaling pathways expressed in portal tracts in Sprague Dawley (SD) rats (control) were also expressed in PCK rats. Mesenchymal cells (myofibroblasts) were frequently found in the connective tissue of portal tracts of 20 embryonic-day-old (E20D), 1-day-old (1D), and 1-week-old (1W) SD and PCK rats and were abundant in PCK rats. Interestingly, myofibroblasts almost disappeared at in both strains of 3W rats. Jagged1 was expressed in mesenchymal cells in portal tracts and was abundant in PCK rats. Double immunostaining showed that Jagged1-positive cells were myofibroblasts. Notch2 and HES1 were expressed in cholangiocytes of the bile ducts of both rats. Sonic Hedgehog was similarly expressed in the bile ducts of both rats. A well-balanced and time-sequential expression of the Notch and Hedgehog family in portal tracts might be essential for the normal development of IHBD in E20D to 1W SD rats, and an imbalanced interaction of these molecules, particularly increased Jagged1 expression in periductal and periportal myofibroblasts and Notch2 expressed in cholangiocytes, may be involved in the formation of bile duct lesions in PCK rats. PMID:23331119

  10. Hepatic metastasis from bile duct cancer of the ampulla is effectively controlled by multidisciplinary treatment including S-1, gemcitabine and bevacizumab: A case report

    OpenAIRE

    TOKUNAGA, YUKIHIKO; KAWASAKI, TOSHIHIKO; Sasaki, Hirokazu; MATSUEDA, SHIGEKI; SAITO, TOHRU

    2010-01-01

    The liver is the most common site for recurrent metastases from bile duct cancer (BDC) in the ampullary area. However, the optimal chemotherapy regimen for recurrent hepatic metastases has not yet been established. An oral combined fluoropyrimidine drug, S-1 (tegafur, gimeracil and oteracil), has recently been introduced alone or in combination with gemcitabine for BDC. A 67-year-old man underwent a pancreaticoduodenectomy (PD) for early stage distal BDC in the ampullary area. A small hepatic...

  11. Combined percutaneous and intraductal radiotherapy. Established method of therapy of bile duct carcinomas. Kombinierte perkutane und intraduktale Strahlentherapie. Fester Platz in der Behandlung von Gallengangskarzinomen

    Energy Technology Data Exchange (ETDEWEB)

    Freund, U. (Radio-Onkologische Klinik, Offenburg (Germany)); Brambs, H.J. (Chirurgische Universitaetsklinik, Heidelberg (Germany). Roentgendiagnostische Abt.); Bruggmoser, G. (Universitaetsklinik Freiburg (Germany). Abt. Strahlentherapie)

    1991-06-01

    Treatment of an inoperable bile duct carcinoma with combined percutaneous and intraductal high dose rate afterloading radiotherapy seems to become a standard within the treatment plan. Via a percutaneous, transhepatic drainage a flexible tube will be inserted, reaching the area of the tumor stenosis, and then a computer controlled Iridium{sup 192}-source will be positioned adequately. Encouraging first results 12-16 months from therapy seem to justify the sophisticated therapeutic method. (orig.).

  12. Intra-Operative vs Pre-Operative Endoscopic Sphincterotomy in Patients with Gallbladder and Common Bile Duct Stones: Cost-Utility and Value-of-Information Analysis

    OpenAIRE

    Kurinchi Gurusamy; Edward Wilson; Burroughs, Andrew K; Davidson, Brian R

    2012-01-01

    Background: Patients with gallbladder and common bile duct stones are generally treated by pre-operative endoscopic sphincterotomy (ES) followed by laparoscopic cholecystectomy (POES). Recently, a meta-analysis has shown that intra-operative ES during laparoscopic cholecystectomy (IOES) results in fewer complications than POES, with similar efficacy. The cost effectiveness of IOES versus POES is unknown. Objective: The objective of this study was to compare the cost effectiveness of IOES vers...

  13. 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.

  14. Oleanolic acid alters bile acid metabolism and produces cholestatic liver injury in mice

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Jie, E-mail: JLiu@kumc.edu [University of Kansas Medical Center, Kansas City, KS 66160 (United States); Zunyi Medical College, Zunyi 563003 (China); Lu, Yuan-Fu [University of Kansas Medical Center, Kansas City, KS 66160 (United States); Zunyi Medical College, Zunyi 563003 (China); Zhang, Youcai; Wu, Kai Connie [University of Kansas Medical Center, Kansas City, KS 66160 (United States); Fan, Fang [Cytopathology, University of Kansas Medical Center, Kansas City, KS 66160 (United States); Klaassen, Curtis D. [University of Kansas Medical Center, Kansas City, KS 66160 (United States)

    2013-11-01

    Oleanolic acid (OA) is a triterpenoids that exists widely in plants. OA is effective in protecting against hepatotoxicants. Whereas a low dose of OA is hepatoprotective, higher doses and longer-term use of OA produce liver injury. This study characterized OA-induced liver injury in mice. Adult C57BL/6 mice were given OA at doses of 0, 22.5, 45, 90, and 135 mg/kg, s.c., daily for 5 days, and liver injury was observed at doses of 90 mg/kg and above, as evidenced by increases in serum activities of alanine aminotransferase and alkaline phosphatase, increases in serum total bilirubin, as well as by liver histopathology. OA-induced cholestatic liver injury was further evidenced by marked increases of both unconjugated and conjugated bile acids (BAs) in serum. Gene and protein expression analysis suggested that livers of OA-treated mice had adaptive responses to prevent BA accumulation by suppressing BA biosynthetic enzyme genes (Cyp7a1, 8b1, 27a1, and 7b1); lowering BA uptake transporters (Ntcp and Oatp1b2); and increasing a BA efflux transporter (Ostβ). OA increased the expression of Nrf2 and its target gene, Nqo1, but decreased the expression of AhR, CAR and PPARα along with their target genes, Cyp1a2, Cyp2b10 and Cyp4a10. OA had minimal effects on PXR and Cyp3a11. Taken together, the present study characterized OA-induced liver injury, which is associated with altered BA homeostasis, and alerts its toxicity potential. - Highlights: • Oleanolic acid at higher doses and long-term use may produce liver injury. • Oleanolic acid increased serum ALT, ALP, bilirubin and bile acid concentrations. • OA produced feathery degeneration, inflammation and cell death in the liver. • OA altered bile acid homeostasis, affecting bile acid synthesis and transport.

  15. Oleanolic acid alters bile acid metabolism and produces cholestatic liver injury in mice

    International Nuclear Information System (INIS)

    Oleanolic acid (OA) is a triterpenoids that exists widely in plants. OA is effective in protecting against hepatotoxicants. Whereas a low dose of OA is hepatoprotective, higher doses and longer-term use of OA produce liver injury. This study characterized OA-induced liver injury in mice. Adult C57BL/6 mice were given OA at doses of 0, 22.5, 45, 90, and 135 mg/kg, s.c., daily for 5 days, and liver injury was observed at doses of 90 mg/kg and above, as evidenced by increases in serum activities of alanine aminotransferase and alkaline phosphatase, increases in serum total bilirubin, as well as by liver histopathology. OA-induced cholestatic liver injury was further evidenced by marked increases of both unconjugated and conjugated bile acids (BAs) in serum. Gene and protein expression analysis suggested that livers of OA-treated mice had adaptive responses to prevent BA accumulation by suppressing BA biosynthetic enzyme genes (Cyp7a1, 8b1, 27a1, and 7b1); lowering BA uptake transporters (Ntcp and Oatp1b2); and increasing a BA efflux transporter (Ostβ). OA increased the expression of Nrf2 and its target gene, Nqo1, but decreased the expression of AhR, CAR and PPARα along with their target genes, Cyp1a2, Cyp2b10 and Cyp4a10. OA had minimal effects on PXR and Cyp3a11. Taken together, the present study characterized OA-induced liver injury, which is associated with altered BA homeostasis, and alerts its toxicity potential. - Highlights: • Oleanolic acid at higher doses and long-term use may produce liver injury. • Oleanolic acid increased serum ALT, ALP, bilirubin and bile acid concentrations. • OA produced feathery degeneration, inflammation and cell death in the liver. • OA altered bile acid homeostasis, affecting bile acid synthesis and transport

  16. 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

  17. 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.

  18. 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.

  19. Visual characteristics of the papilla to estimate cannulation of the common bile duct – a pilot study

    Directory of Open Access Journals (Sweden)

    Ina Zuber-Jerger

    2009-07-01

    Full Text Available Objectives: Performance of endoscopic retrograde cholangiography (ERC depends mainly on the skills of the examiner, but also on anatomical variants. The aim of the study was to investigate patient-, and papilla-related factors for the successful selective cannulation of the common bile duct (CBD. Patients and methods: 50 patients with a papilla with no prior sphincterotomy needing an ERC were enrolled. From a standardized description given by the endoscopist, criteria to characterize the papilla were analyzed. Results: Success was achieved in 92%. Cannulation time was 460 +/- 561 seconds on average. 70% of the papillae were mastered in 300 seconds or less. Concordance between endoscopists concerning descriptive variables was between 86% and 100%. The judgment of the endoscopist concerning expected difficulty was not significantly related to success, demonstrating the necessity of predictive parameters. Typical position of the duodenoscope and performance of precut were significantly related to success. The joint presence of a visible orifice and a typical position of the duodenoscope had a positive predictive value (PPV of 96%. Conclusions: Endoscopists can rely on the joint presence of a visible orifice of the papilla and a typical position of the duodenoscope in X-ray to predict success of ERC.

  20. Detection of common bile duct stones: comparison between endoscopic ultrasonography, magnetic resonance cholangiography, and helical-computed-tomographic cholangiography

    International Nuclear Information System (INIS)

    Objectives: New modalities, namely, endoscopic ultrasonography (EUS), magnetic resonance cholangiopancreatography (MRCP), and helical computed-tomographic cholangiography (HCT-C), have been introduced recently for the detection of common bile duct (CBD) stones and shown improved detectability compared to conventional ultrasound or computed tomography. We conducted this study to compare the diagnostic ability of EUS, MRCP, and HCT-C in patients with suspected choledocholithiasis. Methods: Twenty-eight patients clinically suspected of having CBD stones were enrolled, excluding those with cholangitis or a definite history of choledocholithiasis. Each patient underwent EUS, MRCP, and HCT-C prior to endoscopic retrograde cholangio-pancreatography (ERCP), the result of which served as the diagnostic gold standard. Results: CBD stones were detected in 24 (86%) of 28 patients by ERCP/IDUS. The sensitivity of EUS, MRCP, and HCT-C was 100%, 88%, and 88%, respectively. False negative cases for MRCP and HCT-C had a CBD stone smaller than 5 mm in diameter. No serious complications occurred while one patient complained of itching in the eyelids after the infusion of contrast agent on HCT-C. Conclusions: When examination can be scheduled, MRCP or HCT-C will be the first choice because they were less invasive than EUS. MRCP and HCT-C had similar detectability but the former may be preferable considering the possibility of allergic reaction in the latter. When MRCP is negative, EUS is recommended to check for small CBD stones

  1. 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...

  2. Protective effect of the roots extract of Platycodon grandiflorum on bile duct ligation-induced hepatic fibrosis in rats.

    Science.gov (United States)

    Lim, J-H; Kim, T-W; Song, I-B; Park, S-J; Kim, M-S; Cho, E-S; Jung, J-Y; Son, H-Y; Kim, J-W; Yun, H-I

    2013-11-01

    The aim of the present study was to evaluate the protective effect of aqueous extract from Platycodon grandiflorum (BC703) on bile duct ligation (BDL)-induced hepatic fibrosis in rats. BDL rats were divided into three groups, which orally received distilled water or BC703 (10 or 50 mg/kg/day) for consecutive 28 days. Antifibrotic effects of BC703 on BDL-induced hepatic fibrosis in rats were estimated by assessing serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), blood urea nitrogen (BUN), transforming growth factor-beta 1 (TGF-β1) and hepatic levels of malondialdehyde (MDA), glutathione (GSH), total superoxide dismutase (SOD) and nitric oxide (NO). The biochemical observations were supplemented by histopathological examination of liver samples stained with hematoxylin and eosin and Masson's trichrome stain. ALT, AST, TBIL and BUN were elevated in the group treated with BDL alone than in the sham-operated group. These elevations were significantly decreased by BC703 treatment. Hepatic GSH and SOD levels, depressed by BDL, were also increased in the BC703 group. In addition, increases in hepatic MDA and NO levels in the BDL-induced cholestasis were attenuated by BC703 treatment. Furthermore, BC703 treatment significantly reduced the serum level of fibrogenic cytokine, TGF-β1. Histopathological studies further substantiated the protective effect of BC703 on BDL-induced hepatic fibrosis in rat. BC703 may have beneficial effects not only on hepatic fibrosis by cholestasis but also on hepatic fibrosis development in patients with chronic hepatic disease. PMID:23424213

  3. 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.

  4. 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.

  5. A Frequent PNPLA3 Variant Is a Sex Specific Disease Modifier in PSC Patients with Bile Duct Stenosis

    Science.gov (United States)

    Hov, Johannes Roksund; Steinebrunner, Niels; Weiss, Karl-Heinz; Stiehl, Adolf; Brune, Maik; Schaefer, Petra Kloeters Yvonne; Schemmer, Peter; Sauer, Peter; Schirmacher, Peter; Runz, Heiko; Karlsen, Tom Hemming; Stremmel, Wolfgang; Gotthardt, Daniel Nils

    2013-01-01

    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. PMID:23505555

  6. 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

  7. 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.

  8. 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.

  9. 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.

  10. The Pathology of IgG4-Related Disease in the Bile Duct and Pancreas.

    Science.gov (United States)

    Zen, Yoh

    2016-08-01

    Immunoglobulin G4-related disease (IgG4-RD) in the pancreatobiliary system manifests as sclerosing cholangitis (SC), hepatic inflammatory pseudotumors, and type 1 autoimmune pancreatitis (AIP). The pathology of IgG4-RD involves an inflammatory process and fibrogenic pathway, the combination of which damages the affected organs. Fibroinflammatory injury is characterized by three microscopic findings: a diffuse lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, obliterative phlebitis, and storiform fibrosis. Although the diagnosis of IgG4-related pancreatocholangitis is relatively straightforward in surgical specimens, the current clinical requirement is to diagnose patients using biopsy samples, which remains challenging. Histological differential diagnoses include primary SC, follicular cholangitis/pancreatitis, SC with granulocytic epithelial lesions, and type 2 AIP. Although the massive infiltration of IgG4-positive plasma cells is a histological hallmark of IgG4-RD, many other immune cells (e.g., Th2 lymphocytes, regulatory T cells, and M2 macrophages) appear to be strongly involved in orchestral immune reactions. PMID:27466794

  11. Intrabiliary radiation inhibits smooth muscle formation and biliary duct remodelling after balloon overstretching injury in dogs

    Institute of Scientific and Technical Information of China (English)

    何贵金; 高沁怡; 莫宾; 戴显伟; 姜维国; 孙铎; 陈平健

    2004-01-01

    Background Internal metallic stents have been widely used in clinical practice, but a high postoperative restenosis rate limits its application. The purpose of this study was to determine the effect of intrabiliary radiation on muscle formation and biliary duct remodeling after biliary duct balloon injury in dogs. Methods Twenty male dogs (15-20 kg) were randomly divided into treatment group (n=10) and control group (n=10). Balloon overstretching injury was induced using a balloon catheter placed across the biliary duct. Subsequently, a 103Pd radioactive stent was positioned at the target site in each animal in the treatment group, providing the injured biliary duct with a radiation dose of 12.58×107 Bq. Dogs in the control group received Ni-Ti stents. All the dogs were killed one month after initial injury. The injured sections were dissected free from the dogs, and were processed for histological and morphological study. Cross-sections were stained with hematoxylin-eosin, Masson's trichrome, and Verhoef-van Giesen. Muscle formation area and lumen area were determined using a computer-assisted image analysis system. Results Compared with the control group, 103Pd radioactive stents significantly reduced muscle formation area (78.3%, P<0.01), and percentage area of stenosis [control stents: (60.0±21.6)%, 103Pd radioactive stents: (31.6±9.5)%]. In addition, in the treatment group, the biliary duct lumen area was significantly larger than that in the control group (P<0.01). Conclusions 103Pd radioactive stents providing a radioactive dose of 12.58×107 Bq are effective in reducing muscle formation and biliary duct remodeling after balloon overstretching injury.

  12. Peristaltic flow of a fluid in a porous channel: A study having relevance to flow of bile within ducts in a pathological state

    CERN Document Server

    Maiti, S; 10.1016/j.ijengsci.2011.05.006

    2011-01-01

    The paper deals with a theoretical study of the transport of a fluid in a channel, which takes place by the phenomenon of peristalsis. A mathematical analysis of the said problem has been presented. The analysis involves the application of a suitable perturbation technique. The velocity profile and the critical pressure for the occurrence of reflux are investigated with particular emphasis by using appropriate numerical methods. The effects of various parameters, such as Reynolds number, pressure gradient, porosity parameter, Darcy number, slip parameter, amplitude ratio and wave number on velocity and critical pressure for reflux are investigated in detail. The computed results are compared with a previous analytical work and an experimental investigation reported earlier in existing scientific literatures. The results of the present study are in conformity to both of them. The study has got some relevance to the physiological flow of bile in the common bile duct in a pathological state. It reveals that in t...

  13. Complications of high grade liver injuries: management and outcomewith focus on bile leaks

    Directory of Open Access Journals (Sweden)

    Bala Miklosh

    2012-03-01

    Full Text Available Abstract Background Although liver injury scale does not predict need for surgical intervention, a high-grade complex liver injury should alert the physician to expect an increased risk of hepatic complications following trauma. The aim of the current study was to define hepatic related morbidity in patients sustaining high-grade hepatic injuries that could be safely managed non-operatively. Patients and methods This is a retrospective study of patients with liver injury admitted to Hadassah-Hebrew University Medical Centre over a 10-year period. Grade 3-5 injuries were considered to be high grade. Collected data included the number and types of liver-related complications. Interventions which were required for these complications in patients who survived longer than 24 hours were analysed. Results Of 398 patients with liver trauma, 64 (16% were found to have high-grade liver injuries. Mechanism of injury was blunt trauma in 43 cases, and penetrating in 21. Forty patients (62% required operative treatment. Among survivors 22 patients (47.8% developed liver-related complications which required additional interventional treatment. Bilomas and bile leaks were diagnosed in 16 cases post-injury. The diagnosis of bile leaks was suspected with abdominal CT scan, which revealed intraabdominal collections (n = 6, and ascites (n = 2. Three patients had continuous biliary leak from intraabdominal drains left after laparotomy. Nine patients required ERCP with biliary stent placement, and 2 required percutaneous transhepatic biliary drainage. ERCP failed in one case. Four angioembolizations (AE were performed in 3 patients for rebleeding. Surgical treatment was found to be associated with higher complication rate. AE at admission was associated with a significantly higher rate of biliary complications. There were 24 deaths (37%, the majority from uncontrolled haemorrhage (18 patients. There were only 2 hepatic-related mortalities due to liver failure

  14. Role of ion transporters in the bile acid-induced esophageal injury.

    Science.gov (United States)

    Laczkó, Dorottya; Rosztóczy, András; Birkás, Klaudia; Katona, Máté; Rakonczay, Zoltán; Tiszlavicz, László; Róka, Richárd; Wittmann, Tibor; Hegyi, Péter; Venglovecz, Viktória

    2016-07-01

    Barrett's esophagus (BE) is considered to be the most severe complication of gastro-esophageal reflux disease (GERD), in which the prolonged, repetitive episodes of combined acidic and biliary reflux result in the replacement of the squamous esophageal lining by columnar epithelium. Therefore, the acid-extruding mechanisms of esophageal epithelial cells (EECs) may play an important role in the defense. Our aim was to identify the presence of acid/base transporters on EECs and to investigate the effect of bile acids on their expressions and functions. Human EEC lines (CP-A and CP-D) were acutely exposed to bile acid cocktail (BAC) and the changes in intracellular pH (pHi) and Ca(2+) concentration ([Ca(2+)]i) were measured by microfluorometry. mRNA and protein expression of ion transporters was investigated by RT-PCR, Western blot, and immunohistochemistry. We have identified the presence of a Na(+)/H(+) exchanger (NHE), Na(+)/HCO3 (-) cotransporter (NBC), and a Cl(-)-dependent HCO3 (-) secretory mechanism in CP-A and CP-D cells. Acute administration of BAC stimulated HCO3 (-) secretion in both cell lines and the NHE activity in CP-D cells by an inositol triphosphate-dependent calcium release. Chronic administration of BAC to EECs increased the expression of ion transporters compared with nontreated cells. A similar expression pattern was observed in biopsy samples from BE compared with normal epithelium. We have shown that acute administration of bile acids differently alters ion transport mechanisms of EECs, whereas chronic exposure to bile acids increases the expression of acid/base transporters. We speculate that these adaptive processes of EECs represent an important mucosal defense against the bile acid-induced epithelial injury. PMID:27198194

  15. 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

  16. Bile Duct Exploration

    Science.gov (United States)

    ... Health Centers Emergency Departments Urgent Care Express Care Clinics Pharmacy Imaging & Radiology Labs Pediatrics International All Points of Interest on Main Campus Dining Lodging Parking Shopping Transportation ... & Plastic Surgery Digestive Disease & Surgery Endocrinology & ...

  17. 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.

  18. Bile duct endoprostheses

    Energy Technology Data Exchange (ETDEWEB)

    Billmann, P.; Hoppe-Seyler, P.; Brambs, H.J.

    1985-05-01

    Percutaneous transhepatic biliary drainage is a proven method for treating obstructive jaundice due to malignancy. However, the rate of complications for primary internal drainage is relatively high. Consequently, various types of biliary endoprostheses which can be introduced transhepatically or endoscopically have been developed. These prostheses also have serious disadvantages: there is a high risk of dislocation or obstruction. The present paper describes the technique of combined endoscopic-radiological introduction of large biliary prostheses and discusses the advantages of this method.

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

    Science.gov (United States)

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

    2015-07-01

    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 examination confirmed the correspondence of CT images with the microvascular morphology of the samples. By means of the PCI-CT and three-dimensional (3D) visualization technique, 3D microvascular structures in samples from different stages of liver fibrosis were clearly revealed. Different types of blood vessels, including portal veins and hepatic veins, in addition to ductular proliferation and bile ducts, could be distinguished with good sensitivity, excellent specificity and excellent accuracy. The study showed that PCI-CT could assess the morphological changes in liver microvasculature that result from fibrosis and allow characterization of the anatomical and pathological features of the microvasculature. With further development of PCI-CT technique, it may become a novel noninvasive imaging technique for the auxiliary analysis of liver fibrosis.

  20. 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.)

  1. Percutaneous transhepatic intraductal biliary sonography for lymph node staging at 12.5 MHz in malignant bile duct obstruction: Work in progress

    International Nuclear Information System (INIS)

    Purpose. To assess the value of intraductal ultrasound (US) for lymph node staging in malignant biliary obstruction. Methods, Eighteen patients with malignant extrahepatic obstruction were imaged during percutaneous bile duct drainage with a mechanically rotating US transducer at 12.5 MHz. Detectable lymph nodes were classified as malignant when two of three criteria (hypoechoic, rounded, conspicuous margins) were fulfilled. The results were compared with histopathological data in 8 patients and follow-up CT findings in 10 patients. Results. In 15 of 18 patients (83%) malignant lymph node involvement was suspected at intraductal US and in 5 of 18 patients (28%) during CT. Histopathological investigation after operation (n=8) and follow-up CT studies (n=10) revealed the presence of malignant nodal involvement in 13 of 18 (72%) patients. The sensitivity, specificity, and accuracy of transhepatic intraductal biliary US in determining merely the presence or absence of malignant lymph nodes without specific topographic assignment were 92%, 40%, and 78%, respectively. Conclusion. These preliminary results suggest that intraductal US may develop into a promising adjunctive modality during percutaneous bile duct drainage in patients with suspected malignant regional lymph node involvement

  2. Single Balloon Enteroscopy-Assisted ERCP Using Rendezvous Technique for Sharp Angulation of Roux-en-Y Limb in a Patient with Bile Duct Stones

    Directory of Open Access Journals (Sweden)

    Takao Itoi

    2009-01-01

    Full Text Available The acute angulation of Roux-en-Y (R-Y limb precludes endoscopic access for endoscopic retrograde cholangiopancreatography (ERCP even using a balloon enteroscopy. Here, we describe a case of successful single balloon enteroscopy (SBE-assisted ERCP using a rendezvous technique in a patient with sharply angulated R-Y limb in a 79-year-old woman who had bile duct stones. Method. At first, a guidewire was passed antegradely through the major papilla after the needle puncture using percutaneous transhepatic biliary drainage technique. A hydrophilic guidewire with an ERCP catheter was antegradely advanced beyond the Roux limb. After a guidewire was firmly grasped by a snare forceps, it was pulled out of the body, resulting that the enteroscope could advance to the papilla. After papillary dilation, complete removal of bile duct stones was achieved without any procedure-related complication. In conclusion, although further study is needed, SBE-assisted ERCP using a rendezvous technique may have a potential for selected patients.

  3. 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.)

  4. Pancreatic Duct Glands are Distinct Ductal Compartments that React to Chronic Injury and Mediate Shh-induced Metaplasia

    OpenAIRE

    STROBEL, OLIVER; Rosow, David E.; Rakhlin, Elena Y.; Lauwers, Gregory Y; Trainor, Amanda G.; Alsina, Janivette; Fernández–Del Castillo, Carlos; Warshaw, Andrew Louis; Thayer, Sarah P.

    2009-01-01

    BACKGROUND & AIMS: Pancreatic intraepithelial neoplasia (PanIN) are pancreatic cancer precursor lesions of unclear origin and significance. PanIN aberrantly express sonic hedgehog (Shh), an initiator of pancreatic cancer, and gastrointestinal mucins. A majority of PanIN are thought to arise from ducts. We identified a novel ductal compartment that is gathered in gland-like outpouches (pancreatic duct glands [PDG]) of major ducts and characterized its role in injury and metaplasia. METHODS: Th...

  5. Oxidative stress markers, secondary bile acids and sulfated bile acids classify the clinical liver injury type: Promising diagnostic biomarkers for cholestasis.

    Science.gov (United States)

    Masubuchi, Noriko; Sugihara, Masahiro; Sugita, Tomonori; Amano, Katsushi; Nakano, Masanori; Matsuura, Tomokazu

    2016-08-01

    Clinicians sometimes encounter difficulty in choosing a therapeutic strategy due to the uncertainty regarding the type of liver injury. In particular, cholestasis is difficult to diagnose by conventional markers at an early stage of disease. The aim of this study was to identify promising biomarkers for distinguishing the symptom-based types of liver injury (e.g. hepatocellular injury, cholestasis), which was derived from a rigorously statistical perspective. The associations between diagnostic biomarkers (e.g. bile acid components, oxidative stress markers and liver fibrosis markers) and the liver injury types were assessed by a multiple logistic regression analysis using 304 blood samples from patients with liver disease. As a result, reductions in the lithocholic acid (LCA) and deoxycholic acid (DCA) levels, and elevation of the serum sulfated bile acid (SSBA), liver fibrosis marker IV collagen (type IV collagen), hyaluronic acid (HA) and reactive oxygen species (ROS) levels were all significantly associated with cholestasis. On the other hand, elevations in the LCA and type IV collagen levels, and a reduction in the ursodeoxy cholic acid (UDCA) level, were significantly associated with hepatocellular injury. The receiver operating characteristic (ROC) analyses showed that the largest area under the ROC curve (AUC) was found for ROS, followed by DCA, HA, LCA, SSBA and type IV collagen in the cholestatic-type cases. These results indicated that ROS, the secondary bile acid levels such as DCA and LCA, and SSBA are promising biomarkers for cholestasis and for classifying the type of liver injuries. This comprehensive approach will allow for an accurate diagnosis, which will facilitate the selection of an appropriate therapy at the onset of disease. PMID:26325587

  6. Endoscopic management of pancreatic duct injury by endoscopic stent placement: a case report and literature review

    Directory of Open Access Journals (Sweden)

    Ito Yasuhiro

    2012-07-01

    Full Text Available Abstract Recently, the diagnostic evaluation of pancreatic injury has improved dramatically. On the other hand, it is occasionally difficult to diagnose pancreatic injury, because there are no specific signs, symptoms, or laboratory findings. Radiological imaging also often fails to identify pancreatic injury in the acute phase. Delayed diagnosis results in significant morbidity and mortality. Most cases of pancreatic injury with suspicion or pancreatic duct disruption require surgery. Endoscopic retrograde cholangiopancreatography is one of the most accurate modalities for ductal evaluation and therapy and might enable one to avoid unnecessary surgery. We describe endoscopic management of pancreatic duct injury by endoscopic stent placement. A 45-year-old woman was admitted after a traffic accident. A computed tomography scan showed pancreatic parenchyma disruption at the pancreatic head. Endoscopic retrograde cholangiopancreatography demonstrated disruption of the pancreatic duct with extravasation into the peripancreatic fluid collection. A 5-French endoscopic nasopancreatic drainage (ENPD tube was placed. Her symptoms dramatically improved. ENPD tube was exchanged for a 5-French 5-cm pancreatic stent. Subsequent follow-up CT revealed remarkable improvement. On the 26th day, the patient was discharged from the hospital without symptoms or complications. In this report, a pancreatic stent may lead to rapid clinical improvement and enable surgery to be avoided. On the other hand, the reported complications of long-term follow-up make the role of stenting uncertain. Thus, close attention should be paid to stenting management in the follow-up period. A pancreatic stent is useful for pancreatic ductal injury. If pancreatic ductal injury is managed appropriately, a pancreatic stent may improve the clinical condition, and also prevent unnecessary surgery.

  7. Perturbation of bile acid homeostasis is an early pathogenesis event of drug induced liver injury in rats

    International Nuclear Information System (INIS)

    Drug-induced liver injury (DILI) is a significant consideration for drug development. Current preclinical DILI assessment relying on histopathology and clinical chemistry has limitations in sensitivity and discordance with human. To gain insights on DILI pathogenesis and identify potential biomarkers for improved DILI detection, we performed untargeted metabolomic analyses on rats treated with thirteen known hepatotoxins causing various types of DILI: necrosis (acetaminophen, bendazac, cyclosporine A, carbon tetrachloride, ethionine), cholestasis (methapyrilene and naphthylisothiocyanate), steatosis (tetracycline and ticlopidine), and idiosyncratic (carbamazepine, chlorzoxasone, flutamide, and nimesulide) at two doses and two time points. Statistical analysis and pathway mapping of the nearly 1900 metabolites profiled in the plasma, urine, and liver revealed diverse time and dose dependent metabolic cascades leading to DILI by the hepatotoxins. The most consistent change induced by the hepatotoxins, detectable even at the early time point/low dose, was the significant elevations of a panel of bile acids in the plasma and urine, suggesting that DILI impaired hepatic bile acid uptake from the circulation. Furthermore, bile acid amidation in the hepatocytes was altered depending on the severity of the hepatotoxin-induced oxidative stress. The alteration of the bile acids was most evident by the necrosis and cholestasis hepatotoxins, with more subtle effects by the steatosis and idiosyncratic hepatotoxins. Taking together, our data suggest that the perturbation of bile acid homeostasis is an early event of DILI. Upon further validation, selected bile acids in the circulation could be potentially used as sensitive and early DILI preclinical biomarkers. - Highlights: ► We used metabolomics to gain insights on drug induced liver injury (DILI) in rats. ► We profiled rats treated with thirteen hepatotoxins at two doses and two time points. ► The toxins decreased the

  8. 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.

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

    International Nuclear Information System (INIS)

    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

  10. 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.

  11. Do sensory neurons mediate adaptive cytoprotection of gastric mucosa against bile acid injury?

    Science.gov (United States)

    Mercer, D W; Ritchie, W P; Dempsey, D T

    1992-01-01

    Pretreatment with the mild irritant 1 mmol acidified taurocholate protects the gastric mucosa from the injury induced by the subsequent application of 5 mmol acidified taurocholate, a phenomenon referred to as "adaptive cytoprotection." How this occurs remains an enigma. The purpose of this study was to investigate the role of sensory neurons and mucus secretion in this phenomenon. Prior to injury with 5 mmol acidified taurocholate (pH 1.2), the stomachs of six groups of rats were subjected to the following protocol. Two groups were topically pretreated with either saline or the mild irritant 1 mmol acidified taurocholate. Two other groups received the topical anesthetic 1% lidocaine prior to pretreatment with either saline or 1 mmol acidified taurocholate. The last two groups got the mucolytic agent 10% N-acetylcysteine (NAC) after pretreatment with either saline or 1 mmol acidified taurocholate. Injury was assessed by measuring net transmucosal ion fluxes, luminal appearance of deoxyribonucleic acid (DNA), and gross and histologic injury. Pretreatment with the mild irritant 1 mmol acidified taurocholate significantly decreased bile acid-induced luminal ion fluxes and DNA accumulation, suggesting mucosal protection (corroborated by gross and histologic injury analysis). This effect was negated by lidocaine but not by NAC. Thus, it appears that sensory neurons, and not increased mucus secretion, play a critical role in adaptive cytoprotection. PMID:1733359

  12. 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

  13. 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

  14. [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

  15. 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.).

  16. Intraluminal hyperthermia and radiotherapy using {sup 192}Ir remote after loading system in the treatment of unresectable hilar bile duct cancer

    Energy Technology Data Exchange (ETDEWEB)

    Tsuchida, Akira; Itoh, Masaki; Fujii, Tohru [Hiroshima Univ. (Japan). School of Medicine] [and others

    1995-10-01

    The efficacy of combined therapy of intraluminal hyperthermia and radiotherapy using remote after loading system (RALS) was compared with that of percutaneous transhepatic biliary endoprosthesis (PTBE) alone. The subjects were 60 patients having unresectable hilar bile duct cancer. Percutaneous transhepatic biliary drainage (PTBD) was performed in the all patients, and additionally PTBE in 39, local infusion of bleomycin and intraluminal hyperthermia in 11, and internal irradiation (RALS) in 10. Four fractionated irradiation (4 Gy x 4) was performed on the site 10 mm from the source using {sup 192}Ir high dose RALS, and subsequently two fractionated brachytherapy of 10 Gy and 20 fractionated external irradiation of 40 Gy. The outcome was significantly improved in the RALS group, showing 50% survival time of 444.8 days (PTBE group, 228.7 days; hyperthermia group, 472 days). (S.Y.).

  17. Decreased biliary excretion of cefamandole after percutaneous biliary decompression in patients with total common bile duct obstruction.

    OpenAIRE

    Levi, J U; Martinez, O V; Malinin, T I; Zeppa, R; Livingstone, A.; Hutson, D; Calhoun, P.

    1984-01-01

    The biliary penetration of cefamandole was studied in six patients with total biliary obstruction before and after placement of a transhepatic bile drainage catheter. Biliary levels of cefamandole remained depressed even when the drug was administered as late as 7 days after decompression of the biliary tract.

  18. 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

  19. 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.

  20. Rats with mild bile duct ligation show hepatic encephalopathy with cognitive and motor impairment in the absence of cirrhosis: effects of alcohol ingestion.

    Science.gov (United States)

    Giménez-Garzó, Carla; Salhi, Dounia; Urios, Amparo; Ruíz-Sauri, Amparo; Carda, Carmen; Montoliu, Carmina; Felipo, Vicente

    2015-02-01

    Studies in animal models allow identifying mechanisms and treatments for cognitive and motor alterations in hepatic encephalopathy (HE). Liver diseases leading to HE in humans have different aetiologies (alcoholic, viral, etc.). The International Society for Hepatic Encephalopathy points out that satisfactory model for HE resulting from alcoholic cirrhosis are lacking. This work aimed to develop and characterize an animal model for HE in alcoholic liver cirrhosis. To potentiate the effects of alcohol on liver we administered it (5, 8 or 10% in drinking water) to rats showing mild liver damage induced by "mild" bile duct ligation (MBDL), obtained by sectioning 3 out of 5 bile ducts. MBDL rats show increased markers of cholestasis and liver damage, hyperammonemia and inflammation. MBDL rats also show motor in-coordination, hypokinesia, impaired learning ability in a Y maze and reduced spatial memory in the Morris water maze. Ingesting 10% ethanol does not induce relevant liver damage in control rats but potentiates liver damage in MBDL rats. In contrast, ethanol did not enhance the biochemical or neurological alterations in MBDL rats. This supports that the combination of certain levels of hyperammonemia and inflammation is enough to induce mild cognitive impairment, even in the absence of liver cirrhosis. Rats with MBDL and MBDL-OH survived more than 3 months, allowing performing long-term studies on cognitive and motor alterations and on underlying mechanisms. MBDL-OH rats are a good model to study the mechanisms of ethanol-induced liver cirrhosis and the factors making the liver susceptible to ethanol damage. PMID:24838616

  1. 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.

  2. Perturbation of bile acid homeostasis is an early pathogenesis event of drug induced liver injury in rats.

    Science.gov (United States)

    Yamazaki, Makoto; Miyake, Manami; Sato, Hiroko; Masutomi, Naoya; Tsutsui, Naohisa; Adam, Klaus-Peter; Alexander, Danny C; Lawton, Kay A; Milburn, Michael V; Ryals, John A; Wulff, Jacob E; Guo, Lining

    2013-04-01

    Drug-induced liver injury (DILI) is a significant consideration for drug development. Current preclinical DILI assessment relying on histopathology and clinical chemistry has limitations in sensitivity and discordance with human. To gain insights on DILI pathogenesis and identify potential biomarkers for improved DILI detection, we performed untargeted metabolomic analyses on rats treated with thirteen known hepatotoxins causing various types of DILI: necrosis (acetaminophen, bendazac, cyclosporine A, carbon tetrachloride, ethionine), cholestasis (methapyrilene and naphthylisothiocyanate), steatosis (tetracycline and ticlopidine), and idiosyncratic (carbamazepine, chlorzoxasone, flutamide, and nimesulide) at two doses and two time points. Statistical analysis and pathway mapping of the nearly 1900 metabolites profiled in the plasma, urine, and liver revealed diverse time and dose dependent metabolic cascades leading to DILI by the hepatotoxins. The most consistent change induced by the hepatotoxins, detectable even at the early time point/low dose, was the significant elevations of a panel of bile acids in the plasma and urine, suggesting that DILI impaired hepatic bile acid uptake from the circulation. Furthermore, bile acid amidation in the hepatocytes was altered depending on the severity of the hepatotoxin-induced oxidative stress. The alteration of the bile acids was most evident by the necrosis and cholestasis hepatotoxins, with more subtle effects by the steatosis and idiosyncratic hepatotoxins. Taking together, our data suggest that the perturbation of bile acid homeostasis is an early event of DILI. Upon further validation, selected bile acids in the circulation could be potentially used as sensitive and early DILI preclinical biomarkers. PMID:23360887

  3. Allopurinol and glutamine attenuate bacterial translocation in chronic portal hypertensive and common bile duct ligated growing rats.

    OpenAIRE

    Schimpl, G; Pesendorfer, P; Steinwender, G; Feierl, G; Ratschek, M; Höllwarth, M E

    1996-01-01

    BACKGROUND: Spontaneous bacterial infections and septicaemia result in morbidity and mortality in patients with portal hypertension and obstructive jaundice. AIM: The aim of this study in rats was to investigate the incidence of bacterial translocation in portal hypertension and obstructive jaundice, and to evaluate the effects of allopurinol and glutamine. METHODS: Rats were subjected to sham laparotomy (SL), portal hypertension (PH) by calibrated stenosis of the portal vein, and common bile...

  4. Impairment of Bilirubin Clearance and Intestinal Interleukin-6 Expression in Bile Duct-Ligated Vitamin D Receptor Null Mice

    OpenAIRE

    Ishizawa, Michiyasu; Ogura, Michitaka; Kato, Shigeaki; Makishima, Makoto

    2012-01-01

    The vitamin D receptor (VDR) mediates the physiological and pharmacological actions of 1α,25-dihydroxyvitamin D3 in bone and calcium metabolism, cellular growth and differentiation, and immunity. VDR also responds to secondary bile acids and belongs to the NR1I subfamily of the nuclear receptor superfamily, which regulates expression of xenobiotic metabolism genes. When compared to knockout mouse investigations of the other NR1I nuclear receptors, pregnane X receptor and constitutive androsta...

  5. Lesão iatrogênica de vias biliares Iatrogenic bile duct injuries

    Directory of Open Access Journals (Sweden)

    Guilherme Brasileiro de Aguiar

    2005-04-01

    Full Text Available OBJETIVO: O objetivo do presente estudo foi avaliar os casos de lesões iatrogênicas de vias biliares tratados na clínica cirúrgica do Hospital Getúlio Vargas - HGV nos últimos oito anos. MÉTODO: Foi realizada análise retrospectiva dos prontuários dos pacientes internados no HGV, com hipótese diagnóstica de lesão iatrogênica de vias biliares. Foram incluídos pacientes com lesões provenientes do próprio serviço e de outras instituições. Os prontuários foram revisados e obtidas as seguintes variáveis: procedência do paciente, idade, sexo, data da cirurgia inicial, sintomas, tempo de evolução, valores da bilirrubina, fosfatase alcalina, AST e ALT, TAP, creatinina, além da cirurgia realizada para correção da lesão, complicações, permanência hospitalar e condições do paciente na alta hospitalar. RESULTADOS: Foram confirmados 10 casos de lesão iatrogênica de vias biliares. Todos os paciente eram do sexo feminino, com idades variando entre 18 e 49 anos. Os sinais ou sintomas mais freqüentes foram icterícia, colúria e dor abdominal. Em relação à terapêutica cirúrgica, a hepático-jejunostomia em "Y" de Roux foi o procedimento mais empregado. CONCLUSÕES: As lesões iatrogênicas das vias biliares ainda representam um desafio para os cirurgiões e sua ocorrência está mais relacionada a procedimentos realizados em hospitais não especializados, por cirurgiões sem treinamento adequado. A principal medida a ser adotada é a prevenção da lesão. Após sua ocorrência, esta deve ser corrigida em hospitais com equipe médica treinada.BACKGROUND: The objective of this study was to evaluate the cases of iatrogenic lesions of the biliary tract treated in the surgical clinic at Getulio Vargas Hospital - GVH during the last eight years. METHODS: A retrospective analysis of the patients' charts admitted with the diagnosis of iatrogenic lesions of the biliary tract was performed. Patients with iatrogenic lesions originating from our service and from other institutions were included. The charts were reviewed for the following variables: origin of the patient, age, sex, date of first surgery, symptoms, time elapsed, bilirubin, alkaline phosphate, AST and ALT, TAP, creatine, surgery performed to correct the lesion, presence of complications, hospital stay and patient status on discharge. RESULTS: Ten cases of iatrogenic lesions of the biliary tract were confirmed. All patients were females, whose ages varied from 18 to 40. The most frequent signs and symptoms were icterus, chromaturia and abdominal pain. In regards to the corrective surgery, hepatic-jejunostomy in "Y" of Roux was the procedure most frequently used. CONCLUSION: Iatrogenic lesions of the biliary tract still represent a challenge to general surgeons. It is an occurrence more closely related to procedures performed in nonspecialized hospitals by surgeons without adequate training. The main measure to be taken is to prevent the damage. After the event, it should be corrected by a trained medical team in a well-equipped hospital.

  6. Risk Factors for Development of Cholestatic Drug-Induced Liver Injury: Inhibition of Hepatic Basolateral Bile Acid Transporters Multidrug Resistance-Associated Proteins 3 and 4

    OpenAIRE

    Köck, Kathleen; Ferslew, Brian C.; Netterberg, Ida; Yang, Kyunghee; Urban, Thomas J.; Swaan, Peter W.; Stewart, Paul W.; Brouwer, Kim L.R.

    2014-01-01

    Impaired hepatic bile acid export may contribute to development of cholestatic drug-induced liver injury (DILI). The multidrug resistance-associated proteins (MRP) 3 and 4 are postulated to be compensatory hepatic basolateral bile acid efflux transporters when biliary excretion by the bile salt export pump (BSEP) is impaired. BSEP inhibition is a risk factor for cholestatic DILI. This study aimed to characterize the relationship between MRP3, MRP4, and BSEP inhibition and cholestatic potentia...

  7. β-Cells Are Not Generated in Pancreatic Duct Ligation–Induced Injury in Adult Mice

    OpenAIRE

    Rankin, Matthew M.; Wilbur, Christopher J.; Rak, Kimberly; Shields, Emily J.; Granger, Anne; Kushner, Jake A.

    2013-01-01

    The existence of adult β-cell progenitors remains the most controversial developmental biology topic in diabetes research. It has been reported that β-cell progenitors can be activated by ductal ligation–induced injury of adult mouse pancreas and apparently act in a cell-autonomous manner to double the functional β-cell mass within a week by differentiation and proliferation. Here, we demonstrate that pancreatic duct ligation (PDL) does not activate progenitors to contribute to β-cell mass ex...

  8. Perturbation of bile acid homeostasis is an early pathogenesis event of drug induced liver injury in rats

    Energy Technology Data Exchange (ETDEWEB)

    Yamazaki, Makoto; Miyake, Manami; Sato, Hiroko; Masutomi, Naoya; Tsutsui, Naohisa [Mitsubishi Tanabe Pharma Corporation, Kisarazu, Chiba 292-0818 (Japan); Adam, Klaus-Peter; Alexander, Danny C.; Lawton, Kay A.; Milburn, Michael V.; Ryals, John A.; Wulff, Jacob E. [Metabolon Inc., 617 Davis Drive, Suite 400, Durham, NC 27713 (United States); Guo, Lining, E-mail: lguo@metabolon.com [Metabolon Inc., 617 Davis Drive, Suite 400, Durham, NC 27713 (United States)

    2013-04-01

    Drug-induced liver injury (DILI) is a significant consideration for drug development. Current preclinical DILI assessment relying on histopathology and clinical chemistry has limitations in sensitivity and discordance with human. To gain insights on DILI pathogenesis and identify potential biomarkers for improved DILI detection, we performed untargeted metabolomic analyses on rats treated with thirteen known hepatotoxins causing various types of DILI: necrosis (acetaminophen, bendazac, cyclosporine A, carbon tetrachloride, ethionine), cholestasis (methapyrilene and naphthylisothiocyanate), steatosis (tetracycline and ticlopidine), and idiosyncratic (carbamazepine, chlorzoxasone, flutamide, and nimesulide) at two doses and two time points. Statistical analysis and pathway mapping of the nearly 1900 metabolites profiled in the plasma, urine, and liver revealed diverse time and dose dependent metabolic cascades leading to DILI by the hepatotoxins. The most consistent change induced by the hepatotoxins, detectable even at the early time point/low dose, was the significant elevations of a panel of bile acids in the plasma and urine, suggesting that DILI impaired hepatic bile acid uptake from the circulation. Furthermore, bile acid amidation in the hepatocytes was altered depending on the severity of the hepatotoxin-induced oxidative stress. The alteration of the bile acids was most evident by the necrosis and cholestasis hepatotoxins, with more subtle effects by the steatosis and idiosyncratic hepatotoxins. Taking together, our data suggest that the perturbation of bile acid homeostasis is an early event of DILI. Upon further validation, selected bile acids in the circulation could be potentially used as sensitive and early DILI preclinical biomarkers. - Highlights: ► We used metabolomics to gain insights on drug induced liver injury (DILI) in rats. ► We profiled rats treated with thirteen hepatotoxins at two doses and two time points. ► The toxins decreased the

  9. Unexpected metastasis of intraductal papillary mucinous neoplasm of the bile duct into thoracic cavity with direct extension: Case report

    International Nuclear Information System (INIS)

    Intraductal papillary mucinous neoplasm (IPMN) is known to arise from intraductal proliferation of mucinous cells with findings of marked dilatation of the biliary or pancreatic duct. There are reports of the metastasis and extension of pancreatic IPMN. However, cases of biliary IPMN with direct metastasis, or metastasis to distant locations, are rare. We present a case of metastasis of biliary IPMN with unexpected direct extension into the thoracic cavity, and we attempt to account for the mechanism of this extension

  10. 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...

  11. 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.)

  12. 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

  13. Pyrazinamide Induced Rat Cholestatic Liver Injury through Inhibition of FXR Regulatory Effect on Bile Acid Synthesis and Transport.

    Science.gov (United States)

    Guo, Hong-Li; Hassan, Hozeifa M; Zhang, Yun; Dong, Si-Zhe; Ding, Ping-Ping; Wang, Tao; Sun, Li-Xin; Zhang, Lu-Yong; Jiang, Zhen-Zhou

    2016-08-01

    Pyrazinamide (PZA) is an indispensable first-line drug used for the treatment of tuberculosis which may cause serious hepatotoxicity; however, the mechanisms underlying these toxicities are poorly understood. Cholestasis plays an important role in drug-induced liver injury. Since there were no previous published works reported cholestasis and PZA hepatotoxicity relationship, this study aimed to identify whether PZA can induce liver injury with characterized evidences of cholestasis and to clarify expression changes of proteins related to both bile acid synthesis and transport in PZA-induced liver injury. PZA (2 g/kg) was administered for 7 consecutive days by oral gavage. Results showed there were 2-fold elevation in both ALT and AST serum levels in PZA-treated rats. In addition, a 10-fold increment in serum total bile acid was observed after PZA administration. The mRNA and protein expressions of bile acid synthesis and transport parameters were markedly altered, in which FXR, Bsep, Mrp2, Mdr2, Ostα/β, Oatp1a1, Oatp1b2, and Cyp8b1 were decreased (P < .05), while Mrp3, Ntcp, Oatp1a4, and Cyp7a1 were increased (P < .05). Moreover, treatment with the FXR agonist obeticholic acid (OCA) generated obvious reductions in serum ALT, AST, and TBA levels in PZA-treated rats. Those effects were due to transcriptional regulation of pre-mentioned target genes by OCA. Taken together, these results suggested that PZA-induced cholestatic liver injury was related to FXR inhibition, leading to the dysfunction in bile acid synthesis and transport. PMID:27255380

  14. Evaluation of the mitochondrial respiration of cardiac myocytes in rats submitted to mechanical bile duct obstruction Avaliação da respiração mitocondrial de miócitos cardíacos em ratos ictéricos sumetidos à obstrução do ducto biliar

    OpenAIRE

    Rafael Kemp; Orlando de Castro-e-Silva; José Sebastião dos Santos; Ajith Kumar Sankarankutty; Rodrigo Borges Correa; Caroline Floreoto Baldo; Maria Elisa Jordani Souza; Maria Cecilia Jordani

    2008-01-01

    PURPOSE: The objective of the present study was to evaluate the capacity of the myocardium for energy production by the analysis of mitochondrial respiration in rats with jaundice submitted to bile duct ligature. METHODS: Sixteen male Wistar rats were divided into 2 Groups: Group SO submitted to nontherapeutic laparotomy (sham operation) and Group IC (icteric group) submitted to bile duct ligature. After 7 days, laparotomy was again performed in all animals for cardiac muscle extraction and a...

  15. TGF-β-SMAD3 signaling mediates hepatic bile acid and phospholipid metabolism following lithocholic acid-induced liver injury.

    Science.gov (United States)

    Matsubara, Tsutomu; Tanaka, Naoki; Sato, Misako; Kang, Dong Wook; Krausz, Kristopher W; Flanders, Kathleen C; Ikeda, Kazuo; Luecke, Hans; Wakefield, Lalage M; Gonzalez, Frank J

    2012-12-01

    Transforming growth factor-β (TGFβ) is activated as a result of liver injury, such as cholestasis. However, its influence on endogenous metabolism is not known. This study demonstrated that TGFβ regulates hepatic phospholipid and bile acid homeostasis through MAD homolog 3 (SMAD3) activation as revealed by lithocholic acid-induced experimental intrahepatic cholestasis. Lithocholic acid (LCA) induced expression of TGFB1 and the receptors TGFBR1 and TGFBR2 in the liver. In addition, immunohistochemistry revealed higher TGFβ expression around the portal vein after LCA exposure and diminished SMAD3 phosphorylation in hepatocytes from Smad3-null mice. Serum metabolomics indicated increased bile acids and decreased lysophosphatidylcholine (LPC) after LCA exposure. Interestingly, in Smad3-null mice, the metabolic alteration was attenuated. LCA-induced lysophosphatidylcholine acyltransferase 4 (LPCAT4) and organic solute transporter β (OSTβ) expression were markedly decreased in Smad3-null mice, whereas TGFβ induced LPCAT4 and OSTβ expression in primary mouse hepatocytes. In addition, introduction of SMAD3 enhanced the TGFβ-induced LPCAT4 and OSTβ expression in the human hepatocellular carcinoma cell line HepG2. In conclusion, considering that Smad3-null mice showed attenuated serum ALP activity, a diagnostic indicator of cholangiocyte injury, these results strongly support the view that TGFβ-SMAD3 signaling mediates an alteration in phospholipid and bile acid metabolism following hepatic inflammation with the biliary injury. PMID:23034213

  16. Whipple Made Simple For Surgical Pathologists: Orientation, Dissection, and Sampling of Pancreaticoduodenectomy Specimens For a More Practical and Accurate Evaluation of Pancreatic, Distal Common Bile Duct, and Ampullary Tumors

    OpenAIRE

    Adsay, N. Volkan; Basturk, Olca; Saka, Burcu; Bagci, Pelin; Ozdemir, Denizhan; Balci, Serdar; Sarmiento, Juan M; Kooby, David A; Staley, Charles; Maithel, Shishir K; Everett, Rhonda; Cheng, Jeanette D.; Thirabanjasak, Duangpeng; Weaver, Donald W.

    2014-01-01

    Pancreaticoduodenectomy (PD) specimens present a challenge for surgical pathologists because of the relative rarity of these specimens, combined with the anatomic complexity. Here, we describe our experience on the orientation, dissection, and sampling of PD specimens for a more practical and accurate evaluation of pancreatic, distal common bile duct (CBD), and ampullary tumors. For orientation of PDs, identification of the “trapezoid,” created by the vascular bed at the center, the pancreati...

  17. Regulation of antibacterial defense in the small intestine by the nuclear bile acid receptor

    Science.gov (United States)

    Inagaki, Takeshi; Moschetta, Antonio; Lee, Youn-Kyoung; Peng, Li; Zhao, Guixiang; Downes, Michael; Yu, Ruth T.; Shelton, John M.; Richardson, James A.; Repa, Joyce J.; Mangelsdorf, David J.; Kliewer, Steven A.

    2006-03-01

    Obstruction of bile flow results in bacterial proliferation and mucosal injury in the small intestine that can lead to the translocation of bacteria across the epithelial barrier and systemic infection. These adverse effects of biliary obstruction can be inhibited by administration of bile acids. Here we show that the farnesoid X receptor (FXR), a nuclear receptor for bile acids, induces genes involved in enteroprotection and inhibits bacterial overgrowth and mucosal injury in ileum caused by bile duct ligation. Mice lacking FXR have increased ileal levels of bacteria and a compromised epithelial barrier. These findings reveal a central role for FXR in protecting the distal small intestine from bacterial invasion and suggest that FXR agonists may prevent epithelial deterioration and bacterial translocation in patients with impaired bile flow. bacteria | biliary obstruction | epithelial barrier | ileum

  18. 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.

  19. 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

  20. Ostα depletion protects liver from oral bile acid load.

    Science.gov (United States)

    Soroka, Carol J; Velazquez, Heino; Mennone, Albert; Ballatori, Nazzareno; Boyer, James L

    2011-09-01

    Bile acid homeostasis is tightly maintained through interactions between the liver, intestine, and kidney. During cholestasis, the liver is incapable of properly clearing bile acids from the circulation, and alternative excretory pathways are utilized. In obstructive cholestasis, urinary elimination is often increased, and this pathway is further enhanced after bile duct ligation in mice that are genetically deficient in the heteromeric, basolateral organic solute transporter alpha-beta (Ostα-Ostβ). In this study, we examined renal and intestinal function in Ostα-deficient and wild-type mice in a model of bile acid overload. After 1% cholic acid feeding, Ostα-deficient mice had significantly lower serum ALT levels compared with wild-type controls, indicating partial protection from liver injury. Urinary clearance of bile acids, but not clearance of [(3)H]inulin, was significantly higher in cholic acid-fed Ostα-deficient mice compared with wild-type mice but was not sufficient to account for the protection. Fecal excretion of bile acids over the 5 days of cholic acid feeding was responsible for almost all of the bile acid loss in Ostα-deficient mice, suggesting that intestinal losses of bile acids accounted for the protection from liver injury. Thus fecal loss of bile acids after bile acid overload reduced the need for the kidney to filter and excrete the excess bile acids. In conclusion, Ostα-deficient mice efficiently eliminate excess bile acids via the feces. Inhibition of intestinal bile acid absorption might be an effective therapeutic target in early stages of cholestasis when bile acids are still excreted into bile. PMID:21719738

  1. 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.

  2. TGF-β-SMAD3 signaling mediates hepatic bile acid and phospholipid metabolism following lithocholic acid-induced liver injury[S

    OpenAIRE

    Matsubara, Tsutomu; Tanaka, Naoki; Sato, Misako; Kang, Dong Wook; Krausz, Kristopher W.; Flanders, Kathleen C.; Ikeda, Kazuo; Luecke, Hans; Wakefield, Lalage M.; Frank J. Gonzalez

    2012-01-01

    Transforming growth factor-β (TGFβ) is activated as a result of liver injury, such as cholestasis. However, its influence on endogenous metabolism is not known. This study demonstrated that TGFβ regulates hepatic phospholipid and bile acid homeostasis through MAD homolog 3 (SMAD3) activation as revealed by lithocholic acid-induced experimental intrahepatic cholestasis. Lithocholic acid (LCA) induced expression of TGFB1 and the receptors TGFBR1 and TGFBR2 in the liver. In addition, immunohisto...

  3. Constitutive androstane receptor-mediated changes in bile acid composition contributes to hepatoprotection from lithocholic acid-induced liver injury in mice.

    Science.gov (United States)

    Beilke, Lisa D; Aleksunes, Lauren M; Holland, Ricky D; Besselsen, David G; Beger, Rick D; Klaassen, Curtis D; Cherrington, Nathan J

    2009-05-01

    Pharmacological activation of the constitutive androstane receptor (CAR) protects the liver during cholestasis. The current study evaluates how activation of CAR influences genes involved in bile acid biosynthesis as a mechanism of hepatoprotection during bile acid-induced liver injury. CAR activators phenobarbital (PB) and 1,4-bis[2-(3,5-dichloropyridyloxy)]benzene (TCPOBOP) or corn oil (CO) were administered to C57BL/6 wild-type (WT) and CAR knockout (CAR-null) mice before and during induction of intrahepatic cholestasis using the secondary bile acid, lithocholic acid (LCA). In LCA-treated WT and all the CAR-null groups (excluding controls), histology revealed severe multifocal necrosis. This pathology was absent in WT mice pretreated with PB and TCPOBOP, indicating CAR-dependent hepatoprotection. Decreases in total hepatic bile acids and hepatic monohydroxy, dihydroxy, and trihydroxy bile acids in PB- and TCPOBOP-pretreated WT mice correlated with hepatoprotection. In comparison, concentrations of monohydroxylated and dihydroxylated bile acids were increased in all the treated CAR-null mice compared with CO controls. Along with several other enzymes (Cyp7b1, Cyp27a1, Cyp39a1), Cyp8b1 expression was increased in hepatoprotected mice, which could be suggestive of a shift in the bile acid biosynthesis pathway toward the formation of less toxic bile acids. In CAR-null mice, these changes in gene expression were not different among treatment groups. These results suggest CAR mediates a shift in bile acid biosynthesis toward the formation of less toxic bile acids, as well as a decrease in hepatic bile acid concentrations. We propose that these combined CAR-mediated effects may contribute to the hepatoprotection observed during LCA-induced liver injury. PMID:19196849

  4. 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

  5. Differentiation of infiltrative cholangiocarcinoma from benign common bile duct stricture using three-dimensional dynamic contrast-enhanced MRI with MRCP

    International Nuclear Information System (INIS)

    Aim: To retrospectively evaluate the criteria for discriminating infiltrative cholangiocarcinoma from benign common bile duct (CBD) stricture using three-dimensional dynamic contrast-enhanced (3D-DCE) magnetic resonance imaging (MRI) combined with magnetic resonance cholangiopancreatography (MRCP) imaging and to determine the predictors for cholangiocarcinoma versus benign CBD stricture. Materials and methods: 3D-DCE MRI and MRCP images in 28 patients with infiltrative cholangiocarcinoma and 23 patients with benign causes of CBD stricture were reviewed retrospectively. The final diagnosis was based on surgical or biopsy records. Two radiologists analysed the MRI images for asymmetry, including the wall thickness, length, and enhancement pattern of the narrowed CBD segment, and upstream CBD dilatation. MRI findings that could be used as predictors were identified by univariate analysis and multivariable stepwise logistic regression analysis. Results: Malignant strictures were significantly thicker (4.4 ± 1.2 mm) and longer (16.7 ± 7.7 mm) than the benign strictures (p < 0.05), and upstream CBD dilatation was larger in the infiltrative cholangiocarcinoma cases (20.7 ± 5.7 mm) than in the benign cases (16.5 ± 5.2 mm; p = 0.018). During both the portal venous and equilibrium phases, hyperenhancement was more frequently observed in malignant cases than in benign cases (p < 0.001). The results of the multivariable stepwise logistic regression analysis showed that both hyperenhancement of the involved CBD during the equilibrium phase and the ductal thickness were significant predictors for malignant strictures. When two diagnostic predictive values were used in combination, almost all patients with malignant strictures (n = 26, 92.9%) and benign strictures (n = 21, 91.3%) were correctly identified; the overall accuracy was 92.2% with correct classifications in 47 of the 51 patients. Conclusion: Infiltrative cholangiocarcinoma and benign CBD

  6. 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.

  7. 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.

  8. 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

  9. 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.

  10. Constitutive Androstane Receptor-Mediated Changes in Bile Acid Composition Contributes to Hepatoprotection from Lithocholic Acid-Induced Liver Injury in MiceS⃞

    OpenAIRE

    Beilke, Lisa D.; Aleksunes, Lauren M.; Holland, Ricky D; Besselsen, David G; Beger, Rick D.; Klaassen, Curtis D.; Cherrington, Nathan J.

    2009-01-01

    Pharmacological activation of the constitutive androstane receptor (CAR) protects the liver during cholestasis. The current study evaluates how activation of CAR influences genes involved in bile acid biosynthesis as a mechanism of hepatoprotection during bile acid-induced liver injury. CAR activators phenobarbital (PB) and 1,4-bis[2-(3,5-dichloropyridyloxy)]benzene (TCPOBOP) or corn oil (CO) were administered to C57BL/6 wild-type (WT) and CAR knockout (CAR-null) mice ...

  11. Inhibition of bile salt transport by drugs associated with liver injury in primary hepatocytes from human, monkey, dog, rat, and mouse.

    Science.gov (United States)

    Zhang, Jie; He, Kan; Cai, Lining; Chen, Yu-Chuan; Yang, Yifan; Shi, Qin; Woolf, Thomas F; Ge, Weigong; Guo, Lei; Borlak, Jürgen; Tong, Weida

    2016-08-01

    Interference of bile salt transport is one of the underlying mechanisms for drug-induced liver injury (DILI). We developed a novel bile salt transport activity assay involving in situ biosynthesis of bile salts from their precursors in primary human, monkey, dog, rat, and mouse hepatocytes in suspension as well as LC-MS/MS determination of extracellular bile salts transported out of hepatocytes. Glycine- and taurine-conjugated bile acids were rapidly formed in hepatocytes and effectively transported into the extracellular medium. The bile salt formation and transport activities were time‒ and bile-acid-concentration‒dependent in primary human hepatocytes. The transport activity was inhibited by the bile salt export pump (BSEP) inhibitors ketoconazole, saquinavir, cyclosporine, and troglitazone. The assay was used to test 86 drugs for their potential to inhibit bile salt transport activity in human hepatocytes, which included 35 drugs associated with severe DILI (sDILI) and 51 with non-severe DILI (non-sDILI). Approximately 60% of the sDILI drugs showed potent inhibition (with IC50 values <50 μM), but only about 20% of the non-sDILI drugs showed this strength of inhibition in primary human hepatocytes and these drugs are associated only with cholestatic and mixed hepatocellular cholestatic (mixed) injuries. The sDILI drugs, which did not show substantial inhibition of bile salt transport activity, are likely to be associated with immune-mediated liver injury. Twenty-four drugs were also tested in monkey, dog, rat and mouse hepatocytes. Species differences in potency were observed with mouse being less sensitive than other species to inhibition of bile salt transport. In summary, a novel assay has been developed using hepatocytes in suspension from human and animal species that can be used to assess the potential for drugs and/or drug-derived metabolites to inhibit bile salt transport and/or formation activity. Drugs causing sDILI, except those by immune

  12. T-tube bridging for the management of biliary tree injuries

    Science.gov (United States)

    Olmez, Aydemir; Hatipoglu, Sinan; Itik, Veyis; Kotan, Cetin

    2012-01-01

    Summary Background: Injuries of the biliary tree, which mainly occur as a complication of laparoscopic cholecystectomy, are a potentially life threatening cause of high morbidity and mortality. The reported frequency of biliary injuries after laparoscopic cholecystectomy is from 0.5–0.8%. Such injuries may sometimes become too complicated for surgical repair. Presented here is the case of a patient with a major bile duct injury for whom bile duct continuity was achieved using a T-tube. Case Report: A 53-year-old man, who developed bile duct injury following a laparoscopic cholecystectomy performed in another center for cholelithiasis, was referred to our clinic. A Roux-en-Y hepaticojejunostomy was performed in the early postoperative period. However, ensuing anastomotic leakage prompted undoing of the hepaticojejunostomy followed by placement of a T-tube by which bile duct continuity was achieved. Conclusions: For injuries with tissue loss requiring external drainage, T-tube bridging offers a feasible option in that it provides bile duct continuity with biliary flow into the duodenum, as well as achieving external drainage, thus alleviating the need for further definitive surgery. PMID:23569540

  13. 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

  14. Inhibition of Human Hepatic Bile Acid Transporters by Tolvaptan and Metabolites: Contributing Factors to Drug-Induced Liver Injury?

    Science.gov (United States)

    Slizgi, Jason R; Lu, Yang; Brouwer, Kenneth R; St Claire, Robert L; Freeman, Kimberly M; Pan, Maxwell; Brock, William J; Brouwer, Kim L R

    2016-01-01

    Tolvaptan is a vasopressin V(2)-receptor antagonist that has shown promise in treating Autosomal Dominant Polycystic Kidney Disease (ADPKD). Tolvaptan was, however, associated with liver injury in some ADPKD patients. Inhibition of bile acid transporters may be contributing factors to drug-induced liver injury. In this study, the ability of tolvaptan and two metabolites, DM-4103 and DM-4107, to inhibit human hepatic transporters (NTCP, BSEP, MRP2, MRP3, and MRP4) and bile acid transport in sandwich-cultured human hepatocytes (SCHH) was explored. IC(50) values were determined for tolvaptan, DM-4103 and DM-4107 inhibition of NTCP (∼41.5, 16.3, and 95.6 μM, respectively), BSEP (31.6, 4.15, and 119 μM, respectively), MRP2 (>50, ∼51.0, and >200 μM, respectively), MRP3 (>50, ∼44.6, and 61.2 μM, respectively), and MRP4 (>50, 4.26, and 37.9 μM, respectively). At the therapeutic dose of tolvaptan (90 mg), DM-4103 exhibited a C(max)/IC(50) value >0.1 for NTCP, BSEP, MRP2, MRP3, and MRP4. Tolvaptan accumulation in SCHH was extensive and not sodium-dependent; intracellular concentrations were ∼500 μM after a 10-min incubation duration with tolvaptan (15 μM). The biliary clearance of taurocholic acid (TCA) decreased by 43% when SCHH were co-incubated with tolvaptan (15 μM) and TCA (2.5 μM). When tolvaptan (15 μM) was co-incubated with 2.5 μM of chenodeoxycholic acid, taurochenodeoxycholic acid, or glycochenodeoxycholic acid in separate studies, the cellular accumulation of these bile acids increased by 1.30-, 1.68-, and 2.16-fold, respectively. Based on these data, inhibition of hepatic bile acid transport may be one of the biological mechanisms underlying tolvaptan-associated liver injury in patients with ADPKD. PMID:26507107

  15. Bile loss in the acute intestinal radiation syndrome in rats

    International Nuclear Information System (INIS)

    The effects of bile duct ligation (BDL), choledochostomy, bile acid sequestering within the intestinal lumen by cholestyramine, and fluid and electrolyte replacement on survival time and development of diarrhea after whole-body exposure to doses of ionizing radiation that result in death from acute intestinal injury were studied. BDL significantly prolonged survival and delayed the onset of diarrhea after exposure to 137Cs gamma rays, fission neutrons, or cyclotron-produced neutrons in the range of doses that produce intestinal death or death from a combination of intestinal and hematopoietic injuries. Cannulation of the bile duct with exteriorized bile flow (choledochostomy) to protect the irradiated intestine from the mucolytic action of bile salts did not duplicate the effect of BDL in increasing survival time. Choledochostomy without fluid replacement eliminated the occurrence of diarrhea in 15.4 Gy irradiated rats. Diarrhea did occur in irradiated animals with choledochostomy if they received duodenal injections of fluid and electrolytes to replace the fluid lost as a result of bile drainage. Duodenal injection of fluid and electrolytes had no significant effect on survival time in irradiated rats. Injection of fluid and electrolytes into the peritoneal cavity of irradiated rats resulted in an increase in survival time that was comparable to that observed after BDL. Addition of antibiotics to the peritoneally injected fluid and electrolytes further increased survival time (up to 9 days). This survival time approached that seen in animals receiving the same radiation dose but which had the intestine exteriorized and shielded to minimize radiation injury to the intestine. Postmortem histological examinations of the irradiated small intestine showed mucosal regeneration in these long-term survivors receiving fluid and antibiotic therapy

  16. 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

  17. 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

  18. 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.

  19. 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。

  20. 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.

  1. Hydrophilic bile salt ursodeoxycholic acid protects myocardium against reperfusion injury in a PI3K/Akt dependent pathway.

    Science.gov (United States)

    Rajesh, Katare Gopalrao; Suzuki, Ryoko; Maeda, Hironori; Yamamoto, Murio; Yutong, Xing; Sasaguri, Shiro

    2005-11-01

    The opening of mitochondrial permeability transition pore (PTP) during reperfusion injury of heart has been well demonstrated and thus controlling PTP would attenuate the myocardial damage and cell death. Ursodeoxycholic acid (UDCA) is a hydrophilic bile salt and has been shown to prevent apoptosis in hepatocytes by inhibiting the opening of PTP. Here we demonstrate the role of UDCA in preventing the reperfusion injury of heart through its ability to inhibit PTP. Wistar rats underwent 30 min left coronary artery occlusion (LCA) followed by 180 min reperfusion after treatment with 40 mg/kg per iv infusion of UDCA over 30 min before LCA occlusion. Other groups of rats were treated with PTP agonist atractyloside(5 mg/kg) or PI3 kinase inhibitor wortmannin (16 ug/kg) before UDCA treatment. UDCA treatment prior to LCA occlusion, activated phosphorylation of Akt and Bad. Phosphorylating Bad prevented its translocation in to mitochondria, there by preventing the down regulation of Bcl-2 expression and PTP opening. This was confirmed by reduced cytochrome C release from intramitochondrial space in to the cytosol and hence reduced cell death either by apoptosis (4.8 vs 11.8%, Pinjury by inhibiting the PTP in a PI3K/Akt dependent pathway. PMID:16171810

  2. 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.

  3. 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

  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. Toward Predicting Drug-Induced Liver Injury: Parallel Computational Approaches to Identify Multidrug Resistance Protein 4 and Bile Salt Export Pump Inhibitors

    OpenAIRE

    Welch, Matthew A.; Köck, Kathleen; Urban, Thomas J.; Brouwer, Kim L.R.; Swaan, Peter W.

    2015-01-01

    Drug-induced liver injury (DILI) is an important cause of drug toxicity. Inhibition of multidrug resistance protein 4 (MRP4), in addition to bile salt export pump (BSEP), might be a risk factor for the development of cholestatic DILI. Recently, we demonstrated that inhibition of MRP4, in addition to BSEP, may be a risk factor for the development of cholestatic DILI. Here, we aimed to develop computational models to delineate molecular features underlying MRP4 and BSEP inhibition. Models were ...

  6. 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

  7. Right anterior segmental hepatic duct emptying directly into the cystic duct in a living donor

    Directory of Open Access Journals (Sweden)

    Yasunao Ishiguro, Masanobu Hyodo, Takehito Fujiwara, Yasunaru Sakuma, Nobuyuki Hojo, Koichi Mizuta, Hideo Kawarasaki, Alan T Lefor, Yoshikazu Yasuda

    2010-08-01

    Full Text Available A 35-year-old mother was scheduled to be the living donor for liver transplantation to her second son, who suffered from biliary atresia complicated with biliary cirrhosis at the age of 2 years. The operative plan was to recover the left lateral segment of the mother’s liver for living donor transplantation. With the use of cholangiography at the time of surgery, we found the right anterior segmental duct (RASD emptying directly into the cystic duct, and the catheter passed into the RASD. After repairing the incision in the cystic duct, transplantation was successfully performed. Her postoperative course was uneventful. Biliary anatomical variations were frequently encountered, however, this variation has very rarely been reported. If the RASD was divided, the repair would be very difficult because the duct will not dilate sufficiently in an otherwise healthy donor. Meticulous preoperative evaluation of the living donor’s biliary anatomy, especially using magnetic resonance cholangiography and careful intraoperative techniques, is important to prevent bile duct injury and avoid the risk to the healthy donor.

  8. 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、

  9. 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

  10. 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...

  11. Mirizzi syndrome with an unusual aberrant hepatic duct fistula: a case report.

    Science.gov (United States)

    Wang, Meng; Xing, Yufei; Gao, Quangen; Lv, Zhiqiang; Yuan, Jianmao

    2016-01-01

    Mirizzi syndrome (MS) is a rare complication of chronic cholelithiasis, which is always caused by a calculus in the cystic duct or neck of the gallbladder, resulting in mechanical compression of common bile duct and the gallbladder. It is clinically characterized by abdominal pain, fever, as well as obstructive jaundice. During cholecystectomy, MS is seen as a dangerous adherent and inflammatory tissue in the area of Calot's triangle. In the general population, aberrant right posterior hepatic duct, one of the causes of bile duct injury during duct surgery, is present in 4.8%-8.4% of people. Herein we report a rare case of a 76-year-old female patient, with hepatolithiasis of right posterior lobe and cholecysto-aberrant right posterior hepatic duct fistula. This is a special type of MS; however, interestingly, she did not have any symptoms, and the disease was found by physical examination incidentally. This case highlights another situation, namely, there may be difficulty in diagnosing MS and dissecting for operation. Therefore, to avoid the complication associated with this special situation, the surgeons need to diagnose carefully and adopt an optimal treatment strategy. PMID:27445508

  12. 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.

  13. 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...

  14. 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...

  15. Role of polymorphic bile salt export pump (BSEP, ABCB11) transporters in anti-tuberculosis drug-induced liver injury in a Chinese cohort

    OpenAIRE

    Ru Chen; Jing Wang; Shaowen Tang; Yuan Zhang; Xiaozhen Lv; Shanshan Wu; Zhirong Yang; Yinyin Xia; Dafang Chen; Siyan Zhan

    2016-01-01

    Evidence indicates that the polymorphisms in bile salt export pump (BSEP, encoded by ABCB11) may play an important role in the development of anti-tuberculosis drug-induced liver injury (ATDILI) and we aim to investigate the association between genetic variants of ABCB11 and the risk of ATDILI in a Chinese cohort. A total of 89 tuberculosis patients with ATDILI and 356 matched ATDILI -free patients constituted cases and controls. Genetic polymorphisms of ABCB11 were determined by TaqMan singl...

  16. Rabeprazole is effective for bile reflux oesophagitis after total gastrectomy in a rat model

    Institute of Scientific and Technical Information of China (English)

    Naoki; Hashimoto

    2015-01-01

    AIM:To elucidate the effect of a proton pump inhibitor(PPI,rabeparazole)on oesophageal bile reflux in oesophagitis after total gastrectomy.METHODS:Twenty-one 8-week-old male Wistar rats were studied.They were performed oesophagoduodenostomy of total gastrectomy to induce oesophageal reflux of biliary and pancreatic juice.Five rats were performed the sham operation(Sham).On post-operative day 7,they were treated with saline(Control)(n=8)or PPI(rabeprazole,30 mg/kg per day,ip)(n=8)for 2 wk.On post-operative 21,all rats were sacrificed and each oesophagus was evaluated histologically.Oesophageal injury was evaluated by macroscopic and microscopic findings as well as the expression of cyclooxygenase-2(COX2).We measured bile acid in the oesophageal lumen and the common bile duct.RESULTS:At 3 wk after surgery,a histological study analysis revealed an increase in the thickness of the epithelium,elongation of the lamina propria and basal cell hyperplasia in the oesophageal mucosa.The macroscopic ulcer score and microscopic ulcer length of the control group were significantly higher compared to those of the rabeprazole-treated group.The expression of COX2 was significantly increased according to the immunostaining in the control group compared to rabeprazole-treated group.Although there was no difference between the control and PPI groups in the total bile acid in the common bile duct,the bileacid activity in the oesophageal lumen was significantly decreased in the rabeprazole-treated group due to augmentation of the duodenal motor complex.CONCLUSION:With this model,rabeprazole is good effect for reflux esophagitis after total gastrectomy from bile reflux.Bile acid is an important factor in the mucosal lesion induced by duodenal reflux.

  17. 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

  18. Effects of Veleriana Extracts on Bile Acid Metabolism and Liver Injury%缬草提取物对胆汁酸代谢及肝损伤影响的实验研究

    Institute of Scientific and Technical Information of China (English)

    徐沙丽; 李中明; 李哈妮; 薛存宽

    2011-01-01

    , bile flow and TC- phospholipids- TBA content, gallstone formation, liver histological test and aortic plaque-like porridge were analyzed later. ②24 Wistar rats were randomly divided into 3 groups (n= 8 ), which were fed with high cholesterol -high fat -high sugar diet, except for those in the normal group with basa; diet. The treatment group were fed with valerianaextracts 50 mg · kg-1 daily, the control group was given with the equal volume of 0.9% sodium chloride solution. The serum TC, TBA and liver histology were observed. Results ① Compared with the control group , common bile duct flow and solids content were increased significantly (P<0.01) in the treatment group, TBA concentration in bile was elevated obviously ( P<0.05 ) , serum TBA was predominantly lower ( P<0.05 ),gallstone formation was significantly less (P<0.05), liver injury was significantly alleviated. ②The serum TBA in rats was dropped ( P<0.05 ) in the treatment group compared with that in the control , and the liver injury was attenuated. Conclusion Valeriana extracts could increase the TBA content of bile, improve TBA/TC stone formation, lower the serum TBA concentration and significantly reduce the liver injury.

  19. 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

  20. 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

  1. Acute bile nephropathy secondary to anabolic steroids.

    Science.gov (United States)

    Alkhunaizi, Ahmed M; ElTigani, Mohamed A; Rabah, Rola S; Nasr, Samih H

    2016-02-01

    Renal dysfunction in cholestatic liver disease is multifactorial. Acute kidney injury may develop secondary to renal vasoconstriction in the setting of peripheral vasodilation and relative hypovolemia, tubular obstruction by bile casts, and direct tubular toxicity from bile. Anabolic steroids are frequently used by athletes to boost endurance and increase muscle mass. These agents are a recently recognized cause of hepatotoxicity and jaundice and may lead to acute kidney injury. To increase awareness about this growing problem and to characterize the pathology of acute kidney injury in this setting, we report on a young male who developed acute kidney injury in the setting of severe cholestatic jaundice related to ingestion of anabolic steroids used for bodybuilding. Kidney biopsy showed bile casts within distal tubular lumina, filamentous bile inclusions within tubular cells, and signs of acute tubular injury. This report supports the recently re-emerged concept of bile nephropathy cholemic nephrosis. PMID:26587777

  2. 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

  3. Ascariasis of the pancreatic duct.

    Science.gov (United States)

    Klimovskij, Michail; Dulskas, Audrius; Kraulyte, Zita; Mikalauskas, Saulius

    2015-01-01

    Ascariasis is a common helminthic disease worldwide, although Lithuania and other European countries are not considered endemic areas. The presence of the Ascaris worm in the biliary tree causes choledocholithiasis-like symptoms. We report a case of pancreatic duct ascariasis causing such symptoms. A 73-year-old Lithuanian woman underwent endoscopic retrograde cholangiopancreatography (ERCP) suspecting choledocholithiasis. Contrast injection into the common bile duct demonstrated a slightly dilated biliary tree without any filling defects, and the tail of an Ascaris worm protruding from the opening of the papilla Vater. The worm was captured by a snare but escaped deep into the duct. After a small wirsungotomy the worm was retrieved from the pancreatic duct. The patient received a 150 mg dose of levamisole orally repeated 7 days later and was discharged after complete resolution of symptoms. This first reported sporadic case of pancreatic duct ascariasis in Lithuania was successfully treated with ERCP and Levamisole. PMID:26374772

  4. Cervical thoracic duct cyst: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sang Hyun; Han, Jong Kyu; Lee, Chi Kyu; Jo, Sung Sik; Kim, Hyung Hwan; Bae, Won Kyung; Kim, Il Yung [Chunan Hospital Soonchunhyang University, Chunan (Korea, Republic of)

    2007-06-15

    Thoracic duct cysts are uncommon lesions that most commonly occur in the abdominal and thoracic portion of the thoracic duct: the cervical portion is the rarest location. The main causes of thoracic duct cyst are surgical injuries such as neck dissection and blunt trauma. We report here on a rare case of spontaneous cervical thoracic duct cyst that was noted on ultrasonography and CT. The thoracic duct cyst was confirmed by fine needle aspiration and it was treated by sclerotherapy.

  5. Role of polymorphic bile salt export pump (BSEP, ABCB11) transporters in anti-tuberculosis drug-induced liver injury in a Chinese cohort.

    Science.gov (United States)

    Chen, Ru; Wang, Jing; Tang, Shaowen; Zhang, Yuan; Lv, Xiaozhen; Wu, Shanshan; Yang, Zhirong; Xia, Yinyin; Chen, Dafang; Zhan, Siyan

    2016-01-01

    Evidence indicates that the polymorphisms in bile salt export pump (BSEP, encoded by ABCB11) may play an important role in the development of anti-tuberculosis drug-induced liver injury (ATDILI) and we aim to investigate the association between genetic variants of ABCB11 and the risk of ATDILI in a Chinese cohort. A total of 89 tuberculosis patients with ATDILI and 356 matched ATDILI -free patients constituted cases and controls. Genetic polymorphisms of ABCB11 were determined by TaqMan single-nucleotide polymorphism (SNP) genotyping assay. Odds ratio (OR) with 95% confidence intervals (CIs) was estimated by conditional logistic regression model. There were no significant differences in genotype frequencies of ABCB11 between cases and controls. In the subgroup analysis, polymorphisms of rs2287616 were found to be associated with cholestatic/mixed pattern of liver injury under dominant and addictive model (OR = 3.84, 95% CI:1.16-12.75, P = 0.028 and OR = 2.51, 95% CI:1.12-5.62, P = 0.025, respectively), however the significance disappeared after Bonferroni correction. This study suggested that genetic variants of ABCB11 gene might contribute to anti-tuberculosis drug-induced cholestatic liver injury in Chinese patients. Studies in larger, varied populations are required to confirm these findings. PMID:27293027

  6. Feed-forward regulation of bile acid detoxification by CYP3A4: studies in humanized transgenic mice.

    Science.gov (United States)

    Stedman, Catherine; Robertson, Graham; Coulter, Sally; Liddle, Christopher

    2004-03-19

    Bile acids are potentially toxic end products of cholesterol metabolism and their concentrations must be tightly regulated. Homeostasis is maintained by both feed-forward regulation and feedback regulation. We used humanized transgenic mice incorporating 13 kb of the 5' regulatory flanking sequence of CYP3A4 linked to a lacZ reporter gene to explore the in vivo relationship between bile acids and physiological adaptive CYP3A gene regulation in acute cholestasis after bile duct ligation (BDL). Male transgenic mice were subjected to BDL or sham surgery prior to sacrifice on days 3, 6, and 10, and others were injected with intraperitoneal lithocholic acid (LCA) or vehicle alone. BDL resulted in marked hepatic activation of the CYP3A4/lacZ transgene in pericentral hepatocytes, with an 80-fold increase in transgene activation by day 10. Individual bile acids were quantified by liquid chromatography/mass spectrometry. Serum 6beta-hydroxylated bile acids were increased following BDL, confirming the physiological relevance of endogenous Cyp3a induction to bile acid detoxification. Although concentrations of conjugated primary bile acids increased after BDL, there was no increase in LCA, a putative PXR ligand, indicating that this cannot be the only endogenous bile acid mediating this protective response. Moreover, in LCA-treated animals, 5-bromo-4-chloro-3-indolyl-beta-d-galactopyranoside staining showed hepatic activation of the CYP3A4 transgene only on the liver capsular surface, and minimal parenchymal induction, despite significant liver injury. This study demonstrates that CYP3A up-regulation is a significant in vivo adaptive response to cholestasis. However, this up-regulation is not dependent on increases in circulating LCA and the role of other bile acids as regulatory molecules requires further exploration. PMID:14681232

  7. 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

  8. Disruption of BSEP Function in HepaRG Cells Alters Bile Acid Disposition and Is a Susceptive Factor to Drug-Induced Cholestatic Injury.

    Science.gov (United States)

    Qiu, Xi; Zhang, Yueping; Liu, Tongtong; Shen, Hong; Xiao, Yongling; Bourner, Maureen J; Pratt, Jennifer R; Thompson, David C; Marathe, Punit; Humphreys, W Griffith; Lai, Yurong

    2016-04-01

    In the present study, we characterized in vitro biosynthesis and disposition of bile acids (BAs) as well as hepatic transporter expression followed by ABCB11 (BSEP) gene knockout in HepaRG cells (HepaRG-KO cells). BSEP KO in HepaRG cells led to time-dependent BA accumulation, resulting in reduced biosynthesis of BAs and altered BA disposition. In HepaRG-KO cells, the expression of NTCP, OATP1B1, OATP2B1, BCRP, P-gp, and MRP2 were reduced, whereas MRP3 and OCT1 were up-regulated. As a result, BSEP KO altered the disposition of BAs and subsequently underwent adaptive regulations of BA synthesis and homeostasis to enable healthy growth of the cells. Although BSEP inhibitors caused no or slight increase of BAs in HepaRG wild type cells (HepaRG-WT cells), excessive intracellular accumulation of BAs was observed in HepaRG-KO cells exposed to bosentan and troglitazone, but not dipyridamole. LDH release in the medium was remarkably increased in HepaRG-KO cultures exposed to troglitazone (50 μM), suggesting drug-induced cellular injury. The results revealed that functional impairment of BSEP predisposes the cells to altered BA disposition and is a susceptive factor to drug-induced cholestatic injury. In total, BSEP inhibition might trigger the processes but is not a sole determinant of cholestatic cellular injury. As intracellular BA accumulation is determined by BSEP function and the subsequent adaptive gene regulation, assessment of intracellular BA accumulation in HepaRG-KO cells could be a useful approach to evaluate drug-induced liver injury (DILI) potentials of drugs that could disrupt other BA homeostasis pathways beyond BSEP inhibition. PMID:26910619

  9. Cathepsin B inactivation attenuates hepatic injury and fibrosis during cholestasis

    OpenAIRE

    Canbay, Ali; Guicciardi, Maria Eugenia; Higuchi, Hajime; Feldstein, Ariel; Bronk, Steven F.; Rydzewski, Robert; Tanai, Makiko; Gores, Gregory J.

    2004-01-01

    Although a lysosomal, cathepsin B–dependent (Ctsb-dependent) pathway of apoptosis has been described, the contribution of this pathway to tissue damage remains unclear. Our aim was to ascertain if Ctsb inactivation attenuates liver injury, inflammation, and fibrogenesis after bile duct ligation (BDL). In 3-day BDL mice, hepatocyte apoptosis, mitochondrial cytochrome c release, and serum alanine aminotransferase (ALT) values were reduced in Ctsb–/– versus Ctsb+/+ animals. Likewise, R-3032 (a C...

  10. Naproxen-induced liver injury

    Institute of Scientific and Technical Information of China (English)

    Sharif Ali; Jason D Pimentel; Chan Ma

    2011-01-01

    BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been reported to induce liver injury. Patterns of the injury usually range from mild elevations of liver enzymes to sometimes severe fulminant hepatic failure. Likewise, naproxen is a propionic acid derivative NSAID that was introduced in 1980 and has been available as an over-the-counter medication since 1994, but has rarely been reported to cause liver injury. METHODS: We treated a 30-year-old woman with jaundice and intractablepruritusthatdevelopedshortlyaftertakingnaproxen. We reviewed the medical history and liver histopathology of the patient as well as all previously published case reports of naproxen-associated liver toxicity in the English language literature. RESULTS: The liver biochemical profile of the patient revealed a mixed cholestasis and hepatitis pattern. Consecutive liver biopsies demonstrated focal lobular inflammation, hepatocyte drop-out, and a progressive loss of the small interlobular bile ducts (ductopenia). The biopsy performed two years after onset of the disease showed partial recovery of a small number of bile ducts; however, 10 years passed before the biochemical profile returned to near normal. CONCLUSIONS:  Naproxen-associated liver toxicity remains a rare entity, but should be considered in any patient presenting with cholestasis shortly after its use. Liver injury is most commonly seen in a mixed pattern characterized by cholestasis and hepatitis. The resulting liver damage may take years to resolve.

  11. 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 ...

  12. Surgery for Bile Duct (Cholangiocarcinoma) Cancer

    Science.gov (United States)

    ... removed completely. Palliative surgery is not expected to cure the cancer, but it can sometimes help a person feel ... an option. In some cases it might even cure the cancer. But even for people who are eligible for ...

  13. Stages of Extrahepatic Bile Duct Cancer

    Science.gov (United States)

    ... to a collection bag outside of the body. Percutaneous transhepatic biliary drainage : A procedure used to x-ray the liver ... which may include partial hepatectomy . Stent placement or percutaneous transhepatic biliary drainage as palliative therapy , to relieve jaundice and other ...

  14. Treatment Options for Extrahepatic Bile Duct Cancer

    Science.gov (United States)

    ... to a collection bag outside of the body. Percutaneous transhepatic biliary drainage : A procedure used to x-ray the liver ... which may include partial hepatectomy . Stent placement or percutaneous transhepatic biliary drainage as palliative therapy , to relieve jaundice and other ...

  15. Treatment Option Overview (Extrahepatic Bile Duct Cancer)

    Science.gov (United States)

    ... to a collection bag outside of the body. Percutaneous transhepatic biliary drainage : A procedure used to x-ray the liver ... which may include partial hepatectomy . Stent placement or percutaneous transhepatic biliary drainage as palliative therapy , to relieve jaundice and other ...

  16. 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

  17. 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

  18. 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

  19. 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

  20. Discovery that theonellasterol a marine sponge sterol is a highly selective FXR antagonist that protects against liver injury in cholestasis.

    Directory of Open Access Journals (Sweden)

    Barbara Renga

    Full Text Available BACKGROUND: The farnesoid-x-receptor (FXR is a bile acid sensor expressed in the liver and gastrointestinal tract. Despite FXR ligands are under investigation for treatment of cholestasis, a biochemical condition occurring in a number of liver diseases for which available therapies are poorly effective, mice harboring a disrupted FXR are protected against liver injury caused by bile acid overload in rodent models of cholestasis. Theonellasterol is a 4-methylene-24-ethylsteroid isolated from the marine sponge Theonella swinhoei. Here, we have characterized the activity of this theonellasterol on FXR-regulated genes and biological functions. PRINCIPAL FINDINGS: Interrogation of HepG2 cells, a human hepatocyte cell line, by microarray analysis and transactivation assay shows that theonellasterol is a selective FXR antagonist, devoid of any agonistic or antagonistic activity on a number of human nuclear receptors including the vitamin D receptor, PPARs, PXR, LXRs, progesterone, estrogen, glucorticoid and thyroid receptors, among others. Exposure of HepG2 cells to theonellasterol antagonizes the effect of natural and synthetic FXR agonists on FXR-regulated genes, including SHP, OSTα, BSEP and MRP4. A proof-of-concept study carried out to investigate whether FXR antagonism rescues mice from liver injury caused by the ligation of the common bile duct, a model of obstructive cholestasis, demonstrated that theonellasterol attenuates injury caused by bile duct ligation as measured by assessing serum alanine aminostrasferase levels and extent of liver necrosis at histopathology. Analysis of genes involved in bile acid uptake and excretion by hepatocytes revealed that theonellasterol increases the liver expression of MRP4, a basolateral transporter that is negatively regulated by FXR. Administering bile duct ligated mice with an FXR agonist failed to rescue from liver injury and downregulated the expression of MRP4. CONCLUSIONS: FXR antagonism in vivo

  1. 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

  2. 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

    Directory of Open Access Journals (Sweden)

    Everson Luiz de Almeida Artifon

    2010-04-01

    Full Text Available 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 were stained using Hematoxylin Eosin; Sirius Red to quantitate the amount of collagen present; and Weigert's Resorcin-fuchsin to quantitate the amount of elastin present. RESULTS: The percentage of area stained for collagen was 13.4; 21.5; 29.5 and 32.8, for groups I to IV, respectively. The percentage of area stained for elastin fibers was 7.0; 5.2; 4.0 and 2.9, for groups I to IV, respectively. Collagen/Elastin ratio was 2.4; 5.1; 11.0 and 14.4 for groups I to IV, respectively. CONCLUSIONS: The biliary stenting leads to collagen and elastin deposition in the bile ducts; and collagen deposition and collagen/elastin ratio are proportional to the period of stenting.OBJETIVO: Avaliar os efeitos da colocação de prótese biliar em ratos, analisando a deposição de colágeno e elastina no hepatocolédoco. MÉTODOS: Vinte ratos machos foram submetidos à laparotomia mediana, duodenotomia e colocação transpapilar de uma prótese plástica 22Fr no hepatocolédoco. Os animais foram randomizados em 4 grupos, com cinco componentes cada: (I controle, (II prótese biliar por 7 dias, (III prótese biliar durante 14 dias e (IV prótese biliar por 30 dias. Cortes do hepatocolédoco foram corados com Hematoxilina Eosina; Sirius Red para quantificar o colágeno; e Resorcina-fucsina de Weigert para quantificar a elastina. RESULTADOS: A porcentagem de área corada para colágeno foi de 13,4; 21,5; 29,5 e 32,8 para os grupos I a IV, respectivamente. A porcentagem de

  3. Toward predicting drug-induced liver injury: parallel computational approaches to identify multidrug resistance protein 4 and bile salt export pump inhibitors.

    Science.gov (United States)

    Welch, Matthew A; Köck, Kathleen; Urban, Thomas J; Brouwer, Kim L R; Swaan, Peter W

    2015-05-01

    Drug-induced liver injury (DILI) is an important cause of drug toxicity. Inhibition of multidrug resistance protein 4 (MRP4), in addition to bile salt export pump (BSEP), might be a risk factor for the development of cholestatic DILI. Recently, we demonstrated that inhibition of MRP4, in addition to BSEP, may be a risk factor for the development of cholestatic DILI. Here, we aimed to develop computational models to delineate molecular features underlying MRP4 and BSEP inhibition. Models were developed using 257 BSEP and 86 MRP4 inhibitors and noninhibitors in the training set. Models were externally validated and used to predict the affinity of compounds toward BSEP and MRP4 in the DrugBank database. Compounds with a score above the median fingerprint threshold were considered to have significant inhibitory effects on MRP4 and BSEP. Common feature pharmacophore models were developed for MRP4 and BSEP with LigandScout software using a training set of nine well characterized MRP4 inhibitors and nine potent BSEP inhibitors. Bayesian models for BSEP and MRP4 inhibition/noninhibition were developed with cross-validated receiver operator curve values greater than 0.8 for the test sets, indicating robust models with acceptable false positive and false negative prediction rates. Both MRP4 and BSEP inhibitor pharmacophore models were characterized by hydrophobic and hydrogen-bond acceptor features, albeit in distinct spatial arrangements. Similar molecular features between MRP4 and BSEP inhibitors may partially explain why various drugs have affinity for both transporters. The Bayesian (BSEP, MRP4) and pharmacophore (MRP4, BSEP) models demonstrated significant classification accuracy and predictability. PMID:25735837

  4. 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

  5. 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...

  6. Mechanism by which bile salt disrupts the gastric mucosal barrier in the dog.

    OpenAIRE

    Duane, W C; Wiegand, D M

    1980-01-01

    Bile salts disrupt a functional "gastric mucosal barrier" increasing net forward-diffusion (+) of Na+ and back-diffusion (-) of H+. Studying canine Heidenhain pouches, we attempted to distinguish between two possible mechanisms for this effect: (a) mucosal uptake of bile salt with subsequent cellular injury or (b) dissolution of mucosal lipids by intralumenal bile salt. A 10 mM mixture of six conjugated bile salts simulating the proportions found in human bile induced net Na+ flux of 15.5 +/-...

  7. Intrahepatic biliary injuries associated with radiofrequency ablation of hepatic malignancies

    Institute of Scientific and Technical Information of China (English)

    FU Ying; YANG Wei; WU Jin-yu; YAN Kun; WU Wei; XING Bao-cai; CHEN Min-hua

    2011-01-01

    Background Biliary injury after radiofrequency ablation can cause serious consequences including death. However, there are limited data regarding bile duct changes with or without complications associated with radiofrequency ablation of hepatic malignancies. This study aimed to assess the incidence, prognosis and risk factors of intrahepatic biliary injury associated with radiofrequency ablation.Methods Between June 2001 and January 2009, 638 patients with hepatic malignancies (405 with hepatocellular carcinoma, and 233 with liver metastasis) who had 955 treatment sessions were enrolled in this study. Imaging and laboratory data, the course of treatment, and patient outcomes were reviewed retrospectively. The risk factors of biliary injury and the impact on overall survival of patients were analyzed. The chi-square test, Fisher's exact test, Kaplan-Meier curves and stepwise Logistic regression model were used for statistical analysis where appropriate.Results Biliary injury was observed in 17 patients after 17 ablation sessions based on imaging findings. The overall incidence of biliary injury was 1.8% (17/955) with an average onset time of 12 weeks (2-36 weeks). Mild, moderate and severe complications of biliary injury were identified in 9, 6 and 2 cases, respectively. The median survival time after detection of biliary injury was 40 months. There seemed no notable difference in overall survival between patients with and those without biliary injuries. By multivariate analysis, vessel infiltration (P=0.034) and treatment session ≥4 times (P=0.025) were independent risk factors for biliary injury of hepatocellular carcinoma; while tumor located centrally was the only independent risk factor in the metastasis group (P=0.043).Conclusions The incidence of biliary injury was not frequent (1.8%). Through appropriate treatment, intrahepatic bile duct injuries seemed not affect the patients' long-term survival. Additionally, risk factors may be helpful for selecting

  8. 胆胰肠结合部损伤延迟发现的处理%Management of delayed-diagnosed iatrogenic injury in cho-ledocho-pancreatico-duodenal junction

    Institute of Scientific and Technical Information of China (English)

    王坚

    2009-01-01

    Iatrogenic injury in choledocho-pancreatico-duodenal junction is usually difficult to discover in the course of operation because of its unique anatomical position. The injury can lead to postoperative chilis, fever, pain and swelling of the waist, which would easily be misdiagnosed as acute necrotizing pancreatitis. Controlling operations, such as bile and pancreatic juice separation, duodenal diverticularization, jejunal fistulation for enteral nutrition and abdominal drainage should be performed in dealing with the injury in choledocho-pancreatico-duodenal junction. Combined application of pyloric suture with absorbable thread and ligatian, gastric fistulation, ligation of the distal common bile duct and T-tube drainage is minimally invasive, and can fulfill a fully separation of bile and pancreatic juice and duodenal diverticularization. It will improve the possibility of secondary radical operation by ameliorating pyemia and general nutritional condition.

  9. An Immunocytochemical Profile of the Endocrine Pancreas Using an Occlusive Duct Ligation Model.

    OpenAIRE

    Page BJ; du Toit DF; Muller CJF; Mattysen J; Lyners R

    2000-01-01

    CONTEXT: Ligation of the pancreatic duct, distally to its confluence into the bile duct has been shown to induce endocrine tissue regeneration. The surplus endocrine tissue formed is presumed to be able to replace pathologically and/or experimentally compromised tissue. OBJECTIVE: This is a quantitative study on the histology of duct ligated pancreas employing immunocytochemistry and computerised morphometry. INTERVENTIONS: Pancreatic duct ligation was performed on 25 groups of six normal Spr...

  10. 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)

  11. 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

  12. Activation of a Novel c-Myc-miR27-Prohibitin 1 Circuitry in Cholestatic Liver Injury Inhibits Glutathione Synthesis in Mice

    OpenAIRE

    YANG, Heping; Li, Tony W. H.; Zhou, Yu; Peng, Hui; Liu, Ting; Zandi, Ebrahim; Martínez-Chantar, María Luz; Mato, José M.; Lu, Shelly C.

    2015-01-01

    Aims: We showed that chronic cholestatic liver injury induced the expression of c-Myc but suppressed that of glutamate-cysteine ligase (GCL, composed of catalytic and modifier subunits GCLC and GCLM, respectively). This was associated with reduced nuclear antioxidant response element (ARE) binding by nuclear factor-erythroid 2 related factor 2 (Nrf2). Here, we examined whether c-Myc is involved in this process. Results: Similar to bile duct ligation (BDL), lithocholic acid (LCA) treatment in ...

  13. Bile acids for liver-transplanted patients. Protocol for a Cochrane Review

    DEFF Research Database (Denmark)

    Chen, W; Gluud, C

    2003-01-01

    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...

  14. Conjugated bile acids promote cholangiocarcinoma cell invasive growth through activation of sphingosine 1-phosphate receptor 2

    OpenAIRE

    Liu, Runping; Zhao, Renping; Zhou, Xiqiao; Liang, Xiuyin; Campbell, Deanna JW; Zhang, Xiaoxuan; ZHANG, LUYONG; Shi, Ruihua; Wang, Guangji; Pandak, William M.; Sirica, Alphonse E.; Hylemon, Phillip B.; Zhou, Huiping

    2014-01-01

    Cholangiocarcinoma (CCA) is an often fatal primary malignancy of the intra- and extrahepatic biliary tract that is commonly associated with chronic cholestasis and significantly elevated levels of primary and conjugated bile acids (CBAs), which are correlated with bile duct obstruction (BDO). BDO has also recently been shown to promote CCA progression. However, whereas there is increasing evidence linking chronic cholestasis and abnormal bile acid profiles to CCA development and progression, ...

  15. MR appearance of normal and abnormal bile: Correlation with imaging and endoscopic finding

    International Nuclear Information System (INIS)

    Identification of abnormal bile related to various pathological processes in the pancreaticobiliary tract can be important in the diagnosis of disease and the determination of appropriate treatment. Magnetic resonance (MR) imaging can allow comprehensive evaluation of abnormal bile because MR usually provides better tissue characterization than other imaging modalities. A high-intensity signal from bile is frequently encountered on T1-weighted images and can be seen in concentrated bile, sludge, stones, or hemobilia. Contrast-enhanced MR features, such as inhomogeneous hepatic enhancement in the arterial phase and papillitis or mild-to-moderate bile duct wall thickening with enhancement, along with clinical characteristics, may suggest clinically significant bile, such as sludge or purulent bile, rather than merely concentrated bile. A history of trauma and appropriate imaging findings in the hepatobiliary tract can support a diagnosis of hemobilia. MR imaging may assist in diagnosing intraductal papillary mucinous neoplasm of the bile duct via detection of an intraductal mass or several indirect signs, suggesting a large amount of mucin. Additionally, Gd-EOB-DTPA-enhanced MR may delineate mucin as a filling defect surrounding hyperintense bile. A floating filling defect on all MR sequences is helpful in discriminating pneumobilia from other intraluminal filling defects. Familiarity with the various different MR features of abnormal bile signals can therefore facilitate accurate diagnosis and treatment.

  16. 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.

  17. Technical Note: Thoracic duct embolization for treatment of chylothorax: A novel guidance technique for puncture using combined MRI and fluoroscopy

    Directory of Open Access Journals (Sweden)

    Alampath Praveen

    2012-01-01

    Full Text Available Thoracic duct embolization (TDE is an established radiological interventional procedure for thoracic duct injuries. Traditionally, it is done under fluoroscopic guidance after opacifying the thoracic duct with bipedal lymphangiography. We describe our experience in usinga heavily T2W sequence for guiding thoracic duct puncture and direct injection of glue through the puncture needle without cannulating the duct.

  18. 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

  19. 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.

  20. Bile acid-induced necrosis in primary human hepatocytes and in patients with obstructive cholestasis

    Energy Technology Data Exchange (ETDEWEB)

    Woolbright, Benjamin L.; Dorko, Kenneth [Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, KS (United States); Antoine, Daniel J.; Clarke, Joanna I. [MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool (United Kingdom); Gholami, Parviz [Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS (United States); Li, Feng [Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, KS (United States); Kumer, Sean C.; Schmitt, Timothy M.; Forster, Jameson [Department of Surgery, University of Kansas Medical Center, Kansas City, KS (United States); Fan, Fang [Department of Pathology, University of Kansas Medical Center, Kansas City, KS (United States); Jenkins, Rosalind E.; Park, B. Kevin [MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool (United Kingdom); Hagenbuch, Bruno [Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, KS (United States); Olyaee, Mojtaba [Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS (United States); Jaeschke, Hartmut, E-mail: hjaeschke@kumc.edu [Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, KS (United States)

    2015-03-15

    Accumulation of bile acids is a major mediator of cholestatic liver injury. Recent studies indicate bile acid composition between humans and rodents is dramatically different, as humans have a higher percent of glycine conjugated bile acids and increased chenodeoxycholate content, which increases the hydrophobicity index of bile acids. This increase may lead to direct toxicity that kills hepatocytes, and promotes inflammation. To address this issue, this study assessed how pathophysiological concentrations of bile acids measured in cholestatic patients affected primary human hepatocytes. Individual bile acid levels were determined in serum and bile by UPLC/QTOFMS in patients with extrahepatic cholestasis with, or without, concurrent increases in serum transaminases. Bile acid levels increased in serum of patients with liver injury, while biliary levels decreased, implicating infarction of the biliary tracts. To assess bile acid-induced toxicity in man, primary human hepatocytes were treated with relevant concentrations, derived from patient data, of the model bile acid glycochenodeoxycholic acid (GCDC). Treatment with GCDC resulted in necrosis with no increase in apoptotic parameters. This was recapitulated by treatment with biliary bile acid concentrations, but not serum concentrations. Marked elevations in serum full-length cytokeratin-18, high mobility group box 1 protein (HMGB1), and acetylated HMGB1 confirmed inflammatory necrosis in injured patients; only modest elevations in caspase-cleaved cytokeratin-18 were observed. These data suggest human hepatocytes are more resistant to human-relevant bile acids than rodent hepatocytes, and die through necrosis when exposed to bile acids. These mechanisms of cholestasis in humans are fundamentally different to mechanisms observed in rodent models. - Highlights: • Cholestatic liver injury is due to cytoplasmic bile acid accumulation in hepatocytes. • Primary human hepatocytes are resistant to BA-induced injury

  1. Bile acid-induced necrosis in primary human hepatocytes and in patients with obstructive cholestasis

    International Nuclear Information System (INIS)

    Accumulation of bile acids is a major mediator of cholestatic liver injury. Recent studies indicate bile acid composition between humans and rodents is dramatically different, as humans have a higher percent of glycine conjugated bile acids and increased chenodeoxycholate content, which increases the hydrophobicity index of bile acids. This increase may lead to direct toxicity that kills hepatocytes, and promotes inflammation. To address this issue, this study assessed how pathophysiological concentrations of bile acids measured in cholestatic patients affected primary human hepatocytes. Individual bile acid levels were determined in serum and bile by UPLC/QTOFMS in patients with extrahepatic cholestasis with, or without, concurrent increases in serum transaminases. Bile acid levels increased in serum of patients with liver injury, while biliary levels decreased, implicating infarction of the biliary tracts. To assess bile acid-induced toxicity in man, primary human hepatocytes were treated with relevant concentrations, derived from patient data, of the model bile acid glycochenodeoxycholic acid (GCDC). Treatment with GCDC resulted in necrosis with no increase in apoptotic parameters. This was recapitulated by treatment with biliary bile acid concentrations, but not serum concentrations. Marked elevations in serum full-length cytokeratin-18, high mobility group box 1 protein (HMGB1), and acetylated HMGB1 confirmed inflammatory necrosis in injured patients; only modest elevations in caspase-cleaved cytokeratin-18 were observed. These data suggest human hepatocytes are more resistant to human-relevant bile acids than rodent hepatocytes, and die through necrosis when exposed to bile acids. These mechanisms of cholestasis in humans are fundamentally different to mechanisms observed in rodent models. - Highlights: • Cholestatic liver injury is due to cytoplasmic bile acid accumulation in hepatocytes. • Primary human hepatocytes are resistant to BA-induced injury

  2. 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.

  3. 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 ot