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Sample records for biliary ascariasis histopathological

  1. Biliary ascariasis

    International Nuclear Information System (INIS)

    Biliary ascariasis is a complication of intestinal ascariasis. This results in characteristic findings in the intravenous cholangiocholecystogram and in the sonogram. Characteristic signs of biliary ascariasis are, in the longitudinal section, the 'strip sign', 'spaghetti sign', 'inner tube sign', and in transverse section 'a bull's eye in the triple O'. The helminth can travel from out of the biliary duct system back into the intestinum, so that control examinations can even be negative. (orig.)

  2. Biliary ascariasis

    Energy Technology Data Exchange (ETDEWEB)

    Mensing, M.; Cruz y Rivero, M.A.; Alarcon Hernandez, C.; Garcia Himmelstine, L.; Vogel, H.

    1986-06-01

    Biliary ascariasis is a complication of intestinal ascariasis. This results in characteristic findings in the intravenous cholangiocholecystogram and in the sonogram. Characteristic signs of biliary ascariasis are, in the longitudinal section, the 'strip sign', 'spaghetti sign', 'inner tube sign', and in transverse section 'a bull's eye in the triple O'. The helminth can travel from out of the biliary duct system back into the intestinum, so that control examinations can even be negative.

  3. Biliary ascariasis

    Directory of Open Access Journals (Sweden)

    Sivakumar K

    2007-01-01

    Full Text Available Ascaris lumbricoides, or the common roundworms, has a worldwide distribution but is mainly seen in Asian and Latin American countries. In humans the usual habitat is in the small intestine, mainly in the jejunum. But if the worm load is high, which may go up to a thousand worms, the worms tend to migrate away from the usual site of habitat. This brief paper aims at highlighting the condition of biliary ascariasis through the authors′ experience in managing three such cases over a period of 1 year. The clinical features which arouse suspicion of biliary ascariasis, as well as diagnostic modalities and management, are described. Initially the cases were managed conservatively, but we conclude that if worms are retained in biliary tree for more than 10 days, surgery should be performed; since retention of degraded and calcified dead worm can occur, and this can lead to complications which are difficult to manage.

  4. Biliary ascariasis

    OpenAIRE

    Sivakumar K; Varkey Sam; George Mathan; Rajendran S; Hema R

    2007-01-01

    Ascaris lumbricoides, or the common roundworms, has a worldwide distribution but is mainly seen in Asian and Latin American countries. In humans the usual habitat is in the small intestine, mainly in the jejunum. But if the worm load is high, which may go up to a thousand worms, the worms tend to migrate away from the usual site of habitat. This brief paper aims at highlighting the condition of biliary ascariasis through the authors′ experience in managing three such cases over a perio...

  5. Hepatic and Biliary Ascariasis

    OpenAIRE

    Anup K Das

    2014-01-01

    Ascariasis mainly contributes to the global helminthic burden by infesting a large number of children in the tropical countries. Hepato-biliary ascariasis (HBA) is becoming a common entity now than in the past owing to the frequent usage of ultrasonograms and endoscopic diagnostic procedures in the clinical practice. There are a variety of manifestations in HBA and diagnosis depends on a high index of suspicion in endemic areas coupled with subsequent confirmation by sonographic or endoscopic...

  6. Biliary ascariasis. A case report.

    Science.gov (United States)

    Sarihan, H; Gürkök, S; Sari, A

    1995-01-01

    Ascaris lumbricoides is a worldwide intestinal infestation that may cause various complications. Biliary ascariasis, however, is a rare condition. We describe a child with biliary ascariasis. The patient's clinical symptoms were pain, vomiting and abdominal tenderness, and she was thought to have acute appendicitis. However, laboratory examination revealed high serum alkaline phosphatase and amylase levels, and ultrasonography and percutaneous cholangiography demonstrated biliary ascariasis. The patient was successfully treated with mebendazole and antispasmolytic drugs. PMID:8560608

  7. Hepatic and biliary ascariasis

    Directory of Open Access Journals (Sweden)

    Anup K Das

    2014-01-01

    Full Text Available Ascariasis mainly contributes to the global helminthic burden by infesting a large number of children in the tropical countries. Hepato-biliary ascariasis (HBA is becoming a common entity now than in the past owing to the frequent usage of ultrasonograms and endoscopic diagnostic procedures in the clinical practice. There are a variety of manifestations in HBA and diagnosis depends on a high index of suspicion in endemic areas coupled with subsequent confirmation by sonographic or endoscopic demonstration of the worm. Most of them present with acute abdomen and jaundice. Oriental or recurrent pyogenic cholangiopathy is possibly the result of HBA, commonly encountered in South-East Asian countries. Conservative treatment with anthelminthic agents is used in the majority. Failure to respond to medical therapy usually indicates the need for endoscopic or surgical interventions. Overall, mortality is low and prognosis is good, but many epidemiological and immunological aspects of Ascaris infection are unclear, meaning our understanding the disease and infection still remains incomplete. Therefore, it is difficult to definitely put down a fixed modality of treatment for HBA. This underscores the need for further studies as ascariasis has the potential to adversely affect the national socio-economy by compromising the health of children and adults alike with its sheer number.

  8. Biliary ascariasis: radiological clue to diagnosis

    OpenAIRE

    Sundriyal, Deepak; Bansal, Satish; KUMAR, NAVEEN; Sharma, Navneet

    2015-01-01

    Ascariasis is caused by Ascaris lumbricoides. It is the most common helminthic infection seen worldwide. Ascariasis is an endemic disease in our country. This is due to the prevailing poor sanitary conditions and low level of education. Biliary ascariasis is an uncommon cause of obstructive jaundice. We report a case of biliary ascariasis in a young labourer who presented with acute abdominal pain.

  9. Biliary ascariasis: radiological clue to diagnosis.

    Science.gov (United States)

    Sundriyal, Deepak; Bansal, Satish; Kumar, Naveen; Sharma, Navneet

    2015-03-01

    Ascariasis is caused by Ascaris lumbricoides. It is the most common helminthic infection seen worldwide. Ascariasis is an endemic disease in our country. This is due to the prevailing poor sanitary conditions and low level of education. Biliary ascariasis is an uncommon cause of obstructive jaundice. We report a case of biliary ascariasis in a young labourer who presented with acute abdominal pain. PMID:26634136

  10. Laproscopic Management of Wandering Biliary Ascariasis

    OpenAIRE

    Umesh Jethwani; G. J. Singh; Sarangi, P; Vipul Kandwal

    2012-01-01

    Ascariasis is one of the most common helminthic diseases in humans, occurring mostly in countries with low standards of public health and hygiene, thereby making ascariasis highly endemic in developing countries. In endemic areas, 30% of adults and 60–70% of children harbour the adult worm. Biliary ascariasis is a rare cause of obstructive jaundice. Conventional management involves endoscopic extraction of worm. We are reporting a rare case of ascaris which induced extrahepatic biliary obstru...

  11. Biliary Ascariasis Mimicking Colonic Tumor Infiltration of the Biliary System.

    Science.gov (United States)

    Sundriyal, Deepak; Mittal, Gyanendra; Kumar, Sushil; Manjunath, Suraj; Sharma, Navneet; Gupta, Mahesh

    2015-09-01

    Ascariasis is a common problem in developing countries with poor hygiene and sanitation. It is endemic in India and usually seen in the northern states. Biliary ascariasis is an uncommon cause of obstructive jaundice. We present a case of carcinoma of hepatic flexure of colon in which the patient developed biliary ascariasis and posed a diagnostic challenge as it mimicked tumor infiltration of the biliary system. PMID:27217679

  12. Our experience of biliary ascariasis in children

    OpenAIRE

    Wani M; Chechak Bashir; Reshi Farooq; Pandita Sanjay; Rather Muddasar; Sheikh Tariq; Ganie Ishfaq

    2006-01-01

    Ascariasis is highly endemic in Kashmir valley as temperate climate and wet soil provide excellent conditions for its development. We studied 198 cases (11%) of biliary ascariasis out of 1,800 patients of worm infestation from December 2001 to December 2004 in the age group of 4-15 years. In our study, we found biliary ascariasis to be more common in female children, and most common clinical presentation was biliary colic in 143 patients, cholangitis in 28, cholecystitis in 15, liver a...

  13. An Unusual Presentation of Biliary Ascariasis

    OpenAIRE

    Arsad Bashir Khan, Sanjay Kumar Bhasin, Rajesh Kumar Bhagat, R. K. Chrungoo

    2007-01-01

    Ascariasis is one of the most common disease in human being worldwide. Ascariasis is 2nd to gall stone asa cause of biliary symptoms. The invasion of biliary tract by round worms during early post operativeperiod is an infrequent but serious complication. We present 42 years old man operated for cholelithiasiswith Choledocholthiasis on whom choledochotomy and T -Tube insertion was done. On 5th postoperativeday Ascaris extruded peri-T-Tube and immediate T - Tube cholangiogram done that showed ...

  14. Laproscopic Management of Wandering Biliary Ascariasis

    Directory of Open Access Journals (Sweden)

    Umesh Jethwani

    2012-01-01

    Full Text Available Ascariasis is one of the most common helminthic diseases in humans, occurring mostly in countries with low standards of public health and hygiene, thereby making ascariasis highly endemic in developing countries. In endemic areas, 30% of adults and 60–70% of children harbour the adult worm. Biliary ascariasis is a rare cause of obstructive jaundice. Conventional management involves endoscopic extraction of worm. We are reporting a rare case of ascaris which induced extrahepatic biliary obstruction in a young male who presented with acute cholangitis. The ascaris was removed by laparoscopic exploration of the common bile duct. Postoperative period was uneventful.

  15. Obstructive jaundice induced by biliary ascariasis

    OpenAIRE

    Keating, Aine; Quigley, James Aidan; Genterola, Al Frederick

    2012-01-01

    Ascaris lumbricoides is one of the most prevalent parasitic infections, especially in developing countries. Its presence can lead to a multitude of presentations, one of the rarer ones being obstructive jaundice due to migration of the worm in to the biliary tree. We describe a case of a man who presented as an emergency to the general surgeons complaining of abdominal pain, fever, jaundice and vomiting. Ultrasound was used and the diagnosis of biliary ascariasis was made. The patient underwe...

  16. An Unusual Presentation of Biliary Ascariasis

    Directory of Open Access Journals (Sweden)

    Arsad Bashir Khan, Sanjay Kumar Bhasin, Rajesh Kumar Bhagat, R. K. Chrungoo

    2007-01-01

    Full Text Available Ascariasis is one of the most common disease in human being worldwide. Ascariasis is 2nd to gall stone asa cause of biliary symptoms. The invasion of biliary tract by round worms during early post operativeperiod is an infrequent but serious complication. We present 42 years old man operated for cholelithiasiswith Choledocholthiasis on whom choledochotomy and T -Tube insertion was done. On 5th postoperativeday Ascaris extruded peri-T-Tube and immediate T - Tube cholangiogram done that showed multiplefilling defects in Common Bile Duct (CBD. Patient was managed with saline irrigation of CBD viaT-Tube and anti-heliminthic was given. In view of its rarity and unusual presentation the case is beingreported.

  17. Role of hepatobiliary scintigraphy in biliary ascariasis

    International Nuclear Information System (INIS)

    Following the introduction of immunodiacetic acid (IDA) compounds labelled with 99Tcm, hepatobiliary scintigraphy has successfully been used to identify a variety of hepatobiliary pathologies. This study deals with the scintigraphic findings in patients having involvement of the hepatobiliary system with ascariasis. Patients clinically suspected of having hepatobiliary pathology were routinely sent for radionuclide evaluation of the hepatobiliary system. 99Tcm HIDA, EHIDA or BULLIDA was injected under the gamma camera and one min frames were collected for 40 min over the abdominal region using an on-line computer. After the sequential study was over, if the gallbladder was not visualized, late pictures were taken until the gallbladder was seen or for 4 hours, whichever was earlier. When the gallbladder was visualized, post-fatty-meal images were made for visual analysis and time/activity curves were generated over regions of interest for further evaluation. Patients having total or partial subhepatic biliary channel obstruction with or without dilatation of intrahepatic ducts were subjected to endoscopic retrograde cholangio-pancreatography (ERCP) within the next two to three days. Out of 360 patients thus evaluated, 84 (23%) showed partial, total or near total subhepatic obstruction. In 55 cases the whole biliary tree was dilated; in 17 cases the left hepatic duct and the common bile duct (CBD); in seven cases the left hepatic duct alone, and in five cases the CBD alone. ERCP findings were concurrent in most cases. However, in 13 cases no abnormality of the biliary tree could be detected by ERCP, although worms were found in the duodenum. In 28 cases single or multiple worms were found inside the hepatobiliary channel. Video recordings of the ERCP revealed in some cases that the worms were moving in and out of the biliary channel. In 41 cases of proven biliary ascariasis, scintigraphic finding was indicative in all cases. Hepatobiliary scintigraphy appears to be a

  18. Our experience of biliary ascariasis in children

    Directory of Open Access Journals (Sweden)

    Wani M

    2006-01-01

    Full Text Available Ascariasis is highly endemic in Kashmir valley as temperate climate and wet soil provide excellent conditions for its development. We studied 198 cases (11% of biliary ascariasis out of 1,800 patients of worm infestation from December 2001 to December 2004 in the age group of 4-15 years. In our study, we found biliary ascariasis to be more common in female children, and most common clinical presentation was biliary colic in 143 patients, cholangitis in 28, cholecystitis in 15, liver abscess 7, pancreatitis 4 and postoperative worm infestation in 1 patient. Ultrasonography of abdomen was the diagnostic tool of choice with hundred percent results. Most of the patients were managed conservatively. ERCP was not done in children because of need of general anesthesia and difficulty in performing the procedure. Surgical intervention was required in 23 patients (cholecystectomy with CBD exploration in 5, choledochotomy alone in 13, drainage of liver abscess in 3, choledochoduodenostomy in 1 and peritoneal lavage in 1.

  19. Biliary ascariasis: MR cholangiography findings in two cases

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    Hwang, Cheol Mok; Kim, Tae Kyoung; Ha, Hyun Kwon; Kim, Pyo Nyun; Lee, Moon Gyu [Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2001-09-01

    We describe the imaging features of two cases of biliary ascariasis. Ultrasonography and CT showed no specific abnormal findings, but MR cholangiography clearly demonstrated an intraductal linear filling defect that led to the correct diagnosis. MR cholangiography is thus a useful technique for the diagnosis of biliary ascariasis.

  20. Biliary Ascariasis: MR Cholangiography Findings in Two Cases

    OpenAIRE

    Hwang, Cheol Mok; Kim, Tae Kyoung; Ha, Hyun Kwon; Kim, Pyo Nyun; Lee, Moon-Gyu

    2001-01-01

    We describe the imaging features of two cases of biliary ascariasis. Ultrasonography and CT showed no specific abnormal findings, but MR cholangiography clearly demonstrated an intraductal linear filling defect that led to the correct diagnosis. MR cholangiography is thus a useful technique for the diagnosis of biliary ascariasis.

  1. Biliary ascariasis: MR cholangiography findings in two cases

    International Nuclear Information System (INIS)

    We describe the imaging features of two cases of biliary ascariasis. Ultrasonography and CT showed no specific abnormal findings, but MR cholangiography clearly demonstrated an intraductal linear filling defect that led to the correct diagnosis. MR cholangiography is thus a useful technique for the diagnosis of biliary ascariasis

  2. Hepatolithiasis with biliary ascariasis – a case report

    OpenAIRE

    Khithani AS; Shetty TS; Joshi RM; Amarapurkar AD; Pilankar KS; Chemburkar VV

    2003-01-01

    Abstract Background Biliary ascariasis is regarded as possible etiological factor for hepatolithiasis. Here we report one case of a patient with hepatolithiasis with biliary ascariasis who developed a liver abscess, which was treated with partial hepatectomy. Case presentation A young adult female presented with epigastric pain and vomiting with repeated attacks of cholangitis. ERCP showed evidence of multiple intrahepatic calculi with the development of abscess in the left lobe of liver. The...

  3. Biliary ascariasis in a bile duct stones-removed female patient

    OpenAIRE

    2013-01-01

    Biliary ascariasis is a common problem in rural areas in China. The common presentations include biliary colic, acute cholangitis, obstructive jaundice, choledocholithiasis and acute cholecystitis. Here, we describe a case with biliary ascariasis two days after endoscopic sphincterotomy for choledocholithiasis. A living ascaris was successfully removed by endoscopic retrograde cholangiopancreatography. This case indicated that biliary ascariasis is not an uncommon complication of endoscopic s...

  4. 3 T MR cholangiopancreatography appearances of biliary ascariasis

    Energy Technology Data Exchange (ETDEWEB)

    Ding, Z.X., E-mail: hangzhoudzx73@126.co [Department of Radiology, Zhejiang Provincial People' s Hospital, Hangzhou (China); Yuan, J.H. [Department of Radiology, Zhejiang Provincial People' s Hospital, Hangzhou (China); Chong, V. [Department of Diagnostic Imaging, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore (Singapore); Zhao, D.J. [Department of Hepatobiliary Surgery, Zhejiang Provincial People' s Hospital, Hangzhou (China); Chen, F.H.; Li, Y.M. [Department of Radiology, Zhejiang Provincial People' s Hospital, Hangzhou (China)

    2011-03-15

    Aim: To evaluate the 3 T MR cholangiopancreatography (MRCP) appearances of biliary ascariasis. Materials and methods: Nine patients with a MRCP diagnosis of biliary ascariasis were reviewed. All patients had endoscopic retrograde cholangiopancreatography (ERCP) or surgical confirmation of the disease. Results: On thin-slab MRCP imaging, Ascaris worms are clearly demarcated within the biliary tree. All the identified worms demonstrated a characteristic three-parallel-lines appearance. The middle high-signal intensity line is sandwiched between two low-signal intensity lines and they are in turn surrounded by high signal bile. On thick-slab MRCP the worms also show the three-line sign but with less clarity. However, thick-slab MRCP has the advantage of providing three-dimensional ERCP-like images of the pancreaticobiliary system. Conclusion: The 'three-line' sign appears to be a characteristic sign of biliary ascariasis on 3 T MRCP.

  5. 3 T MR cholangiopancreatography appearances of biliary ascariasis

    International Nuclear Information System (INIS)

    Aim: To evaluate the 3 T MR cholangiopancreatography (MRCP) appearances of biliary ascariasis. Materials and methods: Nine patients with a MRCP diagnosis of biliary ascariasis were reviewed. All patients had endoscopic retrograde cholangiopancreatography (ERCP) or surgical confirmation of the disease. Results: On thin-slab MRCP imaging, Ascaris worms are clearly demarcated within the biliary tree. All the identified worms demonstrated a characteristic three-parallel-lines appearance. The middle high-signal intensity line is sandwiched between two low-signal intensity lines and they are in turn surrounded by high signal bile. On thick-slab MRCP the worms also show the three-line sign but with less clarity. However, thick-slab MRCP has the advantage of providing three-dimensional ERCP-like images of the pancreaticobiliary system. Conclusion: The 'three-line' sign appears to be a characteristic sign of biliary ascariasis on 3 T MRCP.

  6. Biliary ascariasis: Report of a complicated case and literature review

    OpenAIRE

    Sanai F; Al-Karawi M

    2007-01-01

    Invasion of the Ascaris worm into the biliary system leads to a wide variety of clinical syndromes. Most of the descriptions of the disease have originated from the developing world, where due to the environmental factors there is a high level of parasitism. An increased incidence of biliary ascariasis borne out of population migration and increased facilities for diagnosis has led to a renewal of interest in this disease in the developed world. Significant morbidity and mortality is associat...

  7. Periampullary carcinoma following biliary ascariasis--a case report.

    OpenAIRE

    Chowdhury T; Dubey S

    1997-01-01

    A 42 year old man presented with obstructive jaundice and cholangits. Ultrasonography (USG) revealed dilated intrahepatic biliary radicals and common bile duct (CBD). The bile duct also showed a curvilinear parallel intraluminal structure suggesting biliary ascariasis. The CBD was explored and a dead worm removed but jaundice persisted. Endoscopic retrograde cholangio pancreaticography (ERCP) was done showing a periampullary mass which on biopsy showed a villous adenoma with highly dysplastic...

  8. Biliary Ascariasis Coinciding Hepatitis a Infection

    OpenAIRE

    Özen, Metehan; Güngör, Serdal; Karakurt, Cemşit; Kutlu, Ramazan

    2007-01-01

    Intestinal ascariasis is one of the most common parasitic infestation in developing countries. Fifteen years-old male was admitted with the complaints of jaundice, abdominal pain and nausea. Laboratory investigations revealed positivity of anti-HAV-IgM and IgG. We performed abdominal ultrasonography because of long-lasting jaundice and increasing abdominal crampy pain. Examination revealed 7-8 cm long tubular image which is consistent with Ascaris lumbricoides. Single dose albendazole and an...

  9. Biliary Ascariasis on Magnetic Resonance Cholangiopancreatography

    OpenAIRE

    Hashmi, Mohammad A; Jevan K De

    2009-01-01

    A 17-year-old girl presented with features of biliary obstruction. Magnetic resonance cholangi-pancreatography revealed typical linear signals in common bile duct, which appears like Ascaris lumbricoides. The diagnosis was confirmed by endoscopic removal of the worm.

  10. Real-time ultrasonographic findings of biliary ascariasis

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    Woo, Seong Ku; Sung, Dong Wook; Ko, Young Tae; Kim, Ho Kyun; Kim, Soon Yong [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1983-06-15

    Although the ultrasonography has been regarded as a main procedure in the diagnosis of bile duct and gallbladder diseases, a few reports concerning the ultrasonographic findings of biliary ascariasis appeared in the literature. Seven cases of real-time ultrasonographic diagnosis of biliary ascariasis were made in our hospital during last 15 months. In six, the diagnosis was confirmed by surgery or radiographic examination. The results were as follows: 1. The characteristic long, thick, highly reflective echo without distal acoustic shadowing in the extra- and/or intra-hepatic ducts were seen in all six proven cases. 2. The echogenic, nonshadowing images of the worms were seen as single stripe in five cases (containing a central, longitudinal, anechoic tube, suggesting its digestive tract in three cases) or multiple stripes in one case. But so-called coiled appearance or amorphous fragments were not seen in our cases. 3. Associated findings were as follows: mild to moderate dilatation of the extrahepatic duct in all six proven cases, mild dilatation of the intrahepatic ducts in 3 cases, mild dilatation of the pancreatic duct in 1 case, intrahepatic stone in 1 case, contracted gallbladder containing single stone in 1 case and evidence of cholecystitis in 4 cases. 4. One false positive diagnosis of ascariasis in the gallbladder is considered due to reverberation artefact. No false negative was seen.

  11. Real-time ultrasonographic findings of biliary ascariasis

    International Nuclear Information System (INIS)

    Although the ultrasonography has been regarded as a main procedure in the diagnosis of bile duct and gallbladder diseases, a few reports concerning the ultrasonographic findings of biliary ascariasis appeared in the literature. Seven cases of real-time ultrasonographic diagnosis of biliary ascariasis were made in our hospital during last 15 months. In six, the diagnosis was confirmed by surgery or radiographic examination. The results were as follows: 1. The characteristic long, thick, highly reflective echo without distal acoustic shadowing in the extra- and/or intra-hepatic ducts were seen in all six proven cases. 2. The echogenic, nonshadowing images of the worms were seen as single stripe in five cases (containing a central, longitudinal, anechoic tube, suggesting its digestive tract in three cases) or multiple stripes in one case. But so-called coiled appearance or amorphous fragments were not seen in our cases. 3. Associated findings were as follows: mild to moderate dilatation of the extrahepatic duct in all six proven cases, mild dilatation of the intrahepatic ducts in 3 cases, mild dilatation of the pancreatic duct in 1 case, intrahepatic stone in 1 case, contracted gallbladder containing single stone in 1 case and evidence of cholecystitis in 4 cases. 4. One false positive diagnosis of ascariasis in the gallbladder is considered due to reverberation artefact. No false negative was seen

  12. Biliary ascariasis on magnetic resonance cholangiopancreatography

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    Mohammad A Hashmi

    2009-01-01

    Full Text Available A 17-year-old girl presented with features of biliary obstruction. Magnetic resonance cholangi-pancreatography revealed typical linear signals in common bile duct, which appears like Ascaris lumbricoides. The diagnosis was confirmed by endoscopic removal of the worm.

  13. Clinical features and management of biliary ascariasis in a non-endemic area

    OpenAIRE

    Misra, S; Dwivedi, M.

    2000-01-01

    Biliary ascariasis is common in certain geographical areas of the world. In India, it is common in the Kashmir valley and only stray cases have been reported from other parts of the country. Between January 1995 and May 1997, 14 patients with biliary ascariasis were seen at our centre, which is more than 1000 km from the Kashmir valley. The mean (± SD) age of the patients was 31.7 (± 6.1) years and all were females. None of them had been to a place known to be endemic for biliary ascariasis. ...

  14. Biliary Ascariasis in the Indian Subcontinent: A Study of 42 Cases

    OpenAIRE

    Mukhopadhyay Madhumita

    2009-01-01

    Background/Aim: History of ascariasis is known to stretch back many centuries. One quarter of the world′s population is known to be infected by ascariasis. It is endemic in various parts of the Indian subcontinent and the gangetic plain of West Bengal is one of them. We aimed to study the various types of clinical presentations, complications and different diagnostic tools and to assess various options for the management of biliary ascariasis. Materials and Methods: Forty-two cases ...

  15. A cause of obstructive icter: Ascariasis and endoscopic treatment (biliary acariasis and treatment)

    OpenAIRE

    GÜRSOY, Şebnem; BAŞKOL, Mevlüt; YURCİ, Alper; GÜVEN, Kadri; ÖZBAKIR, Ömer; YÜCESOY, Mehmet

    2004-01-01

    Ascariasis is one of the most common helmintic diseases. Biliary ascariasis is less frequent but important because of its complications. In this paper, we present a patient who admitted to our clinic with the complaints of abdominal pain and progressive icterus. His liver function tests were abnormal. Abdominal ultrasonography was compatible with cholangitis and possible parasitic infection of biliary ducts. ERCP was performed and several ascaris worms were seen at the papilla. Endosco...

  16. Ascariasis

    Science.gov (United States)

    ... enabling JavaScript. Top Banner Content Area Skip Content Marketing Share this: Main Content Area Ascariasis Ascariasis, or ... intestinal wall, the eggs reach your lungs by means of the bloodstream or lymphatic system. In your lungs, ...

  17. Comparative Study on Presentation of Biliary Ascariasis with Dead and Living Worms

    OpenAIRE

    Alam, Shahinul; Mustafa, Golam; Rahman, Salimur; Kabir, Shamsul A.; Rashid, Harun O.; Khan, Mobin

    2010-01-01

    Background/Aim: Ascariasis is a common parasitic infestation in Asia and Latin America. The most serious presentation is biliary and pancreatic ascariasis (BPA). The aim of the present study was to compare the clinical presentation of BPA with dead worms with that with living worms. Materials and Methods: We included 138 consecutive cases of BPA that occured during the period January 2005 to July 2009. All the patients had endoscopically proven BPA consisting of living or dead worms. Comparis...

  18. Hepatobiliary and pancreatic ascariasis-sonographic pictorial essay on four pediatric cases with acute biliary colic.

    Science.gov (United States)

    Lynser, Donboklang; Marbaniang, Evarisalin

    2016-04-01

    Hepatobiliary and pancreatic ascariasis occur due to migration of the round worm ascaris lumbricoides through the bile duct orifice finally reaching the common bile duct, main pancreatic duct, intrahepatic ducts or gallbladder. These resulted in acute epigastric and right hypochondriac region colicky pain. Ultrasound is the investigation of choice in hepatobiliary ascariasis. We present here sonographic images on four pediatric patients with acute biliary colic. PMID:26690772

  19. Hepatobiliary alterations in massive biliary ascariasis: histopathological aspects of an autopsy case Lesões hepatobiliares em ascaridíase biliar maciça: aspectos histopatológicos em um caso de autópsia

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    Luiz Carlos da Costa Gayotto

    1990-04-01

    Full Text Available Hepatobiliary alterations found in an autopsy case of massive Biliary Ascariasis, are reported on histological grounds. Severe cholangitis was the main finding, but other changes were also detected, such as pyloric and intestinal metaplasia, hyperplasia of the epithelial lining, with intraductal papillomas and adenomatous proliferation. Remnants of the worm were observed tightly adhered to the epithelium, forming microscopic intrahepatic calculi. Mucopolysaccharides, especially acid, showed to be strongly positive on the luminal border, and in proliferated glands around the ducts. The authors discuss the similarity between such findings and Oriental Cholangiohepatitis, and suggest that inflammation and the presence of the parasitic remnants are responsible for the hyperplastic and metaplastic changes, similarly with what occurs in chlonorchiasis, fascioliasis and schistosomiasis.Os autores apresentam os aspectos histopatológicos encontrados no fígado de um caso de autópsia de Ascaridíase Biliar maciça. A intensa colangite foi o aspecto predominante, mas outras lesões também foram encontradas, tais como metaplasia pilórica e intestinal, hiperplasia epitelial com papilomas intraductais, e por vezes padrão adenomatoso. Restos do helminto foram encontrados fortemente aderidos ao epitélio, sendo intensa a positividade de mucopolissacárides, principalmente ácidos, na borda luminal do epitélio ductal e em glândulas proliferadas ao redor dos ductos. Os autores discutem a semelhança da Ascaridíase Biliar com a Colangio Hepatite Oriental, e sugerem que o processo inflamatório e a presença de restos do verme são responsáveis pelas alterações hiperplásicas e metaplásicas, analogamente ao que ocorre na clonorquíase, fasciolíase e esquistossomose.

  20. Biliary ascariasis in the Indian subcontinent: A study of 42 cases

    Directory of Open Access Journals (Sweden)

    Mukhopadhyay Madhumita

    2009-01-01

    Full Text Available Background/Aim: History of ascariasis is known to stretch back many centuries. One quarter of the world′s population is known to be infected by ascariasis. It is endemic in various parts of the Indian subcontinent and the gangetic plain of West Bengal is one of them. We aimed to study the various types of clinical presentations, complications and different diagnostic tools and to assess various options for the management of biliary ascariasis. Materials and Methods: Forty-two cases of hepatobiliary ascariasis were studied over a period of 3 years. All the patients were adults aged between 20 and 50 years and all but two were admitted with acute upper abdominal pain. Results: In this study, biliary ascariasis was found to be more common in females, 73.8% (31 patients. The most common presentation was upper abdominal pain in 95.2% of the patients (40 patients. Complications observed were obstructive jaundice in 28.56% (12 patients, cholangitis in 16.7% (seven patients, acute pancreatitis in 2.4% (one patient and hepatic abscess in 2.4% (one patient. History of worm emesis was present in 38.1% (16 patients. History of previous cholecystectomy was present in 16.7% (seven patients and endoscopic sphincterotomy in 4.8% (two patients. Ultrasound was the diagnostic tool of choice with 100% results. Conservative management was successful in 83.3% (35 patients. During follow-up, worm reinvasion of the biliary system occurred in 7.1% (three patients. Conclusion: In endemic countries, ascariasis should be suspected in patients with biliary disease, especially if a cholecystectomy or sphincterotomy has been performed in the past. Most of the patients respond to conservative management.

  1. Endoscopy treatment of multiple ascariasis biliary in children Cases report and review

    International Nuclear Information System (INIS)

    The Ascaridiasis is a problem of public health in the most countries located in the third world, one of the most common presentations of this parasitism is the biliary erratic ascariasis, which involves the biliary ways and the pancreatic conduit, although most of the research works report about the low incidence of this pathology in kids. In the present Article we report five cases of kids with a manifestation of ascariasis in common bile duct, four of them are the most interesting cases due to the presence of multiple biliary parasites. Once a revision made of paraclinical reports of these five cases and the characteristics of the E.R.C.P endoscopic procedure, we are showing the advantages of this method for the diagnostic and treatment of this pathology at the same time it is exposed to the readers a brief actualization of this infestations

  2. An alien in the gallbladder. A rare case of biliary ascariasis in an Italian emergency department

    Directory of Open Access Journals (Sweden)

    Enrico Ferri

    2016-04-01

    Full Text Available Ascariasis is a common infection in many developing countries. The prevalence of ascariasis is related to poverty, poor hygienic and sanitary conditions. The adult form of Ascaris lumbricoides usually resides in the human intestinal lumen (more frequently in the jejunum and middle ileum and does not cause symptoms. However, it can occasionally cause severe complications such as intestinal obstruction or perforation peritonitis. Its migration into the biliary tract is not uncommon but gallbladder involvement is very rare. Abdominal ultrasonography is essential to detect the presence of this parasite. In this article, we describe the radiologic findings, clinical manifestations and successful medical treatment of a patient with gallbladder ascariasis diagnosed in an emergency setting.

  3. Comparative study on presentation of biliary ascariasis with dead and living worms

    Directory of Open Access Journals (Sweden)

    Alam Shahinul

    2010-01-01

    Full Text Available Background/Aim: Ascariasis is a common parasitic infestation in Asia and Latin America. The most serious presentation is biliary and pancreatic ascariasis (BPA. The aim of the present study was to compare the clinical presentation of BPA with dead worms with that with living worms. Materials and Methods: We included 138 consecutive cases of BPA that occured during the period January 2005 to July 2009. All the patients had endoscopically proven BPA consisting of living or dead worms. Comparison was done by chi-square and independent t tests. Results: The age (mean ± SD of the patients was 36.8 ± 16.1 years. Prevalence ratio between male and female patients was 1:5. Ninety eight patients contained living worms and 40 had dead worms. Males were more prone to develop dead worm BPA. The commonest presentation was biliary colic (131; 94.9%; others were acute cholangitis (30; 21.7%, obstructive jaundice (19; 13.8%, choledocholithiasis (20; 14.5%, acute pancreatitis (10; 7.2%, acute cholecystitis (6; 4.3%, liver abscess (2; 1.4%, hepatolithiasis (3; 2.2%, stricture of common bile duct (2; 1.4%, pancreatic abscess (1; 0.7% and cirrhosis of liver (1; 0.7%. Choledocholithiasis, hepatolithiasis, liver abscess and cirrhosis were associated only with dead worms. We could successfully remove all the worms with endoscopic interventions, but 5 patients required surgical intervention as there were strictures and stones within the biliary tree or Ascaris were in gallbladder. Recurrences of stone and cholangitis occurred only in those with dead worms. Conclusion: Biliary ascariasis with dead worms is more dangerous than that with living worms. Endoscopic or surgical intervention may be required repeatedly in those with dead worms.

  4. Biliary ascariasis: the value of ultrasound in the diagnosis and management

    International Nuclear Information System (INIS)

    Conventional methods of radiographic examination are often unsatisfactory for identifying worms in the biliary tract. Ultrasonography is a non-invasive, quick and safe procedure known to have diagnostic accuracy. We studied the ultrasonographic appearance of biliary ascariasis and the role of ultrasonography in diagnosis and management. In a prospective 5-year study, a sonogarphic diagnosis of biliary ascariasis was made on 46 Yemeni patients. The diagnosis was based mainly on sonographic appearences supported by clinical and laboratory results and proved by outcome of either surgical or medical management or spontaneous exit of worms. Follow-up ultrasound was performed, for all patients, to confirm the diagnosis and to monitor the management. Parasites were present in the dilated main bile duct in 23 patients, in the gallbladder in 12 patients, in the intrahepatic ducts in 6 patients, in the main pancreatic duct in 4 patients and as an intrahepatic abscess in one patient. The characteristic appearance of Ascaris lumbricoides was a single or multiple echogenic non-shadowing linear or curved strips with or without echoic tubular central lines that represent the digestive tracts of the worm. A spaghetti-like appearance was seen in 9 patients and amorphous fragments were seen in 2 patients. Sixteen patients underwent surgery, 20 patients were treated medically (including spontaneous exit of the worm in 7 patients without treatment) and in 10 patients worms were extracted by endoscopic retrograde cholangiopancreatography. Follow-up ultrasound was found to be effective in confirming the diagnosis and monitoring management. (author)

  5. Intrahepatic Duct Stones Harboring Ascariasis Ova: A Case Report.

    Science.gov (United States)

    Lee, Chen-Fang; Lee, Wei-Chen; Wu, Ren-Chin; Chen, Tse-Ching

    2016-03-01

    Ascariasis lumbricoides is one of the most common helminthic infestations in humans. Despite the fact that the prevalence of ascariasis in developed countries has been decreasing, biliary ascariasis can cause serious complications, such as acute cholangitis, pancreatitis, and liver abscess. Here we presented a rare ascariasis-related complication-hepatolithiasis.A 60-year-old female patient had symptoms of recurrent cholangitis. Abdominal computed tomography scan revealed left intrahepatic duct stones with left liver lobe atrophy. Endoscopic retrograde cholangiopancreatography was performed, but the stones could not be removed due to left main intrahepatic duct stenosis. The patient was treated with left hemi-hepatectomy. Unexpectedly, Ascaris ova were found on the histopathological examination. She received antihelminthic therapy orally and was on regular follow-up without any complications.Our study indicates that clinicians should be aware of biliary ascariasis in patients with hepatolithiasis, though not living in endemic areas. PMID:27015193

  6. Magnetic resonace appearance of Gall Bladder Ascariasis

    Directory of Open Access Journals (Sweden)

    Arya Prafull

    2005-05-01

    Full Text Available Ascariasis is a common disease in many developing countries and is a common cause of biliary and pancreatic diseases in endemic areas. Numerous studies have been published on biliary tract ascariasis. All these have documented ultrasonography as the primary imaging modality for biliary tract ascariasis. Magnetic Resonance Cholangiopancreatography (MRCP has been the latest entrant for the study of bilary tract. MRCP findings of biliary tract ascariasis have been scarcely documented. MRCP is a unique non-invasive investigation for demonstrating ascariasis in Gall bladder and bilary tract clearly. We present MR appearances of Gall bladder and biliary tract in a proven case of biliary ascariasis.

  7. Sonographic images of hepato-pancreatico-biliary and intestinal ascariasis: A pictorial review

    OpenAIRE

    Lynser, Donboklang; Handique, Akash; Daniala, Chhunthang; Phukan, Pranjal; Marbaniang, Evarisalin

    2015-01-01

    Abstract Despite advancement in the diagnosis and treatment of intestinal helminthiasis, ascariasis remains the most common cause of helminthic infections in the developing countries. Ultrasound offers a rapid, safe, and noninvasive approach to the diagnosis of intestinal ascariasis. Ultrasound is also the modality of choice for diagnosis of hepatobiliary ascariasis, which is relatively rare and is due to migration of intestinal worms through the papilla of Vater. We present an imaging spectr...

  8. Magnetic resonace appearance of Gall Bladder Ascariasis

    OpenAIRE

    Arya Prafull; Kukreti Ranjan; Arya Muktanjali; Gupta Sachida

    2005-01-01

    Ascariasis is a common disease in many developing countries and is a common cause of biliary and pancreatic diseases in endemic areas. Numerous studies have been published on biliary tract ascariasis. All these have documented ultrasonography as the primary imaging modality for biliary tract ascariasis. Magnetic Resonance Cholangiopancreatography (MRCP) has been the latest entrant for the study of bilary tract. MRCP findings of biliary tract ascariasis have been scarcely documented. MRCP is a...

  9. Pancreatic ascariasis with periampullary carcinoma

    OpenAIRE

    Arulprakash, S; Sahu, Manoj Kumar; Dutta, Amit Kumar; Joseph, A; Chandy, George M.

    2015-01-01

    Ascarias lumbricoides infestation is endemic in tropical countries. Most infections are asymptomatic, but it can produce a wide spectrum of manifestations including hepatobiliary and pancreatic complications. There are reports of association of biliary ascariasis with bilary malignancies in the past, but same is not known for pancreatic ascariasis. We report a case of association of periampullary malignancy with pancreatic ascariasis.

  10. Tilfaeldigt fund af biliaer ascariasis

    DEFF Research Database (Denmark)

    Kristensen, Anders Donatsky; Achiam, Michael

    2010-01-01

    We describe a case of biliary ascariasis in a 27-year-old Philippine au-pair with recurrent upper abdominal pain. Hepatobiliary ascariasis is rarely seen in non-endemic areas. The diagnosis is important because severe complications can occur. If migrated into the biliary tree, it is recommended to...

  11. Ultrasonography findings of biliary ascariasis as a rare cause of acalculous cholecystitis

    OpenAIRE

    Şalk, İsmail; Atalar, Mehmet H.

    2014-01-01

    AbstractAscaris lumbricoides is the most common intestinal parasite to infect humans. The incidence of ascariasis is increasing in all part of the world because of world travel and population migration. Ascaris lumbricoides may cause various complications in the gastrointestinal system. Abdominal pain and tenderness with weight loss are the most common clinical presentations. The parasite can cause invagination at the intestinal segments and can enter the bile duct and cause cholangitis or bi...

  12. Multiple biliary hamartomas: magnetic resonance features with histopathologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Tohme-Noun, Carla [Beaujon Hospital, Assistance Publique, Department of Radiology, Clichy (France); Sacre-Coeur Hospital, Department of Radiology, Hazmie (Lebanon); Cazals, Dominique [Beaujon Hospital, Assistance Publique, Department of Pathology, Clichy (France); Noun, Roger [Hotel-Dieu de France Hospital, Department of Digestive Surgery, Beirut (Lebanon); Menassa, Lina [Hotel-Dieu de France Hospital, Department of Radiology, Beirut (Lebanon); Valla, Dominique [Beaujon Hospital, Assistance Publique, Department of Hepatology, Clichy (France); Vilgrain, Valerie [Beaujon Hospital, Assistance Publique, Department of Radiology, Clichy (France)

    2008-03-15

    The purpose of this study was to report the magnetic resonance imaging (MRI) features of multiple biliary hamartoma (MBH) and to correlate them with histopathology. MRI features of 11 patients with MBH proven by histology were retrospectively reviewed and correlated to histopathology. MBH presented as multiple, tiny, and uniformly distributed lesions in all cases. All were hypointense on T1-weighted images and hyperintense on T2-weighted images relative to the liver parenchyma. Mural nodules were identified in 10 of 11 (91%) cases. They were isosignal on T1-weighted images, intermediate signal on T2-weighted images. Gadolinium-enhanced images showed mural nodule enhancement in 9 of 10 patients (90%) or a peripheral rim-like enhancement of the whole lesion in one case (9%). MBH were present in all liver specimens. In the six patients examined at MR cholangiography, the lesions lacked communication with the biliary tree. At histopathology, the mural nodule corresponded to an endocystic polypoid projection made of conjunctive septa. Three (27%) patients had associated focal nodular hyperplasia, and 1 (9%) had concomitant cholangiocarcinoma. MRI features allowed diagnosis of MBH with accuracy. Their recognition, especially the mural nodule, may help avoid misdiagnosis. (orig.)

  13. Multiple biliary hamartomas: magnetic resonance features with histopathologic correlation

    International Nuclear Information System (INIS)

    The purpose of this study was to report the magnetic resonance imaging (MRI) features of multiple biliary hamartoma (MBH) and to correlate them with histopathology. MRI features of 11 patients with MBH proven by histology were retrospectively reviewed and correlated to histopathology. MBH presented as multiple, tiny, and uniformly distributed lesions in all cases. All were hypointense on T1-weighted images and hyperintense on T2-weighted images relative to the liver parenchyma. Mural nodules were identified in 10 of 11 (91%) cases. They were isosignal on T1-weighted images, intermediate signal on T2-weighted images. Gadolinium-enhanced images showed mural nodule enhancement in 9 of 10 patients (90%) or a peripheral rim-like enhancement of the whole lesion in one case (9%). MBH were present in all liver specimens. In the six patients examined at MR cholangiography, the lesions lacked communication with the biliary tree. At histopathology, the mural nodule corresponded to an endocystic polypoid projection made of conjunctive septa. Three (27%) patients had associated focal nodular hyperplasia, and 1 (9%) had concomitant cholangiocarcinoma. MRI features allowed diagnosis of MBH with accuracy. Their recognition, especially the mural nodule, may help avoid misdiagnosis. (orig.)

  14. Gall bladder ascariasis

    OpenAIRE

    Ranendra Hajong

    2013-01-01

    Hepatobiliary ascariasis is commonly reported from highly endemic regions like India, Bangladesh, Latin America, parts of Middle East and Africa. In humans, the usual habitat of Ascaris lumbricoides is the small intestine. When the worm load is high, going as high as more than 1000 worms, then the worms tend to migrate away from the usual site. Patients with hepatobiliary ascariasis may present with biliary colic due to obstruction caused by the worms in the gall bladder, common bile duct or ...

  15. Gall bladder ascariasis

    Directory of Open Access Journals (Sweden)

    Ranendra Hajong

    2013-01-01

    Full Text Available Hepatobiliary ascariasis is commonly reported from highly endemic regions like India, Bangladesh, Latin America, parts of Middle East and Africa. In humans, the usual habitat of Ascaris lumbricoides is the small intestine. When the worm load is high, going as high as more than 1000 worms, then the worms tend to migrate away from the usual site. Patients with hepatobiliary ascariasis may present with biliary colic due to obstruction caused by the worms in the gall bladder, common bile duct or as a result of obstructive symptoms caused by calcified worms or lithiasis, which is commonly found in patients with hepatobiliary ascariasis. Acute pancreatitis may also be caused by ascariasis. Management usually is conservative if it is still alive or can be extracted by endoscopic retrograde cholangio-pancreatography or surgery.

  16. ASCARIASIS AND COEXISTANT STONE IN COMMON BILE DUCT IN POST CHOLECYSTECTOMY POST CHOLEDOCHOLITHOTOMY WOMAN: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Khalid

    2014-11-01

    Full Text Available Ascariasis is one of the commonest infections in Asia. Biliary ascariasis is a serious presentation of ascariasis which can result in life threatening complications including cholangitis, choledocholithiasis, Liver abscess, and Pancreatitis. We present a case of female from north Bihar who presented to us with biliary ascariasis and concomitant stone. Diagnosis was established by abdominal ultrasonography. Choledocholithotomy done and a live round worm with two biliary stone extracted.

  17. ASCARIASIS AND COEXISTANT STONE IN COMMON BILE DUCT IN POST CHOLECYSTECTOMY POST CHOLEDOCHOLITHOTOMY WOMAN: A CASE REPORT

    OpenAIRE

    Khalid,; Mahendra; Pradeep; Krishna; Vibhuti; Haque; Sanjay; Vijayanand,; Sangeeta

    2014-01-01

    Ascariasis is one of the commonest infections in Asia. Biliary ascariasis is a serious presentation of ascariasis which can result in life threatening complications including cholangitis, choledocholithiasis, Liver abscess, and Pancreatitis. We present a case of female from north Bihar who presented to us with biliary ascariasis and concomitant stone. Diagnosis was established by abdominal ultrasonography. Choledocholithotomy done and a live round worm with two biliary stone ...

  18. 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

  19. Acute pancreatitis due to ascariasis: a sonographic pictorial essay on four cases.

    Science.gov (United States)

    Lynser, Donboklang; Thangkhiew, R S; Laloo, Demitrost; Hek, M D; Marbaniang, Evarisalin; Tariang, Satisfy

    2016-06-01

    Ascariasis is the commonest helminthic disease to infect humans. Due to their wandering nature, the roundworms from the second part of the duodenum migrate through the biliary opening into the hepatobiliary and pancreatic ducts. Ascariasis is the most common parasitic cause of pancreatitis in endemic region. Pancreatitis can result due to pancreatic ascariasis, biliary ascariasis or both. Pancreatitis due to ascariasis can be severe and life-threatening. We present a pictorial essay of acute pancreatitis due to ascariasis on four cases. PMID:27059341

  20. Imaging of ascariasis

    International Nuclear Information System (INIS)

    Full text: Ascaris lumbricoides is one of the most common parasitic infestations of the gastrointestinal tract worldwide. During the intestinal phase of the disease, the adult worms usually remain clinically silent, sometimes causing a variety of non-specific abdominal symptoms. When present in large numbers, the worms may get intertwined into a bolus, causing intestinal obstruction, volvulus or even perforation. Occasionally, the adult Ascaris worm may migrate into the Vater's ampulla and enter the bile duct, gall bladder or pancreatic duct, leading to a variety of complications such as biliary colic, gallstone formation, cholecystitis, pyogenic cholangitis, liver abscess and pancreatitis. Imaging plays a significant role in showing the presence of worms and possible complications in intestinal as well as hepatobiliary ascariasis. This pictorial essay aims to illustrate various imaging features of ascariasis and its associated complications

  1. A report of two cases of ascariasis pancreatitis managed conservatively

    OpenAIRE

    Darlong, Laleng M.; Rubul Das; Ranendra Hajong; Noor Topno

    2011-01-01

    Ascaris lumbricoides is a common intestinal parasite in tropical and temperate regions. Although usually asymptomatic, infection can lead to biliary or intestinal obstruction and very rarely obstruction of the main pancreatic duct due to its smaller lumen. We report two cases of ascariasis in the main pancreatic duct, which is not a common site, presenting as acute pancreatitis and recovering uneventfully with conservative management.

  2. Ascariasis as an Unexpected Cause of Acute Pancreatitis with Cholangitis: A Rare Case Report from Urban Area

    OpenAIRE

    Pochamana Phisalprapa; Varayu Prachayakul

    2013-01-01

    Context Ascaris lumbricoides is one of the most common parasitic infestations of human gastrointestinal tract. This parasiticinfestation might be asymptomatic and only few studies on extraintestinal ascariasis have been reported. Ascending cholangitis and acute pancreatitis as a result of the Ascaris lumbricoides migrating into the biliary system and pancreatic duct were very rare complications. Here, we presented a case report of biliary ascariasis induced acute pancreatitis with cholangitis...

  3. Appendiceal ascariasis in children

    OpenAIRE

    2010-01-01

    BACKGROUND: The propensity of Ascaris lumbricoides to wander leads to varied surgical complications in the abdomen. Wandering A lumbricoides may sometimes reach the vermiform appendix and its presence there may remain silent or incite pathology. Our aim was to study ascariadial appendicitis. METHODS: Over a period of 3 years, we identified children who were found to have appendiceal ascariasis during surgery for different intestinal complications due to ascariasis. We studied the relationship...

  4. Albendazole Therapy in Ascariasis

    OpenAIRE

    Ishtyak Ahmed Mir ,Nazir Ahmed Wani, Rekha Patnaik

    2003-01-01

    Patients in the paediatric age group with moderate to severe intestinal ascariasis were treated withvarious antihelminthic dJugs. Albendazole, Pyrantel pamoate and Levamisole were used. Comparisonofthe percentage cure rate, was made and albendazole was found to be the most effective in 92.26%of patients followed by pyrantel pamoate and levamisole in 80.82% and 64.70% of the patientsrespectively.

  5. A report of two cases of ascariasis pancreatitis managed conservatively

    Directory of Open Access Journals (Sweden)

    Laleng M Darlong

    2011-01-01

    Full Text Available Ascaris lumbricoides is a common intestinal parasite in tropical and temperate regions. Although usually asymptomatic, infection can lead to biliary or intestinal obstruction and very rarely obstruction of the main pancreatic duct due to its smaller lumen. We report two cases of ascariasis in the main pancreatic duct, which is not a common site, presenting as acute pancreatitis and recovering uneventfully with conservative management.

  6. Albendazole Therapy in Ascariasis

    Directory of Open Access Journals (Sweden)

    Ishtyak Ahmed Mir ,Nazir Ahmed Wani, Rekha Patnaik

    2003-10-01

    Full Text Available Patients in the paediatric age group with moderate to severe intestinal ascariasis were treated withvarious antihelminthic dJugs. Albendazole, Pyrantel pamoate and Levamisole were used. Comparisonofthe percentage cure rate, was made and albendazole was found to be the most effective in 92.26%of patients followed by pyrantel pamoate and levamisole in 80.82% and 64.70% of the patientsrespectively.

  7. Ascariasis cholecystitis: An unusual cause

    Directory of Open Access Journals (Sweden)

    Shetty Balakrishna

    2008-01-01

    Full Text Available Ascariasis is the most common helminthic infection to infest man. Usually the adult worm lives in the small intestine. Rarely it migrates through the ampulla of vater and enters the common bile duct. We are reporting a case of gall bladder ascariasis causing acute cholecystitis treated by laparoscopic cholecystectomy. Presence of Ascaris lumbricoides in gallbladder is rare entity as it is difficult to reach there due to the narrow and tortuous cystic duct.

  8. Ascariasis cholecystitis: An unusual cause

    OpenAIRE

    Shetty Balakrishna; Shetty Prashanth; Sharma Pritam

    2008-01-01

    Ascariasis is the most common helminthic infection to infest man. Usually the adult worm lives in the small intestine. Rarely it migrates through the ampulla of vater and enters the common bile duct. We are reporting a case of gall bladder ascariasis causing acute cholecystitis treated by laparoscopic cholecystectomy. Presence of Ascaris lumbricoides in gallbladder is rare entity as it is difficult to reach there due to the narrow and tortuous cystic duct.

  9. Percutaneous Transcatheteral Biliary Biopsy (PTBB)

    OpenAIRE

    Kim, Dae Ghon; Song, Suck Hyun; Jang, Hyun Cheol; Kim, Jung Gweon; Ahn, Hong Suck; Ahn, Deuk Soo; Kim, Jong Soo; Han, Yeung Min

    1989-01-01

    In two patients with obstructive jaundice, percutaneous transhepatic cholangiography (PTC) and percutaneous transhepatic biliary drainage (PTBD) were performed. During PTBD, the percutaneous transcatheteral biliary biopsy (PTBB) with the biopsy forceps of the gastrofiberscope was performed through the biliary stent catheter. Biopsy specimens were successfully obtained and histopathologic findings were satisfactory in both cases.

  10. HEPATOBILIARY ASCARIASIS: 2 CASE REPORT

    OpenAIRE

    Samrendra Nath; Satya Prakash

    2016-01-01

    Hepatobiliary ascariasis is a relatively uncommon helminthic disease occasionally found in Indian subcontinent and third world country. They commonly present as right hypochondrial pain with mild jaundice. Vomiting may also be associated finding of this disease. Ultrasound investigation is an important, easily available, low cost tool for early diagnosis and followup. Its safety, accuracy, easy repeatability, quick and non-invasive property makes it the first and prime modality fo...

  11. Ascariasis of the gall bladder. Report of two cases.

    Science.gov (United States)

    Dantas, W; Salles, C G

    1976-01-01

    A radiological diagnosis of ascariasis of the gallbladder was made in two middle-aged women with high abdominal pain having biliary colic characteristics. In one case round worm was demonstrated by means of the intravenous cholangiography, but in the other the procedure was negative only the common bile duct being contrasted. Oral cholangiography made some days later permitted the visualization of the parasite in the gallbladder. The patients were treated by cholecistectomy and choledocostomy and the diagnosis was confirmed. The post-operative course was uneventful. There was Ascaris lumbricoides ova in the feces and the histological examination of the removed gallbladder showed large eosinophilic infiltration in both cases. The patients received levamisole some days after surgery. PMID:829874

  12. Pulmonary ascariasis in tropical communities.

    Science.gov (United States)

    Spillmann, R K

    1975-09-01

    To determine the incidence of Loeffler's syndrome in a tropical region, a survey was conducted over a 1-year period in two locations in Colombia, South America, one inland and urban (Cali), the other rural and coastal (Guapi). Among 700 hospitalized patients, 12,000 patients coming to health centers, and 44 families with 328 members, 4 cases of Loeffler's syndrome were found--3 during the survey and 1 before it began. Only one was typical and of some severity. None of the family members developed a perceptible reaction to larvae, though surveillance was close and 83 new intestinal infections were documented. Infection rates for intestinal ascariasis were 25% to 30% in Cali, and 80% to 90% in Guapi. When infections in 30 families were eliminated, previous levels of infection were reached within 10 months. When undisturbed by treatment, the levels of intestinal infection remained stable or showed fluctuations which were not linked to climatic changes. In view of the high prevalence of infection and year-round transmission, which was assumed to occur frequently in the population, it is noteworthy that symptomatic pulmonary ascariasis appeared to be rare and complications from adult worms in heavy infections were uncommon. The findings suggest that frequent and uninterrupted contact between Ascaris lumbricoides and its host results in a high degree of natural tolerance and control. PMID:1238026

  13. A Case of Ascariasis Mimicking Jejunal Intussusception

    OpenAIRE

    Sekmenli, Tamer; Ciftci, Ilhan; Emiroglu, Halil Haldun; Koplay, Mustafa

    2015-01-01

    Intussusception is the common abdominal emergency in early childhood. The clinical presentation is characterized by the triad of abdominal colics, red jelly stools (positive in 66%) and a palpable mass (70%). Ascariasis is a common infestation in tropical countries because of poor hygiene and low socioeconomic conditions. Ascariasis can cause serious intra-abdominal complications such as intestinal obstruction. We have reported a case of abdominal pain and intestinal obstruction, which was fi...

  14. Ultrasonographic features of pseudotumorous form of ascariasis

    International Nuclear Information System (INIS)

    We report the ultrasonographic findings of a 60 year old woman with pseudotumorous form of ascariasis. Real-time ultrasonographic examination using a curved array transducer revealed grossly thickened small bowel loops, multiple small circular deposits throughout the peritoneal cavity, and a moderate amount of ascites. The English literature on the different forms of abdominal ascariasis is reviewed. Specific signs, which include the 'strip' sign, the 'four-lines', 'inner tube', or 'double tube' sign, the 'bull's eye' or 'target' sign, a 'worm mass' or 'spaghetti-like' appearance, and the 'zig-zag' sign can be present in any form of abdominal ascariasis, as they represent the image of the Ascaris worms visualized under ultrasonographic examination. However, the non-specific signs are not peculiar to A. lumbricoides infections, but are results of secondary changes due to A. lumbricoides infections in the corresponding organs

  15. Parasitic disease of the liver and biliary tree

    Directory of Open Access Journals (Sweden)

    Mohamed Abdulrahman

    1997-01-01

    Full Text Available Several parasites infest liver or biliary tree, either during their maturation stages or as adult worms. Bile iry tree parasites may cause pancreatitis, cholecystitis, biliary tree obstruction, recurrent cholangitis, biliary tree strictures and some may lead to cholangiocarcinoma. This review discusses the hepatobiliary parasites, and shows our experience in diagnosis and management of these parasites. Ultrasonography of the liver is diagnostic in schistosomiasis, hydatid cysts, amebic liver abscess, ascariasis and other biliary tree parasites showing bile duct dilatation. Percutaneous aspiration under ultrasonography guidance of hydatid liver cysts or amebic abscess are effective measures in management. Endoscopic retrograde cholangiopancreatography (ERCP is safe and effective in diagnosis and management of biliary tree parasites.

  16. Biliary obstruction: Helical computed tomography cholangiography evaluation

    International Nuclear Information System (INIS)

    Helical computed tomography cholangiography (HCTC) takes advantage of the improvement in the quality of multiplanar and three-dimensional reconstructions resulting from the volumetric acquisition of data achieved with helical computed tomography and the indirect opacification of the bile ducts provided by cholangiographic contrast media. This method was used to evaluate 31 patients with suspected biliary obstruction over a one-year period and the findings were compared with those of direct cholangiography and/or surgery. Biliary opacification was sufficient to allow three-dimensional reconstructions in 90,3% of cases. Sensitivity was 81% for the diagnosis of choledochoolithiasis and 100% for ascariasis, choledochal cysts and anatomic variants of the biliary tree. Our results indicate that HCTC is a valuable alternative as a diagnostic method prior to direct cholangiography. Direct cholangiography should be reserved for those patients who require it as part of a therapeutic procedure

  17. Massive Infestation of the biliary duct for Ascaris lumbricoides: case report

    International Nuclear Information System (INIS)

    We present a case of a woman who arrived with acute cholangitis symptomatology, and was diagnosed preoperatively by ultrasound as biliary ascariasis. During surgery, we extracted 32 worms of Ascaris lumbricoides from the Gallbladder and the common bile duct. Clinical outcome was successful, with out retention of worms

  18. Incidence of ascariasis in gastric carcinoma

    International Nuclear Information System (INIS)

    Prompted by the finding that the radiological incidence of small bowel ascariasis in the patient with gastric carcinoma was unexpectedly lower than the incidence in the normal population, a clinical study was performed to investigate possible relationship between gastric carcinoma and intestinal ascariasis. As a preliminary survey, we reviewed the radiological incidence of ascariasis in a total of 2,446 cases of upper GI series performed at the Department of Radiology, St Mary's Hospital Catholic Medical College. These included 1,573 normal subjects, 146 gastric carcinoma patients, 100 benign gastric ulcer and 249 duodenal ulcer patients and 378 other upper GI diseases. Following the preliminary study, a more accurate parasitologic study was conducted in another 578 normal subjects and 51 gastric carcinoma patients. The radiological incidences of ascaiasis in normal subjects and gastric carcinoma patients were 15.1% and 28.1%, respectively. The incidence of overall helminthiasis including ascaris lumbricoides, trichocephalus trichiurus and trichostrongyloides orientalis in normal subjects of the present series was 73.5%. This figure is virtually the same with 69.1% of the general population incidence reported by Kim, et al. (1971), but the incidence in gastric carcinoma patients was 94.1%. The high incidence pattern of overall helminthiasis in gastric carcinoma patients is, however, reversed as for as ascariasis is concerned. Thus, the incidence of ascariasis of gastric carcinoma patients was much lower than that of normal subjects (9.8% vs 19.4%). From the present observation, it is postulated that there can be some possible antagonistic relationship between evolution of gastric carcinoma and small bowel infestation of ascaris lumbricoides

  19. Incidence of ascariasis in gastric carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Woo; Rhee, Hak Song; Bahk, Yong Whee [St Mary' s Hospital Catholic Medical College, Seoul (Korea, Republic of)

    1972-09-15

    Prompted by the finding that the radiological incidence of small bowel ascariasis in the patient with gastric carcinoma was unexpectedly lower than the incidence in the normal population, a clinical study was performed to investigate possible relationship between gastric carcinoma and intestinal ascariasis. As a preliminary survey, we reviewed the radiological incidence of ascariasis in a total of 2,446 cases of upper GI series performed at the Department of Radiology, St Mary's Hospital Catholic Medical College. These included 1,573 normal subjects, 146 gastric carcinoma patients, 100 benign gastric ulcer and 249 duodenal ulcer patients and 378 other upper GI diseases. Following the preliminary study, a more accurate parasitologic study was conducted in another 578 normal subjects and 51 gastric carcinoma patients. The radiological incidences of ascaiasis in normal subjects and gastric carcinoma patients were 15.1% and 28.1%, respectively. The incidence of overall helminthiasis including ascaris lumbricoides, trichocephalus trichiurus and trichostrongyloides orientalis in normal subjects of the present series was 73.5%. This figure is virtually the same with 69.1% of the general population incidence reported by Kim, et al. (1971), but the incidence in gastric carcinoma patients was 94.1%. The high incidence pattern of overall helminthiasis in gastric carcinoma patients is, however, reversed as for as ascariasis is concerned. Thus, the incidence of ascariasis of gastric carcinoma patients was much lower than that of normal subjects (9.8% vs 19.4%). From the present observation, it is postulated that there can be some possible antagonistic relationship between evolution of gastric carcinoma and small bowel infestation of ascaris lumbricoides.

  20. Ascariasis as an Unexpected Cause of Acute Pancreatitis with Cholangitis: A Rare Case Report from Urban Area

    Directory of Open Access Journals (Sweden)

    Pochamana Phisalprapa

    2013-01-01

    Full Text Available Context Ascaris lumbricoides is one of the most common parasitic infestations of human gastrointestinal tract. This parasiticinfestation might be asymptomatic and only few studies on extraintestinal ascariasis have been reported. Ascending cholangitis and acute pancreatitis as a result of the Ascaris lumbricoides migrating into the biliary system and pancreatic duct were very rare complications. Here, we presented a case report of biliary ascariasis induced acute pancreatitis with cholangitis without imaging supported in a patient coming from urban area. Case report A 33-year-old woman lives in Bangkok, urban area of Thailand. She presented with severe epigastric pain for one day. Her diagnosis was Ascaris lumbricoides induced acute pancreatitis accompanied with ascending cholangitis. The investigation results showed no eosinophilia and no ascaris eggs in stool examination. The abdominal computed tomography showed slightly common bile duct dilatation. The parasite was found during an endoscopic retrograde cholangiopancreatography performed. The cholangiography revealed a roundworm in common bile duct. The parasite was successfully removed by using an extraction balloon catheter and a snare. Microbiological examination of the parasite revealed a 22 cm long adult form of Ascaris lumbricoides. Conclusion Ascaris lumbricoides is the uncommon cause of biliary obstruction with complications. It is also a possible cause even in the patients who live in urban areas. Endoscopic removal is the treatment of choice in addition to antihelminthic medications.

  1. HEPATOBILIARY ASCARIASIS COMPLICATED BY PANCREATITIS.

    Science.gov (United States)

    Azhar, Muhammad; Sheikh, Ali Sibtain Farooq; Khan, Asim; Mustafa, Saqib; Shah, Imran Ali; Hameed, Bilal

    2015-01-01

    Ascaris lumbricoides is the commonest organism causing soil-transmitted helminth infection. It is particularly common in poor sanitary conditions. Nevertheless, involvement of the gallbladder by Ascaris is a rare entity. A lady presented to us with long-standing history of vague abdominal symptoms suggesting dyspepsia. Ultrasound showed a tube like structure invading the biliary channels. Serum amylase was elevated and the patient was managed conservatively, as for acute pancreatitis. She improved clinically, but subsequent imaging with magnetic resonance cholangiopancreatography revealed worm in the gallbladder. Laparoscopic cholecystectomy was done and Ascaris lumbricoides was removed. Ascaris infestation is an important differential diagnosis of patients with upper abdominal symptoms and screening with stool examination and ultrasound is warranted in high-risk population. PMID:26411145

  2. Percutaneous transhepatic biliary biopsy using gastrofiberscopic biopsy forceps.

    OpenAIRE

    Kim, C. S.; Han, Y M; Song, H. Y.; Choi, K. C.; Kim, D. G.; B.H. Cho

    1992-01-01

    To obtain a histopathologic diagnosis at the site of a biliary obstruction, we recently have performed 24 cases of biliary biopsy using gastrofiberscopic biopsy forceps (Olympus, Tokyo, Japan) via transhepatic tracts provided in the course of the procedure of percutaneous biliary drainage. Histopathologic diagnosis was successfully made at the first attempt of biopsy procedure but a second trial was made a week later in 6 cases who were negative for malignant cells on the first attempt. The h...

  3. Ultrasonographic features of pseudotumorous form of ascariasis

    Energy Technology Data Exchange (ETDEWEB)

    Hui, Joyce Y.H.; Woo, Patrick C.Y. E-mail: pcywoo@hkucc.hku.hk; Kan, Pan Shing; Lai, Yeong Man; Tang, Alice P.Y

    2001-09-01

    We report the ultrasonographic findings of a 60 year old woman with pseudotumorous form of ascariasis. Real-time ultrasonographic examination using a curved array transducer revealed grossly thickened small bowel loops, multiple small circular deposits throughout the peritoneal cavity, and a moderate amount of ascites. The English literature on the different forms of abdominal ascariasis is reviewed. Specific signs, which include the 'strip' sign, the 'four-lines', 'inner tube', or 'double tube' sign, the 'bull's eye' or 'target' sign, a 'worm mass' or 'spaghetti-like' appearance, and the 'zig-zag' sign can be present in any form of abdominal ascariasis, as they represent the image of the Ascaris worms visualized under ultrasonographic examination. However, the non-specific signs are not peculiar to A. lumbricoides infections, but are results of secondary changes due to A. lumbricoides infections in the corresponding organs.

  4. Radiological findings of intraparenchymal liver Ascaris (hepatobiliary ascariasis)

    Energy Technology Data Exchange (ETDEWEB)

    Akata, D.; Oezmen, M.N.; Kaya, A.; Akhan, O. [Dept. of Radiology, Hacettepe University School of Medicine, Ankara (Turkey)

    1999-02-01

    Ascariasis is a well-known cause of acute cholangitis and cholecystitis; however, very rarely do worms penetrate and colonize the liver parenchyma. Here we present the unique radiological demonstration (US, CT and ERCP) of hepatobiliary ascariasis in which worm was first alive in the parenchyma of the liver and subsequently died and formed liver abscess. (orig.) (orig.) With 3 figs., 8 refs.

  5. Radiological findings of intraparenchymal liver Ascaris (hepatobiliary ascariasis)

    International Nuclear Information System (INIS)

    Ascariasis is a well-known cause of acute cholangitis and cholecystitis; however, very rarely do worms penetrate and colonize the liver parenchyma. Here we present the unique radiological demonstration (US, CT and ERCP) of hepatobiliary ascariasis in which worm was first alive in the parenchyma of the liver and subsequently died and formed liver abscess. (orig.) (orig.)

  6. Ascaridíase hepatobiliar complicada por pneumonia lipoídica Hepatobiliary ascariasis complicated by lipoid pneumonia

    Directory of Open Access Journals (Sweden)

    Lisieux Eyer de Jesus

    2008-06-01

    Full Text Available OBJETIVO: Apresentar um caso de ascaridíase hepatobiliar complicado por pneumonia lipoídica e discutir as implicações anestésicas envolvidas. DESCRIÇÃO DO CASO: Menina de dois anos de idade com ascaridíase hepatobiliar complicada por pneumonia lipoídica por aspiração e desnutrição grave, advinda de família em condições sociais precárias em zona rural, com quatro irmãos. Foi tratada com sucesso por uma combinação de lavados broncopulmonares sucessivos e cirurgia. COMENTÁRIOS: Ascaridíase biliar corresponde a cerca de 10% dos casos de complicações de ascaridíase. Apenas uma minoria precisa de tratamento cirúrgico. O uso de óleo mineral por via oral é um tratamento tradicional para a suboclusão intestinal pelo Ascaris lumbricoides, mas a broncoaspiração do óleo e a conseqüente pneumonia lipoídica representam um risco alto para o seu uso. Anestesia geral para laparotomia exploradora em pré-escolar desnutrido com pneumonia lipóide e ascaridíase biliar é uma situação pouco contemplada na literatura médica, o que exigiu um planejamento terapêutico específico.OBJECTIVE: To present a case of hepatobiliary ascariasis complicated by exogenous lipoid aspirative pneumonia and the anesthetic implications involved. CASE DESCRIPTION: We present a case of hepatobiliary ascariasis complicated by exogenous lipoid aspirative pneumonia and severe undernourishment in a two-year-old female from a five-children poor family from the Brazilian rural area. She was successfully treated by the association of repeated bronchopulmonary lavage and surgery. COMMENTS: Biliary ascariasis corresponds roughly to 10% of complicated ascariasis cases. Only a minority requires surgery. Mineral oil is a traditional treatment for intestinal Ascaris lumbricoides subocclusion, but oil aspiration and lipoid pneumonia remain a highly morbid risk of this practice. General anesthesia and laparotomy in an undernourished small child with lipoid

  7. [Acute cholangitis secondary to ascariasis and complicated by liver abscesses].

    Science.gov (United States)

    Rakotonaivo, A; Ranoharison, H D; Razarimahefa, S H; Rakotozafindrabe, R; Rabenjanahary, T H; Ramanampamonjy, R M

    2015-01-01

    Acute cholangitis secondary to ascariasis is rare and occurs mainly in areas of high endemicity. The clinical presentation is non-specific, sometimes complicated by liver abscess. Abdominal ultrasound plays an important role in diagnosis and therapeutic surveillance. We report the case of a 35-year-old Malagasy woman with an acute cholangitis secondary to ascariasis and complicated by liver abscesses and its course to full recovery under medical treatment. PMID:26742557

  8. Determination of cholesterol in human biliary calculus by TLC scanning

    Institute of Scientific and Technical Information of China (English)

    Yin Kang Yang; Kai Xiong Qiu; Yu Zhu Zhan; Er Yi Zhan; Hai Ming Yang; Ping Zheng

    2000-01-01

    AIM To study the physico-chemical properties of biliary calculus and the relationship between the calculusformation and the phase change of liquid crystal, providing the best evidence for the biliary calculusprevention and treatment.METHODS The cholesterol contents in thirty one cases of biliary calculus in Kunming were determined bydouble-wave-length TLC scanning with high efficiency silica gel films.RESULTS Under magnifiers, the granular biliary calculus from 31 patients were classified according totheir section structures and colours, as cholesterol cholelith, 25 cases; bilirubin cholelith, 4 cases andcompound cholelith, 2 cases. By TLC scanning, it was found that the content of cholesterol in human biliarycalculus was 71%- 100%, about 80% cholesterol bilestones whose cholesterol content was more than 90%being pure cholesterol bilestones.CONCLUSION Cholesterol bilestone is the main human biliary calculus in Kunming, which was inaccordance with X-ray analysis. Compared with the related reports, it is proved that the proportion ofcholesterol bilestones to biliary calculus is increasing because of the improved life standard and the decreaseof bilirubin bilestones resulted from bile duct ascariasis or bacteria infection in China since 90s, and that theincrease of cholesterol in-take leads to the increase of cholesterol metabolism disorder

  9. Biopsy - biliary tract

    Science.gov (United States)

    Cytology analysis - biliary tract; Biliary tract biopsy ... A sample for a biliary tract biopsy can be obtained in different ways. A needle biopsy can be done if you have a well-defined tumor. The biopsy site ...

  10. Biliary endoprosthesis

    International Nuclear Information System (INIS)

    Biliary endoprosthesis could provide permanent internal biliary drainage in patient with obstructive jaundice with advantages of absence of troublesome external catheter and no loss of fluid, bile and electrolytes over external drainage. Incidence of sepsis and cholangitis be lowered. Endoprosthesis was performed in 18 patients of obstructive jaundice from January, 1985 to December, 1985 at Department of Radiology, Kyungpook National University Hospital. The results are as follows 2. The cases of obstructive jaundice included bile duct cancer in 11, stomach ca. metastasis in 3, ca. of ampulla of Vater in 1, ca. of head of pancreas in 1, CBD cancer with postop. recurrence in 1, and impacted CBD stone in 1 case. 2. The levels of obstruction were at the trifurcation in 8, CHD in 5, proximal CBD in 3, and distal CBD in 2 cases. 3. Decline of serum bilirubin level was noted in 15 cases with the most rapid decline within 1 week after the procedure. 4. The complication occurred in 5 cases. The three cases were recovered spontaneously, but one died of bile peritonitis, another experienced obstruction of endoprosthesis. 5. The endoprosthesis is beneficial in treatment of obstructive jaundice for which surgery is not indicated, and saving expensive abdominal surgery and less advantageous percutaneous external drainage, hence enhancing life quality.

  11. Asymptomatic intraperitoneal ascariasis: Importance of diagnostic laparoscopy

    OpenAIRE

    Santhosh Anand; Sharma, Aditya P; Sandeep Aggarwal; Devajit Nath; Sandeep Mathur

    2014-01-01

    Migration of Ascaris from intestine into peritoneal cavity is rare and usually presents as acute abdomen. We report a case of 41-year-old male who was admitted for laparoscopic mesh rectopexy for rectal prolapse. During the initial laparoscopy, purulent fluid was seen in pelvis. A complete diagnostic laparoscopy was done. An omental nodule was found, which was excised and extracted in a bag. On histopathology, the omental nodule revealed gravid Ascaris lumbricoides.

  12. Gangrenous Meckel's diverticulum secondary to ascariasis in a child

    OpenAIRE

    Akhtar, Tanveer; Alladi, Anand; Siddappa, OS; Bahubali, G

    2012-01-01

    Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, which is usually asymptomatic. In patients with intestinal ascariasis, Meckel's diverticulum may pursue a silent course or may be complicated by diverticulitis, gangrene and perforation. We report an unusual complication of volvulus of Meckel's diverticulum and an adjacent segment of ileum due to incarceration of worm bolus in a narrow based Meckel's diverticulum leading to gangrene and perforation.

  13. An unusual case of ascariasis of the appendix

    OpenAIRE

    Paganelli Arnaldo; Krstić Slobodan; Ivanov Dejan; Anđelkov Katarina; Zaccheddu Renato; Sforza Marcos

    2011-01-01

    Introduction. Amongst various causes responsible for the obstruction of digestive tract, intestinal ascariasis is certainly one of the least frequent. Case Outline. We report an extremely rare case of a 5-year-old male patient operated on for appendicitis due to adult Ascaris Lumbricoides worms intraoperatively detected in the appendiceal lumen. Conclusion. On examination patient’s clinical features indicated acute appendicitis. Therefore, the treatment-of-choice could only be surgical....

  14. Acute Lower Gastrointestinal Haemorrhage Secondary to Small Bowel Ascariasis

    OpenAIRE

    Daphne Dewi, Stephen; Sze Li, Siow

    2012-01-01

    Acute lower gastrointestinal haemorrhage secondary to small bowel ascariasis is extremely rare. A high level of suspicion should be maintained when dealing with acute gastrointestinal haemorrhage in migrants and travellers. Small bowel examination is warranted when carefully repeated upper and lower endoscopies have failed to elicit the source of bleeding. Appropriate test selection is determined by the availability of local expertise. We present a case of acute lower gastrointestinal haemorr...

  15. Radio-pathological diagnosis of hepatobiliary ascariasis: A rare entity

    OpenAIRE

    Indranil Chakrabarti; Amita Giri; De, Anuradha; Asit Chandra Roy

    2011-01-01

    Ascariasis is the commonest helminthic infection in humans, caused by the nematode Ascaris lumbricoides. The adult worms usually reside in the small intestine. Rarely, they migrate into the bile duct and pancreatic ducts, but involvement of the gall bladder and/or liver parenchyma is extremely rare. Here, we describe a case of a 32-year-old woman who presented with fever, anorexia, right upper quadrant pain and mild hepatomegaly. Ultrasonography revealed a liver abscess and a concurrent movin...

  16. Ascariasis of gall bladder associated with xanthogranulomatous inflammation and cholelithiasis

    OpenAIRE

    Deshmukh, Sanjay D; Pathak, Gayatri S; Ashturkar, Amrut V; Avinash R Joshi; Shelke, Rahul R

    2011-01-01

    We report a rare case of ascariasis of gall bladder. The unusual features in this case were the presence of eggs of Ascaris lumbricoides in the lumen. Some of the eggs had evoked a foreign body reaction indicating chronicity. The bladder wall was unevenly thickened with yellowish white nodules and showed maximum thickness around the neck region. Microscopy showed predominantly xanthogranulomatous inflammation in the thickened parts of the wall.

  17. Ascariasis Presenting as Acute Abdomen—A Case Report

    OpenAIRE

    Nag, Hirdaya H.; Ji, Ram

    2012-01-01

    Infection with Ascaris lumbricoides is common in tropical and subtropical regions of the world. Prevalence of ascariasis is related to poverty, poor hygiene and poor fecal sanitation. This helminth usually lives harmlessly in small intestine but can also cause intestinal obstruction or perforation peritonitis which is common in childhood. Ascaris can also migrate through ampulla of vater to produce cholangitis, pancreatitis,cholecystitis and rarely hepatic abscess. Ascaris induced hepatic abs...

  18. Ascariasis as a cause of recurrent abdominal pain.

    Science.gov (United States)

    Guzman, Gerly Edson; Teves, Pedro Montes; Monge, Eduardo

    2010-04-01

    Ascariasis is the most common helminthic infection in developing countries. It may cause chronic abdominal pain, tenderness and bloating. Our aim is to report a case of acute episodic abdominal pain and pancreatitis associated with ascariasis. We report a 59-year-old female patient who was admitted for acute abdominal pain, having had several previous similar events before one of them was diagnosed as acute idiopathic pancreatitis. On admission, her physical exam was normal. Laboratory results showed hemoglobin 12.2 g/dL, white blood cell count 11 900 cells/mm(3), eosinophils 420 cells/mm(3), serum amylase 84 IU/mL, lipase 22 IU/mL and normal liver function tests. Abdominal ultrasound and a plain abdominal X-ray were also normal. An upper endoscopy showed round white worms in the duodenum and the stomach, some of them with bile in their intestines. The intestinal parasites were diagnosed as Ascaris lumbricoides, and the patient was started on albendazole, with full recovery within a week. We believe that ascariasis should be considered in patients with recurrent abdominal pain and idiopathic pancreatitis. PMID:20447214

  19. [Three recent cases of ascariasis in northern Kyushu].

    Science.gov (United States)

    Makiya, K; Tsukamoto, M; Unoki, H; Sujita, K; Mori, N; Miki, T; Yokoyama, M

    1988-03-01

    Ascariasis is considered to be one of the rare infectious diseases in Japan, but recently it has been slightly increasing. This paper reports three ascariasis cases who seemed to be infected recently in the Kitakyushu area, Japan. Case 1: A 59-year-old woman in Kitakyushu City passed a round worm after continuous abdominal pain. The patient was discharged from the hospital because of no further abnormal intestinal symptoms and findings. Case 2: An 85-year-old woman in Nakama City, who suffered from cerebral infarction, vomited a round worm before hospitalization. Many ascarid eggs were detected after admission, and after treatment with pyrantel pamoate (Combantrin) two round worms were passed and egg detection became negative. Case 3: A 77-year-old man in Saikawa Town vomited 3 round worms after gastrectomy due to early gastric cancer. Many unfertilized eggs were also detected from the stool together with hook worm eggs, but no eggs were found after administration of pyrantel pamoate. Morphological examination was made by a scanning electron microscope on the denticles on the dentigerous lip ridges of the worms to differentiate from possible infection with a pig parasite, Ascaris suum. The three cases were diagnosed as ascariasis due to human Ascaris lumbricoides based on the following evidences that the expelled worms had 1) less pointed tips of the denticles and shallower or wider interdenticle notches, and 2) far more denticles of smaller size along the dentigerous ridges, compared with Ascaris suum. The necessity of differentiating pig- from human-ascarids, when considering human infection with Ascaris suum, is discussed. PMID:3368668

  20. Gastro-intestinal ascariasis--an unusual autopsy case report.

    Science.gov (United States)

    Kanchan, Tanuj; Wasti, Harihar; Acharya, Jenash

    2015-09-01

    Ascaris lumbricoides or roundworms' propensity to produce large number of eggs that are resistant to extremes of environmental conditions have made them one of the highly prevalent and geographically well distributed nematodes among poor socio-economic regions throughout the world. We present an unusual case of fatal gastro-intestinal ascariasis where general neglect, and firm and prolonged reliance on traditional healing methods led to aggregation of roundworms to such an extent that otherwise seems improbable in modern times and, hence, is worth reporting. PMID:25748290

  1. Intestinal ascariasis at pediatric emergency room in a developed country.

    Science.gov (United States)

    Umetsu, Shuichiro; Sogo, Tsuyoshi; Iwasawa, Kentaro; Kondo, Takeo; Tsunoda, Tomoyuki; Oikawa-Kawamoto, Manari; Komatsu, Haruki; Inui, Ayano; Fujisawa, Tomoo

    2014-10-14

    Ascaris lumbricoides infection is rare among children in developed countries. Although large numbers of adult Ascaris in the small intestine can cause various abdominal symptoms, this infection remains asymptomatic until the number of worms in the intestine considerably increases in most cases. Ascaris causing bilious vomiting suggesting ileus is rare, especially in developed countries. A 6-year-old boy who lived in Japan, presented with abdominal colic, bilious vomiting at the pediatric emergency room. He appeared pale, and had no abdominal distention, tenderness, palpable abdominal mass, or findings of dehydration. He experienced bilious vomiting again during a physical examination. Laboratory tests showed mild elevation of white blood cells and C-reactive protein levels. Antigens of adenovirus, rotavirus, and norovirus were not detected from his stool, and stool culture showed normal flora. Ultrasonography showed multiple, round-shaped structures within the small intestine, and a tubular structure in a longitudinal scan of the small intestine. Capsule endoscopy showed a moving worm of Ascaris in the jejunum. Intestinal ascariasis should be considered as a cause of bilious vomiting in children, even at the emergency room in industrial countries. Ultrasound examination and capsule endoscopy are useful for diagnosis of pediatric intestinal ascariasis. PMID:25320546

  2. Preoperative biliary drainage.

    Science.gov (United States)

    Saxena, Payal; Kumbhari, Vivek; Zein, Mohamad E L; Khashab, Mouen A

    2015-01-01

    The role of preoperative biliary drainage (PBD) in patients with distal or proximal biliary obstruction secondary to resectable tumors has been a matter for debate. A review of the literature using Medline, Embase and Cochrane databases was undertaken for studies evaluating routes of drainage (endoscopic or percutaneous) and stent types (plastic or metal) in patients with resectable disease. Preoperative biliary drainage is indicated for relief of symptomatic jaundice, cholangitis, patients undergoing neoadjuvant therapy or those patients where surgery may be delayed. Endoscopic methods are preferred over percutaneous methods because of lower complication rates. In patients with proximal biliary obstruction, PBD should be guided by imaging studies to aid in selective biliary cannulation for unilateral drainage in order to reduce the risk of cholangitis in undrained liver segments. PMID:25293587

  3. Ascariasis as a cause of hepatic abscess: A report of 3 cases

    OpenAIRE

    Chauhan, V; Thakur, S; Rana, B

    2015-01-01

    We receive around 60 cases of hepatic abscess in a year. The commonest diagnosis reached at the time of discharge is amoebic liver abscess. The diagnosis of amoebic liver abscess is mostly presumptive and thus the patients are usually given a mixed treatment with injection ceftriaxone and tablet metronidazole. Here we report three cases of hepatic abscess diagnosed recently, where ascariasis was the probable etiology. Ascariasis may be a much commoner cause of hepatic abscesses in this region...

  4. Ascariasis as a cause of hepatic abscess: A report of 3 cases.

    Science.gov (United States)

    Chauhan, V; Thakur, S; Rana, B

    2015-01-01

    We receive around 60 cases of hepatic abscess in a year. The commonest diagnosis reached at the time of discharge is amoebic liver abscess. The diagnosis of amoebic liver abscess is mostly presumptive and thus the patients are usually given a mixed treatment with injection ceftriaxone and tablet metronidazole. Here we report three cases of hepatic abscess diagnosed recently, where ascariasis was the probable etiology. Ascariasis may be a much commoner cause of hepatic abscesses in this region than we think. PMID:26068350

  5. The Efficacy of Single-Dose Albendazole for The Treatment of Ascariasis

    OpenAIRE

    Putra, Deddy S.; Dalimunthe, W.; Lubis, M.; Pasaribu, S.; Lubis, Chairuddin P.

    2005-01-01

    Objective This study aims to assess the efficacy of single-dose albendazole in treating mild, moderate, and severe ascariasis. Methods Stool specimens were collected from randomly selected elementary school children in Suka village, Sumatera Utara, from March to April 2002. Based on the number of eggs per gram feces (NEPG), samples were categorized as mild (NEPG 35,000) ascariasis. All subjects then received 400 mg albendazole orally....

  6. Percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Percutaneous transhepatic biliary drainage was successfully made 20 times on 17 patients of obstructive jaundice for recent 1 year since June 1981 at Department of Radiology in Seoul National University Hospital. The causes of obstructive jaundice was CBD Ca in 13 cases, metastasis in 2 cases, pancreatic cancer in 1 case and CBD stone in 1 case. Percutaneous transhepatic biliary drainage is a relatively ease, safe and effective method which can be done after PTC by radiologist. It is expected that percutaneous transhepatic biliary drainage should be done as an essential procedure for transient permanent palliation of obstructive jaundice

  7. Stenting in Malignant Biliary Obstruction.

    Science.gov (United States)

    Almadi, Majid A; Barkun, Jeffrey S; Barkun, Alan N

    2015-10-01

    Decompression of the biliary system in patients with malignant biliary obstruction has been widely accepted and implemented as part of the care. Despite a wealth of literature, there remains a significant amount of uncertainty as to which approach would be most appropriate in different clinical settings. This review covers stenting of the biliary system in cases of resectable or palliative malignant biliary obstruction, potential candidates for biliary drainage, technical aspects of the procedure, as well as management of biliary stent dysfunction. Furthermore, periprocedural considerations including proper mapping of the location of obstruction and the use of antibiotics are addressed. PMID:26431598

  8. Bezafibrate for primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Rudic, Jelena S; Poropat, Goran; Krstic, Miodrag N;

    2012-01-01

    Treatment of primary biliary cirrhosis is complicated. There are studies suggesting that bezafibrate, alone or in combination with ursodeoxycholic acid (UDCA), is effective in the treatment of primary biliary cirrhosis, but no systematic review has summarised the evidence yet.......Treatment of primary biliary cirrhosis is complicated. There are studies suggesting that bezafibrate, alone or in combination with ursodeoxycholic acid (UDCA), is effective in the treatment of primary biliary cirrhosis, but no systematic review has summarised the evidence yet....

  9. [Malignant biliary obstruction].

    Science.gov (United States)

    Hucl, Tomáš

    2016-01-01

    Pancreatic cancer and cholangiocarcinoma are the most common causes of malignant biliary obstruction. They are diseases of increasing incidence and unfavorable prognosis. Only patients with localized disease indicated for surgery have a chance of long-term survival. These patients represent less than 20 % of all patients, despite the progress in our diagnostic abilities.Locally advanced and metastatic tumors are treated with palliative chemotherapy or chemoradiotherapy; the results of such treatments are unsatisfactory. The average survival of patients with unresectable disease is 6 months and only 5-10 % of patients survive 5 years.Biliary drainage is an integral part of palliative treatment. Endoscopically or percutaneosly placed stents improve quality of life, decrease cholestasis and pruritus, but do not significantly improve survival. Biliary stents get occluded over time, possibly resulting in acute cholangitis and require repeated replacement.Photodynamic therapy and radiofrequency ablation, locally active endoscopic methods, have been increasingly used in recent years in palliative treatment of patients with malignant biliary obstruction. In photodynamic therapy, photosensitizer accumulates in tumor tissue and is activated 48 hours later by light of a specific wave length. Application of low voltage high frequency current during radiofrequency ablation results in tissue destruction by heat. Local ablation techniques can have a significant impact in a large group of patients with malignant biliary obstruction, leading to improved prognosis, quality of life and stent patency. PMID:26898789

  10. Bile Acid Analysis in Biliary Tract Cancer

    OpenAIRE

    Park, Jeong Youp; Park, Byung Kyu; Ko, Jun Sang; Bang, Seungmin; Song, Si Young; Chung, Jae Bock

    2006-01-01

    The etiology of biliary tract cancer is obscure, but there are evidences that bile acid plays a role in carcinogenesis. To find the association between biliary tract cancer and bile acid, this study compared the bile acid concentration and composition among patients with biliary cancer, biliary tract stones, and no biliary disease. Bile was compared among patients with biliary tract cancer (n = 26), biliary tract stones (n = 29), and disease free controls (n = 9). Samples were obtained by per...

  11. Percutaneous transhepatic biliary drainage

    Energy Technology Data Exchange (ETDEWEB)

    Lee, M. J.; Kim, K. W.; Lee, J. T.; Lee, Y. H.; Park, C.Y. [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1983-12-15

    Percutaneous transhepatic biliary drainage (PTBD) was performed 27 times in 24 patients with obstructive jaundice, from May, 1981 to October, 1982 at Department of Radiology Severance Hospital, Yonsei University, College of Medicine. Internal drainage was performed in 5 cases and external drainage in 19 cases. Daily drainage amount was corrected with the decline of serum bilirubin level. Six patients with sepsis were all improved after PTBD. This procedure effectively decompress the sevely obstructed biliary tree prior to surgery, palliates the clinical problems in patient with unresectable malignant obstruction and controls sepsis effectively.

  12. Percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Percutaneous transhepatic biliary drainage (PTBD) was performed 27 times in 24 patients with obstructive jaundice, from May, 1981 to October, 1982 at Department of Radiology Severance Hospital, Yonsei University, College of Medicine. Internal drainage was performed in 5 cases and external drainage in 19 cases. Daily drainage amount was corrected with the decline of serum bilirubin level. Six patients with sepsis were all improved after PTBD. This procedure effectively decompress the sevely obstructed biliary tree prior to surgery, palliates the clinical problems in patient with unresectable malignant obstruction and controls sepsis effectively

  13. Ascariasis as a cause of hepatic abscess: A report of 3 cases

    Directory of Open Access Journals (Sweden)

    V Chauhan

    2015-01-01

    Full Text Available We receive around 60 cases of hepatic abscess in a year. The commonest diagnosis reached at the time of discharge is amoebic liver abscess. The diagnosis of amoebic liver abscess is mostly presumptive and thus the patients are usually given a mixed treatment with injection ceftriaxone and tablet metronidazole. Here we report three cases of hepatic abscess diagnosed recently, where ascariasis was the probable etiology. Ascariasis may be a much commoner cause of hepatic abscesses in this region than we think.

  14. Incipient primary biliary cirrhosis/autoimmune hepatitis overlap or hepatitic form of primary biliary cirrhosis: a case report

    OpenAIRE

    Minz, Ranjana W; Chhabra, Seema; Aggarwal, Ritu; Das, Ashim; Saikia, Biman; Yogesh K Chawla

    2009-01-01

    A 42 year old asymptomatic female detected as incipient Primary Biliary Cirrhosis/Autoimmune Hepatitis overlap during routine checkup. The biochemical profile showed evolution from a mildly deranged liver function test in 2004 along with increased erythrocyte sedimentation rate to a 4 times elevation of alkaline phosphatase in 2006 with mildly deranged alanine transaminase. Autoimmune markers demonstrable were Anti mitochondrial antibody M2 and sp100. Histopathology showed dual features, domi...

  15. Ascariasis in humans and pigs on small-scale farms, Maine, USA, 2010-2013.

    Science.gov (United States)

    Miller, Leigh Ann; Colby, Kate; Manning, Susan E; Hoenig, Donald; McEvoy, Elizabeth; Montgomery, Susan; Mathison, Blaine; de Almeida, Marcos; Bishop, Henry; Dasilva, Alexandre; Sears, Stephen

    2015-02-01

    Ascaris is a genus of parasitic nematodes that can cause infections in humans and pigs. During 2010-2013, we identified 14 cases of ascariasis in persons who had contact with pigs in Maine, USA. Ascaris spp. are important zoonotic pathogens, and prevention measures are needed, including health education, farming practice improvements, and personal and food hygiene. PMID:25626125

  16. Ascariasis in Humans and Pigs on Small-Scale Farms, Maine, USA, 2010–2013

    OpenAIRE

    Miller, Leigh Ann; Colby, Kate; Manning, Susan E.; Hoenig, Donald; McEvoy, Elizabeth; Montgomery, Susan; Mathison, Blaine; de Almeida, Marcos; Bishop, Henry; DaSilva, Alexandre; Sears, Stephen

    2015-01-01

    Ascaris is a genus of parasitic nematodes that can cause infections in humans and pigs. During 2010–2013, we identified 14 cases of ascariasis in persons who had contact with pigs in Maine, USA. Ascaris spp. are important zoonotic pathogens, and prevention measures are needed, including health education, farming practice improvements, and personal and food hygiene.

  17. Preoperative biliary drainage for biliary tract and ampullary carcinomas

    OpenAIRE

    Nagino, Masato; Takada, Tadahiro; Miyazaki, Masaru; Miyakawa, Shuichi; TSUKADA, KAZUHIRO; Kondo, Satoshi; Furuse, Junji; Saito, Hiroya; Tsuyuguchi, Toshio; Yoshikawa, Tatsuya; Ohta, Tetsuo; Kimura, Fumio; Ohta, Takehiro; Yoshitomi, Hideyuki; Nozawa, Satoshi

    2008-01-01

    We posed six clinical questions (CQ) on preoperative biliary drainage and organized all pertinent evidence regarding these questions. CQ 1. Is preoperative biliary drainage necessary for patients with jaundice? The indications for preoperative drainage for jaundiced patients are changing greatly. Many reports state that, excluding conditions such as cholangitis and liver dysfunction, biliary drainage is not necessary before pancreatoduodenectomy or less invasive surgery. However, the morbidit...

  18. Distribution and pathological features of pancreatic, ampullary, biliary and duodenal cancers resected with pancreaticoduodenectomy

    OpenAIRE

    Chandrasegaram, Manju D.; Chiam, Su C; Chen, John W.; Khalid, Aisha; Mittinty, Murthy L; Neo, Eu L.; Tan, Chuan P; Dolan, Paul M; Brooke-Smith, Mark E.; Kanhere, Harsh; Worthley, Chris S

    2015-01-01

    Background Pancreatic cancer (PC) has the worst survival of all periampullary cancers. This may relate to histopathological differences between pancreatic cancers and other periampullary cancers. Our aim was to examine the distribution and histopathologic features of pancreatic, ampullary, biliary and duodenal cancers resected with a pancreaticoduodenectomy (PD) and to examine local trends of periampullary cancers resected with a PD. Methods A retrospective review of PD between January 2000 a...

  19. Percutaneous biliary drainage in acute suppurative cholangitis with biliary sepsis

    International Nuclear Information System (INIS)

    Acute suppurative cholangitis is a severe inflammatory process of the bile duct occurred as result of partial or complete obstruction of the bile duct, and may manifest clinically severe form of disease, rapidly deteriorating to life-threatening condition. We analyzed emergency percutaneous transhepatic biliary drainage in 20 patients of acute suppurative cholangitis with biliary sepsis to evaluate the therapeutic effect and complication of the procedure. The underlying cause were 12 benign disease(stones) and eight malignant tumors and among eight malignant tumors, bile duct stones(n=4) and clonorchiasis(n=1) were combined. Percutaneous transhepatic biliary drainage was performed successfully in 17 of 20 patients resulting in improvement of general condition and failed in three patients. The procedure were preterminated due to the patient's condition in two and biliary-proto fistula was developed in one. After biliary decompression by percutaneous transhepatic biliary drainage, effective and successful elective surgery was performed in nine cases, which were seven biliary stones and two biliary cancer with stones. Our experience suggest that emergency percutaneous transhepatic biliary drainage is an initial and effective treatment of choice for acute suppurative cholangitis with sepsis and a safe alternative for nonsurgical treatment

  20. Percutaneous biliary drainage in acute suppurative cholangitis with biliary sepsis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyung Lyul; Cho, June Sik; Kwon, Soon Tae; Lee, Sang Jin; Rhee, Byung Chull [Chungnam National University College of Medicine, Daejeon (Korea, Republic of)

    1993-11-15

    Acute suppurative cholangitis is a severe inflammatory process of the bile duct occurred as result of partial or complete obstruction of the bile duct, and may manifest clinically severe form of disease, rapidly deteriorating to life-threatening condition. We analyzed emergency percutaneous transhepatic biliary drainage in 20 patients of acute suppurative cholangitis with biliary sepsis to evaluate the therapeutic effect and complication of the procedure. The underlying cause were 12 benign disease(stones) and eight malignant tumors and among eight malignant tumors, bile duct stones(n=4) and clonorchiasis(n=1) were combined. Percutaneous transhepatic biliary drainage was performed successfully in 17 of 20 patients resulting in improvement of general condition and failed in three patients. The procedure were preterminated due to the patient's condition in two and biliary-proto fistula was developed in one. After biliary decompression by percutaneous transhepatic biliary drainage, effective and successful elective surgery was performed in nine cases, which were seven biliary stones and two biliary cancer with stones. Our experience suggest that emergency percutaneous transhepatic biliary drainage is an initial and effective treatment of choice for acute suppurative cholangitis with sepsis and a safe alternative for nonsurgical treatment.

  1. Endoscopic ultrasound-guided biliary drainage of hilar biliary obstruction.

    Science.gov (United States)

    Park, Do Hyun

    2015-09-01

    Only 20-30% of patients with hilar cholangiocarcinoma (CC) are candidates for potentially curative resection. However, even after curative (R0) resection, these patients have a disease recurrence rate of up to 76%. The prognosis of hilar cholangiocarcinoma (CC) is limited by tumor spread along the biliary tree leading to obstructive jaundice, cholangitis, and liver failure. Therefore, palliative biliary drainage may be a major goal for patients with hilar CC. Endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is an established method for palliation of patients with malignant biliary obstruction. However, there are patients for whom endoscopic stent placement is not possible because of failed biliary cannulation or tumor infiltration that limits transpapillary access. In this situation, percutaneous transhepatic biliary drainage (PTBD) is an alternative method. However, PTBD has a relatively high rate of complications and is frequently associated with patient discomfort related to external drainage. Endoscopic ultrasound-guided biliary drainage has therefore been introduced as an alternative to PTBD in cases of biliary obstruction when ERCP is unsuccessful. In this review, the indications, technical tips, outcomes, and the future role of EUS-guided intrahepatic biliary drainage, such as hepaticogastrostomy or hepaticoduodenostomy, for hilar biliary obstruction will be summarized. PMID:26178753

  2. Biliary complications following liver transplantation

    OpenAIRE

    Kochhar, Gursimran; Parungao, Jose Mari; Hanouneh, Ibrahim A; Parsi, Mansour A

    2013-01-01

    Biliary tract complications are the most common complications after liver transplantation. These complications are encountered more commonly as a result of increased number of liver transplantations and the prolonged survival of transplant patients. Biliary complications remain a major source of morbidity in liver transplant patients, with an incidence of 5%-32%. Post liver transplantation biliary complications include strictures (anastomotic and non-anastomotic), leaks, stones, sphincter of ...

  3. Clinical features of the overlap syndrome of autoimmune hepatitis and primary biliary cirrhosis: retrospective study

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ PBC-AIH overlap syndrome is an autoimmune liver disease between AIH (autoimmune hepatitis) and PBC (primary biliary cirrhosis). To investigate the characteristic of the PBC-AIH overlap syndrome, we have conducted a retros- pective study of 12 diagnosed overlap syndrome patients and compared them with typical PBC and AIH on the basis of clinical, biochemical, serological and histopathological findings.

  4. Endoscopic retrograde cholangio-pancreatographic diagnosis and extraction of massive biliary ascariasis presented with acute pancreatitis: a case report.

    Science.gov (United States)

    Saowaros, V

    1999-05-01

    This paper reports the case of a young female Thai patient who presented with periodic severe abdominal pains which proved to be acute pancreatitis. Conventional investigations and treatments failed to prove and improve her condition. ERCP was done on the twelfth day after admission. 3 caudal ends of living round worms were noted protruding from the papillary orifice during endoscopy. Cholangiography revealed impacted multiple round worms in the common bile duct and both intrahepatic ducts. Endoscopic extraction of the worms was done by using dormia basket and removed with endoscope. Repeated procedure was done 21 times in two and a half hours, obtaining 26 live, mature Ascaris lumbricoides varying from 13 to 24 cm in length. Repeated cholangiogram confirmed complete removal of the worms. The patient was relieved from abdominal pain immediately after the procedure, and given oral albendazole 400 mg daily for 7 days. She was discharged asymptomatic 8 days after Ascaris removal. PMID:10443103

  5. Future developments in biliary stenting

    Directory of Open Access Journals (Sweden)

    Hair CD

    2013-06-01

    Full Text Available Clark D Hair,1 Divyesh V Sejpal21Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA; 2Department of Medicine, Section of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, North Shore University Hospital, Manhasset, NY, USAAbstract: Biliary stenting has evolved dramatically over the past 30 years. Advancements in stent design have led to prolonged patency and improved efficacy. However, biliary stenting is still affected by occlusion, migration, anatomical difficulties, and the need for repeat procedures. Multiple novel plastic biliary stent designs have recently been introduced with the primary goals of reduced migration and improved ease of placement. Self-expandable bioabsorbable stents are currently being investigated in animal models. Although not US Food and Drug Administration approved for benign disease, fully covered self-expandable metal stents are increasingly being used in a variety of benign biliary conditions. In malignant disease, developments are being made to improve ease of placement and stent patency for both hilar and distal biliary strictures. The purpose of this review is to describe recent developments and future directions of biliary stenting.Keywords: plastic stents, self-expandable metal stents, drug eluting stents, bioabsorbable stents, malignant biliary strictures, benign biliary strictures

  6. Methotrexate for primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Giljaca, Vanja; Poropat, Goran; Stimac, Davor;

    2010-01-01

    Methotrexate has been used to treat patients with primary biliary cirrhosis as it possesses immunosuppressive properties. The previously prepared version of this review from 2005 showed that methotrexate seemed to significantly increase mortality in patients with primary biliary cirrhosis. Since...... that last review version, follow-up data of the included trials have been published....

  7. Colchicine for primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Gong, Yan; Gluud, Christian

    2005-01-01

    Colchicine is used for patients with primary biliary cirrhosis due to its immunomodulatory and antifibrotic potential. The results from randomized clinical trials have, however, been inconsistent. We conducted a systematical review to evaluate the effect of colchicine for primary biliary cirrhosis....

  8. Azathioprine for primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Gong, Yanzhang; Christensen, E; Gluud, C

    Azathioprine is used for patients with primary biliary cirrhosis, but the therapeutic responses in randomised clinical trials have been conflicting.......Azathioprine is used for patients with primary biliary cirrhosis, but the therapeutic responses in randomised clinical trials have been conflicting....

  9. Biliary scintigraphy in acute pancreatitis

    International Nuclear Information System (INIS)

    A prospective study was carried out in 60 patients to determine the efficacy of 99/sup m/Tc-PIPIDA scintigraphy in differentiating biliary pancreatitis from nonbiliary pancreatitis. Forty patients were classified as having biliary pancreatitis and 20 patients as having the nonbiliary type. Scintigraphic scans were divided into five main types according to the time to visualization of the gallbladder and the time to excretion of 99/sup m/Tc-PIPIDA into the intestinal tract. Normal scans were obtained in 95% of patients (19/20) with nonbiliary pancreatitis; 22.5% of patients (9/40) with biliary pancreatitis had normal scans. It is concluded that elevated amylase levels together with an abnormal biliary scan, as defined by the criteria presented here, indicate biliary pancreatitis, while a normal scan largely excludes such diagnosis

  10. Biliary scintigraphy in acute pancreatitis

    International Nuclear Information System (INIS)

    A prospective study was carried out in 60 patients to determine the efficacy of /sup 99m/Tc-PIPIDA scintigraphy in differentiating biliary pancreatitis from nonbiliary pancreatitis. Forty patients were classified as having biliary pancreatitis and 20 patients as having the nonbiliary type. Scintigraphic scans were divided into five main types according to the time to visualization of the gallbladder and the time to excretion of /sup 99m/Tc-PIPIDA into the intestinal tract. Normal scans were obtained on 95% of patients (19/20) with nonbiliary pancreatitis; 22.5% of patients (9/40) with biliary pancreatitis had normal scans. It is concluded that elevated amylase levels together with an abnormal biliary scan, as defined by the criteria presented here, indicate biliary pancreatitis, while a normal scan largely excludes such diagnosis

  11. A Comparison of Preoperative Biliary Drainage Methods for Perihilar Cholangiocarcinoma: Endoscopic versus Percutaneous Transhepatic Biliary Drainage

    OpenAIRE

    Kim, Kwang Min; Park, Ji Won; Lee, Jong Kyun; Lee, Kwang Hyuck; Lee, Kyu Taek; Shim, Sang Goon

    2015-01-01

    Background/Aims Controversy remains over the optimal approach to preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma. We compared the clinical outcomes of endoscopic biliary drainage (EBD) with those of percutaneous transhepatic biliary drainage (PTBD) in patients undergoing preoperative biliary drainage for perihilar cholangiocarcinoma. Methods A total of 106 consecutive patients who underwent biliary drainage before surgical treatment were divided into two...

  12. Endoscopicmanagementofpostcholecystectomy biliary leakage

    Institute of Scientific and Technical Information of China (English)

    Virendra Singh; Gurpreet Singh; Ganga R Verma; Rajesh Gupta

    2010-01-01

    BACKGROUND: Biliary leak is an uncommon but signiifcant complication following cholecystectomy. Endotherapy is an established method of treatment. However, the optimal intervention is not known. METHOD: Eighty-ifve patients with postcholecystectomy biliary leaks from July 2000 to March 2009 were retrospectively evaluated. RESULTS: The study population was 20 males and 65 females with a mean age of 42.47 years. Patients presented with abdominal pain (46), jaundice (23), fever (23), abdominal distension (42), or bilious abdominal drain (67). Endoscopic retrograde cholangiopancreatography detected a leak at the cystic duct stump in 45 patients, stricture with middle common bile duct leak in 4, leak from the right hepatic duct in 3, and a ligated common bile duct in 32. Twelve also had bile duct stones. One had a broken T-tube with stones. Endotherapy was possible in 53 patients. Three patients with stones, one with a broken T-tube with stones, and 4 with stricture of the common bile duct with a leak were managed with sphincterotomy and stenting. Eight patients with a cystic duct stump leak with stones were managed with sphincterotomy and stone extraction. Three outpatients and 12 inpatients with a cystic duct stump leak were managed with sphincterotomy and stent and sphincterotomy and nasobiliary drain, respectively. Five patients with a cystic duct stump leak were managed with stenting. Sixteen with coagulopathy were managed with only nasobiliary drain (9) or stent (7). Leak closure was achieved in 100%patients. Four developed mild pancreatitis which improved with conservative treatment. CONCLUSIONS: Endoscopic intervention is a safe and effective method of treatment of postcholecystectomy biliary leaks. However, management should be individualized based on factors such as outpatients or inpatients, presence of stone, stricture, ligature, or coagulopathy.

  13. Influence of the Biliary System on Biliary Bacteria Revealed by Bacterial Communities of the Human Biliary and Upper Digestive Tracts

    OpenAIRE

    Ye, Fuqiang; Shen, Hongzhang; Li, Zhen; Meng, Fei; Li, Lei; Yang, Jianfeng; Chen, Ying; Bo, Xiaochen; Zhang, Xiaofeng; Ni, Ming

    2016-01-01

    Biliary bacteria have been implicated in gallstone pathogenesis, though a clear understanding of their composition and source is lacking. Moreover, the effects of the biliary environment, which is known to be generally hostile to most bacteria, on biliary bacteria are unclear. Here, we investigated the bacterial communities of the biliary tract, duodenum, stomach, and oral cavity from six gallstone patients by using 16S rRNA amplicon sequencing. We found that all observed biliary bacteria wer...

  14. Evaluation of two years of mass chemotherapy against ascariasis in Hamadan, Islamic Republic of Iran.

    OpenAIRE

    2002-01-01

    OBJECTIVE: To evaluate the mass treatment of ascariasis in rural areas of Hamadan Province, Islamic Republic of Iran. METHODS: A control programme in rural areas of Hamadan Province, which began in November 1997, involved giving all persons a single dose of 400 mg albendazole at intervals of three months. The efficacy of the treatment was evaluated by the formalin-ether concentration technique for stool examination and by the Stoll quantitative method. FINDINGS: The average rate of infection ...

  15. Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma.

    OpenAIRE

    Esrey, S. A.; Potash, J. B.; Roberts, L.; Shiff, C.

    1991-01-01

    A total of 144 studies were analysed to examine the impact of improved water supply and sanitation facilities on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. These diseases were selected because they are widespread and illustrate the variety of mechanisms through which improved water and sanitation can protect people. Disease-specific median reduction levels were calculated for all studies, and separately for the more methodologically rigorous ones...

  16. Biliary Fasciola gigantica infestation in a nonendemic area--An intraoperative surprise.

    Science.gov (United States)

    Menon, Prema; Sinha, Amit Kumar; Rao, Katragadda Lakshmi Narasimha; Khurana, Sumeeta; Lal, Sadhana; Thapa, Babu Ram

    2015-11-01

    A 7year old girl infected with the zoonotic trematode, Fasciola gigantica is reported because of the extreme rarity of this condition in our region. Because of the overlap in symptomatology and radiological features, the more common amebic/pyogenic liver abscess in the initial hepatic migratory phase and later choledochal cyst/biliary ascariasis when the parasite was finally located in the extrahepatic bile ducts, were thought of delaying effective treatment. The diagnosis was confirmed only by surgical exploration. The characteristic contrast enhanced computed tomography scan features retrospectively identified were multiple clustered hypodense lesions in the liver with peripheral enhancement in the acute hepatic migratory phase, and periportal tracking in the previously affected areas of the liver with biliary dilatation and a linear hypointense lesion within the common bile duct in the chronic phase. Although a known association, she did not have eosinophilia. This child, who became symptomatic at the age of 5.5years, also appears to be one of the youngest patients reported with Fasciola gigantica. PMID:26362003

  17. Incipient primary biliary cirrhosis/autoimmune hepatitis overlap or hepatitic form of primary biliary cirrhosis: a case report.

    Science.gov (United States)

    Minz, Ranjana W; Chhabra, Seema; Aggarwal, Ritu; Das, Ashim; Saikia, Biman; Chawla, Yogesh K

    2009-01-01

    A 42 year old asymptomatic female detected as incipient Primary Biliary Cirrhosis/Autoimmune Hepatitis overlap during routine checkup. The biochemical profile showed evolution from a mildly deranged liver function test in 2004 along with increased erythrocyte sedimentation rate to a 4 times elevation of alkaline phosphatase in 2006 with mildly deranged alanine transaminase. Autoimmune markers demonstrable were Anti mitochondrial antibody M(2) and sp100. Histopathology showed dual features, dominant findings were of autoimmune heptatitis. Features consistent with Primary Biliary Cirrhosis were minimal with an occasional portal tract showing paucity of bile ducts and occasional bile duct proliferation. Human leucocyte antigen DR/DQ genotype was as follows: DRB1*03, DRB1*07, DQB1*02, DQB1*04. PMID:19829977

  18. Malignant biliary obstruction

    International Nuclear Information System (INIS)

    This paper assesses the value of CT in predicting surgical resectability of tumors in patients with malignant biliary obstruction. A retrospective analysis was performed on 320 consecutive patients with malignant biliary obstruction over a 3-1/2-year period. Most patients were treated nonoperatively. Fifty-one patients fulfilled the selection criteria of surgical exploration, pathological confirmation of malignancy, and prepoperative CT scans available for review. The CT scans were reviewed by a blinded reader and assessed for surgical resectability of tumors. There were 32 patients with pancreatic adenocarcinoma, 6 with ampullary carcinoma, 5 with cholangiocarcinoma, 2 with gallbladder carcinoma, and 6 with other pathologic diagnoses. Of 36 patients thought to have unresectable tumors based on CT findings, 32 were found to have surgically unresectable tumors (positive predictive value, 89%). Of 15 patients thought to have resectable tumors based on CT findings, 11 had surgically resectable tumors (positive predictive value, 73%). CT missed positive duodenal lymph nodes in 2 patients, portal vein infiltration in 1 patient, and small liver metastases in 1 patient

  19. IATROGENIC BILIARY LESIONS

    Directory of Open Access Journals (Sweden)

    J. M. Schiappa

    2007-10-01

    Full Text Available Iatrogenic bile duct injury carries a high rate of morbidity. After the introduction of laparoscopiccholecystectomy the incidence of these injuries has at least doubled, and even after the learningcurve, the incidence has remained of about 0.5%. Etiology of the iatrogenic biliary injuries is theresult of the anatomical conditions (biliary or vascular anomalies, pathology (acute cholecystitis,adhesions, technical equipment, surgeon (the lerning curve. The type of the injuries, thediagnostic procedures and therapeutic approach are discussed. Most of the minor bile duct injuries,including cystic duct leaks and bile duct strictures, are well treatable with endoscopic techniques,whereas most of the major injuries require operative treatment, which at optimal circumstancesgives good results. Interdisciplinary cooperation and early referral to an experienced center iscrucial in the management of these iatrogenic lesions. The best „treatment” for this iatrogenicpathology is prevention: surgical access adapted to morphology, good exposure of the hepatoduodenalspace, good identification of structures before tying, appropriate dissection, selectivecholangiography, great care with the use of electrosurgery.

  20. Primary biliary cirrhosis.

    Science.gov (United States)

    Nguyen, Douglas L; Juran, Brian D; Lazaridis, Konstantinos N

    2010-10-01

    Primary biliary cirrhosis (PBC) is an idiopathic chronic autoimmune liver disease that primarily affects women. It is believed that the aetiology for PBC is a combination between environmental triggers in genetically vulnerable persons. The diagnosis for PBC is made when two of the three criteria are fulfilled and they are: (1) biochemical evidence of cholestatic liver disease for at least 6 month's duration; (2) anti-mitochondrial antibody (AMA) positivity; and (3) histologic features of PBC on liver biopsy. Ursodeoxycholic acid (UDCA) is the only FDA-approved medical treatment for PBC and should be administered at a recommended dose of 13-15 mg/kg/day. Unfortunately despite adequate dosing of UDCA, approximately one-third of patients does not respond adequately and may require liver transplantation. Future studies are necessary to elucidate the role of environmental exposures and overall genetic impact not only in the development of PBC, but on disease progression and variable clinical response to therapy. PMID:20955967

  1. Percutaneous transhepatic biliary endoprostheses

    International Nuclear Information System (INIS)

    Eighty biliary endoprostheses were introduced by the transhepatic route in sixty patients with obstructive jaundice. Complication rate was 21% (no mortality). Average survival time is sixteen weeks (maximum 53 weeks). In most patients, a 12 F teflon endoprosthesis was introduced four to five days after the initial catheter drainage. Patients in poor condition had a primary implant of a 9 F endoprosthesis. A combined transhepatic/transoral implantation was carried out five times. Results have shown that implantation of a prosthesis is as effective as a surgical bypass operation for palliation of obstructive jaundice and that it is better than catheter drainage. In-vitro experiments have indicated that failure of a 12 F prosthesis due to encrustation may be expected in about 23 weeks. This is in line with the survival time of patients with carcinomas. (orig.)

  2. Percutaneous transhepatic biliary endoprostheses

    Energy Technology Data Exchange (ETDEWEB)

    Lammer, J.

    1985-03-01

    Eighty biliary endoprostheses were introduced by the transhepatic route in sixty patients with obstructive jaundice. Complication rate was 21% (no mortality). Average survival time is sixteen weeks (maximum 53 weeks). In most patients, a 12 F teflon endoprosthesis was introduced four to five days after the initial catheter drainage. Patients in poor condition had a primary implant of a 9 F endoprosthesis. A combined transhepatic/transoral implantation was carried out five times. Results have shown that implantation of a prosthesis is as effective as a surgical bypass operation for palliation of obstructive jaundice and that it is better than catheter drainage. In-vitro experiments have indicated that failure of a 12 F prosthesis due to encrustation may be expected in about 23 weeks. This is in line with the survival time of patients with carcinomas.

  3. Percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    The authors have developed their own technique for percutaneous transhepatic biliary drainage (PTD) which they describe. Results of drainages performed since 1977 are presented. As a special application, the authors have also developed a radiation technique, according to the after-loading-method and using PTD. Similar to the intracavitary irradiation of gynecological tumors, a very high dose can be directly applied to the tumour with use of low volume dose and sparing of the neighbouring healthy tissue. The previously inserted drainage catheter is exchanged for a wide bore Teflon-tube and the radiation source Ir-192 is automatically advanced into the tumour stenosis. The isodose distribution is subsequently made under computer assisted guidance. (Auth.)

  4. Biliary hypoplasia in Williams syndrome

    OpenAIRE

    O'Reilly, K; Ahmed, S F; Murday, V.; McGrogan, P

    2006-01-01

    Neonatal hepatitis and biliary hypoplasia are not recognised features of Williams syndrome. A case of Williams syndrome, presenting with neonatal conjugated hyperbilirubinaemia leading to an initial misdiagnosis is reported.

  5. Importance of early diagnosis of pancreaticobiliary maljunction without biliary dilatation

    Institute of Scientific and Technical Information of China (English)

    Kensuke Takuma; Terumi Kamisawa; Taku Tabata; Seiichi Hara; Sawako Kuruma; Yoshihiko Inaba; Masanao Kurata

    2012-01-01

    AIM:To clarify the strategy for early diagnosis of pancreaticobiliary maljunction (PBM) without biliary dilatation and to pathologically examine gallbladder before cancer develops.METHODS:The anatomy of the union of the pancreatic and bile ducts was assessed by using endoscopic retrograde cholangiopancreatography (ERCP).Patients with a long common channel in which communication between the pancreatic and bile ducts was maintained even during sphincter contraction were diagnosed as having PBM.Of these,patients in which the maximal diameter of the bile duct was less than 10 mm were diagnosed with PBM without biliary dilatation.The process of diagnosing 54 patients with PBM without biliary dilatation was retrospectively investigated.Histopathological analysis of resected gallbladder specimens from 8 patients with PBM without biliary dilatation or cancer was conducted.RESULTS:Thirty-six PBM patients without biliary dilatation were diagnosed with gallbladder cancer after showing clinical symptoms such as abdominal or back pain (n =16) or jaundice (n =12).Radical surgery for gallbladder cancer was only possible in 11 patients (31%)and only 4 patients (11%) survived for 5 years.Eight patients were suspected as having PBM without biliary dilatation from the finding of gallbladder wall thickening on ultrasound and the diagnosis was confirmed by ERCP and/or magnetic resonance cholangiopancreatography (MRCP).The median age of these 8 patients was younger by a decade than PBM patients with gallbladder cancer.All 8 patients underwent prophylactic cholecystectomy and bile duct cancer has not occurred.Wall thickness and mucosal height of the 8 resected gallbladders were significantly greater than controls,and hyperplastic changes,hypertrophic muscular layer,subserosal fibrosis,and adenomyomatosis were detected in 7 (88%),5 (63%),7 (88%) and 5 (63%) patients,respectively.Ki-67 labeling index was high and K-ras mutation was detected in 3 of 6 patients

  6. Future developments in biliary stenting

    OpenAIRE

    Hair CD; Sejpal DV

    2013-01-01

    Clark D Hair,1 Divyesh V Sejpal21Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA; 2Department of Medicine, Section of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, North Shore University Hospital, Manhasset, NY, USAAbstract: Biliary stenting has evolved dramatically over the past 30 years. Advancements in stent design have led to prolonged patency and improved efficacy. However, biliary stenting is still affected...

  7. Spontaneous Biliary Peritonitis in Children

    Directory of Open Access Journals (Sweden)

    Supreethi Kohli

    2013-01-01

    Full Text Available Pediatric Spontaneous Bile duct perforation is a rare clinical condition with only around 150 cases reported worldwide. Early management gives excellent prognosis but the condition often presents a diagnostic dilemma. Hepato-biliary Technetium-99m-iminodiacetic acid scintiscan is the diagnostic investigation of choice but its availability in third world countries is limited. We present two cases of spontaneous biliary peritonitis in children, which were diagnosed without scintiscanning. The first case was a one-and -a half-year-old child, who was diagnosed with biliary peritonitis without pneumoperitoneum by a combination of Ultrasound (USG, Contrast enhanced computed tomography (CECT, and Magnetic Resonance Imaging (MRI. The child underwent USG-guided drainage and subsequent cholecystectomy with hepatico-jejunostomy. The second child also had biliary peritonitis without pneumoperitoneum, which was initially suspected on USG. CECT revealed dilated gall bladder and fluid collection in sub-hepatic space and pelvis. Abdominal paracentesis revealed presence of bile. The child responded to conservative therapy. Both are doing well on two-year follow-up. In a patient with jaundice, biliary tract abnormalities and/or free fluid, either generalized or localized to peri-cholecystic/sub-hepatic space on USG/CT/MRI, in the absence of pneumoperitoneum, suggest a diagnosis of biliary perforation even in the absence of scintiscanning.

  8. Epidemiological Study of Ascariasis in Hamadan City , West of Iran, 2001

    Directory of Open Access Journals (Sweden)

    M. Fallah

    2004-04-01

    Full Text Available Ascaris lumbricoides is the most common intestinal parasite in the world. Various studies has indicated the high prevalence of this parasite in Iran, specially in the west parts of Iran. The epidemiological study of intestinal parasitic infection is prerequisite for planning of control programs. The Hamadan province is one of the most tourist attraction regions of Iran and providing a safe environment for travelers is the main aim of regional authorities. A mass chemotherapy for Ascariasis performed in rural areas of Hamadan province for a five years period but, no any intervention was done for control of this parasite in the Hamadan city. Therefore, an epidemiological study of Ascariasis in this town was necessary. A cross sectional study carried out by cluster random sampling in Hamadan and 580 stool specimens collected from different parts of city. The stools were examined by formalin ether concentration technique for ova and parasites and intensity of infection was determined by quantitative modified Stoll method. Mean infection rate of Ascariasis was 19.5%. The Farhangian suburb (northern part had higher infection rate than other parts(28.5% and central parts of city showed lower infection rate(12.7%. The highest infection rate were found in the 31-40 years age group (33.8% and in the females(23.9%.In view of intensity, 59.3% of infections were moderate and 48.3% had low intensity. No any high intensity were found. Mean egg per gram(epg were 7129 and 48.7% of eggs were infertile. This study indicated that , prevalence of Ascaris in Hamadan city is considerable at present and a suitable intervention, like health education and selective chemotherapy is necessary to decrease the infection.

  9. Evaluation of biliary disease by scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Ram, M.D.; Hagihara, P.F.; Kim, E.E.; Coupal, J.; Griffen, W.O.

    1981-01-01

    The value of biliary scintigraphy was studied in 180 patients with suspected biliary tract disease. Most of the patients were investigated additionally by conventional techniques such as cholecystography, cholangiography and ultrasonography. It is concluded that biliary scintigraphy is a simple and safe technique for visualization of the biliary tract. It is particularly useful in the evaluation of acute cholecystitis, in patients with iodine sensitivity obstructive from nonobstructive jaundice.

  10. Current treatment of benign biliary strictures

    OpenAIRE

    Costamagna, Guido; Boškoski, Ivo

    2013-01-01

    Endoscopy is a widely used approach for the treatment of benign biliary strictures. Most common benign biliary strictures amandable to endoscopic treatment are post-cholecystectomy, dominant biliary strictures due to primary sclerosing cholangitis, biliary anastomotic strictures occurring after liver transplantation, and common bile duct strictures due to chronic pancreatitis. Surgery is a valid option in cases of complete transection or ligation of the common bile duct, in selected patients ...

  11. Control of ascariasis through age-targeted chemotherapy: impact of 6-monthly chemotherapeutic regimens.

    OpenAIRE

    Thein-Hlaing; Than-Saw; Myat-Lay-Kyin

    1990-01-01

    A field trial of 6-monthly ascariasis chemotherapeutic regimens targeted at 1-19-, 1-14-, and 5-19-year-olds was carried out in three communities in rural Myanmar to observe the effects on the prevalence, intensity, and morbidity indicators over 2 years. After periodic chemotherapy, the prevalence and intensity of Ascaris infection in age-targeted and non-age-targeted groups fell in all the study areas, more markedly among the 1-19- and 1-14-year-olds. There was also a decrease in the frequen...

  12. A critical assessment of abattoir surveillance as a screening test for swine ascariasis.

    OpenAIRE

    Bernardo, T M; Dohoo, I R; Ogilvie, T

    1990-01-01

    The following data on ascarid burden were collected on an individual basis for 380 hogs marketed in the fall of 1987: a series of fecal ascarid-egg counts during the growing period; the level of milk spot lesions on the liver at slaughter; and the number of ascarids in the small intestines at slaughter. The presence of milk spots had a high sensitivity, very low specificity, and a high negative predictive value as a screening test for ascariasis in individual hogs. Results were consistent whe...

  13. Extrahepatic biliary atresia with choledochal cyst: Prenatal MRI predicted and post natally confirmed: A case report

    OpenAIRE

    Madhavi Nori; J Venkateshwarlu; Vijaysekhar,; Raghavendra Prasad, G.

    2013-01-01

    Extrahepatic biliary atresia (EHBA) is an uncommon cause of neonatal jaundice. Antenatal Magnetic Resonance Imaging (MRI) diagnosis of EHBA has not been published to the best of our knowledge till date. EHBA with cystic component is likely to be mistaken for choledochal cyst. A case that was antenatally predicted and postnatally confirmed by surgery and histopathology is being reported. All imaging signs are analyzed herewith. Imaging helps in the prediction of EHBA and also helps in early po...

  14. Percutaneous biliary drainage and stenting

    International Nuclear Information System (INIS)

    Full text: Percutaneous transhepatic cholangiography (PTC) is an X-ray or US guided procedure that involves the injection of a contrast material directly into the bile ducts inside the liver to produce pictures of them. If a blockage or narrowing is found, additional procedures may be performed: 1. insertion of a catheter to drain excess bile out of the body or both - internal and external; 2. plastic endoprothesis placement; 3. self-expandable metal stents placement to help open bile ducts or to bypass an obstruction and allow fluids to drain. Current percutaneous biliary interventions include percutaneous transhepatic cholangiography (PTC) and biliary drainage to manage benign and malignant obstructions. Internal biliary stents are either plastic or metallic, and various types of each kind are available. Internal biliary stents have several advantages. An external tube can be uncomfortable and have a psychological disadvantage. An internal stent prevents the problems related to external catheters, for example, pericatheter leakage of bile and the need for daily flushing. The disadvantages include having to perform endoscopic retrograde cholangiopancreatography (ERCP) or new PTC procedures to obtain access in case of stent obstruction. Better patency rates are reported with metallic than with plastic stents in cases of malignant obstruction, though no effect on survival is noted. Plastic internal stents are the cheapest but reportedly prone to migration. Metallic stents are generally not used in the treatment of benign disease because studies have shown poor long-term patency rates. Limited applications may include the treatment of patients who are poor surgical candidates or of those in whom surgical treatment fails. Most postoperative strictures are treated surgically, though endoscopic and (less commonly) percutaneous placement of nonmetallic stents has increasingly been used in the past few years. Now there are some reports about use of biodegradable biliary

  15. Studies in primary biliary cirrhosis

    NARCIS (Netherlands)

    B.G. Taal

    1981-01-01

    textabstractThe specific aims of the study were: - To (re)define the clinical features of the primary biliary cirrhosis syndrome. - To develop objective criteria which combine specificity with sensitivity for the diagnosis of PBC. - To study the relation of IgM in various forms (pentameric, monomeri

  16. Biliary Innate Immunity: Function and Modulation

    Directory of Open Access Journals (Sweden)

    Kenichi Harada

    2010-01-01

    Full Text Available Biliary innate immunity is involved in the pathogenesis of cholangiopathies in patients with primary biliary cirrhosis (PBC and biliary atresia. Biliary epithelial cells possess an innate immune system consisting of the Toll-like receptor (TLR family and recognize pathogen-associated molecular patterns (PAMPs. Tolerance to bacterial PAMPs such as lipopolysaccharides is also important to maintain homeostasis in the biliary tree, but tolerance to double-stranded RNA (dsRNA is not found. In PBC, CD4-positive Th17 cells characterized by the secretion of IL-17 are implicated in the chronic inflammation of bile ducts and the presence of Th17 cells around bile ducts is causally associated with the biliary innate immune responses to PAMPs. Moreover, a negative regulator of intracellular TLR signaling, peroxisome proliferator-activated receptor-γ (PPARγ, is involved in the pathogenesis of cholangitis. Immunosuppression using PPARγ ligands may help to attenuate the bile duct damage in PBC patients. In biliary atresia characterized by a progressive, inflammatory, and sclerosing cholangiopathy, dsRNA viruses are speculated to be an etiological agent and to directly induce enhanced biliary apoptosis via the expression of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL. Moreover, the epithelial-mesenchymal transition (EMT of biliary epithelial cells is also evoked by the biliary innate immune response to dsRNA.

  17. Hepatobiliary scintigraphy in the assessment of biliary obstruction after hepatic resection with biliary-enteric anastomosis

    International Nuclear Information System (INIS)

    We investigated the usefulness of hepatobiliary scintigraphy (HBS) for diagnosing biliary obstruction after curative hepatic resection with biliary-enteric anastomosis. The study population consisted of 54 patients who underwent surgery for benign (n=18) or malignant (n=36) biliary disease. We analysed 68 technetium-99m DISIDA scintigrams which were performed at least 1 month after the surgery (median: 9 months). Final diagnosis was made by operative exploration, other invasive radiological studies or clinical and radiological follow-up for at least 6 months after the surgery. Diagnostic accuracy was analysed according to the pretest likelihood of biliary obstruction. There were two total and 15 segmental biliary obstructions. In patients with symptoms of biliary obstruction and abnormal liver function, HBS always allowed correct diagnosis (two instances of total obstruction, seven of segmental obstruction and seven of non-obstruction). Among the patients with non-specific symptoms or isolated elevation of serum alkaline phosphatase, HBS diagnosed segmental biliary obstruction in seven of the eight instances, and non-obstruction in 22 of 23 instances. There were no cases of biliary obstruction and no false-positive results of HBS in 21 instances with no clinical signs or symptoms of biliary obstruction. The diagnostic sensitivity and specificity of HBS for biliary obstruction were 94% (16/17) and 97% (50/51), respectively. In conclusion, HBS is a highly accurate modality for the diagnosis of segmental biliary obstruction during long-term follow-up after hepatic resection with biliary-enteric anastomosis. (orig.)

  18. Biliary tract duplication cyst with gastric heterotopia

    International Nuclear Information System (INIS)

    Cystic duplications of the biliary tract are rare anomalies, easily mistaken for choledochal cysts. Surgical drainage is the preferred therapy for choledochal cyst, but cystic duplication necessitates surgical excision as duplications may contain heterotopic gastric mucosa leading to peptic ulceration of the biliary tract. We report a case of biliary tract duplication cyst containing heterotopic alimentary mucosa which had initially been diagnosed and surgically treated as a choledochal cyst. (orig.)

  19. Current Status of Biliary Metal Stents

    OpenAIRE

    Nam, Hyeong Seok; Kang, Dae Hwan

    2016-01-01

    Many advances have been achieved in biliary stenting over the past 30 years. Endoscopic stent placement has become the primary management therapy to relieve obstruction in patients with benign or malignant biliary tract diseases. Compared with plastic stents, a self-expandable metallic stent (SEMS) has been used for management in patients with malignant strictures because of a larger lumen and longer stent patency. Recently, SEMS has been used for various benign biliary strictures and leaks. ...

  20. Contemporary Management of Acute Biliary Pancreatitis

    OpenAIRE

    Orhan Ozkan

    2014-01-01

    Acute biliary pancreatitis is one of the major causes of acute pancreatitis.Gallstones, biliary sludge and microlithiasis, especially in pancreatitis without detectable reason, can be the cause of acute pancreatitis. Acute biliary pancreatitis has many controversions in the literature, and its classification and guidelines are being updated very frequently. Atlanta classifications which determine the definitions and guidelines about acute pancreatitis were renewed and published in 2013. It ha...

  1. Westernblottinginthediagnosisof duodenal-biliary and pancreaticobiliary relfuxesinbiliarydiseases

    Institute of Scientific and Technical Information of China (English)

    Guo-Zhe Xian; Shuo-Dong Wu; Chun-Chih Chen; Yang Su

    2009-01-01

    BACKGROUND: Currently adopted diagnostic methods for duodenal-biliary and pancreaticobiliary relfuxes carry many lfaws, so the incidence of the two relfuxes demands further larger sample size studies. This study aimed to evaluate Western blotting for the diagnosis of relfuxes in biliary diseases. METHODS: An oral radionuclide 99mTc-DTPA test (radio-nuclide, RN) was conducted for the observation of duodenal-biliary relfux prior to measuring bile radioactivity and Western blotting for detecting bile enterokinase (EK). Pancreaticobiliary relfux was assessed by biochemical and Western blotting tests for biliary amylase activity and trypsin-1, respectively. In accordance with bile sample origin, our samples were classiifed into ductal bile and gall bile groups;based on each individual biliary disease, we further classiifed the ductal bile group into ifve sub-groups, and the gall bile group into four sub-groups. Western blotting was conducted to assess the two relfuxes in biliary diseases. RESULTS: Consistencies were noted between EK and RN tests when diagnosing duodenal-biliary relfux (P0.05); in the common bile duct cyst group, the EK positive rate was signiifcantly lower than the trypsin-1 positive rate (P CONCLUSIONS: Western blotting can accurately relfect duodenal-biliary and pancreaticobiliary relfuxes. EK has greater sensitivity than RN for duodenal-biliary relfux. The majority of biliary amylase and lipase comes from the pancreas in all biliary diseases;pancreaticobiliary relfux is the predominant source in the common bile duct cyst group and duodenal-biliary relfux is responsible for the ductal pigment stone group.

  2. Biliary tract duplication cyst with gastric heterotopia

    Energy Technology Data Exchange (ETDEWEB)

    Grumbach, K.; Baker, D.H.; Weigert, J.; Altman, R.P.

    1988-05-01

    Cystic duplications of the biliary tract are rare anomalies, easily mistaken for choledochal cysts. Surgical drainage is the preferred therapy for choledochal cyst, but cystic duplication necessitates surgical excision as duplications may contain heterotopic gastric mucosa leading to peptic ulceration of the biliary tract. We report a case of biliary tract duplication cyst containing heterotopic alimentary mucosa which had initially been diagnosed and surgically treated as a choledochal cyst.

  3. Radiological interventions in malignant biliary obstruction.

    Science.gov (United States)

    Madhusudhan, Kumble Seetharama; Gamanagatti, Shivanand; Srivastava, Deep Narayan; Gupta, Arun Kumar

    2016-05-28

    Malignant biliary obstruction is commonly caused by gall bladder carcinoma, cholangiocarcinoma and metastatic nodes. Percutaneous interventions play an important role in managing these patients. Biliary drainage, which forms the major bulk of radiological interventions, can be palliative in inoperable patients or pre-operative to improve liver function prior to surgery. Other interventions include cholecystostomy and radiofrequency ablation. We present here the indications, contraindications, technique and complications of the radiological interventions performed in patients with malignant biliary obstruction. PMID:27247718

  4. Successive breaks in biliary stents.

    Science.gov (United States)

    Espinel, Jesús; Pinedo, Eugenia; Ojeda, Vanesa; Guerra, María

    2016-04-01

    A 64 year-old male, was diagnosed with obstructive jaundice due to a well-differentiated pancreatic neuroendocrine tumor with liver metastases. The patient underwent endoscopic placement of covered self-expanding biliary stent (10x60 mm, Hanaro) by ERCP. He was admitted with cholangitis one year later. The following ERCP revealed a fractured stent with loss of the distal end (duodenal) and partial migration of the remaining stent to the common bile duct. The fragmented stent was removed from the common bile duct and a new, similar one was inserted. Four months later the patient was admitted with cholangitis. A new ERCP was done and biliary stent was also fragmented. It was removed and an uncovered stent (Wallflex) was inserted. PMID:27065248

  5. [Ascariasis: comparison of the therapeutic efficacy between paico and albendazole in children from Huaraz].

    Science.gov (United States)

    López De Guimaraes, D; Neyra Llanos, R S; Romero Acevedo, J H

    2001-01-01

    A therapeutical clinical trial was designed to study the effectiveness of Paico and Albendazole, for the treatment of ascariasis in a group of 60 children, between 3 and 14 years old, from a rural community in Huaraz. It was carried out between May and August, 2000. The sample was randomly divided into 30 cases for Paico and 30 for Albendazole, the criteria for entering the trial being a positive examination for Ascaris lumbricoides in feces. The treatment consisted in Paico juice: 1 ml/Kg for less than 10 Kg, and 2 ml/Kg in larger children, one dose before breakfast, for three consecutive days. The Albendazole was administered in a single dose of 400 mg in those over five years of age, and 200 mg in younger children. The effectiveness was evaluated qualitatively (the disappearance of the ascaris eggs from the feces) and quantitatively (decrease in the parasitic burden); in the stool examinations carried out in all cases on entering the study and 15 days after the treatment. All the stool samples were processed in the Referential Laboratory of the Regional Health Authority in Ancash. The qualitative effectiveness between Paico and Albendazole for the eradication of ascariasis was similar at 86.7%. The quantitative effectiveness was 59.5% for Paico and 58.3% for Albendazole. However, it was observed that, unlike Albedazole, Paico is 100% effective in the treatment of Hymenolepsis nana. Adverse effects were presented in 23.3% of the cases for both drugs. It is concluded that, although Paico and Albendazole have a similar effectiveness against Ascaris lumbricoides, Paico has the additional benefit of being effective against Hymenolepsis nana. PMID:11818981

  6. GWAS in Primary Biliary Cirrhosis

    OpenAIRE

    Gulamhusein, Aliya F.; Juran, Brian D.; Lazaridis, Konstantinos N.

    2015-01-01

    Genome wide association studies (GWAS) have been a significant technological advance in our ability to evaluate the genetic architecture of complex diseases such as Primary Biliary Cirrhosis (PBC). To date, six large-scale studies have been performed which identified 27 non-HLA risk loci associated with PBC. The identified risk variants emphasize important disease concepts; namely, that disturbances in immunoregulatory pathways are important in the pathogenesis of PBC and that such perturbati...

  7. Diet and biliary tract cancer

    OpenAIRE

    Moerman CJ; Bueno de Mesquita HB; Runia S; Smeets FWM

    1991-01-01

    We studied the relation between diet and biliary tract cancer in a case-control study, comprising 111 incident cases and 480 controls from the general population. Food intake was assessed with a semi- quantitative food frequency questionnaire, which covered diet comprehensively. In half of the cases and 30% of the controls the information was obtained from the spouse or other relatives (indirect respondents). Mono- and disaccharides showed an elevated risk, independent from other sources of e...

  8. ERCP in acute biliary pancreatitis

    OpenAIRE

    Kapetanos, Dimitrios J

    2010-01-01

    The role of urgent endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis is for many years a subject for disagreement among physicians. Although the evidence seemed to be in favor of performing ERCP, endoscopists usually hesitate to conform to the guidelines. ERCP is an invasive procedure, with complications which can affect patients’ outcome. Recent evidence suggests that we should probably modify our policy, recruiting less invasive procedures, like magnetic re...

  9. Endoscopic ultrasound guided biliary drainage

    OpenAIRE

    2012-01-01

    Endoscopic retrograde cholangio-pancreatography is the most appropriate technique for treating common bile duct and pancreatic duct stenosis secondary to benign and malignant diseases. Even if the procedure is performed by skillful endoscopist, there are patients in whom endoscopic stent placement is not possible. Common causes of failure include complex peri-papillary diverticula, prior surgery procedures, tumor involvement of the papilla, biliary sphincter stenosis, and impacted stones. Per...

  10. THE HISTOPATHOLOGY OF PSORIASIS

    Directory of Open Access Journals (Sweden)

    C. Mignogna

    2011-09-01

    Full Text Available Psoriasis is a common, chronic, relapsing, papulo-squamous dermatitis, with overlying silvery scales. The scalp, sacral region, and extensor surfaces of extremity are commonly involved, even if flexural and intertriginous areas may be affected in the so-called “inverse psoriasis”. Involvement of nails is frequent. Oral lesions (geographic stomatitis and/or glossitis are commonly described. 5-8% of psoriatic patients develop arthritis. Interphalangeal joints are characteristically involved, but large joints are also affected. From a histological point of view, psoriasis is a dynamic dermatosis that changes during the evolution of an individual lesion; we can classify it in an early stage, advanced stage, and later lesions. Lesions are usually diagnostic only in early stages or near the margin of advancing plaques. Munro microabscesses and Kogoj micropustoles are diagnostic clues of psoriasis, but they aren’t always present. All other features can be found in numerous eczematous dermatitis. Key words: Psoriasis, histopathology, immunohistochemistry

  11. Pathological diagnosis of flat epithelial lesions of the biliary tract with emphasis on biliary intraepithelial neoplasia.

    Science.gov (United States)

    Sato, Yasunori; Sasaki, Motoko; Harada, Kenichi; Aishima, Shinichi; Fukusato, Toshio; Ojima, Hidenori; Kanai, Yae; Kage, Masayoshi; Nakanuma, Yasuni; Tsubouchi, Hirohito

    2014-01-01

    Flat epithelial lesions of the biliary tract cannot be detected by the image analysis, and the diagnosis entirely depends on pathological examination. The biliary tract is often affected by inflammatory conditions, and the resultant changes of the biliary epithelium make it difficult to differentiate them from neoplasia. Thus, the pathological diagnosis of biliary flat epithelial lesions can be challenging. In the biliary tract, there are several forms of intraepithelial neoplasia of the flat type, and biliary intraepithelial neoplasia (BilIN) is known as one of such lesions that represent the multistep cholangiocarcinogenesis. In this article, the diagnostic criteria and the differential diagnosis of biliary flat epithelial lesions, particularly focusing on BilIN, were presented and discussed to provide help to advance clinical and research applications of the BilIN system. PMID:23616173

  12. Biliary tract intraductal papillary mucinous neoplasm: A brief report and review of literature

    Directory of Open Access Journals (Sweden)

    Raveendran Subhash

    2014-01-01

    Full Text Available Biliary Tract Intraductal Papillary Mucinous Neoplasm (BT-IPMN is a very rare entity, gradually emerging into attention as sporadic cases are being reported worldwide. In this brief report we discuss about such an entity from our part of the world, based on a case from our institution. A 47-year-old female was referred to our department with jaundice, intermittent fever with chills and rigor of 6 weeks duration. Initial evaluation revealed obstructive jaundice with distended gall bladder. Imaging with ultrasonogram (USG and magnetic resonance imaging (MRI showed hugely dilated intra and extrahepatic biliary radicles with multiple and diffuse soft tissue lesions filling the common bile duct (CBD extending to the ductal system of left lobe of liver. A side viewing endoscopy demonstrated mucin extruding from a prominent ampulla of Vater. The patient was managed successfully by left hepatectomy with pancreaticoduodenectomy (HPD. Gross pathological examination of the specimen showed marked dilatation of intra and extra hepatic bile ducts with multiple polypoidal lesions and plenty of mucin filling the entire biliary ductal system. Histopathology revealed predominantly intraductal papillary mucinous adenocarcinoma at the hilum extending to left bile duct with diffuse dysplastic changes throughout the biliary tree. Thus the clinical, radiological and pathological features of this lesion clearly fit into the diagnosis of BT-IPMN, which is slowly being established as a definite clinical entity with features much similar to its pancreatic counterpart.

  13. Biliary complications after orthotopic liver transplantation

    NARCIS (Netherlands)

    Karimian, Negin; Westerkamp, Andrie C.; Porte, Robert J.

    2014-01-01

    Purpose of reviewThe incidence, pathogenesis and management of the most common biliary complications are summarized, with an emphasis on nonanastomotic biliary strictures (NAS) and potential strategies to prevent NAS after liver transplantation.Recent findingsNAS have variable presentations in time

  14. Current Status of Biliary Metal Stents.

    Science.gov (United States)

    Nam, Hyeong Seok; Kang, Dae Hwan

    2016-03-01

    Many advances have been achieved in biliary stenting over the past 30 years. Endoscopic stent placement has become the primary management therapy to relieve obstruction in patients with benign or malignant biliary tract diseases. Compared with plastic stents, a self-expandable metallic stent (SEMS) has been used for management in patients with malignant strictures because of a larger lumen and longer stent patency. Recently, SEMS has been used for various benign biliary strictures and leaks. In this article, we briefly review the characteristics of SEMS as well as complications of stent placement. We review the current guidelines for managing malignant and benign biliary obstructions. Recent developments in biliary stenting are also discussed. PMID:26911896

  15. Current Status of Biliary Metal Stents

    Science.gov (United States)

    Nam, Hyeong Seok; Kang, Dae Hwan

    2016-01-01

    Many advances have been achieved in biliary stenting over the past 30 years. Endoscopic stent placement has become the primary management therapy to relieve obstruction in patients with benign or malignant biliary tract diseases. Compared with plastic stents, a self-expandable metallic stent (SEMS) has been used for management in patients with malignant strictures because of a larger lumen and longer stent patency. Recently, SEMS has been used for various benign biliary strictures and leaks. In this article, we briefly review the characteristics of SEMS as well as complications of stent placement. We review the current guidelines for managing malignant and benign biliary obstructions. Recent developments in biliary stenting are also discussed. PMID:26911896

  16. Computed tomography of primary intrahepatic biliary malignancy

    International Nuclear Information System (INIS)

    Fifteen patients with primary intrahepatic biliary malignancy (cholangiocarcinoma in 13, biliary cystadenocarcinoma in two) were examined by computed tomography (CT). The CT features were classified into three types: (A) a well-defined round cystic mass with internal papillary projections, (B) a localized intrahepatic biliary dilatation without a definite mass lesion, and (C) miscellaneous low-density masses. Intraphepatic biliary dilatation was noted in all cases of Types A and B and half of those of Type C; dilatation of extrahepatic bile ducts occurred in 4/4, 1/3, and 0/8, respectively. CT patterns, such as a well-defined round cystic mass with papillary projections or dilatation of intra- and extrahepatic ducts, give important clues leading to a correct diagnosis of primary intrahepatic biliary malignancy

  17. Percutaneous transcather biliary biopsy with a biotoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Goo; Park, Eaui Dong; Ahn, In Oak [Gyeongsang National University College of Medicine, Chinju (Korea, Republic of)

    1993-07-15

    For the purpose of the precise diagnosis and proper treatment planning of obstructive jaundice, various techniques to obtain tissues from biliary stricture sites have been proposed. We performed percutaneous transcatheter biopsy of biliary strictures with a biotome in six patients with obstructive jaundice. The site of biliary stricture were distal common bile ducts (n=1), and confluence of both intrahepatic ducts (n=2). Their histologic diagnose were adenocarcinoma (n=2), chronic choleochitis (n=3), and atypical cell suspicious of malignancy (n=1). False positive or false negative results were not documented by other means (including laparotomy), when regarding atypical cell suspicious of malignancy as true positive for malignancy. Percutaneous transcatheter biliary biopsy with a biotome is easy to perform in conjunction with percutaneous transhepatic biliary drainage procedure, and can be able to obtain specific tissue for correct diagnosis.

  18. Biliary acute pancreatitis: a review

    Institute of Scientific and Technical Information of China (English)

    Osvaldo M. Tiscomia; Susana Hamamura; Enriqueta S. de Lehmann; Graciela Otero; Hipólito Waisman; Patricia Tiscornia-Wasserman; Simmy Bank

    2000-01-01

    @@INTRODUCTION It is axiomatic that the most effective and soundly based plan of treatment of any disorder is one aimed at the mechanism or mechanisms responsible for its development[1]. This basic notion, coupled with recent reports[2- 11] in which, surprisingly there is a total lack of reference to the probable involvement of autonomic-arc-reflexes in the physiopathogenesis of biliary acute pancreatitis have prompted this presentation. Undoubtedly, this disease entity has numerous causes, an obscure physiopathology, few effective remedies, and, often, an unpredictable outcome. At the turn of the century, Opie[12,13] brought to light the association between gallstone migration and acute pancreatitis.

  19. 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.

  20. Establishment of an animal model of ischemic type intrahepatic biliary lesion in rabbits

    Institute of Scientific and Technical Information of China (English)

    Qin-Song Sheng; Da-Zhi Chen; Ren Lang; Qiang He; Yong-Jiu Yang; Zhao-Wei Qu; De-Fang Zhao; Xiao-Sheng Zhang

    2009-01-01

    AIM: To explore a method to establish an animal model of ischemic type intrahepatic biliary lesion in rabbits. METHODS: Forty Japanese white rabbits of clean grade were divided randomly into four groups (10 rabbits per group) including sham operation (SO) group, and artery-bile obstruction (ABO)-1 h group, ABO-2 h group and ABO-3 h group. All the rabbits in this study underwent the same initial surgical procedure in which the liver was prepared as for graft removal during liver transplantation. Subsequently in the SO group, no additional vascular intervention was performed, while in groups ABO-1 h, ABO-2 h and ABO-3 h, the animals underwent combined clamping of the hepatic artery and common bile duct with microvascular clips for 1, 2 and 3 h, respectively. After the scheduled occlusion time, the clip was removed to recover blood supply. The animals were killed 4 wk after operation. The survival rate, liver function, cholangiography and histopathological manifestation of the rabbits in each group were observed. RESULTS: The survival rate was 100% in groups SO, ABO-1 h and ABO-2 h, while it was 60% in group ABO-3 h. At each observation time, the change degree of the indexes of liver function was proportional to the clamping time (ABO-3 h > ABO-2 h > ABO-1 h > SO, P < 0.05). Cholangiographical and histopathologic manifestations both showed that intrahepatic biliary lesion aggravated proportionally with the increase of the clamping time. CONCLUSION: An animal model of ischemic type intrahepatic biliary lesion in rabbits is successfully established, which may provide a reliable technique for basic and clinical research into the etiology, development and prophylaxis of ischemic type intrahepatic biliary lesion after liver transplantation.

  1. Imaging findings of biliary hamartomas

    Institute of Scientific and Technical Information of China (English)

    Rong-Qin Zheng; Bo Zhang; Masatoshi Kudo; Hirokazu Onda; Tatsuo Inoue

    2005-01-01

    AIM: To evaluate the imaging findings of biliary hamartomas (von Meyenburg complexes, VMCs) and discuss the differential diagnosis with other related diseases.METHODS: Imaging findings of biliary hamartomas on ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), MR cholangiopancreatography (MRCP)and hepatobiliary scintigraphy were retrospectively analyzed in six patients.RESULTS: On ultrasound images, five of the six cases showed multiple small hyper- and hypo-echoic lesions with comet-tail echoes, especially when magnified by US with the usage of zoom function. In all the six cases,multiple tiny hypodense lesions less than 10 mm in diameter were revealed as scattered throughout the liver with no enhancement on CT. These tiny lesions were demonstrated to be hyper- and hypo-intensity on T2- and TI-weighed images, respectively, in three patients who underwent MRI examinations. MRCP was performed in two patients, and clearly showed multiple tiny irregular- and round-shaped hyper-intensity lesions.MRCP and hepatobiliary scintigraphy showed normal appearances of intra- and extra-hepatic bile ducts in two and one patients, respectively.CONCLUSION: Imaging modalities are useful in the diagnosis and differential diagnosis of VMCs. A correct diagnosis might be obtained when typical imaging findings are present even without a histological confirmation.

  2. Endoscopic Stent Placement in the Palliation of Malignant Biliary Obstruction

    OpenAIRE

    Kim, Jin Hong

    2011-01-01

    Biliary drainage with biliary stent placement is the treatment of choice for palliation in patients with malignant biliary obstruction caused by unresectable neoplasms. In such patients, the endoscopic approach can be initially used with percutaneous radiological intervention. In patients with unresectable malignant distal bile duct obstructions, endoscopic biliary drainage with biliary stent placement has now become the main and least invasive palliative modality, which has been proven to be...

  3. Heterogeneity of the intrahepatic biliary epithelium

    Institute of Scientific and Technical Information of China (English)

    Shannon Glaser; Heather Francis; Sharon DeMorrow; Gene LeSage; Giammarco Fava; Marco Marzioni; Julie Venter; Gianfranco Alpini

    2006-01-01

    The objectives of this review are to outline the recent findings related to the morphological heterogeneity of the biliary epithelium and the heterogeneous pathophysiological responses of different sized bile ducts to liver gastrointestinal hormones and peptides and liver injury/toxins with changes in apoptotic, proliferative and secretory activities. The knowledge of biliary function is rapidly increasing because of the recognition that biliary epithelial cells (cholangiocytes) are the targets of human cholangiopathies, which are characterized by proliferation/damage of bile ducts within a small range of sizes. The unique anatomy, morphology, innervation and vascularization of the biliary epithelium are consistent with function of cholangiocytes within different regions of the biliary tree. The in vivo models [e.g., bile duct ligation (BDL), partial hepatectomy, feeding of bile acids,carbon tetrachloride (CCl4) or α-naphthylisothiocyanate (ANIT)] and the in vivo experimental tools [e.g., freshly isolated small and large cholangiocytes or intrahepatic bile duct units (IBDU) and primary cultures of small and large murine cholangiocytes] have allowed us to demonstrate the morphological and functional heterogeneity of the intrahepatic biliary epithelium.These models demonstrated the differential secretory activities and the heterogeneous apoptotic and proliferative responses of different sized ducts. Similar to animal models of cholangiocyte proliferation/injury restricted to specific sized ducts, in human liver diseases bile duct damage predominates specific sized bile ducts.Future studies related to the functional heterogeneity of the intrahepatic biliary epithelium may disclose new pathophysiological treatments for patients with cholangiopathies.

  4. CT biliary cystoscopy of gallbladder polyps

    Institute of Scientific and Technical Information of China (English)

    Ming-Wu Lou; Wei-Dong Hu; Yi Fan; Jin-Hua Chen; Zhan-Sen E; Guang-Fu Yang

    2004-01-01

    AIM: CT virtual endoscopy has been used in the study of various organs of body including the biliary tract, however,CT virtual endoseopy in diagnosis of gallbladder polyps has not yet been reported. This study was to evaluate the diagnostic value of CT virtual endoscopy in polyps of the gallbladder.METHODS: Thirty-two cases of gallbladder polyps were examined by CT virtual endoscopy, ultrasound, CT scan with oral biliary contrast separately and confirmed by operation and pathology. CT biliary cystoscopic findings were analyzed and compared with those of ultrasound and CT scan with oral biliary contrast, and evaluated in comparison with operative and pathologic findings in all cases.RESULTS: The detection rate of gallbladder polyps was 93.8%(90/96), 96.9%(93/96) and 79.2%(76/96) for CT cystoscopy, ultrasound and CT scan with oral contrast,respectively. CT biliary cystoscopy corresponded well with ultrasound as well as pathology in demonstrating the location, size and configuration of polyps. CT endoscopy was superior to ultrasound in viewing the polyps in a more precise way, 3 dimensionally from any angle in space, and showing the surface in details. CT biliary cystoscopy was also superior to CT scan with oral biliary contrast in terms of observation of the base of polyps for the presence of a pedicle, detection rates as well as image quality. The smallest polyp detected by CT biliary cystoscopy was measured 1.5 mmx2.2 mmx2.5 mm.CONCLUSION: CT biliary cystoscopy is a non-invasive and accurate technique for diagnosis and management of gallbladder polyps.

  5. Inaccurate preoperative imaging assessment on biliary anatomy not increases biliary complications after living donor liver transplantation

    International Nuclear Information System (INIS)

    Backgrounds and aims: Accurate assessment of graft bile duct is important to plan surgical procedure. Magnetic resonance cholangiopancreatography (MRCP) has become an important diagnostic procedure in evaluation of pancreaticobiliary ductal abnormalities and has been reported as highly accurate. We aim to estimate the efficacy of preoperative MRCP on depicting biliary anatomy in living donor liver transplantation (LDLT), and to determine whether inaccurate preoperative imaging assessment would increase the biliary complications after LDLT. Methods: The data of 118 cases LDLT were recorded. Information from preoperative MRCP was assessed using intraoperative cholangiography (IOC) as the gold standard. The possible risk factors of recipient biliary complications were analyzed. Results: Of 118 donors, 84 had normal anatomy (type A) and 34 had anatomic variants (19 cases of type B, 9 cases of type C, 1 case of type E, 2 cases of type F and 3 cases of type I) confirmed by IOC. MRCP correctly predicted all 84 normal cases and 17 of 34 variant cases, and showed an accuracy of 85.6% (101/118). The incidence of biliary complications was comparable between cases with accurate and inaccurate classification of biliary tree from MRCP, and between cases with normal and variant anatomy of bile duct. While cases with graft duct opening ≤5 mm showed a significant higher incidence of total biliary complications (21.1% vs. 6.6%, P = 0.028) and biliary stricture (10.5% vs. 1.6%, P = 0.041) compared with cases with large duct opening >5 mm. Conclusion: MRCP could correctly predict normal but not variant biliary anatomy. Inaccurate assessment of biliary anatomy from MRCP not increases the rate of biliary complications, while small-sized graft duct may cause an increase in biliary complications particularly biliary stricture after LDLT.

  6. US and RTG guided percutaneous biliary drainage

    International Nuclear Information System (INIS)

    Under combined US and fluoroscopic guidance from anterior approach through left liver lobe a Seldinger technique was used for biliary drainage in 46 patients with nonresectable malignant biliary obstruction. In 9 cases of hilar tumor separating both hepatic ducts a second catheter was inserted through right liver lobe. In 11 cases an internal-external drainage was established. In 3 cases the externally drained bile was recycled by connecting the transhepatic catheter to a percutaneous gastrostomy also performed under US guidance. No severe complications were observed. A described drainage technique provides an effective palliative intervention for advanced biliary malignancies. (author)

  7. Extrahepatic biliary atresia with choledochal cyst: Prenatal MRI predicted and post natally confirmed: A case report

    Directory of Open Access Journals (Sweden)

    Madhavi Nori

    2013-01-01

    Full Text Available Extrahepatic biliary atresia (EHBA is an uncommon cause of neonatal jaundice. Antenatal Magnetic Resonance Imaging (MRI diagnosis of EHBA has not been published to the best of our knowledge till date. EHBA with cystic component is likely to be mistaken for choledochal cyst. A case that was antenatally predicted and postnatally confirmed by surgery and histopathology is being reported. All imaging signs are analyzed herewith. Imaging helps in the prediction of EHBA and also helps in early postnatal surgical referral which in turn improves the results of Kasai′s portoenterostomy.

  8. Extrahepatic biliary atresia with choledochal cyst: Prenatal MRI predicted and post natally confirmed: A case report.

    Science.gov (United States)

    Nori, Madhavi; Venkateshwarlu, J; Vijaysekhar; Prasad, G Raghavendra

    2013-07-01

    Extrahepatic biliary atresia (EHBA) is an uncommon cause of neonatal jaundice. Antenatal Magnetic Resonance Imaging (MRI) diagnosis of EHBA has not been published to the best of our knowledge till date. EHBA with cystic component is likely to be mistaken for choledochal cyst. A case that was antenatally predicted and postnatally confirmed by surgery and histopathology is being reported. All imaging signs are analyzed herewith. Imaging helps in the prediction of EHBA and also helps in early postnatal surgical referral which in turn improves the results of Kasai's portoenterostomy. PMID:24347854

  9. Application of percutaneous transhepatic biliary drainage and percutaneous transhepatic insertion of biliary stent in treating malignant biliary obstruction

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical efficacy of percutaneous transhepatic biliary drainage (PTBD) and percutaneous transhepatic insertion of biliary stent (PTIBS) for malignant biliary obstruction. Methods: PTBD or PTIBS were performed in 56 patients with malignant biliary obstruction, which were caused by hepatic carcinoma (n=14), biliary duct carcinoma (n=11), gallbladder carcinoma (n=5), stomach carcinoma accompanied with metastasis of lymph node (n=14), carcinoma of ampulla (n=1) or carcinoma of pancreatic head (n=11). The diagnosis was confirmed by ultrasonography, CT or MRI in all patients. The obstructed site was well identified, including high obstruction in 19 patients and lower obstruction in 37 patients. Based on the imaging findings, suitable interventional procedure was employed. Results: PTBD or PTIBS were performed successfully in all 56 patients, of them PTBD was adopted in 11, PTIBS in 40 and both PTBD and PTIBS in 5. The serum total bilirubin decreased from (295.65 ± 152.86) μmol/L before the procedure to (151.05 ± 107.36) μmol/L after the procedure (P<0.01). Postoperative infection could affect the fading of jaundice (P<0.01), but the location of the obstruction carried no relationship with the fading of jaundice (P=0.063). Conclusion: Both PTBD and PTIBS are safe and effective palliative therapies for malignant biliary obstruction, which can markedly relieve patient of jaundice, improve the quality of life and elongate the survival period. (authors)

  10. Plasma exchange in primary biliary cirrhosis

    OpenAIRE

    Keeling, P W N; Kingston, P.; Bull, J.; Thompson, R. P. H.

    1981-01-01

    The symptoms of patients with primary biliary cirrhosis are frequently intractable to traditional therapy. Three patients are reported in whom several symptoms were alleviated by plasma exchange, using a Hemonetics Model 30 cell separator.

  11. Bisphosphonates for osteoporosis in primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Rudic, Jelena; Giljaca, Vanja; Krstic, Miodrag N;

    2011-01-01

    Bisphosphonates are widely used for treatment of postmenopausal osteoporosis. Patients with primary biliary cirrhosis often have osteoporosis - either postmenopausal or secondary to the liver disease. No systematic review or meta-analysis has assessed the effects of bisphosphonates for osteoporosis...

  12. Ursodeoxycholic acid for primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Gong, Y.; Huang, Z.B.; Christensen, Erik;

    2008-01-01

    references of identified studies. The last search was performed in January 2007. SELECTION CRITERIA: Randomised clinical trials evaluating UDCA versus placebo or no intervention in patients with primary biliary cirrhosis. DATA COLLECTION AND ANALYSIS: The primary outcomes were mortality and mortality or......, trial duration, and patient's severity of primary biliary cirrhosis. We also used Bayesian meta-analytic approach to estimate the UDCA effect as sensitivity analysis. MAIN RESULTS: Sixteen randomised clinical trials evaluating UDCA against placebo or no intervention were identified. Data from three......BACKGROUND: Primary biliary cirrhosis is an uncommon autoimmune liver disease with unknown aetiology. Ursodeoxycholic acid (UDCA) has been used for primary biliary cirrhosis, but the effects remain controversial. OBJECTIVES: To evaluate the benefits and harms of UDCA on patients with primary...

  13. Biliary papillomatosis: analysis of 18 cases

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ Biliary papillomatosis (BP) is an extremely rare pathological condition, which is characterized by papillary proliferation of the bile duct epithelia. Although initially thought to be a benign entity, this tumor has been shown to have a tendency for malignant transformation.

  14. Benign Biliary Strictures: Diagnostic Evaluation and Approaches to Percutaneous Treatment.

    Science.gov (United States)

    Fidelman, Nicholas

    2015-12-01

    Interventional radiologists are often consulted to help identify and treat biliary strictures that can result from a variety of benign etiologies. Mainstays of noninvasive imaging for benign biliary strictures include ultrasound, contrast-enhanced computed tomography and magnetic resonance imaging, magnetic resonance cholangiopancreatography, and computed tomography cholangiography. Endoscopic retrograde cholangiography is the invasive diagnostic procedure of choice, allowing both localization of a stricture and treatment. Percutaneous biliary interventions are reserved for patients who are not candidates for endoscopic retrograde cholangiography (eg, history of distal gastrectomy and biliary-enteric anastomosis to a jejunal roux limb). This review discusses the roles of percutaneous transhepatic cholangiography and biliary drainage in the diagnosis of benign biliary strictures. The methodology for crossing benign biliary strictures, approaches to balloon dilation, management of recalcitrant strictures (ie, large-bore biliary catheters and retrievable covered stents), and the expected outcomes and complications of percutaneous treatment of benign biliary strictures are also addressed. PMID:26615161

  15. Mechanisms of biliary carcinogenesis and growth

    OpenAIRE

    Wise, Candace; Pilanthananond, Metaneeya; Perry, Benjamin F; Alpini, Gianfranco; McNeal, Michael; Glaser, Shannon S.

    2008-01-01

    Cholangiocarcinoma is a rare cancer originating from the neoplastic transformation of the epithelial cells (i.e. cholangiocytes) that line the biliary tract. The prognosis for patients with cholangiocarcinoma is grim due to lack of viable treatment options. The increase in world-wide incidence and mortality from cholangiocarcinoma highlights the importance of understanding the intracellular mechanisms that trigger the neoplastic transformation of cholangiocytes and the growth of biliary cance...

  16. How Should Biliary Stones be Managed?

    OpenAIRE

    Shim, Chan Sup

    2010-01-01

    Minimally invasive therapy is currently invaluable for the treatment of biliary stones. Clinicians should be familiar with the various endoscopic modalities that have been evolving. I reviewed the treatment of biliary stones from the common practice to pioneering procedures, and here I also briefly summarize the results of many related studies. Lithotripsy involves procedures that fragment large stones, and they can be roughly classified into two groups: intracorporeal modalities and extracor...

  17. Percutaneous Transhepatic Biliary Drainage Complicated by Bilothorax

    OpenAIRE

    Kim, Stephanie H.; Zangan, Steven M.

    2015-01-01

    Percutaneous transhepatic biliary drainage (PTBD) is a well-established and safe technique for the management of biliary obstructions and leaks. While approach is variable based on operator preference, patient anatomy, and indications; PTBD is commonly performed via a right-sided intercostal route. With a right-sided approach, pleural complications may be encountered. The authors describe a case of a right PTBD complicated by a leak into the pleural space, with the subsequent development of b...

  18. Reality named endoscopic ultrasound biliary drainage

    OpenAIRE

    Guedes, Hugo Gonçalo; Lopes, Roberto Iglesias; de Oliveira, Joel Fernandez; Artifon, Everson Luiz de Almeida

    2015-01-01

    Endoscopic ultrasound (EUS) is used for diagnosis and evaluation of many diseases of the gastrointestinal (GI) tract. In the past, it was used to guide a cholangiography, but nowadays it emerges as a powerful therapeutic tool in biliary drainage. The aims of this review are: outline the rationale for endoscopic ultrasound-guided biliary drainage (EGBD); detail the procedural technique; evaluate the clinical outcomes and limitations of the method; and provide recommendations for the practicing...

  19. Percutaneous Transhepatic Biliary Drainage Complicated by Bilothorax.

    Science.gov (United States)

    Kim, Stephanie H; Zangan, Steven M

    2015-03-01

    Percutaneous transhepatic biliary drainage (PTBD) is a well-established and safe technique for the management of biliary obstructions and leaks. While approach is variable based on operator preference, patient anatomy, and indications; PTBD is commonly performed via a right-sided intercostal route. With a right-sided approach, pleural complications may be encountered. The authors describe a case of a right PTBD complicated by a leak into the pleural space, with the subsequent development of bilothorax. PMID:27053829

  20. Percutaneous transhepatic biliary drainage using endoprosthesis

    International Nuclear Information System (INIS)

    Even in the presence of intrahepatic metastases or previous failure of biliary enteric anastomosis, patients suffering from malignant obstructive jaundice can bve given relief by biliary endoprosthesis. Mean survival time is four months. Other than with a catheter drain, spetic cholangitis is rarely observed after the insertion of an endoprosthesis. The intervention's risk will hardly be augmented by drainage of both lobes as often necessary. (orig.)

  1. Percutaneous transhepatic biliary drainage using endoprosthesis

    Energy Technology Data Exchange (ETDEWEB)

    Golder, W.; Rupp, N.

    1986-06-01

    Even in the presence of intrahepatic metastases or previous failure of biliary enteric anastomosis, patients suffering from malignant obstructive jaundice can bve given relief by biliary endoprosthesis. Mean survival time is four months. Other than with a catheter drain, spetic cholangitis is rarely observed after the insertion of an endoprosthesis. The intervention's risk will hardly be augmented by drainage of both lobes as often necessary.

  2. Ascaridíase biliar complicada: espectro de problemas e táticas cirúrgicas Biliary ascariasis: spectrum of surgical problems and tactics

    OpenAIRE

    Lisieux Eyer de Jesus; Ricardo Pecoraro Raposo; Alexandre Guazelli

    2004-01-01

    OBJETIVO: Discutir as variantes clínicas e táticas para tratamento cirúrgico da ascaridíase biliar complicada. MÉTODO: Trabalho retrospectivo de pacientes operados por complicações de ascaridíase biliar num período de cinco anos. RESULTADOS: São descritos quatro casos de ascaridíase biliar complicada em crianças (três pré escolares e um escolar), expressos através de pseudocisto pancreático, icterícia obstrutiva, colangite e múltiplos abscessos hepáticos, todos tratados cirurgicamente. Descre...

  3. Effect of biliary obstruction and internal biliary drainage on hepatic cytochrome P450 isozymes in rats

    Institute of Scientific and Technical Information of China (English)

    Shintaro Fukushima; Hiroyasu Okuno; Nobuyuki Shibatani; Yoshitsugu Nakahashi; Toshihito Seki; Kazuichi Okazaki

    2008-01-01

    AIM: To investigate the total cytochrome P450 (CYP)content, microsomal mixed-function oxidase (MFO)activity, and expression of mRNAs for various CYP isozymes in a simple rat model of reversible obstructive jaundice.METHODS: Obstructive jaundice was created in male rats by causing bile duct obstruction with polyester tape.In another group of rats, bile duct obstruction was followed by internal biliary drainage after releasing the tape.The expression of various CYP isozyme mRNAs was semi-quantitatively assessed by competitive RTPCR.RESULTS: The total CYP content and microsomal MFO activity showed a significant decrease after biliary obstruction, but returned to respective control levels after biliary drainage.A marked reduction in the expression of CYPIA2, 2B1/2, 2Cll, 2E1, 3A1, and 3A2 mRNA was detected during biliary obstruction,while expression increased significantly toward the control level after biliary drainage.Although expression of CYP4A1 mRNA showed no reduction during biliary obstruction, it still increased significantly after biliary drainage.CONCLUSION: These results suggest that not only obstructive jaundice, but also the subsequent internal biliary drainage may affect regulatory medications of the synthesis of individual CYP isozymes differently.

  4. Biliary duct obstruction treatment with aid of percutaneous transhepatic biliary drainage

    Directory of Open Access Journals (Sweden)

    Daniel Knap

    2016-06-01

    Conclusions: PTBD is an effective method of biliary tract decompression and it is an important alternative to endoscopic drainage. This method is indicated in patients with neoplastic obstruction of biliary tract with low expected survival rate and thus is a palliative procedure.

  5. Intra-biliary contrast-enhanced ultrasound for evaluating biliary obstruction during percutaneous transhepatic biliary drainage: A preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Er-jiao [Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630 (China); Zheng, Rong-qin, E-mail: zhengrq@mail.sysu.edu.cn [Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630 (China); Su, Zhong-zhen; Li, Kai; Ren, Jie; Guo, Huan-yi [Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630 (China)

    2012-12-15

    Objectives: The aimed of this study was to investigate the value of intra-biliary contrast-enhanced ultrasound (IB-CEUS) for evaluating biliary obstruction during percutaneous transhepatic biliary drainage (PTBD). Materials and methods: 80 patients with obstructive jaundice who underwent IB-CEUS during PTBD were enrolled. The diluted ultrasound contrast agent was injected via the drainage catheter to perform IB-CEUS. Both conventional ultrasound and IB-CEUS were used to detect the tips of the drainage catheters and to compare the detection rates of the tips. The obstructive level and degree of biliary tract were evaluated by IB-CEUS. Fluoroscopic cholangiography (FC) and computer tomography cholangiography (CTC) were taken as standard reference for comparison. Results: Conventional ultrasound displayed only 43 tips (43/80, 53.8%) of the drainage catheters within the bile ducts while IB-CEUS identified all 80 tips (80/80, 100%) of the drainage catheters including 4 of them out of the bile duct (P < 0.001). IB-CEUS made correct diagnosis in 44 patients with intrahepatic and 36 patients with extrahepatic biliary obstructions. IB-CEUS accurately demonstrated complete obstruction in 56 patients and incomplete obstruction in 21 patients. There were 3 patients with incomplete obstruction misdiagnosed to be complete obstruction by IB-CEUS. The diagnostic accuracy of biliary obstruction degree was 96.3% (77/80). Conclusion: IB-CEUS could improve the visualization of the drainage catheters and evaluate the biliary obstructive level and degree during PTBD. IB-CEUS may be the potential substitute to FC in the PTBD procedure.

  6. Intra-biliary contrast-enhanced ultrasound for evaluating biliary obstruction during percutaneous transhepatic biliary drainage: A preliminary study

    International Nuclear Information System (INIS)

    Objectives: The aimed of this study was to investigate the value of intra-biliary contrast-enhanced ultrasound (IB-CEUS) for evaluating biliary obstruction during percutaneous transhepatic biliary drainage (PTBD). Materials and methods: 80 patients with obstructive jaundice who underwent IB-CEUS during PTBD were enrolled. The diluted ultrasound contrast agent was injected via the drainage catheter to perform IB-CEUS. Both conventional ultrasound and IB-CEUS were used to detect the tips of the drainage catheters and to compare the detection rates of the tips. The obstructive level and degree of biliary tract were evaluated by IB-CEUS. Fluoroscopic cholangiography (FC) and computer tomography cholangiography (CTC) were taken as standard reference for comparison. Results: Conventional ultrasound displayed only 43 tips (43/80, 53.8%) of the drainage catheters within the bile ducts while IB-CEUS identified all 80 tips (80/80, 100%) of the drainage catheters including 4 of them out of the bile duct (P < 0.001). IB-CEUS made correct diagnosis in 44 patients with intrahepatic and 36 patients with extrahepatic biliary obstructions. IB-CEUS accurately demonstrated complete obstruction in 56 patients and incomplete obstruction in 21 patients. There were 3 patients with incomplete obstruction misdiagnosed to be complete obstruction by IB-CEUS. The diagnostic accuracy of biliary obstruction degree was 96.3% (77/80). Conclusion: IB-CEUS could improve the visualization of the drainage catheters and evaluate the biliary obstructive level and degree during PTBD. IB-CEUS may be the potential substitute to FC in the PTBD procedure.

  7. Biliary tree and cholecyst: post surgery imaging

    Energy Technology Data Exchange (ETDEWEB)

    Valek, Vlastimil [Department of Radiology, University Hopistal Brno, Jihlavska 20, 63900 Brno (Czech Republic)]. E-mail: v.valek@fnrbno.cz; Kala, Zdenek [Department of Surgery, University Hospital Brno, Jihlavska 20, 63900 Brno (Czech Republic); Kysela, Petr [Department of Surgery, University Hospital Brno, Jihlavska 20, 63900 Brno (Czech Republic)

    2005-03-01

    Recently, with improvements in surgical techniques there has been a substantial reduction in the incidence of biliary complications of hepatobiliary surgery. Nevertheless, bile duct injuries and other post-cholecystectomy complications are a serious problem and a major cause of morbidity and mortality. Early complications may include bile duct injury caused by mistakenly placed clips, erroneous cutting of bile ducts based on misinterpretation of biliary anatomy, periductal bile leakage that causes edema, fibrosis and secondary stricturing, and ischemia due to injury to the right hepatic artery. Bile duct strictures are the most common of the late complications and can develop a few months or many years after surgery. Early detection and accurate diagnosis have a fundamental importance for the successful treatment of these complications. Therefore, early and meaningful application of the imaging methods immediately after detection of the first symptoms is essential. Peroperative ultrasound and direct iodine contrast application into the biliary tree (operative cholangiography) are highly important for immediate visualization of the complications during surgery. Ultrasound can be used to aid in identification of ductal structures and the cholangiogram should be obtained to document the anatomy. Plain abdominal film could be made in the patients in poor clinical conditions after biliary surgery. Oral cholecystography has largely been replaced by ultrasonography (US) for evaluation of cholelithiasis and complications like post-cholecystectomy fluid collections. The same methodology replaced the conventional intravenous cholangiography. Nowadays computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiography (MRCP) and ultrasound (US) have essential roles as primary imaging modalities after biliary tree and gallbladder surgery in the evaluation of associated complications and residual biliary stones. We review the role

  8. Malignant biliary obstruction treated with metallic stents

    International Nuclear Information System (INIS)

    Purpose: The outcome of 33 patients with malignant biliary obstruction treated with metallic stents is presented. Materials and methods: Thirty-eight biliary metallic stents were placed in 33 patients with malignant biliary obstruction. They were 52-71 years old (mean = 61.7); 23 were male and 10 were female. The biliary obstruction was caused by biliary carcinoma (n = 16), pancreatic carcinoma (n = 2), hepatoma (n = 2), metastasis in liver (n = 3) and lymph node metastasis (n = 10). Six types and 38 metallic stents were used. After stentering, 3 cases were treated with intrastent brachytherapy, 7 cases treated with external radiotherapy and 2 patients treated with interventional radiology. Patients were followed for 6-28 months, mean 11 months. Results: Stent placement was successful in all 33 cases. The same time, 4 patients were treated with plastic tube for external drainage only. The successful rate was 90%. Twenty-nine patients were placed in one time, 4 cases began with plastic tube which was replaced with metallic stents after 1-2 weeks. Nine had metallic stents and plastic tube, because of complicated obstruction. The external drainage catheters were removed after 15-200 days. Three patients had stents crossing the ampulla. In 28 cases (84.85%), jaundice was reduced satisfactorily while in 5 cases with complicated biliary obstruction, the result was unsatisfactory. The median survival was 7 months. After stentering, 12 cases were treated with locat chemotherapy, brachytherapy or radiotherapy. The median survival period was 10 months. Conclusion: The metallic stent provides good palliative drainage and is well tolerated by patients. It improves the survival rate when combined with radiotherapy, brachytherapy and chemotherapy in patients with malignant biliary obstruction

  9. Barium X-ray diagnosis of intestinal ascariasis%肠道蛔虫病的钡造影X线诊断

    Institute of Scientific and Technical Information of China (English)

    洪瑞锋

    2014-01-01

    Objective To study the value of X-ray diagnosis of intestinal ascariasis. Methods 2cases of intestinal ascariasis underwent barium contrast examination. Results of 2 cases of intestinal ascariasis X-ray manifestations have varying degrees of gastrointestinal adverse change, direct sign as intestinal barium insect film. Has the vital significance conclusion X-ray contrast examination in diagnosis of intestinal ascariasis, it can find the cause for direct found ascaris.%目的:探讨肠道蛔虫病的X线诊断价值。方法对2例肠道蛔虫病患者行钡造影检查。结果2例肠道蛔虫病X线表现均有不同程度胃肠功能不良改变,直接征象为肠道内钡虫影。结论 X线造影检查对肠道蛔虫病的诊断具有重要的意义,它可以为直接发现蛔虫找出病因。

  10. Comparative clinical studies of nitazoxanide, albendazole and praziquantel in the treatment of ascariasis, trichuriasis and hymenolepiasis in children from Peru.

    Science.gov (United States)

    Juan, Jave Ortiz; Lopez Chegne, Nicholas; Gargala, Gilles; Favennec, Loic

    2002-01-01

    Three randomized clinical studies were conducted in 2000 to evaluate the efficacy of nitazoxanide paediatric suspension compared to albendazole in the treatment of ascariasis and trichuriasis and praziquantel in the treatment of hymenolepiasis in children from Cajamarca, Peru. Nitazoxanide was administered at a dose of 100 mg (age 1-3 years) or 200 mg (age 4-11 years) twice daily for 3 days, albendazole as a 400-mg single dose and praziquantel as a 25-mg/kg single dose. Post-treatment parasitological examinations were carried out on 3 faecal samples, each collected on a different day between 21 and 30 days following initiation of treatment. Nitazoxanide cured 89% (25/28), 89% (16/18) and 82% (32/39) of the cases of ascariasis, trichuriasis and hymenolepiasis respectively compared with 91% (32/35), 58% (11/19) and 96% (47/49) for the comparator drugs. Each of the drugs produced egg reduction rates in excess of 98%. There were no significant adverse events or abnormalities in haematology or clinical chemistry values or urinalysis. PMID:12055813

  11. Sequential computerized hepatobiliary imaging during percutaneous transhepatic biliary drainage

    Energy Technology Data Exchange (ETDEWEB)

    Falchero, F.; Valentini, M.; Ciambellotti, E.; Becchi, G.

    1985-04-01

    Sequential computerized hepatobiliary imaging was performed in 11 jaundiced patients before, during, and after biliary decompression. The rates of plasma clearances and radionuclide accumulation in liver cells and biliary tree were calculated, in addition to the uptake and retention index.

  12. Sequential computerized hepatobiliary imaging during percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Sequential computerized hepatobiliary imaging was performed in 11 jaundiced patients before, during, and after biliary decompression. The rates of plasma clearances and radionuclide accumulation in liver cells and biliary tree were calculated, in addition to the uptake and retention index

  13. Ursodeoxycholic acid for patients with primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Gong, Yan; Huang, Zhibi; Christensen, Erik; Gluud, Christian

    2007-01-01

    Ursodeoxycholic acid (UDCA) is used for primary biliary cirrhosis (PBC), but the beneficial effects remain controversial.......Ursodeoxycholic acid (UDCA) is used for primary biliary cirrhosis (PBC), but the beneficial effects remain controversial....

  14. GWAS in Primary Biliary Cirrhosis

    Science.gov (United States)

    Gulamhusein, Aliya F.; Juran, Brian D.

    2015-01-01

    Genome wide association studies (GWAS) have been a significant technological advance in our ability to evaluate the genetic architecture of complex diseases such as Primary Biliary Cirrhosis (PBC). To date, six large-scale studies have been performed which identified 27 non-HLA risk loci associated with PBC. The identified risk variants emphasize important disease concepts; namely, that disturbances in immunoregulatory pathways are important in the pathogenesis of PBC and that such perturbations are shared among a diverse number of autoimmune diseases – suggesting the risk architecture may confer a generalized propensity to autoimmunity not necessarily specific to PBC. Furthermore, the impact of non-HLA risk variants, particularly in genes involved with IL-12 signaling, and ethnic variation in conferring susceptibility to PBC have been highlighted. While GWAS have been a critical stepping-stone in understanding common genetic variation contributing to PBC, limitations pertaining to power, sample availability, and strong linkage disequilibrium across genes have left us with an incomplete understanding of the genetic underpinnings of disease pathogenesis. Future efforts to gain insight into this missing heritability, the genetic variation that contributes to important disease outcomes and the functional consequences of associated variants will be critical if practical clinical translation is to be realized. PMID:26676814

  15. Management issues in post living donor liver transplant biliary strictures

    OpenAIRE

    Wadhawan, Manav; Kumar, Ajay

    2016-01-01

    Biliary complications are common after living donor liver transplant (LDLT) although with advancements in surgical understanding and techniques, the incidence is decreasing. Biliary strictures are more common than leaks. Endoscopic retrograde cholangiopancreatography (ERCP) is the first line modality of treatment of post LDLT biliary strictures with a technical success rate of 75%-80%. Most of ERCP failures are successfully treated by percutaneous transhepatic biliary drainage (PTBD) and rend...

  16. Magnetic resonance cholangiography: comparison of two- and three-dimensional sequences for assessment of malignant biliary obstruction

    International Nuclear Information System (INIS)

    The purpose was to retrospectively compare two-dimensional (2D) magnetic resonance cholangiography (MRC) including breath-hold single-shot rapid acquisition with relaxation enhancement (RARE) and multislice half-Fourier RARE versus navigator-triggered 3D-RARE MRC in the evaluation of biliary malignancy. MRC findings were evaluated in 31 patients with malignant biliary obstruction, including biliary malignancy, gallbladder carcinoma, and ampullary cancer. Two observers independently reviewed the images to assess the overall image quality, artifacts, ductal conspicuity, extent of disease, diagnostic confidence of tumor extent, and origin of tumor. The results were compared with surgical and histopathologic findings. Studies obtained with 3D-MRC were of significantly higher technical quality than those obtained with 2D-MRC. However, the accuracy between two sequences for classification of tumor showed no statistical significance. There was no significant difference between the Az values of 2D- and 3D-MRC for overall tumor extent in bilateral second order branch, intrapancreatic common bile duct (CBD) involvement (Az = 0.889, 0.881 for 2D and Az = 0.903, 0.864 for 3D). Nor was there a significant difference between two sequences in the assessment of the origin of tumor. Although 3D-MRC has superior image quality over 2D-MRC, 3D-MRC showed no statistically significant difference in accuracy compared with 2D-MRC for evaluating the extent of disease in malignant biliary obstructions. (orig.)

  17. Magnetic resonance cholangiography: comparison of two- and three-dimensional sequences for assessment of malignant biliary obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin-Young [Yonsei University College of Medicine, Department of Diagnostic Radiology, Seoul (Korea); Yonsei University College of Medicine, Research Institute of Radiological Science, Seoul (Korea); Yonsei University College of Medicine, Institute of Gastroenterology, Seoul (Korea); Seoul National University Hospital, Department of Radiology, Seoul (Korea); Seoul National University Hospital, Institute of Radiation Medicine, Seoul (Korea); Kim, Myeong-Jin [Yonsei University College of Medicine, Department of Diagnostic Radiology, Seoul (Korea); Yonsei University College of Medicine, Brain Korea 21 Project for Medical Science, Seoul (Korea); Yonsei University College of Medicine, Research Institute of Radiological Science, Seoul (Korea); Yonsei University College of Medicine, Institute of Gastroenterology, Seoul (Korea); Lee, Jeong Min; Lee, Jae Young; Kim, Se Hyung; Han, Joon Koo; Choi, Byung Ihn [Seoul National University Hospital, Department of Radiology, Seoul (Korea); Seoul National University Hospital, Institute of Radiation Medicine, Seoul (Korea); Kim, Ki Whang [Yonsei University College of Medicine, Department of Diagnostic Radiology, Seoul (Korea); Yonsei University College of Medicine, Research Institute of Radiological Science, Seoul (Korea)

    2008-01-15

    The purpose was to retrospectively compare two-dimensional (2D) magnetic resonance cholangiography (MRC) including breath-hold single-shot rapid acquisition with relaxation enhancement (RARE) and multislice half-Fourier RARE versus navigator-triggered 3D-RARE MRC in the evaluation of biliary malignancy. MRC findings were evaluated in 31 patients with malignant biliary obstruction, including biliary malignancy, gallbladder carcinoma, and ampullary cancer. Two observers independently reviewed the images to assess the overall image quality, artifacts, ductal conspicuity, extent of disease, diagnostic confidence of tumor extent, and origin of tumor. The results were compared with surgical and histopathologic findings. Studies obtained with 3D-MRC were of significantly higher technical quality than those obtained with 2D-MRC. However, the accuracy between two sequences for classification of tumor showed no statistical significance. There was no significant difference between the Az values of 2D- and 3D-MRC for overall tumor extent in bilateral second order branch, intrapancreatic common bile duct (CBD) involvement (Az = 0.889, 0.881 for 2D and Az = 0.903, 0.864 for 3D). Nor was there a significant difference between two sequences in the assessment of the origin of tumor. Although 3D-MRC has superior image quality over 2D-MRC, 3D-MRC showed no statistically significant difference in accuracy compared with 2D-MRC for evaluating the extent of disease in malignant biliary obstructions. (orig.)

  18. Biliary Atresia - Translational Research on Key Molecular Processes Regulating Biliary Injury and Obstruction

    Directory of Open Access Journals (Sweden)

    Jorge A. Bezerra

    2006-06-01

    Full Text Available Biliary atresia is the most common cause of pathologic jaundice in young infants andresults from the obstruction of the extrahepatic bile ducts by an inflammatory and fibroobliterativeprocess. Although the pathogenesis of the disease is multifactorial, recentpatient- and animal-based studies began deciphering the molecular pathways involved in biliaryinjury and duct obstruction. Using large-scale genomics and immunostaining of liversfrom children with biliary atresia, investigators have discovered unique molecular signaturesof dominant proinflammatory cytokines at the time of diagnosis. To study hypotheses generatedfrom these patient-based studies, the anatomical and inflammatory profiles of a mousemodel of rotavirus-induced biliary atresia were analyzed and found to share striking similaritieswith the human profiles. Then, using these mice in mechanistic studies, interferongamma(IFNγ has been shown to regulate the biliary tropism of lymphocytes to the biliarysystem, and to play a critical role in the inflammatory obstruction of extrahepatic bile ducts.The ability to combine human studies with a laboratory model of neonatal biliary injury andobstruction opens a new era of opportunities to advance the field of biliary atresia, and todevelop new therapeutic strategies to improve long-term outcome with the native liver ofchildren with biliary atresia.

  19. Histopathology reconstruction on digital imagery

    Science.gov (United States)

    Li, Wenjing; Lieberman, Rich W.; Nie, Sixiang; Xie, Yihua; Eldred, Michael; Oyama, Jody

    2009-02-01

    Diagnosing cervical cancer in a woman is a multi-step procedure involving examination of the cervix, possible biopsy and follow-up. It is open to subjective interpretation and highly dependent upon the skills of cytologists, colposcopists, and pathologists. In an effort to reduce the subjectiveness of the colposcopist-directed biopsy and to improve the diagnostic accuracy of colposcopy, we have developed new colposcopic imaging systems with accompanying computer aided diagnostic (CAD) techniques to guide a colposcopist in deciding if and where to biopsy. If the biopsy's histopathology, the identification of the disease state at the cellular and near-cellular level, is to be used as the gold standard for CAD, then the location of the histopathologic analysis must match exactly to the location of the biopsy tissue in the digital image. Otherwise, no matter how perfect the histopathology and the quality of the digital imagery, the two data sets cannot be matched and the true sensitivity and specificity of the CAD cannot be ascertained. We report here on new approaches to preserving, continuously, the location and orientation of a biopsy sample with respect to its location in the digital image of the cervix so as to preserve the exact spatial relationship throughout the mechanical aspects of the histopathologic analysis. This new approach will allow CAD to produce a linear diagnosis and pinpoint the location of the tissue under examination.

  20. Congenital biliary atresia: liver injury begins at birth

    DEFF Research Database (Denmark)

    Makin, Erica; Quaglia, Alberto; Kvist, Nina;

    2009-01-01

    BACKGROUND: The timing of onset of liver injury in biliary atresia (BA) is not known, although in approximately 10% of cases, biliary pathologic condition associated with the biliary atresia splenic malformation syndrome must begin well before birth. METHODS: The study involved retrospective case...

  1. Viral infections of the biliary tract

    Directory of Open Access Journals (Sweden)

    Gupta Ekta

    2008-01-01

    Full Text Available Bacterial infections of the biliary tract are often considered to be an important cause of acute cholangitis. Viral infections of the biliary tract however, are very often mistaken as viral hepatitis. This article highlights various viral causes of common biliary tract infections. Viral cholangitis is both less common and less discussed than viral hepatitis. Hepatotropic viruses (A, B, C, and E are generally regarded as hepatocellular pathogens, yet cholangitic manifestations are now well described in association with these diseases. Systemic viral diseases also lead to cholangitis in varying proportion to hepatitis. Human immunodeficiency virus is associated with protean hepatic complications, including cholangitis due to several causes. Other systemic viruses, most notably those of the herpes virus family, also cause hepatic disease including cholangitis and possibly ductopenia in both immunocompromised and immunocompetent patients.

  2. Contemporary Management of Acute Biliary Pancreatitis

    Directory of Open Access Journals (Sweden)

    Orhan Ozkan

    2014-03-01

    Full Text Available Acute biliary pancreatitis is one of the major causes of acute pancreatitis.Gallstones, biliary sludge and microlithiasis, especially in pancreatitis without detectable reason, can be the cause of acute pancreatitis. Acute biliary pancreatitis has many controversions in the literature, and its classification and guidelines are being updated very frequently. Atlanta classifications which determine the definitions and guidelines about acute pancreatitis were renewed and published in 2013. It has various clinical aspects, ranging from a mild form which is easily treated, to a severe form that causes complications leading to mortality. The pathogenesis of this disease has not been fully elucidated and several theories have been suggested. New scoring systems and laboratory methods such as proteomics have been suggested for both diagnosis and to predict disease severity, and research on these topics is still in progress. Novel therapeutic approaches with technological developments such as ERCP, ES, MRCP, and EUS are also suggested.

  3. Broncho-biliary fistula secondary to biliary obstruction and lung abscess in a patient with pancreatic neuro-endocrine tumor

    Directory of Open Access Journals (Sweden)

    Dipanjan Panda

    2016-06-01

    Full Text Available We present a case report of broncho-biliary fistula that developed due to the blockage of biliary stent placed during the management of pancreatic neuroendocrine tumor (pNET; diagnosed on high clinical suspicion, percutaneous cholangiogram and contrast enhanced computed tomography (CECT; and successfully treated with percutaneous transhepatic biliary drainage (PTBD.

  4. Broncho-biliary fistula secondary to biliary obstruction and lung abscess in a patient with pancreatic neuro-endocrine tumor

    OpenAIRE

    Dipanjan Panda; Mayank Aggarwal; Vikas Yadav; Sachin Kumar; Amar Mukund; Saphalta Baghmar

    2016-01-01

    We present a case report of broncho-biliary fistula that developed due to the blockage of biliary stent placed during the management of pancreatic neuroendocrine tumor (pNET); diagnosed on high clinical suspicion, percutaneous cholangiogram and contrast enhanced computed tomography (CECT); and successfully treated with percutaneous transhepatic biliary drainage (PTBD).

  5. Broncho-biliary fistula secondary to biliary obstruction and lung abscess in a patient with pancreatic neuro-endocrine tumor.

    Science.gov (United States)

    Panda, Dipanjan; Aggarwal, Mayank; Yadav, Vikas; Kumar, Sachin; Mukund, Amar; Baghmar, Saphalta

    2016-06-01

    We present a case report of broncho-biliary fistula that developed due to the blockage of biliary stent placed during the management of pancreatic neuroendocrine tumor (pNET); diagnosed on high clinical suspicion, percutaneous cholangiogram and contrast enhanced computed tomography (CECT); and successfully treated with percutaneous transhepatic biliary drainage (PTBD). PMID:26994644

  6. Biliary cysts: Etiology, diagnosis and management

    Institute of Scientific and Technical Information of China (English)

    Beata Jablo(n)ska

    2012-01-01

    Biliary cysts (BC) are rare dilatations of different parts of a biliary tract.They account for approximately 1% of all benign biliary diseases.BC occur the most frequently in Asian and female populations.They are an important problem for pediatricians,gastroenterologists,radiologists and surgeons.Clinical presentation and management depend on the BC type.Cholangiocarcinoma is the most serious and dangerous BC complication.The other complications associated with BC involve cholelithiasis and hepatolithiasis,cholangitis,acute and chronic pancreatitis,portal hypertension,liver fibrosis and secondary liver cirrhosis and spontaneous cyst perforation.Different BC classifications have been described in the literature.Todani classification dividing BC into five types is the most useful in clinical practice.The early diagnosis and proper treatment are very important,because BC are associated with a risk of carcinogenesis.A malignancy risk increases with the age.Radiological investigations (ultrasonography,computed tomography,endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography) play an important role in BC diagnostics.Currently,prenatal diagnosis using ultrasonography is possible.It allows to differentiate biliary disorders in fetals and to perform the early surgical treatment that improves results.In most patients,total cyst excision with Roux-Y hepaticojejunostomy is the treatment of choice.Surgical treatment of BC is associated with high success rate and low morbidity and mortality.The early treatment is associated with a lower number of complications.Patients following BC surgery require permanent and careful postoperative observation using laboratory and imaging investigations because of possibility of biliary anastomosis stricture and biliary cancer in tissue remnant.

  7. Intestinal obstruction in children due to Ascariasis: A tertiary health centre experience

    Directory of Open Access Journals (Sweden)

    Mishra P

    2008-01-01

    Full Text Available Background: Ascariasis is the infestation by the largest intestinal nematode of man, a common problem in the tropics attributed to poor hygienic and low socioeconomic conditions. The aim of this research is to analyse the presentation, diagnosis and management of bowel obstruction caused by Ascaris lumbricoides, with special emphasis on the role of conservative management. Materials and Methods: This is a single centre, two consultant based 5 year retrospective study of childhood intestinal obstruction due to worms. Diagnosis in the suspected patients was based on history of passage of worms per mouth or rectum and on x-ray and ultrasonography findings. Only the patients of intestinal obstruction with documented evidence of roundworm infestation were included in the study and were followed for one year. Results: One hundred and three children with intestinal obstruction due to Ascaris lumbricoides were treated in the past five years at our centre. Abdominal pain was the most common presentation seen in 96 children followed by vomiting in 77 children. 20 children had history of vomiting worms and another 43 had history of passing worms in stool. Abdominal tenderness was present in 50 children, 48 had abdominal distension of varying degree, 50 had abdominal mass due to worm bolus, and 16 had or developed abdominal guarding or rigidity. All the children were managed as for acute intestinal obstruction along with hypertonic saline enema. The aim of management was "to starve the worm and hydrate the patient". 87 patients (84.47% responded favourably and were relieved of the obstruction by the conservative management, 16 children (15.53% had abdominal guarding or rigidity and underwent emergency exploration. Conclusion: Roundworm obstruction should be considered in the differential diagnoses of all cases of intestinal obstruction in children. Clinical history and examination along with X-ray and ultrasonography are very helpful for diagnosis of this

  8. Acute biliary pancreatitis: Diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Hazem Zakaria

    2009-01-01

    Full Text Available Gallstones are the commonest cause of acute pancreatitis (AP, a potentially life-threatening condition, worldwide. The pathogenesis of acute pancreatitis has not been fully understood. Laboratory and radiological investigations are critical for diagnosis as well prognosis prediction. Scoring systems based on radiological findings and serologic inflammatory markers have been proposed as better predictors of disease severity. Early endoscopic retrograde cholangiopancreatography (ERCP is beneficial in a group of patients with gallstone pancreatitis. Laparoscopic cholecystectomy with preoperative endoscopic common bile duct clearance is recommended as a treatment of choice for acute biliary pancreatitis. The timing of cholecystectomy, following ERCP, for biliary pancreatitis can vary markedly depending on the severity of pancreatitis

  9. Biliary scintigraphy in neonatal cytomegalovirus cholestasis

    International Nuclear Information System (INIS)

    Diagnostic value of hepatobiliary scintigraphy using mebrofenin-Te-99m was assessed in three newborns with cytomegalovirus (CMV) hepatitis and one baby with hepatitis B jaundice. All cases were affected by persistent jaundice with predominately conjugated bilirubin, alcoholic stools, anemia. One of this newborns (case number 1) was suspected of having biliary atresia due to the absence of intestinal excretion of the tracer. After three weeks intestinal passage was seen in scintiscan late after 24 h. Hepatobiliary scintigraphy represents a non-invasive diagnostic procedure which enables the detection of permeability of the biliary tract. (Author)

  10. CT diagnosis of biliary tract diseases

    Energy Technology Data Exchange (ETDEWEB)

    Sobota, J.; Horak, J.; Antos, Z.; Vodak, M. (Ustredni Vojenska Nemocnice, Prague (Czechoslovakia))

    1983-09-01

    The possibilities are discussed offered by computed tomography in the diagnosis of biliary tract diseases. Attention is paid to difficulties associated with the diagnosis of pathological changes in the biliary tract, and to the detection of isodense concrements where diagnostic problems are reliably resolved by PTHC and ERCP. It is therefore useful to supplement CT with other examination methods. A suitable combination is cholescintigraphy and CT with the possibility of a final diagnosis or selection of further examination, as a rule of an invasive nature.

  11. CT diagnosis of biliary tract diseases

    International Nuclear Information System (INIS)

    The possibilities are discussed offered by computed tomography in the diagnosis of biliary tract diseases. Attention is paid to difficulties associated with the diagnosis of pathological changes in the biliary tract, and to the detection of isodense concrements where diagnostic problems are reliably resolved by PTHC and ERCP. It is therefore useful to supplement CT with other examination methods. A suitable combination is cholescintigraphy and CT with the possibility of a final diagnosis or selection of further examination, as a rule of an invasive nature. (author)

  12. Diagnosis of liver, biliary tract and gastrointestine

    International Nuclear Information System (INIS)

    The role of RI imaging in the diagnosis of lesions of the liver, biliary tracts and gastrointestinal tracts are reviewed, and representative cases are shown. Liver scintigraphy was of value for the diagnosis of lesions limitted to the liver such as primary and metastatic liver cancer and inflammatory liver diseases. However, RI methods were less useful in the diagnosis of lesions of the biliary tracts and stomach. RI scintigraphy was more sensitive than angiography in the detection of Meckel's deverticulum, Ballet's esophagus, and gastrointestinal hemorrhage. (Tsunoda, M.)

  13. PERCUTAENOUS BILIARY DRAINAGE IN MALIGNANT OBSTRUCTIVE JAUNDICE

    Directory of Open Access Journals (Sweden)

    V. Fotea

    2008-10-01

    Full Text Available In patients with malignant obstructive jaundice for whom surgery is not indicated the treatment of choice is palliative biliary drainage either endoscopic or percutaneous. We present our experience with percutaneous drainage. Although percutaneous placement of an endoprosthesis is preferred, the patients are seldom candidates for such a procedure because of locally advanced disease, and even when successful survival is not significantly affected but merely the patients’ quality of life. For this patients internal-external catheter drainage or external biliary drainage might still be of help provided that a proper care and periodical catheter change is ensured.

  14. Extrahepatic biliary cystadenoma with mesenchymal stroma: a true biliary cystadenoma? A case report.

    LENUS (Irish Health Repository)

    Hennessey, Derek B

    2012-02-01

    Biliary cystadenomas are benign but potentially malignant cystic neoplasms, which classically contain mesenchymal stroma similar to ovarian tissue. We report a case of an extra-hepatic biliary cystadenoma with mesenchymal stroma along with a discussion of current pathological opinion. CASE PRESENTATION: A 54-year-old female presented with abdominal pain, abnormal liver function tests and a mass on ultrasound. Computerized Tomography identified a complex multi-locular cyst in the common hepatic duct. Radical excision of the lesion and a Roux-en-Y loop bilio-enteric anastomosis was performed. Histology confirmed the presence of a benign biliary cystadenoma with ovarian type stroma. CONCLUSION: Biliary cystadenomas classically contain mesenchymal stroma similar to ovarian tissue. It now appears that cystadenomas without mesenchymal stroma appear to be more akin to similar cystic lesions of the pancreas, and may represent a dissimilar neoplasm. Therefore, malignant transformation can occur, so complete excision is recommended.

  15. Biliary metal stents are superior to plastic stents for preoperative biliary decompression in pancreatic cancer

    OpenAIRE

    Decker, Christopher; Christein, John D.; Phadnis, Milind A.; Mel Wilcox, C.; Varadarajulu, Shyam

    2011-01-01

    Background It is unclear whether plastic or metal stents are more suitable for preoperative biliary decompression in pancreatic cancer. The objective of this study was to compare the rate of endoscopic reinterventions in patients with pancreatic cancer undergoing plastic or self-expandable metal stent (SEMS) placements for preoperative biliary decompression. Methods This was a retrospective study of all patients with obstructive jaundice secondary to pancreatic head cancer who underwent their...

  16. Considerations Regarding Biliary-digestive Bypasses in Benign and Malignant Diseases of the Biliary- Pancreatic Confluence

    OpenAIRE

    Horațiu Flaviu Coman; Cornel Iancu; Octavian Andercou; Bogdan Stancu; Aurel Andercou

    2014-01-01

    Introduction. The usual indication for a biliary-digestive bypass is the obstruction by a benign or a malignant stricture which can occur at the biliary- pancreatic confluence. Benign strictures mostly occur in the distal bile duct as a result of stones or chronic pancreatitis. Malignant obstructions involve mostly the distal end as a result of a ductal adenocarcinoma of the head of the pancreas, the ampulla of Vater and cholangiocarcinoma and can be virtually impossible to distinguish from e...

  17. Interventional radiology in the management of benign biliary stenoses, biliary leaks and fistulas: a pictorial review

    OpenAIRE

    Krokidis, Miltiadis; Orgera, Gianluigi; Rossi, Michele; Matteoli, Marco; Hatzidakis, Adam

    2012-01-01

    Background Benign biliary postoperative stenoses and biliary leaks and fistulas usually occur due to injury after laparoscopic cholecystectomy, gastric or hepatic resection, bilio-enteric anastomoses and after liver transplantation. In most of the cases a new surgical intervention is not possible and the percutaneous trans-hepatic approach is of paramount importance in the diagnosis and treatment of the problem. This review aims to highlight the spectrum of percutaneous cholangiographic findi...

  18. Biliary duct obstruction treatment with aid of percutaneous transhepatic biliary drainage

    OpenAIRE

    Daniel Knap; Natalia Orlecka; Renata Judka; Aleksandra Juza; Michał Drabek; Maciej Honkowicz; Tomasz Kirmes; Bartosz Kadłubicki; Dominik Sieroń; Jan Baron

    2016-01-01

    Introduction: Percutaneous Transhepatic Biliary Drainage (PTBD) is a procedure indicated in patients with non-operative lesions, when endoscopic application of prosthesis is impossible due to anatomic reasons, complications or severe general condition of patient. Most often it is a palliative procedure, aiming for live-quality improvement, although not altering prognosis of basic disease. Aim: This study presents own experience in biliary drainage with the aid of percutaneous transhepatic ...

  19. Incidental detection of ascariasis worms on USG in a protein energy malnourished (PEM) child with abdominal pain.

    Science.gov (United States)

    Suthar, Pokhraj Prakashchandra; Doshi, Rajkumar Prakashbhai; Mehta, Chetan; Vadera, Khyati P

    2015-01-01

    A 10-year-old child presented with dull aching periumbilical abdominal pain for 15 days. The child was not gaining weight despite a good appetite. Physical examination of the child revealed grade-I protein energy malnourishment (PEM) according to IAP (Indian Academic of Paediatrics) classification. The rest of the systemic examination was normal. Routine blood investigation revealed anaemia with eosinophilia. Abdominal ultrasonography did not show any abnormality with curvilinear transducer (3.5-5 MHz), however, linear ultrasound transducer (7.5-12 MHz) with harmonic tissue imaging showed worms in the lumen of the small intestine with curling movement on real time scanning. Stool examination for the eggs of ascariasis was positive. The patient was treated with antihelminthic drugs. Dietary modification for the PEM was advised. After 3 months of treatment, the patient improved and stool examination for Ascaris was negative on follow-up. PMID:25766437

  20. Radiological biliary tract diagnosis after cholecystectomy

    Energy Technology Data Exchange (ETDEWEB)

    Schindler, G.; Kueper, K.

    1982-01-01

    Fifty-three patients with biliary symptoms were studied at least four years after cholecystectomy by isotope techniques. There was a highly significant correlation between symptoms and disturbances of bile flow, such as dyskinesia or obstruction. There was no correlation with serum enzyme levels such as gamma-GT, alkaline phosphatase, bilirubin or transaminases. Measurements of the diameter of the bile duct on cholangiograms provided no evidence of obstruction up to 15 mm, although a diameter in excess of 10 mm. made obstruction likely. The upper value for 'normal' bile flow derived from hilar flow curves of patients without dyskinesia showed a half value period of 27.5 minutes. The disturbances of flow demonstrated by isotope methods in the presence of typical symptoms, and without other pathological findings, indicate a pre-clinical stage of a partly compensated biliodynamic insufficiency. Where there is no morphological evidence of biliary obstruction, one must assume inflammatory changes round the papilla of Vater; these are frequent even in normal biliary tracts and almost always present after cholecystectomy. Quantitative hepato-biliary scintigraphy is the most reliable method for objective measurement of disturbances of bile flow and make it possible to avoid the vague diagnosis of 'postcholecystectomy syndrome'.

  1. Surgical treatment of congenital biliary duct cyst

    Directory of Open Access Journals (Sweden)

    Wang De-chun

    2012-03-01

    Full Text Available Abstract Background It is acknowledged that total cyst excision is a safe and ideal surgical treatment for congenital biliary duct cyst, compared to simple internal drainage. The aim of this study was to determine the optimal operation occasion and the effect of laparoscopy on congenital biliary duct cyst based upon total cyst excision. Methods From January 2002 to January 2011, 217 patients were admitted to Southwest Hospital for congenital biliary duct cyst. To determine the optimal surgery occasion, we divided these subjects into three groups, the infant group (age ≤ 3 years, the immaturity group (3 18 years, and then evaluated the feasibility, risk and long-term outcome after surgery in the three groups. To analyze the effect of laparoscopic technique on congenital biliary duct cyst, we divided the patients into the laparoscopy and the open surgery groups. Results Among the three groups, the morbidity from cholangiolithiasis before surgical treatment had obvious discrepancy (p 0.05. Similarly, no significant discrepancy was observed in the morbidity from postoperative complications or long-term postoperative complications (p > 0.05 between the laparoscopic and the open surgery groups. Conclusions We conclude that total cyst excision should be performed as early as possible. The optimal treatment occasion is the infant period, and laparoscopic resection may be a new safe and feasible minimally invasive surgery for this disease.

  2. Extrahepatic biliary obstruction; postoperative morbidity and mortality

    International Nuclear Information System (INIS)

    The objectives of this study are to evaluate the surgical management, both definitive and palliative, in selected patients with biliary obstruction and to find out the postoperative morbidity and mortality in these patients. Duration of the study is two years conducted from June 2002 to May 2004. The study was carried out at. the surgical. unit 4 of the Combined Military Hospital and surgical department of the Military Hospital. Thirty eight cases of biliary obstruction were included. A convenient sampling technique was followed. Data analyzed by using SPSS version 10.0 for windows on computer. Descriptive statistics like frequency, percentage, average etc were computed for data presentation. Any inferential test-was not found to be applicable for this descriptive type case series. We selected 38 patients with features of extrahepatic biliary obstruction. Out of these (n 38) 15 patients (39.5%) suffered from benign diseases while those having malignant diseases were 23 (60.5%). 19 (50%) patients died within two years of follow up while 19 (50%) were the survivors. Mortality was maximum for the malignant cases. In benign cases only one patient died. Maximum deaths 6 (31.6%) occurred in the period of up to one month of operation. 20 patients had one or another complication of operation and hence the morbidity came out to be 52%. According to our results the mortality and morbidity related to extrahepatic biliary obstruction in our patients was higher compared to other studies which can only be reduced by early detection and treatment. (author)

  3. Targeted Therapy for Biliary Tract Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Furuse, Junji, E-mail: jfuruse@ks.kyorin-u.ac.jp [Department of Internal Medicine, Medical Oncology, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611 (Japan); Okusaka, Takuji [Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 (Japan)

    2011-05-03

    It is necessary to establish effective chemotherapy to improve the survival of patients with biliary tract cancer, because most of these patients are unsuitable candidates for surgery, and even patients undergoing curative surgery often have recurrence. Recently, the combination of cisplatin plus gemcitabine was reported to show survival benefits over gemcitabine alone in randomized clinical trials conducted in the United Kingdom and Japan. Thus, the combination of cisplatin plus gemcitabine is now recognized as the standard therapy for unresectable biliary tract cancer. One of the next issues that need to be addressed is whether molecular targeted agents might also be effective against biliary tract cancer. Although some targeted agents have been investigated as monotherapy for first-line chemotherapy, none were found to exert satisfactory efficacy. On the other hand, monoclonal antibodies such as bevacizumab and cetuximab have also been investigated in combination with a gemcitabine-based regimen and have been demonstrated to show promising activity. Furthermore, clinical trials using new targeted agents for biliary tract cancer are also proposed. This cancer is a relatively rare and heterogeneous tumor consisting of cholangiocarcinoma and gallbladder carcinoma. Therefore, a large randomized clinical trial is necessary to confirm the efficacy of chemotherapy, and international collaboration is important.

  4. IDUS for Biliary and Pancreatic Duct Lesions

    Institute of Scientific and Technical Information of China (English)

    Takao ltoi

    2008-01-01

    @@ In the recent decade, wire-guided intraductal US(IDUS), which can be passed through the working channel of standard duodenoscopes to provide high-frequency ultrasound images, has been developed as a newly diagnostic tool for biliary and pancreatic duct lesions.

  5. Fibrate treatment for primary biliary cirrhosis

    NARCIS (Netherlands)

    Cuperus, F.J.C.; Halilbasic, E.; Trauner, M.

    2014-01-01

    PURPOSE OF REVIEW: Primary biliary cirrhosis (PBC) can lead to end-stage liver disease and death. Ursodeoxycholic acid (UDCA) treatment can normalize serum liver enzymes in PBC, and such UDCA-responsive patients have a similar life expectancy as age and sex-matched controls. Nearly up to 50% of the

  6. The results of percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Significant reduction in serum bilirubin levels was obtained in 90.7% of 75 patients on whom percutaneous transhepatic biliary drainage had been carried out, either immediately before operation or as a prolonged palliative procedure. The technical requirements, complications, mortality rate and length of stay in hospital are less than following palliative surgery. (orig.)

  7. Results of percutaneous transhepatic biliary drainage

    Energy Technology Data Exchange (ETDEWEB)

    Lackner, K.; Steudel, A.; Baeuerle, R.; Engel, C.; Schneider, B.

    1985-06-01

    Significant reduction in serum bilirubin levels was obtained in 90.7% of 75 patients on whom percutaneous transhepatic biliary drainage had been carried out, either immediately before operation or as a prolonged palliative procedure. The technical requirements, complications, mortality rate and length of stay in hospital are less than following palliative surgery.

  8. Targeted Therapy for Biliary Tract Cancer

    International Nuclear Information System (INIS)

    It is necessary to establish effective chemotherapy to improve the survival of patients with biliary tract cancer, because most of these patients are unsuitable candidates for surgery, and even patients undergoing curative surgery often have recurrence. Recently, the combination of cisplatin plus gemcitabine was reported to show survival benefits over gemcitabine alone in randomized clinical trials conducted in the United Kingdom and Japan. Thus, the combination of cisplatin plus gemcitabine is now recognized as the standard therapy for unresectable biliary tract cancer. One of the next issues that need to be addressed is whether molecular targeted agents might also be effective against biliary tract cancer. Although some targeted agents have been investigated as monotherapy for first-line chemotherapy, none were found to exert satisfactory efficacy. On the other hand, monoclonal antibodies such as bevacizumab and cetuximab have also been investigated in combination with a gemcitabine-based regimen and have been demonstrated to show promising activity. Furthermore, clinical trials using new targeted agents for biliary tract cancer are also proposed. This cancer is a relatively rare and heterogeneous tumor consisting of cholangiocarcinoma and gallbladder carcinoma. Therefore, a large randomized clinical trial is necessary to confirm the efficacy of chemotherapy, and international collaboration is important

  9. Linear 125I seeds strand implantation combined with biliary stenting for the treatment of malignant biliary obstruction

    International Nuclear Information System (INIS)

    Objective: To evaluate the therapeutic efficacy of linear 125I seeds strand implantation combined with biliary stenting in treating malignant biliary obstruction. Methods: Linear 125I seeds strand implantation combined with biliary stenting was carried out in 28 patients with malignant biliary obstruction. The technical success rate, the clinical efficacy, the postoperative complications and the survival rate were analyzed. Results: Both biliary stenting and 125I seeds strand implantation were successfully accomplished in all patients. No serious complications occurred. After the procedure the biliary obstruction symptoms were markedly improved and the bilirubin level was significantly reduced (P125I seeds strand implantation together with biliary stenting is safe and effective although its long-term efficacy needs to be further studied. (authors)

  10. Biliary leaks after laparoscopic cholecystectomy:timetostentortimetodrain

    Institute of Scientific and Technical Information of China (English)

    Haim Pinkas; Patrick G. Brady

    2008-01-01

    BACKGROUND: Endoscopic retrograde cholangiopan-creatography (ERCP) with placement of a biliary stent or nasobiliary (NB) drain is the procedure of choice for treatment of post-cholecystectomy bile duct leaks. The aim of this study was to compare the effect of NB drainage versus internal biliary stenting on rates of leak closure, time elapsed until drain or stent removal, length of hospital stay and number of required endoscopic procedures. METHODS: Charts were reviewed on 20 patients who underwent laparoscopic cholecystectomy complicated by Luschka or cystic duct leak. Ten patients were treated with NB drains connected to low intermittent suction and repeat NB cholangiograms were performed until leak closure was observed. Ten patients were treated with internal biliary stents. Biliary sphincterotomies were performed for stone extraction or a presumed papillary stenosis. Large bilomas were drained percutaneously prior to stenting. RESULTS: In all 20 patients, a cholangiogram and successful placement of a NB drain or internal stent was achieved. Four patients (20%) were found to have bile duct stones, which were extracted following a sphincterotomy. Sixteen patients required percutaneous drains to evacuate large bilomas prior to biliary instrumentation. Fifteen cystic duct leaks and 5 Luschka duct leaks were reviewed. There were no complications related to ERCP. Closure of the leak was documented within 2 to 11 days (mean 4.7±0.9 days) in patients receiving a NB drain. The drains were removed non-endoscopically following leak closure. The internal stent group required stenting for 14 to 53 days (mean 29.1±4.4 days). The stent was then removed endoscopically after documentation of leak closure. Bile leaks following laparoscopic cholecystectomy closed rapidly after NB drainage and did not require repeat endoscopy for removal of the NB drain, resulting in fewer ERCPs required for treatment of biliary leaks. Internal biliary stents were in place longer owing

  11. Percutaneous transhepatic biliary drainage in 107 patients

    International Nuclear Information System (INIS)

    Percutaneous transhepatic biliary drainage has played a major role in treatment of patients of patients with biliary tract disease, especially obstruction by malignant disease. Percutaneous transhepatic biliary drainage was performed 128 times in 107 patients of obstructive jaundice for recent 2 years and 8 months from July, 1981 to March, 1984 at department of radiology, Seoul National University Hospital. The results were as follows: 1) The male to female ratio was 2:1 and the age ranged from 19 to 88 with average of 54/ 2) The causes of obstructive jaundice included 94 malignant diseases and 13 benign diseases. Malignant diseases were 48 cases of bile duct cancer, 20 cases of metastasis, 20 cases of pancreatic cancer, 4 cases of gallbladder cancer, 1 case of ampulla Vater cancer, and 1 case of duodenal cancer. Benign diseases were 8 cases of common bile duct stone and 3 cases of benign stricture and 2 cases of cholangitis. 3) The most common indication was palliative drainage of obstruction secondary to malignant tumor in 78 cases. 4) The overall success rate was 93.7%. Internal drainage was achieved in 34 (26.5%) and external drainage was accomplished in 86 (67.2%). 5) Decline in serum bilirubin level was found in 100 cases (93.3%) with the most rapid decline within 1 week after the procedure. 6) Acute major complication occurred in 6 of 107 cases (5.6%). Percutaneous transheaptic biliary drainage is a proven technique for non-operative biliary decompression and established alternative to surgery

  12. Percutaneous transhepatic biliary drainage in 107 patients

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Byung Ihn; Lim, Duk; Park, Jae Hyung; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1984-06-15

    Percutaneous transhepatic biliary drainage has played a major role in treatment of patients of patients with biliary tract disease, especially obstruction by malignant disease. Percutaneous transhepatic biliary drainage was performed 128 times in 107 patients of obstructive jaundice for recent 2 years and 8 months from July, 1981 to March, 1984 at department of radiology, Seoul National University Hospital. The results were as follows: 1) The male to female ratio was 2:1 and the age ranged from 19 to 88 with average of 54/ 2) The causes of obstructive jaundice included 94 malignant diseases and 13 benign diseases. Malignant diseases were 48 cases of bile duct cancer, 20 cases of metastasis, 20 cases of pancreatic cancer, 4 cases of gallbladder cancer, 1 case of ampulla Vater cancer, and 1 case of duodenal cancer. Benign diseases were 8 cases of common bile duct stone and 3 cases of benign stricture and 2 cases of cholangitis. 3) The most common indication was palliative drainage of obstruction secondary to malignant tumor in 78 cases. 4) The overall success rate was 93.7%. Internal drainage was achieved in 34 (26.5%) and external drainage was accomplished in 86 (67.2%). 5) Decline in serum bilirubin level was found in 100 cases (93.3%) with the most rapid decline within 1 week after the procedure. 6) Acute major complication occurred in 6 of 107 cases (5.6%). Percutaneous transheaptic biliary drainage is a proven technique for non-operative biliary decompression and established alternative to surgery.

  13. Selection of biliary drainage route and the effect of adjunctive therapy for unresectable malignant biliary stricture

    Energy Technology Data Exchange (ETDEWEB)

    Shinohara, Yasushi; Takeda, Kazuya [Tokyo Medical Coll. (Japan)

    2000-03-01

    The outcome of combination of biliary tract drainage with other adjunctive therapies for unresectable malignant biliary tract stricture was evaluated in the 135 patients with known outcome treated in this unit between June, 1986 and May, 1998. Compared to percutaneous transhepatic drainage, transpapillary drainage significantly shortened the jaundice reduction period but yielded a slightly inferior technical success rate. The efficacy of transpapillary drainage for jaundice was extremely poor in cases of stricture in the upper part of the biliary tract. A histological comparison of bile duct lumen after various adjunctive therapies showed that intraluminal therapy was much more effective than extracorporeal radiation. Adjunctive therapies significantly increased the survival period in patients with cholangiocarcinoma but they were less effective in patients with pancreatic carcinoma and not effective at all in patients with gallbladder carcinoma. Intraluminal therapy markedly prolonged the internal fistula maintenance period and was effective in improving the quality of life in patients with superior bile duct stricture at multiple sites. The hospital stay was significantly longer in patients who received adjunctive therapy than in those who received biliary tract drainage alone. This finding suggests that adjunctive therapy should not be conducted if it is not expected to result in an increase in the survival period that compensates for disadvantages of a prolonged hospital stay. In conclusion, in the treatment of inoperable malignant biliary tract stricture, adjunctive therapy should be conducted whenever possible in combination with percutaneous biliary tract drainage, which enable intraluminal therapy, in patients with cholangiocarcinoma. However, biliary tract drainage alone is recommended in patients with pancreatic and gallbladder carcinoma because adjunctive therapy does not seem to be effective. A transpapillary approach is recommended for pancreatic

  14. Co-existent Ascariasis and Multiloculated Tuberculous Pleurisy Treated with Intrapleural Streptokinase.

    Science.gov (United States)

    Mahmud, Talha; Naeem, Omer Muhammad

    2015-10-01

    This case describes a young male with pleuro-pulmonary tuberculosis having one-week history of fever and hemoptysis along with a multiloculated right sided exudative lymphocytic pleural effusion. His pulmonary diagnostic confusion was due to passage of adult Ascaris lumbricoides per orally but that was found to be of intestinal origin. Pleural tissue histopathology revealed necrotizing granulomatous inflammation and right upper lobe bronchial washings were positive for acid fast bacilli. His multiloculated pleural effusion was successfully resolved with intrapleural streptokinase injections via a 10 French pleural catheter. Treatment with class-I anti-tuberculous drugs led to complete clearance of remaining pleuro-pulmonary shadowing. PMID:26522189

  15. Percutaneous Biliary Drainage Using Open Cell Stents for Malignant Biliary Hilar Obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Sun Jun; Bae, Jae Ik; Han, Tae Sun; Won, Je Hwan; Kim, Ji Dae; Kwack, Kyu Sung; Lee, Jae Hee; Kim, Young Chul [Dept. of Radiology, Ajou University School of Medicine, Suwon (Korea, Republic of)

    2012-11-15

    To evaluate the feasibility, safety and the effectiveness of the complex assembly of open cell nitinol stents for biliary hilar malignancy. During the 10 month period between January and October 2007, 26 consecutive patients with malignant biliary hilar obstruction underwent percutaneous insertion of open cell design nitinol stents. Four types of stent placement methods were used according to the patients' ductal anatomy of the hilum. We evaluated the technical feasibility of stent placement, complications, patient survival, and the duration of stent patency. Bilobar biliary stent placement was conducted in 26 patients with malignant biliary obstruction-T (n = 9), Y (n 7), crisscross (n = 6) and multiple intersecting types (n = 4). Primary technical success was obtained in 24 of 26 (93%) patients. The crushing of the 1st stent during insertion of the 2nd stent occurred in two cases. Major complications occurred in 2 of 26 patients (7.7%). One case of active bleeding from hepatic segmental artery and one case of sepsis after procedure occurred. Clinical success was achieved in 21 of 24 (87.5%) patients, who were followed for a mean of 141.5 days (range 25-354 days). The mean primary stent patency period was 191.8 days and the mean patient survival period was 299 days. Applying an open cell stent in the biliary system is feasible, and can be effective, especially in multiple intersecting stent insertions in the hepatic hilum.

  16. Evaluation of the biliary tract in patients with functional biliary symptoms

    Institute of Scientific and Technical Information of China (English)

    Peter Funch-Jensen; Asbj(φ)rn Mohr Drewes; László Madácsy

    2006-01-01

    The aim of this paper was to describe functional biliary syndromes and methods for evaluation of the biliary tract in these patients. Functional biliary symptoms can be defined as biliary symptoms without demonstrable organic substrate. Two main syndromes exist: Gallbladder dysfunction and sphincter of Oddi dysfunction. The most important investigative tools are cholescintigraphy and endoscopic sphincter of Oddi manometry. In gallbladder dysfunction a scintigraphic gallbladder ejection fraction below 35% can select patients who will benefit from cholecystectomy. Endoscopic sphincter of Oddi manometry is considered the gold standard in sphincter of Oddi dysfunction but recent development in scintigraphic methods is about to change this. Thus,calculation of hilum-to-duodenum transit time and duodenal appearance time on cholescintigraphy have proven useful in these patients. In conclusion, ambient methods can diagnose functional biliary syndromes.However, there are still a number of issues where further knowledge is needed. Probably the next step forward will be in the area of sensory testing and impedance planimetric methods.

  17. Obstructing fungal cholangitis complicating metal biliary stent placement in pancreatic cancer

    OpenAIRE

    Story, Brian; Gluck, Michael

    2010-01-01

    Biliary obstructions can lead to infections of the biliary system, particularly in patients with occluded biliary stents. Fungal organisms are frequently found in biliary aspirates of patients who have been on antibiotics and have stents; however, fungal masses, or “balls”, that fully obstruct the biliary system are uncommon and exceedingly difficult to eradicate. We present 4 cases of obstructing fungal cholangitis in patients who had metal biliary stents placed for pancreatic malignancies, ...

  18. Obstructing fungal cholangitis complicating metal biliary stent placement in pancreatic cancer

    Institute of Scientific and Technical Information of China (English)

    Brian; Story; Michael; Gluck

    2010-01-01

    Biliary obstructions can lead to infections of the biliary system, particularly in patients with occluded biliary stents. Fungal organisms are frequently found in bili-ary aspirates of patients who have been on antibiotics and have stents; however, fungal masses, or "balls", that fully obstruct the biliary system are uncommon and exceedingly diff icult to eradicate. We present 4 cases of obstructing fungal cholangitis in patients who had metal biliary stents placed for pancreatic malignancies, and subsequen...

  19. Radiotherapy Prolongs Biliary Metal Stent Patency in Malignant Pancreatobiliary Obstructions

    OpenAIRE

    Park, Semi; Park, Jeong Youp; Bang, Seungmin; Park, Seung Woo; Chung, Jae Bock; Song, Si Young

    2013-01-01

    Background/Aims Biliary stenting is the most effective decompressive method for treating malignant biliary obstructive jaundice. Although the main cause of stent occlusion is tumor growth, few studies have investigated whether stent patency is affected by the combination of cancer-treatment modalities. The aim of this study was to evaluate the effects of local radiotherapy on metal-stent patency in patients with malignant biliary obstruction. Methods Patients who underwent self-expandable bil...

  20. Functional Self-Expandable Metal Stents in Biliary Obstruction

    OpenAIRE

    Kwon, Chang-Il; Ko, Kwang Hyun; Hahm, Ki Baik; Kang, Dae Hwan

    2013-01-01

    Biliary stents are widely used not only for palliative treatment of malignant biliary obstruction but also for benign biliary diseases. Each plastic stent or self-expandable metal stent (SEMS) has its own advantages, and a proper stent should be selected carefully for individual condition. To compensate and overcome several drawbacks of SEMS, functional self-expandable metal stent (FSEMS) has been developed with much progress so far. This article looks into the outcomes and defects of each st...

  1. Evaluation of different percutaneous modalities for managing malfunctioning biliary stents

    OpenAIRE

    M. Alwarraky; A. Aljaky; E. Tharwa; Aziz, A.

    2015-01-01

    Background: There is no consensus regarding optimal management of biliary metal stent occlusion. Aim: To evaluate the efficacy of different percutaneous methods for managing biliary metal stent occlusion. Patients and methods: Thirty-eight patients were included in the study. Metal biliary stent occlusions were managed by insertion of another metal stent in 18 patients (group 1), insertion of an internal–external catheter in 15 patients (group 2), and mechanical cleaning in 5 patients (...

  2. Imaging of malignancies of the biliary tract- an update

    OpenAIRE

    Hennedige, Tiffany Priyanthi; Neo, Wee Thong; Venkatesh, Sudhakar Kundapur

    2014-01-01

    Malignancies of the biliary tract include cholangiocarcinoma, gallbladder cancers and carcinoma of the ampulla of Vater. Biliary tract adenocarcinomas are the second most common primary hepatobiliary cancer. Due to their slow growing nature, non-specific and late symptomatology, these malignancies are often diagnosed in advanced stages with poor prognosis. Apart from incidental discovery of gall bladder carcinoma upon cholecystectomy, early stage biliary tract cancers are now detected with co...

  3. Guidelines for chemotherapy of biliary tract and ampullary carcinomas

    OpenAIRE

    Furuse, Junji; Takada, Tadahiro; Miyazaki, Masaru; Miyakawa, Shuichi; Tsukada, Kazuhiro; Nagino, Masato; Kondo, Satoshi; Saito, Hiroya; Tsuyuguchi, Toshio; Hirata, Koichi; Kimura, Fumio; Yoshitomi, Hideyuki; Nozawa, Satoshi; YOSHIDA, Masahiro; Wada, Keita

    2008-01-01

    Few randomized controlled trials (RCTs) with large numbers of patients have been conducted to date in patients with biliary tract cancer, and standard chemotherapy has not been established yet. In this article we review previous studies and clinical trials regarding chemotherapy for unresectable biliary tract cancer, and we present guidelines for the appropriate use of chemotherapy in patients with biliary tract cancer. According to an RCT comparing chemotherapy and best supportive care for t...

  4. Surgical significance of variations in anatomy in the biliary region

    OpenAIRE

    Ashfaq Ul Hassan; Showqat A. Zargar; Aijaz Malik; Pervez Shah

    2013-01-01

    Variations in the anatomy of the gallbladder, the bile ducts, and the arteries that supply them and the liver are important to the surgeon, because failure to recognize them can cause iatrogenic injury to the biliary tract. A surgeon should be always be careful while operating in this area. In addition these anomalies are associated with a range of other congenital anomalies, including biliary atresia and cardiovascular or other gastrointestinal malformations, biliary lithiasis, choledochal c...

  5. Tumor extension along percutaneous transhepatic biliary drainage tracts

    International Nuclear Information System (INIS)

    Percutaneous Transhepatic Biliary Catheterization is commonly employed in the diagnosis and management of obstructive jaundice associated with malignant lesions. Tumor manipulation as an effort to obtain a histological diagnosis or to establish short or long-term internal-external biliary drainage is liable to disseminate the malignancy along the catheter tract. Two cases of malignant seeding of the catheter tract after biliary drainage have been observed. (orig.)

  6. Flowcharts for the management of biliary tract and ampullary carcinomas

    OpenAIRE

    Miyakawa, Shuichi; Ishihara, Shin; Takada, Tadahiro; Miyazaki, Masaru; TSUKADA, KAZUHIRO; Nagino, Masato; Kondo, Satoshi; Furuse, Junji; Saito, Hiroya; Tsuyuguchi, Toshio; Kimura, Fumio; Yoshitomi, Hideyuki; Nozawa, Satoshi; Yoshida, Masahiro; Wada, Keita

    2008-01-01

    No strategies for the diagnosis and treatment of biliary tract carcinoma have been clearly described. We developed flowcharts for the diagnosis and treatment of biliary tract carcinoma on the basis of the best clinical evidence. Risk factors for bile duct carcinoma are a dilated type of pancreaticobiliary maljunction (PBM) and primary sclerosing cholangitis. A nondilated type of PBM is a risk factor for gallbladder carcinoma. Symptoms that may indicate biliary tract carcinoma are jaundice and...

  7. Percutaneous Transhepatic Biliary Interventions in Benign Diseases of Children

    OpenAIRE

    Medih Celiktas

    2015-01-01

    Purpose: Percutaneous transhepatic biliary interventions are performed safely and effectively in adults. There is less experience of these interventions in benign diseases of children. We aimed to evaluate the safety and efficacy of percutaneous biliary interventions in benign diseases of children. Materials and Methods: In this retrospective study, percutaneous biliary interventions were performed in fifteen children with a mean age of 10.2 years (range 14 days-14 years). Patients present...

  8. Tumor extension along percutaneous transhepatic biliary drainage tracts

    Energy Technology Data Exchange (ETDEWEB)

    Tersigni, R.; Bochicchio, O.; Cavallini, M.; Bufalini, G.; Alessandroni, L.; Arena, L.; Armeni, O.; Miraglia, F.; Stipa, S.; Rossi, P.

    1986-11-01

    Percutaneous Transhepatic Biliary Catheterization is commonly employed in the diagnosis and management of obstructive jaundice associated with malignant lesions. Tumor manipulation as an effort to obtain a histological diagnosis or to establish short or long-term internal-external biliary drainage is liable to disseminate the malignancy along the catheter tract. Two cases of malignant seeding of the catheter tract after biliary drainage have been observed.

  9. Percutaneous Transhepatic Biliary Interventions in Benign Diseases of Children

    OpenAIRE

    Çeliktaş, Medih

    2015-01-01

    Purpose: Percutaneous transhepatic biliary interventions are performed safely and effectively in adults. There is less experience of these interventions in benign diseases of children. We aimed to evaluate the safety and efficacy of percutaneous biliary interventions in benign diseases of children. Materials and Methods: In this retrospective study, percutaneous biliary interventions were performed in fifteen children with a mean age of 10.2 years (range 14 days-14 years). Patients presented ...

  10. [Digestive endoscopy: biliary tract and pancreas].

    Science.gov (United States)

    Costamagna, Guido

    2016-06-01

    New technological developments in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound, both for diagnosis and treatment of biliary and pancreatic diseases, have opened up new scenarios in the recent years. For instance, removal of large bile duct stones with endoscopic sphincterotomy followed by large balloon dilation has been proven to be a safe and effective technique. Also cholangioscopy evolved in terms of better imaging, tissue acquisition and stones management. Self-expandable metal stents are used mostly for malignant diseases, but their role in benign diseases has also been deeply investigated in the last years. The rapid evolution in the field of radiofrequency brought new devices for safer ablation and palliation of biliary tumours. Self-expandable metal stents are also used for ultrasound-guided drainage of walled off pancreatic necrosis and for choledocoduodenostomy and cholecystogastrostomy. PMID:27362720

  11. Hemobilia after percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Objective: To retrospectively analyze the occurance and management for patients with hemobilia after percutaneous transhepatic biliary drainage (PTBD). Methods: Consecutive 139 patients with inoperable obstructive jaundice were treated by PTBD. After taking percutaneous transhepatic cholangiography, procedure of puncturing the dilated biliary duct with metallic stent or plastic catheter placement was undertaken. Follow up was carded out with clinical, radiographic and laboratory evaluation. Procedure-and device-related complications were also recorded. Results: All patients went though PTBD successfully with total serum bilirnbin reducing from 360 μmol/l to 158.2 μmol/l, postoperatively. 43 cases received hemostatic. Transient hemobilia occurred in 11 cases, and severe hemobilia in other 5 cases requiring further management. Other 4 cases needed arterial embolization with another one failure. Conclusion: Hemobilia is a complication after PTBD, which can be promptly controlled with improving skillful maneuver. (authors)

  12. Recent Advances of Biliary Stent Management

    International Nuclear Information System (INIS)

    Recent progress in chemotherapy has prolonged the survival of patients with malignant biliary strictures, leading to increased rates of stent occlusion. Even we employed metallic stents which contributed to higher rates and longer durations of patency, and occlusion of covered metallic stents now occurs in about half of all patients during their survival. We investigated the complication and patency rate for the removal of covered metallic stents, and found that the durations were similar for initial stent placement and re-intervention. In order to preserve patient quality of life, we currently recommend the use of covered metallic stents for patients with malignant biliary obstruction because of their removability and longest patency duration, even though uncovered metallic stents have similar patency durations.

  13. Endoscopic management of hilar biliary strictures.

    Science.gov (United States)

    Singh, Rajiv Ranjan; Singh, Virendra

    2015-07-10

    Hilar biliary strictures are caused by various benign and malignant conditions. It is difficult to differentiate benign and malignant strictures. Postcholecystectomy benign biliary strictures are frequently encountered. Endoscopic management of these strictures is challenging. An endoscopic method has been advocated that involves placement of increasing number of stents at regular intervals to resolve the stricture. Malignant hilar strictures are mostly unresectable at the time of diagnosis and only palliation is possible.Endoscopic palliation is preferred over surgery or radiological intervention. Magnetic resonance cholangiopancreaticography is quite important in the management of these strictures. Metal stents are superior to plastic stents. The opinion is divided over the issue of unilateral or bilateral stenting.Minimal contrast or no contrast technique has been advocated during endoscopic retrograde cholangiopancreatography of these patients. The role of intraluminal brachytherapy, intraductal ablation devices, photodynamic therapy, and endoscopic ultrasound still remains to be defined. PMID:26191345

  14. Recent advances of biliary stent management.

    Science.gov (United States)

    Kida, Mitsuhiro; Miyazawa, Shiro; Iwai, Tomohisa; Ikeda, Hiroko; Takezawa, Miyoko; Kikuchi, Hidehiko; Watanabe, Maya; Imaizumi, Hiroshi; Koizumi, Wasaburo

    2012-01-01

    Recent progress in chemotherapy has prolonged the survival of patients with malignant biliary strictures, leading to increased rates of stent occlusion. Even we employed metallic stents which contributed to higher rates and longer durations of patency, and occlusion of covered metallic stents now occurs in about half of all patients during their survival. We investigated the complication and patency rate for the removal of covered metallic stents, and found that the durations were similar for initial stent placement and re-intervention. In order to preserve patient quality of life, we currently recommend the use of covered metallic stents for patients with malignant biliary obstruction because of their removability and longest patency duration, even though uncovered metallic stents have similar patency durations. PMID:22563289

  15. Mechanisms of biliary carcinogenesis and growth.

    Science.gov (United States)

    Wise, Candace; Pilanthananond, Metaneeya; Perry, Benjamin-F; Alpini, Gianfranco; McNeal, Michael; Glaser, Shannon-S

    2008-05-21

    Cholangiocarcinoma is a rare cancer originating from the neoplastic transformation of the epithelial cells (i.e. cholangiocytes) that line the biliary tract. The prognosis for patients with cholangiocarcinoma is grim due to lack of viable treatment options. The increase in world-wide incidence and mortality from cholangiocarcinoma highlights the importance of understanding the intracellular mechanisms that trigger the neoplastic transformation of cholangiocytes and the growth of biliary cancers. The purpose of the following review is to address what has been learned over the past decade concerning the molecular basis of cholangiocarcinogenesis. The material presented is divided into two sections: (1) mechanisms regulating neoplastic transformation of cholangiocytes; and (2) factors regulating cholangiocarcinoma growth. An understanding of the growth regulatory mechanisms of cholangiocarcinoma will lead to the identification of therapeutic targets for this devastating cancer. PMID:18494047

  16. Technical problems during percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Technical problems are repeatedly encountered during percutaneous transhepatic drainage by catheter or endo-prosthesis which are caused by the position, extent and tightness of the stenosis in the biliary ducts. All means of overcoming these problems must be used, otherwise technical failure or complications become inevitable. The methods to be adopted if catheters break and endo-prostheses become displaced or occluded, and for haemorrhage, are described, as well as methods for draining multiple, proximal or intrahepatic stenoses. This is based on an experience with 74 patients on whom 130 drainage procedures have been perforemd (80 catheters, 50 endo-prostheses. All complications and mortality (five patients, 3.8%) were due to problems which could not be solved. Internal biliary drainage by means of an endoprosthesis is markedly superior to catheter drainage. (orig.)

  17. Arterial Complications of Percutaneous Transhepatic Biliary Drainage

    International Nuclear Information System (INIS)

    Purpose: To report on the frequency and treatment of arterial complications due to percutaneous transhepatic biliary drainage (PTBD).Materials: Lesions of the intrahepatic artery were encountered in 10 of 525 patients treated by PTBD (2%). Hemobilia followed in 9 patients and subcapsular hematoma in 1. Seven patients had a benign biliary stenosis and 3 had a malignant stenosis.Results: The bleeding resolved spontaneously in 3 patients. In 7 it required arterial embolization, which was successfully achieved either through the percutaneous catheter (n= 3) or by arteriography (n= 4).Conclusion: Arterial bleeding is a relatively rare complication of PTBD that can easily be treated by selective arterial embolization when it does not resolve spontaneously. In this series its frequency was much higher (16%) when the stenosis was benign than when it was malignant (0.6%)

  18. Technical problems during percutaneous transhepatic biliary drainage

    Energy Technology Data Exchange (ETDEWEB)

    Weber, J.; Hoever, S.

    1985-11-01

    Technical problems are repeatedly encountered during percutaneous transhepatic drainage by catheter or endo-prosthesis which are caused by the position, extent and tightness of the stenosis in the biliary ducts. All means of overcoming these problems must be used, otherwise technical failure or complications become inevitable. The methods to be adopted if catheters break and endo-prostheses become displaced or occluded, and for haemorrhage, are described, as well as methods for draining multiple, proximal or intrahepatic stenoses. This is based on an experience with 74 patients on whom 130 drainage procedures have been perforemd (80 catheters, 50 endo-prostheses). All complications and mortality (five patients, 3.8%) were due to problems which could not be solved. Internal biliary drainage by means of an endoprosthesis is markedly superior to catheter drainage. (orig.).

  19. Photodynamic therapy for occluded biliary metal stents

    Science.gov (United States)

    Roche, Joseph V. E.; Krasner, Neville; Sturgess, R.

    1999-02-01

    In this abstract we describe the use of photodynamic therapy (PDT) to recanalize occluded biliary metal stents. In patients with jaundice secondary to obstructed metal stents PDT was carried out 72 hours after the administration of m THPC. Red laser light at 652 nm was delivered endoscopically at an energy intensity of 50 J/cm. A week later endoscopic retrograde cholangiogram showed complete recanalization of the metal stent.

  20. Biliary tract obstruction in chronic pancreatitis

    OpenAIRE

    Abdallah, Abdul A.; Krige, Jake E J; Bornman, Philippus C.

    2007-01-01

    Bile duct strictures are a common complication in patients with advanced chronic pancreatitis and have a variable clinical presentation ranging from an incidental finding to overt jaundice and cholangitis. The diagnosis is mostly made during investigations for abdominal pain but jaundice may be the initial clinical presentation. The jaundice is typically transient but may be recurrent with a small risk of secondary biliary cirrhosis in longstanding cases. The management of a bile duct strictu...

  1. Diagnosis of biliary tract and ampullary carcinomas

    OpenAIRE

    Tsukada, Kazuhiro; Takada, Tadahiro; Miyazaki, Masaru; Miyakawa, Shuichi; Nagino, Masato; Kondo, Satoshi; Furuse, Junji; Saito, Hiroya; Tsuyuguchi, Toshio; Kimura, Fumio; Yoshitomi, Hideyuki; Nozawa, Satoshi; YOSHIDA, Masahiro; Wada, Keita; Amano, Hodaka

    2008-01-01

    Diagnostic methods for biliary tract carcinoma and the efficacy of these methods are discussed. Neither definite methods for early diagnosis nor specific markers are available in this disease. When this disease is suspected on the basis of clinical symptoms and risk factors, hemato-biochemical examination and abdominal ultrasonography are performed and, where appropriate, enhanced computed tomography (CT) and/or magnetic resonance cholangiopancreatography (MRCP) is carried out. Diagnoses of e...

  2. Pulmonary involvement in primary biliary cirrhosis.

    OpenAIRE

    Rodriguez-Roisin, R.; Pares, A; Bruguera, M; Coll, J; Picado, C.; Agusti-Vidal, A; Burgos, F.; Rodes, J

    1981-01-01

    The association of pulmonary fibrosis and primary biliary cirrhosis (PBC) remains controversial. To determine the frequency of pulmonary fibrosis in PBC, a carefully selected series of 14 PBC patients, seven patients with Sicca complex, and 14 control subjects have been studied. Seven of the 14 patients with PBC had Sjögren's syndrome, four of whom had some clinical evidence of pulmonary disease. Evaluation of ventilatory capacity, gas transfer factor, arterial blood gases, and lung mechanics...

  3. Ultrasonographic findings of type IIIa biliary atresia

    International Nuclear Information System (INIS)

    To describe the ultrasonographic (US) findings of type IIIa biliary atresia. We retrospectively reviewed a medical database of patients pathologically confirmed to have biliary atresia, Kasai type IIIa, between January 2002 and May 2013 (n=18). We evaluated US findings including the visible common bile duct (CBD), triangular cord thickness, gallbladder size and shape, and subcapsular flow on color Doppler US; laboratory data; and pathological hepatic fibrosis grades. We divided them into two groups-those with visible (group A) and invisible (group B) CBD on US-and compared all parameters between the two groups. CBD was visible on US in five cases (27.8%; group A) and invisible in 13 cases (72.2%; group B). US was performed at an earlier age in group A than in group B (median, 27 days vs. 60 days; P=0.027) with the maximal age of 51 days. A comparison of the US findings revealed that the triangular cord thickness was smaller (4.1 mm vs. 4.9 mm; P=0.004) and the gallbladder length was larger (20.0 mm vs. 11.7 mm; P=0.021) in group A. The gallbladder shape did not differ between the two groups, and the subcapsular flow was positive in all cases of both groups. There was no significant difference in the laboratory data between the two groups. Upon pathological analysis, group A showed low-grade and group B showed low- to high-grade hepatic fibrosis. When CBD is visible on US in patients diagnosed with type IIIa biliary atresia, other US features could have a false negative status. A subcapsular flow on the color Doppler US would be noted in the type IIIa biliary atresia patients.

  4. Colon Cancer Metastatic to the Biliary Tree.

    Science.gov (United States)

    Strauss, Alexandra T; Clayton, Steven B; Markow, Michael; Mamel, Jay

    2016-04-01

    Metastasis of colon adenocarcinoma is commonly found in the lung, liver, or peritoneum. Common bile duct (CBD) tumors related to adenomas from familial adenomatous polyposis metastasizing from outside of the gastrointestinal tract have been reported. We report a case of biliary colic due to metastatic colon adenocarcinoma to the CBD. Obstructive jaundice with signs of acalculous cholecystitis on imaging in a patient with a history of colon cancer should raise suspicion for metastasis to CBD. PMID:27144209

  5. Ischemic type biliary lesion (ITBL) after liver transplantation. Case report

    International Nuclear Information System (INIS)

    Ischemic type biliary lesion (ITBL) is a rare and relative late complication after orthotopic liver transplantation. ITBL is characterized by bile duct necrosis leading to alternations of the ductal lumen. The paper reports a case of 52-year-old women with ITBL syndrome after orthotopic liver transplantation. The clinical picture and results of direct cholangiography, MRCP and ultrasound imaging are discussed. Ischemic type biliary lesion is defined as non-ischemic destruction of the graft's biliary tree after liver transplantation. The diagnosis of ITBL syndrome is based upon results of cholangiography and ultrasound imaging with a characteristic picture of the biliary tree with normal flow in the hepatic artery. (author)

  6. Bilothorax as a complication of percutaneous transhepatic biliary drainage.

    Science.gov (United States)

    Sano, Atsushi; Yotsumoto, Takuma

    2016-01-01

    We report two cases of bilothorax that occurred as a complication of percutaneous transhepatic biliary drainage. In an 86-year-old woman who had undergone percutaneous transhepatic biliary drainage for obstructive jaundice, bilothorax occurred after accidental removal of the tube. She recovered with chest drainage only. An 83-year-old man who had undergone percutaneous transhepatic biliary drainage for cholecystitis developed bilothorax with infection. He recovered with thoracoscopic curettage. Although bilothorax is a rare complication of percutaneous transhepatic biliary drainage, appropriate diagnosis and prompt treatment is important, especially when bilothorax is accompanied by infection. PMID:26294694

  7. Septic Shock Due to Biliary Stones in a Postcholecystectomy Patient.

    Science.gov (United States)

    Azfar, Mohammad Feroz; Khan, Muhammad Faisal; Khursheed, Moazzum

    2015-10-01

    Septic shock leading to multi-organ failure is not uncommon. Early diagnosis to confirm the source is the distinctive attribute of sepsis management guidelines. Cholangitis as the source of sepsis can become a diagnostic dilemma in patients who have had cholecystectomy in the past. CT abdomen should be the investigation of choice in this group of patients. This report describes two postcholecystectomy patients who presented with septic shock secondary to biliary stones. The source of septic shock in both patients were biliary stones was confirmed with abdominal CT. Ultrasound abdomen failed to report biliary stones in these patients. Both improved on percutaneous transhepatic biliary drainage. PMID:26522207

  8. Congenital biliary tract malformation resembling biliary cystadenoma in a captive juvenile African lion (Panthera leo).

    Science.gov (United States)

    Caliendo, Valentina; Bull, Andrew C J; Stidworthy, Mark F

    2012-12-01

    A captive 3-mo-old white African lion (Panthera leo) presented with clinical signs of acute pain and a distended abdomen. Despite emergency treatment, the lion died a few hours after presentation. Postmortem examination revealed gross changes in the liver, spleen, and lungs and an anomalous cystic structure in the bile duct. Histologic examination identified severe generalized multifocal to coalescent necrotizing and neutrophilic hepatitis, neutrophilic splenitis, and mild interstitial pneumonia, consistent with bacterial septicemia. The abnormal biliary structures resembled biliary cystadenoma. However, due to the age of the animal, they were presumed to be congenital in origin. Biliary tract anomalies and cystadenomas have been reported previously in adult lions, and this case suggests that at least some of these examples may have a congenital basis. It is unclear whether the lesion was an underlying factor in the development of hepatitis. PMID:23272363

  9. Malignant Biliary Obstruction: Evidence for Best Practice

    Science.gov (United States)

    Pu, Leonardo Zorrón Cheng Tao; Singh, Rajvinder; Loong, Cheong Kuan; de Moura, Eduardo Guimarães Hourneaux

    2016-01-01

    What should be done next? Is the stricture benign? Is it resectable? Should I place a stent? Which one? These are some of the questions one ponders when dealing with biliary strictures. In resectable cases, ongoing questions remain as to whether the biliary tree should be drained prior to surgery. In palliative cases, the relief of obstruction remains the main goal. Options for palliative therapy include surgical bypass, percutaneous drainage, and stenting or endoscopic stenting (transpapillary or via an endoscopic ultrasound approach). This review gathers scientific foundations behind these interventions. For operable cases, preoperative biliary drainage should not be performed unless there is evidence of cholangitis, there is delay in surgical intervention, or intense jaundice is present. For inoperable cases, transpapillary stenting after sphincterotomy is preferable over percutaneous drainage. The use of plastic stents (PS) has no benefit over Self-Expandable Metallic Stents (SEMS). In case transpapillary drainage is not possible, Endoscopic Ultrasonography- (EUS-) guided drainage is still an option over percutaneous means. There is no significant difference between the types of SEMS and its indication should be individualized. PMID:26981114

  10. Malignant Biliary Obstruction: Evidence for Best Practice

    Directory of Open Access Journals (Sweden)

    Leonardo Zorrón Cheng Tao Pu

    2016-01-01

    Full Text Available What should be done next? Is the stricture benign? Is it resectable? Should I place a stent? Which one? These are some of the questions one ponders when dealing with biliary strictures. In resectable cases, ongoing questions remain as to whether the biliary tree should be drained prior to surgery. In palliative cases, the relief of obstruction remains the main goal. Options for palliative therapy include surgical bypass, percutaneous drainage, and stenting or endoscopic stenting (transpapillary or via an endoscopic ultrasound approach. This review gathers scientific foundations behind these interventions. For operable cases, preoperative biliary drainage should not be performed unless there is evidence of cholangitis, there is delay in surgical intervention, or intense jaundice is present. For inoperable cases, transpapillary stenting after sphincterotomy is preferable over percutaneous drainage. The use of plastic stents (PS has no benefit over Self-Expandable Metallic Stents (SEMS. In case transpapillary drainage is not possible, Endoscopic Ultrasonography- (EUS- guided drainage is still an option over percutaneous means. There is no significant difference between the types of SEMS and its indication should be individualized.

  11. Excretion of biliary compounds during intrauterine life

    Institute of Scientific and Technical Information of China (English)

    Rocio IR Macias; Jose JG Marin; Maria A Serrano

    2009-01-01

    In adults, the hepatobiliary system, together with thekidney, constitute the main routes for the eliminationof several endogenous and xenobiotic compounds intobile and urine, respectively. However, during intrauterinelife the biliary route of excretion for cholephiliccompounds, such as bile acids and biliary pigments, isvery poor. Although very early in pregnancy the fetal liver produces bile acids, bilirubin and biliverdin, these compounds cannot be efficiently eliminated by the fetal hepatobiliary system, owing to the immaturity of the excretory machinery in the fetal liver. Therefore, the potentially harmful accumulation of cholephilic compounds in the fetus is prevented by their elimination across the placenta. Owing to the presence of detoxifying enzymes and specific transport systems at different locations of the placental barrier, such as the endothelial cells of chorionic vessels and trophoblast cells, this organ plays an important role in the hepatobiliary-like function during intrauterine life. The relevance of this excretory function in normal fetal physiology is evident in situations where high concentrations of biliary compounds are accumulated in the mother. This may result in oxidative stress and apoptosis, mainly in the placenta and fetal liver, which might affect normal fetal development and challenge the fate of the pregnancy. The present article reviews current knowledge of the mechanisms underlying the hepatobiliary function of the fetal-placental unit and the repercussions of several pathological conditions on this tandem.

  12. Sonographic findings of biliary tract disease

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Duck Soo; Kim, Jung Sick; Kim, Byung Young; Kim, Si Woon; Lee, Chong Kil [Fatima Hospital, Taegu (Korea, Republic of)

    1983-03-15

    Forty one patients gallbladder and bile duct diseases were studied clinically and sonographically. Twenty nine (seventy one percent) patients were distributed between age forty to fifty nine and male to female ratio was 1 : 1.4. The order of frequency of biliary tract disease was cholelithiasis, acclculous cholecystitis, CBD stone and CBD cancer. Sonographic findings of cholelithiasis were strong echo with posterior shadowing, faint internal echoes without shadowing, gallbladder wall thickening and anechoicity of the gallbladder wall. Instead of small proportion of gallbladder distension and wall anechoicity, faint internal echoes without shadowing were seen in ten of nineteen cases of choleithiasis. On choledocholithiasis, meniscus sign at the junction of the stone and gallbladder wall was identified in most cases and was helpful to differentiation stone from malignancy. The degree of CBD dilatation was more severe in malignancy than in CBD stone and ascaris in CBD. Sonographic examination was useful in detection of gallbladder and biliary tree pathology and the cause of biliary tract obstruction could be identified.

  13. Sonographic findings of biliary tract disease

    International Nuclear Information System (INIS)

    Forty one patients gallbladder and bile duct diseases were studied clinically and sonographically. Twenty nine (seventy one percent) patients were distributed between age forty to fifty nine and male to female ratio was 1 : 1.4. The order of frequency of biliary tract disease was cholelithiasis, acclculous cholecystitis, CBD stone and CBD cancer. Sonographic findings of cholelithiasis were strong echo with posterior shadowing, faint internal echoes without shadowing, gallbladder wall thickening and anechoicity of the gallbladder wall. Instead of small proportion of gallbladder distension and wall anechoicity, faint internal echoes without shadowing were seen in ten of nineteen cases of choleithiasis. On choledocholithiasis, meniscus sign at the junction of the stone and gallbladder wall was identified in most cases and was helpful to differentiation stone from malignancy. The degree of CBD dilatation was more severe in malignancy than in CBD stone and ascaris in CBD. Sonographic examination was useful in detection of gallbladder and biliary tree pathology and the cause of biliary tract obstruction could be identified

  14. Reality named endoscopic ultrasound biliary drainage.

    Science.gov (United States)

    Guedes, Hugo Gonçalo; Lopes, Roberto Iglesias; de Oliveira, Joel Fernandez; Artifon, Everson Luiz de Almeida

    2015-10-25

    Endoscopic ultrasound (EUS) is used for diagnosis and evaluation of many diseases of the gastrointestinal (GI) tract. In the past, it was used to guide a cholangiography, but nowadays it emerges as a powerful therapeutic tool in biliary drainage. The aims of this review are: outline the rationale for endoscopic ultrasound-guided biliary drainage (EGBD); detail the procedural technique; evaluate the clinical outcomes and limitations of the method; and provide recommendations for the practicing clinician. In cases of failed endoscopic retrograde cholangiopancreatography (ERCP), patients are usually referred for either percutaneous transhepatic biliary drainage (PTBD) or surgical bypass. Both these procedures have high rates of undesirable complications. EGBD is an attractive alternative to PTBD or surgery when ERCP fails. EGBD can be performed at two locations: transhepatic or extrahepatic, and the stent can be inserted in an antegrade or retrograde fashion. The drainage route can be transluminal, duodenal or transpapillary, which, again, can be antegrade or retrograde [rendezvous (EUS-RV)]. Complications of all techniques combined include pneumoperitoneum, bleeding, bile leak/peritonitis and cholangitis. We recommend EGBD when bile duct access is not possible because of failed cannulation, altered upper GI tract anatomy, gastric outlet obstruction, a distorted ampulla or a periampullary diverticulum, as a minimally invasive alternative to surgery or radiology. PMID:26504507

  15. Role of ultrasound in the perioperative evaluation of percutaneous transhepatic biliary drainage

    Institute of Scientific and Technical Information of China (English)

    Chuan Fu; Si-Ze Wu; Guang-Qing Liu; Tian-Lun Fan; You-Ke Chen

    2015-01-01

    Objective:To explore the evaluation and application of the color doppler ultrasound imaging for percutaneous transhepatic biliary drainage (PTBD) in the treatment of obstructive jaundice of preoperative, intraoperative and postoperative.Methods: The related information of 133 patients prepared with PTBD in our hospital from January 2009 to January 2015 was analyzed retrospectively. Including the clinical manifestation of PTBD preoperative, intraoperative and postoperative, laboratory examination, color Doppler ultrasound imaging, CT and/or MR imaging, X-ray and ultrasound guided interventional therapy, surgical treatment, histopathologic analysis record, the evaluation analysis of the role of ultrasound in the perioperative PTBD.Result:In 133 patients prepare with PTBD, preoperative evaluation for ultrasound guided PTBD 105 cases (78.94%, 105/133), finally complete the ultrasound guided PTBD 56 cases, with smoothly and one-time 100% success rate. Postoperative patients with jaundice and skin itching rate significantly reduced, increase food intake and better mental state. At seventh day of postoperative, liver function index improved significantly, ultrasonic follow-up show bile duct with different degree of inside and outside diameters. Postoperative complications were mild with the rate of 7.14%. No biliary infection, liver abscess, bile leakage complications, biliary tumor or liver function damage.Conclusion:The ultrasound evaluation of preoperative PTBD can be helpful with certain patients. Also to formulate operation program, correct positioning and guided with ultrasound is the key to the successful PTBD. Beside to avoid or reduce the complications, ultrasound follow-up provide important information in the detection of postoperative complications.

  16. Sequential algorithm analysis to facilitate selective biliary access for difficult biliary cannulation in ERCP: a prospective clinical study

    OpenAIRE

    Lee, Tae Hoon; Hwang, Soon Oh; Choi, Hyun Jong; Jung, Yunho; Cha, Sang Woo; Chung, Il-Kwun; Moon, Jong Ho; Cho, Young Deok; Park, Sang-Heum; Kim, Sun-Joo

    2014-01-01

    Background Numerous clinical trials to improve the success rate of biliary access in difficult biliary cannulation (DBC) during ERCP have been reported. However, standard guidelines or sequential protocol analysis according to different methods are limited in place. We planned to investigate a sequential protocol to facilitate selective biliary access for DBC during ERCP. Methods This prospective clinical study enrolled 711 patients with naïve papillae at a tertiary referral center. If wire-g...

  17. Commercial formalin substitutes for histopathology

    DEFF Research Database (Denmark)

    Prentø, P; Lyon, H

    1997-01-01

    We compared the performance of six commercial fixatives proposed to be formalin substitutes with the performance of buffered formalin, Clarke's ethanol-acetic acid, and ethanol, using rat liver, small intestine, and kidney. We investigated the rate of penetration, mode of fixation, extent of...... performed equally well on all tissues tested. While several of the commercial fixatives appeared to preserve liver tissue at 200x, the preservation of kidney, intestinal villi, and smooth muscle was unacceptable. Histological distortion, cell shrinkage and vacuolization were prominent when the substitutes...... was obtained by combining formalin fixation with antigen retrieval. We conclude that none of the proposed commercial substitutes for buffered formalin are adequate for critical histology or histopathology....

  18. In Vivo Study of Polyurethane-Coated Gianturco-Rosch Biliary Z-Stents

    International Nuclear Information System (INIS)

    Purpose: Prototypes of Gianturco-Rosch Z-stents coated with polycarbonate urethane (PCU) were placed in the biliary tree of pigs, in order to test their biomechanical behavior, stability, and biocompatibility. Methods: The stents were surgically implanted in the common bile duct of three pairs of pigs, which were killed after 1, 3, and 6 months respectively. Explanted livers from pigs of the same race, age, and size were used to provide comparative data. The bile ducts were radiologically and histopathologically examined; the stents were processed and examined by scanning electron microscopy. Results: No complications occurred and the animals showed a normal weight gain. The main bile duct appeared radiologically and macroscopically dilated, but the stents proved to be in place. Histologically, the bile duct epithelium was destroyed, but neither hyperplastic nor inflammatory fibrotic reactions of the wall were evident. Both the metallic structure and the polymeric coating of the stents were intact. A layer of organic material with a maximum thickness of approximately 3 μm was evident on the inner surface of the stents. Conclusion: The present in vivo study demonstrates the biocompatibility, efficacy, and stability of PCU-coated Gianturco-Rosch stents in the biliary environment

  19. Liver, biliary and pancreatic injuries in pancre-aticobiliary maljunction model in cats

    Institute of Scientific and Technical Information of China (English)

    Feng Chen; Lin Tang; Zhi-Qi Zhang; Bing-Wei Jin; Wei-Feng Dong; Jian Wang; Shun-Gen Huang

    2015-01-01

    BACKGROUND: Pancreaticobiliary maljunction is a high risk factor of pancreatitis and biliary tract cancer. How this mal-junction affects the liver remains obscure. This study aimed to examine the effects of pancreaticobiliary maljunction on the liver, pancreas and gallbladder in a cat model. METHODS: A model of choledocho-pancreatic side-to-side ductal anastomosis was created in ten cats.Before the procedure, a small piece of tissue from the liver, pancreas and gallbladder was collected as a control. The common channel formation was checked by cholecystography. The livers, pancreases and gall-bladders of these cats were harvested for histological examina-tion. The expression of proliferating cell nuclear antigen in the gallbladder was examined with immunohistochemistry. RESULTS: Seven of the 10 cats survived for 6 months after surgery. The color of the liver was darker in the PBM model than the control specimen, with nodules on the surface. His-tological examination showed ballooning changes and inflam-matory infiltrations and the histopathological score increased significantly (P CONCLUSION: The present study demonstrated that pancreatico-biliary maljunction can lead to the injuries of the liver, pancreas and gallbladder.

  20. Biliary fascioliasis--an uncommon cause of recurrent biliary colics: report of a case and brief review.

    Science.gov (United States)

    Al Qurashi, Hesham; Masoodi, Ibrahim; Al Sofiyani, Mohammad; Al Musharaf, Hisham; Shaqhan, Mohammed; All, Gamal Nasr Ahmed Abdel

    2012-01-01

    Biliary parasitosis is one of the important causes of biliary obstruction in endemic areas, however due to migration and travel the disease is known to occur in non endemic zones as well. The spectrum of biliary fascioliasis ranges from recurrent biliary colics to acute cholangitis. The long term complications are gall stones, sclerosing cholangitis and biliary cirrhosis. We describe fascioliasis as a cause of recurrent biliary colics in a young male necessitating multiple hospitalizations over a period of four years. Investigative profile had been non-contributory every time he was hospitalized for his abdominal pain prior to the current presentation. He never had cholangitis due to the worm in the common bile duct. It was only at endoscopic retrograde cholangiopancreatography (ERCP) biliary fascioliasis was discovered to be the cause of his recurrent biliary colics. After removal of the live Fasciola hepatica from the common bile duct he became symptom free and is attending our clinic for last 11 months now. Clinical spectrum of biliary fascioliasis is discussed in this report. PMID:22566787

  1. 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

  2. Percutaneous management of tumoral biliary obstruction in children

    International Nuclear Information System (INIS)

    There is limited experience of percutaneous biliary interventions in children although they are safe and effective procedures. To evaluate the efficacy and safety of percutaneous management of tumoral biliary obstruction in children. Percutaneous biliary interventions were performed in eight children (six boys, two girls) with a mean age of 10.5 years (range 4-17 years). The interventions included percutaneous biliary drainage (five patients), percutaneous biliary drainage and placement of a self-expanding metallic stent (two patients), and percutaneous cholecystostomy (one patient). All patients had signs of obstructive jaundice and two had cholangitis. All procedures were successful. No procedure-related mortality was observed. Bilirubin levels returned to normal in four of the eight patients. Findings of cholangitis resolved in the two affected patients after the procedure and antibiotic treatment. Two patients underwent surgery after percutaneous biliary drainage procedures. A self-expanding metallic stent was placed in two patients with malignancy and the stents remained patent until death. Percutaneous biliary interventions can be performed safely for the management of tumoral biliary obstruction in children. (orig.)

  3. Ceftriaxone-associated nephrolithiasis and biliary pseudolithiasis in a child

    International Nuclear Information System (INIS)

    Ceftriaxone is a widely used third-generation cephalosporin. It is generally very safe, but complications of biliary pseudolithiasis and, rarely, nephrolithiasis have been reported in children. These complications generally resolve spontaneously with cessation of the ceftriaxone therapy; however, they may symptomatically mimic more serious clinical problems, such as cholecystitis. We report a case of both ceftriaxone-induced biliary pseudolithiasis and nephrolithiasis. (orig.)

  4. Ceftriaxone-associated nephrolithiasis and biliary pseudolithiasis in a child

    Energy Technology Data Exchange (ETDEWEB)

    Prince, Jeffrey S. [Department of Radiology, UCSD Medical Center, 200 West Arbor Dr., Mail Code 8756, San Diego, CA 92103-8756 (United States); Senac, Melvin O. [Department of Radiology, Children' s Hospital and Health Center, 3020 Children' s Way, San Diego, CA 92123-4282 (United States)

    2003-09-01

    Ceftriaxone is a widely used third-generation cephalosporin. It is generally very safe, but complications of biliary pseudolithiasis and, rarely, nephrolithiasis have been reported in children. These complications generally resolve spontaneously with cessation of the ceftriaxone therapy; however, they may symptomatically mimic more serious clinical problems, such as cholecystitis. We report a case of both ceftriaxone-induced biliary pseudolithiasis and nephrolithiasis. (orig.)

  5. Colchicine for primary biliary cirrhosis. Protocol for a Cochrane Review

    DEFF Research Database (Denmark)

    Gong, Y; Gluud, C

    2003-01-01

    Colchicine has been used for patients with primary biliary cirrhosis because of its immunomodulatory and antifibrotic potential. The therapeutical responses to colchicine in randomised clinical trials were inconsistent.......Colchicine has been used for patients with primary biliary cirrhosis because of its immunomodulatory and antifibrotic potential. The therapeutical responses to colchicine in randomised clinical trials were inconsistent....

  6. Biliary stenosis in the radiologist's eyes: A review

    International Nuclear Information System (INIS)

    The authors discuss the epidemiology, etiology, morphology, and staging of biliary stenoses and coexisting diseases. The best known classification of biliary stenosis, based on anatomic relationships and cholangiographic images, is described. Diagnostic approach, including both historical methods and modern imaging techniques such as ultrasound, computed tomography, endoscopic procedures, and magnetic resonance, are also presented. (author)

  7. Percutaneous management of tumoral biliary obstruction in children

    Energy Technology Data Exchange (ETDEWEB)

    Akinci, Devrim; Gumus, Burcak; Ozkan, Orhan S.; Ozmen, Mustafa N.; Akhan, Okan [Hacettepe School of Medicine, Department of Radiology, Sihhiye, Ankara (Turkey); Ekinci, Saniye [Hacettepe School of Medicine, Department of Paediatric Surgery, Sihhiye, Ankara (Turkey); Akcoren, Zuhal [Hacettepe School of Medicine, Department of Paediatric Pathology, Sihhiye, Ankara (Turkey); Kutluk, Tezer [Hacettepe School of Medicine, Department of Paediatric Oncology, Sihhiye, Ankara (Turkey)

    2007-10-15

    There is limited experience of percutaneous biliary interventions in children although they are safe and effective procedures. To evaluate the efficacy and safety of percutaneous management of tumoral biliary obstruction in children. Percutaneous biliary interventions were performed in eight children (six boys, two girls) with a mean age of 10.5 years (range 4-17 years). The interventions included percutaneous biliary drainage (five patients), percutaneous biliary drainage and placement of a self-expanding metallic stent (two patients), and percutaneous cholecystostomy (one patient). All patients had signs of obstructive jaundice and two had cholangitis. All procedures were successful. No procedure-related mortality was observed. Bilirubin levels returned to normal in four of the eight patients. Findings of cholangitis resolved in the two affected patients after the procedure and antibiotic treatment. Two patients underwent surgery after percutaneous biliary drainage procedures. A self-expanding metallic stent was placed in two patients with malignancy and the stents remained patent until death. Percutaneous biliary interventions can be performed safely for the management of tumoral biliary obstruction in children. (orig.)

  8. Percutaneous transhepatic biliary drainage in malignant extrahepatic cholestasis

    Energy Technology Data Exchange (ETDEWEB)

    Hoevels, J.

    1985-03-01

    The technique of non-surgical percutaneous transhepatic biliary drainage has been improved recently. Combined internal and external drainage of bile was enabled by manipulation of a guide wire and a drainage catheter through the stenosed or obstructed section of the extrahepatic biliary ducts. Experience have been gained concerning internal drainage of bile by percutaneous transhepatic insertion of an endoprosthesis for some years now.

  9. Management of Biliary Complications in the Liver Transplant Patient

    OpenAIRE

    James W. Ostroff

    2010-01-01

    Biliary complications after liver transplantation remain common. Resources for livers are limited, and these individuals are often ill, making nonoperative treatment and management attractive options. The endoscopic route for evaluation (endoscopic retrograde cholangiopancreatography) remains preferable, due to its safety profile, as opposed to the percutaneous route (percutaneous transhepatic cholangiography with percutaneous transhepatic biliary drainage), though the endoscopic route may no...

  10. Cholangiography and Interventional Biliary Radiology in Adult Liver Transplantation

    OpenAIRE

    Zajko, Albert B.; Campbell, William L.; Bron, Klaus M.; Lecky, James W.; Iwatsuki, Shunzaburo; Shaw, Byers W.; Starzl, Thomas E.

    1985-01-01

    Radiographic assessment of the biliary tract is often essential in patients who have undergone liver transplantation. T- or straight-tube cholangiography, percutaneous transhepatic cholangiography, and endoscopic retrograde cholangiography all may be used. A total of 264 cholangiograms in 79 adult liver transplant patients (96 transplants) was reviewed. Normal radiographic features of biliary reconstructive procedures, including choledochocholedochostomy and choledochojejunostomy, are demonst...

  11. Interventional radiology of the biliary system and pancreas

    Energy Technology Data Exchange (ETDEWEB)

    Teplick, S.K.; Haskin, P.H.; Matsumoto, T.; Wolferth, C.C. Jr.; Pavlides, C.A.; Gain, T.

    1984-02-01

    In recent years, newer techniques have become available to the clinician for the diagnosis and treatment of biliary and pancreatic disease. This article emphasizes interventional procedures through the liver, such as percutaneous transhepatic cholangiography, percutaneous transhepatic biliary drainage, and ancillary techniques. Also discussed are the nonsurgical management of bile duct calculi and the diagnosis and treatment of pancreatic tumors, abscesses, and pseudocysts.

  12. Treatment of malignant biliary obstruction by combined percutaneous transhepatic biliary drainage with local tumor treatment

    Institute of Scientific and Technical Information of China (English)

    Xiao-Jun Qian; Ren-You Zhai; Ding-Ke Dai; Ping Yu; Li Gao

    2006-01-01

    AIM: To evaluate the utility of local tumor therapy combined with percutaneous transhepatic biliary drainage (PTBD) for malignant obstructive biliary disease.METHODS: A total of 233 patients with malignant biliary obstruction were treated in our hospital with PTBD by placement of metallic stents and/or plastic tubes. After PTBD, 49 patients Accepted: brachytherapy or extraradiation therapy or arterial infusion chemotherapy. The patients were followed up with clinical and radiographic evaluation. The survival and stent patency rate were calculated by Kaplan-Meier survival analysis.RESULTS: Twenty-two patients underwent chemotherapy (11 cases of hepatic carcinoma, 7 cases of pancreatic carcinoma, 4 cases of metastatic lymphadenopathy), and 14 patients received radiotherapy (10 cases of cholangiocarcinoma, 4 cases of pancreatic carcinoma), and 13patients Accepted: brachytherapy (7 cases of cholangiocarcinoma, 3 cases of pancreatic carcinoma, 4 cases of metastatic lymphadenopathy). The survival rate of the local tumor treatment group at 1, 3, 6, and 12 months was 97.96%, 95.92%, 89.80%, and 32.59% respectively,longer than that of the non treatment group. The patency rate at 1, 3, 6, and 12 months was 97.96%, 93.86%,80.93%, and 56.52% respectively. The difference of patency rate was not significant between treatment group and non treatment group.CONCLUSION: Our results suggest that local tumor therapy could prolong the survival time of patients with malignant biliary obstruction, and may improve stent patency.

  13. Antioxidants vitamin E and C attenuate hepatic fibrosis in biliary-obstructed rats

    Institute of Scientific and Technical Information of China (English)

    Ali Riza Soylu; Huseyin Baloglu; Mevlut Ture; Kemal Kutlu; Kadir Kaymak; Nurettin Aydogdu; Umit Nusret Basaran; Semsi Altaner; Orhan Tarcin; Nursal Gedik; Hasan Umit; Ahmet Tezel; Gulbin Dokmeci

    2006-01-01

    AIM:To investigate whether antioxidants vitamin E and C can retard development of hepatic fibrosis in the biliary-obstructed rats.METHODS: Fifty Wistar albino rats were randomly assigned to 5 groups (10 rats in each). Bile duct was ligated in 40 rats and they were treated as follows: group vitC, vitamin C 10 rog/kg sc daily; group vitE, vitamin E 15 mg/kg sc daily; group vitEC, both of the vitamins; bile duct-ligated (BDL, control) group, physiological saline sc. The fifth group was assigned to sham operation. At the end of fourth week, the rats were decapitated, and hepatic tissue biochemical collagen content and collagen surface area were measured. Hepatic tissue specimens were histopathologically evaluated according to Scheuer system. Serum hyaluronate levels were measured by ELTSA method.RESULTS: Despite being higher than sham group, hepatic collagen level was significantly decreased in each of the vitC, vitE and vitEC groups (32.7 ± 1.2, 33.8 ±2.9, 36.7 ± 0.5 μg collagen/mg protein, respectively)compared to BDL (48.3 ± 0.6 mg collagen/g protein) (P< 0.001 for each vitamin group). Each isolated vitamin C, isolated vitamin E and combined vitamin E/C supplementation prevented the increase in hepatic collagen surface density (7.0% ± 1.1%, 6.2% ± 1.7%, 12.3% ±2.0%, respectively) compared to BDL (17.4% ± 5.6%) (P< 0.05 for each). The same beneficial effect of vitamin C,vitamin E and combined vitamin E/C treatment was also observed on the decrease of serum hyaluronate levels compared to BDL group (P < 0.001). The relative liver and spleen weights, serum transaminases, cholestatic enzymes, bilirubins and histopathological inflammation scores were not different between the antioxidant treatment groups and the control. However, fibrosis staging scores were obviously reduced only in the vitamin E/C combination group (vit EC: 2.4 ± 0.8 vs BDL: 3.1 ± 0.7;P < 0.05).CONCLUSION: Each antioxidant vitamin E, vitamin C and their combination retard hepatic

  14. Biliary reflux detection in anomalous union of the pancreatico-biliary duct patients

    Institute of Scientific and Technical Information of China (English)

    Suk Keu Yeom; Seung Wha Lee; Sang Hoon Cha; Hwan Hoon Chung; Bo Kyung Je; Baek Hyun Kim; Jong Jin Hyun

    2012-01-01

    AIM:To demonstrate the imaging findings of biliopancreatic and pancreatico-biliary reflux in patients with anomalous union of the pancreatico-biliary duct (AUPBD)on gadoxetic acid-enhanced functional magnetic resonance cholangiography (fMRC).METHODS:This study included six consecutive patients (two men and four women; mean age 47.5 years) with AUPBD.All subjects underwent endoscopic retrograde cholangiopancreatography (ERCP); one subject also underwent bile sampling of the common bile duct (CBD) to measure the amylase level because his gadoxetic acidenhanced fMRC images showed evidence of pancreatico-biliary reflux of pancreatic secretions.Of the five patients with choledochal cysts,four underwent pyloruspreserving pancreaticoduodenectomy.RESULTS:The five cases of choledochal cysts were classified as Todani classification I.In three of the six patients with AUPBD,injected contrast media reached the distal CBD and pancreatic duct on delay images,suggesting biliopancreatic reflux.In two of these six patients,a band-like filling defect was noted in the CBD on pre-fatty meal images,which decreased in size on delayed post-fatty meal images,suggesting pancreatico-biliary reflux of pancreatic secretions,and the bile sampled from the CBD in one patient had an amylase level of 113 000 IU/L.In one of the six patients with AUPBD,contrast media did not reach the distal CBD due to multiple CBD stones.CONCLUSION:Gadoxetic acid-enhanced fMRC successfully demonstrated biliopancreatic reflux of bile and pancreatico-biliary reflux of pancreatic secretions in patients with AUPBD with and without choledochal cysts.

  15. Percutaneous cholangioscopy in obstructed biliary metal stents

    International Nuclear Information System (INIS)

    Purpose. To reevaluate the reasons for the occlusion of self-expanding biliary metal stents, on the basis of cholangioscopic findings. Methods. Percutaneous transhepatic cholangioscopy (PTCS) was performed in 15 patients with obstructed biliary Wallstents. The reason for stent insertion was a malignant obstruction in 14 patients; 1 had a benign biliary stricture. Conventional noncovered stents had been inserted in 12 patients; in 3 cases a polyurethane-covered prototype Wallstent had been used. Stent occlusions occurred after 1-55 months. PTCS was performed with a 2.3-mm endoscope through an 11 Fr sheath. Biopsies were taken via the working channel of the endoscope. Results. In all patients with noncovered stents the inner surface of the stent was highly irregular with seaweed-like protrusions (biopsy-proven granulation tissue). Stent incorporation varied from absent (n=1) to subtotal (n=8), but was always incomplete, no matter how long the stent had been in place. Tumor ingrowth was histologically proven in 2 patients. One patient had a large occluding concrement at the proximal end of the stent. In patients with covered stents, the inner surface appeared more regular; however, viable granulation tissue was found inside two stents and tumor ingrowth in one of them. Conclusion. PTCS showed that incorporation of the stent is virtually always incomplete. The factors contributing most to stent occlusion are the buildup of granulation tissue, bile sludge, and tumor overgrowth. Stone formation and tumor ingrowth can also be important, although less common causes of occlusion. A polyurethane stent covering could not prevent tumor ingrowth in one patient and the buildup of viable granulation tissue inside the stent in two further patients; mean stent patency in the three patients with such a stent was 3 months

  16. Successful endoscopic ultrasound-guided overstenting biliary drainage through a pre-existing proximal migrated metal biliary stent.

    Science.gov (United States)

    Artifon, E L A; Takada, J; Okawa, L; Ferreira, F; Santos, M; Moura, E G H; Otoch, J P; Sakai, P

    2011-01-01

    Biliary endoscopic drainage using metallic self-expanded stents has become a well-established method for palliative treatment of malignant biliary obstruction. However, its occlusion, mainly by tumor overgrowth, is still the main complication without a standard treatment. We here describe a new method of treatment for biliary metallic stent occlusion, through the echo guided biliary drainage. We present a 68-year-old patient with metastatic pancreatic cancer previously treated for jaundice with ERCP and self-expandable metallic stent insertion. Four weeks later, the patient developed jaundice and symptoms of gastric outlet obstruction. A new ERCP confirmed obstruction of the second portion of the duodenum, due to diffuse tumor growth. EUS was performed, and the previous metal biliary stent was seen occluded at the distal portion in the common bile duct. A EUS-guided choledocododenostomy was performed and then, an overlapping self-expanding metal enteral stent was placed through the malignant obstruction. There were no early complications and the procedure was also clinically effective in relieving jaundice and gastric outlet obstruction symptoms. If ERCP fails in the management of occluded biliary metallic stents, EUS biliary drain can provide effective biliary decompression and should be considered an alternative to other endoscopic techniques. PMID:22041320

  17. Radiation diagnosis of hepatic and biliary diseases

    International Nuclear Information System (INIS)

    The paper deals with combined diagnosis of hepatic and biliary diseases, involving a wide range of nosological entities. It shown the potentialities of currently available diagnostic techniques for the most common diseases. A complex of the used diagnostic techniques involved ultrasonic scanning, X-ray computed tomography, hepatobiliary scintigraphy, angiography, retrograde cholangiopancreatography, transhepatic cholangiography, etc. The authors have demonstrated that each method used is highly diagnostically effective. At the same time they have shown the limits of each technique in the diagnosis of certain diseases. The authors' data suggest that the total efficiency of the applied complex of diagnostic means approaches 100%. 64 refs., 7 figs., 3 tabs

  18. Genetics and genomics of primary biliary cirrhosis.

    Science.gov (United States)

    Juran, Brian D; Lazaridis, Konstantinos N

    2008-05-01

    The etiologic and pathogenic factors contributing to primary biliary cirrhosis (PBC) development, progression, response to treatment, and outcome remain a mystery. Recognition of the genomic regions harboring risk factors is hindered by the rarity and late onset of PBC. Recent advancements in genomics hold promise for understanding, prevention, and therapy of PBC. Large registries and biospecimen repositories of patients who have PBC, their family members, and controls are needed. Haplotype mapping-based association studies are necessary for defining genetic predisposition. Experimental data will provide the means for fine mapping studies, resequencing efforts, functional experimentation, and elucidation of gene-environment and gene-gene interaction. PMID:18456185

  19. Percutaneous transhepatic embolization of biliary leakage with N-butyl cyanoacrylate

    OpenAIRE

    Gianpaolo Carrafiello; Anna Maria Ierardi; Filippo Piacentino; Larissa N Cardim

    2012-01-01

    Biliary leakage is a known complication after biliary surgery. In this report, we describe an uncommon treatment of a common biliary complication, wherein we used percutaneous transhepatic injection of N-butyl cyanoacrylate (NBCA) to treat a biliary leak in an 83-year-old patient.

  20. Optimal biliary drainage for inoperable Klatskin's tumor based on Bismuth type

    OpenAIRE

    Lee, Sang Hyub; Park, Joo Kyung; Yoon, Won Jae; Lee, Jun Kyu; Ryu, Ji Kon; Yoon, Yong Bum; Kim, Yong-Tae

    2007-01-01

    AIM: To investigate differences in the effects of biliary drainage procedures in patients with inoperable Klatskin’s tumor based on Bismuth type, considering endoscopic retrograde biliary drainage (ERBD), external percutaneous transhepatic biliary drainage (EPTBD) and internal biliary stenting via the PTBD tract (IPTBD).

  1. Percutaneous transhepatic embolization of biliary leakage with N-butyl cyanoacrylate

    Directory of Open Access Journals (Sweden)

    Gianpaolo Carrafiello

    2012-01-01

    Full Text Available Biliary leakage is a known complication after biliary surgery. In this report, we describe an uncommon treatment of a common biliary complication, wherein we used percutaneous transhepatic injection of N-butyl cyanoacrylate (NBCA to treat a biliary leak in an 83-year-old patient.

  2. Elevated serum levels of a biliary glycoprotein (BGP I) in patients with liver or biliary tract disease

    International Nuclear Information System (INIS)

    Human hepatic bile contains a glycoprotein (Biliary glycoprotein I BGP I) which cross-reacts with the carcinoembryonic antigen (CEA). A radioimmunoassay for BGP I was developed. The interference of CEA or 'non-specific cross-reacting antigen' (NCA) was small. The serum levels of BGP I were determined in healthy subjects, in patients with hepato-biliary diseases and in patients with various infections or inflammatory disorders. Healthy individuals, including pregnant women, had a serum BGP I concentration of about 0.5 - 1 mg/l. Diseases of the liver or biliary tract (e.g. hepatitis A or B, cytomegalovirus Hepatitis, obstructive jaundice or primary biliary cirrhosis) were associated with elevated serum levels of BGP I, as opposed to infectious diseases not affecting the liver mostly showing values within the normal range. Raised levels of serum BGP I activity may reflect biliary obstruction as a results of interference with normal BGP I secretion in the bile. (author)

  3. EUS-guided biliary drainage with placement of a new partially covered biliary stent for palliation of malignant biliary obstruction: a case series.

    Science.gov (United States)

    Fabbri, C; Luigiano, C; Fuccio, L; Polifemo, A M; Ferrara, F; Ghersi, S; Bassi, M; Billi, P; Maimone, A; Cennamo, V; Masetti, M; Jovine, E; D'Imperio, N

    2011-05-01

    Endoscopic ultrasonography-guided biliary drainage (EUS-BD) has been developed as an alternative drainage technique in patients with obstructive jaundice where endoscopic retrograde cholangiopancreatography (ERCP) has failed. Between July 2008 and December 2009, 16 patients (9 men; median age 79 years) with biliopancreatic malignancy, who were candidates for alternative techniques of biliary decompression because ERCP had been unsuccessful, underwent EUS-BD with placement of a transmural or transpapillary partially covered nitinol self-expandable metal stent (SEMS). EUS-assisted cholangiography was successful in all patients, with definition of the relevant anatomy, but biliary drainage was successfully performed in only 12 (75 %) of the 16 patients (9 choledochoduodenostomies with SEMS placement and 3 biliary rendezvous procedures with papillary SEMS placement), with regression of the cholestasis. No major complications and no procedure-related deaths occurred. There was one case of pneumoperitoneum which was managed conservatively. The median follow-up was 170 days. During the follow-up, eight patients of the 12 patients in whom biliary draining was successful died; four are currently alive. None of the patients required endoscopic reintervention. This series demonstrated that EUS-BD with a partially covered SEMS has a high rate of clinical success and low complication rates, and could represent an alternative choice for biliary decompression. PMID:21271507

  4. Enzyme inhibition assay for pyruvate dehydrogenase complex: Clinical utility for the diagnosis of primary biliary cirrhosis

    Institute of Scientific and Technical Information of China (English)

    Katsuhisa Omagri; Hiroaki Hazama; Shigeru Kohno

    2005-01-01

    Primary biliary cirrhosis (PBC) is usually diagnosed by the presence of characteristic histopathological features of the liver and/or antimitochondrial antibodies (AMA) in the serum traditionally detected by immunofluorescence.Recently, new and more accurate serological assays for the detection of AMA, such as enzyme-linked immunosorbent assay (ELISA), immunoblotting, and enzyme inhibition assay, have been developed. Of these,the enzyme inhibition assay for the detection of antipyruvate dehydrogenase complex (PDC) antibodies offers certain advantages such as objectivity, rapidity,simplicity, and low cost. Since this assay has almost 100% specificity, it may have particular applicability in screening the at-risk segment of the population in developing countries. Moreover, this assay could be also used for monitoring the disease course in PBC. Almost all sera of PBC-suspected patients can be confirmed for PBC or non-PBC by the combination results of immunoblotting and enzyme inhibition assay without histopathological examination. For the development of a "complete" or "gold standard" diagnostic assay for PBC, similar assays of the enzyme inhibition for anti2-oxoglutarate dehydrogenase complex (OGDC) and anti-branched chain oxo-acid dehydrogenase complex (BCOADC) antibodies will be needed in future.

  5. Malignant biliary obstruction: From palliation to treatment

    Science.gov (United States)

    Boulay, Brian R; Birg, Aleksandr

    2016-01-01

    Malignant obstruction of the bile duct from cholangiocarcinoma, pancreatic adenocarcinoma, or other tumors is a common problem which may cause debilitating symptoms and increase the risk of subsequent surgery. The optimal treatment - including the decision whether to treat prior to resection - depends on the type of malignancy, as well as the stage of disease. Preoperative biliary drainage is generally discouraged due to the risk of infectious complications, though some situations may benefit. Patients who require neoadjuvant therapy will require decompression for the prolonged period until attempted surgical cure. For pancreatic cancer patients, self-expanding metallic stents are superior to plastic stents for achieving lasting decompression without stent occlusion. For cholangiocarcinoma patients, treatment with percutaneous methods or nasobiliary drainage may be superior to endoscopic stent placement, with less risk of infectious complications or failure. For patients of either malignancy who have advanced disease with palliative goals only, the choice of stent for endoscopic decompression depends on estimated survival, with plastic stents favored for survival of stent patency and patient survival for these patients by achieving local control of the obstructing tumor. Both photodynamic therapy and radiofrequency ablation may play a role in extending survival of patients with malignant biliary obstruction. PMID:27326319

  6. [Appropriate Biliary Drainage Methods for Unresectable Cholangiocarcinomas].

    Science.gov (United States)

    Oishi, Tatsurou; Kanemoto, Yoshiaki; Yoshioka, Yuuta; Sawada, Ryuuichirou; Sekine, Sachi; Miyanaga, Hiroto; Sakahira, Hideki; Takahashi, Hironori; Miyamoto, Katsufumi; Koyama, Takashi

    2015-11-01

    We investigated the efficacy of different biliary drainage methods for the treatment of unresectable cholangiocarcinomas. We performed a retrospective study of 28 patients with unresectable cholangiocarcinomas who underwent biliary drainage at our hospital between January 2008 and June 2014 to compare the incidence of post-drainage stent dysfunction (SD) and reintervention (RI) for SD according to primary drainage method, lesion site, and complication status (the presence or absence of cholangitis). The duration of stent patency was compared between the different stent types. No significant differences in the incidence of SD and RI were found according to primary drainage methods, lesion site, or the presence or absence of cholangitis. The mean durations of stent patency for plastic and metal stents were 2.7 months and 7.4 months, respectively, suggesting that metal stents should be selected when the estimated prognosis is ≥2 months. Furthermore, metal stent placement, rather than the additional placement of plastic stents, should be considered a feasible option in cases of SD. PMID:26805093

  7. Metallic stents in malignant biliary obstruction

    International Nuclear Information System (INIS)

    Purpose. Retrospective analysis of our results with metallic stent placement for malignant biliary strictures. We sought to determine parameters that influence stent patency. Methods. A total of 95 Wallstents were implanted in 65 patients (38 men, 27 women; mean age, 65.1 years) with malignant biliary obstruction. Serum bilirubin levels were assessed in 48 patients; the mean value prior to intervention was 15.0 mg/dl. Results. In 12 patients (21%) complications occurred as a result of percutaneous transhepatic drainage. Stent implantation was complicated in 13 patients, but was possible in all patients. A significant decrease in bilirubin level was seen in 83.3% of patients following stent implantation. Approximately 30% of patients developed recurrent jaundice after a mean 97.1 days. In 9 patients (15%) the recurrent jaundice was caused by stent occlusion due to tumor growth. The mean follow-up was 141.8 days, the mean survival 118.7 days. Patients with cholangiocarcinomas and gallbladder carcinomas had the best results. Worse results were seen in patients with pancreatic tumors and with lymph node metastases of colon and gastric cancers. Conclusions. The main predictive factors for occlusion rate and survival are the type of primary tumor, tumor stage, the decrease in bilirubin level, and the general condition of the patient

  8. Cholangiocyte anion exchange and biliary bicarbonate excretion

    Institute of Scientific and Technical Information of China (English)

    Jesús M Banales; Jesús Prieto; Juan F Medina

    2006-01-01

    Primary canalicular bile undergoes a process of fluidization and alkalinization along the biliary tract that is influenced by several factors including hormones, innervation/neuropeptides, and biliary constituents. Theexcretion of bicarbonate at both the canaliculi and the bile ducts is an important contributor to the generation of the so-called bile-salt independent flow. Bicarbonate is secreted from hepatocytes and cholangiocytes through parallel mechanisms which involve chloride efflux through activation of Cl- channels, and further bicarbonate secretion via AE2/SLC4A2-mediated Cl-/HCO3-exchange. Glucagon and secretin are two relevant hormones which seem to act very similarly in their target cells (hepatocytes for the former and cholangiocytes for the latter). These hormones interact with their specific G protein-coupled receptors, causing increases in intracellular levels of cAMP and activation of cAMP-dependent Cl- and HCO3- secretory mechanisms. Both hepatocytes and cholangiocytes appear to have cAMP-responsive intracellular vesicles in which AE2/SLC4A2 colocalizes with cell specific Cl- channels (CFTR in cholangiocytes and not yet determined in hepatocytes) and aquaporins (AQP8 in hepatocytes and AQP1 in cholangiocytes). cAMP-induced coordinated trafficking of these vesicles to either canalicular or cholangiocyte lumenal membranes and further exocytosis results in increased osmotic forces and passive movement of water with net bicarbonate-rich hydrocholeresis.

  9. Malignant biliary obstruction: From palliation to treatment.

    Science.gov (United States)

    Boulay, Brian R; Birg, Aleksandr

    2016-06-15

    Malignant obstruction of the bile duct from cholangiocarcinoma, pancreatic adenocarcinoma, or other tumors is a common problem which may cause debilitating symptoms and increase the risk of subsequent surgery. The optimal treatment - including the decision whether to treat prior to resection - depends on the type of malignancy, as well as the stage of disease. Preoperative biliary drainage is generally discouraged due to the risk of infectious complications, though some situations may benefit. Patients who require neoadjuvant therapy will require decompression for the prolonged period until attempted surgical cure. For pancreatic cancer patients, self-expanding metallic stents are superior to plastic stents for achieving lasting decompression without stent occlusion. For cholangiocarcinoma patients, treatment with percutaneous methods or nasobiliary drainage may be superior to endoscopic stent placement, with less risk of infectious complications or failure. For patients of either malignancy who have advanced disease with palliative goals only, the choice of stent for endoscopic decompression depends on estimated survival, with plastic stents favored for survival of < 4 mo. New endoscopic techniques may actually extend stent patency and patient survival for these patients by achieving local control of the obstructing tumor. Both photodynamic therapy and radiofrequency ablation may play a role in extending survival of patients with malignant biliary obstruction. PMID:27326319

  10. Chronic typhoid infection and the risk of biliary tract cancer and stones in Shanghai, China

    OpenAIRE

    Pruckler James; Chen Jinbo; Wang Bing-Shen; Rashid Asif; Quraishi Sabah M; Sakoda Lori C; Gao Yu-Tang; Safaeian Mahboobeh; Mintz Eric; Hsing Ann W

    2011-01-01

    Abstract Previous studies have shown a positive association between chronic typhoid carriage and biliary cancers. We compared serum Salmonella enterica serovar Typhi antibody titers between biliary tract cancer cases, biliary stone cases without evidence of cancer, and healthy subjects in a large population-based case-control study in Shanghai, China. Participants included 627 newly diagnosed primary biliary tract cancer patients; 1,037 biliary stone cases (774 gallbladder and 263 bile-duct) ...

  11. Successful Endoscopic Ultrasound-Guided Transduodenal Biliary Drainage Through a Pre-Existing Duodenal Stent

    OpenAIRE

    Paul J Belletrutti; Hans Gerdes; Schattner, Mark A

    2010-01-01

    Context When ERCP fails in the setting of combined biliary and duodenal obstruction, EUS-guided biliary drainage has emerged as an alternate method of biliary decompression. Case report We present a case of a 40-year-old man with advanced pancreatic cancer and a pre-existing duodenal wall stent who subsequently develops jaundice due to biliary obstruction. An ERCP was technically unsuccessful as the papilla was inaccessible despite probing within the duodenal stent. Transduodenal biliary drai...

  12. Therapeutic transjejunal endoscopy for the treatment of biliary complications after choledochojejunostomy

    OpenAIRE

    Liu, Guo-Ping; Wen-xi ZHU; CHENG, GUANG-MING; Shu-ren MA

    2012-01-01

    The present study aimed to assess the value of endoscopic jejunostomy for post-biliary intestinal anastomosis biliary complications. The clinical data of the endoscopic therapies by jejunal approach for post-biliary intestinal anastomosis biliary complications in 13 patients (16 surgeries in total) were retrospectively analyzed. The surgical success rate was 100% (16/16). Nasobiliary tube detention was performed for 2 patients, plastic stent placement for 5 and biliary metal stent placement f...

  13. Unilobar Versus Bilobar Biliary Drainage: Effect on Quality of Life and Bilirubin Level Reduction

    OpenAIRE

    Shivanand Gamanagatti; Tejbir Singh; Raju Sharma; Srivastava, Deep N; Nihar Ranjan Dash; Pramod Kumar Garg

    2016-01-01

    Background: Percutaneous biliary drainage is an accepted palliative treatment for malignant biliary obstruction. Purpose: To assess the effect on quality of life (QOL) and bilirubin level reduction in patients with inoperable malignant biliary obstruction treated by unilobar or bilobar percutaneous transhepatic biliary drainage (PTBD). Materials and Methods: Over a period of 2 years, 49 patients (age range, 22–75 years) of inoperable malignant biliary obstruction were treated by PTBD. T...

  14. Breast Hemangioma: MR Appearance with Histopathological Correlation

    Directory of Open Access Journals (Sweden)

    Rasha Ameen

    2012-01-01

    Full Text Available Breast hemangioma is a rare tumor and when small, it may be difficult to diagnose using conventional imaging techniques. In this report the MR appearance is described with histopathological correlation.

  15. Breast Hemangioma: MR Appearance with Histopathological Correlation

    OpenAIRE

    Rasha Ameen; Uday Mandalia; Amanda (Anne) Marr; Paula Mckensie

    2012-01-01

    Breast hemangioma is a rare tumor and when small, it may be difficult to diagnose using conventional imaging techniques. In this report the MR appearance is described with histopathological correlation.

  16. Management of benign biliary strictures: current status and perspective.

    Science.gov (United States)

    Kaffes, Arthur J

    2015-09-01

    Benign biliary strictures are common and occur either from hepato-biliary surgery or from diseases including chronic pancreatitis and primary sclerosing cholangitis, among others. The treatment of many such strictures is endoscopic with evolving new approaches especially with fully covered metal stents. The only classification system available is for postoperative strictures with the intention to guide surgical correction. There is no useful classification system to guide both assessment and management of benign biliary strictures. This proposed classification is relevant to patient care in assisting diagnosis and endoscopic management. PMID:26147976

  17. Metallic stents for management of malignant biliary obstruction

    International Nuclear Information System (INIS)

    In patients with inoperable malignant biliary obstruction, percutaneous transhepatic biliary drainage (PTBD) has been the method of choice for palliative treatment. All patients except three had undergone PTBD, and the stents were placed 5-7 days after the initial drainage procedure. Three patients underwent stent placement on the same day of PTBD. External drainage catheter is converted to various types of tube endoprostheses with associated physiologic and psychologic benefits. Tube stents, however, have some problems such as migration, occlusion, and traumatic implantation procedure. We report our experiences and clinical results of percutaneous placement of metallic stents in 40 patients with malignant biliary obstruction

  18. Balloon dilatation of intrahepatic biliary strictures in liver transplantation

    International Nuclear Information System (INIS)

    Objective: To evaluate the efficacy of balloon dilatation in the treatment of intrahepatic biliary strictures in patients with liver transplantation. Methods: Of the 100 patients with liver transplantation, 16 patients had intrahepatic biliary strictures and received balloon dilatation treatment. Results: Initial technical balloon dilatation was successful in 14 caes but failed in 2 cases. There were no procedure-related complications. 4 restenosis occurred and they were treated with repeated balloon dilatation treatment. Conclusion: Balloon dilatation represented an effective and relatively safe treatment for biliary stricture in liver transplant recipients. For restenosis, balloon dilatation was also an effective treatment

  19. Biliary excretion of intravenous [14C] omeprazole in humans

    International Nuclear Information System (INIS)

    We have studied the biliary excretion of [14C] omeprazole in humans. The study was performed in eight healthy subjects and the technique used was based on multiple marker dilution principles with double-lumen tubes placed in both the stomach and intestine. The results obtained show a 16% biliary excretion of [14C] omeprazole. These data suggest a minimal spillover of omeprazole from the gastric mucosa into the gastric lumen in humans. The results also agree with previous data of the fecal recovery of radiolabeled omeprazole that suggest that the fecal excretion of intravenous omeprazole in humans is entirely accounted for by biliary excretion

  20. Cystic diseases of the biliary tract and liver

    Directory of Open Access Journals (Sweden)

    Nafiye Urgancı

    2008-06-01

    Full Text Available Cystic diseases of liver are recognized in infancy and childhood initially. Cystic diseases of liver and biliary tract are choledocal cysts, autosomal recessive and autosomal dominant polycystic kidney disease, congenital hepatic fibrosis and Caroli disease (cystic dilatation of intrahepatic bile ducts. Choledochal cysts and Caroli disease do not allow biliary flow, cause chronic or obstructive cholestasis and progressive liver disease. In congenital hepatic fibrosis and polycystic kidney disease there is cystic formations at terminal interlobular bile ducts, but cholestasis is not seen. They don’t cause liver and biliary tract functional disturbances. (Turk Arch Ped 2008; 43: 40-5

  1. Biliary enhanced MR imaging by Gd-DTPA

    Energy Technology Data Exchange (ETDEWEB)

    Ohkawa, Shinichi; Fujikura, Yuji; Kanai, Toshio (Hiratsuka City Hospital, Kanagawa (Japan)); Hiramatsu, Kyoichi

    1992-05-01

    Biliary enhanced MRI (BEMRI) by Gd-DTPA via PTCD and/or PTGBD tube for obstructive jaundice was performed in 8 patients. In all cases, biliary tract was clearly visualised as high signal intensity on T1 weighted images. On same images, primary lesion such as common bile duct cancer was also visualised as well as portal system. In addition, MR angiography (MRA) by 2D-time of flight method was performed. MRA with BEMRI shows portal encasement on the same image as biliary tract obstruction. This suggests MRA with BEMRI may replace the other modality for obstructive jaundice. (author).

  2. Peritoneal seeding of cholangiocarcinoma in patients with percutaneous biliary drainage

    International Nuclear Information System (INIS)

    Percutaneous transhepatic catheter decompression is performed increasingly as an adjunct or alternative to surgery in patients with benign or malignant biliary obstruction. The authors recently saw three patients with cholangiocarcinoma in whom metastatic seeding of the peritoneal serosa was identified some months after initial percutaneous transhepatic biliary drainage. Although no tumor was found along the hepatic tract of the biliary drainage catheters to implicate the drainage tubes as the direct source of peritoneal spread, the occurrence of this rare type of metastasis of cholangiocarcinoma in patients with potential access of tumor cells to the peritoneal cavity via the catheter tracts does suggest such a relation. The clinical history of one patient is presented

  3. Peritoneal seeding of cholangiocarcinoma in patients with percutaneous biliary drainage

    Energy Technology Data Exchange (ETDEWEB)

    Miller, G.A. Jr.; Heaston, D.K.; Moore, A.V. Jr.; Mills, S.R.; Dunnick, N.R.

    1983-09-01

    Percutaneous transhepatic catheter decompression is performed increasingly as an adjunct or alternative to surgery in patients with benign or malignant biliary obstruction. The authors recently saw three patients with cholangiocarcinoma in whom metastatic seeding of the peritoneal serosa was identified some months after initial percutaneous transhepatic biliary drainage. Although no tumor was found along the hepatic tract of the biliary drainage catheters to implicate the drainage tubes as the direct source of peritoneal spread, the occurrence of this rare type of metastasis of cholangiocarcinoma in patients with potential access of tumor cells to the peritoneal cavity via the catheter tracts does suggest such a relation. The clinical history of one patient is presented.

  4. Metallic stents for management of malignant biliary obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Byung Hee; Do, Young Soo; Byun, Hong Sik; Kim, Kie Hwan; Chin, Soo Yil [Korea Cancer Center Hospital, Seoul (Korea, Republic of)

    1992-11-15

    In patients with inoperable malignant biliary obstruction, percutaneous transhepatic biliary drainage (PTBD) has been the method of choice for palliative treatment. All patients except three had undergone PTBD, and the stents were placed 5-7 days after the initial drainage procedure. Three patients underwent stent placement on the same day of PTBD. External drainage catheter is converted to various types of tube endoprostheses with associated physiologic and psychologic benefits. Tube stents, however, have some problems such as migration, occlusion, and traumatic implantation procedure. We report our experiences and clinical results of percutaneous placement of metallic stents in 40 patients with malignant biliary obstruction.

  5. Spectrum of biliary complications following live donor livertransplantation

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Liver transplantation is the optimal treatment formany patients with advanced liver disease, includingdecompensated cirrhosis, hepatocellular carcinomaand acute liver failure. Organ shortage is the maindeterminant of death on the waiting list and hence livingdonor liver transplantation (LDLT) assumes importance.Biliary complications are the most common post operativemorbidity after LDLT and occur due to anatomical andtechnical reasons. They include biliary leaks, stricturesand cast formation and occur in the recipient as well asthe donor. The types of biliary complications after LDLTalong with their etiology, presenting features, diagnosisand endoscopic and surgical management are discussed.

  6. Locally organised medical audit in histopathology.

    OpenAIRE

    Ramsay, A D

    1991-01-01

    The principles behind medical audit are straightforward, and histopathology departments are not exempt from the increasing requirement for audit in hospitals throughout the United Kingdom. Participation in a local audit scheme can offer more direct benefits than those which may be achieved by participation in a diagnosis based external quality assurance system, but the two are not incompatible. Histopathology Departments should establish their own system, developing an audit strategy for thei...

  7. Is routine histopathology of tonsil specimen necessary?

    OpenAIRE

    Agida S Adoga; Danle N Ma`an; Samuel I Nuhu

    2011-01-01

    Background: Tonsillar diseases are common in paediatric and adult otolaryngological practice. These diseases require tonsillectomy. Specimens are subjected to histopathology routinely in my institution for fear of infections and tumour without consideration for risk factors. The financial burden is on the patients and waste of histopathologist′s man hour because other specimens are left un-attended. This study aims to find out the necessity of routine histopathology of tonsil specimens. Mater...

  8. High-dose-rate afterloading intracavitary irradiation and expandable metallic biliary endoprosthesis for malignant biliary obstruction

    International Nuclear Information System (INIS)

    A double lumen catheter was developed as an applicator for the remote afterloading system (RALS) of 60Co for the intracavitary irradiation of an obstructed common bile duct due to gallbladder cancer in 1 case and by cholangiocarcinoma in 7 cases. This was followed by the biliary endoprosthesis with expandable metallic stents to maintain patency. The mean survival period after treatment was not long (14 weeks). However, removal of the external drainage tube was possible in 7 of the 8 cases, and none of the 8 cases showed dislodgement or deformity of the stent, or obstruction of the bile duct in the stent-inserted area. This combination effectively provided palliation, and has considerable potential for malignant biliary obstruction. (author)

  9. Biliary pressure: manometric and perfusion studies at percutaneous transhepatic cholangiography and percutaneous biliary drainage

    International Nuclear Information System (INIS)

    Manometric pressure recordings were attempted during percutaneous transhepatic cholangiography (PTC) and after percutaneous biliary drainage (PBD) in 203 cases. Successful readings were achieved at PTC in 85% (104/122) of patients. Pressure measurements were also obtained through 56 biliary drainage catheters, and controlled perfusion challenges were performed in 12 patients (on 18 occasions). Documentation of the occasionally poor correlation between the caliber of ducts and the degree of obstruction (i.e., pressure) was shown, and it was suggested that very high pressures may be predictive of a bile leak after PTC. Adequacy of percutaneous drainage and stricture dilatation were further assessed with these manometric techniques. Pressure and perfusion data aided in detecting and determining the significance of the nondilated obstructed duct, the dilated nonobstructed ductal system, and subtle distal ductal strictures. The knowledge obtained from percutaneous pressure recordings may help to determine appropriate therapy

  10. Intrahepatic biliary cysts after hepatic portoenterostomy in four children with biliary atresia

    Energy Technology Data Exchange (ETDEWEB)

    Ishii, K.; Matsuo, S.; Hirayama, Y.; Taguchi, T.; Yakabe, S.; Ikeda, K.; Hirata, T.; Kawanami, T.

    1989-07-01

    We report our experience with 4 cases of cystic dilatation of intrahepatic bile ducts following hepatic portoenterostomy for biliary atresia. Two of the cases did not achieve satisfactory bile excretion and all four cases developed recurrent cholangitis after hepatic portoenterostomy. The attacks of cholangitis seemed to be associated with the presence of intrahepatic cysts. Although one case resulted in death from hepatic failure, three other cases are now outpatients. Patients who develop recurrent cholangitis following hepatic portoenterostomy, should be examined to exclude the presence of intrahepatic biliary cysts. Ultrasonography, computed tomography and percutaneous transhepatic cholangiography were all effective in detecting cysts and provided valuable information for planning treatment. Percutaneous transhepatic or surgical drainage of the bile ducts was effective in reducing jaundice, and recurrent cholangitis. (orig.).

  11. Gianturco metallic biliary stent in malignant biliary obstruction: results of follow-up in dead patients

    International Nuclear Information System (INIS)

    In order to study the patency, restenosis, efficacy, and complication of the metallic stent in the course of treatment of malignant biliary obstruction, the results of follow up of the dead patients after stent insertion were reviewed. Self-expandable Gianturco metallic stent with 10-mm diameter was successfully inserted in 33 patients: 10 with Klatskin tumor, 7 with common bile duct cancer, 7 with gallbladder cancer, 5 with pancreatic cancer, 2 with recurred stomach cancer, one with periampullary cancer, one with hepatocellular carcinoma. The overall duration of survival and patency of the stents in 33 patients were 5.2 months(1-12 months) and 4.9 months(1-14 months), respectively. Restenosis of metallic stents was found in 9 cases(27%), after 6.1 months in average. Causes of stent occlusion were overgrowing of tumor in 5, overgrowing and ingrowing of tumor in 3, extraductal dislodgement in one case. Two cases of symptomatic cholangitis after stent placement were successfully treated with percutaneous cholecystostomy. Three cases of destruction and migration of metallic stents were found after 6 months. On the basis of our experience, insertion of Gianturco metallic biliary stent is an acceptable treatment method in the malignant biliary obstruction, especially for whom short term survival is expected

  12. Gianturco metallic biliary stent in malignant biliary obstruction: results of follow-up in dead patients

    Energy Technology Data Exchange (ETDEWEB)

    Roh, Byung Suk; Kim, Chan Soo; Lee, Kyung Soo; Choi, See Sung; Won, Jong Jin; Kim, Haak Cheul; Chae, Kwon Mook [Wonkwang University School of Medicine, Iri (Korea, Republic of)

    1994-04-15

    In order to study the patency, restenosis, efficacy, and complication of the metallic stent in the course of treatment of malignant biliary obstruction, the results of follow up of the dead patients after stent insertion were reviewed. Self-expandable Gianturco metallic stent with 10-mm diameter was successfully inserted in 33 patients: 10 with Klatskin tumor, 7 with common bile duct cancer, 7 with gallbladder cancer, 5 with pancreatic cancer, 2 with recurred stomach cancer, one with periampullary cancer, one with hepatocellular carcinoma. The overall duration of survival and patency of the stents in 33 patients were 5.2 months(1-12 months) and 4.9 months(1-14 months), respectively. Restenosis of metallic stents was found in 9 cases(27%), after 6.1 months in average. Causes of stent occlusion were overgrowing of tumor in 5, overgrowing and ingrowing of tumor in 3, extraductal dislodgement in one case. Two cases of symptomatic cholangitis after stent placement were successfully treated with percutaneous cholecystostomy. Three cases of destruction and migration of metallic stents were found after 6 months. On the basis of our experience, insertion of Gianturco metallic biliary stent is an acceptable treatment method in the malignant biliary obstruction, especially for whom short term survival is expected.

  13. Endoscopic management of hilar biliary strictures

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Hilar biliary strictures are caused by various benign andmalignant conditions. It is difficult to differentiate benignand malignant strictures. Postcholecystectomy benignbiliary strictures are frequently encountered. Endoscopicmanagement of these strictures is challenging.Anendoscopic method has been advocated that involvesplacement of increasing number of stents at regularintervals to resolve the stricture. Malignanthilar stricturesare mostly unresectable at the time of diagnosis and onlypalliation is possible.Endoscopic palliation is preferredover surgery or radiological intervention. Magneticresonance cholangiopancreaticographyis quite importantin the managementof these strictures. Metal stents aresuperior to plastic stents. The opinion is divided over theissue of unilateral or bilateral stenting.Minimal contrastor no contrast technique has been advocated duringendoscopicretrograde cholangiopancreatography ofthese patients. The role of intraluminal brachytherapy,intraductal ablation devices, photodynamic therapy, andendoscopic ultrasound still remains to be defined.

  14. The effect of morphine on biliary dynamics

    International Nuclear Information System (INIS)

    The effect of morphine on biliary dynamics was studied by cholescintigraphy with 99mTc-HIDA. Among 30 normals without morphine injection 3 did not demonstrate intestinal radioactivity after 1 h, whereas all visualized the gallbladder. Eight normals with morphine injection did not demonstrate intestinal radioactivity after 2 h, but all had gallbladder visualization very early. Variables of the time-activity curves from liver areas did not point to impaired uptake or excretion. Morphine-induced increase in resistance to passage from the common duct to the intestines in normals is of a magnitude that forces the total amount of bile to accumulate in the gallbladder. Results from 11 patients after cholecystectomy indicate that the increase in pressure is less than the maximal secretory pressure of the liver. The resorptive capacity and the compliance of the gallbladder enable these events to take place without signs of secondary liver impairment

  15. Environmental factors in primary biliary cirrhosis.

    Science.gov (United States)

    Juran, Brian D; Lazaridis, Konstantinos N

    2014-08-01

    The etiology of the autoimmune liver disease primary biliary cirrhosis (PBC) remains largely unresolved, owing in large part to the complexity of interaction between environmental and genetic contributors underlying disease development. Observations of disease clustering, differences in geographical prevalence, and seasonality of diagnosis rates suggest the environmental component to PBC is strong, and epidemiological studies have consistently found cigarette smoking and history of urinary tract infection to be associated with PBC. Current evidence implicates molecular mimicry as a primary mechanism driving loss of tolerance and subsequent autoimmunity in PBC, yet other environmentally influenced disease processes are likely to be involved in pathogenesis. In this review, the authors provide an overview of current findings and touch on potential mechanisms behind the environmental component of PBC. PMID:25057950

  16. Endoscopic therapy of benign biliary strictures

    Institute of Scientific and Technical Information of China (English)

    Joel R Judah; Peter V Draganov

    2007-01-01

    Benign biliary strictures are being increasingly treated with endoscopic techniques. The benign nature of the stricture should be first confirmed in order to ensure appropriate therapy. Surgery has been the traditional treatment, but there is increasing desire for minimally invasive endoscopic therapy. At present, endoscopy has become the first line approach for the therapy of postliver transplant anastomotic strictures and distal (Bismuth Ⅰ and Ⅱ) post-operative strictures. Strictures related to chronic pancreatitis have proven more difficult to treat,and endoscopic therapy is reserved for patients who are not surgical candidates. The preferred endoscopic approach is aggressive treatment with gradual dilation of the stricture and insertion of multiple plastic stents. The use of uncovered self expandable metal stents should be discouraged due to poor long-term results. Treatment with covered metal stents or bioabsorbable stents warrants further evaluation. This area of therapeutic endoscopy provides an ongoing opportunity for fresh research and innovation.

  17. Comparing percutaneous primary and secondary biliary stenting for malignant biliary obstruction: A retrospective clinical analysis

    Directory of Open Access Journals (Sweden)

    Nikolaos Chatzis

    2013-01-01

    Full Text Available Purpose: Percutaneous transhepatic primary biliary stenting (PS is an alternative to the widely used staged procedure (secondary biliary stenting, SS for treating obstructive jaundice in cancer patients. To evaluate the efficacy and safety of PS and SS, a retrospective analysis was carried out. Materials and Methods: The percutaneous biliary stenting procedures performed between January 2000 and December 2007 at one hepatobiliary center were retrospectively analyzed, comparing the technical success rates, complications, and length of hospitalization of the two procedures. Of 61 patients (mean age 65.5 ± 13.1 years; range 31.1-92.7 years suffering from obstructive jaundice caused by primary or metastatic tumors, 30 received PS and 31 received SS. The groups were comparable in the anatomical level of the obstruction, stent configuration, or the concurrent presence of cholangitis. Placement of metallic stents required one session for patients in the PS group and an average of 2.6 ± 1.1 sessions for patients in the SS group. Results: The overall technical success rate was 98.4% with 1 (1/61 failed approach to transcend the occlusion in the SS group. The rate of minor complications was 10% in the PS group and 6.5% in the SS group. The corresponding rates of major complications were 23.3% and 54.8%, respectively. SS patients had a higher rate of complications in general ( P < 0.05, as well as a higher rate of severe complications in particular ( P < 0.05. Procedural mortality was 0% for both the groups. The mean overall length of hospitalization was 7.7 ± 9.6 days for PS and 20.6 ± 19.6 days for SS ( P < 0.001. Conclusion: Primary percutaneous biliary stenting of malignant biliary obstructions is as efficacious and safer than a staged procedure with secondary stenting. By virtue of requiring shorter hospital stays, primary stenting is likely to be more cost-effective.

  18. Evidence-Based Decompression in Malignant Biliary Obstruction

    International Nuclear Information System (INIS)

    As recent advances in chemotherapy and surgical treatment have improved outcomes in patients with biliary cancers, the search for an optimal strategy for relief of their obstructive jaundice has become even more important. Without satisfactory relief of biliary obstruction, many patients would be ineligible for treatment. We review all prospective randomized trials and recent retrospective non-randomized studies for evidence that would support such a strategy. For distal malignant biliary obstruction, an optimal strategy would be insertion of metallic stents either endoscopically or percutaneously. Evidence shows that a metallic stent inserted percutaneously has better outcomes than plastic stents inserted endoscopically. For malignant hilar obstruction, percutaneous biliary drainage with or without metallic stents is preferred.

  19. Risk of primary biliary cirrhosis in patients with coeliac disease

    DEFF Research Database (Denmark)

    Sørensen, Henrik Toft; Thulstrup, Ane Marie; Blomqvist, P;

    1999-01-01

    BACKGROUND: Several case reports, but only a few studies, have examined the coexistence of coeliac disease and primary biliary cirrhosis. AIM: To estimate the risk of primary biliary cirrhosis in two national cohorts of patients with coeliac disease in Denmark and Sweden. METHODS: Through record...... linkage all Danish patients hospitalised with coeliac disease were followed for possible occurrence of primary biliary cirrhosis from 1 January 1977 until 31 December 1992. All patients hospitalised with coeliac disease in Sweden from 1987 to 1996 were also followed in a separate analysis. RESULTS: A...... total of 896 patients with coeliac disease were identified in Denmark with a median follow up period of 9.1 years for a total of 8040 person-years at risk. Two cases of primary biliary cirrhosis were observed where 0.07 were expected, giving a standardised incidence ratio of 27.6 (95% confidence...

  20. Mucin-hypersecreting biliary neoplasms: two case report

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Gye Yon; Lee, Jae Mun; Park, Jeong Mi; Jung, So Lyung; Kim, Choon Yul; Shinn, Kyung Sub [Catholic University Medical College, Seoul (Korea, Republic of)

    1995-09-15

    Mucin-hypersecreting biliary neoplasm excretes excessive mucin that fills the biliary tree and results in marked dilatation of the bile ducts and obstructive jaundice. In these neoplasm, the much produced by the tumor rather than the tumor itself plays an important role in clinical course and radiologic patterns. The purpose of this paper is to report characteristic radiologic patterns of mucin-hypersecreting biliary neoplasms in two cases. These neoplasms were characterized by not only multilocular cystic hepatic mass or extra-hepatic bile duct mass resulting in marked biliary dilatation distal to the mass on US or CT, but also change of shape and extent of amorphous filling defects in the markedly dilated bile duct on serial cholangiograms.

  1. Role of stents and laser therapy in biliary strictures

    Science.gov (United States)

    Chennupati, Raja S.; Trowers, Eugene A.

    2001-05-01

    The most frequent primary cancers causing malignant obstructive jaundice were pancreatic cancer (57%), hilar biliary cancer (19% including metastatic disease), nonhilar biliary cancer (14%) and papillary cancer (10%). Endoscopic stenting has widely replaced palliative surgery for malignant biliary obstruction because of its lower risk and cost. Self-expandable metal stents are the preferred mode of palliation for hilar malignancies. Plastic stents have a major role in benign biliary strictures. Major complications and disadvantages associated with metallic stents include high cost, cholangitis. malposition, migration, unextractability, and breakage of the stents, pancreatitis and stent dysfunction. Dysfunction due to tumor ingrowth can be relieved by thermal methods (argon plasma coagulator therapy). We present a concise review of the efficacy of metallic stents for palliation of malignant strictures.

  2. Evidence-Based Decompression in Malignant Biliary Obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Ho, Chia Sing [University of Toronto, Toronto General Hospital, Toronto (Canada); Warkentin, Andrew E [University of Toronto, 1 King& #x27; s College Circle, Toronto (Canada)

    2012-02-15

    As recent advances in chemotherapy and surgical treatment have improved outcomes in patients with biliary cancers, the search for an optimal strategy for relief of their obstructive jaundice has become even more important. Without satisfactory relief of biliary obstruction, many patients would be ineligible for treatment. We review all prospective randomized trials and recent retrospective non-randomized studies for evidence that would support such a strategy. For distal malignant biliary obstruction, an optimal strategy would be insertion of metallic stents either endoscopically or percutaneously. Evidence shows that a metallic stent inserted percutaneously has better outcomes than plastic stents inserted endoscopically. For malignant hilar obstruction, percutaneous biliary drainage with or without metallic stents is preferred.

  3. Eclectic use of cholecystostomy in biliary tract procedures

    International Nuclear Information System (INIS)

    Twenty-seven patients underwent percutaneous aspiration or catheterization of gallbladder for the diagnosis or treatment of biliary tract disease, including 12 cases of cholecystitis, nine malignancies, two cases of choledocholithiasis, and one case of biliary structure. In three patients the cholangiograms were normal. Cholestostomy catheters were placed in 25 patients, including those with normal cholangiograms; the catheters were withdrawn from these patients after the procedure. In all other patients with obstruction the catheters were left in place for drainage, stone chemolysis, or assistance with ductal opacification during percutaneous biliary dilation. There were two minor and no major complications. In addition to its uses in gallbladder disease, percutaneous cholecystostomy is a safe, less painful alternative to percutaneous transhepatic cholangiography. In conjunction with transhepatic drainage for malignancy, it allows control of biliary opacification and optimal selection of the site of ductal puncture

  4. LAPAROSCOPIC ANATOMY OF THE EXTRAHEPATIC BILIARY TRACT

    Directory of Open Access Journals (Sweden)

    E. Târcoveanu

    2005-01-01

    Full Text Available Development of mini-invasive surgery determinates a rapid improvement in laparoscopic regional anatomy. As laparoscopy is becoming common in most surgical departments, basic laparoscopic anatomy is mandatory for all residents in general surgery. Successful general surgery starts in the anatomy laboratory. Successfully minim invasive surgery starts in the operative theatre with laparoscopic exploration. The initial laparoscopic view of the right upper quadrant demonstrates primarily the subphrenic spaces, abdominal surface of the diaphragm and diaphragmatic surface of the liver. The falciform ligament is a prominent dividing point between the left subphrenic space and the right subphrenic space. The ligamentum teres hepatis is seen in the free edge of the falciform. Upward traction on the gallbladder exposes the structures of Calot’s triangle and the hepatoduodenal ligament. The liver is divided into anatomic segments based on internal anatomy that is invisible to the laparoscopist. Surface landmarks include the falciform ligament and the gallbladder fossa. The surgical procedures performed laparoscopically currently include liver biopsy, wedge resection, fenestration of hepatic cysts, laparoscopic approach of the hidatid hepatic cyst, and atypical hepatectomy. We present the laparoscopic anatomy of extrahepatic biliary tract. Once the gallbladder is elevated, inspection reveals Hartmann’s pouch and the cystic duct. The typical angular junction of the cystic duct on the common duct actually occurs in a minority of patients and the length and course of the cystic duct are highly variable. The boundaries of Calot’s triangle are often not well seen. The cystic artery is often visible under the peritoneum as it runs along the surface of the gallbladder. The variations of the structures of the hepatoduodenal ligament may occur to injuries during laparoscopic cholecystectomy. Cholangiography increases the safety of dissection of biliary tract by

  5. Management of Simultaneous Biliary and Duodenal Obstruction: The Endoscopic Perspective

    OpenAIRE

    Baron, Todd H

    2010-01-01

    Obstructive jaundice often develops in patients with unresectable malignancy in and around the head of the pancreas. Duodenal obstruction can also occur in these patients, and usually develops late in the disease course. Palliation of both malignant biliary and duodenal obstruction is traditionally performed with surgical diversion of the bile duct and stomach, respectively. With the advent of nonsurgical palliation of biliary obstruction using endoscopic transpapillary expandable metal stent...

  6. Mechanisms of Biliary Plastic Stent Occlusion and Efforts at Prevention

    OpenAIRE

    Kwon, Chang-Il; Lehman, Glen A.

    2016-01-01

    Biliary stenting via endoscopic retrograde cholangiopancreatography has greatly improved the quality of patient care over the last 30 years. Plastic stent occlusion limits the life span of such stents. Attempts to improve plastic stent patency duration have mostly failed. Metal stents (self-expandable metal stents [SEMSs]) have therefore replaced plastic stents, especially for malignant biliary strictures. SEMS are at least 10 times more expensive than plastic stents. In this focused review, ...

  7. Resolution of tuberculous biliary stricture after medical therapy

    OpenAIRE

    Alsawat, Khalid E; Aljebreen, Abdulrahman M.

    2006-01-01

    Tuberculosis (TB) is a very rare cause of biliary stricture that is difficult to diagnose and usually requires surgical intervention in order to rule out underlying malignant etiology. We report a 56-year-old man presented with jaundice, weight loss and poor appetite. Initial work up showed the dilated biliary system secondary to distal common bile duct stricture. Investigations to define the etiology of this stricture showed inconclusive brush cytology with absent abdominal masses and lymph ...

  8. Cholescintigraphic study of biliary reflux after esophageal or gastric surgery

    International Nuclear Information System (INIS)

    In a total of 36 patients cholescintigraphy was performed after esophageal or gastric surgery to detect bile reflux into the esophagus. The radioisotope method is physiological, and proved to be reliable and sensitive. Close correlation was found between clinical-endoscopical findings and biliary reflux detected by cholescintigraphy. In patients with suspected esophagitis after esophageal or gastric surgery cholescintigraphy should be performed to detect biliary reflux into the esophagus. (author)

  9. Biliary cholesterol secretion: More than a simple ABC

    Institute of Scientific and Technical Information of China (English)

    Arne; Dikkers; Uwe; JF; Tietge

    2010-01-01

    Biliary cholesterol secretion is a process important for 2 major disease complexes, atherosclerotic cardiovascular disease and cholesterol gallstone disease. With respect to cardiovascular disease, biliary cholesterol secretion is regarded as the f inal step for the elimination of cholesterol originating from cholesterol-laden macrophage foam cells in the vessel wall in a pathway named reverse cholesterol transport. On the other hand, cholesterol hypersecretion into the bile is considered the main pathophys...

  10. Sulphoxidation and sulphation capacity in patients with primary biliary cirrhosis.

    Science.gov (United States)

    Davies, M H; Ngong, J M; Pean, A; Vickers, C R; Waring, R H; Elias, E

    1995-05-01

    We have previously reported an association of impaired S-oxidation with primary biliary cirrhosis. In order to confirm and further define this relationship, we retested S-oxidation capacity via three metabolic pathways and sulphation capacity via a fourth pathway. Metabolism of S-carboxymethyl-L-cysteine is polymorphic -20% of healthy individuals being poor S-oxidisers. We found 26% with primary biliary cirrhosis were poor S-oxidisers, compared with 36% with other liver disease and 25% of healthy controls. Differences were not statistically significant. S-oxidation of ranitidine is dependent upon flavin mono-oxygenases. We showed a non-significant trend toward less S-oxide in primary biliary cirrhosis and other liver disease, compared with healthy controls, with no significant difference between disease groups. Conversion of cysteine to sulphate depends predominantly on cysteine dioxygenase. Impaired activity may be reflected by decreased plasma sulphate and elevated cysteine. We found that the plasma cysteine: sulphate ratio was significantly elevated not only in primary biliary cirrhosis (p < 0.0001), but also in other liver disease (p < 0.0001), compared with healthy individuals. Sulphation capacity was studied by analysing paracetamol metabolism. Paracetamol sulphate and sulphate: glucuronide ratio were reduced in primary biliary cirrhosis compared with normal individuals, (p < 0.05). A trend towards less sulphate in primary biliary cirrhosis compared other liver disease was not significant (p = 0.42). We conclude that although sulphation and some sulphoxidation pathways are impaired in primary biliary cirrhosis, we can currently find no evidence to substantiate the hypothesis that primary biliary cirrhosis is a disease specifically associated with poor S-oxidation, as assessed via these metabolic pathways. PMID:7650336

  11. Cystic diseases of the biliary tract and liver

    OpenAIRE

    Nafiye Urgancı

    2008-01-01

    Cystic diseases of liver are recognized in infancy and childhood initially. Cystic diseases of liver and biliary tract are choledocal cysts, autosomal recessive and autosomal dominant polycystic kidney disease, congenital hepatic fibrosis and Caroli disease (cystic dilatation of intrahepatic bile ducts). Choledochal cysts and Caroli disease do not allow biliary flow, cause chronic or obstructive cholestasis and progressive liver disease. In congenital hepatic fibrosis and polycystic kidney di...

  12. Cystic diseases of the biliary tract and liver Invited Editor

    OpenAIRE

    Urgancı, Nafiye

    2008-01-01

    Cystic diseases of liver are recognized in infancy and childhood initially Cystic diseases of liver and biliary tract are choledocal cysts autosomal recessive and autosomal dominant polycystic kidney disease congenital hepatic fibrosis and Caroli disease cystic dilatation of intrahepatic bile ducts Choledochal cysts and Caroli disease do not allow biliary flow cause chronic or obstructive cholestasis and progressive liver disease In congenital hepatic fibrosis and polycystic kidney disease th...

  13. Biliary Sludge: A Risk Factor for ‘Idiopathic’ Pancreatitis?

    OpenAIRE

    Marotta, Paul J.; Gregor, James C; Taves, Donald H.

    1996-01-01

    Idiopathic acute pancreatitis is common. Recent evidence suggests that biliary sludge may be the etiology in many patients with this disorder. In this case-control study, admission ultrasound examinations of patients with idiopathic pancreatitis, patients with acute alcohol-associated pancreatitis and a control group were compared. Biliary sludge was found in seven of 21 patients (33%) with idiopathic pancreatitis, two of 25 (8%) with acute alcohol-associated pancreatitis and one of 63 contro...

  14. Percutaneous transhepatic biliary drainage in malignant extrahepatic cholestasis

    International Nuclear Information System (INIS)

    The technique of non-surgical percutaneous transhepatic biliary drainage has been improved recently. Combined internal and external drainage of bile was enabled by manipulation of a guide wire and a drainage catheter through the stenosed or obstructed section of the extrahepatic biliary ducts. Experience have been gained concerning internal drainage of bile by percutaneous transhepatic insertion of an endoprosthesis for some years now. (orig./WU)

  15. Cholecystobronchocolic Fistula: A Late Complication of Biliary Sepsis

    OpenAIRE

    Collie, D A; Redhead, D. N.; O. J. Garden

    1994-01-01

    A case of a 48 year old woman presenting with bilioptysis due to a cholecystobronchocolic fistula is reported. Bilioptysis is a rare complication of biliary fistulae, with a high mortality due to chemical pneumonitis. Bronchospasm and rapid respiratory failure may ensue if aggressive management is not adopted. The site of fistulation is established by cholangiography, preferably by the percutaneous transhepatic route. Continued biliary drainage can lead to closure of these fistulae, or allow ...

  16. Techniques of biliary drainage for acute cholangitis: Tokyo Guidelines

    OpenAIRE

    Tsuyuguchi, Toshio; Takada, Tadahiro; Kawarada, Yoshifumi; Nimura, Yuji; Wada, Keita; Nagino, Masato; Mayumi, Toshihiko; Yoshida, Masahiro; Miura, Fumihiko; Tanaka, Atsushi; Yamashita, Yuichi; Hirota, Masahiko; Hirata, Koichi; Yasuda, Hideki; Kimura, Yasutoshi

    2007-01-01

    Biliary decompression and drainage done in a timely manner is the cornerstone of acute cholangitis treatment. The mortality rate of acute cholangitis was extremely high when no interventional procedures, other than open drainage, were available. At present, endoscopic drainage is the procedure of first choice, in view of its safety and effectiveness. In patients with severe (grade III) disease, defined according to the severity assessment criteria in the Guidelines, biliary drainage should be...

  17. Surgery for recurrent biliary carcinoma: results for 27 recurrent cases

    OpenAIRE

    Noji, Takehiro; Tsuchikawa, Takahiro; Mizota, Tomoko; Okamura, Keisuke; Nakamura, Toru; Tamoto, Eiji; Shichinohe, Toshiaki; Hirano, Satoshi

    2015-01-01

    Background Various chemotherapies have been used as best practice to treat recurrent biliary malignancies. Conversely, relatively few surgeries have been described for recurrent extrahepatic biliary carcinoma (RExBC), so whether surgery for RExBC is feasible has remained unclear. This retrospective study was conducted to evaluate the feasibility of surgery for RExBC. Methods From February 2000 to January 2014, a total of 27 patients, comprising 18 patients with extrahepatic cholangiocarcinoma...

  18. Suggestions on the guidelines for percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Percutaneous transhepatic biliary drainage (PTBD) is an effective therapeutic option for obstructive jaundice. With various novel puncture instruments being created, the manipulating technique being improved and medical idea being updated, PTBD has been widely employed in clinical practice for alleviating the biliary tract obstruction. In order to standardize this technique this paper aims to make some suggestions for the PTBD guidelines concerning the indications, contraindications, operative skill, postoperative management, complications and their preventions, points for attention, etc. (authors)

  19. SPONTANEOUS DUODENO-BILIARY FISTULA CAUSED BY DUODENAL PEPTIC ULCER

    Directory of Open Access Journals (Sweden)

    N. Danila

    2005-07-01

    Full Text Available Spontaneous duodeno-biliary fistula represents a rare complication of chronic duodenal peptic ulcer. The authors present two cases with this pathology and also the particularities of surgical approach. Spontaneous duodeno-biliary fistula caused by chronic peptic ulcer is often a surprising diagnostic in the era of H2 blockers. The difficulties and the complexity of the diagnosis associated with the particularities of surgical technique represent the key of this rare disease.

  20. BACTERIOLOGICAL INVESTIGATION ON Fasciola hepatica AND CATTLE BILIARY DUCTS

    OpenAIRE

    2009-01-01

    The aim of this work was to investigate the occurrence of bacteria in Fasciola hepatica and into cattle biliary ducts containing the parasite. A total of 24 liver and 58 F. hepatica samples were analysed. In all biliary ducts and in 62,06% of parasite Enterobacteriaceae were isolated. The bacterial specie more frequently isolated from parasite were Citrobacter freundii (34%), Proteus mirabilis (18%), Providencia rettgeri (12%), Staphylococcus spp. (18%), Enterobacter spp. (12%). There doesn&r...

  1. Primary biliary cirrhosis: geographical clustering and symptomatic onset seasonality.

    OpenAIRE

    Hamlyn, A. N.; Macklon, A F; James, O

    1983-01-01

    Patients with primary biliary cirrhosis (primary non-suppurative destructive cholangitis) in the north east region of England were studied over a five year period and, to evaluate epidemicity, compared with two contemporaneous disease series of known occurrence. These were: terminal renal failure, all causes (low or absent epidemicity n = 106) and an outbreak of echovirus 19 disease (high epidemicity n = 201). Eight primary biliary cirrhosis-affected men and 109 women from an estimated catchm...

  2. On the mechanical behavior of the human biliary system

    Institute of Scientific and Technical Information of China (English)

    Xiaoyu Luo; Wenguang Li; Nigel Bird; Swee Boon Chin; NA Hill; Alan G Johnson

    2007-01-01

    This paper reviews the progress made in understanding the mechanical behaviour of the biliary system.Gallstones and diseases of the biliary tract affect more than 10% of the adult population. The complications of gallstones, i.e. acute pancreatitis and obstructive jandice, can be lethal, and patients with acalculous gallbladder pain often pose diagnostic difficulties and undergo repeated ultrasound scans and oral cholecystograms. Moreover, surgery to remove the gallbladder in these patients, in an attempt to relieve the symptoms, gives variable results. Extensive research has been carried out to understand the physiological and pathological functions of the biliary system, but the mechanism of the pathogenesis of gallstones and pain production still remain poorly understood. It is believed that the mechanical factors play an essential role in the mechanisms of the gallstone formation and biliary diseases. However, despite the extensive literature in clinical studies, only limited work has been carried out to study the biliary system from the mechanical point of view. In this paper, we discuss the state of art knowledge of the fluid dynamics of bile flow in the biliary tract, the solid mechanics of the gallbladder and bile ducts, recent mathematical and numerical modelling of the system,and finally the future challenges in the area.

  3. Interventional treatment on vascular and biliary complications after liver transplantation

    International Nuclear Information System (INIS)

    Objective: To evaluate the value of angiography and cholangiography on the diagnosis and interventional treatment on vascular and biliary complications after liver transplantation. Methods: Sixteen of 46 patients (15 males, 1 female, 17-60 years old) after orthotopic liver transplantation received angiography due to abnormal ultrasonography or edema of lower limbs, or cholangiography due to progressing jaundice. 15 cases received angiography and proved vascular complications and 4 cases received cholangiography and biliary complications were found. 3 of them appeared both vascular and biliary complications. Results: Hepatic artery complication was the most common complication (seen in 9/16 patients), including hepatic artery thrombosis or stenosis (6/9), bleeding (2/9) and hepatic artery-dissecting aneurysm (1/9). One case with hepatic artery thrombosis received transcatheter thrombolysis and two cases with bleeding received coil embolization. Stenosis of inferior vena cava and portal vein were observed in 6 and 2 patients respectively. After balloon angioplasty or stent placement, clinical symptom of all cases alleviated. Biliary complications including biliary stricture and anastomotic bile leak occurred in 4 patients. Jaundice decreased after percutaneous transhepatic cholangiography and drainage. Conclusion: Interventional methods offered both diagnosis and mini-invasive treatment for patients after liver transplantation with vascular and biliary complications. Balloon angiography and stent placement of venous stenosis is an useful procedure for the treatment of these problems

  4. Biliary excretion of iron and ferritin in idiopathic hemochromatosis

    International Nuclear Information System (INIS)

    The role of biliary excretion of iron and ferritin in iron overload was studied and evaluated. Ten patients with idiopathic hemochromatosis and two groups of controls (14 gallstone patients and 16 healthy subjects) were included. Liver tissue (obtained by percutaneous or operative biopsy) was investigated with light microscopy and transmission electron microscopy in combination with x-ray microanalysis. Fasting bile samples were obtained through duodenal aspiration or at cholecystectomy. Iron was determined in liver tissue and bile using atomic absorption spectroscopy, and ferritin was determined in serum and bile with a radioimmunoassay technique. All patients with hemochromatosis had iron-positive staining as seen in light microscopy. Electron microscopy showed iron-containing proteins in the lysosomes and cytosol of liver parenchymal cells, and this observation was supported by x-ray microanalysis. Hepatic iron concentration was increased about eightfold in the patients with hemochromatosis (p less than 0.001). Biliary iron concentration, expressed per millimole of bile acid, was increased about twofold (p less than 0.05) and biliary ferritin concentration about fivefold (p less than 0.001) in hemochromatosis. Four of the patients with hemochromatosis were reexamined after completed treatment with venesection; this resulted in normalized biliary concentrations of iron and ferritin. We conclude that biliary secretion of ferritin occurs in humans and that both iron and ferritin excretion are enhanced in hepatic iron overload. The apparently limited capacity of biliary iron excretion may be of importance for the hepatic iron accumulation in hemochromatosis

  5. Management issues in post living donor liver transplant biliary strictures.

    Science.gov (United States)

    Wadhawan, Manav; Kumar, Ajay

    2016-04-01

    Biliary complications are common after living donor liver transplant (LDLT) although with advancements in surgical understanding and techniques, the incidence is decreasing. Biliary strictures are more common than leaks. Endoscopic retrograde cholangiopancreatography (ERCP) is the first line modality of treatment of post LDLT biliary strictures with a technical success rate of 75%-80%. Most of ERCP failures are successfully treated by percutaneous transhepatic biliary drainage (PTBD) and rendezvous technique. A minority of patients may require surgical correction. ERCP for these strictures is technically more challenging than routine as well post deceased donor strictures. Biliary strictures may increase the morbidity of a liver transplant recipient, but the mortality is similar to those with or without strictures. Post transplant strictures are short segment and soft, requiring only a few session of ERCP before complete dilatation. Long-term outcome of patients with biliary stricture is similar to those without stricture. With the introduction of new generation cholangioscopes, ERCP success rate may increase, obviating the need for PTBD and surgery in these patients. PMID:27057304

  6. Pancreatitis of biliary origin, optimal timing of cholecystectomy (PONCHO trial): study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Bouwense, S.A.W.; Besselink, M.G.; Brunschot, S. van; Bakker, O.J.; Santvoort, H.C. van; Schepers, N.J.; Boermeester, M.A.; Bollen, T.L.; Bosscha, K.; Brink, M.A.; Bruno, M.J.; Consten, E.C.; Dejong, C.H.; Duijvendijk, P. van; Eijck, C.H. van; Gerritsen, J.J.; Goor, H. van; Heisterkamp, J.; Hingh, I.H.J.T. de; Kruyt, P.M.; Molenaar, I.Q.; Nieuwenhuijs, V.B.; Rosman, C.; Schaapherder, A.F.; Scheepers, J.J.; Spanier, M.B.; Timmer, R.; Weusten, B.L.; Witteman, B.J.; Ramshorst, B. van; Gooszen, H.G.; Boerma, D.; for the Dutch Pancreatitis Study, G.; Verbeek, A.L.

    2012-01-01

    ABSTRACT: BACKGROUND: After an initial attack of biliary pancreatitis, cholecystectomy minimizes the risk of recurrent biliary pancreatitis and other gallstone-related complications. Guidelines advocate performing cholecystectomy within 2 to 4 weeks after discharge for mild biliary pancreatitis. Dur

  7. Pancreatitis of biliary origin, optimal timing of cholecystectomy (PONCHO trial) : Study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Bouwense, Stefan A.; Besselink, Marc G.; van Brunschot, Sandra; Bakker, Olaf J.; van Santvoort, Hjalmar C.; Schepers, Nicolien J.; Boermeester, Marja A.; Bollen, Thomas L.; Bosscha, Koop; Brink, Menno A.; Bruno, Marco J.; Consten, Esther C.; Dejong, Cornelis H.; van Duijvendijk, Peter; van Eijck, Casper H.; Gerritsen, Jos J.; van Goor, Harry; Heisterkamp, Joos; de Hingh, Ignace H.; Kruyt, Philip M.; Molenaar, I. Quintus; Nieuwenhuijs, Vincent B.; Rosman, Camiel; Schaapherder, Alexander F.; Scheepers, Joris J.; Spanier, Marcel B. W.; Timmer, Robin; Weusten, Bas L.; Witteman, Ben J.; van Ramshorst, Bert; Gooszen, Hein G.; Boerma, Djamila

    2012-01-01

    Background: After an initial attack of biliary pancreatitis, cholecystectomy minimizes the risk of recurrent biliary pancreatitis and other gallstone-related complications. Guidelines advocate performing cholecystectomy within 2 to 4 weeks after discharge for mild biliary pancreatitis. During this w

  8. Pancreatitis of biliary origin, optimal timing of cholecystectomy (PONCHO trial): study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    S.A.W. Bouwense (Stefan); M.G. Besselink (Marc); S. van Brunschot (Sandra); O.J. Bakker (Olaf ); H.C. van Santvoort (Hjalmar); N.J. Schepers (Nicolien ); M.A. Boermeester (Marja); T.L. Bollen (Thomas); K. Bosscha (Koop); M.A. Brink (Menno); M.J. Bruno (Marco); E.C. Consten (Esther); C.H. Dejong (Cees); P. van Duijvendijk (Peter); C.H.J. van Eijck (Casper); J.J. Gerritsen (Jos); H. van Goor (Harry); J. Heisterkamp (Joos); I.H.J.T. de Hingh (Ignace); Ph.M. Kruyt (Philip); I.Q. Molenaar (I.Quintus); V.B. Nieuwenhuijs (Vincent); C. Rosman (Camiel); A.F.M. Schaapherder (Alexander); J.J. Scheepers (Joris); B.W.M. Spanier (Marcel); R. Timmer (Robin); B.L. Weusten (Bas); B.J.M. Witteman (Ben); B. van Ramshorst (Bert); H.G. Gooszen (Hein); D. Boerma (Djamila)

    2012-01-01

    textabstractBackground: After an initial attack of biliary pancreatitis, cholecystectomy minimizes the risk of recurrent biliary pancreatitis and other gallstone-related complications. Guidelines advocate performing cholecystectomy within 2 to 4 weeks after discharge for mild biliary pancreatitis. D

  9. Biliary obstruction caused by intra-biliary tumor growth from recurred hepatocellular carcinoma after radiofrequency ablation: Case report

    Energy Technology Data Exchange (ETDEWEB)

    Yi, Ji Hyun; Kim, Jae Won [Dept. of Radiology, Yeungnam University College of Medicine, Daegu (Korea, Republic of)

    2014-04-15

    A 59-year-old man with a known central hepatocellular carcinoma (HCC) underwent a trans-arterial-chemo-embolization (TACE) and a post-TACE percutaneous radiofrequency ablation (PRFA). Two months after the PRFA, the patient presented jaundice and an abdominal computed tomography was obtained. An arterial enhancing mass adjacent to the ablated necrotic lesion with a continuously coexisting mass inside the right hepatic duct, suggestive of a HCC recurrence with a direct extension to the biliary tract was found. Finally a biliary tumor obstruction has been developed and a percutaneous transhepatic biliary drainage was performed. This case of biliary obstruction caused by directly invaded recurred HCC after PRFA will be reported because of its rare occurrence.

  10. Quality and safety aspects in histopathology laboratory.

    Science.gov (United States)

    Adyanthaya, Soniya; Jose, Maji

    2013-09-01

    Histopathology is an art of analyzing and interpreting the shapes, sizes and architectural patterns of cells and tissues within a given specific clinical background and a science by which the image is placed in the context of knowledge of pathobiology, to arrive at an accurate diagnosis. To function effectively and safely, all the procedures and activities of histopathology laboratory should be evaluated and monitored accurately. In histopathology laboratory, the concept of quality control is applicable to pre-analytical, analytical and post-analytical activities. Ensuring safety of working personnel as well as environment is also highly important. Safety issues that may come up in a histopathology lab are primarily those related to potentially hazardous chemicals, biohazardous materials, accidents linked to the equipment and instrumentation employed and general risks from electrical and fire hazards. This article discusses quality management system which can ensure quality performance in histopathology laboratory. The hazards in pathology laboratories and practical safety measures aimed at controlling the dangers are also discussed with the objective of promoting safety consciousness and the practice of laboratory safety. PMID:24574660

  11. Hepatic portocholecystostomy for biliary atresia: a 25-year follow-up and review.

    Science.gov (United States)

    Schecter, Samuel C; Courtier, Jesse; Cho, Soo-Jin; Saadai, Payam; Hirose, Shinjiro; Mackenzie, Tippi C; Miniati, Doug

    2013-01-01

    We report the successful salvage of a patient's native liver 25 years after hepatic portocholecystostomy for biliary atresia. Our case demonstrates the effectiveness of biliary specific, high-resolution CT imaging in the diagnosis of, and operative planning for complex cases of biliary obstruction. We also report the longest-term pathologic follow-up of biliary atresia after hepatic portocholecystostomy. Life-long follow-up of patients with biliary atresia is important to prevent life-threatening complications of biliary stasis/obstruction. PMID:23331828

  12. 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

  13. Hepato-biliary clinical trials and their inclusion in the Cochrane Hepato-Biliary Group register and reviews

    DEFF Research Database (Denmark)

    Klingenberg, Sarah Louise; Nikolova, Dimitrinka; Alexakis, Nicholas; Als-Nielsen, Bodil; Colli, Agostino; Conte, Dario; D'Amico, Gennaro; Davidson, Brian; Fingerhut, Abe; Fraquelli, Mirella; Gluud, Christian Nyfeldt; Gurusamy, Kurinchi; Keus, Frederik; Khan, Saboor; Koretz, Ronald; van Laarhoven, Cornelis; Liu, Jianping; Myers, Robert; Pagliaro, Luigi; Simonetti, Rosa; Sutton, Robert; Thorlund, Kristian

    2011-01-01

    The Cochrane Hepato-Biliary Group (CHBG) is one of the 52 collaborative review groups within The Cochrane Collaboration. The activities of the CHBG focus on collecting hepato-biliary randomized clinical trials (RCT) and controlled clinical trials (CCT), and including them in systematic reviews wi...... meta-analyses of the trials. In this overview, we present the growth of The CHBG Controlled Trials Register, as well as the systematic reviews that have been produced since March 1996....

  14. Biliary Infection May Exacerbate Biliary Cystogenesis Through the Induction of VEGF in Cholangiocytes of the Polycystic Kidney (PCK) Rat

    OpenAIRE

    Ren, Xiang Shan; Sato, Yasunori; Harada, Kenichi; Sasaki, Motoko; Yoneda, Norihide; Lin, Zhen Hua; Nakanuma, Yasuni

    2011-01-01

    Cholangitis arising from biliary infection dominates the prognosis in Caroli's disease. To clarify the influences of bacterial infection on the biliary cystogenesis, in vivo and in vitro studies were performed using the polycystic kidney (PCK) rat as an animal model of Caroli's disease. Cholangitis became a frequent histological finding in aged PCK rats, and neovascularization around the bile ducts also increased in aged PCK rats. Immunohistochemistry revealed that expression of vascular endo...

  15. Hepato-biliary clinical trials and their inclusion in the Cochrane Hepato-Biliary Group register and reviews

    DEFF Research Database (Denmark)

    Klingenberg, Sarah Louise; Nikolova, Dimitrinka; Alexakis, Nicholas;

    2011-01-01

    The Cochrane Hepato-Biliary Group (CHBG) is one of the 52 collaborative review groups within The Cochrane Collaboration. The activities of the CHBG focus on collecting hepato-biliary randomized clinical trials (RCT) and controlled clinical trials (CCT), and including them in systematic reviews with...... meta-analyses of the trials. In this overview, we present the growth of The CHBG Controlled Trials Register, as well as the systematic reviews that have been produced since March 1996....

  16. Concurrent biliary drainage and portal vein embolization in preparation for extended hepatectomy in patients with biliary cancer.

    OpenAIRE

    Nilsson, Jan; Eriksson, Sam; Nørgaard Larsen, Peter; Keussen, Inger; Christiansen Frevert, Susanne; Lindell, Gert; Sturesson, Christian

    2015-01-01

    Background Patients with perihilar cholangiocarcinoma and gallbladder cancer extending into the hilum often present with jaundice and a small future liver remnant (FLR). If resectable, preoperative biliary drainage and portal vein embolization (PVE) are indicated. Classically, these measures have been performed sequentially, separated by 4–6 weeks. Purpose To report on a new regime where percutaneous transhepatic biliary drainage (PTBD) and PVE are performed simultaneously, shortening the pre...

  17. Effect of ursodeoxycholate on the biliary excretion of cefotiam and sulbenicillin in patients with percutaneous transhepatic biliary drainage.

    OpenAIRE

    Higashi, K; Hayakawa, T; Katagiri, K; Tsukada, K.; Ito, K; Hoshino, M; M Miyaji; Takeuchi, T.; Yamamoto, T.

    1988-01-01

    The effects of ursodeoxycholate administration on the biliary excretion of the antibiotics cefotiam and sulbenicillin were studied in five patients with stable hepatic function receiving percutaneous transhepatic biliary drainage for obstructive jaundice. Cefotiam (I g) and sulbenicillin (2 g) were administered intravenously before and after ursodeoxycholate administration, and the maximum concentrations of the antibiotics in the bile and total amounts excreted in the bile during the 4 h afte...

  18. Angiography of histopathologic variants of synovial sarcoma

    International Nuclear Information System (INIS)

    Synovial sarcomas are rare soft tissue tumors which histopathologically can be divided into monophasic, biphasic and mixed variants. As part of a protocol for intra-arterial chemotherapy 12 patients with biopsy proven synovial sarcoma underwent angiography. The angiograms on these patients were reviewed to determine whether synovial sarcomas and their variants demonstrated a characteristic angiographic appearance. Synovial sarcomas appeared angiographically as soft tissue masses which showed a fine network of tumor vessels with an inhomogeneous capillary blush. Their degree of vascularity varied according to their histopathology. Monophasic synovial sarcomas demonstrated in general a higher degree of neovascularity than the biphasic form. This finding was also suggested by histopathologic analysis of the vessels in the tumor. Although angiography did not show a distinctive vascular pattern it may be useful to evaluate tumor size and vascularity. (orig.)

  19. Is routine histopathology of tonsil specimen necessary?

    Directory of Open Access Journals (Sweden)

    Agida S Adoga

    2011-01-01

    Full Text Available Background: Tonsillar diseases are common in paediatric and adult otolaryngological practice. These diseases require tonsillectomy. Specimens are subjected to histopathology routinely in my institution for fear of infections and tumour without consideration for risk factors. The financial burden is on the patients and waste of histopathologist′s man hour because other specimens are left un-attended. This study aims to find out the necessity of routine histopathology of tonsil specimens. Materials and Methods : A 2 year retrospective review of the histopathological results of two (paediatric and adult groups of 61 patients managed for tonsillar diseases at the ENT UNIT of Jos University Teaching Hospital from July 2005 to June, 2007. Data extracted included biodata, clinical features and histopathological diagnosis. Result : The 61 patients comprise 35 children and 26 adults. The youngest and oldest paediatric patients were 1 year and 3 months and 16 years respectively, a range of 1 year 3 months to 16 years. The youngest and oldest adults were 17 and 50 years with a range of 17-50 years. Groups mean ages were 5.1 and 28.5 years. The gender ratios were 1:2.7 and 1:1.9 respectively. One adult was HIV positive. The histopathological diagnosis were chronic nonspecific tonsillitis in 10(16.6%, follicular tonsillitis in 23(38.3%, chronic suppurative tonsillitis in 10(16.6%, lymphoid hyperplasia in 18(30.0% and lymphoma in 1(1.0% respectively. Conclusion : Histopathologic request for tonsillectomy specimens should be based on certain risk factors with consideration of the cost to patients and to spare the histopathologist′s man hour.

  20. High-Dose-Rate intraluminal brachytherapy for biliary obstruction by secondary malignant biliary tumors

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Won Sup; Kim, Tae Hyun; Yang, Dae Sik; Choi, Myung Sun; Kim, Chul Yong [College of Medicine, Korea Univ., Seoul (Korea, Republic of)

    2003-03-01

    To analyze the survival period, prognostic factors and complications of patients having under gone high-dose-rate intraluminal brachytherapy (HDR-ILB) as a salvage radiation therapy, while having a catheter, for percutaneous transhepatic biliary drainage (PTBD), inserted due to biliary obstruction caused by a secondary malignant biliary tumor. A retrospective study was performed on 24 patients having undergone HDR-ILB, with PTBD catheter insertion, between December 1992 and August 2001, Their median age was 58.5, ranging from 35 to 82 years. The primary cancer site were the stomach, gallbladder, liver, pancreas and the colon, with 12, 6, 3, 2 and 1 cases, respectively. Eighteen patients were treated with external beam radiation therapy and HDR-ILB, while six were treated with HDR-ILB only. The total external beam, and brachytherapy radiations dose were 30-61.2 and 9-30 Gy, with median doses of 50 and 15 Gy, respectively. Of the 24 patients analyzed, 22 died during the follow-up period, with a median survival of 7.3 months. The 6 and 12 months survival rates were 54.2 (13 patients) and 20.8% (5 patients), respectively. The median survivals for stomach and gallbladder cancers were 7.8 and 10.2 months, respectively. According to the univariate analysis, a significant factor affecting survival of over one year was the total radiation dose (over 50 Gy) (0=0.0200), with all the patients surviving more than one year had been irradiated with more than 50 Gy. The acute side effects during the radiation therapy were managed with conservative treatment. During the follow-up period, 5 patients showed symptoms of cholangitis due to the radiation therapy. An extension to the survival of those patients treated with HDR-ILB is suggested compared to the median historical survival of those patients treated with external biliary drainage. A boost radiation dose could be effectively given, by performing HDR-ILB, which is a prognostic factor. In addition, the acute complications of

  1. Malignant biliary obstruction: treatment with interventional radiology

    Institute of Scientific and Technical Information of China (English)

    翟仁友; 钱晓军; 戴定可; 于平

    2003-01-01

    Objective To evaluate the method of palliative drainage by means of metallic indwelling stents or plastic tubes for patients with malignant biliary obstruction. Methods From January 1995 to Febuary 2001, 243 consecutive patients (161 men and 82 women; aged 26-91 years, mean of 61.3 years) with malignant biliary obstruction were treated with transhepatic placement of metallic stents and/or plastic tubes. Among them, 47 patients had pancreatic carcinoma, 98 cholangiocarcinoma, 28 metastatic carcinoma and 60 hepatic carcinoma. 169 stents of nine types were used in this series. After stenting, 47 patients were treated for local tumors. Procedure- and device-related complications were recorded. Patient survival and stent patency rates were calculated with Kaplan-Meier survival analysis.Results One hundred and three patients underwent successfully stent placement for the first time. Others had their stents installed 1-2 weeks after catheterization. Stents were used in 132 patients. Ninety-five patients were treated with a single stent. Seventeen patients had two stents installed for bilateral drainage,20 patients had two stents installed from top to bottom to create stenting of adequate ength, and 12 patients had stents placed across the ampulla. The 2-month mortality rate was 8.64% (21/243). Major complications occurred in two patients (0.8%, 2/243). Minor complications included self-limited bleeding into the drainage tubes and fever. The average patency of the initial stent was 7.5 months and average survival was 9 months. Thirteen patients received brachytherapy in their stents, 15 extra radiation therapy, and 19 intra-arterial infusion chemotherapy. The 47 patients treated for local tumors had an average survival of 11.3 months (log rank 32.8,P<0.001) with an average patency of 9.7 months(log rank 4.7,P<0.05).Conclusion Percutaneous transhepatic bile drainage as a palliative procedure is well tolerated by patients. After stenting, treatment for local tumor may

  2. High dose rate sup 60 Co-RALS intraluminal radiation therapy for advanced biliary tract cancer with obstructive jaundice

    Energy Technology Data Exchange (ETDEWEB)

    Tamada, Toshiaki; Yoshimura, Hitoshi; Yoshioka, Tetsuya; Iwata, Kazuro; Ohishi, Hajime; Uchida, Hideo (Nara Medical Univ., Kashihara (Japan))

    1991-12-01

    High-dose-rate intraluminal irradiation with a {sup 60}Co remote afterloading system, using our newly developed applicator, was performed in 15 cases of advanced biliary tract cancer (2 gallbladder cancers, 13 cholangiocarcinomas). The applicator which was thin with an outer diameter of 14 Fr had a double lumen which included a small lumen for a guide wire for easy exchange to a drainage tube. Therefore, the irradiation procedure could be easily finished in a short time within little distress to the patient. The tumor marker CA1 19-9 was useful in assessing the therapeutic effect and follow-up observation after treatment. The average tube-free period and survival time were 5.9 months and 8.3 months, respectively. Histopathological examination of the cases autopsied showed that the combination of intraluminal (30 Gy) and external (30 Gy) irradiation offered good local control of the cancer that was within 1 cm from the source. Cholangiocarcinoma with relatively short length of obstruction, stage III or stage IV when the cancer infiltration was localized around the bile duct, achieved a comparatively long survival time. It was suggested that the combined use of high-dose-rate intraluminal radiotherapy, with precisely delivered radical radiation to tumors localized in the bile duct wall, and external radiotherapy delivered as additional radiation to the surrounding bile duct would provide radiotherapeutic advantage and contribute to survival after treatment for advanced biliary tract cancer. (author).

  3. Successful Endoscopic Ultrasound-Guided Transduodenal Biliary Drainage Through a Pre-Existing Duodenal Stent

    Directory of Open Access Journals (Sweden)

    Paul J Belletrutti

    2010-05-01

    Full Text Available Context When ERCP fails in the setting of combined biliary and duodenal obstruction, EUS-guided biliary drainage has emerged as an alternate method of biliary decompression. Case report We present a case of a 40-year-old man with advanced pancreatic cancer and a pre-existing duodenal wall stent who subsequently develops jaundice due to biliary obstruction. An ERCP was technically unsuccessful as the papilla was inaccessible despite probing within the duodenal stent. Transduodenal biliary drainage was achieved using EUS guidance to create a choledochoduodenostomy tract. A fully covered metal biliary stent was then deployed through the mesh of the duodenal wall stent. The patient’s jaundice and pruritus subsequently resolved. Conclusion This is the first report of successful transduodenal EUS-guided biliary drainage performed through an existing enteral wall stent and can still be considered as an alternate mode of biliary drainage in this setting.

  4. The histopathology of Langerhans cell histiocytosis.

    OpenAIRE

    Favara, B. E.; Jaffe, R.

    1994-01-01

    Selected aspects of the histopathology of Langerhans cell histiocytosis representing diagnostic difficulty and/or controversy are presented with emphasis on the composition of pathological lesions. Lesional cell phenotypes and the factors influencing variations are noted. Features of several skin-based histiocytic disorders, dermatopathic lymphadenopathy and Rosai-Dorfman disease are compared. Associations between Langerhans cell histiocytosis and juvenile xanthogranuloma and malignant disord...

  5. 42 CFR 493.1273 - Standard: Histopathology.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Standard: Histopathology. 493.1273 Section 493.1273 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... group of patient slides. Reaction(s) of the control slide with each special stain must be documented....

  6. Prognostic factors after percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    The authors reviewed the clinical charts and the radiographic files of 93 patients with obsructive jaundice -in 86 cases due to neoplasms -treated with PTBD. The test of differences from survival curves was used to identify the clinical parameters predictive of short survival after PTBD. The difference in survival curves was significant relative to serum indirect bilirubin (cut point: 7.6 mg%), to serum cholinesterase (cut point: 1290 mU/ml), to white blood cells counts (cut point: 8600/mm3), to blood urea nitrogen (BUN) levels (cut point: 60 mg%). Because of the market negative prognostic value of high BUN levels, our data seemto indicate that PTBD should not be performed when severe renal insufficiency is present. Other parameters correlated with a short survival after PTBD were the histotype of metastasis (in comparison with the other ones) and in large neoplastic volume (in comparison with a small and medium ones). Through pre-PTBD radiological and laboratory data analysis, a group of patients can be selected in whom the procedure will increase neither well-being nor survival, as plotted against those patients who are likely to benefit from biliary drainage

  7. Primary cancers of extrahepatic biliary passages

    International Nuclear Information System (INIS)

    The records of 22 patients with cancers of extrahepatic biliary passages (EHBP) were analyzed to understand their natural histories and patterns of failure and to evaluate the effectiveness of various treatments. None of the preoperative investigations consistently defined the entire extent of tumor. Percutaneous transhepatic cholangiography (PTHC) was the most helpful (100%) in accurately defining the site of ductal obstruction. Computed tomography was helpful in diagnosing liver metastases in 53% and primary tumor mass in 23% of patients. The most common sites of tumor failure or persistence were: liver (67%), tumor bed (56%), peritoneum (22%), porta hepatis and lymph nodes (17%). The median survival for the entire group was 6.8 months. Surgery plays an important role in managing these tumors and in defining tumor extent for subsequent adjuvant irradiation. Patients receiving radiation doses greater than or equal to 70 TDF had a longer median survival (11 months) than patients receiving less than 70 TDF (4.4 months). All three patients, who were alive and free of disease greater than 1 year, received radiation doses greater than or equal to 70 TDF. From the data, it is difficult to comment on the effectiveness of chemotherapy. The authors have made suggestions regarding radiation volume and doses to various structures. The need for entering these patients into multi-institutional clinical trials is stressed

  8. Primary cancers of extrahepatic biliary passages

    Energy Technology Data Exchange (ETDEWEB)

    Mittal, B.; Deutsch, M.; Iwatsuki, S.

    1985-04-01

    The records of 22 patients with cancers of extrahepatic biliary passages (EHBP) were analyzed to understand their natural histories and patterns of failure and to evaluate the effectiveness of various treatments. None of the preoperative investigations consistently defined the entire extent of tumor. Percutaneous transhepatic cholangiography (PTHC) was the most helpful (100%) in accurately defining the site of ductal obstruction. Computed tomography was helpful in diagnosing liver metastases in 53% and primary tumor mass in 23% of patients. The most common sites of tumor failure or persistence were: liver (67%), tumor bed (56%), peritoneum (22%), porta hepatis and lymph nodes (17%). The median survival for the entire group was 6.8 months. Surgery plays an important role in managing these tumors and in defining tumor extent for subsequent adjuvant irradiation. Patients receiving radiation doses greater than or equal to 70 TDF had a longer median survival (11 months) than patients receiving less than 70 TDF (4.4 months). All three patients, who were alive and free of disease greater than 1 year, received radiation doses greater than or equal to 70 TDF. From the data, it is difficult to comment on the effectiveness of chemotherapy. The authors have made suggestions regarding radiation volume and doses to various structures. The need for entering these patients into multi-institutional clinical trials is stressed.

  9. Primary cancers of extrahepatic biliary passages.

    Science.gov (United States)

    Mittal, B; Deutsch, M; Iwatsuki, S

    1985-04-01

    We analyzed the records of 22 patients with cancers of extrahepatic biliary passages (EHBP) to understand their natural histories and patterns of failure and to evaluate the effectiveness of various treatments. None of the preoperative investigations consistently defined the entire extent of tumor. Percutaneous transhepatic cholangiography (PTHC) was the most helpful (100%) in accurately defining the site of ductal obstruction. Computed tomography was helpful in diagnosing liver metastases in 53% and primary tumor mass in 23% of patients. The most common sites of tumor failure or persistence were: liver (67%), tumor bed (56%), peritoneum (22%), porta hepatis and lymph nodes (17%). The median survival for the entire group was 6.8 months. Surgery plays an important role in managing these tumors and in defining tumor extent for subsequent adjuvant irradiation. Patients receiving radiation doses greater than or equal to 70 TDF had a longer median survival (11 months) than patients receiving less than 70 TDF (4.4 months). All three patients, who were alive and free of disease greater than 1 year, received radiation doses greater than or equal to 70 TDF. From our data, it is difficult to comment on the effectiveness of chemotherapy. We have made suggestions regarding radiation volume and doses to various structures. The need for entering these patients into multi-institutional clinical trials is stressed. PMID:3980281

  10. Biliary tract obstruction secondary to Burkitt lymphoma

    International Nuclear Information System (INIS)

    The abdomen, in particular the ileocecal region, appendix and colon, is the most common primary site for Burkitt non Hodgkin's lymphoma (NHL). Involvement of the bile duct is rare. The authors describe a patient with abdominal NHL in which jaundice due to bile duct obstruction was the first clinical sign. Case report: a 3 year old white boy presented with one month of progressive jaundice, clay-colored stools, tea colored urine and increase of abdominal volume. Physical examination showed jaundice 3+/4+ and pale mucosa. The abdomen was moderately distended and timpanous and the liver was enlarged. Laboratory examinations confirmed cholestasis with total bilirubin of 8.2 mg/dl (direct bilirubin of 7.8 mg/dl), and microcytic and hypochromic anemia. Ultrasonography (US) and abdominal CT showed two solid tumors in hepatic hilar topography, and dilated intrahepatic biliary tree. The Doppler US showed hepatic artery and portal vein dislocation by the nodules. Comment: although jaundice occurs frequently as a late manifestation of NHL, it is rarely seen as the presenting sign. When jaundice is the first clinical sign and image studies show hepatic hilar tumor and bile duct obstruction, NHL should be considered in the differential diagnosis. (author)

  11. Primary biliary cirrhosis: From bench to bedside

    Institute of Scientific and Technical Information of China (English)

    Elias; Kouroumalis; George; Notas

    2015-01-01

    Primary biliary cirrhosis(PBC) is a chronic non-suppurative destructive intrahepatic cholangitis leading to cirrhosis after a protractive non cirrhotic stage. The etiology and pathogenesis are largely unknown and autoimmne mechanisms have been implicated to explain the pathological lesions. Many epitopes and autoantigens have been reported as crucial in the pathophysiology of the disease and T and B cells abnormalities have been described, the exact pathways leading to the destruction of small intrahepatic ductules are mostly speculative. In this review we examined the various epidemiologal and geoepidemiological data as well as the complex pathogenetic aspects of this disease, focusing on recent in vivo and in vitro studies in this field. Initiation and progression of PBC is believed to be a multifactorial process with strong infuences from the patient’s genetic background and by various environmental factors. The role of innate and adaptive immunity, including cytokines, chemokines, macrophages and the involvement of apoptosis and reactive oxygen species are outlined in detailed. The current pathogenetic aspects are presented and a novel pathogenetic theory unifying the accumulated clinical information with in vitro and in vivo data is formulated. A review of clinical manifestations and immunological and pathological diagnosis was presented. Treatment modalities, including the multiple mechanisms of action of ursodeoxycholate were finally discussed.

  12. 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

  13. EUS-Guided Choledochoduodenostomy for Biliary Drainage in Unresectable Pancreatic Cancer: A Case Series

    OpenAIRE

    Everson LA Artifon; Jonas Takada; Luciano Okawa; Eduardo GH Moura; Paulo Sakai

    2010-01-01

    Context Endoscopic retrograde cholangiopancreatography (ERCP) is the procedure of choice for biliary decompression in patients with unresectable pancreatic cancer. However, it may be unsuccessful in 3 to 10% of cases. When ERCP is unsuccessful, the usual alternatives are percutaneous transhepatic biliary drainage or surgery. Recently, several authors have reported the use of EUS-guided biliary drainage in patients with malignant biliary obstructions, with acceptable success and complication r...

  14. Predictors for occlusion of the first inserted metallic stent in patients with malignant biliary obstruction

    OpenAIRE

    Wandong Hong; Yunfei Zhu; Yanyan Dong; Yanqing Wu; Mengtao Zhou; Haizhen Ni

    2015-01-01

    Background/Aims: Endoscopic biliary stent drainage plays an important role in the palliative treatment of malignant biliary obstruction. The aim of this study was to investigate predictors of occlusion of first metal inserted stent in patients with malignant biliary obstruction. Patients and Methods: The retrospective analysis was performed in 178 patients with malignant biliary obstruction. Factors associated with stent occlusion were analyzed by Cox regression analysis. Results: Median over...

  15. Placement of removable metal biliary stent in post-orthotopic liver transplantation anastomotic stricture

    OpenAIRE

    Tee, Hoi-Poh; James, Martin W; Kaffes, Arthur J

    2010-01-01

    Postoperative biliary strictures are the most common cause of benign biliary stricture in Western countries, secondary to either operative injury or bile duct anastomotic stricture following orthotopic liver transplantation (OLT). Surgery or endoscopic interventions are the mainstay of treatment for benign biliary strictures. We aim to report the outcome of 2 patients with refractory anastomotic biliary stricture post-OLT, who had successful temporary placement of a prototype removable covere...

  16. Stenting and interventional radiology for obstructive jaundice in patients with unresectable biliary tract carcinomas

    OpenAIRE

    Tsuyuguchi, Toshio; Takada, Tadahiro; Miyazaki, Masaru; Miyakawa, Shuichi; Tsukada, Kazuhiro; Nagino, Masato; Kondo, Satoshi; Furuse, Junji; Saito, Hiroya; Suyama, Masafumi; Kimura, Fumio; Yoshitomi, Hideyuki; Nozawa, Satoshi; Yoshida, Masahiro; Wada, Keita

    2008-01-01

    Together with biliary drainage, which is an appropriate procedure for unresectable biliary cancer, biliary stent placement is used to improve symptoms associated with jaundice. Owing to investigations comparing percutaneous transhepatic biliary drainage (PTBD), surgical drainage, and endoscopic drainage, many types of stents are now available that can be placed endoscopically. The stents used are classified roughly as plastic stents and metal stents. Compared with plastic stents, metal stents...

  17. Placement of removable metal biliary stent in post-orthotopic liver transplantation anastomotic stricture

    Institute of Scientific and Technical Information of China (English)

    Hoi-Poh; Tee; Martin; W; James; Arthur; J; Kaffes

    2010-01-01

    Postoperative biliary strictures are the most common cause of benign biliary stricture in Western countries, secondary to either operative injury or bile duct anastomotic stricture following orthotopic liver transplantation(OLT).Surgery or endoscopic interventions are the mainstay of treatment for benign biliary strictures.We aim to report the outcome of 2 patients with refractory anastomotic biliary stricture post-OLT,who had successful temporary placement of a prototype removable covered self-expandable m...

  18. Risk factors for biliary tract and ampullary carcinomas and prophylactic surgery for these factors

    OpenAIRE

    Miyazaki, Masaru; Takada, Tadahiro; Miyakawa, Shuichi; Tsukada, Kazuhiro; Nagino, Masato; Kondo, Satoshi; Furuse, Junji; Saito, Hiroya; Tsuyuguchi, Toshio; Chijiiwa, Kazuo; Kimura, Fumio; Yoshitomi, Hideyuki; Nozawa, Satoshi; YOSHIDA, Masahiro; Wada, Keita

    2008-01-01

    Curative resection is the only treatment for biliary tract cancer that achieves long-term survival. However, patients with advanced biliary tract cancer have only a limited prognosis even after radical surgical resection. Thus, to improve the longterm results, the early detection of biliary tract cancer and subsequent cure seem to be essential. The purpose of this study was to review the literature concerning the risk factors for cancerous and precancerous lesions of the biliary tract, and pr...

  19. A New Method for Palliative Biliary Drainage in Malignant Obstructive Jaundice

    OpenAIRE

    Ali Aminian; Ali, Fouzeyah A. H.

    2008-01-01

    When advanced biliary or pancreatic malignancies preclude application of surgery or stent placement for relief of jaundice, the remaining option is percutaneous transhepatic biliary drainage (PTBD). However, it is associated with problems such as loss of biliary fluid and minerals, malabsorption of fat, and discomfort. A new surgical method for palliative biliary drainage in malignant obstructive jaundice consists of connection of PTBD catheter to a jejunostomy catheter. With this configurati...

  20. Combined Interventional Radiological and Endoscopical Approach for the Treatment of a Postoperative Biliary Stricture and Fistula

    OpenAIRE

    1995-01-01

    A 43-year old woman was admitted 11 days after open cholecystectomy with a iatrogenic bile duct injury. On admission the patient showed an uncontrolled biliary fistula through an external drain placed at an emergency laparotomy for biliary peritonitis with fever and jaundice. PTC showed a biliary stricture type II (Bismuth). A percutaneous drainage was performed to decompress the biliary system. Three weeks later, percutaneous balloon dilatation of the stricture was performed. However, bile l...

  1. EUS-Guided Transduodenal Biliary Drainage in Unresectable Pancreatic Cancer with Obstructive Jaundice

    OpenAIRE

    Tiing Leong Ang; Eng Kiong Teo; Kwong Ming Fock

    2007-01-01

    Context Endoscopic transpapillary biliary drainage is the procedure of choice for biliary decompression in patients with unresectable pancreatic cancer. When ERCP is unsuccessful, the usual alternative is percutaneous transhepatic biliary drainage. Recently, the use of EUS-guided biliary drainage has been reported, but it is not clear whether it is feasible for this technique to find more widespread use as an alternative to failed ERCP. We herein describe our experience with two cases of unre...

  2. Usefulness of a Biliary Manipulation Catheter in Percutaneous Transhepatic Biliary Drainage

    Energy Technology Data Exchange (ETDEWEB)

    Paek, Auh Whan [Dept. of Radiology, Virginia University Heath Center, Charlottesville (United States); Won, Je Hwan; Lee, Jei Hee; Sun, Joo Sung; Kwak, Kyu Sung; Bae, Jae Ik [Dept. of Radiology, Ajou University School of Medicine, Suwon (Korea, Republic of)

    2011-04-15

    To evaluate usefulness of a manipulation catheter in percutaneous transhepatic biliary drainage (PTBD). A biliary manipulation catheter was used for the aspiration of retained bile and lesion crossing during an initial PTBD in 91 consecutive patients over a 6 month period. This catheter allowed for a 0.035 inch guide wire made of 5F short steel braided polyurethane. The terminal 1 cm segment was tapered and 45 degree angulated. Two side holes were made in the terminal segment to facilitate the aspiration of bile. The safety of this procedure was evaluated based on whether the catheters caused complications during insertion and manipulation, and whether cholangitis was aggravated after the procedure. Effectiveness of the procedure was evaluated based on the ability to aspirate retained bile and to cross the lesion. Both the insertion of a 0.035 inch hydrophilic guide wire and aspiration of sufficient retained bile were successful with the catheter. Crossing the common bile duct (CBD) lesion had a 98.1% success rate during the initial PTBD. Crossing the hilar obstruction lesion was had a 94.7% success rate to the CBD and 92.1% to the contralateral lobe. Cholangitis improved in 97% of cases, and aggravated transiently in only 3% of cases after PTBD.

  3. Usefulness of a Biliary Manipulation Catheter in Percutaneous Transhepatic Biliary Drainage

    International Nuclear Information System (INIS)

    To evaluate usefulness of a manipulation catheter in percutaneous transhepatic biliary drainage (PTBD). A biliary manipulation catheter was used for the aspiration of retained bile and lesion crossing during an initial PTBD in 91 consecutive patients over a 6 month period. This catheter allowed for a 0.035 inch guide wire made of 5F short steel braided polyurethane. The terminal 1 cm segment was tapered and 45 degree angulated. Two side holes were made in the terminal segment to facilitate the aspiration of bile. The safety of this procedure was evaluated based on whether the catheters caused complications during insertion and manipulation, and whether cholangitis was aggravated after the procedure. Effectiveness of the procedure was evaluated based on the ability to aspirate retained bile and to cross the lesion. Both the insertion of a 0.035 inch hydrophilic guide wire and aspiration of sufficient retained bile were successful with the catheter. Crossing the common bile duct (CBD) lesion had a 98.1% success rate during the initial PTBD. Crossing the hilar obstruction lesion was had a 94.7% success rate to the CBD and 92.1% to the contralateral lobe. Cholangitis improved in 97% of cases, and aggravated transiently in only 3% of cases after PTBD.

  4. MR and CT cholangiography in evaluation of the biliary tract

    Energy Technology Data Exchange (ETDEWEB)

    Masui, T.; Fujiwara, T.; Ichijo, K.; Imaoka, I.; Naito, M. [Seirei Mikatabara General Hospital, Hamamatsu (Japan). Dept. of Radiology; Takehara, Y.; Kaneko, M. [Hamamatsu Univ. School of Medicine (Japan). Dept. of Radiology; Yamamoto, H.; Watahiki, H. [Seirei Mikatabara General Hospital, Hamamatsu (Japan). Dept. of Gastroenterology

    1998-09-01

    Objective: To compare MR and CT cholangiography (MRC and CTC) in evaluating the anatomy of the extrahepatic biliary tract and the pathology related to the gallbladder. Material and Methods: Twenty-three patients underwent MRC and CTC with a biliary contrast medium for investigation of biliary disease. 3D displays of both were also obtained. Endoscopic retrograde cholangiography was performed in 17 patients, and the pathology of all 23 was evaluated. Results: Overall, the image quality was higher with CTC than with MRC (4.7 vs 3.9, p<0.05). The cystic duct was demonstrated better by CTC than MRC (p<0.05). Multiplanar reformation (MPR) and source images provided additional information to that obtained from 3D MRC and CTC images. Gallstones were revealed in 6 patients by CTC and in 5 of these 6 by MRC. In 2 patients with cholecystitis, CTC demonstrated gallbladder wall thickening but MRC did not. In 3 patients with adenomyomatosis, MRC demonstrated Rokitansky-Aschoff sinuses (RAS) while CTC demonstrated focal gallbladder wall thickening in all 3 and RAS in 1 of them. Conclusion: Both MRC and CTC provided anatomical and pathological information about the biliary system. With both techniques, however, either MPR or source images proved necessary in addition for evaluating the biliary system anatomy and pathology. The gallbladder wall was depicted clearly in source CTC, but MRC is recommended for the evaluation of adenomyomatosis because its depicts RAS clearly. (orig.)

  5. Management of complications during percutaneous implementation of biliary stents

    International Nuclear Information System (INIS)

    Objective: To retrospectively analyze the complications and management of complications during percutaneous implementation of biliary stents in 17 patients. Methods: Percutaneous biliary drainage and implementation of biliary stents for malignant biliary obstruction under fluoroscopic guidance was performed in 64 patients. 17 cases developed complications. Bradycardia and hypotension was seen in 5 cases, slipping of the stent into the duodenum in 1, bile duct perforation in 2, the fine guidewire broken in the hepatic parenchyma in 2, malposition of the stent in 3, hepato-renal failure leading to hemorrhage in 2, exchanging guidewire broken in the duodenum in 1, and balloon broken leading to stent dislocation in 1, respectively. Results: Bradycardia and hypotension in the 5 cases was treated medically and the procedure was interrupted. Slipping of the stent into the duodenum was passed off spontaneously. Broken of the fine guidewire in the liver did not present any complaints until the death of the patients. Perforation of bile duct was treated conservatively with a clinical successful outcome. Malposition of the stent was treated by reimplementation of shorter stents. The broken exchanging guidewire in the duodenum during implementation was removed with the gastroscope. The hepato-renal failure leading to hemorrhage had poor prognosis. The broken balloon caused stent dislocation was treated by reimplementation of stent. Conclusion: Percutaneous implementation of stent is effective and safe for elderly patients with proximal stenosis of the biliary tract. However, one must be very careful to avoid the complications

  6. The clinical application of domestic biliary metallic stents

    International Nuclear Information System (INIS)

    Objective: To determine the clinical efficacy and safety of domestic biliary metallic stents in the management of biliary obstruction. Methods: 75 domestic biliary metallic stents were implanted in 66 of 72 patients with obstructive jaundice due to malignant (n=70) and benign stenoses (n=2). Results: The technical successful rate was 92.7% (64/66). Palliation with rid of jaundice was achieved in 96.9% (64/66) within 1 month. The 30-day mortality rate was 3% (2/66). Early complications occurred in 7.6% (5/66). 44 patients were followed from 2 to 24 months after treatment. 33 (33/42) of 42 patients with malignancy died after a median survival of 5.3 months (range 2-23 months). The remaining 9 patients (9/42) remained alive with a mean follow-up of 11.6 months. The stent patency rates were 92.8%, 89.9% and 79.4 % at 3, 6, 12 months respectively. 6 patients (6/42) presented stent occlusion within a median period of 3 months. One of two patients with benign stenoses sustained a patency duration time of 24 months. One patient died 3 months after treatment. Conclusions: The domestic biliary metallic stent implantation is efficacy and safety in the management of biliary obstruction. (authors)

  7. Complications and treatment of migrated biliary endoprostheses: A review of the literature

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Endoscopic biliary stent insertion is a well-established procedure. It is especially successful in treating postoperative biliary leaks, and may prevent surgical intervention. A routine change of endoprostheses after 3 mo is a common practice but this can be prolonged to 6 mo. We reported a colonic perforation due to biliary stent dislocation and migration to the rectosigmoid colon, and reviewed the literature.

  8. Acute Duodenal Obstruction After Percutaneous Placement of Metallic Biliary Stents: Peroral Treatment with Enteral Stents

    International Nuclear Information System (INIS)

    Three patients with malignant biliary obstruction were treated with placement of metallic biliary stents. Two patients had known partial duodenal stenosis but had no symptoms of gastrointestinal obstruction. The patients developed symptomatic duodenal obstruction early after biliary metallic stent placement. The symptomatic duodenal obstructions were successfully treated with peroral placement of duodenal stents, which obviated the need for surgical intervention

  9. Concurrent cystic endometrial hyperplasia, ovarian luteoma and biliary cyst adenoma in an aged rabbit (Oryctolagus cuniculus):case report and literature review

    Institute of Scientific and Technical Information of China (English)

    Askari Nasrin; Akhtardanesh Baharak; Kheirandish Reza

    2012-01-01

    A 6-year-old female nulliparous Dutch Rabbit (Oryctolagus cuniculus) was presented in shock status with a history of abdominal distention, inappetance, lethargy, polydipsia, diarrhea and weight loss since 2 weeks ago. There was no breeding history. Radiographic survey showed increased soft tissue opacity dorsal to the urinary bladder and ventral to the colon on the lateral view consistent with uteromegaly and severe intestinal distention resembling intussusceptions. Conservative treatment was failed and the animal died. In necropsy, ileocecal intussusception was noted as the main death factor. Thickened uterine endometrium in both horns was observed and the uterus was filled with mucoid fluid. Both ovaries were multilobulated and distended. On the other hand, a small cyst sized 1.5 × 2.5 cm was diagnosed on the liver surface. Several samples were obtained from lesions for histopathological evaluation. Histopathologically, dilated cystic glands of variable size lined by densely packed epithelium and hyperplasia of the endometrium resulting in irregular folds or papillar projection into the lumen were evident and the sections of ovaries revealed ovarian luteoma that composed of polyhedral cells with pale stained vacuolated cytoplasm, centrally located nuclei with distinct cytoplasmic borders and the cytoplasm of cells contain lipid droplet. The occurrence of biliary cyst adenoma was confirmed by microscopic examination of the mass that composed of multicystic space in different sizes lined by flattened to cuboidal biliary epithelium with papillary projections. These cysts were seperated by variable amount of connective tissue. The lack of postmortem investigations in aged rabbits reduced the incidence of neoplastic disease diagnosis in this species. Whereas uterine adenecarcinoma and lymphosarcoma were commonly reported in rabbits, luteoma and biliary cyst adenoma that are well described in this case report were uncommon in rabbit medicine.

  10. Management of post-surgical biliary leakage with percutaneous transhepatic biliary drainage (PTBD) and occlusion balloon (OB) in patients without dilatation of the biliary tree: preliminary results

    International Nuclear Information System (INIS)

    To compare the outcome of patients affected by biliary leak after major biliary surgery and treated with percutaneous transhepatic biliary drainage (PTBD) alone with that of similar patients treated with PTBD and concurrent positioning of an occlusion balloon (PTBD-OB). We retrospectively reviewed the results of the use of PTBD or PTBD-OB performed at our institution from 2004 to 2008 in patients with post-surgical biliary leak. Sixteen patients entered the evaluation. PTDB alone was performed in 9 men (age 59.7 ± 13.4 years [mean ± standard deviation]; median 60 years), while PTBD-OB was performed in 7 patients (5 men, 2 women, age 71.3 ± 9.3 years; median 68 years). No significant difference between groups was found regarding age (p = 0.064) and sex (p = 0.175) distribution, number of procedures (3.1 ± 1.62; 2 vs 1.7 ± 1.1; 1, p = 0.151), and days of disease before recovery, death or modification of treatment (51.6 ± 66.8; 23 vs 18.6 ± 15.1; 14, p = 0.266). The number of patients treated with PTBD-OB who fully recovered (7/7, 100%) was significantly higher than that of patients treated with PTBD alone (4/9, 44%, p = 0.034). This procedure appears to be clinically effective, being associated with a higher probability of recovery in patients treated for post-surgical biliary leak. Further studies are needed to confirm these preliminary results. (orig.)

  11. Management of post-surgical biliary leakage with percutaneous transhepatic biliary drainage (PTBD) and occlusion balloon (OB) in patients without dilatation of the biliary tree: preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Pedicini, Vittorio; Poretti, Dario; Brambilla, Giorgio [Humanitas Clinical Institute, Department of Diagnostic Imaging, Rozzano, Milan (Italy); Mauri, Giovanni; Trimboli, Manuela [Humanitas Clinical Institute, Department of Diagnostic Imaging, Rozzano, Milan (Italy); University of Milan School of Medicine, Unit of Radiology, Ospedale San Paolo, Milan (Italy); Sconfienza, Luca Maria; Sardanelli, Francesco [University of Milan School of Medicine, Unit of Radiology, IRCCS Policlinico San Donato, Department of Medical and Surgical Sciences, Milan (Italy); Cornalba, Gianpaolo [University of Milan School of Medicine, Unit of Radiology, Ospedale San Paolo, Milan (Italy)

    2010-05-15

    To compare the outcome of patients affected by biliary leak after major biliary surgery and treated with percutaneous transhepatic biliary drainage (PTBD) alone with that of similar patients treated with PTBD and concurrent positioning of an occlusion balloon (PTBD-OB). We retrospectively reviewed the results of the use of PTBD or PTBD-OB performed at our institution from 2004 to 2008 in patients with post-surgical biliary leak. Sixteen patients entered the evaluation. PTDB alone was performed in 9 men (age 59.7 {+-} 13.4 years [mean {+-} standard deviation]; median 60 years), while PTBD-OB was performed in 7 patients (5 men, 2 women, age 71.3 {+-} 9.3 years; median 68 years). No significant difference between groups was found regarding age (p = 0.064) and sex (p = 0.175) distribution, number of procedures (3.1 {+-} 1.62; 2 vs 1.7 {+-} 1.1; 1, p = 0.151), and days of disease before recovery, death or modification of treatment (51.6 {+-} 66.8; 23 vs 18.6 {+-} 15.1; 14, p = 0.266). The number of patients treated with PTBD-OB who fully recovered (7/7, 100%) was significantly higher than that of patients treated with PTBD alone (4/9, 44%, p = 0.034). This procedure appears to be clinically effective, being associated with a higher probability of recovery in patients treated for post-surgical biliary leak. Further studies are needed to confirm these preliminary results. (orig.)

  12. The application of biliary catheter folding technique in the treatment of hilar nonanastomotic biliary strictures after orthotopic liver transplantation

    International Nuclear Information System (INIS)

    Objective: To introduce a newly-designed percutaneous single catheter folding technique, by which bilateral biliary drainage and stenting can be completed through single access, and to assess the effectiveness and safety of this technique in treating hilar nonanastomotic strictures occurred after orthotopic liver transplantation. Methods: A total of 10 patients with nonanastomotic strictures, who were encountered during the period from July 2000 to July 2010 in authors' hospital, were enrolled in this study. Balloon dilatation was used for the biliary tract stenosis. After the placement of biliary drainage tube, the catheter was folded into 'Y' shape within the biliary duct at hepatic portal region, and triaxial supporting drainage, i.e. the left hepatic duct, the right hepatic duct and the common hepatic duct, was established. The technical success rate, the clinical efficacy, the complications and the recurrence were documented and analyzed. Results: Technical success rate was 100% (10/10). In 9 patients, the clinical symptoms were obviously relieved, the biochemical indexes were gradually restored to normal and the imaging findings were markedly improved. During the follow-up lasting 26 months (median), no recurrence was seen. Minor complications occurred in two cases. One patient died after he received second orthotopic liver transplantation because of failure to respond to initial treatment. Conclusion: Percutaneous transhepatic biliary catheter folding technique is technically feasible. The results of this study indicate that this technique carries satisfactory success rate and is very effective and safe for the treatment of hilar nonanastomotic strictures occurred after orthotopic liver transplantation. (authors)

  13. Endoscopic ultrasound guided biliary and pancreatic duct interventions

    Institute of Scientific and Technical Information of China (English)

    David; Prichard; Michael; F; Byrne

    2014-01-01

    When endoscopic retrograde cholangio-pancreatog-raphy fails to decompress the pancreatic or biliary system, alternative interventions are required. In this situation, endosonography guided cholangio-pancrea-tography(ESCP), percutaneous radiological therapy or surgery can be considered. Small case series reporting the initial experience with ESCP have been superseded by comprehensive reports of large cohorts. Although these reports are predominantly retrospective, they demonstrate that endoscopic ultrasound(EUS) guided biliary and pancreatic interventions are associated with high levels of technical and clinical success. The proce-dural complication rates are lower than those seen with percutaneous therapy or surgery. This article describes and discusses data published in the last five years relat-ing to EUS-guided biliary and pancreatic intervention.

  14. Mechanisms of Biliary Plastic Stent Occlusion and Efforts at Prevention.

    Science.gov (United States)

    Kwon, Chang-Il; Lehman, Glen A

    2016-03-01

    Biliary stenting via endoscopic retrograde cholangiopancreatography has greatly improved the quality of patient care over the last 30 years. Plastic stent occlusion limits the life span of such stents. Attempts to improve plastic stent patency duration have mostly failed. Metal stents (self-expandable metal stents [SEMSs]) have therefore replaced plastic stents, especially for malignant biliary strictures. SEMS are at least 10 times more expensive than plastic stents. In this focused review, we will discuss basic mechanisms of plastic stent occlusion, along with a systematic summary of previous efforts and related studies to improve stent patency and potential new techniques to overcome existing limitations. PMID:27000422

  15. Biliary Ischemia Following Embolization of a Pseudoaneurysm after Pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    Roger Noun

    2006-07-01

    Full Text Available Aim :To report an uncommon consequence of hepatic artery occlusion in the management of a bleeding pseudoaneurysm following pancreaticoduodenectomy. Imaging :Analysis of a case involving a single patient in which a bleeding pseudoaneurysm of the gastroduodenal arterial stump following pancreaticoduodenectomy was treated by transcatheter arterial embolization. Case report: Effective hemostasis necessitated interruption of the hepatic arterial flow and was complicated by biliary ischemia and intrahepatic biloma. Conclusion :Transarterial embolization of the hepatic artery following ancreaticoduodenectomy can result in biliary ischemia and biloma formation.

  16. BACTERIOLOGICAL INVESTIGATION ON Fasciola hepatica AND CATTLE BILIARY DUCTS

    Directory of Open Access Journals (Sweden)

    A. Panebianco

    2009-03-01

    Full Text Available The aim of this work was to investigate the occurrence of bacteria in Fasciola hepatica and into cattle biliary ducts containing the parasite. A total of 24 liver and 58 F. hepatica samples were analysed. In all biliary ducts and in 62,06% of parasite Enterobacteriaceae were isolated. The bacterial specie more frequently isolated from parasite were Citrobacter freundii (34%, Proteus mirabilis (18%, Providencia rettgeri (12%, Staphylococcus spp. (18%, Enterobacter spp. (12%. There doesn’t appear to be a correlation between bacterial specie from parasite and ducts. The Authors conclude with some related inspective consideration.

  17. Permanent external percutaneous transhepatia biliary drainage in inoperable patients

    International Nuclear Information System (INIS)

    The authors refer about their experiences with percutaneous transhepatic biliary drainage (PTBD) which they have performed in a group of 20 patients. In all of these cases the indications for procedures were malignant biliary obstructions with jaundice. Since 1992 till now they have performed 20 external PTBD-s with a success rate of 85%. In their group of patients they had one serious complication. In three cases the catheter was withdrawned and the drainage had to be repeated. (authors). 5 figs., 9 refs

  18. Histopathology of submandibular glands removed for sialolithiasis.

    Science.gov (United States)

    Marchal, F; Kurt, A M; Dulguerov, P; Becker, M; Oedman, M; Lehmann, W

    2001-05-01

    We reviewed the clinical history of 48 consecutive patients who underwent submandibular gland removal for radiologically proven sialolithiasis. The specimens were examined by a pathologist blinded to the clinical data. A histopathologic classification into I of 3 grades was established by evaluating the degrees of atrophy, fibrosis, and inflammation. A correlation between the clinical and pathological variables was sought in order to define clinical variables that would predict abnormal submandibular glands that required extirpation. A significant percentage of the submandibular glands exhibited normal histologic findings. The patients with normal submandibular glands had a clinical evolution similar to that of other patients with severely damaged glands. The only clinical variable that correlated with increased histopathologic alteration was the patient's age. In view of the newly available diagnostic and therapeutic techniques for sialolithiasis, a conservative attitude to submandibular gland resection appears justified. PMID:11372932

  19. Histopathology of Lyme arthritis in LSH hamsters

    Energy Technology Data Exchange (ETDEWEB)

    Hejka, A.; Schmitz, J.L.; England, D.M.; Callister, S.M.; Schell, R.F.

    1989-05-01

    The authors studied the histopathologic evolution of arthritis in nonirradiated and irradiated hamsters infected with Borrelia burgdorferi. Nonirradiated hamsters injected in the hind paws with B. burgdorferi developed an acute inflammatory reaction involving the synovium, periarticular soft tissues, and dermis. This acute inflammatory reaction was short-lived and was replaced by a mild chronic synovitis as the number of detectable spirochetes in the synovium, periarticular soft tissues, and perineurovascular areas diminished. Exposing hamsters to radiation before inoculation with B. burgdorferi exacerbated and prolonged the acute inflammatory phase. Spirochetes also persisted longer in the periarticular soft tissues. A major histopathologic finding was destructive and erosive bone changes of the hind paws, which resulted in deformation of the joints. These studies should be helpful in defining the immune mechanism participating in the onset, progression, and resolution of Lyme arthritis.

  20. Histopathology of Lyme arthritis in LSH hamsters

    International Nuclear Information System (INIS)

    The authors studied the histopathologic evolution of arthritis in nonirradiated and irradiated hamsters infected with Borrelia burgdorferi. Nonirradiated hamsters injected in the hind paws with B. burgdorferi developed an acute inflammatory reaction involving the synovium, periarticular soft tissues, and dermis. This acute inflammatory reaction was short-lived and was replaced by a mild chronic synovitis as the number of detectable spirochetes in the synovium, periarticular soft tissues, and perineurovascular areas diminished. Exposing hamsters to radiation before inoculation with B. burgdorferi exacerbated and prolonged the acute inflammatory phase. Spirochetes also persisted longer in the periarticular soft tissues. A major histopathologic finding was destructive and erosive bone changes of the hind paws, which resulted in deformation of the joints. These studies should be helpful in defining the immune mechanism participating in the onset, progression, and resolution of Lyme arthritis

  1. Histopathological findings after Leksell gamma knife radiosurgery

    International Nuclear Information System (INIS)

    Radiosurgery for uveal melanoma can achieve tumor control according to clinical studies, yet histopathological proof has not been described. 8 eyes after radiosurgery which had to be removed either to regression failure or severe complications like neovascular glaucoma or persisting retinal detachment were investigated histopathologically and compared to 10 uveal melanomas that were treated by enucleation alone. Uveal melanomas treated with the gamma knife showed tumor necrosis (in more than 50 % total necrosis), a higher number of balloon cells, less number of mitoses and vascular changes (thickening of the vessel's walls, obliteration, thrombosis) which could not be demonstrated in enucleated eyes without irradiation. Leksell gamma knife can cause tumor necrosis and varying degrees of cell death and reduced reproducibility. Vascular changes seem to play a major role in tumor regression. (author)

  2. Primary Biliary Cirrhosis and Primary Sjögren's Syndrome: Insights for the Stomatologist.

    Science.gov (United States)

    Lins, Liliane; Paraná, Raymundo; Almeida Reis, Silvia Regina; Pereira Falcão, Antônio Fernando

    2014-05-01

    Primary biliary cirrhosis (PBC) is a chronic progressive autoimmune disease characterized by portal inflammation and immune-mediated destruction of the intrahepatic bile ducts. Primary Sjögren's syndrome is an autoimmune disease characterized by lymphocytic infiltration of exocrine glands, mainly the lachrymal and salivary glands, in the absence of other definitively diagnosed rheumatologic disease. We report a diagnosed case of primary Sjögren's syndrome associated with PBC. A 59-year-old Caucasian woman went to oral evaluation reporting dry mouth, difficulty in eating associated with burning mouth syndrome, dysgeusia and dysphagia. Intraoral examination revealed extensive cervical caries, gingivitis, gingival retraction, angular cheilitis and atrophic tongue. Hyposalivation was detected by salivary flow and Schirmer's test was positive. Antinuclear and antimitochondrial antibodies were both positive. Anti-Ro/SSA and anti-La/SSB antibodies were negative. A minor salivary gland biopsy of the lower lip was performed. Histopathologic analysis revealed lymphocytic infiltrate with destruction of salivary gland architecture in some areas and replacement of glandular tissues by mononuclear cells. Optimal management of PBC associated with Sjögren's syndrome requires a multidisciplinary approach as the key to optimal patient care. Dental practitioners should be able to recognize the clinical features of this associated condition. Appropriate dental care may prevent tooth decay, periodontal disease and oral infections as well as improve the patient's quality of life. PMID:25298762

  3. Primary Biliary Cirrhosis and Primary Sjögren's Syndrome: Insights for the Stomatologist

    Directory of Open Access Journals (Sweden)

    Liliane Lins

    2014-08-01

    Full Text Available Primary biliary cirrhosis (PBC is a chronic progressive autoimmune disease characterized by portal inflammation and immune-mediated destruction of the intrahepatic bile ducts. Primary Sjögren's syndrome is an autoimmune disease characterized by lymphocytic infiltration of exocrine glands, mainly the lachrymal and salivary glands, in the absence of other definitively diagnosed rheumatologic disease. We report a diagnosed case of primary Sjögren's syndrome associated with PBC. A 59-year-old Caucasian woman went to oral evaluation reporting dry mouth, difficulty in eating associated with burning mouth syndrome, dysgeusia and dysphagia. Intraoral examination revealed extensive cervical caries, gingivitis, gingival retraction, angular cheilitis and atrophic tongue. Hyposalivation was detected by salivary flow and Schirmer's test was positive. Antinuclear and antimitochondrial antibodies were both positive. Anti-Ro/SSA and anti-La/SSB antibodies were negative. A minor salivary gland biopsy of the lower lip was performed. Histopathologic analysis revealed lymphocytic infiltrate with destruction of salivary gland architecture in some areas and replacement of glandular tissues by mononuclear cells. Optimal management of PBC associated with Sjögren's syndrome requires a multidisciplinary approach as the key to optimal patient care. Dental practitioners should be able to recognize the clinical features of this associated condition. Appropriate dental care may prevent tooth decay, periodontal disease and oral infections as well as improve the patient's quality of life.

  4. Histopathology of submandibular glands removed for sialolithiasis

    OpenAIRE

    Marchal, Francis; Kurt, Anne-Marie; Dulguerov, Pavel; Becker, Minerva; Oedman, Micaela Louise; Lehmann, Willy

    2001-01-01

    We reviewed the clinical history of 48 consecutive patients who underwent submandibular gland removal for radiologically proven sialolithiasis. The specimens were examined by a pathologist blinded to the clinical data. A histopathologic classification into I of 3 grades was established by evaluating the degrees of atrophy, fibrosis, and inflammation. A correlation between the clinical and pathological variables was sought in order to define clinical variables that would predict abnormal subma...

  5. Lip Augmentation Dermal Filler Reactions, Histopathologic Features

    OpenAIRE

    Eversole, Roy; Tran, Khahn; Hansen, Doyle; Campbell, John

    2013-01-01

    Instances of perioral and labial foreign body reactions to a variety of injectable dermal fillers were selected from the oral and maxillofacial pathology and dermatopathology archives at Pacific Pathology Laboratory of San Diego with the objective being to engender a compilation of histopathologic characteristics that allow the pathologist to identify the inciting materials. All cases of foreign body reactions located in the lips and perioral regions were reviewed by four pathologists, retain...

  6. Regulated cell death in diagnostic histopathology.

    Science.gov (United States)

    Skenderi, Faruk; Vranic, Semir; Damjanov, Ivan

    2015-01-01

    Regulated cell death (RCD) is a controlled cellular process, essential for normal development, tissue integrity and homeostasis, and its dysregulation has been implicated in the pathogenesis of various conditions including developmental and immunological disorders, neurodegenerative diseases, and cancer. In this review, we briefly discuss the historical perspective and conceptual development of RCD, we overview recent classifications and some of the key players in RCD; finally we focus on current applications of RCD in diagnostic histopathology. PMID:26009238

  7. Microbiological and histopathological aspects of canine pyometra

    OpenAIRE

    Coggan, Jennifer Anne; Melville, Priscilla Anne; de Oliveira, Clair Motos; Faustino, Marcelo; Moreno, Andréa Micke; Benites, Nilson Roberti

    2008-01-01

    As pyometra is recognized as one of the main causes of disease and death in the bitch the purposes of this study were to evaluate microbiological and histopathological aspects of canine pyometra and to research the virulence factors of the E. coli isolates identifying possible risks to human health. The microbiological isolation from the intrauterine contents of 100 dogs with pyometra was carried out and the virulence factors in the E. coli strains were identified using PCR method. This study...

  8. Large Penile Mass With Unusual Benign Histopathology.

    Science.gov (United States)

    Johnson, Nate; Voznesensky, Maria; VerLee, Graham

    2015-09-01

    Pseudoepitheliomatous hyperplasia is an extremely rare condition presenting as a lesion on the glans penis in older men. Physical exam without biopsy cannot differentiate malignant from nonmalignant growth. We report a case of large penile mass in an elderly male with a history of lichen sclerosis, highly suspicious for malignancy. Subsequent surgical removal and biopsy demonstrated pseudoepitheliomatous hyperplasia, an unusual benign histopathologic diagnosis with unclear prognosis. We review the literature and discuss options for treatment and surveillance. PMID:26793536

  9. Large Penile Mass With Unusual Benign Histopathology

    Directory of Open Access Journals (Sweden)

    Nate Johnson

    2015-09-01

    Full Text Available Pseudoepitheliomatous hyperplasia is an extremely rare condition presenting as a lesion on the glans penis in older men. Physical exam without biopsy cannot differentiate malignant from nonmalignant growth. We report a case of large penile mass in an elderly male with a history of lichen sclerosis, highly suspicious for malignancy. Subsequent surgical removal and biopsy demonstrated pseudoepitheliomatous hyperplasia, an unusual benign histopathologic diagnosis with unclear prognosis. We review the literature and discuss options for treatment and surveillance.

  10. Interventional treatment of biliary stent restenosis: recent progress in clinical management

    International Nuclear Information System (INIS)

    Malignant obstructive jaundice is biliary obstruction disorders which are caused by various malignant tumors. Usually the disease is at its advanced stage and is inoperable when the diagnosis is confirmed. At present, percutaneous transhepatic biliary drainage (PTCD) and endoscopic or interventional implantation of plastic or self-expanding metal stent (SEMS) are the main managements in clinical practice. Due to the improved survival time, biliary stent restenosis has become a quite common clinical problem. Photodynamic therapy (PDT) and biliary tract radiofrequency ablation (RFA) have provided new therapeutic means for clinical use. Especially, with its development in technology and equipment, RFA has played more and more important role in treating biliary stent restenosis. (authors)

  11. Efficient nucleus detector in histopathology images.

    Science.gov (United States)

    Vink, J P; Van Leeuwen, M B; Van Deurzen, C H M; De Haan, G

    2013-02-01

    In traditional cancer diagnosis, (histo)pathological images of biopsy samples are visually analysed by pathologists. However, this judgment is subjective and leads to variability among pathologists. Digital scanners may enable automated objective assessment, improved quality and reduced throughput time. Nucleus detection is seen as the corner stone for a range of applications in automated assessment of (histo)pathological images. In this paper, we propose an efficient nucleus detector designed with machine learning. We applied colour deconvolution to reconstruct each applied stain. Next, we constructed a large feature set and modified AdaBoost to create two detectors, focused on different characteristics in appearance of nuclei. The proposed modification of AdaBoost enables inclusion of the computational cost of each feature during selection, thus improving the computational efficiency of the resulting detectors. The outputs of the two detectors are merged by a globally optimal active contour algorithm to refine the border of the detected nuclei. With a detection rate of 95% (on average 58 incorrectly found objects per field-of-view) based on 51 field-of-view images of Her2 immunohistochemistry stained breast tissue and a complete analysis in 1 s per field-of-view, our nucleus detector shows good performance and could enable a range of applications in automated assessment of (histo)pathological images. PMID:23252774

  12. EUS-Guided Transduodenal Biliary Drainage in Unresectable Pancreatic Cancer with Obstructive Jaundice

    Directory of Open Access Journals (Sweden)

    Tiing Leong Ang

    2007-07-01

    Full Text Available Context Endoscopic transpapillary biliary drainage is the procedure of choice for biliary decompression in patients with unresectable pancreatic cancer. When ERCP is unsuccessful, the usual alternative is percutaneous transhepatic biliary drainage. Recently, the use of EUS-guided biliary drainage has been reported, but it is not clear whether it is feasible for this technique to find more widespread use as an alternative to failed ERCP. We herein describe our experience with two cases of unresectable pancreatic cancer associated with obstructive jaundice treated by EUS-guided biliary drainage. Case report Two men presented with obstructive jaundice due to unresectable pancreatic cancer. ERCP was unsuccessful in both cases because of complete tumor obstruction at the distal common bile duct. Both patients rejected the standard option of percutaneous transhepatic biliary drainage and EUS-guided biliary drainage was performed. The obstructed biliary system was successfully decompressed by the creation of a choledochoduodenal fistula and the insertion of a transduodenal biliary stent. Conclusion EUS-guided biliary drainage has the potential of replacing percutaneous transhepatic biliary drainage in unresectable pancreatic cancer with obstructive jaundice when ERCP is unsuccessful

  13. Percutaneous Intraductal Radiofrequency Ablation Combined with Biliary Stent Placement for Nonresectable Malignant Biliary Obstruction Improves Stent Patency but not Survival

    Science.gov (United States)

    Wang, Jianfeng; Zhao, Lizhen; Zhou, Chuanguo; Gao, Kun; Huang, Qiang; Wei, Baojie; Gao, Jun

    2016-01-01

    Abstract Although radiofrequency (RF) ablation has been accepted as a curative treatment modality for solid organ tumors, intraductal RF ablation for malignant biliary obstruction has not been widely described. The aim of this study was to evaluate the feasibility, safety, and efficacy (in terms of stent patency and survival) of intraductal RF ablation combined with biliary stent placement for nonresectable malignant biliary obstruction. A search of the nonresectable malignant extrahepatic biliary obstruction database (179 patients) identified 18 consecutive patients who were treated with biliary intraluminal RF ablation during percutaneous transhepatic cholangiodrainage and inner stent placement (RF ablation group) and 18 patients who underwent inner stent placement without biliary intraluminal RF ablation (control group). The patients were matched for tumor type, location of obstruction, tumor stage, and Child–Pugh class status. Primary endpoints included safety, stent patency time, and survival rates. The secondary endpoint was effectiveness of the technique. The RF ablation and control groups were closely matched in terms of age, diagnosis, presence of metastases, presence of locally advanced tumor, American Society of Anesthesiologists (ASA) grade, and chemotherapy regimen (all P > 0.05). The technical success rate for both groups was 100%. The median time of stent patency in the RF ablation and control groups were 5.8 (2.8–11.5) months and 4.5 (2.4–8.0) months, respectively (Kaplan–Meier analysis: P = 0.03). The median survival times in the RF ablation and control groups were 6.1 (4.8–15.2) months and 5.8 (4.2–16.5) months, with no significant difference according to Kaplan–Meier analysis (P = 0.45). In univariate and multivariate analyses, poorer overall survival was associated with advanced age and presence of metastases (P < 0.05). Intraductal RF ablation combined with biliary stent placement for nonresectable malignant

  14. The observation and nursing of patients receiving interventional management for biliary complications occurred after liver transplantation

    International Nuclear Information System (INIS)

    Objective: To discuss the perioperative nursing norm for patients who are suffering from biliary complications occurred after liver transplantation and who will receive interventional management to treat the complications. Methods: Interventional therapies were performed in 20 patients with biliary complications due to liver transplantation. The interventional procedures performed in 20 cases included percutaneous biliary drainage (n = 13), percutaneous biliary balloon dilatation (n = 5) and biliary stent implantation (n = 7). The clinical results were observed and analyzed. Results: Biliary tract complications occurred after liver transplantation were seen frequently. Proper interventional management could markedly improve the successful rate of liver transplantation and increase the survival rate of the patients. In accordance with the individual condition, proper nursing measures should be taken promptly and effectively. Conclusion: Conscientious and effective nursing can contribute to the early detection of biliary complications and, therefore, to improve the survival rate of both the transplanted liver and the patients. (authors)

  15. Hepatobiliary scintigraphy in the assessment of long-term complication after biliary-enteric anastomosis: role in the diagnosis of post-operative segmental or total biliary obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Seung; Moon, Dae Hyuk; Lee, Sung Gyu; Lee, Yung Joo; Park, Kwang Min; Shin, Jung Woo; Ryu, Jin Sook; Lee, Hee Kyung [Asan Medicial Center, Seoul (Korea, Republic of)

    1998-07-01

    The purpose of this study was to investigate the accuracy of hepatobiliary scintigraphy (HBS) in the diagnosis of segmental or total biliary obstruction during long-term follow-up period after curative radical surgery with biliary-enteric anastomosis. The study population included 80 patients who underwent biliary-enteric anastomoses for benign (n=33) or malignant (n=47) biliary disease. Fifty-six of these 80 patients also underwent curative hepatic resection. Ninety eight hepatobiliary scintigrams using {sup 99m}Tc-DISIDA were performed at least 1 month after surgery (median 9 month). The scintigraphic criteria of total biliary obstruction we used were intestinal excretion beyond one hour or delayed hepatobiliary washout despite the presence of intestinal excretion. Segmental biliary obstruction was defined as delayed segmental excretion. The accuracy for biliary obstruction was evaluated according to different clinical situations. There were 9 instances with total biliary obstruction and 23 with segmental bile duct obstruction. Diagnosis of biliary obstruction was confirmed by percutaneous transhepatic cholangiography or surgery in 13, and follow-up clinical data for at least 6 months in 19 instances. Among the 32 instances with biliary symptoms and abnormal liver function, HBS allowed correct diagnosis in all 32(9 total, 14 segmental obstruction and 9 non-obstruction). Of the 40 with nonspecific symptom or isolated elevation of serum alkaline phosphatase, HBS diagnosed 8 of the 9 segmental biliary obstruction and 30 of the 31 non-obstruction. There were no biliary obstruction and no false positive result of scintigraphy in 26 instances which had no clinical symptom or signs of biliary obstruction. Diagnostic sensitivity of HBS was 100% (9/9) for total biliary obstruction, and 96%(22/23) for segmental bile obstruction. Specificity was 98%(39/40) in patients who had abnormal symptom or sign. Hepatobiliary scintigraphy is a highly accurate modality in the

  16. Ascariasis (For Parents)

    Science.gov (United States)

    ... hands well and often, especially after using the bathroom and before eating. Professional Treatment Doctors usually prescribe ... or her hands often, especially after using the bathroom and before eating. Have your pets checked for ...

  17. Molecular epidemiology of ascariasis

    DEFF Research Database (Denmark)

    Betson, Martha; Halstead, Fennella; Nejsum, Peter;

      We are using molecular epidemiology techniques to study the population structure of Ascaris obtained from humans and pigs. Worms were obtained from human hosts on Zanzibar and in Uganda, Bangladesh, Guatemala and Nepal and Ascaris from pigs were collected from in Uganda, Tanzania, Denmark...

  18. Ascaris and ascariasis

    OpenAIRE

    HOLLAND, CELIA

    2011-01-01

    PUBLISHED Ascaris lumbricoides and Ascaris suum are widespread parasitic nematodes of humans and pigs respectively. Recent prevalence data suggests that approximately 1.2 billion people are infected. Adult worms exhibit an overdispersed frequency distribution in their hosts and individuals harbouring heavy burdens display associated morbidity. In this review, we describe the parasite, its distribution and measures undertaken to control infection.

  19. Molecular epidemiology of ascariasis

    DEFF Research Database (Denmark)

    Betson, Martha; Nejsum, Peter; Bendall, Richard P.;

    2014-01-01

    BACKGROUND: The roundworm Ascaris lumbricoides infects 0.8 billion people worldwide, and Ascaris suum infects innumerable pigs across the globe. The extent of natural cross-transmission of Ascaris between pig and human hosts in different geographical settings is unknown, warranting investigation....... METHODS: Adult Ascaris organisms were obtained from humans and pigs in Europe, Africa, Asia, and Latin America. Barcodes were assigned to 536 parasites on the basis of sequence analysis of the mitochondrial cytochrome c oxidase I gene. Genotyping of 410 worms was also conducted using a panel of...... microsatellite markers. Phylogenetic, population genetic, and Bayesian assignment methods were used for analysis. RESULTS: There was marked genetic segregation between worms originating from human hosts and those originating from pig hosts. However, human Ascaris infections in Europe were of pig origin, and...

  20. A novel biliary stent coated with silver nanoparticles prolongs the unobstructed period and survival via anti-bacterial activity

    OpenAIRE

    Fuchun Yang; Zhigang Ren; Qinming Chai; Guangying Cui; Li Jiang; Hanjian Chen; Zhiying Feng; Xinhua Chen; Jian Ji; Lin Zhou; Weilin Wang; Shusen Zheng

    2016-01-01

    Symptomatic biliary stricture causes life-threatening complications, such as jaundice, recurrent cholangitis and secondary biliary cirrhosis. Fully covered self-expanding metal stents (FCSEMSs) are gaining acceptance for treatments of benign biliary stricture and palliative management of malignant biliary obstructions. However, the high rate of FCSEMS obstruction limits their clinic use. In this study, we developed a novel biliary stent coated with silver nanoparticles (AgNPs) and investigate...

  1. Diabetes in relation to biliary tract cancer and stones: a population-based study in Shanghai, China

    OpenAIRE

    Shebl, F M; Andreotti, G; Rashid, A; Gao, Y-T; Yu, K; Shen, M-C; Wang, B-S; Li, Q.; Han, T-Q; Zhang, B-H; Fraumeni, J F; Hsing, A W

    2010-01-01

    Background: Biliary tract cancers are rare but fatal malignancies. Diabetes has been related to biliary stones, but its association with biliary tract cancers is less conclusive. Methods: In a population-based case–control study of 627 cancers, 1037 stones, and 959 controls in Shanghai, China, we examined the association between diabetes and the risks of biliary tract cancer and stones, as well as the effect of potential mediating factors, including serum lipids and biliary stones (for cancer...

  2. Percutaneous transhepatic biliary drainage for hilar cholangiocarcinoma

    International Nuclear Information System (INIS)

    Objective: To evaluate the effect of PTBD in treating malignant biliary obstruction caused by hilar cholangiocarcinoma. Methods: We retrospectively analyzed the data of 103 patients(M:62,F:41)with malignant obstructive jaundice caused by hilar cholangiocarcinoma. After taking percutaneous transhepatic cholangiography, metallic stent or plastic external catheter or external-internal catheter for drainage was deployed and then followed up was undertaken with clinical and radiographic evaluation and laboratory. examination. Results: All patients went though PTBD successfully (100%). According to Bismuth classification, all 103 cases consisted of I type(N=30), II type (N=30), III type (N=26) and IV type (N=17). Thirty-nine cases were placed with 47 stents and 64 eases with drainage tubes. 4 cases installed two stems for bilateral drainage, 2 cases installed two stents because of long segmental strictures with stent in stent, 1 case was placed with three stents, and 3 cases installed stent and plastic catheter together. Sixty-four cases received plastic catheters in this series, 35 cases installed two or more catheters for bilateral drainage, 28 cases installed external and internal drainage catheters, 12 eases installed external drainage catheters, and 24 eases installed both of them. There were 17 patients involving incorporative infection before procedure, 13 cases cured after procedure, and 15 new patients got inflammation after procedure. 13 cases showed increase of amylase (from May, 2004), 8 eases had bloody bile drainage and 1 case with pyloric obstruction. Total serum bilirubin reduced from (386 ± 162) μmol/L to (161 ± 117) μmol/L, (P<0.01) short term curative effect was related with the type of hilar cholangiocarcinoma. The survival time was 186 days(median), and 1, 3, 6, 12 month survival rate were 89.9%, 75.3%, 59.6%, 16.9%, respectively. Conclusion: Percutaneous transhepatic bile drainage is a safe and effective palliative therapy of malignant

  3. A sign of symptomatic chronic cholecystitis on biliary scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Al-Sheikh, W.; Hourani, M.; Barkin, J.S.; Clarke, L.P.; Ashkar, F.S.; Serafini, A.N.

    1983-02-01

    Five hundred patients with acute right-upper-quadrant pain underwent biliary scintigraphy with /sup 99m/Tc paraisopropyliminodiacetic acid. One hundred and thirty-four studies were reported normal (both gallbladder and activity in bowel are noted in 1 hr). Of the 134 studies reported as normal, 32 showed intestinal activity before gallbladder visualization during the first hour of the study. Sonography and/or oral cholecystography revealed that 24 patients had gallstones, and eight patients had no demonstrable pathology in the biliary system. Of the 134 studies, 102 showed visualization of the gallbladder before intestinal activity during the first hour of the study. Sonography and/or oral cholecystography showed that 73 patients had normal biliary system. The remaining 29 patients had gallstones. The overall sensitivity of this finding is 45%, the specificity is 90%, and the accuracy is 73%. In this group of symptomatic patients, the appearance of intestinal activity before gallbladder activity on biliary scintigraphy warrants further evaluation of these patients by sonography and/or oral cholecystography.

  4. A sign of symptomatic chronic cholecystitis on biliary scintigraphy

    International Nuclear Information System (INIS)

    Five hundred patients with acute right-upper-quadrant pain underwent biliary scintigraphy with /sup 99m/Tc paraisopropyliminodiacetic acid. One hundred and thirty-four studies were reported normal (both gallbladder and activity in bowel are noted in 1 hr). Of the 134 studies reported as normal, 32 showed intestinal activity before gallbladder visualization during the first hour of the study. Sonography and/or oral cholecystography revealed that 24 patients had gallstones, and eight patients had no demonstrable pathology in the biliary system. Of the 134 studies, 102 showed visualization of the gallbladder before intestinal activity during the first hour of the study. Sonography and/or oral cholecystography showed that 73 patients had normal biliary system. The remaining 29 patients had gallstones. The overall sensitivity of this finding is 45%, the specificity is 90%, and the accuracy is 73%. In this group of symptomatic patients, the appearance of intestinal activity before gallbladder activity on biliary scintigraphy warrants further evaluation of these patients by sonography and/or oral cholecystography

  5. Biliary sludge and recurrent ketoacidosis: a case report

    Directory of Open Access Journals (Sweden)

    Kalra Sanjay

    2009-12-01

    Full Text Available Abstract A five year old boy, weighing 14 kg with no family history of diabetes, presented in frank diabetic ketoacidosis. He recovered, but continued to have episodes of ketoacidosis. He was diagnosed to have biliary sludge, which recovered with insulin treatment.

  6. Hormone replacement for osteoporosis in women with primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Rudic, Jelena S; Poropat, Goran; Krstic, Miodrag N;

    2011-01-01

    Women with primary biliary cirrhosis often suffer from postmenopausal osteoporosis due to their age, or osteoporosis secondary to their liver disease, or treatments provided for their liver disease. Hormone replacement increases bone mineral density and reduces fractures in postmenopausal women. On...

  7. Biliary cholesterol secretion: More than a simple ABC

    Directory of Open Access Journals (Sweden)

    Arne Dikkers, Uwe JF Tietge

    2010-12-01

    Full Text Available Biliary cholesterol secretion is a process important for 2 major disease complexes, atherosclerotic cardiovascular disease and cholesterol gallstone disease. With respect to cardiovascular disease, biliary cholesterol secretion is regarded as the final step for the elimination of cholesterol originating from cholesterol-laden macrophage foam cells in the vessel wall in a pathway named reverse cholesterol transport. On the other hand, cholesterol hypersecretion into the bile is considered the main pathophysiological determinant of cholesterol gallstone formation. This review summarizes current knowledge on the origins of cholesterol secreted into the bile as well as the relevant processes and transporters involved. Next to the established ATP-binding cassette (ABC transporters mediating the biliary secretion of bile acids (ABCB11, phospholipids (ABCB4 and cholesterol (ABCG5/G8, special attention is given to emerging proteins that modulate or mediate biliary cholesterol secretion. In this regard, the potential impact of the phosphatidylserine flippase ATPase class I type 8B member 1, the Niemann Pick C1-like protein 1 that mediates cholesterol absorption and the high density lipoprotein cholesterol uptake receptor, scavenger receptor class B type I, is discussed.

  8. Lymph node metastasis in the biliary tract carcinoma: CT evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Byung Hee; Lee, Ah Ra; Kim, Kie Hwan; Do, Young Soo; Chin, Soo Yil [Korea Cancer Center Hospital, Seoul (Korea, Republic of)

    1994-07-15

    The primary biliary carcinoma is usually unresectable at presentation, because of early lymphatic spread. To determine the incidence and the spread pattern of lymph node metastases according to the location of the primary tumor, we analyzed the CT scans of the patients with primary biliary adenocarcinoma. We reviewed the CT scans of 92 patients with pathologically proven primary biliary adenocacinima, including 45 peripheral cholangiocarcinomas, 22 hilar cholangiocarcinomas, 18 gallbladder carcinomas, and 7 common bile duct carcinomas. Positive adenopathy was diagnosed when the node exceeded 10 mm in short axis. The overall incidence of nodal metastases was 59.8% (55/92); 66.7% in peripheral cholangiocarcinoma, 54.5% in hilar cholangiocarcinoma, 55.6% in gallbladder carcinoma, and 42.9% in common bile duct carcinoma. The most commonly involved nodal group was the lesser omentum, followed by the celiac, periaortic, and peripancreatic group. The phrenic node group was only involved in the cases with the peripheral or hilar cholangiocarcinoma. The primary biliary carcinoma has a high incidence of lymph node metastases at the time of diagnosis, and shows different nodal spread pattern according to the location of the primary tumor. Involvement of the phrenic node was limited to the peripheral and hilar cholangiocarcinoma.

  9. Discordance of sonography and cholescintigraphy in acute biliary obstruction

    International Nuclear Information System (INIS)

    Animal studies have shown that there is a brief interval of several hours after acute biliary obstruction during which sonography will demonstrate only normal-sized bile ducts while /sup 99m/Tc cholescintigraphy will document total obstruction. Serial studies documented this phenomenon in a patient whose case is reported and reviewed

  10. Absorption of biliary cobalamin in baboons following total gastrectomy

    International Nuclear Information System (INIS)

    Absorption of radiolabeled cobalamin in baboons was assessed by whole body counting. Retention of biliary cobalamin and an aqueous solution of cyanocobalamin was measured in normal baboons and in baboons after total gastrectomy by using 57Co-labeled biliary cobalamin and 58C0-cyanocobalamin, with and without baboon gastric juice containing intrinsic factor. Radiolabeled biliary cobalamin was obtained by intravenous injection of 57Co-cyanocobalamin in baboons and collection of bile through a cannula placed in the common bile duct. Cobalamin absorption was not completely abolished by gastrectomy and biliary cobalamin was better retained than cyanocobalamin; intrinsic factor enhanced absorption of both forms. After gastrectomy there was steady depletion of liver and serum cobalamin levels, which ceased after a new equilibrium was reached between a progressively diminishing cobalamin loss and the impaired but significant residual level of absorption. These studies in the nonhuman primate provide further information concerning the enterohepatic circulation of cobalamin and suggest that the form of cobalamin in bile may be more readily absorbed than is cyanocobalamin or that bile itself may have an enhancing effect on cobalamin absorption. The data also suggest that physiologically significant amounts of cobalamin may be absorbed in the absence of a gastric source of intrinsic factor

  11. Biliary phosphatidylcholine and lysophosphatidylcholine profiles in sclerosing cholangitis

    Science.gov (United States)

    Gauss, Annika; Ehehalt, Robert; Lehmann, Wolf-Dieter; Erben, Gerhard; Weiss, Karl-Heinz; Schaefer, Yvonne; Kloeters-Plachky, Petra; Stiehl, Adolf; Stremmel, Wolfgang; Sauer, Peter; Gotthardt, Daniel Nils

    2013-01-01

    AIM: To analyze phospholipid profiles in intrahepatic bile from patients with primary sclerosing cholangitis (PSC) and secondary sclerosing cholangitis (SSC). METHODS: Intrahepatic bile specimens collected via endoscopic retrograde cholangiography from 41 patients were analyzed. Fourteen of these patients were diagnosed with PSC, 10 with SSC, 11 with choledocholithiasis or no identifiable biliary disease, and 6 with cholangiocellular carcinoma (CCC). Bile acid, cholesterol, protein, and bilirubin contents as well as pancreas lipase activity in bile were determined by biochemical methods. Phosphatidylcholine (PC) and lysophosphatidylcholine (LPC) species were quantified using nano-electrospray ionization tandem mass spectrometry. RESULTS: Bile from all the examined patient groups showed a remarkably similar PC and LPC species composition, with only minor statistical differences. Total biliary PC concentrations were highest in controls (8030 ± 1843 μmol/L) and lowest in patients with CCC (1969 ± 981 μmol/L) (P = 0.005, controls vs SSC and CCC, respectively, P < 0.05). LPC contents in bile were overall low (4.2% ± 1.8%). Biliary LPC/PC ratios and ratios of biliary PC to bilirubin, PC to cholesterol, PC to protein, and PC to bile acids showed no intergroup differences. CONCLUSION: PC and LPC profiles being similar in patients with or without sclerosing cholangitis, these phospholipids are likely not of major pathogenetic importance in this disease group. PMID:24023488

  12. Radioanatomy and physiology of liver and biliary tract

    International Nuclear Information System (INIS)

    Peculiarities of the structure and functioning of liver and biliary tract are considered. Comparison with anatomy and physiology of these healthy organs is carried out. The know ledge of radioanatomy of the given organs is shown to be the necessary condition of right interpretation of roentgenological data

  13. Percutaneous transhepatic biliary drainage: analysis of 175 cases

    International Nuclear Information System (INIS)

    Percutaneous transhepatic biliary drainage is a safe, effective and palliative means of treatment in biliary obstruction, especially in cases with malignant obstruction which are inoperable. 175 cases of transhepatic biliary drainage were performed on 119 patients with biliary obstruction from January 1985 to June 1989 at Kyung-pook National University Hospital. The causes of obstructive jaundice were 110 malignant diseases and 9 benign diseases. The most common indication for drainage was palliative intervention of obstruction secondary to malignant tumor in 89 cases. 86 cases of external drainage were performed including 3 cases of left duct approach, 29 cases of external-internal drainage and 60 cases of endoprosthesis. In external and external-internal drainages, immediate major complications (11.9%) occurred, including not restricted to, but sepsis, bile peritonitis and hemobilia. Delayed major complications (42.9%) were mainly catheter related. The delayed major complication of endoprosthesis resulted from obstruction of the internal stent. The mean time period to reobstruction of the internal stent was about 12 weeks. To improve management status, regular follow-up is required, as is education of both patients and their families as to when immediate clinical attention is mandated. Close communication amongst the varying medical specialities involved will be necessary to provide optional treatment for each patient

  14. Clogging of biliary endoprostheses. A morphologic and bacteriologic study

    DEFF Research Database (Denmark)

    Dowidar, N; Kolmos, H J; Lyon, H; Matzen, Peter

    1991-01-01

    The main problem encountered with the use of biliary endoprostheses is their tendency to clog, which necessitates their exchange. We studied this problem by performing light and electron microscopy and bacterial cultures on both unused and clinically used endoprostheses. These examinations showed...

  15. A Different Method of Hepaticojejunostomy for Proximal Biliary Injuries

    Directory of Open Access Journals (Sweden)

    Diane M. Radford

    1996-01-01

    Full Text Available The management of proximal biliary injuries presents a surgical challenge. Anastomoses can be difficult to perform and can have poor results. We describe a method of hepaticojejunostomy done from within the Roux-en-Y loop, which can be utilized in this situation.

  16. Preoperative biliary drainage before resection for cholangiocarcinoma (Pro)

    OpenAIRE

    Nimura, Y.

    2008-01-01

    Three types of preoperative biliary drainage (BD): percutaneous transhepatic (PTBD), endoscopic (EBD), and endoscopic nasobiliary (ENBD) can be indicated before resection of cholangiocarcinoma. However, three randomized controlled trials (RCTs) have revealed that preoperative PTBD does not improve perioperative results. Other RCTs have revealed that preoperative EBD for malignant obstructive jaundice has no demonstrable benefit and after EBD for hilar cholangiocarcinoma there are highly devel...

  17. Percutaneous transhepatic biliary drainage: analysis of 175 cases

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Kyung Jin; Lee, Sang Kwon; Kim, Tae Hun; Kim, Yong Joo; Kang, Duk Sik [College of Medicine, Kyungpook National Univ., Daegu (Korea, Republic of)

    1990-10-15

    Percutaneous transhepatic biliary drainage is a safe, effective and palliative means of treatment in biliary obstruction, especially in cases with malignant obstruction which are inoperable. 175 cases of transhepatic biliary drainage were performed on 119 patients with biliary obstruction from January 1985 to June 1989 at Kyung-pook National University Hospital. The causes of obstructive jaundice were 110 malignant diseases and 9 benign diseases. The most common indication for drainage was palliative intervention of obstruction secondary to malignant tumor in 89 cases. 86 cases of external drainage were performed including 3 cases of left duct approach, 29 cases of external-internal drainage and 60 cases of endoprosthesis. In external and external-internal drainages, immediate major complications (11.9%) occurred, including not restricted to, but sepsis, bile peritonitis and hemobilia. Delayed major complications (42.9%) were mainly catheter related. The delayed major complication of endoprosthesis resulted from obstruction of the internal stent. The mean time period to reobstruction of the internal stent was about 12 weeks. To improve management status, regular follow-up is required, as is education of both patients and their families as to when immediate clinical attention is mandated. Close communication amongst the varying medical specialities involved will be necessary to provide optional treatment for each patient.

  18. Interval Biliary Stent Placement Via Percutaneous Ultrasound Guided Cholecystostomy: Another Approach to Palliative Treatment in Malignant Biliary Tract Obstruction

    International Nuclear Information System (INIS)

    Percutaneous cholecystostomy is a minimally invasive procedure for providing gallbladder decompression, often in critically ill patients. It can be used in malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography when the intrahepatic ducts are not dilated or when stent insertion is not possible via the bile ducts. In properly selected patients, percutaneous cholecystostomy in obstructive jaundice is a simple, safe, and rapid option for biliary decompression, thus avoiding the morbidity and mortality involved with percutaneous transhepatic biliary stenting. Subsequent use of a percutaneous cholecystostomy for definitive biliary stent placement is an attractive concept and leaves patients with no external drain. To the best of our knowledge, it has only been described on three previous occasions in the published literature, on each occasion forced by surgical or technical considerations. Traditionally, anatomic/technical considerations and the risk of bile leak have precluded such an approach, but improvements in catheter design and manufacture may now make it more feasible. We report a case of successful interval metal stent placement via percutaneous cholecystostomy which was preplanned and achieved excellent palliation for the patient. The pros and cons of the procedure and approach are discussed.

  19. Endoscopic ultrasound-guided biliary drainage with placement of a fully covered metal stent for malignant biliary obstruction

    Institute of Scientific and Technical Information of China (English)

    Tae Hyeon Kim; Seong Hun Kim; Hyo Jeong Oh; Young Woo Sohn; Seung Ok Lee

    2012-01-01

    AIM:To determine the utility of endoscopic ultrasoundguided biliary drainage (EUS-BD) with a fully covered self-expandable metal stent for managing malignant biliary stricture.METHODS:We collected data from 13 patients who presented with malignant biliary obstruction and underwent EUS-BD with a nitinol fully covered selfexpandable metal stent when endoscopic retrograde cholangiopancreatography (ERCP) fails.EUS-guided choledochoduodenostomy (EUS-CD) and EUS-guided hepaticogastrostomy (EUS-HG) was performed in 9 patients and 4 patients,respectively.RESULTS:The technical and functional success rate was 92.3% (12/13) and 91.7% (11/12),respectively.Using an intrahepatic approach (EUS-HG,n =4),there was mild peritonitis (n =1) and migration of the metal stent to the stomach (n =1).With an extrahepatic approach (EUS-CD,n =10),there was pneumoperitoneum (n =2),migration (n =2),and mild peritonitis (n =1).All patients were managed conservatively with antibiotics.During follow-up (range,1-12 mo),there was re-intervention (4/13 cases,30.7%) necessitated by stent migration (n =2) and stent occlusion (n =2).CONCLUSION:EUS-BD with a nitinol fully covered self-expandable metal stent may be a feasible and effective treatment option in patients with malignant biliary obstruction when ERCP fails.

  20. Lichen Planus-a Clinico-histopathological

    OpenAIRE

    Garg Vijay; Nangia Anitha; Logani KulBhushan; Sharma Ravi

    2000-01-01

    The clinico-histopathological features of 75 patients of lichen planus were studied. The male to female ratio was 1:13. The largest number of patients (30.6%) fell into the 31-40 year age group. Two patients had systemic hypertension. There was no history of lichen planus in the family. All patients presented with severe itching within 1-2 months of onset. Papular lesions were seen in 72% and papules with plaques were seen 16%. Lower limbs were involved in 38% of c...

  1. Comparative histopathology of scabies versus nodular scabies

    Directory of Open Access Journals (Sweden)

    Mittal R

    1997-01-01

    Full Text Available Comparative histopathology was studied in 25 cases of scabies versus 25 cases of nodular scabies which were selected from Dermato-Venereology out patients. Salient differences observed were that in scabies lifting of stratum corneum at places was seen in all 100% cases, spongiosis in 100%, spongiotic vesicles in 28%, burrows in 56%, mite in 40% and vasculitis in 28% whereas in nodular scabies acanthosis was seen in 100%, pseudo epitheliomatous hyperplasia in 8%, burrows in 48%, mite in 24% and vasculitis in 84%. In nodular scabies, dermal infiltrate in 32% cases was arranged as lymphoid follicles with admixture of plasma cells and eosinophils.

  2. Histopathologically verified cerebral CT findings in AIDS

    International Nuclear Information System (INIS)

    Computer tomographic and histopathological findings in 55 patients who died of the complications of acquired immunodeficiency syndrome, were reviewed retrospectively. In 23 patients (42%) an increased space of the internal or external cerebral spinal fluid was diagnosed. 20 patients (36%) had focal lesions. We differentiated between single, multiple and ring-shaped lesions with contrast enhancement and hypodense lesions. In 12 cases (22%) no CT abnormalities were found. Focal lesions proved to be secondary to toxoplasmosis in 85%. Single lesions were never caused by toxoplasmosis. (orig.)

  3. Histopathology for the diagnosis of infectious diseases

    Directory of Open Access Journals (Sweden)

    Gupta E

    2009-01-01

    Full Text Available Histopathological examination of tissue biopsies for the identification of infectious organisms is a very important diagnostic tool. Conventional culture confirmation of tissue biopsies often fail to identify any pathogen as, first of all, invariably most of the tissue samples that are collected and sent for culture isolation are inappropriately collected in formalin, which prevents pathogen growth in culture media. Inadequate processing like grinding, etc. further hinders isolation. Presence of inhibitors like dead tissue debris, fibers, etc. also delays isolation. Microbiologists often lack expertise in identifying infectious pathogens directly from tissue biopsies by microscopic visualization. This review therefore acquaints microbiologists with the various methods available for detecting infectious agents by using histological stains. On histopathological examination of the tissue biopsy once, it is determined that a disease is likely to be due to an infection and has characterized the inflammatory response and hence associated microorganisms should be thoroughly looked for. Although some microorganisms or their cytopathic effects may be clearly visible on routine haematoxylin- and eosin-stained sections, additional histochemical stains are often needed for their complete characterization. Highly specific molecular techniques, such as immunohistochemistry, in situ hybridization and nucleic acid amplification, may be needed in certain instances to establish the diagnosis of infection. Through appropriate morphologic diagnoses and interlaboratory communication and collaboration, direct microscopic visualization of tissue samples can thus be very helpful in reaching a correct and rapid diagnosis.

  4. Percutaneous Embolization of Transhepatic Tracks for Biliary Intervention

    International Nuclear Information System (INIS)

    Significant pain can occur after removing transhepatic catheters from biliary access tracks, after percutaneous biliary drainage (PBD) or stenting. We undertook a randomized prospective study to ascertain whether track embolization decreases the amount of pain or analgesic requirement after PBD. Fifty consecutive patients (M:F, 22:28; age range:29-85 years; mean age: 66.3 years) undergoing PBD were randomized to receive track embolization or no track embolization after removal of biliary drainage catheters. A combination of Lipoidol and n-butyl cyanoacrylate were used to embolize transhepatic tracks using an 8F dilator. The patients who did not have track embolization performed had biliary drainage catheters removed over a guide wire. A visual analog scoring (VAS) system was used to grade pain associated with catheter removal, 24 h afterward. A required analgesic score (RAS) was devised to tabulate the analgesia required. No analgesia had a score of 0, oral or rectal nonopiate analgesics had a score of 1, oral opiates had a score of 2, and parenteral opiates had a score of 3. The average VAS and RAS for both groups were calculated and compared.Seven patients were excluded for various reasons, leaving 43 patients in the study group. Twenty-one patients comprised the embolization group and 22 patients comprised the nonembolization group. The mean biliary catheter dwell time was not significantly different (p > 0.05) between the embolization group and nonembolization (mean: 5.4 days vs 6.9 days, respectively). In the nonembolization group, the mean VAS was 3.4. Eight patients required parenteral opiates, three patients required oral opiates, and five patients required oral or rectal analgesics, yielding a mean RAS of 1.6. In the embolization group, the mean VAS was 0.9. No patient required parenteral opiates, six patients required oral opiates, and two patients had oral analgesia. The average RAS was 0.6. Both the VAS and the RAS were significantly lower in the

  5. Current status of endoscopic biliary drainage for unresectable malignant hilar biliary strictures

    Institute of Scientific and Technical Information of China (English)

    Hironari; Kato; Koichiro; Tsutsumi; Hirofumi; Kawamoto; Hiroyuki; Okada

    2015-01-01

    The management of jaundice and cholangitis is important for improving the prognosis and quality of life of patients with unresectable malignant hilar biliary strictures(UMHBS). In addition, effective chemotherapy, such as a combination of gemcitabine and cisplatin, requires the successful control of jaundice and cholangitis. However, endoscopic drainage for UMHBS is technical demanding, and continuing controversies exist in the selection of the most appropriate devices and techniques for stent deployment. Although metallic stents(MS) are superior to the usual plastic stents in terms of patency, an extensive comparison between MS and "inside stents", which are deployed above the sphincter of Oddi, is necessary. Which techniques are preferred remains as yet unresolved: for instance, whether to use a unilateral or bilateral drainage, or a stent-in-stent or side-by-side method for the deployment of bilateral MS, although a new cell design and thin delivery system for MS allowed us to accomplish successful deployments of bilateral MS. The development of techniques and devices for re-intervention after stent occlusion is also imperative. Further critical investigations of more effective devices and techniques, and increased randomized controlled trials are warranted to resolve these important issues.

  6. Initial clinical experience on improved percutaneous transhepatic biliary drainage in the treatment of malignant obstruction of the proximal biliary

    International Nuclear Information System (INIS)

    Objective: To investigate feasibility and clinical application value of improved percutaneous transhepatic biliary internal-external drainage (PTBIED). Methods: Consecutive patients from April 2007 to April 2010 with malignant obstructive jaundice were diagnosed by medical imaging or pathological confirmation whenever possible. The patients with proximal malignant biliary obstruction and intact inferior common bile ducts > 3 cm in length, and a bilirubin of 70 μmol/L or higher, were included in the experimental group. The control group included patients with low malignant biliary obstruction, and those who met the criteria for the exper/mental group but refused to receive the altered method of PTBIED. The patients underwent traditional PTBIED in control group. The patients in the experimental group received the procedure as following: according to percutaneous transhepatic cholangiography, a biliary external drainage catheter was modified by adding side-holes. Then under fluoroscopic guidance, the loop tip of the modified biliary drainage catheter was positioned in the inferior common hepatic duct/common bile duct, while the additional side-holes were located in the expanded hepatic duct. Technical success rate, complications, hepatic function and white cell count (WBC) were recorded pre- and post-procedure. All patients were followed-up until death. A t-test was used to compare continuous variable data changes, the Chi-square test was used to compare categorical variable data in two groups, and survival time was assessed using the Kaplan-Meier method. Results: Forty-six patients were included in the study, with 21 in the experimental group and 25 in the control group. The procedures were successfully performed in all patients in the two groups. There was no procedure-related death in the two groups. Symptoms were improved similarly after procedures in the two groups. The mean quantity of drained bile per day [experimental group (521±136) ml/d, control group (606

  7. 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.)

  8. Portal Vein Occlusion after Biliary Metal Stent Placement in Hilar Cholangiocarcinoma

    OpenAIRE

    Woo, Kyung Hee; Kim, Jin Bae; Chang, Yoon Jung; Kim, Hyo Jung; Baek, Il Hyun; Ko, Jin Seok; Woo, Ji Young; Kim, Hong Dae; Lee, Myung Seok

    2008-01-01

    Acute symptomatic portal vein obstruction related to biliary stenting is an extremely rare but life-threatening complication. This usually occurs in patients with either tumor invasion into the portal vein or pre-existing portal vein thrombus. Therefore, the portal vein should be carefully evaluated before placing a biliary metallic stent in such patients. We describe a case of acute portal vein obstruction after placing metallic biliary stents in a patient with a periductal-infiltrating type...

  9. Aortoduodenal fistula and aortic aneurysm secondary to biliary stent-induced retroperitoneal perforation

    Institute of Scientific and Technical Information of China (English)

    Tae Hoon Lee; Do Hyun Park; Ji-Young Park; Suck-Ho Lee; Il-Kwun Chung; Hong Soo Kim; Sang-Heum Park; Sun-Joo Kim

    2008-01-01

    Duodenal perforations caused by biliary prostheses are not uncommon, and they are potentially life threatening and require immediate treatment. We describe an unusual case of aortic aneurysm and rupture which occurred after retroperitoneal aortoduodenal fistula formation as a rare complication caused by biliary metallic stent-related duodenal perforation. To our knowledge, this is the first report describing a lethal complication of a bleeding, aortoduodenal fistula and caused by biliary metallic stent-induced perforation.

  10. Portal vein occlusion after biliary metal stent placement in hilar cholangiocarcinoma.

    Science.gov (United States)

    Woo, Kyung Hee; Kim, Jin Bae; Chang, Yoon Jung; Kim, Hyo Jung; Baek, Il Hyun; Ko, Jin Seok; Woo, Ji Young; Kim, Hong Dae; Lee, Myung Seok

    2008-06-01

    Acute symptomatic portal vein obstruction related to biliary stenting is an extremely rare but life-threatening complication. This usually occurs in patients with either tumor invasion into the portal vein or pre-existing portal vein thrombus. Therefore, the portal vein should be carefully evaluated before placing a biliary metallic stent in such patients. We describe a case of acute portal vein obstruction after placing metallic biliary stents in a patient with a periductal-infiltrating type of hilar cholangiocarcinoma. PMID:20485610

  11. Expansion of PROMININ-1-expressing cells in association with fibrosis of biliary atresia

    OpenAIRE

    Mavila, Nirmala; James, David; Shivakumar, Pranavkumar; Nguyen, Marie V.; Utley, Sarah; Mak, Katrina; Wu, Allison; Zhou, Shengmei; Wang, Larry; Vendyres, Christopher; Groff, Megan; Asahina, Kinji; Wang, Kasper S

    2014-01-01

    Biliary atresia (BA), the most common cause of end-stage liver disease and the leading indication for pediatric liver transplantation, is associated with intrahepatic ductular reactions within regions of rapidly expanding periportal biliary fibrosis. While the extent of such biliary fibrosis is a negative predictor of long-term transplant-free survival, the cellular phenotypes involved in the fibrosis are not well established. Using a Rhesus rotavirus (RRV)-induced mouse model of BA, we demon...

  12. Outcome of stenting in biliary and pancreatic benign and malignant diseases: A comprehensive review

    OpenAIRE

    Mangiavillano, Benedetto; Pagano, Nico; Baron, Todd H.; Luigiano, Carmelo

    2015-01-01

    Endoscopic stenting has become a widely method for the management of various malignant and benign pancreatico-biliary disorders. Biliary and pancreatic stents are devices made of plastic or metal used primarily to establish patency of an obstructed bile or pancreatic duct and may also be used to treat biliary or pancreatic leaks, pancreatic fluid collections and to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis. In this review, relevant literature search and expert o...

  13. Features of morphological changes of duodenal mucosa in patients with biliary calculosis

    OpenAIRE

    Shcherbinina M.B.; Gladun V.M.; Korolenko A.S.

    2009-01-01

    Today there are up to the end not established mechanisms of pathological changes of a duodenal mucosa at biliary calculosis. Investigation of morphological condition of duodenal mucosa at patients with biliary calculosis was the aim of this work. Histological examination of duodenal mucosa bioptats taken during esophagogastroduodenoscopy of two groups of supervision was carried out. 1-st group included patients with presence in a gallbladder biliary sludge and stones ≤5 mm (n=13). 2-nd group ...

  14. Long-term effects of forgotten biliary stents: a case series and literature review

    OpenAIRE

    Odabasi, Mehmet; Arslan, Cem; Akbulut, Sami; Abuoglu, Haci Hasan; Ozkan, Erkan; Yildiz, Mehmet Kamil; Eris, Cengiz; Gunay, Emre; Tekesin, Kemal; Muftuoglu, Tolga

    2014-01-01

    There are many studies about the biliary stents, however there is a little information about the long-term stayed forgotten biliary stents except a few case reports. We have reported the results of a number of cases with biliary stents that were forgotten or omitted by the patient and the endoscopist. During February 2010 to May 2013, five patients were referred to the general surgery clinic of Haydarpasa Numune Training and Research Hospital, Istanbul Turkey. Past history and medical documen...

  15. Acceptable Toxicity After Stereotactic Body Radiation Therapy for Liver Tumors Adjacent to the Central Biliary System

    Energy Technology Data Exchange (ETDEWEB)

    Eriguchi, Takahisa; Takeda, Atsuya; Sanuki, Naoko; Oku, Yohei; Aoki, Yousuke [Radiation Oncology Center, Ofuna Chuo Hospital, Kanagawa (Japan); Shigematsu, Naoyuki [Department of Radiology, Keio University School of Medicine, Tokyo (Japan); Kunieda, Etsuo, E-mail: kunieda-mi@umin.ac.jp [Department of Radiation Oncology, Tokai University, Kanagawa (Japan)

    2013-03-15

    Purpose: To evaluate biliary toxicity after stereotactic body radiation therapy (SBRT) for liver tumors. Methods and Materials: Among 297 consecutive patients with liver tumors treated with SBRT of 35 to 50 Gy in 5 fractions, patients who were irradiated with >20 Gy to the central biliary system (CBS), including the gallbladder, and had follow-up times >6 months were retrospectively analyzed. Toxicity profiles, such as clinical symptoms and laboratory and radiologic data especially for obstructive jaundice and biliary infection, were investigated in relation to the dose volume and length relationship for each biliary organ. Results: Fifty patients with 55 tumors were irradiated with >20 Gy to the CBS. The median follow-up period was 18.2 months (range, 6.0-80.5 months). In the dose length analysis, 39, 34, 14, and 2 patients were irradiated with >20 Gy, >30 Gy, >40 Gy, and >50 Gy, respectively, to >1 cm of the biliary tract. Seven patients were irradiated with >20 Gy to >20% of the gallbladder. Only 2 patients experienced asymptomatic bile duct stenosis. One patient, metachronously treated twice with SBRT for tumors adjacent to each other, had a transient increase in hepatic and biliary enzymes 12 months after the second treatment. The high-dose area >80 Gy corresponded to the biliary stenosis region. The other patient experienced biliary stenosis 5 months after SBRT and had no laboratory changes. The biliary tract irradiated with >20 Gy was 7 mm and did not correspond to the bile duct stenosis region. No obstructive jaundice or biliary infection was found in any patient. Conclusions: SBRT for liver tumors adjacent to the CBS was feasible with minimal biliary toxicity. Only 1 patient had exceptional radiation-induced bile duct stenosis. For liver tumors adjacent to the CBS without other effective treatment options, SBRT at a dose of 40 Gy in 5 fractions is a safe treatment with regard to biliary toxicity.

  16. Percutaneous transhepatic biliary drainage and stenting for malignant obstructive jaundice: A report of two cases

    OpenAIRE

    SHAO, JIN-HUI; FANG, HAI-XING; Li, Guo-Wei; HE, JIA-SHENG; Wang, Bao-Quan; Sun, Jun-Hui

    2015-01-01

    Malignant obstructive jaundice comprises a group of diseases that can be caused by primary biliary and extra-biliary carcinomas. Generally, surgical resection is the primary treatment for malignant obstructive jaundice; however, for the patients that are unable to undergo surgery, urgent treatment is required to improve hepatic function. Percutaneous transhepatic biliary drainage (PTBD) and stenting are emerging alternative treatments for malignant obstructive jaundice. PTBD and stenting have...

  17. Endoscopic and Percutaneous Preoperative Biliary Drainage in Patients with Suspected Hilar Cholangiocarcinoma

    OpenAIRE

    Kloek, Jaap J.; van der Gaag, Niels A.; Aziz, Yalda; Rauws, Erik A. J.; van Delden, Otto M.; Lameris, Johan S; Busch, Olivier R.C.; Gouma, Dirk J; van Gulik, Thomas M.

    2009-01-01

    Introduction Controversy exists over the preferred technique of preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCCA) requiring major liver resection. The current study compared outcomes of endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) in patients with resectable HCCA. Methods One hundred fifteen consecutive patients were explored for HCCA between 2001 and July 2008 and assigned by initial PBD procedure to either EBD or ...

  18. In vitro biliary clearance of angiotensin II receptor blockers and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors in sandwich-cultured rat hepatocytes: comparison with in vivo biliary clearance.

    Science.gov (United States)

    Abe, Koji; Bridges, Arlene S; Yue, Wei; Brouwer, Kim L R

    2008-09-01

    Previous reports have indicated that in vitro biliary clearance (Cl(biliary)) determined in sandwich-cultured hepatocytes correlates well with in vivo Cl(biliary) for limited sets of compounds. This study was designed to estimate the in vitro Cl(biliary) in sandwich-cultured rat hepatocytes (SCRHs) of angiotensin II receptor blockers and HMG-CoA reductase inhibitors that undergo limited metabolism, to compare the estimated Cl(biliary) values with published in vivo Cl(biliary) data in rats, and to characterize the mechanism(s) of basolateral uptake and canalicular excretion of these drugs in rats. The average biliary excretion index (BEI) and in vitro Cl(biliary) values of olmesartan, valsartan, pravastatin, rosuvastatin, and pitavastatin were 15, 19, 43, 45, and 20%, respectively, and 1.7, 3.2, 4.4, 46.1, and 34.6 ml/min/kg, respectively. Cl(biliary) predicted from SCRHs, accounting for plasma unbound fraction, correlated with reported in vivo Cl(biliary) for these drugs. The rank order of Cl(biliary) values predicted from SCRHs was consistent with in vivo Cl(biliary) values. Bromosulfophthalein inhibited the uptake of all drugs. BEI and Cl(biliary) values of olmesartan, valsartan, pravastatin, and rosuvastatin, known multidrug resistance-associated protein (Mrp) 2 substrates, were reduced in SCRHs from Mrp2-deficient (TR(-)) compared with wild-type (WT) rats. Although Mrp2 plays a minor role in pitavastatin biliary excretion, pitavastatin BEI and Cl(biliary) were reduced in TR(-) compared with WT SCRHs; Bcrp expression in SCRHs from TR(-) rats was decreased. In conclusion, in vitro Cl(biliary) determined in SCRHs can be used to estimate and compare in vivo Cl(biliary) of compounds in rats and to characterize transport proteins responsible for their hepatic uptake and excretion. PMID:18574002

  19. Reliability of pre- and intraoperative tests for biliary lithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Escallon, A. Jr.; Rosales, W.; Aldrete, J.S.

    1985-05-01

    The records of 242 patients, operated consecutively for biliary lithiasis, were analyzed to determine the reliability of oral cholecystography (OCG), ultrasonography (US), and HIDA in detecting biliary calculi. Preoperative interpretations were correlated to operative findings. OCG obtained in 138 patients was accurate in 92%. US obtained in 150 was correct in 89%. The accuracy of HIDA was 92% in acute and 78% in chronic cholecystitis. Intraoperative cholangiography (IOC) done in 173 patients indicated the need for exploratory choledochotomy in 24; 21 had choledocholithiasis. These observations suggest that OCG and US are very accurate, but not infallible, in detecting cholelithiasis. US should be done first; when doubt persists, the addition of OCG allows the preoperative diagnosis of gallstones in 97% of the cases. HIDA is highly accurate but not infallible in detecting acute calculous cholecystitis. IOC is very reliable in detecting choledocholithiasis; thus, its routine is justifiable.

  20. Reliability of pre- and intraoperative tests for biliary lithiasis.

    Science.gov (United States)

    Escallon, A; Rosales, W; Aldrete, J S

    1985-05-01

    The records of 242 patients, operated consecutively for biliary lithiasis, were analyzed to determine the reliability of oral cholecystography (OCG), ultrasonography (US), and HIDA in detecting biliary calculi. Preoperative interpretations were correlated to operative findings. OCG obtained in 138 patients was accurate in 92%. US obtained in 150 was correct in 89%. The accuracy of HIDA was 92% in acute and 78% in chronic cholecystitis. Intraoperative cholangiography (IOC) done in 173 patients indicated the need for exploratory choledochotomy in 24; 21 had choledocholithiasis. These observations suggest that OCG and US are very accurate, but not infallible, in detecting cholelithiasis. US should be done first; when doubt persists, the addition of OCG allows the preoperative diagnosis of gallstones in 97% of the cases. HIDA is highly accurate but not infallible in detecting acute calculous cholecystitis. IOC is very reliable in detecting choledocholithiasis; thus, its routine is justifiable. PMID:3888131