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Sample records for biliary drainage analysis

  1. 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

  2. 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

  3. Cytological Sampling Versus Forceps Biopsy During Percutaneous Transhepatic Biliary Drainage and Analysis of Factors Predicting Success

    International Nuclear Information System (INIS)

    Purpose: To assess the accuracy of cytological sampling and forceps biopsy in obstructing biliary lesions and to identify factors predictive of success. Methods: Consecutive patients (n = 119) with suspected malignant inoperable obstructive jaundice treated with percutaneous transhepatic biliary drainage during 7 years were included (60 male; mean age 72.5 years). All patients underwent forceps biopsy plus cytological sampling by washing the forceps device in cytological solution. Patient history, procedural and pathological records, and clinical follow-up were reviewed. Statistical analysis included chi-square test and multivariate regression analysis. Results: Histological diagnosis after forceps biopsy was more successful than cytology: Sensitivity was 78 versus 61%, and negative predictive value was 30 versus 19%. Cytology results were never positive when the forceps biopsy was negative. The cytological sample was negative and forceps sample positive in 2 cases of cholangiocarcinoma, 16 cases of pancreatic carcinoma, and 1 case of benign disease. Diagnostic accuracy was predicted by low bilirubin (p < 0.001), aspartate transaminase (p < 0.05), and white cell count (p ≤ 0.05). Conclusions: This technique is safe and effective and is recommended for histological diagnosis during PTBD in patients with inoperable malignant biliary strictures. Diagnostic yield is greater when bilirubin levels are low and there is no sepsis; histological diagnosis by way of forceps biopsy renders cytological sampling unnecessary.

  4. Cytological Sampling Versus Forceps Biopsy During Percutaneous Transhepatic Biliary Drainage and Analysis of Factors Predicting Success

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    Tapping, C. R.; Byass, O. R.; Cast, J. E. I., E-mail: james.cast@hey.nhs.uk [Hull Royal Infirmary, Department of Radiology (United Kingdom)

    2012-08-15

    Purpose: To assess the accuracy of cytological sampling and forceps biopsy in obstructing biliary lesions and to identify factors predictive of success. Methods: Consecutive patients (n = 119) with suspected malignant inoperable obstructive jaundice treated with percutaneous transhepatic biliary drainage during 7 years were included (60 male; mean age 72.5 years). All patients underwent forceps biopsy plus cytological sampling by washing the forceps device in cytological solution. Patient history, procedural and pathological records, and clinical follow-up were reviewed. Statistical analysis included chi-square test and multivariate regression analysis. Results: Histological diagnosis after forceps biopsy was more successful than cytology: Sensitivity was 78 versus 61%, and negative predictive value was 30 versus 19%. Cytology results were never positive when the forceps biopsy was negative. The cytological sample was negative and forceps sample positive in 2 cases of cholangiocarcinoma, 16 cases of pancreatic carcinoma, and 1 case of benign disease. Diagnostic accuracy was predicted by low bilirubin (p < 0.001), aspartate transaminase (p < 0.05), and white cell count (p {<=} 0.05). Conclusions: This technique is safe and effective and is recommended for histological diagnosis during PTBD in patients with inoperable malignant biliary strictures. Diagnostic yield is greater when bilirubin levels are low and there is no sepsis; histological diagnosis by way of forceps biopsy renders cytological sampling unnecessary.

  5. Effect of preoperative biliary drainage on malignantobstructive jaundice: A meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Yu-Dong Qiu; Jian-Ling Bai; Fang-Gui Xu; Yi-Tao Ding

    2011-01-01

    AIM: To evaluate the effect of preoperative biliary drainage(PBD) on obstructive jaundice resulting from malignant tumors.METHODS: According to the requirements of Cochrane systematic review, studies in the English language were retrieved from MEDLINE and Embase databases from 1995 to 2009 with the key word "preoperative biliary drainage". Two reviewers independently screened the eligible studies, evaluated their academic level and extracted the data from the eligible studies confirmed by cross-checking. Data about patients with and without PBD after resection of malignant tumors were processed for meta-analysis using the Stata 9.2 software, including postoperative mortality, incidence of postoperative pancreatic and bile leakage, abdominal abscess, delayed gastric emptying and incision infection.RESULTS: Fourteen retrospective cohort studies involving 1826 patients with malignant obstructive jaundice accorded with our inclusion criteria, and were included in meta-analysis. Their baseline characteristics were comparable in all the studies. No significant difference was found in combined risk ratio (RR) of postoperative mortality and incidence of pancreatic and bile leakage, abdominal abscess, delayed gastric emptying between patients with and without PBD. However, the combined RR for the incidence of postoperative incision infectionwas improved better in patients with PBD than in those without PBD (P<0.05).CONCLUSION: PBD cannot significantly reduce the postoperative mortality and complications of malignant obstructive jaundice, and therefore should not be used as a preoperative routine procedure for malignant obstructive jaundice.

  6. 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

  7. 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

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

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    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.

  9. Effect of preoperative biliary drainage on outcome of classical pancreaticoduodenectomy

    Institute of Scientific and Technical Information of China (English)

    Chandra Shekhar Bhati; Chandrashekhar Kubal; Pankaj Kumar Sihag; Ankur Atal Gupta; Raj Kamal Jenav; Nicholas G Inston; Jagdish M Mehta

    2007-01-01

    AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy.METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pancreaticoduodenectomy from March 1994 to March 2004 in department of surgery at SMS medical college, Jaipur, India. Demographic variables, details of preoperative stenting, operative procedure and post operative complications were noted.RESULTS: Preoperative biliary drainage was performed in 21 patients (43.5%). The incidence of septic complications was significantly higher in patients with biliary stent placement (P < 0.05, 0 vs 4). This group of patients also had a significantly higher minor biliary leak rate. Mortality and hospital stay in each group was comparable.CONCLUSION: Within this study population the use of PBD by endoscopic stenting was associated with a high incidence of infective complications. These findings do not support the routine use of biliary stenting in patients prior to pancreatico-duodenectomy.

  10. Reality named endoscopic ultrasound biliary drainage

    Institute of Scientific and Technical Information of China (English)

    Hugo; Gon?alo; Guedes; Roberto; Iglesias; Lopes; Joel; Fernandez; de; Oliveira; Everson; Luiz; de; Almeida; Artifon

    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 cholangio-graphy, but nowadays it emerges as a powerful thera-peutic 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 retro-grade 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 trans-papillary, 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.

  11. [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

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

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    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

  13. 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)

  14. 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

  15. A comparative analysis of nasogastric and intravenous fluid resuscitation in patients with malignant obstructive jaundice prior to endoscopic biliary drainage

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    Kavita Baghel

    2013-01-01

    Full Text Available Background: An alternative to intravenous is nasogastric fluid administration through normal functioning gut. Though not common, this practice has significance in mass causalities and elective situations. Aim: The study was designed to compare nasogastric and intravenous fluid resuscitation in malignant obstructive jaundice (OJ and their effect on endotoxemia. Materials and Methods: Sixty patients with malignant OJ undergoing endoscopic biliary drainage were randomized into two groups. A total of 4 l of fluid (Ringer′s lactate was administered to Group A through nasogastric tube and to Group B through intravenous route for 48 h. Vital parameters, serum bilirubin, serum creatinine, creatinine clearance rate, electrolytes, and endotoxemia were monitored. Results: Significant improvement in blood pressure (Group A, P = 0.014; Group B, P = 0.020 and significant decrease in serum bilirubin level (Group A, P = 0.001; Group B, P < 0.0001 was observed in both groups after resuscitation. Significantly decreased (P = 0.036 post hydration endotoxin level was observed in Group A as compared to Group B. Febrile events were significantly higher (P = 0.023 in Group B as compared to Group A (6 vs 0. Electrolyte abnormalities were found more in Group B, however statistically insignificant. Conclusion: In OJ patient undergoing biliary drainage, preoperative fluid resuscitation through nasogastric tube may be helpful in reducing postoperative septic complications and endotoxemia.

  16. The Effects of Cholecystojejunostomy and Biliary Drainage on Biliary Motor

    Institute of Scientific and Technical Information of China (English)

    郑启昌; 陈阳龙

    2002-01-01

    Summary: Simulating physiological neuronal and hormonal conditions during digestive and interdigestive periods, the study identified the changes of the motility of biliary system including bile duct and sphincter of Oddi (SO) before and after cholecystojejunostomy. Thirty-five rabbits were divided into five groups randomly. The experimental groups received the venous injection of CCK 10 ng/kg, ery thromycin 10 mg/kg, atropine 3 μg/kg and L-NAME 10 mg/kg respectively. Each rabbit under went manometry through introducing a three-lumen catheter via the papilla retrogradely, using the low-compliance papillary infusion system. Then the gallbladder and the upper segment of the jejunum was anastomosed and the manometric procedures repeated after one week. SO basal pressure was in creased, contraction amplitude decreased, contraction time shortened after cholecystojejunostomy. L-NAME, CCK and erythromycin could all excite SO. L-NAME could increase basal pressure and con traction amplitude, CCK increase basal pressure contraction amplitude and frequency, and ery-thromycin increase contraction amplitude, respectively. But comparing with that before cholecystoje junostomy, the increasing extent was decreased. The tensional and spontaneous contractions of the SO were under the control of the neural and hormonal mechanism. The anastomosis of gallbladder and jejunum and the drainage of bile made the tensional contraction stronger, but the spontaneous contraction weakened after the operation due to the decreases of the sensitivity of SO to hormonal fac tors. The clinical symptoms may not be relieved when the patients with SO dysfunction accepted cholecystojejunostomy.

  17. 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.

  18. 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.

  19. 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.

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

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    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.

  1. Current status of preoperative drainage for distal biliary obstruction

    Institute of Scientific and Technical Information of China (English)

    Harutoshi; Sugiyama; Toshio; Tsuyuguchi; Yuji; Sakai; Rintaro; Mikata; Shin; Yasui; Yuto; Watanabe; Dai; Sakamoto; Masato; Nakamura; Reina; Sasaki; Jun-ichi; Senoo; Yuko; Kusakabe; Masahiro; Hayashi; Osamu; Yokosuka

    2015-01-01

    Preoperative biliary drainage(PBD) was developed to improve obstructive jaundice, which affects a number of organs and physiological mechanisms in patients waiting for surgery. However, its role in patients who will undergo pancreaticoduodenectomy for biliary obstruction remains controversial. This article aims to review the current status of the use of preoperative drainage for distal biliary obstruction. Relevant articles published from 1980 to 2015 were identified by searching MEDLINE and Pub Med using the keywords "PBD", "pancreaticoduodenectomy", and "obstructive jaundice". Additional papers were identified by a manual search of the references from key articles. Current studies have demonstrated that PBD should not be routinely performed because of the postoperative complications. PBD should only be considered in carefully selected patients, particularly in cases where surgery had to be delayed. PBD may be needed in patients with severe jaundice, concomitant cholangitis, or severe malnutrition. The optimal method of biliary drainage has yet to be confirmed. PBD should be performed by endoscopic routes rather than by percutaneous routes to avoid metastatic tumor seeding. Endoscopic stenting or nasobiliary drainage can be selected. Although more expensive, the use of metallic stents remains a viable option to achieve effective drainage without cholangitis and reintervention.

  2. Ampullary carcinoma: Effect of preoperative biliary drainage on surgical outcome

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    Sheikh Anwar Abdullah; Tarun Gupta; Khairul Azhar Jaafar; Yaw Fui Alexander Chung; London Lucien Peng Jin Ooi; Steven Joseph Mesenas

    2009-01-01

    AIM: To evaluate the influence of preoperative biliary drainage on morbidity and mortality after surgical resection for ampullary carcinoma. METHODS: We analyzed retrospectively data for 82 patients who underwent potentially curative surgery for ampullary carcinoma between September 1993 and July 2007 at the Singapore General Hospital, a tertiary referral hospital. Diagnosis of ampullary carcinoma was confirmed histologically. Thirty-five patients underwent preoperative biliary drainage (PBD group), and 47 were not drained (non-PBD group). The mode of biliary drainage was endoscopic retrograde cholangiopancreatography ( n = 33) or percutaneous biliary drainage ( n = 2). The following parameters were analyzed: wound infection, intra-abdominal abscess, intra-abdominal or gastrointestinal bleeding, septicemia, biliary or pancreatic leakage, pancreatitis, gastroparesis, and re-operation rate. Mortality was assessed at 30 d (hospital mortality) and also longterm. The statistical endpoint of this study was patient survival after surgery. RESULTS: The groups were wel l matched for demographic criteria, clinical presentation and operative characteristics, except for lower hemoglobin in the non- PBD group (10.9 ± 1.6 vs 11.8 ± 1.6 in the PBD group). group (10.9 ± 1.6 vs 11.8 ± 1.6 in the PBD group). Of the parameters assessing postoperative morbidity, incidence of wound infection was significantly less in the PBD than the non-PBD group [1 (2.9%) vs 12 (25.5%)]. However, the rest of the parameters did not differ significantly between the groups, i.e. sepsis [10 (28.6%) vs 14 (29.8%)], intra-abdominal bleeding [1 (2.9%) vs 5 (10.6%)], intra-abdominal abscess [1 (2.9%) vs 8 (17%)], gastrointestinal bleeding [3 (8.6%) vs 5 (10.6%)], pancreatic leakage [2 (5.7%) vs 3 (6.4%)], biliary leakage [2 (5.7%) vs 3 (6.4%)], pancreatitis [2 (5.7%) vs 2 (4.3%)], gastroparesis [6 (17.1%) vs 10 (21.3%)], need for blood transfusion [10 (28.6%) vs 17 (36.2%)] and re-operation rate [1 (2

  3. Unilobar versus bilobar biliary drainage: effect on quality of life and bilirubin level reduction

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    Shivanand Gamanagatti

    2016-01-01

    Conclusion: Percutaneous biliary drainage provides good palliation of malignant obstructive jaundice. Partial-liver drainage achieved results as good as those after complete liver drainage with significant improvements in QOL and reduction of the bilirubin level.

  4. Liver fibrosis caused by choledocholith to regress after biliary drainage

    Institute of Scientific and Technical Information of China (English)

    Zuo-Bing Chen; Shu-Sen Zheng; Guo-Zhi Hu; Yuan Gao; Chen-Yan Ding; Yun Zhang; Xue-Hong Zhao; Lin-Mei Ni

    2005-01-01

    AIM: To study the correlation between liver fibrosis severity and biliary drainage in patients with choledocholith.METHODS: A follow-up study on seven patients with liver fibrosis due to choledocholith was made. The data, including biochemical tests (aspartate aminotransferase, alanine aminotransferase) and liver histological features before and after biliary drainage, were collected and studied. The fibrosis severity was scored on a scale from 0 to 3, with 0 denoting none, 1 portal and periportal fibrosis, 2 the presence of numerous fiber septa, and 3 cirrhosis. The average liver fibrosis severity scores of the first and second biopsy were compared with statistical method.RESULTS: The first, second liver fibrosis severity scores of these seven patients were 2,1; 2,1; 1,0; 1,1; 2,1; 2,1;1,0 respectively. The results showed that the average liver fibrosis severity score of the second liver biopsy decreased significantly compared with the first liver biopsy (n = 7, t = 4.25, P<0.05).CONCLUSION: Liver fibrosis due to choledocholith may regress after biliary drainage.

  5. 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.

  6. 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...

  7. Preoperative biliary drainage for periampullary tumors causing obstructive jaundice; DRainage vs. (direct OPeration (DROP-trial

    Directory of Open Access Journals (Sweden)

    Sosef Meindert N

    2007-03-01

    Full Text Available Abstract Background Surgery in patients with obstructive jaundice caused by a periampullary (pancreas, papilla, distal bile duct tumor is associated with a higher risk of postoperative complications than in non-jaundiced patients. Preoperative biliary drainage was introduced in an attempt to improve the general condition and thus reduce postoperative morbidity and mortality. Early studies showed a reduction in morbidity. However, more recently the focus has shifted towards the negative effects of drainage, such as an increase of infectious complications. Whether biliary drainage should always be performed in jaundiced patients remains controversial. The randomized controlled multicenter DROP-trial (DRainage vs. Operation was conceived to compare the outcome of a 'preoperative biliary drainage strategy' (standard strategy with that of an 'early-surgery' strategy, with respect to the incidence of severe complications (primary-outcome measure, hospital stay, number of invasive diagnostic tests, costs, and quality of life. Methods/design Patients with obstructive jaundice due to a periampullary tumor, eligible for exploration after staging with CT scan, and scheduled to undergo a "curative" resection, will be randomized to either "early surgical treatment" (within one week or "preoperative biliary drainage" (for 4 weeks and subsequent surgical treatment (standard treatment. Primary outcome measure is the percentage of severe complications up to 90 days after surgery. The sample size calculation is based on the equivalence design for the primary outcome measure. If equivalence is found, the comparison of the secondary outcomes will be essential in selecting the preferred strategy. Based on a 40% complication rate for early surgical treatment and 48% for preoperative drainage, equivalence is taken to be demonstrated if the percentage of severe complications with early surgical treatment is not more than 10% higher compared to standard treatment

  8. Preoperative biliary drainage for periampullary tumors causing obstructive jaundice; DRainage vs. (direct) OPeration (DROP-trial)

    NARCIS (Netherlands)

    N.A. van der Gaag; S.M.M. de Castro; E.A.J. Rauws; M.J. Bruno; C.H.J. van Eijck; E.J. Kuipers; J.J.G.M. Gerritsen; J.P. Rutten; J.W. Greve; E.J. Hesselink; J.H.G. Klinkenbijl; I.H.M. Borel Rinkes; D. Boerma; B.A. Bonsing; C.J. van Laarhoven; F.J.G.M. Kubben; E. van der Harst; M.N. Sosef; K. Bosscha; I.H.J.T. de Hingh; L.T. de Wit; O.M. van Delden; O.R.C. Busch; T.M. van Gulik; P.M.M. Bossuyt; D.J. Gouma

    2007-01-01

    Background Surgery in patients with obstructive jaundice caused by a periampullary (pancreas, papilla, distal bile duct) tumor is associated with a higher risk of postoperative complications than in non-jaundiced patients. Preoperative biliary drainage was introduced in an attempt to improve the gen

  9. Preoperative biliary drainage for periampullary tumors causing obstructive jaundice; DRainage vs. (direct) OPeration (DROP-trial)

    NARCIS (Netherlands)

    N.A. van der Gaag (Niels); S.M.M. de Castro (Steve); E.A.J. Rauws; M.J. Bruno (Marco); C.H.J. van Eijck (Casper); E.J. Kuipers (Ernst); J.J.G.M. Gerritsen (Josephus); J.P. Rutten (Joost Paul); J.W. Greve; E.J. Hesselink (Eric); J.H. Klinkenbijl (Jean); I.H.M.B. Rinkes; D. Boerma (Djamila); B.A. Bonsing (Bert); C.J. van Laarhoven (Cees); F.J. Kubben; E. van der Harst (Erwin); M.N. Sosef (Meindert); K. Bosscha (Koop); I.H.J.T. de Hingh (Ignace); L. Th de Wit (Laurens); O.M. van Delden (Otto); O.R.C. Busch (Olivier); T.M. van Gulik (Thomas); P.M.M. Bossuyt (Patrick); D.J. Gouma (Dirk)

    2007-01-01

    textabstractBackground. Surgery in patients with obstructive jaundice caused by a periampullary (pancreas, papilla, distal bile duct) tumor is associated with a higher risk of postoperative complications than in non-jaundiced patients. Preoperative biliary drainage was introduced in an attempt to im

  10. 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...

  11. Treatment of malignant biliary occlusion by means of transhepatic percutaneous biliary drainage with insertion of metal stents - results of an 8-year follow-up and analysis of the prognostic parameters

    International Nuclear Information System (INIS)

    Purpose: To analyze outcome and predictive factors for patient survival and patency rates of unresectable malignant biliary obstruction treated with percutaneous transhepatic insertion of metal stents. Materials and Methods: This is a retroselective analysis of 130 patients treated in one interventional radiological center with data collected from patient records and by telephone interviews. The procedure-related data had been prospectively documented in a computer data base. The Kaplan-Meier analysis was performed for univariate and multivariate comparison of survival and patency rates with the log-rank test used for different tumor types. Predictive factors for survival and 30-day mortality were analyzed by a stepwise logistic regression. Results: Underlying causes of malignant biliary obstructions were cholangiocarcinoma in 50, pancreatic carcinoma in 29, liver metastases in 27, gallbladder carcinoma in 20, and other tumors in 4 patients. The technical success rate was 99%, the complication rate 27% and the 30-day mortality 11%. Primary patency rates (406 days with a median of 207 days) did not differ significantly for different tumor types. The survival rates were significantly (p = 0.03 by log-rank test) better for patients with cholangiocarcinoma than for patients with pancreatic carcinoma and liver metastases. Multiple regression analysis revealed no predictive factor for patient survival and 30-day mortality. Conclusion: Percutaneous transhepatic insertion of metal biliary endoprostheses offers a good initial and long-term relief of jaundice caused by malignant biliary obstruction. Although survival rates for patients with cholangiocarcinoma are better than for other causes of malignant biliary obstruction, a clear predictive factor is lacking for patients undergoing palliative biliary stent insertion. (orig.)

  12. A Case of Malignant Biliary Obstruction with Severe Obesity Successfully Treated by Endoscopic Ultrasonography-Guided Biliary Drainage

    Science.gov (United States)

    Yamasaki, Shuuji

    2016-01-01

    Here, we present a case of malignant biliary tract obstruction with severe obesity, which was successfully treated by endoscopic ultrasonography-guided biliary drainage (EUS-BD). A female patient in her sixties who had been undergoing chemotherapy for unresectable pancreatic head cancer was admitted to our institution for obstructive jaundice. She had diabetes mellitus, and her body mass index was 35.1 kg/m2. Initially, endoscopic retrograde cholangiopancreatography (ERCP) was performed, but bile duct cannulation was unsuccessful. Percutaneous transhepatic biliary drainage (PTBD) from the left hepatic biliary tree also failed. Although a second PTBD attempt from the right hepatic lobe was accomplished, biliary tract bleeding followed, and the catheter was dislodged. Consequently, EUS-BD (choledochoduodenostomy), followed by direct metallic stent placement, was performed as a third drainage method. Her postprocedural course was uneventful. Following discharge, she spent the rest of her life at home without recurrent jaundice or readmission. In cases of severe obesity, we consider EUS-BD, rather than PTBD, as the second drainage method of choice for distal malignant biliary obstruction when ERCP fails.

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

    Directory of Open Access Journals (Sweden)

    Everson LA Artifon

    2010-11-01

    Full Text Available 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 rates. We describe three cases of unresectable pancreatic cancer associated with obstructive jaundice, treated by EUS-guided biliary drainage. Case report Three patients with unresectable pancreatic cancer, associated with obstructive jaundice, were included. ERCP was unsuccessful because of complete tumor obstruction of the distal common bile duct and papilla invasion. An EUS-guided rendezvous maneuver was attempted, without success. Then, EUS-guided choledochoduodenostomy, with a partially covered self-expanding metal stent, was performed in the same procedure. There were no early complications and the procedure was also clinically effective in relieving jaundice in all cases. Conclusions EUS-guided biliary drainage is a feasible alternative to percutaneous transhepatic biliary drainage or surgery in unresectable pancreatic cancer with obstructive jaundice when ERCP fails. However, the development of new specific instruments and studies comparing this procedure with percutaneous transhepatic biliary drainage and surgery are needed.

  14. THE ROLE OF IF PREOPERATIVE BILIARY DRAINAGE IN THE PANCREATIC CANCER SURGERY

    Directory of Open Access Journals (Sweden)

    Dana Iancu

    2011-05-01

    Full Text Available Introduction: Preoperative biliary drainage pre DPC is a very controversial subject; the indication for this endoscopic procedure is not yet unanimous accepted. Material and methods: The aim of this study is to find out if preoperative biliary drainage is bringing benefits to the perioperatory evolution of the patient. This is a prospective study from 2008 till 2010, done in Surgery Clinic no III of Cluj-Napoca. 201 patients with pancreatic cancer on which surgery with biliary anastomosis was performed were included in the study; 41 of them were preoperative biliary drained. Results: Patients who had preoperative biliary drainage had a higher percentage of postoperatory complications (p=0,049. Preoperative biliary drainage determined a non significant longer intraoperative time, blood lost and a not much harder intraoperative conditions. Septic complications were twice more frequent in patients with preoperative biliary drainage; the data were statistically validated (p=0,036. Conclusions: Preoperative biliary drainage must be done in carefully selected cases; the intervention that follows this endoscopic procedure should be performed by specialized surgical teams that can cope with harder intraoperative conditions.

  15. 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

  16. Sedations and analgesia in patients undergoing percutaneous transhepatic biliary drainage

    Energy Technology Data Exchange (ETDEWEB)

    Hatzidakis, A.A.; Charonitakis, E.; Athanasiou, A.; Tsetis, D.; Chlouverakis, G.; Papamastorakis, G.; Roussopoulou, G.; Gourtsoyiannis, N.C

    2003-02-01

    AIM: To present our experience using intravenous sedoanalgesia for percutaneous biliary drainage. MATERIALS AND METHODS: This study comprised 100 patients, all of whom were continuously monitored [electrocardiogram (ECG), blood pressure, pulse oxymetry] and received an initial dose of 2 mg midazolam followed by 0.02 mg fentanyl. Before every anticipated painful procedure, a maintenance dose of 0.01 mg fentanyl was administered. If the procedure continued and the patient became aware, another 1 mg midazolam was given. This was repeated if patients felt pain. A total dose of 0.08 mg fentanyl and 7 mg midazolam was never exceeded. Immediately after the procedure, the nurse was asked to evaluate patients' pain score. The patients were asked 3 h later to complete a visual 10-degree pain score scale. RESULTS: The average dose of fentanyl and midazolam was 0.042 mg (0.03-0.08 mg) and 4.28 mg (2-7 mg), respectively. Only one patient recorded the procedure as painful. The scores given by the attending nurse (1-7 points, mean 2.9) correlated well with those given by the patients (1-6 points, mean 2.72). No complications were noted. CONCLUSION: According to our experience, interventional radiologists practising biliary procedures can administer low doses of midazolam and minimize the doses of fentanyl, without loss of adequate sedation and analgesia. Hatzidakis, A. A. et al. (2003). Clinical Radiology58, 121-127.

  17. 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...

  18. Ultrasound-guided percutaneous transhepatic biliary drainage: Experiences in 146 patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jai Keun [Sohwa Children' s Hospital, Seoul(Korea, Republic of); Yu, Jeong Sik; Kim, Ki Whang; Chung, Soo Yoon; Jeong, Mi Gyoung [Yonsei University College of Medicine, Seoul (Korea, Republic of); Choi, Deuk Lin; Kwon, Gui Hyang; Lee, Hae Kyung [Soonchunhyang University College of Medicine, Seoul (Korea, Republic of)

    1999-03-15

    Percutaneous biliary drainage is an important technique for palliative therapy of obstructive biliary disease and diagnostic information. The purpose of this study is to review and evaluate the experiences of ultrasound-guided percutaneous transhepatic biliary drainage. Ultrasound-guided percutaneous transhepatic biliary drainage was performed on 146 occasions in 134 patients. The causes of biliary obstruction were: benign diseases (19 cases, 14.2%) such as bile duct stones or stricture, cholangiocarcinoma (37 cases, 27.6%), pancreatic carcinoma (35 cases, 26.1%), metastasis (22 cases, 16.5%), gall bladder cancer (14 cases, 10.4%), ampulla of Vater cancer (4 cases, 3.0%), hepatocellular carcinoma (3 cases, 2.2%). Retrospectively reviewing medical records, we found out frequency of external or external/internal biliary drainages, puncture of left or right hepatic duct, and presence of bileinfection. Ultrasound-guided percutaneous transhepatic biliary drainage was compared with conventional biliary drainage of previous reports on the basis of frequency of complications. External (124 procedures, 84.9%) and external/internal biliary drainage (22 procedures, 15.1%) were carried out by puncture of dilated right (59.6%) or left (40.4%) intrahepatic duct. Sixty-nine complications occurred in 47 patients. Catheter related complications (33/69, 47.8%) were most common: catheter dislodgement (17/69, 24.6%), malfunction (9/69, 13.1%), leakage (7/69, 10.1%). Other minor complications such as simple fever (16/69, 23.2%), cholangitis (7/69, 10.1%), hemobilia (4/69, 5.8%), biloma (2/69, 2.9%) and wound infection (1/69, 1.5%) occurred. Major complications including sepsis (4/69, 5.8%) and bile peritonitis (2/69, 2.9%) were also noted. Puncture-related complications such as hemobilia, biloma and bile peritonitis occurred in 8 cases (5.5%). Comparing with conventional X-ray guided drainage, ultrasound-guided percutaneous transhepatic biliary drainage is a safe procedure for

  19. Endotoxin, cytokines, and endotoxin binding proteins in obstructive jaundice and after preoperative biliary drainage

    OpenAIRE

    Kimmings, A. N.; Deventer, van, S.J.H.; Obertop, H; Rauws, E.A.J.; Huibregtse, K; Gouma, D. J.

    2000-01-01

    BACKGROUND—Obstructive jaundice is associated with postoperative complications related to increased endotoxaemia and the inflammatory response. In animals obstructive jaundice is associated with endotoxaemia and cytokine induction, which are reversed by internal biliary drainage.
AIMS—To study endotoxaemia and the subsequent inflammatory response in obstructive jaundiced patients and after endoscopic biliary drainage.
METHODS—In 15 patients with malignant distal obstructive jaundice, inflamma...

  20. Preoperative Biliary Drainage in Cases of Borderline Resectable Pancreatic Cancer Treated with Neoadjuvant Chemotherapy and Surgery

    Science.gov (United States)

    Tsuboi, Tomofumi; Sasaki, Tamito; Serikawa, Masahiro; Ishii, Yasutaka; Mouri, Teruo; Shimizu, Akinori; Kurihara, Keisuke; Tatsukawa, Yumiko; Miyaki, Eisuke; Kawamura, Ryota; Tsushima, Ken; Murakami, Yoshiaki; Uemura, Kenichiro; Chayama, Kazuaki

    2016-01-01

    Objective. To elucidate the optimum preoperative biliary drainage method for patients with pancreatic cancer treated with neoadjuvant chemotherapy (NAC). Material and Methods. From January 2010 through December 2014, 20 patients with borderline resectable pancreatic cancer underwent preoperative biliary drainage and NAC with a plastic or metallic stent and received NAC at Hiroshima University Hospital. We retrospectively analyzed delayed NAC and complication rates due to biliary drainage, effect of stent type on perioperative factors, and hospitalization costs from diagnosis to surgery. Results. There were 11 cases of preoperative biliary drainage with plastic stents and nine metallic stents. The median age was 64.5 years; delayed NAC occurred in 9 cases with plastic stent and 1 case with metallic stent (p = 0.01). The complication rates due to biliary drainage were 0% (0/9) with metallic stents and 72.7% (8/11) with plastic stents (p = 0.01). Cumulative rates of complications determined with the Kaplan-Meier method on day 90 were 60% with plastic stents and 0% with metallic stents (log-rank test, p = 0.012). There were no significant differences between group in perioperative factors or hospitalization costs from diagnosis to surgery. Conclusions. Metallic stent implantation may be effective for preoperative biliary drainage for pancreatic cancer treated with NAC. PMID:26880897

  1. Preoperative Biliary Drainage in Cases of Borderline Resectable Pancreatic Cancer Treated with Neoadjuvant Chemotherapy and Surgery

    Directory of Open Access Journals (Sweden)

    Tomofumi Tsuboi

    2016-01-01

    Full Text Available Objective. To elucidate the optimum preoperative biliary drainage method for patients with pancreatic cancer treated with neoadjuvant chemotherapy (NAC. Material and Methods. From January 2010 through December 2014, 20 patients with borderline resectable pancreatic cancer underwent preoperative biliary drainage and NAC with a plastic or metallic stent and received NAC at Hiroshima University Hospital. We retrospectively analyzed delayed NAC and complication rates due to biliary drainage, effect of stent type on perioperative factors, and hospitalization costs from diagnosis to surgery. Results. There were 11 cases of preoperative biliary drainage with plastic stents and nine metallic stents. The median age was 64.5 years; delayed NAC occurred in 9 cases with plastic stent and 1 case with metallic stent (p=0.01. The complication rates due to biliary drainage were 0% (0/9 with metallic stents and 72.7% (8/11 with plastic stents (p=0.01. Cumulative rates of complications determined with the Kaplan-Meier method on day 90 were 60% with plastic stents and 0% with metallic stents (log-rank test, p=0.012. There were no significant differences between group in perioperative factors or hospitalization costs from diagnosis to surgery. Conclusions. Metallic stent implantation may be effective for preoperative biliary drainage for pancreatic cancer treated with NAC.

  2. 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

  3. 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.

  4. Treatment of biliary obstruction by percutaneous transhepatic drainage and metallic stent placement

    International Nuclear Information System (INIS)

    Objective: To evaluate the percutaneous transhepatic drainage and biliary stent placement as the treatment of biliary obstruction. Methods: Twenty-three patients with biliary obstruction received percutaneous transhepatic cholangiography and drainage (PTCD). And among the 23, stent placement was performed in 12 patients. Results: All 23 patients jaundice was satisfactorily relieved, and total bilirubin value was decreased from 147.4 pmol/L-648.7 pmol/L, the pre-procedure data, to the post-procedure data at normal level or very close to normal level. In 22 case of malignant biliary obstruction, the survival rate of 3 and 6 months 70% and 60% respectively. the median survival was 6 months. Conclusion: The combination of metallic stent placement and local therapy are effective in the treatment of biliary obstruction which is unable to be cured by surgical procedure. (authors)

  5. Endoscopic ultrasonography-guided bi-lateral biliary drainage: A case series study

    OpenAIRE

    Reimão, S.; Francioni, E.; Bories, E.; Caillol, F.; Pesenti, C.; Giovannini, M

    2014-01-01

    Introduction: Biliary obstruction is preferentially managed by endoscopic retrograde cholangiopancreatography (ERCP). However, after ERCP failed, alternatives include percutaneous transhepatic drainage, surgery and more recently, endoscopic ultrasonography (EUS)-guided hepaticogastrostomy. The limitation of this technique is that the drainage is restricted to the left side. The aim of this study is to describe a new method of drainage of both hepatic ductal systems by hepaticogastrostomy in p...

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

    Institute of Scientific and Technical Information of China (English)

    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).METHODS: The initial success rate, cumulative patency rate, and complication rate were compared retrospectively, according to the Bismuth type and ERBD,EPTBD, and IPTBD. Patency was defined as the duration for adequate initial bile drainage or to the point of the patient's death associated with inadequate drainage.RESULTS: One hundred thirty-four patients (93 men,41 women; 21 Bismuth type Ⅱ, 47 Ⅲ, 66 Ⅳ; 34 ERBD,66 EPTBD, 34 IPTBD) were recruited. There were no differences in demographics among the groups.Adequate initial relief of jaundice was achieved in 91% of patients without a significant difference in the results among different procedures or Bismuth types. The cumulative patency rates for ERBD and IPTBD were better than those for EPTBD with Bismuth type Ⅲ.IPTBD provided an excellent response for Bismuth type Ⅳ. However, there was no difference in the patency rate among drainage procedures for Bismuth type Ⅱ.Procedure-related cholangitis occurred less frequently with EPTBD than with ERBD and IPTBD.CONCLUSION: ERBD is recommended as the firstline drainage procedure for the palliation of jaundice in patients with inoperable Klatskin's tumor of Bismuth type Ⅱ or Ⅲ, but IPTBD is the best option for Bismuth type Ⅳ.

  7. Endoscopic internal biliary drainage in a child with malignant obstructive jaundice caused by neuroblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Tadao; Yoshida, Hideo; Matsunaga, Tadashi; Kouchi, Katunori; Ohtsuka, Yasuhiro; Ohnuma, Naomi [Department of Paediatric Surgery, Chiba University, School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677 (Japan); Tsuyuguchi, Toshio; Yamaguchi, Taketo; Saisho, Hiromitsu [First Department of Internal Medicine, Chiba University School of Medicine, Chiba (Japan)

    2003-02-01

    We describe a 13-year-old girl who underwent insertion of a Flexima biliary stent for obstructive jaundice due to compression of the extrahepatic bile duct by an enlarged lymph node secondary to neuroblastoma. This novel endoscopic internal biliary drainage procedure was safe and effective even for a child, and improved her quality of life. We further review other treatment options available for malignant obstructive jaundice in children. (orig.)

  8. 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.

  9. 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.

  10. Balloon dilatation biopsy of the biliary stricture through the percutaneous transhepatic biliary drainage tract: Feasibility and diagnostic accuracy

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Ji Hoon; Ryeom, Hun Kyu; Jang, Yun Jin; Kim, Gab Chul; Cho, Seung Hyun; Song, Jung Hup [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2016-01-15

    To evaluate the feasibility and diagnostic accuracy of the balloon dilatation biopsy for the biliary stricture through the percutaneous transhepatic biliary drainage (PTBD) tract. The study included 35 patients who underwent balloon dilatation biopsy for the biliary stricture through the PTBD tract. Balloon dilatation was done with a balloon catheter of 10-mm or 12-mm diameter. Soft tissue adherent to the retrieved balloon catheter and soft tissue components separated by gauze filtration of evacuated bile were sampled for histopathologic examination. The results were compared with the final diagnosis which was made by clinical and imaging follow-up for mean 989 days (n = 34) and surgery with histopathologic examination (n = 1). Procedure-related complications and diagnostic accuracy were assessed. Tissues suitable for histopathologic examination were obtained in 31 out of 35 patients (88.6%). In 3 patients, self-limiting hemobilia was noted. No major complication was noted. The sensitivity, specificity, diagnostic accuracy, positive and negative predictive values for diagnosis of malignant stricture were 70.0%, 100%, 90.3%, 100%, and 87.5%, respectively. Balloon dilatation biopsy of the biliary stricture through the PTBD tract is a feasible and accurate diagnostic method. It can be a safe alternative to the endoscopic retrograde cholangiography biopsy or forceps biopsy through the PTBD tract.

  11. Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status

    NARCIS (Netherlands)

    N.A. van der Gaag; J.J. Kloek; S.M.M. de Castro; O.R.C. Busch; T.M. van Gulik; D.J. Gouma

    2009-01-01

    Preoperative biliary drainage (PBD) has been introduced to improve outcome after surgery in patients suffering from obstructive jaundice due to a potentially resectable proximal or distal bile duct/pancreatic head lesion. In experimental models, PBD is almost exclusively associated with beneficial r

  12. 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.

  13. Successful biliary drainage using a metal stent through the gastric stoma.

    Science.gov (United States)

    Matsumoto, Kazuyuki; Kato, Hironari; Tsutsumi, Koichiro; Akimoto, Yutaka; Uchida, Daisuke; Tomoda, Takeshi; Yamamoto, Naoki; Noma, Yasuhiro; Horiguchi, Shigeru; Okada, Hiroyuki; Yamamoto, Kazuhide

    2015-06-28

    We report a case of biliary drainage for malignant stricture using a metal stent with an ultrathin endoscope through the gastric stoma. A 78-year-old female was referred to our hospital for jaundice and fever. She had undergone percutaneous endoscopic gastrostomy (PEG) for esophageal obstruction after radiation therapy for cancer of the pharynx. Abdominal contrast-enhanced computed tomography showed a 3-cm enhanced mass in the middle bile duct and dilatation of the intra-hepatic bile duct. We initially performed endoscopic retrograde cholangiopancreatography (ERCP) with a trans-oral approach. However, neither the side-viewing endoscope nor the ultrathin endoscope passed through the esophageal orifice. Thus, we eventually performed ERCP via the PEG stoma using an ultrathin endoscope. We performed biliary drainage with a 6F introducer self-expanding metal stent. The cytology findings obtained by brush cytology showed malignancy. Her laboratory results were restored to normal levels after drainage and no complication occurred. PMID:26140009

  14. Risk Factors for Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis and Stent Dysfunction after Preoperative Biliary Drainage in Patients with Malignant Biliary Stricture.

    Science.gov (United States)

    Hashimoto, Shinichi; Ito, Kei; Koshida, Shinsuke; Kanno, Yoshihide; Ogawa, Takahisa; Masu, Kaori; Iwashita, Yuji; Horaguchi, Jun; Kobayashi, Go; Noda, Yutaka

    2016-01-01

    Objective To retrospectively evaluate the risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and stent dysfunction after performing preoperative biliary drainage (BD) in patients with malignant biliary stricture. Methods Between January 2003 and February 2013, 105 consecutive patients who had undergone transpapillary BD before surgery were enrolled in this study. Procedure-related complications, stent dysfunction rates, and their respective risk factors were investigated. PEP was defined according to the consensus guidelines. Results Fifty-five patients had bile duct cancer, 31 had pancreatic cancer, 16 had ampullary cancer, and 3 had gallbladder cancer. Endoscopic biliary stenting (EBS) and nasobiliary drainage (NBD) were performed in 84 patients and 21 patients, respectively. PEP occurred in 10% of the patients, with a significantly higher frequency in those with hilar/upper bile duct stricture (p=0.026) and a normal bilirubin level at admission (p=0.016). Of the 84 patients who underwent initial EBS, stent dysfunction occurred in 13%. The mean number of days from EBS to stent dysfunction was 14±12 days. A multivariate analysis revealed a male gender (p=0.048), a stent diameter ≤8 Fr (p=0.036), and an ERCP procedure time ≥45 minutes (p=0.021) to be risk factors for stent dysfunction. No NBD tube dysfunction was observed. Conclusion Patients with upper/hilar bile duct stricture or a normal bilirubin level are at high risk of developing PEP after preoperative BD. NBD or EBS with a large-bore stent is therefore recommended as preoperative BD. PMID:27629944

  15. Successful biliary drainage using a metal stent through the gastric stoma

    OpenAIRE

    Matsumoto, Kazuyuki; Kato, Hironari; Tsutsumi, Koichiro; Akimoto, Yutaka; UCHIDA, DAISUKE; Tomoda, Takeshi; Yamamoto, Naoki; Noma, Yasuhiro; Horiguchi, Shigeru; Okada, Hiroyuki; Yamamoto, Kazuhide

    2015-01-01

    We report a case of biliary drainage for malignant stricture using a metal stent with an ultrathin endoscope through the gastric stoma. A 78-year-old female was referred to our hospital for jaundice and fever. She had undergone percutaneous endoscopic gastrostomy (PEG) for esophageal obstruction after radiation therapy for cancer of the pharynx. Abdominal contrast-enhanced computed tomography showed a 3-cm enhanced mass in the middle bile duct and dilatation of the intra-hepatic bile duct. We...

  16. Clinical Evaluation of ERCP and Naobiliary Drainage for Biliary Fungal Infection--A Report of Five Cases of Severe Combined Bacterial and Fungal Infection of Biliary Tract

    Institute of Scientific and Technical Information of China (English)

    ZHAO Qiu; LIAO Jiazhi; QIN Hua; WANG Jialong

    2005-01-01

    This study studied the use of ERCP and nasobiliary tube in the diagnosis of fungal infection of biliary tract and the efficacy of combined use of local administration via nasobiliary tube and intravenous antifungal treatment for severe biliary tract fungal infection. 5 patients in our series,with age ranging from 47 to 68 y (mean 55.8), were diagnosed as having mixed bacterial and fungal infection of biliary tract as confirmed by smear or/and culture of bile obtained by ERCP and nasobiliary drainage. Besides routine anti-bacteria therapy, all patients received local application of fluconazole through nasobiliary tube and intravenous administration of fluconazole or itraconazole in terms of the results of in vitro sensitivity test. The mean duration of intravenous fluconazole or itraconazole was 30 days (24-40 days), and that of local application of fluconazole through nasobiliary drainage tube was 19 days (8-24 days). During a follow-up period of 3-42 months, all patient's fungal infection of biliary tract was cured. It is concluded that on the basis of typical clinical features of biliary tract infection, fungal detection of smear/culture of bile obtained by ERCP was the key for the diagnosis of fungal infection of biliary tract. Local application antifungal drug combined with intravenous anti-fungal drugs might be an effective and safe treatment for fungal infection of biliary tract.

  17. The interventional treatment for biliary recurrent obstruction after palliative T tube drainage in patients with obstruction due to cholangiocarcinoma

    International Nuclear Information System (INIS)

    Objective: To explore the interventional method to treat biliary recurrent jaundice after T tube drainage in patients with malignant obstructive jaundice due to cholangiocarcinoma. Methods: 7 biliary metallic stents were placed in 7 patients with recurrent jaundice after T-tube drainage in cholangiocarcinoma cases. Results: Stent placement was once successful in all 7 cases with successful rate of 100%. For all cases, TBIL, ALT, GTP and AKP values 7 days postoperatively were significantly lower than that of preoperation together with subsidence of jaundice satisfactorily for 100% after the treatment. Conclusions: Percutaneous placement of biliary metallic stents was effective economic, minimal invasive and safe for palliation of biliary recurrent jaundice after T tube drainage in cholangiocarcinoma-induced obstructive jaundice

  18. Catheter tract implantation metastases associated with percutaneous biliary drainage for extrahepatic cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Jun Sakata; Yoshio Shirai; Toshifumi Wakai; Tatsuya Nomura; Eiko Sakata; Katsuyoshi Hatakeyama

    2005-01-01

    AIM: To estimate the incidence of catheter tract implantation metastasis among patients undergoing percutaneous transhepatic biliary drainage (PTBD) for extrahepatic cholangiocarcinoma, and to provide data regarding the management of this unusual complication of PTBD by reviewing cases reported in the literature.METHODS: A retrospective analysis of 67 consecutive patients who underwent PTBD before the resection of extrahepatic cholangiocarcinoma was conducted. The median follow-up period after PTBD was 106 mo. The English language literature (PubMed, National Library of Medicine, Bethesda, MD, USA), from January 1966through December 2004, was reviewed.RESULTS: Catheter tract implantation metastasis developed in three patients. The cumulative incidence of implantation metastasis reached a plateau (6%)at 20 mo after PTBD. All of the three patients with implantation metastasis died of tumor progression at 3, 9, and 20 mo after the detection of this complication. Among the 10 reported patients with catheter tract implantation metastasis from extrahepatic cholangiocarcinoma (including our three patients), two survived for more than 5 years after the excision of isolated catheter tract metastases.CONCLUSION: Catheter tract implantation metastasis is not a rare complication following PTBD for extrahepatic cholangiocarcinoma. Although the prognosis for patients with this complication is generally poor, the excision of the catheter tract may enable survival in selected patients with isolated metastases along the catheter tract.

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

    International Nuclear Information System (INIS)

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

  20. The clinical application of double-tube drainage technique in treating biliary tract stricture occurred after orthotopic liver transplantation: report of 4 cases

    International Nuclear Information System (INIS)

    Objective: To discuss the clinical value of double-tube drainage with the help of percutaneous transhepatic puncture technique in treating biliary tract stricture which occurred after orthotopic liver transplantation. Methods: Double-tube drainage management was carried out in four patients with biliary tract stricture which occurred after orthotopic liver transplantation. With the help of percutaneous transhepatic puncture technique one or two tunnels were established, via which two tubes were established, via which two tubes were inserted and double-tube drainage was performed. The clinical data were retrospectively analyzed. Results: All the four patients were suffered multiple biliary tract strictures accompanied with biliary sludge. The mean age, the cold ischemia time and warm ischemia time of grafting liver were 55 year, 11.4 hours and 6 minutes, respectively. Biliary reconstruction was accomplished by end-to-end anastomosis of the bile ducts. The two drainage tubes were inserted through one tunnel in two cases and through two tunnels in another two cases. In the four cases the biliary balloon dilatation and bile drainage were respectively performed 3, 9, 11 and 35 times. Good clinical result was obtained in three cases and ineffective result was seen in one case. Conclusion: The double-tube drainage technique can be selectively applied in the patients with multiple biliary tract strictures and biliary sludge. Repeated biliary plasty and thoroughly drainage are the keys to ensure an effective treatment of biliary stricture occurred after orthotopic liver transplantation. (authors)

  1. Histological changes at an endosonography-guided biliary drainage site: A case report

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Endosonography-guided biliary drainage (ESBD) is a new method enabling internal drainage of an obstructed bile duct. However, the histological conditions associated with fistula development via the duodenum to the bile duct have not been reported. We performed ESBD 14 d preoperatively in a patient with an ampullary carcinoma and histologically confirmed changes in and around the fistula. The female patient developed no complications relevant to ESBD. Levels of serum bilirubin and hepatobiliary enzymes declined quickly, and pancreatoduodenectomy was carried out uneventfully. The resected specimen was sliced and stained with hematoxylin-eosin. Histological evaluation of the puncture site in the duodenum and bile-duct wall, and the sinus tract revealed no hematoma, bile leakage, or abscess in or around the sinus tract. Little sign of granulation, fibrosis, and inflammatory cell infiltration was observed. Although further large-scale confirmatory studies are needed, the findings here may encourage more active use of ESBD as a substitute for percutaneous transhepatic drainage in cases with failed/difficult endoscopic biliary stenting.

  2. Soft-Tissue-Anchored Transcutaneous Port for Long-Term Percutaneous Transhepatic Biliary Drainage

    International Nuclear Information System (INIS)

    Purpose. A transcutaneous port (T-port) has been developed allowing easy exchange of a catheter, which was fixed inside the device, using the Seldinger technique. The objective of the study was to test the T-port in patients who had percutaneous transhepatic biliary drainage (PTBD). Methods. The T-port, made of titanium, was implanted using local anesthesia in 11 patients (mean age 65 years, range 52-85 years) with biliary duct obstruction (7 malignant and 4 benign strictures). The subcutaneous part of the T-port consisted of a flange with several perforations allowing ingrowth of connective tissue. The T-port allowed catheter sizes of 10 and 12 Fr. Results. All wounds healed uneventfully and were followed by a stable period without signs of pronounced inflammation or infection. It was easy to open the port and to exchange the drainage tube. The patient's quality of life was considerably improved even though several patients had problems with repeated bile leakage due to frequent recurrent obstructions of the tubes. The ports were implanted for a mean time of 9 months (range 2-21 months). Histologic examination in four cases showed that the port was well integrated into the soft tissue. Tilting of the T-port in two cases led to perforation of the skin by the subcutaneous part of the ports, which were removed after 7 and 8 months. Conclusion. The T-port served as an excellent external access to the biliary ducts. The drainage tubes were well fixed within the ports. The quality of life of the patients was considerably improved. Together with improved aesthetic appearance they found it easier to conduct normal daily activities and personal care. However, the problem of recurrent catheter obstruction remained unsolved

  3. Endoscopic ultrasound-guided biliary drainage using a lumen-apposing self-expanding metal stent: a case series.

    Science.gov (United States)

    Brückner, Stefan; Arlt, Alexander; Hampe, Jochen

    2015-09-01

    Endoscopic ultrasound-guided biliary drainage (EUS-BD) might be an alternative to percutaneous or transpapillary biliary drainage in unresectable pancreatic or biliary cancer. A lumen-apposing, fully covered, self-expanding metal stent, which creates a sealed transluminal conduit between the biliary and gastrointestinal tract may offer advantages over conventional plastic and metal stents. In this retrospective, observational, open-label case study, five patients underwent EUS-BD for obstructive jaundice in pancreatic cancer (n = 4) or distal cholangiocarcinoma (n = 1). Technical and functional success was achieved in all patients without complications. The development of specialized stent and delivery systems may render EUS-BD an effective and safe alternative to percutaneous or transpapillary approaches. PMID:26021309

  4. The effects of ferulic acid on the pharmacokinetics of warfarin in rats after biliary drainage

    Directory of Open Access Journals (Sweden)

    Li H

    2016-07-01

    Full Text Available Haigang Li,1,2 Yang Wang,1 Rong Fan,1 Huiying Lv,3 Hua Sun,4 Haitang Xie,4 Tao Tang,1 Jiekun Luo,1 Zian Xia1 1Department of Integrated Traditional Chinese and Western Medicine, Laboratory of Ethnopharmacology, Xiangya Hospital, Central South University, 2Department of Pharmacy, Changsha Medical University, 3Hunan Agricultural Product Processing Institute, Hunan Academy of Agricultural Sciences, Changsha, 4Anhui Provincial Centre for Drug Clinical Evaluation, Yijishan Hospital of Wannan Medical College, Wuhu, People’s Republic of China Abstract: According to previous research studies, warfarin can be detected in human bile after oral administration. Ferulic acid (FA is the main bioactive component of many Chinese herbs for the treatment of cardiovascular disease. To elucidate the effects of FA on the pharmacokinetics of warfarin in rats after biliary drainage is necessary. Twenty rats were randomly divided into four groups: Group 1 (WN: healthy rats after the administration of warfarin sodium, Group 2 (WO: a rat model of biliary drainage after the administration of warfarin sodium, Group 3 (WFN: healthy rats after the administration of warfarin sodium and FA, and Group 4 (WFO: a rat model of biliary drainage after the administration of warfarin sodium and FA. Blood samples were collected at different time points after administration. The concentrations of blood samples were determined by ultraperformance liquid chromatography–tandem mass spectrometry. Comparisons between groups were performed according to the main pharmacokinetic parameters calculated by the DAS 2.1.1 software. The pharmacokinetic parameters showed a significant difference between the WN and WO groups, the WO group showed a decrease of 51% and 41.6% in area under the curve from 0 to time (AUC0–t and peak plasma concentration (Cmax, respectively, whereas time to Cmax (Tmax was delayed 3.27 folds. There were significant differences between the WFO and WFN groups, the WFO

  5. Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography

    Science.gov (United States)

    Khashab, Mouen A.; Van der Merwe, Schalk; Kunda, Rastislav; El Zein, Mohamad H.; Teoh, Anthony Y.; Marson, Fernando P.; Fabbri, Carlo; Tarantino, Ilaria; Varadarajulu, Shyam; Modayil, Rani J.; Stavropoulos, Stavros N.; Peñas, Irene; Ngamruengphong, Saowanee; Kumbhari, Vivek; Romagnuolo, Joseph; Shah, Raj; Kalloo, Anthony N.; Perez-Miranda, Manuel; Artifon, Everson L.

    2016-01-01

    Background and aims: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative to traditional radiologic and surgical drainage procedures after failed endoscopic retrograde cholangiopancreatography (ERCP). However, prospective multicenter data are lacking. The aims of this study were to prospectively assess the short- and long-term efficacy and safety of EUS-BD in patients with malignant distal biliary obstruction. Patients and methods: Consecutive patients at 12 tertiary centers (5 US, 5 European, 1 Asian, 1 South American) with malignant distal biliary obstruction and failed ERCP underwent EUS-BD. Technical success was defined as successful stent placement in the desired position. Clinical success was defined as a reduction in bilirubin by 50 % at 2 weeks or to below 3 mg/dL at 4 weeks. Adverse events were prospectively tracked and graded according to the American Society for Gastrointestinal Endoscopy (ASGE) lexicon’s severity grading system. Overall survival and duration of stent patency were calculated using Kaplan–Meier analysis. Results: A total of 96 patients (mean age 66 years, female 45 %, pancreatic cancer 55 %) underwent EUS-BD. Stent placement (technical success) was achieved in 92 (95.8 %) patients (metallic stent 84, plastic stent 8). Mean procedure time was 40 minutes. Clinical success was achieved in 86 (89.5 %) patients. A total of 10 (10.5 %) adverse events occurred: pneumoperitoneum (n = 2), sheared wire (n = 1), bleeding (n = 1), bile leak (n = 3), cholangitis (n = 2), and unintentional perforation (n = 1); 4 graded as mild, 4 moderate, 1 severe, and 1 fatal (due to perforation). A total of 38 (44 %) patients died of disease progression during the study period. The median patient survival was 167 days (95 %CI 112 – 221) days. The 6-month stent patency rate was 95 % (95 %CI 94.94 – 95.06 %) and the 1-year stent patency was 86 % (95 %CI 85.74 – 86

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

    International Nuclear Information System (INIS)

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

  7. Endoscopic placement of biliary metal stent drainage combined with endoscopic naso-biliary drainage in the treatment of malignant biliary obstruction%经内镜放置胆管金属支架联合鼻胆管引流治疗恶性胆管梗阻

    Institute of Scientific and Technical Information of China (English)

    刘华; 周莹群; 徐选福; 赵严; 冯百岁

    2015-01-01

    Objective To evaluate the effect of biliary mental stent drainage combined with endoscopic naso-biliary drainage in the treatment of malignant biliary obstruction. Methods One hundred and thirteen patients with maligmant biliary obstruction who had lost the chance for surgery, were treated with biliary stent through endoscopic retrograde cholangiopancreatography:48 patients were treated with endoscopic retrograde biliary drainage with plastic stent, 30 pa-tients were treated with endoscopic retrograde biliary drainage with mental stent, and 37 patients were treated with endo-scopic metal stent drainage combined with naso-biliary drainage. Results The levels of ALT, TBIL, DBIL and AKP of pre-stenting were much higher than that of post-stenting ( P0 . 05 ) . The re-blockage rates of metal stent group and metal stent drainage combined with naso-biliary drainage group three months after surgey were much lower than plastic stent group ( P0 . 05 ) . There was no difference of successful rate between plastic stent group and metal stent group and metal stent drainage combined with naso-biliary drainage group ( P>0 . 05 ) . Early complication of plastic stent group was much higher than that of met-al stent drainage combined with naso-biliary drainage group ( P0.05);术后3个月内金属支架组和金属支架联合鼻胆管组再堵塞的发生率明显低于塑料支架组(P0.05);塑料支架组的手术成功率与金属支架组及金属支架联合鼻胆管组相比,差异无统计学意义(P>0.05),塑料支架组的早期并发症发生率明显高于金属支架联合鼻胆管组,差异有统计学意义(P<0.05)。结论经内镜逆行胰胆管造影下放置胆管金属支架联合鼻胆管对于恶性胆管梗阻有确切的引流效果。

  8. Therapeutic Delay and Survival After Surgery for Cancer of the Pancreatic Head With or Without Preoperative Biliary Drainage

    NARCIS (Netherlands)

    W.J. Eshuis; N.A. van der Gaag; E.A.J. Rauws; C.H.J. van Eijck; M.J. Bruno; E.J. Kuipers; P.P. Coene; F.J.G.M. Kubben; J.J.G.M. Gerritsen; J.W. Greve; M.F. Gerhards; I.H.J.T. de Hingh; J.H. Klinkenbijl; C.Y. Nio; S.M.M. de Castro; O.R.C. Busch; T.M. van Gulik; P.M.M. Bossuyt; D.J. Gouma

    2010-01-01

    Objective: To evaluate the relation between delay in surgery because of preoperative biliary drainage (PBD) and survival in patients scheduled for surgery for pancreatic head cancer. Background: Patients with obstructive jaundice due to pancreatic head cancer can undergo PBD. The associated delay of

  9. Evaluation of EMS insertion and radiotherapy for malignant biliary stricture. Endoscopic bilateral hepatic drainage with wallstents

    Energy Technology Data Exchange (ETDEWEB)

    Kin, Hideyuki; Sumitomo, Yasuhiko; Kiriya, Keiichi [Shizuoka General Hospital (Japan)] [and others

    1998-10-01

    Usefulness of radiotherapy for unresectable malignant biliary obstruction was evaluated. Patients were 62 cases having inside stoma by expandable metallic stent (EMS) (male: 28 cases, female: 34 cases, mean age: 65.4-year-old (34-91)). In 6 cases of porta hepatis obstruction, bilateral hepatic drainage was tried using wallstent. Thirty-five patients received external irradiation with average of 39 (25-65) Gy, and the EMS was inserted during radiotherapy. Patency period after EMS insertion and survival time were compared with those of the group of EMS without irradiation. As for patency period of EMS, there was no significant difference between EMS group without irradiation and group with external irradiation. The 50% cumulative survival time was 132 days and 208 days, respectively. There was significant elongation of survival time in the group with external irradiation. (K.H.)

  10. Evaluation of EMS insertion and radiotherapy for malignant biliary stricture. Endoscopic bilateral hepatic drainage with wallstents

    International Nuclear Information System (INIS)

    Usefulness of radiotherapy for unresectable malignant biliary obstruction was evaluated. Patients were 62 cases having inside stoma by expandable metallic stent (EMS) (male: 28 cases, female: 34 cases, mean age: 65.4-year-old (34-91)). In 6 cases of porta hepatis obstruction, bilateral hepatic drainage was tried using wallstent. Thirty-five patients received external irradiation with average of 39 (25-65) Gy, and the EMS was inserted during radiotherapy. Patency period after EMS insertion and survival time were compared with those of the group of EMS without irradiation. As for patency period of EMS, there was no significant difference between EMS group without irradiation and group with external irradiation. The 50% cumulative survival time was 132 days and 208 days, respectively. There was significant elongation of survival time in the group with external irradiation. (K.H.)

  11. Percutaneous transhepatic biliary drainage(PTBD): comparative data of right and left hepatic lobe approach

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Choon Hyeong; Oh, Joo Hyeong; Yoon, Yup [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1995-08-15

    To evaluate the difference in each procedure time and complication rates related to percutaneous transhepatic biliary drainage(PTBD) via the right and the left hepatic lobe. We performed PTBD in 120 patients with biliary obstruction below both main hepatic ducts. Of the 120 catheters, 54 were introduced via a left lobe approach and 66 through the right lobe. All procedures were performed under fluoroscopic guidance by the same operator. For each patient, procedure time was recorded prospectively. PTBD related complications were classified as either early(up to 30 days after procedure) or late(after 30 days), and each complication graded as major, or minor according to its intensity. The difference in the mean procedure time(28.8 min, versus 36.2 min, left versus right approach group) and that in complication rates (37% versus 58%) were statistically significant({rho} < 0.05). Concerning major complication(bile peritonitis, sepsis, massive hemobilia, liver abscess, pyothorax), the percentages related to left and right lobe approach were 1.8% and 10.6%, and concerning minor complications(catheter obstruction or dislodgement, transient hemobilia, persistent fever or pain), the percentages were 36% and 51% respectively. PTBD via the left lobe approach was superior with short procedure time and low complication rates than the right approach.

  12. Clinical Feasibility and Usefulness of CT Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage in Emergency Patients with Acute Obstructive Cholangitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Hyung [Sam Anyang Hospital, Anyang (Korea, Republic of)

    2009-04-15

    To evaluate the feasibility of CT fluoroscopy (CTF)-guided percutaneous transhepatic biliary drainage (PTBD) in emergency patients with acute obstructive cholangitis. The study included 28 patients admitted to the emergency center due to obstructive jaundice and found to require urgent biliary drainage, as well as judged to have a suitable peripheral bile duct for a CTF-guided puncture (at least 4 mm in width). Prior to the CTF-guided puncture, a CT scan was performed to evaluate bile duct dilatation and the underlying causes of biliary obstruction. If the patient was judged to be a suitable candidate, a CTF-guided PTBD was performed in the same CT unit without additional fluoroscopic guidance. Technical feasibility of the procedure was investigated with the evaluation of overall success rate and causes of failure. A hepatic puncture was attempted at the left lobe in 23 patients and right lobe in five patients. The procedure was successful in 24 of 28 patients (86%) Successful biliary puncture was achieved on the first attempt in 16 patients, the second attempt in five patients, and the third attempt in three patients. The causes of failure included guide wire twisting in one patient, biliary puncture failure in two patients, and poor visualization of the guide wire in one patient. There were no significant procedure-related complication. The CTF-guided PTBD is technically feasible and highly successful in patients judged to have a suitable indication. Moreover, although the procedure is unfamiliar and inconvenient to interventionalists, it has economical advantages in that it saves time and manpower. We believe this method can be used in the emergency patients requiring urgent biliary drainage as an alternative for the fluoroscopy-guided PTBD.

  13. Clinical Feasibility and Usefulness of CT Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage in Emergency Patients with Acute Obstructive Cholangitis

    International Nuclear Information System (INIS)

    To evaluate the feasibility of CT fluoroscopy (CTF)-guided percutaneous transhepatic biliary drainage (PTBD) in emergency patients with acute obstructive cholangitis. The study included 28 patients admitted to the emergency center due to obstructive jaundice and found to require urgent biliary drainage, as well as judged to have a suitable peripheral bile duct for a CTF-guided puncture (at least 4 mm in width). Prior to the CTF-guided puncture, a CT scan was performed to evaluate bile duct dilatation and the underlying causes of biliary obstruction. If the patient was judged to be a suitable candidate, a CTF-guided PTBD was performed in the same CT unit without additional fluoroscopic guidance. Technical feasibility of the procedure was investigated with the evaluation of overall success rate and causes of failure. A hepatic puncture was attempted at the left lobe in 23 patients and right lobe in five patients. The procedure was successful in 24 of 28 patients (86%) Successful biliary puncture was achieved on the first attempt in 16 patients, the second attempt in five patients, and the third attempt in three patients. The causes of failure included guide wire twisting in one patient, biliary puncture failure in two patients, and poor visualization of the guide wire in one patient. There were no significant procedure-related complication. The CTF-guided PTBD is technically feasible and highly successful in patients judged to have a suitable indication. Moreover, although the procedure is unfamiliar and inconvenient to interventionalists, it has economical advantages in that it saves time and manpower. We believe this method can be used in the emergency patients requiring urgent biliary drainage as an alternative for the fluoroscopy-guided PTBD

  14. International multicenter comparative trial of transluminal EUS-guided biliary drainage via hepatogastrostomy vs. choledochoduodenostomy approaches

    Science.gov (United States)

    Khashab, Mouen A.; Messallam, Ahmed A.; Penas, Irene; Nakai, Yousuke; Modayil, Rani J.; De la Serna, Carlos; Hara, Kazuo; El Zein, Mohamad; Stavropoulos, Stavros N.; Perez-Miranda, Manuel; Kumbhari, Vivek; Ngamruengphong, Saowanee; Dhir, Vinay K.; Park, Do Hyun

    2016-01-01

    Background and study aims: Endoscopic ultrasound-guided biliary drainage (EUS-BD) can be performed entirely transgastrically (hepatogastrostomy/EUS-HG) or transduodenally (choledochoduodenostomy/EUS-CDS). It is unknown how both techniques compare. The aims of this study were to compare efficacy and safety of both techniques and identify predictors of adverse events. Patients and methods: Consecutive jaundiced patients with distal malignant biliary obstruction who underwent EUS-BD at multiple international centers were included. Technical/clinical success, adverse events, stent complications, and survival were assessed. Results: A total of 121 patients underwent EUS-BD (CDS 60, HG 61). Technical success was achieved in 112 (92.56 %) patients (EUS-CDS 93.3 %, EUS-HG 91.8 %, P = 0.75). Clinical success was attained in 85.5 % of patients who underwent EUS-CDS group as compared to 82.1 % of patients who underwent EUS-HG (P = 0.64). Adverse events occurred more commonly in the EUS-HG group (19.67 % vs. 13.3 %, P = 0.37). Both plastic stenting (OR 4.95, 95 %CI 1.41 – 17.38, P = 0.01) and use of non-coaxial electrocautery (OR 3.95, 95 %CI 1.16 – 13.40, P = 0.03) were independently associated with adverse events. Length of hospital stay was significantly shorter in the CDS group (5.6 days vs. 12.7 days, P stent patency probability was greater in the EUS-CDS group [0.98 (95 %CI 0.76 – 0.96) vs 0.60 (95 %CI 0.35 – 0.78)] but overall patency was not significantly different. There was no difference in median survival times between the groups (P = 0.36) Conclusions: Both EUS-CDS and EUS-HG are effective and safe techniques for the treatment of distal biliary obstruction after failed ERCP. However, CDS is associated with shorter hospital stay, improved stent patency, and fewer procedure- and stent-related complications. Metallic stents should be placed whenever feasible and non-coaxial electrocautery should be

  15. Liver elasticity measurement before and after biliary drainage in patients with obstructive jaundice: a prospective cohort studya prospective cohort study

    OpenAIRE

    Kubo, Kimitoshi; Kawakami, Hiroshi; Kuwatani, Masaki; Nishida, Mutsumi; Kawakubo, Kazumichi; Kawahata, Shuhei; Taya, Yoko; Kubota, Yoshimasa; Amano, Toraji; Shirato, Hiroki; Sakamoto, Naoya

    2016-01-01

    Background Obstructive jaundice has been reported to influence liver elasticity, independent of liver fibrosis. The aim of our prospective study was to evaluate the changes in liver elasticity, before and after biliary drainage, in patients with obstructive jaundice, and to evaluate the correlation between elasticity measures and serum markers of liver fibrosis. Methods This is a prospective cohort study of 20 patients with obstructive jaundice. Liver elasticity was assessed by Transient Elas...

  16. Treatment of malignant biliary occlusion by means of transhepatic percutaneous biliary drainage with insertion of metal stents - results of an 8-year follow-up and analysis of the prognostic parameters; Behandlung der malignen Gallenwegsstenose mittels perkutaner transhepatischer Metallendoprothesenimplantation: 8 Jahres-Ergebnisse und Analyse prognostischer Faktoren

    Energy Technology Data Exchange (ETDEWEB)

    Alfke, H.; Alfke, B.; Froelich, J.J.; Klose, K.J.; Wagner, H.J. [Klinik fuer Strahlendiagnostik Philipps Univ. Marburg (Germany)

    2003-08-01

    Purpose: To analyze outcome and predictive factors for patient survival and patency rates of unresectable malignant biliary obstruction treated with percutaneous transhepatic insertion of metal stents. Materials and Methods: This is a retroselective analysis of 130 patients treated in one interventional radiological center with data collected from patient records and by telephone interviews. The procedure-related data had been prospectively documented in a computer data base. The Kaplan-Meier analysis was performed for univariate and multivariate comparison of survival and patency rates with the log-rank test used for different tumor types. Predictive factors for survival and 30-day mortality were analyzed by a stepwise logistic regression. Results: Underlying causes of malignant biliary obstructions were cholangiocarcinoma in 50, pancreatic carcinoma in 29, liver metastases in 27, gallbladder carcinoma in 20, and other tumors in 4 patients. The technical success rate was 99%, the complication rate 27% and the 30-day mortality 11%. Primary patency rates (406 days with a median of 207 days) did not differ significantly for different tumor types. The survival rates were significantly (p = 0.03 by log-rank test) better for patients with cholangiocarcinoma than for patients with pancreatic carcinoma and liver metastases. Multiple regression analysis revealed no predictive factor for patient survival and 30-day mortality. Conclusion: Percutaneous transhepatic insertion of metal biliary endoprostheses offers a good initial and long-term relief of jaundice caused by malignant biliary obstruction. Although survival rates for patients with cholangiocarcinoma are better than for other causes of malignant biliary obstruction, a clear predictive factor is lacking for patients undergoing palliative biliary stent insertion. (orig.) [German] Ziel: Ergebnisse der perkutanen transhepatischen Metallendoprothesenimplantation bei malignen Gallenwegsverschluessen zu evaluieren und

  17. 内镜下胆管引流术治疗恶性胆道梗阻%Endoscopic biliary drainage for the treatment of malignant biliary obstruction

    Institute of Scientific and Technical Information of China (English)

    张燕宁; 黄晓俊; 金安琴; 王祥; 王伟; 刘子燕

    2013-01-01

    Objective To explore the clinical value and therapeutic effect of endoscopic nasobiliary drainage (ENBD),endoscopic retrograde biliary drainage (ERBD) and endoscopic metal biliary endoprosthesis (EMBE) via endoscopic retrograde cholangiopancreatography (ERCP) on malignant biliary obstruction.Methods One hundred and thirty-six patients with malignant biliary obstruction underwent ENBD,ERBD or EMBE according to the patients' conditions and the therapeutic effect,stent mean patency duration and mean survival time were observed.Results The successful rate of procedure was 95.4%.Within a week after endoscopic procedure,patients' liver function and clinical symptoms were significantly improved and drainage satisfaction rate was 91.0%.Post-drainage complication rate was 5.4%.The mean patency duration of ERBD and EMBE was (88.0 ± 21.9) d and (200.6 ± 46.6) d respectively,there was significant difference between them (P<0.01).The mean survival time of ERBD and EMBE was (215.4 ± 111.3) d and (271.8 ± 100.8) d respectively,there was no significant difference between them (P>0.05).Conclusion The measure of biliary stent insertion and ENBD via ERCP for malignant biliary obstruction is a safe and effective treatment.%目的 探讨经内镜逆行胰胆管造影术(ERCP)加鼻胆管引流(ENBD)、塑料支架置入引流(ERBD)或金属支架置入引流(EMBE)治疗恶性胆道梗阻的疗效比较.方法 136例恶性胆道梗阻患者,分为:ENBD组、ERBD组和EMBE组,观察各组疗效、支架通畅时间及生存时间.结果 三组总体置管成功率95.4%;治疗1周内肝功能及临床症状较术前明显好转,引流总体有效率为91.0%;并发症发生率为5.4%.ERBD组平均通畅时间(88.0±21.9)d,EMBE组平均通畅时间(200.6±46.6)d,两组差异有统计学意义(P< 0.0 1);ERBD组平均生存时间(215.4±111.3)d,EMBE组平均生存时间(271.8±100.8)d,两组差异无统计学意义(P> 0.05).结论 经ERCP对恶性胆道梗阻患

  18. Change and significance of T-cell subsets and TNF-α in patients with advanced malignant obstructive jaundice treated by percutaneous transhepatic biliary external and internal drainage

    Institute of Scientific and Technical Information of China (English)

    ZHU Lidong; CHEN Xiaoping

    2007-01-01

    The aim of this article was to study the influence of immunity function of advanced malignant obstructive jaundice(MOJ)treated by percutaneous transhepatic biliary external and internal drainage.Ninety-six cases of MOJ were divided into two groups according to the different ways of biliary drainage.Fifty-two external drainage tubes were placed in 41 cases of percutaneous transhepatic biliary external drainage group and 66 metal stents were placed in 55 cases of percutaneous transhepatic biliary internal drainage group.Liver function,serum TNF-α and cellular function were examined one day before operation and one week after operation and liver function was re-examined two weeks after operation,in order to observe the change and analyze the association among them and compare with the control group.All patients' conditions were improved after operation.In the percutaneous transhepatic biliary external and internal drainage groups,the total level of bilirubin decreased from(343.54±105.56)μmol/L and(321.19±110.50)μmol/L to(290.56±103.46)μmol/L and(283.72±104.95)μmol/L after operation respectively,which were significantly lower than pre-operation(P<0.05),but there was no significant difference between the two groups(P>0.05).Serum alanine aminotransferase(ALT)of all patients one week after operation was significantly lower than that before operation.TNFin percutaneous transhepatic biliary external and internal groups decreased from(108.58±19.95)pg/mL,(109.98±16.24)pg/mL of pre-operation to(104.32±19.59)pg/mL,(83.92±13.43)pg/mL of post-operation respectively,there was notable improvement(P<0.01)in internal drainage group after operation.Patients' serum CD4,CD3 and CD4/CD8 were notably increased,but CD8 was notably decreased (P<0.05).There was no difference in external drainage group (P>0.05).There was a significant difference between the two groups.Serum TNF-α and ALT had positive correlation.Percutaneous transhepatic biliary internal or external

  19. Clinical Analysis and Prevention of Biliary Tract Infection after Percutaneous Transhepatic Cholang-ial Drainage in Patients with Malignant Obstructive Jaundice%恶性梗阻性黄疸患者经皮穿刺肝胆管引流术后胆管感染的临床分析及预防研究

    Institute of Scientific and Technical Information of China (English)

    滕春雨

    2015-01-01

    Objective To analyze the risk factors of biliary tract infection after percutaneous transhepatic cholangial drainage(PTCD) in patients with malignant obstructive jaundice.Methods A total of 75 patients with malignant obstructive jaundice admitted in Dalian Friendship Hospital from Jan.2011 to Jan.2013 were selected,distribution and composition of pathogens of postoperative biliary tract infection after PTCD and risk factors of the infection were analyzed.Results Among 75 patients, biliary tract infections occurred in 19 patients,the infection rate was 25.3%.Specimens were collected and 159 strains of pathogens were cultured, including 81 strains of positive samples,among which there were 12 stains of gram -positive bacteria,account-ing for 14.8%;69 strains of gram-negative bacteria,accounting for 85.2%.Gram-positive bacteria mainly in-cluded Enterococcus faecalis(8.6%) and birds enterococci(4.9%);while gram-negative bacteria mainly included Escherichia coli(48.1%) and Klebsiella(24.7%).Results of multivariate logistic analysis showed that site of obstruction(OR =14.261,95%CI 5.281-31.862),bile duct restenosis(OR =3.862,95%CI 5.281-31.862),inwelling of external drainage catheter (OR=9.137,95%CI 1.469-15.957) were the risk factors of biliary tract infection after PTCD(P <0.05).Conclusion Biliary tract infection after PTCD is common complication of obstruction,site of obstruction,bile duct restenosis and indwelling time of external drainage catheter are independent risk factors for the infection ,effective preventive measures can reduce the incidence of biliary tract infection after PTCD .%目的:分析恶性梗阻性黄疸患者经皮穿刺肝胆管引流( PTCD)术后胆管感染的危险因素,并探讨预防措施。方法选择2011年1月至2013年1月在大连市友谊医院接受诊治的恶性梗阻性黄疸患者75例,分析行PTCD术后胆管感染病原菌的分布及构成情况,并对其危险因素进行筛选分析。结果本组75

  20. Endoscopic Ultrasound-Guided Biliary Drainage Using a Fully Covered Metallic Stent after Failed Endoscopic Retrograde Cholangiopancreatography.

    Science.gov (United States)

    Guo, Jintao; Sun, Siyu; Liu, Xiang; Wang, Sheng; Ge, Nan; Wang, Guoxin

    2016-01-01

    Background and Study Aims. Endoscopic ultrasound- (EUS-) guided biliary drainage (EUS-BD) is an alternative treatment for biliary obstruction after failed endoscopic retrograde cholangiopancreatography (ERCP). In this study, we present the outcomes of inpatients with obstructive jaundice treated with EUS-BD using a fully covered metallic stent after failed ERCP. Patients and Methods. A total of 21 patients with biliary obstruction due to malignant tumors and prior unsuccessful ERCP underwent EUS via an intra- or extrahepatic approach with fully covered metallic stent between March 2014 and October 2015. A single endoscopist performed all procedures. Results. Seven patients underwent hepatogastrostomy (HGS) and 14 underwent choledochoduodenostomy (CDS). The technical and clinical success rates were both 100%. There was no difference in efficacy between HGS and CDS. Adverse events occurred in three patients, including two in the HGS group (1 bile leakage and 1 sepsis) and one in the CDS group (sepsis). Four patients died as a result of their primary tumors during a median follow-up period of 13 months (range: 3-21 months). No patient presented with stent migration. Conclusion. EUS-BD using a fully covered metallic stent appears to be a safe and effective method for the treatment of obstructive jaundice. PMID:27594881

  1. 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.

  2. Early postoperative follow-up of liver transplant: influence of biliary drainage on transplant function

    International Nuclear Information System (INIS)

    In 26 patients with orthotopic liver graft, hepatobiliary scintigraphy (99mTc-mebrofenin; 180-330 MBq) was performed in early post-operative period (9.1 ± 4.3 days). The examination included an angio-scintigraphic phase and a functional phase. In all patients the bile duct reconstruction was achieved by a choledoco-choledocostomy 'with' (n = 13) or 'without' (n 13) T-tube stenting. The region of interest method allowed to generate time-activity curves A(t) for the liver graft for the angio-scintigraphic phase in order to evaluate the relative contribution of arterial and portal component and for the functional phase in order to identify captation and/or excretion abnormalities. Quantitative analysis of these curves gave three groups of results: a normal perfusion did not necessarily imply a normal captation (8/9 cases ie, 89 %) nor a normal excretion (7/9 cases ie, 78 %); an abnormal perfusion was always associated with a abnormal captation external drainage (respectively 11/13 cases ie, 85 % and 7/13 ie, 54 % for excretion). This study showed that hepatobiliary scintigraphy was e vary useful examination to detect perfusion and function abnormalities of liver graft and to evaluate the influence of drainage on the functional status of the graft in the early post-operative period. (author)

  3. US-guided percutaneous transhepatic biliary drainage: comparative study of right-sided and left-sided approach

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Hwan; Cha, Soon Joo [College of Medicine, Inje Univ., Kimhae (Korea, Republic of)

    2002-02-01

    To compare the feasibility and safety of US-guided right and left percutaneous transhepatic biliary drainage (PTBD). Between March 1998 and May 1999, 32 patients underwent 36 US-guided right or left PTBD in referred order, alternatively. The causes of biliary obstruction were bile duct stone (n=2), bile duct carcinoma (n=10), carcinoma of the pancreas (n=9), GB carcinoma (n=7), metastasis to the porta hepatis (n=3), and carcinoma of the ampulla of vater (n=1). Technical success, procedure time, fluoroscopic time, and complications were evaluated. PTBD was successful in 94% of both right and left approach. The average procedure time was 9.7 {+-}3.8 min. in the right approach and 9.6 {+-}3.1 min. in the left approach, respectively (p=0.794). The average fluoroscopic time were 3.9{+-}2.4 min. in the right approach and 3.8{+-}2.2 min. in the left approach (p=0.892). A major complication, bile peritonitis, occurred in one of 16 patient with right-sided approach. Minor complications occurred in six right (2 hemobilia, 3 tube malfunction, 1 cholangitis) and three left (1 hemobilia, 1 fever, 1cholangitis) PTBD. There were no significant difference in the complication rates between right and left PTBD (p=0.729). There were no significant differences in feasibility and safety in US-guided right and left PTBD.

  4. Endoscopic ultrasound-guided choledochoduodenostomy with a lumen-apposing, self-expandable fully covered metal stent for palliative biliary drainage.

    Science.gov (United States)

    French, Joshua Blake; Coe, Adam Wesley; Pawa, Rishi

    2016-04-01

    In addition to the poor prognosis associated with pancreatic adenocarcinoma, it can also lead to several other conditions including obstructive jaundice that can affect a patient's quality of life. This is a major concern in non-operative patients where palliation is considered the main therapeutic goal. Traditionally, there are several ways to pursue palliative biliary drainage including endoscopic methods, a variety of surgical procedures, and percutaneous techniques. Generally, endoscopic methods such as endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary stent placement are considered first-line therapies. Unfortunately, ERCP is not always possible due to several potential reasons. Although endoscopic ultrasound-guided biliary puncture has been well described for several years, there are limitations to its usefulness in biliary drainage, in part due to complication concerns. However, more recently a lumen-apposing, self-expandable fully covered metal stent has been employed for such situations. We describe two cases in which this type of stent was used in patients for palliative biliary drainage in pancreatic adenocarcinoma where standard ERCP was not feasible. In both cases, stent deployment was successful without immediate complications related to the procedure or the stent. Furthermore, the main goal of these therapies was palliation and in both cases the patient chose this procedure for quality of life reasons. In the future, randomized trials are needed to better define the long-term effectiveness and safety of these stents compared to more standard therapies. PMID:26956721

  5. 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...

  6. 内镜超声引导下胆道穿刺引流技术的应用%Application of endoscopic ultrasound guided biliary drainage technology

    Institute of Scientific and Technical Information of China (English)

    王晟; 孙思予; 刘香; 葛楠; 郭瑾陶; 刘文; 王树朋; 胡金龙

    2015-01-01

    目的 评价经内镜逆行胰胆管造影术(ERCP)治疗失败的胆道梗阻患者行内镜超声引导下胆道穿刺引流(EUS-BD)的疗效及安全性.方法 回顾性总结2014年8月至2015年1月期间,8例ERCP引流失败后行EUS-BD的胆道梗阻患者的临床资料,分析EUS-BD的疗效及并发症发生情况.结果 8例均操作成功,于胆道与消化道之间顺利放置全覆膜金属支架,解除胆道梗阻,且术后恢复良好,无明显并发症发生.结论 EUS-BD是一种安全、有效的胆道引流方式,可以作为ERCP失败后的备用治疗方案.%Objective To evaluate the effectiveness and safety of endoscopic ultrasound guided biliary drainage (EUS-BD)technology for biliary obstruction where ERCP(endoscopic retrograde cholangiopancreatography) failed.Methods EUS-BD was performed on 8 patients with biliary obstruction after failure of ERCP.Clinical data were collected,and effectiveness and complications of EUS-BD were analysed.Results Procedures were performed successfully on 8 patients.Full covered metallic stents were placed between biliary and digestive tract to relieve biliary obstruction,and all patients recovered with no complications.Conclusion EUS-BD is a safe and effective way for the biliary drainage,and it can be used as a standby treatment after the failure of ERCP.

  7. Risk factors of cholangitis following endoscopic biliary drainage for malignant biliary obstruction%恶性胆道梗阻ERCP引流术后并发胆管炎原因分析

    Institute of Scientific and Technical Information of China (English)

    刘军; 邓登豪; 朱海杭; 王璐

    2011-01-01

    Objective To investigate the acute suppurative cholangitis (ASC) complication factors in patients with malignant biliary obstruction who received the endoscopic retrograde cholan-giopancreatography (ERCP). Methods Retrospective analysis was made of 43 cases of malignant biliary obstruction patients who received endoscopic biliary drainage in our hospital during March 2003 to October 2010, and then the impact factors were studied on ASC in the following four aspects: time of ASC occurrence, different parts of obstructive lesions, the drainage options and liver functional recovery. Results We did the observation for 6 months, and 24 cases (55. 8%) had ASC symptoms. According to the different time periods, ASC may appear after ERCP, four cases appeared in early (9.3%), 10 cases in medium-term (23.3%), and 10 cases in later (25.6%). Among the ASC, malignant hilar obstruction occurred in a higher proportion, that was 8/9 (88. 9%), while the middle biliary duct 9/19 (47.4%), and low common bile duct, 7/15(46.7%). ASC occurred more often in hilar than that of in lower bile duct after draining by ERCP (P0.05), but more patients who placed plastic stents were suffering ASC in early and middle time, (8/17 cases of 47.1 % ), was significantly higher than the metal stent (6/26 cases of 2 3.1%), there was a significant difference ( P < 0 . 05 ) . ASCoccurrencewaslessin those whose liver function recovered well, 13/29 (44.8%) cases, was significantly lower than those abnormal liver function with poor recovery 11/14(78.6%), which had a significant difference ( P < 0.01), and among the liver function abnormality patients 10/14 cases (71.4%), ASC occurred in early and mid - term periods. Conclusion The ASC complication following ERCP draining for malignant biliary obstruction may be relative to the obstruction location, drainage way, the restoration of liver function status, and effective drainage plays an important part in preventing ASC.%目的 探讨恶性胆道梗阻性内镜

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

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

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

    OpenAIRE

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

    2009-01-01

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

  10. Nursing of patients with T-tube drainage after operation on biliary tract%胆道手术T管引流的护理

    Institute of Scientific and Technical Information of China (English)

    侯密群

    2012-01-01

    目的 探讨胆道手术T管引流的护理经验.方法 回顾性分析和总结204例因胆道梗阻或结石行胆道手术患者的T管引流护理要点.结果 本组204例患者中,有2例患者拔除T管后发生胆漏,经处理治愈出院;其余202例患者无1例发生T管堵塞、脱出及逆行感染等并发症.结论 做好健康宣教,妥善固定T管,保持引流通畅,观察引流液性质,做好T管周围皮肤护理、拔管前后护理,对保证T管的护理质量具有重要意义.%Objective To explore the experience of nursing the patients with T-tube drainage after operation on biliary tract. Method The nursing histories of 204 patients with T-tube drainage after operation on biliary tract because of biliary obstruction or calculus were retrospectively reviewed for concluding the nursing points. Results Among 204 patients, 2 had biliary leakage after withdrawal of T-tube, but they were cured and discharged after treatment for 3 ~ 5 days. No complication like T-tube obstruction, shedding and retroinfection occurred. Conclusion The T-tubes for drainage may be well cared and protected only if health education, T-tube fixation, unobstructed drainage, observation of drained fluids, care of the skin around the T-tube and nursing of patients at pre- and post-withdrawal of the tube are conducted.

  11. Endosonography-Guided Biliary Drainage with One-Step Placement of a Newly Developed Fully Covered Metal Stent Followed by Duodenal Stenting for Pancreatic Head Cancer

    OpenAIRE

    Kei Ito; Naotaka Fujita; Yutaka Noda; Go Kobayashi; Takashi Obana; Jun Horaguchi; Shinsuke Koshita; Yoshihide Kanno; Takahisa Ogawa; Yuhei Kato; Yasunobu Yamashita

    2010-01-01

    An 83-year-old man was admitted to our department, presenting with jaundice, fever, and nausea. CT revealed a pancreatic head tumor with duodenal invasion. Endoscopic transpapillary biliary drainage was unsuccessful due to stenosis at the second portion of the duodenum and tumor invasion to the papilla of Vater. Using a convex linear array echoendoscope, a fully-covered metal stent was placed across the puncture tract to bridge the duodenum and the bile duct. After improvement of jaundice, a ...

  12. Cholecysto-appendicostomy as partial internal biliary drainage in Progressive Familial Intrahepatic Cholestasis Type 1: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Yee Ian Yik

    2016-01-01

    Full Text Available Intractable pruritus secondary to bile salts retention in Progressive Familial Intrahepatic Cholestasis (PFIC can be relieved surgically by diverting bile drainage from ileum to reduce bile salts reabsorption into entero-hepatic circulation. We are reporting on the successful biliary diversion in a child with PFIC, with the use of the appendix as a conduit to drain bile from gallbladder to the colon (cholecysto-appendicostomy.

  13. Endoscopic biliary drainage for patients with unresectable pancreatic cancer with obstructive jaundice who are to undergo gemcitabine chemotherapy

    Institute of Scientific and Technical Information of China (English)

    Osamu Takasawa; Naotaka Fujita; Go Kobayashi; Yutaka Noda; Kei Ito; Jun Horaguchi

    2006-01-01

    AIM: To assess optimum endoscopic biliary drainage (EBD) in cases with unresectable pancreatic cancer in the era of gemcitabine (GEM).METHODS: Thirty patients with unresectable pancreatic cancer, who presented with jaundice and underwent chemotherapy using GEM after EBD were included in this study (GEM group). Fifteen cases with the same clinical manifestation and stage of pancreatic cancer treated with EBD alone were also included as controls. A covered metallic stent (CMS) or a plastic stent (PS) was used for EBD. The mean survival time (MST) in each group,risk factors of survival time, type of stent used and associated survival time, occlusion rate of stent, patency period of stent, and risk factors of stent occlusion were evaluated.RESULTS: MST in the GEM group was longer than that in the control (9.9 mo vs 6.2 mo). In the GEM group,the survival time was not different between those who underwent metallic stenting and those who underwent plastic stenting. Stent occlusion occurred in 60% of the PS group and 7% of the CMS group. The median stent patency in the PS-GEM group and the CMS-GEM group was 5 mo and 7.5 mo, respectively. Use of a PS was the only risk factor of stent occlusion.CONCLUSION: A CMS is recommended in cases presenting with jaundice due to unresectable pancreatic cancer, since the use of a CMS makes it possible to continue chemotherapy using GEM without repetition of stent replacement.

  14. 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 ...

  15. Endosonography-Guided Biliary Drainage with One-Step Placement of a Newly Developed Fully Covered Metal Stent Followed by Duodenal Stenting for Pancreatic Head Cancer

    Directory of Open Access Journals (Sweden)

    Kei Ito

    2010-01-01

    Full Text Available An 83-year-old man was admitted to our department, presenting with jaundice, fever, and nausea. CT revealed a pancreatic head tumor with duodenal invasion. Endoscopic transpapillary biliary drainage was unsuccessful due to stenosis at the second portion of the duodenum and tumor invasion to the papilla of Vater. Using a convex linear array echoendoscope, a fully-covered metal stent was placed across the puncture tract to bridge the duodenum and the bile duct. After improvement of jaundice, a duodenal metal stent was placed across the stricture of the duodenum. No procedure-related complications occurred. Neither migration nor obstruction of the two stents was observed during the three months followup period. Combination of ESBD using a fully covered metal stent and duodenal stenting is a feasible technique and possibly a less invasive treatment option for malignant biliary and duodenal obstruction compared to surgery.

  16. 胆道支架引流联合腔内射频消融治疗胆道恶性梗阻%Biliary drainage combined with intraductal radiofrequency ablation for treatment of malignant biliary obstruction

    Institute of Scientific and Technical Information of China (English)

    吴军; 潘亚敏; 王田田; 高道键; 胡冰

    2013-01-01

    Objective To evaluate the safety and clinical effectiveness of biliary drainage combined with endoscopic intraductal radiofrequency ablation (RFA) for treatment of malignant biliary obstruction. Methods Eighteen patients with malignant biliary obstruction, who were unsuitable for surgical resection, were prospectively selected for this study. During endoscopic retrograde cholangiopancreatography (ERCP), when biliary cannulation was successfully done, a bipolar radiofrequency probe was introduced into the bile duct via a guide wire. RFA was done under fluoroscopy, which was followed by stent placement. The patients were closely observed and followed up after procedure. Results All patients received successful RFA and biliary drainage. Twelve patients were implanted with plastic stents and 6 with metal stents; 3 patients were also implanted with pancreatic stents. Four patients developed mild complications (2 cholangitis and 2 pancreatitis), which were controlled by conservative therapy. Jaundice was promptly controlled in 61% (11/18) patients. The patients were followed up for a median of 10. 9 months (range 2. 0-15. 4 months). The stent patency rates of 3 months, 6 months and 12 months were 87%(13/15), 64% (9/14) and 25% (2/8), respectively. The 6 month- and 12 month-survival rates were 67% (8/12) and 50% (4/8), respectively. Conclusion Biliary drainage combined with endoscopic intraductal RFA is technically feasible and safe for treatment of malignant biliary obstruction.%目的 探讨胆道支架引流联合腔内射频消融治疗胆道恶性梗阻的安全性及临床疗效.方法 前瞻性纳入18例因胆道恶性梗阻接受内镜逆行胆胰管造影(ERCP)治疗的患者,在胆管插管成功后,循导丝插入双极射频电极,于肿瘤部位进行射频消融,并留置胆道支架进行引流,观察治疗的安全性及临床疗效.结果 所有患者均成功接受射频消融治疗;胆道引流成功率为100%(18/18),12例患者留置塑料支架,6

  17. Topological Analysis of Urban Drainage Networks

    Science.gov (United States)

    Yang, Soohyun; Paik, Kyungrock; McGrath, Gavan; Rao, Suresh

    2016-04-01

    Urban drainage networks are an essential component of infrastructure, and comprise the aggregation of underground pipe networks carrying storm water and domestic waste water for eventual discharge to natural stream networks. Growing urbanization has contributed to rapid expansion of sewer networks, vastly increasing their complexity and scale. Importance of sewer networks has been well studied from an engineering perspective, including resilient management, optimal design, and malfunctioning impact. Yet, analysis of the urban drainage networks using complex networks approach are lacking. Urban drainage networks consist of manholes and conduits, which correspond to nodes and edges, analogous to junctions and streams in river networks. Converging water flows in these two networks are driven by elevation gradient. In this sense, engineered urban drainage networks share several attributes of flows in river networks. These similarities between the two directed, converging flow networks serve the basis for us to hypothesize that the functional topology of sewer networks, like river networks, is scale-invariant. We analyzed the exceedance probability distribution of upstream area for practical sewer networks in South Korea. We found that the exceedance probability distributions of upstream area follow power-law, implying that the sewer networks exhibit topological self-similarity. The power-law exponents for the sewer networks were similar, and within the range reported from analysis of natural river networks. Thus, in line with our hypothesis, these results suggest that engineered urban drainage networks share functional topological attributes regardless of their structural dissimilarity or different underlying network evolution processes (natural vs. engineered). Implications of these findings for optimal design of sewer networks and for modeling sewer flows will be discussed.

  18. Palliative biliary drainage for advanced malignant obstructive jaundice%晚期恶性梗阻性黄疸的姑息性治疗

    Institute of Scientific and Technical Information of China (English)

    余立权; 张道权; 姜波; 陈江明; 谢胜学; 耿小平

    2015-01-01

    Objective To analyze the effects on advanced malignant obstructive jaundice using three ways of pallia-tive biliary drainage. Methods Clinical data of 58 patients with advanced malignant obstructive jaundice treated in our hospital from 2010 March to 2012 July were analyzed retrospectively. There were three groups including 16 cases in the group of open biliary-enteric anastomosis, 18 cases in the group of percutaneous transhepatic biliary stent(PTBS) and 24 cases in the group of endoscopic bile duct metal stents drainage(EBMSD). Serum bilirubin and alanine aminotransferase levels of three groups before and after treatment were analyzed and the survival time was followed-up. Results One week after drainage, serum total bilirubin and direct bilirubin levels of the patients in all three groups decreased remarkably (P0.05). Recovery time of postoperative gastrointestinal function in the group of open biliary-enteric anastomosis was longer significantly than that in the other two groups(P>0.05). The morbility was less in EBMSD group than that in the other groups. Conclusions Compared with the open bilioenterostomy, EBMSD and PTBS are minimally injured and the patients quickly recovered postoperatively. PTBS has more complications and might be suggested when EBMSD is failure. EBMSD has the advantage of wider indication and lower morbidity.%目的:分析晚期恶性梗阻性黄疸的三种姑息性引流方法的临床疗效。方法:回顾性分析我院2010年3月至2012年7月58例晚期恶性梗阻性黄疸病人的临床资料。按照治疗方法分为3组:胆肠内引流组16例,经皮肝穿刺胆管支架置入(percutaneous transhepatic biliary stent, PTBS)组18例,内镜胆管金属支架引流(endoscopic bile duct metal stents drainage, EBMSD)组24例。观察3组治疗前后的血胆红素、丙氨酸转氨酶水平,并随访生存时间。结果:引流1周后,3组总胆红素及直接胆红素水平均较术前明显下降(P0.05),3组间

  19. 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

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

    Institute of Scientific and Technical Information of China (English)

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

    2008-01-01

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

  1. Endoscopic retrograde biliary drainage for 25 patients with biliary obstruction of pancreatic carcinoma%内镜下胆道支架置入术治疗胰腺癌合并胆道梗阻25例

    Institute of Scientific and Technical Information of China (English)

    周宏华; 徐晓玲; 关心; 邓登豪; 向晓星

    2015-01-01

    Objective To evaluate the effect of palliative therapy of biliary obstruction of pancreatic carcinoma by endoscopic placement of metal stent .Methods A total of 25 patients with biliary obstruction of pancreatic carcinoma were collected from Jan.2013 to Dec.2013 underwent insertion of metal stents endoscopically .The TBIL, DBIL, ALT, ALP,γ-GT were compared in preoperative and postoperative serum .We followed up all patients for 3~6 months.Re-sults Successful stent placement was achieved in all cases .After operation of 7 days, in plating gold biliary stent groups, the rates of descent of TBIL , DBIL, ALT, ALP,γ-GT were 53.9%, 61.0%, 60.2%, 36.8%and 57.1%, respectively .Jaundice was improved in 92%of serum bilirubin post-drainage complication rate was 12%.Complication included pancreatitis, cholangititis, 1 case of intrastent impaction occurred on the 48th day after endoscopic placement of metal stent.Five patients died of tumor progression at the 32th, 44th, 63th, 72th, 123th day, respectively.Conclu-sion Endoscopic placement of metal stent shows the following advantages: having little trauma and low complication rate, suitable for persistent biliary drainage , improving clinical symptoms and quality of life of the patients , prolonging lifespan.It is a secure and effective management for pancreatic carcinoma .%目的:评估内镜下置入胆道金属支架对胰腺癌合并胆道梗阻患者姑息性治疗的疗效。方法收集苏北人民医院2013年1月1日-2013年12月31日临床确诊为胰腺癌合并胆道梗阻患者25例,均行ERCP术及置入胆管金属支架,比较手术前后血清总胆红素( TBIL)、直接胆红素( DBIL)、谷丙转氨酶( ALT)、碱性磷酸酶( ALP)、γ-谷氨酰转肽酶(γ-GT)等指标变化情况,并随访3~6个月。结果该组ERCP胆道支架置入成功率为100%。胆道金属支架置入一周后,患者TBIL下降53.9%,DBIL下降61.0%, ALT下降60.2%,ALP下降36

  2. A Survival Analysis of Patients with Malignant Biliary Strictures Treated by Percutaneous Metallic Stenting

    International Nuclear Information System (INIS)

    Background. Percutaneous metal stenting is an accepted palliative treatment for malignant biliary obstruction. Nevertheless, factors predicting survival are not known. Methods. Seventy-six patients with inoperable malignant biliary obstruction were treated with percutaneous placement of metallic stents. Twenty patients had non-hilar lesions. Fifty-six patients had hilar lesions classified as Bismuth type I (n = 15 patients), type II (n = 26), type III (n = 12), or type IV (n = 3 patients). Technical and clinical success rates, complications, and long-term outcome were recorded. Clinical success rates, patency, and survival rates were compared in patients treated with complete (n = 41) versus partial (n = 35) liver parenchyma drainage. Survival was calculated and analyzed for potential predictors such as the tumor type, the extent of the disease, the level of obstruction, and the post-intervention bilirubin levels. Results. Stenting was technically successful in all patients (unilateral drainage in 70 patients, bilateral drainage in 6 patients) with an overall significant reduction of the post-intervention bilirubin levels (p < 0.001), resulting in a clinical success rate of 97.3%. Clinical success rates were similar in patients treated with whole-liver drainage versus partial liver drainage. Minor and major complications occurred in 8% and 15% of patients, respectively. Mean overall primary stent patency was 120 days, while the restenosis rate was 12%. Mean overall secondary stent patency was 242.2 days. Patency rates were similar in patients with complete versus partial liver drainage. Mean overall survival was 142.3 days. Survival was similar in the complete and partial drainage groups. The post-intervention serum bilirubin level was an independent predictor of survival (p < 0.001). A cut-off point in post-stenting bilirubin levels of 4 mg/dl dichotomized patients with good versus poor prognosis. Patient age and Bismuth IV lesions were also independent predictors

  3. Fractal Analysis of Drainage Basins on Mars

    Science.gov (United States)

    Stepinski, T. F.; Marinova, M. M.; McGovern, P. J.; Clifford, S. M.

    2002-01-01

    We used statistical properties of drainage networks on Mars as a measure of martian landscape morphology and an indicator of landscape evolution processes. We utilize the Mars Orbiter Laser Altimeter (MOLA) data to construct digital elevation maps (DEMs) of several, mostly ancient, martian terrains. Drainage basins and channel networks are computationally extracted from DEMs and their structures are analyzed and compared to drainage networks extracted from terrestrial and lunar DEMs. We show that martian networks are self-affine statistical fractals with planar properties similar to terrestrial networks, but vertical properties similar to lunar networks. The uniformity of martian drainage density is between those for terrestrial and lunar landscapes. Our results are consistent with the roughening of ancient martian terrains by combination of rainfall-fed erosion and impacts, although roughening by other fluvial processes cannot be excluded. The notion of sustained rainfall in recent Mars history is inconsistent with our findings.

  4. 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...

  5. Analysis of Etiology and Drug Resistance of Biliary Infections

    Institute of Scientific and Technical Information of China (English)

    王欣; 李秋; 邹声泉; 孙自庸; 朱峰

    2004-01-01

    The bile was collected from fro patients with biliary infections, with the bacterium isolated to study the sensitivity of each kind of the bacterium to several antibiotics in common use. Except G- bacterium, we also found some kinds of G+ bacterium in infection bile. G- bacterium were not sensitive to Clindamycin, G+ bacterium were sensitive to Ciprofloxacin. Escherichia coli,Xanthomonas maltophilia, Enterobacter cloacae, Pseudomonas aeruginosa were sensitive to Ampicillin. G+ bacterium were not sensitive to Azactam. Enterococcus faecalis, Enterococcus faecium,Enterobacter cloacae were not sensitive to Ceftazidime. Enterococcus faecalis, Staphylococcus coagulase negative, Staphylococcus epidermidis, Pseudomonas aeruginosa were not sensitive to Ceftriaxone Sodium. We didn't found any bacterium resistance Imipenem. The possibility of the existence of G+ bacterium as well as drug resistance should be considered n patients with biliary infections.The value of susceptibility test should be respected to avoid drug abuse of antibiotics.

  6. Urban drainage models - making uncertainty analysis simple

    DEFF Research Database (Denmark)

    Vezzaro, Luca; Mikkelsen, Peter Steen; Deletic, Ana;

    2012-01-01

    There is increasing awareness about uncertainties in modelling of urban drainage systems and, as such, many new methods for uncertainty analyses have been developed. Despite this, all available methods have limitations which restrict their widespread application among practitioners. Here, a modif...... probability distributions (often used for sensitivity analyses) and prediction intervals. To demonstrate the new method, it is applied to a conceptual rainfall-runoff model using a dataset collected from Melbourne, Australia....

  7. 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...

  8. Biliary stenting in advanced malignancy: an analysis of predictive factors for survival

    Directory of Open Access Journals (Sweden)

    Afshar M

    2014-12-01

    Full Text Available Mehran Afshar,1 Koudeza Khanom,2 Yuk Ting Ma,1,3 Pankaj Punia1 1Cancer Centre, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, UK; 2St James Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 3School of Cancer Sciences, University of Birmingham, Birmingham, UK Purpose: Stenting of the biliary tree is a common palliative procedure to relieve obstructive jaundice in advanced malignancy. Although effective in relief of biliary obstruction and palliation of symptoms, little information is available on predictive factors for survival post-procedure. This retrospective study sought to assess factors influencing post-procedure survival in cancer patients after biliary stenting. Methods: Case notes of all patients from a regional academic cancer center, who underwent biliary stenting for obstructive jaundice related to malignancy during 2008 and 2009 were reviewed. We collected epidemiological, biochemical, treatment and survival data on all patients. We used Kaplan–Meyer analysis to assess survival from day of first biliary stenting (adjusted for cancer types, and the Cox proportional hazards model for univariate and multivariate analysis. Results: One hundred and ninety-four patients were included in the final analysis. Most cases were related to pancreatic cancer or cholangiocarcinoma (89 and 46 cases respectively. Median survival for all patients was 143 days. In multivariate analysis serum albumin ≥34 g/L at the time of procedure (hazard ratio 0.573; 95% confidence interval 0.424–0.773, P<0.001 and chemotherapy post-stent (hazard ratio 0.636; 95% confidence interval 0.455–0.889, P=0.008 were two independent prognostic factors predicting a better survival post-stenting. The 30 day mortality post-procedure in the 194 patients was 12%. Conclusion: This study suggests that stenting of the biliary tree in cases of malignant obstruction allows durable palliation of symptoms even in

  9. Partially Covered Self-Expandable Metal Stents versus Polyethylene Stents for Malignant Biliary Obstruction: A Cost-Effectiveness Analysis

    OpenAIRE

    Barkun, Alan N; Viviane Adam; Myriam Martel; Khalid AlNaamani; Moses, Peter L

    2015-01-01

    BACKGROUND/OBJECTIVE: Partially covered self-expandable metal stents (SEMS) and polyethylene stents (PES) are both commonly used in the palliation of malignant biliary obstruction. Although SEMS are significantly more expensive, they are more efficacious than PES. Accordingly, a cost-effectiveness analysis was performed.METHODS: A cost-effectiveness analysis compared the approach of initial placement of PES versus SEMS for the study population. Patients with malignant biliary obstruction unde...

  10. Intrahepatic biliary cystadenocarcinoma:clinical analysis of 4 cases

    Institute of Scientific and Technical Information of China (English)

    Qiang Yu; Tao Chen; Yun-Le Wan; Jun Min; Yu Cheng; Hua Guo

    2009-01-01

    BACKGROUND: Intrahepatic biliary cystadenocarcinoma (IBC) is a low-incidence disease which is often mis-diagnosed because of insufifcient recognition. This study aimed to investigate the clinical features, diagnosis and treatment of the disease. METHOD: The clinical data of 4 IBC patients treated in the Second Afifliated Hospital of Sun Yat-Sen University were retrospectively analyzed. RESULTS: The 4 patients complained of right upper abdominal pain and mass or masses. One patient presented with moderate fever and chills, and two had moderately impaired liver function. The levels of carbohydrate antigens (CA125 and CA19-9) were signiifcantly elevated and the level of carcinoembryonic antigen was slightly elevated in 3 patients. The level of serum transaminase was elevated in 2 patients, and the level of serum total bilirubin elevated in 2. Intrahepatic cystic masses ranging from 5.0 to 20.5 cm in diameter were found in all patients by ultrasound and CT/MR scan. Three of the 4 patients were misdiagnosed on admission as having hepatic cyst and one as having hepatic abscess. Radical removal of masses was performed in three patients after pathological diagnosis. One patient died from tumor recurrence 7 years after operation, 2 were followed up for 12 and 17 months without evidence of recurrence. The high risk patients who received palliative therapy were closely followed up. CONCLUSIONS: The diagnosis of IBC without speciifc clinical features mainly depends on imaging and pathological examination. Increased levels of serum CA125 and CA19-9 might contribute to the diagnosis and prognosis of some IBC patients. Radical excision is the only effective treatment.

  11. Analysis of divergences of the results of choleography and radioscintigraphy to evaluate the extrahepatic biliary ducts

    Energy Technology Data Exchange (ETDEWEB)

    Zubovskij, G.A.; Popova, Z.P.; Ogneva, T.V.; Sycheva, N.A.; Mikhajlova, N.A.; Medvedeva, Eh.S. (Nauchno-Issledovatel' skij Inst. Rentgenologii i Radiologii, Moscow (USSR))

    A great share of hepatic and bile cyst diseases among gastrointestinal diseases necessitates attempts to collect the most complete information on the state of the above organs while using an optimum complex of examination methods. The authors present the results of a multimodality study of 98 patients including i.v. cholecystography and computerized hepatobiliscintigraphy with sup(99m)Tc-HIDA. A detailed analysis of coincidences and divergences in diagnosis is provided. A conclusion has been made as to the great informative value of the x-ray methods for detection of organic defects of the biliary ducts and the advantages of radionuclide study in the evaluation of functional disorders in the liver and biliary tract.

  12. Magnetic Resonance Cholangiopancreatographv: A Meta-Analysis of Test Performance in Suspected Biliary Disease

    International Nuclear Information System (INIS)

    Magnetic resonance cholangiopancreatography (MRCP) is one of many newer noninvasive tests that can image the biliary tree. To precisely estimate the overall sensitivity and specificity of MRCP in suspected biliary obstruction and to evaluate clinically important subgroups. MEDLINE search (January 1987 to March 2003) for studies in English or French, bibliographies, and subject matter experts. Studies were included if they allowed construction of 2x2 contingency tables of MRCP compared with a reasonable gold standard for at least 1 of the following: the presence, level, or cause of biliary obstruction. Two independent observers graded study quality, which included consecutive enrollment, blinding, use of a single (versus composite) gold standard, and nonselective use of the gold standard. Logistic regression was used to examine the influence of publication year, quality score, proportion of patients having a direct gold standard, and clinical context on diagnostic performance. Of 498 studies identified, 67 were included (4711 patients). Mixed-effect models were used to estimate the sensitivity and specificity, and quantitative receiver-operating characteristic analysis was performed. Magnetic resonance cholangiopancreatography had a high overall pooled sensitivity (95% (+/-1.96 SD: spread of SD, 75% to 99%) and specificity (97% (spread of SD, 86% to 99 %)) The procedure was less sensitive for stones (92%; odds ratio, 0.51 (CI, 0.35 to 0.75) and malignant conditions (88%; odds ratio, 0.28 (CI, 0.18 to 0.44f) than for the presence of obstruction, In addition, diagnostic performance was higher in studies that were larger, did not use consecutive enrollment, and did not use gold standard assessment for some patients. Magnetic resonance cholangiopancreatography is a noninvasive imaging test with excellent overall sensitivity and specificity for demonstrating the level and presence of biliary obstruction; however, it seems less sensitive for detecting stones or

  13. [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

  14. Nurse of External Drainage Pancreatic Biliary Jejunum Back of Duodenal Diverticulum Child%十二指肠憩室化术外引流胰液胆汁空肠回输患儿的护理

    Institute of Scientific and Technical Information of China (English)

    李小婷

    2015-01-01

    Summerizing the nurse of external drainage pancreatic biliary jejunum back of duodenal diverticulum child. Observing whether the child appears complication such as fistula of duodenum and abdominal infection, cor ectly handle incision drainage, external drainage of bile by sterile operation and pancreatic juice indirectly through the jejunum nutrition tube to provide nutrition. Children recovered after active treatment and nursing treatment.%本文总结1例十二指肠憩室化手术后双重外引流胰液胆汁空肠回输患儿的护理体会。对患儿严密观察,是否出现十二指肠瘘、腹腔感染等并发症,正确处理切口引流,以无菌操作方法外引流胆汁、胰液间接经空肠营养管回输,并给以营养支持。患儿经积极治疗和护理后痊愈出院。

  15. Clinical Observation of Endoscopic Biliary Metallic Stent Drainage in Management of Hilar Cholangiocarcinoma and Extrahepatic Malignant Biliary Obstruction%内镜下金属支架引流术治疗肝门部胆管癌和肝外恶性胆道梗阻临床观察

    Institute of Scientific and Technical Information of China (English)

    周慧; 宛新建; 陆伦根; 罗声政; 蔡晓波; 李雷; 朱峰

    2012-01-01

    临床上恶性胆道梗阻性疾病预后较差.对于不能手术切除者,通常选择内镜下置入胆道支架以解除梗阻,然而该技术对进展期肝门部肿瘤的疗效报道不一.目的:探讨内镜下金属支架引流术对肝门部胆管癌和肝外恶性胆道梗阻的疗效和并发症发生情况.方法:纳入上海交通大学附属第一人民医院2006年6月~2009年6月收治的82例接受ERCP下置入自膨式金属胆道支架引流治疗的恶性胆道狭窄患者,根据病变部位分为肝门部胆管癌组和肝外恶性胆道梗阻组,对其ERCP参数和术后6个月随访记录进行回顾性分析,并分析随访期间急性胆管炎发生的危险因素.结果:两组支架置入成功率均为100%.与肝外恶性胆道梗阻组相比,肝门部胆管癌组术后1周总胆红素降低显效率较低,术后6个月内急性胆管炎发生率增高,初次发生时间提前,支架再狭窄率增高(P=0.000).ERCP术中括约肌切开为随访期间发生急性胆管炎的危险因素(P=0.004,OR:8.196).结论:内镜下金属支架引流术对肝门部胆管癌的疗效不及肝外恶性胆道梗阻,且更易早期发生急性胆管炎和支架再狭窄,术中括约肌切开可增加术后急性胆管炎的发生风险.%Background: The prognosis (or malignant biliary obstructive diseases is poor. For unresectable lesions, endoscopic biliary stenl drainage was usually applied to palliate obstruction. However, controversies exist regarding the therapeutic effect of this technique for advanced hilar cholangiocarcinoma. Aims: To assess (he therapeutic effect and complications of endoscopic biliary metallic stent drainage in management of hilar cholangiocarcinoma and extrahepatic malignant biliary obstruction. Methods: A total of 82 patients with malignant biliary obstructive diseases were enrolled from Jun. 2006 to Jun. 2009 at Shanghai First People' s Hospital, Shanghai Jiaotong University. All patients received endoscopic biliary

  16. Risk analysis of sustainable urban drainage and irrigation

    Science.gov (United States)

    Ursino, Nadia

    2015-09-01

    Urbanization, by creating extended impervious areas, to the detriment of vegetated ones, may have an undesirable influence on the water and energy balances of urban environments. The storage and infiltration capacity of the drainage system lessens the negative influence of urbanization, and vegetated areas help to re-establish pre-development environmental conditions. Resource limitation, climate, leading to increasing water scarcity, demographic and socio-institutional shifts promote more integrated water management. Storm-water harvesting for landscape irrigation mitigates possible water restrictions for the urban population in drought scenarios. A new probabilistic model for sustainable rainfall drainage, storage and re-use systems was implemented in this study. Risk analysis of multipurpose storage capacities was generalized by the use of only a few dimensionless parameters and applied to a case study in a Mediterranean-type climate, although the applicability of the model is not restricted to any particular climatic type.

  17. Biliary ascariasis.

    Science.gov (United States)

    Arcilla, C A; Varilla, A

    1978-01-01

    The presenting clinical features of a series of cases of biliary tract ascariasis are described, in particular the characteristic colicky pain which occurs. The term 'ascaritic biliary pain' is introduced for the symptom diagnostic of live Ascaris adult worms inside the biliary passages. Methods of diagnosis before, and in the course of, operation are discussed and seem adequate. The management of worms discovered in the bile ducts, and those in the proximal small bowel, is described.

  18. Systematic review and meta-analysis of closed suction drainage versus non-drainage in primary hip arthroplasty.

    Science.gov (United States)

    Kelly, Enda G; Cashman, James P; Imran, Farrah H; Conroy, Ronán; O'Byrne, John

    2014-03-01

    The routine use of drains in surgery has been dogmatically instituted in some disciplines. Orthopaedic surgery is one such sub-speciality. The use of postoperative closed suction drainage in total hip arthroplasty (THA) has become increasingly controversial with multiple randomised control trials performed to assess the benefit to outcome in THA. The hypothesis of this systematic review is that closed suction drainage does not infer a benefit and increase transfusion requirements of primary total hip arthroplasty patients. A systematic review and meta-analysis was conducted adhering to the PRISMA guidelines. A search of the available literature was performed on PubMed, Cochrane Central Registry of Controlled Trials, MEDLINE (OVID) and EMBASE using a combination of MeSH terms and Boolean operators. All data analysis was performed using the Cochrane Collaboration's Review Manager 5.1. Sixteen studies (n=2705) were included in the analysis. Post-operative closed suction drainage was found to increase total blood loss and blood transfusion requirements (p<0.05). Surgical site infection demonstrated no significant difference between the two groups (p=0.82). No significant difference in haematoma formation between groups (p=0.19) was elicited. The routine use of closed suction drainage systems post primary hip arthroplasty is not supported by this meta-analysis. However, the heterogeneity between studies does limit the accuracy of the meta-analysis. PMID:24574017

  19. Systematic review and meta-analysis of closed suction drainage versus non-drainage in primary hip arthroplasty.

    LENUS (Irish Health Repository)

    Kelly, Enda G

    2014-03-01

    The routine use of drains in surgery has been dogmatically instituted in some disciplines. Orthopaedic surgery is one such sub-speciality. The use of postoperative closed suction drainage in total hip arthroplasty (THA) has become increasingly controversial with multiple randomised control trials performed to assess the benefit to outcome in THA. The hypothesis of this systematic review is that closed suction drainage does not infer a benefit and increase transfusion requirements of primary total hip arthroplasty patients. A systematic review and meta-analysis was conducted adhering to the PRISMA guidelines. A search of the available literature was performed on PubMed, Cochrane Central Registry of Controlled Trials, MEDLINE (OVID) and EMBASE using a combination of MeSH terms and Boolean operators. All data analysis was performed using the Cochrane Collaboration\\'s Review Manager 5.1. Sixteen studies (n=2705) were included in the analysis. Post-operative closed suction drainage was found to increase total blood loss and blood transfusion requirements (p<0.05). Surgical site infection demonstrated no significant difference between the two groups (p=0.82). No significant difference in haematoma formation between groups (p=0.19) was elicited. The routine use of closed suction drainage systems post primary hip arthroplasty is not supported by this meta-analysis. However, the heterogeneity between studies does limit the accuracy of the meta-analysis.

  20. Retrospetive Review of 32 Patients with Malignant Biliary Obstruction Treated by Endoscopic Retrograde Biliary Drainage%内镜下胆道支架置入治疗恶性胆道梗阻32例临床分析

    Institute of Scientific and Technical Information of China (English)

    刘鹏飞; 冯义朝; 张剑青; 戴光荣; 马莹; 屈彩云; 杨列云

    2011-01-01

    Objective To explore the clinical effects of biliary tract endoprosthesis through endoscopic retrograde cholangiopan creatography(ERCP) on unresectable malignant biliary obstruction(MBO). Methods A retrospective review of 32 patients with malignant obstructive jaundice receiving ERCP was taken. Different biliary stents were placed according to the patient' s conditions. Outcomes were followed at three and six months. Results ERCP were successful in 30 eases of all the 32 cases, the successful rate was 93.8% (30/32) ;and 18 cases were successfully embedded with self-expandable metal stents, 12 cases were embedded with plastic stents;two cases had complications, the complications included ERCP associated pancreatitis (1 cases, 3.33 % ) and cholangitis ( 1 cases,3.33% ), but none of them had sequela after correct treatment. After stent was implanted, icteric and itch of skin were relieved quickly in 30 patients with malignant biliary obstruction. The serum level of total bilirubin decreased from( 170.84 ± 101.72) μ mol/L to ( 105.42 ± 82.44) μmol/L after treatment( P <0.01 ). The follow-up in 21 patients (70%) indicated that the survival rates of 3 months and 6 months after the treatment were 93% and 79%, respectively. Conclusion Biliary stenting is effective and safe in the treatment of MBO patients with contraindications for surgical treatments. It is a good choice to improve symptoms and increase quality of life for the late MBO cases.%目的 探讨通过纤维十二指肠镜逆行胆胰管造影(ERCP)放置胆道内支架治疗晚期恶性胆道梗阻的,临床疗效.方法 32例恶性梗阻性黄疸的患者,均行ERCP(经内镜逆行胰胆管造影)术,根据情况置入不同支架,观察其疗效和3个月、6个月生存率.结果 30例患者插管成功,插管成功率93.8%.其中18例置入金属支架,12例置入塑料支架.发生并发症2例(3.33%),其中急性胰腺炎1例,胆管炎1例.以上2例均经治疗后痊愈出院,术后黄

  1. Improvement of liver function of rats with obstructive jaundice by selective external biliary drainage%选择性胆管外引流改善梗阻性黄疸大鼠肝功能的研究

    Institute of Scientific and Technical Information of China (English)

    曾永毅; 郑树国; 董家鸿

    2008-01-01

    目的 探讨选择性胆管外引流(约占30%肝脏体积)对梗阻性黄疸大鼠肝功能的影响.方法 检测梗阻性黄疸大鼠(梗阻10 d)经选择性胆管外引流组及非选择性(全肝)胆管外引流组引流的0、1、4、7、10 d右叶肝质量/体质量的比率,并通过RT-PCR及Western blot法检测两实验组肝组织胆盐输出泵(bile salt export pump,BSEP)、多药抑制相关蛋白2(multidrug resistance-associated protein 2,MRF2)基因及蛋白的表达.结果 选择性胆管外引流组在开放引流后右叶肝质量/体质量的比率继续增加,而非选择性胆管外引流组逐渐恢复正常,两组比较差异有统计学意义(t=15.569,P<0.05);选择性胆管外引流组开放引流后BSEP、MRP2基因及蛋白的表达始终高于非选择性胆管外引流组,两组比较差异有统计学意义(t=4.485,7.143,9.169,5.178,P<0.05).结论 选择性胆管外引流能够改善梗阻性黄疸大鼠肝功能,与预保留侧肝脏体积代偿性增加和开放引流后预保留侧肝脏单位体积的膜转运蛋白表达增高有关.%Objective To explore the effects of selective external biliary drainage (SEBD) on the liver function of rats with obstructive jaundice. Methods The rates of right hepatic lobe weight against body weight of SD rats in SEBD group and total external biliary drainage (TEBD) group were calculated at day 0, 1, 4, 7, 10 after external biliary drainage. The mRNA and protein expressions of multidrug resistance-associated protein 2 (MRP2) and bile salt export pump (BSEP) were detected by RT-PCR and Western blot. Results Compared with TEBD group, the rate of right hepatic lobe weight against body weight and mRNA and protein expression of MRP2 and BSEP were significantly higher in SEBD group (t=15.569, P <0.05 ; t =4.485, 7.143, 9.169, 5.178, P <0.05). Conclusions SEBD improves the liver function of rats with obstructive jaundice, which may be related to the compensatory increase of remnant liver volume and

  2. 内镜胆道金属支架联合鼻胆管引流姑息性治疗恶性胆道梗阻%Endoscopic metal biliary endoprosthesis combined with endoscopic nasobiliary drainage for palliative treatment of malignant biliary obstruction

    Institute of Scientific and Technical Information of China (English)

    韩今朝; 秦鸣放

    2013-01-01

    目的:探讨内镜胆道金属支架置入术(endoscopic metal biliary endoprosthesis,EMBE)联合鼻胆管引流术(endoscopic naso-biliary drainage,ENBD)姑息性治疗恶性胆道梗阻的临床效果及应用价值.方法:回顾了2010-04至2012-10行内镜逆行胆胰管造影术(endoscopic retrograde cholangiopa ncreatography,ERCP)并放置EMBE联合ENBD的68例恶性胆道梗阻患者的临床资料,对其疗效、并发症、术后生存时间及支架通畅时间进行分析.结果:68例患者中行ERCP并放置胆道金属支架成功64例,失败4例,成功率为94.12%(64/68);支架置入术后1 wk黄疸明显消退,肝功能各项指标较术前显著改善,黄疸消退有效率为95.31%;术后并发症5例,其中高淀粉酶血症3例,急性胰腺炎l例、急性胆管炎1例,经保守治疗后痊愈;术后随访58例患者,平均生存时间为10.00 mo±2.30 mo(3-26 mo),半年生存率为67.24%(39/58),1年生存率为43.10%(25/58),2年生存率为5.17%(3/58);平均支架通畅时间为4.00 mo±2.26 mo(0-9 mo).结论:胆道金属支架置入术联合鼻胆管引流术可以有效解除胆道梗阻,改善肝功能,同时具有创伤小、疗效确切、并发症少、符合生理、方便术后观察等优点,已成为目前治疗恶性胆道梗阻的重要方法之一,是一种安全有效的姑息性治疗手段.%AIM: To explore the clinical effect of endoscopic metal biliary endoprosthesis (EMBE) combined with endoscopic nasobiliary drainage (ENBD) in the palliative treatment of malignant biliary obstruction. METHODS: The clinical data for 68 patients with malignant biliary obstruction who underwent endoscopic retrograde cholangiopancrea-tography (ERCP) for EMBE and ENBD from April 2010 to October 2012 were reviewed and analyzed. RESULTS: ERCP and biliary stent placement were successful in 64 of 68 cases, and the suc- cess rate was 94.12%. Jaundice obviously subsided in 95.31% of patients one week after stent placement. Postoperatively

  3. 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.

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

    Directory of Open Access Journals (Sweden)

    Wandong Hong

    2015-01-01

    Full Text Available 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 overall stent patency was 178 days. Total cumulative obstruction rate of the first stents during the follow up was 33%, 57%, 83%, and 96% at 90, 180, 360, and 720 days. Multivariate analysis revealed that hilar obstruction (hazard ratio [HR] =3.26, 95% confidence interval [CI, 2.31–4.61, metastasis cancer (HR = 2.61, 95% CI, 1.79–3.80, and length of stent (HR = 1.74, 95% CI, 1.24–2.46 were independent predictors of stent occlusion. Conclusions: Hilar biliary stricture, metastatic cancer, and length of stent were important predictors of occlusion of first-inserted metal stent in patients with malignant biliary obstruction.

  5. Effect of percutaneous transhepatic biliary drainage combined with metallic stent implantation treatment for biliary obstruction after portoenterostomy of bile duct cancer%经皮肝穿刺胆管引流术联合金属内支架植入术治疗胆管癌胆肠吻合术后梗阻性黄疸的疗效

    Institute of Scientific and Technical Information of China (English)

    谢军; 时启良; 郭长东; 王洪剑; 吕维富

    2015-01-01

    Objective To study the effect of clinical application of percutaneous transhepatic catheter drainage(PTCD)and metallic stents on biliary obstruction after portoenterostomy of bile duct cancer. Methods Form Nov. 2011 to May. 2014,a total of 24 patients with obstructive jaundice after portoenterostomy were admitted to the hospital and their clinical data were retrospectively analyzed. The PTCD or implantation of metallic stents was performed in 24 patients. The change of bilirubin restored,AST,ALT and the survival rate of the patients were documented and analyzed. Results The operation was successful in all 24 patients. Among 14 patients of obstruction of lower biliary tract,stent implantation was carried out in 10 patients. Among 10 patients of obstruction of higher biliary tract,stent implantation was carried out in 3 patients. The difference between the two groups was significant (P<0. 05). After the treatment,relief of jaundice symptoms was a-chieved,and the bilirubin restored to normal or acceptable lever,and hepatic function was improved obviously. The median follow-up time was 120 days. During the follow-up,death occurred in 7 cases among 11 patients while death occurred in 2 cases among 13 patients in com-bined-stents group. The difference in the survival rate between the two groups was significant statistically (P<0. 05). Conclusion PTCD or PTCD combined stents is an effective and advisable therapy for biliary obstruction after portoenterostomy of bile duct cancer. Obstruction of lower biliary tract is easier to implant stent. The technique of PTCD combined stents is superior to PTCD technique in the survival rate.%目的:探讨经皮肝穿刺胆管引流术(PTCD)联合金属内支架植入术治疗胆管癌胆肠吻合术后梗阻性黄疸的临床应用效果。方法回顾性分析24例胆管癌胆肠吻合术后梗阻性黄疸患者临床资料,采用经皮穿刺胆管引流(引流组)或经皮穿刺胆管引流术联合金属内支架植入

  6. Palliation of Malignant Biliary and Duodenal Obstruction with Combined Metallic Stenting

    International Nuclear Information System (INIS)

    Purpose. The purpose of this study is to evaluate the efficacy of palliation of malignant biliary and duodenal obstruction with combined metallic stenting under fluoroscopy guidance. Materials and Methods. A retrospective analysis of 9 patients (6 men and 3 women) who underwent biliary and duodenal stenting was performed. The mean age of patients was 61 years (range: 42-80 years). The causes of obstruction were pancreatic carcinoma in 7 patients, cholangiocellular carcinoma in one, and duodenal carcinoma in the other. Biliary and duodenal stents were placed simultaneously in 4 patients. In other 5 patients dudodenal stents were placed after biliary stenting when the duodenal obstruction symptoms have developed. In two patients duodenal stents were advanced via transgastric approach. Results. Technical success rate was 100 %. After percutaneous biliary drainage and stenting bilirubin levels decreased to normal levels in 6 patients and in remaining 3 patients mean reduction of 71% in bilirubin levels was achieved. Tumoral ingrowth occurred in one patient and percutaneous biliary restenting was performed 90 days after the initial procedure. Of the 9 patients, 6 patients were able to tolerate solid diet, whereas 2 patients could tolerate liquid diet and one patient did not show any improvement. Mean survival periods were 111 and 73 days after biliary and duodenal stenting, respectively. Conclusion. Combined biliary and duodenal stent placement which can be performed under fluoroscopic guidance without assistance of endoscopy is feasible and an effective method of palliation of malignant biliary and duodenal obstructions. If transoral and endoscopic approaches fail, percutaneous gastrostomy route allows duodenal stenting

  7. Gas-solid coupling analysis and numerical simulation of the dynamic process of gas drainage

    Institute of Scientific and Technical Information of China (English)

    Kai WANG; Bo LI; Jian-Ping WEI; Peng LI

    2013-01-01

    Based on the basic theory of gas seepage and coal seam deformation,using the numerical simulation method,this paper established the gas-solid coupling model of gas drainage from borehole.Using multi-physical coupling analysis software,the authors studied the stress change conditions around the drainage borehole,the influence of the gas drainage effect caused by the drilling gap,and the gas drainage effect under the conditions of different borehole radius and different permeabilities.The results show that the effective drainage radius is 1.03 m during 30 days of drainage.The effect of the diameter change of the drainage borehole is limited,but the influence of coal seam permeability is much bigger.After the same drainage period,the greater the permeability of coal seam is,the bigger the drainage radius is.For a low permeability coal seam,coal miners should take pressure-relief measures and increase the permeability to improve the drainage effects before draining gas through drilling.

  8. 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

  9. 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.

  10. Clinical analysis of biliary stent placement combined with gamma-knife for the treatment of complex hilar cholangiocarcinoma

    Directory of Open Access Journals (Sweden)

    Zhi-qiang FENG

    2011-05-01

    Full Text Available Objective To evaluate the therapeutic effect of biliary stent placement combined with gamma-knife for the treatment of complex hilar cholangiocarcinoma.Methods Five patients with type IV hilar cholangiocarcinoma,according to Bismuth classification,combined with stenosis of distant common bile duct were treated with biliary stent placement and gamma-knife.The left intrahepatic bile duct was catheterized under the guidance of ultrasound,followed by catheterization of right intrahepatic bile duct aided by percutaneous transhepatic cholangiography for drainage(PTCD.Three biliary stents were inserted to relieve obstruction.Patients then underwent gamma-knife treatment after subsidence of jaundice,and bilirubin,followed by determination of transaminase and observation of the condition of the tumor.Results Total bilrubin,direct bilrubin and alanine transaminase of patients were 289.38±101.43μmol/L,180.42±72.50μmol/L and 148.80±82.65 U/L respectively before PTCD,and 94.2±20.43μmol/L,62.37±30.41μmol/L and 109.27±45.52 U/L,respectively,7 days after PTCD,and they declined to 27.20±14.60μmol/L,20.58±9.33μmol/L and 59.80±35.18 U/L,respectively,one month after PTCD.Five patients survived for 10,13,14,17 and 24 months,respectively.The median survival time was 15 months.Conclusion The combination of insertion of metallic stents and gamma-knife therapy is a safe and effective treatment for complex hilar cholangiocarcinoma,and this therapeutic strategy may improve survival rate and control the rate of grouth of carcinoma.

  11. Biliary pain in postcholecystectomy patients without biliary obstruction. A prospective radionuclide study.

    Science.gov (United States)

    Grimon, G; Buffet, C; André, L; Etienne, J P; Desgrez, A

    1991-03-01

    Biliary pain without obvious biliary obstruction is common in postcholecystectomy patients. We studied 20 symptomatic patients with episodes of biliary-type pain after cholecystectomy (all having undergone endoscopic retrograde cholangiography), and in 18 asymptomatic postcholecystectomy controls. We performed quantitative hepatobiliary radionuclide analysis with dimethyl-imidodiacetic acid. From a series of 90 dynamic images at 1-min intervals using a gamma camera coupled to a computer, time-activity curves were produced in regions of interest in the liver, intrahepatic biliary tree, common duct, and heart, from which quantitative biliary excretion indexes were obtained. The results demonstrate a biliary kinetic dysfunction in patients with postcholecystectomy pain without morphological abnormalities. PMID:1995268

  12. 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.

  13. 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.

  14. Biliary stenting in advanced malignancy: an analysis of predictive factors for survival

    OpenAIRE

    Afshar M; Khanom K; Ma YT; Punia P

    2014-01-01

    Mehran Afshar,1 Koudeza Khanom,2 Yuk Ting Ma,1,3 Pankaj Punia1 1Cancer Centre, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, UK; 2St James Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 3School of Cancer Sciences, University of Birmingham, Birmingham, UK Purpose: Stenting of the biliary tree is a common palliative procedure to relieve obstructive jaundice in advanced malignancy. Although effective in relief of biliary obstr...

  15. Biliary cystadenoma

    Institute of Scientific and Technical Information of China (English)

    Miguel A Hernandez Bartolome; Sagrario Fuerte Ruiz; Israel Manzanedo Romero; Beatriz Ramos Lojo; Ignacio Rodriguez Prieto; Luis Gimenez Alvira; Rosario Granados Carreno; Manuel Limones Esteban

    2009-01-01

    The diagnosis of cystadenoma is rare, even more so when located in the extrahepatic bile duct. Unspecific clinical signs may lead this pathology to be misdiagnosed. The need for pathological anatomy in order to distinguish cystadenomas from simple biliary cysts is crucial. The most usual treatment nowadays is resection of the bile duct, together with cholecystectomy and Roux-en-Y reconstruction.

  16. Right Gastric Venous Drainage: Angiographic Analysis in 100 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Seong, Nak Jong [Seoul National University Bundang Hospital, Sungnam (Korea, Republic of); Chung, Jin Wook; Kim, Hyo Cheol; Park, Jae Hyung; Jae, Hwan Jun [Seoul National University Hospital, Seoul (Korea, Republic of); An, Sang Bu [National Cancer Center, Ilsan (Korea, Republic of); Cho, Baik Hwan [Chonbuk National University Hospital, Chonju (Korea, Republic of)

    2012-01-15

    To evaluate the pattern of right gastric venous drainage by use of digital subtraction angiography. A series of 100 consecutive patients who underwent right gastric arteriography during transcatheter arterial chemoembolization for hepatocellular carcinoma were included in this study. Angiographic findings were retrospectively analyzed with respect to the presence or absence of the right and aberrant gastric veins, multiplicity of draining veins, aberrant right gastric venous drainage sites, and the termination pattern of aberrant right gastric veins (ARGVs). We also compared the relative size of the right and left gastric veins. A total of 49 patients collectively had 66 ARGVs. The common drainage sites for the ARGVs included the hepatic segment IV (n = 35) and segment I (n = 15). The termination pattern of ARGV could be classified into 4 different types. The most common type was termination as a superficial parenchymal blush formation in small areas without demonstrable portal branches. A statistically significant difference was found for the dominance of the right gastric vein in gastric venous drainage between the two groups with or without ARGV (p < 0.05, Fisher's exact test). In the group of patients without ARGV (n = 51), the right gastric vein was equal to (n = 9) or larger than (n = 17) the left gastric vein in 26 patients (26 of 51, 51%). The incidence of ARGV is higher than expected with four distinct types in its termination pattern. The right gastric vein may play a dominant role in gastric venous drainage.

  17. Ultrasonic diagnosis of biliary atresia: A retrospective analysis of 20 patients

    Institute of Scientific and Technical Information of China (English)

    Shi-Xing Li; Yao Zhang; Mei Sun; Bo Shi; Zhong-Yi Xu; Ying Huang; Zhi-Qin Mao

    2008-01-01

    AIM: To investigate the clinical value of ultrasonographic diagnosis of biliary atresia (BA), a retrospective analysis of the sonogram of 20 children with BA was undertaken.METHODS: Ultrasonography (US) was performed in 20 neonates and infants with BA, which was confirmed with cholangiography by operation or abdominoscopy. The presence of triangular cord, the size and echo of liver, the changes in empty stomach gallbladder and postprandial gallbladder were observed and recorded.RESULTS: The triangular cord could be observed at the porta hepatis (thickness: 0.3-0.6cm) in 10 cases. Smaller triangular cord (0.2-0.26cm) can be observed in 3 cases. The gallbladder was not observed in 2 cases, and 1 case showed a streak gallbladder without capsular space. The gallbladders of 15 cases were flat and small. The gallbladders of 2 cases were of normal size and appearance, however, there was no postprandial contraction. The livers of all cases showed hepatomegaly and hetreogeneous echogenicity. Statistical analysis was performed to compare the hepatomegaly and hetreogeneous echogenicity and the stage of hepatic fibrosis.CONCLUSION: The presence of the triangular cord at the porta hepatis is specific. However, it is not the only diagnostic criterion, since flat and small gallbladder and poor contraction are also of important diagnostic and differential diagnostic significance. The degree of hepatomegaly and hetreogeneous echogenicity is proportional with liver fibrosis, and able to indicate the duration of course and prognosis.

  18. Drainage vent systems: investigation and analysis of air pressure regime

    Energy Technology Data Exchange (ETDEWEB)

    Swaffield, J.A.; Jack, L.B. [Heriot-Watt University, Edinburgh (United Kingdom). Dept. of Building Engineering and Surveying

    1998-12-31

    Knowledge of the performance of building drainage vent systems and associated appliance trap seal loss and retention has developed in recent years due to extensive research into the generation and propagation of air pressure transients within drainage networks. This paper demonstrates how data gathered from experimental testing of several single stack systems, considering the influence of a wide range of parameters including stack diameter, roughness, height and applied water flow rate, can be used to provide generally applicable mathematical expressions which assist in determining the pressure regime present at critical points within such systems. (author)

  19. Urban drainage models simplifying uncertainty analysis for practitioners

    DEFF Research Database (Denmark)

    Vezzaro, Luca; Mikkelsen, Peter Steen; Deletic, Ana;

    2013-01-01

    There is increasing awareness about uncertainties in the modelling of urban drainage systems and, as such, many new methods for uncertainty analyses have been developed. Despite this, all available methods have limitations which restrict their widespread application among practitioners. Here, a m...... probability distributions (often used for sensitivity analyses) and prediction intervals. To demonstrate the new method, it is applied to a conceptual rainfall-runoff model (MOPUS) using a dataset collected from Melbourne, Australia....

  20. Experimental analysis of drainage and water storage of litter layers

    Directory of Open Access Journals (Sweden)

    A. Guevara-Escobar

    2007-06-01

    Full Text Available Leaf litter overlying forested floors are important for erosion control and slope stability, but also reduces pasture growth in silvopastoral systems. Little information exists regarding the value of percolation and storage capacity parameters for litter layers. These estimates are needed for modelling better management practices for leaf litter. Therefore, this work measured the effect of four rainfall intensities: 9.8, 30.2, 40.4 and 70.9 mm h−1 on the hydrological response of layers of three materials: recently senesced poplar leaves, fresh grass and woodchips. Maximum storage (Cmax, defined as the detention of water immediately before rainfall cessation, increased with rainfall intensity. The magnitude of the increment was 0.2 mm between the lowest and highest rainfall intensities. Mean values of Cmax were: 1.27, 1.51, 1.67 and 1.65 mm for poplar leaves; 0.63 0.77, 0.73 and 0.76 for fresh grass and; 1.64, 2.23, 2.21 and 2.16 for woodchips. Drainage parameters were: 9.9, 8.8 and 2.2 mm−1 for poplar, grass and woodchips layers. An underlying soil matrix influenced the drainage flow from poplar leaf layers producing pseudo-Hortonian overland flow, but this occurred only when the rainfall intensity was 40.4 and 70.9 mm h−1 and accounted for 0.4 and 0.8‰ of total drainage. On the other hand, the presence of a poplar leaf layer had a damping effect on the drainage rate from the underlying soil matrix, particularly at intermediate rainfall intensities: 30.2 or 40.4 mm h−1.

  1. 导丝介入法在胆道梗阻患者内镜下鼻胆管引流术中的应用%Application of interventional guidewire in endoscopic nasal biliary drainage in patients with ;obstruction of biliary tract

    Institute of Scientific and Technical Information of China (English)

    黄茵; 曾婷

    2014-01-01

    目的:探讨导丝介入法经内镜下鼻胆管引流术中的应用价值。方法2014年1月至2015年1月将120例因胆道梗阻行内镜下鼻胆管引流术的住院患者,随机分为观察组(n =60)和对照组(n =60)。观察组采用导丝从咽后壁牵引拉出牵引管再将鼻胆管引出鼻腔固定;对照组采用手术者食、中指伸至患者咽后壁夹出牵引管方法。分别比较两组临床结果和并发症。结果观察组与对照组相比较,观察组的总成功率(P <0.05),一次成功率优于对照组(P <0.01);鼻胆管远端脱出率(P <0.05);口腔内打折率(P <0.01);术者手指被咬伤率(P <0.01)。结论采用导丝从咽部牵引出牵引管将鼻胆管自口经鼻引出固定法,具有简便、易操作,患者反应轻、副作用少,成功率高等优点。%Objective To discuss the application and the value of inventional guidewire in endoscopic nasal biliary drainage.Methods A total of 120 patients who underwent nasal biliary drainage admitted during the period from January 2014 to January 2015 were randomly divided into observational group (n =60)and control group (n =60).The patients in the observation group were applied with guide wire from the posterior pharyngeal wall pulling nasobiliary and then leading nasal tube fixed.The surgeons used forefingers and middle fingers to clip out the traction from the patients′pharyngeal tube in the control group. The clinical results and complications of both groups were compared.Results The success rate in the observational group was higher than that in the control group (P <0.05);especially the one-time pass rate was higher than that in the control group (P <0.01 );nasobiliary distal prolapse rate (P <0.05 );oral discount rate (P <0.01 );finger′s bitten rate of surgeons (P <0.01 ).Conclusion The application of guidewire tube via pharynx to pull out nose duct from mouth is convenient and easy

  2. Systematic review and meta-analysis: bezafibrate in patients with primary biliary cirrhosis

    Directory of Open Access Journals (Sweden)

    Yin Q

    2015-09-01

    Full Text Available Qin Yin,1,2,* Jingjing Li,3,* Yujing Xia,3 Rong Zhang,3,4 Jianrong Wang,3,4 Wenxia Lu,3,4 Yuqing Zhou,1,2 Yuanyuan Zheng,3 Huerxidan Abudumijiti,3 Rongxia Chen,3 Kan Chen,3 Sainan Li,3 Tong Liu,3 Fan Wang,3 Jie Lu,3 Yingqun Zhou,3 Chuanyong Guo3 1Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 2The First Affiliated Hospital of Soochow University, Suzhou, 3Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 4The First Clinical Medical College of Nanjing Medical University, Nanjing, People’s Republic of China *These authors contributed equally to this work and should be considered co-first authors Background and aim: Ursodeoxycholic acid (UDCA is the standard treatment for primary biliary cirrhosis (PBC, but not all cases respond well. Evidence has shown that combination therapy of UDCA with bezafibrate significantly improved liver function. A meta-analysis was performed to assess the efficacy and safety of UDCA and bezafibrate combination therapy in the treatment of PBC.Results: Nine trials, with a total of 269 patients, were included in the analysis. The bias risk of these trials was high. Compared with UDCA alone, the combination with bezafibrate improved the Mayo risk score (mean difference [MD], 0.60; 95% confidence interval [CI], 0.25–0.95; P=0.0008 and liver biochemistry: alkaline phosphatase (MD, -238.21 IU/L; 95% CI, -280.83 to -195.60; P<0.00001; gamma-glutamyltransferase (MD, -38.23 IU/L; 95% CI, -50.16 to -25.85; P<0.00001; immunoglobulin M (MD, -128.63 IU/L; 95% CI, -151.55 to -105.71; P<0.00001; bilirubin (MD, -0.20 mg/dL; 95% CI, -0.33 to -0.07; P=0.002; triglycerides (MD, -26.84 mg/dL; 95% CI, -36.51 to -17.17; P<0.0001; total cholesterol (MD, -21.58 mg/dL; 95% CI, -30.81 to -12.34; P<0.0001, and serum alanine aminotransferase (MD, -10.24 IU/L; 95% CI, -12.65 to -78.5; P<0.00001. However

  3. Drainage Network and Lineament Analysis: An Approach for Potwar Plateau (Northern Pakistan)

    Institute of Scientific and Technical Information of China (English)

    Faisal SHAHZAD; Syed Amer MAHMOOD; Richard GLOAGUEN

    2009-01-01

    Drainage responds rapidly to tectonic changes and thus it is a potential parameter for tectonogeomorphological analysis. Drainage network of Potwar is a good geological record of movement, displacements, regional uplifts and erosion of the tectonic units. This study focuses on utilizing drainage network extracted from Shuttle Radar Digital Elevation Data (SRTM-DEM) in order to constrain the structure of the Potwar Plateau. SWAN syncline divides Potwar into northern Potwar deformed zone (NPDZ) and southern Potwar platform zone (SPPZ). We extracted the drainage network from DEM and analyzed 112 streams using stream power law. Spatial distribution of concavity and steepness indices were used to prepare uplift rate map for the area. DEM was further utilized to extract lineaments to study the mutual relationship between lineaments and drainage patterns. We compared the local correlation between the extracted lineaments and drainage network of the area that gives us quantitative information and shows promising prospects. The streams in the NPDZ indicate high steepness values as compared to the streams in the SPPZ. The spatial distribution of geomorphic parameters and uplift rates suggest the distinctive deformation among eastern, central and western parts. The local correlation between drainage network and lineaments from DEM is strongly positive in the area within 1 km of radius.

  4. 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.)

  5. 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.)

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

    Science.gov (United States)

    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 were detectable in the upper digestive tract. The biliary microbiota had a comparatively higher similarity with the duodenal microbiota, versus those of the other regions, but with a reduced diversity. Although the majority of identified bacteria were greatly diminished in bile samples, three Enterobacteriaceae genera (Escherichia, Klebsiella, and an unclassified genus) and Pyramidobacter were abundant in bile. Predictive functional analysis indicated enhanced abilities of environmental information processing and cell motility of biliary bacteria. Our study provides evidence for the potential source of biliary bacteria, and illustrates the influence of the biliary system on biliary bacterial communities.

  7. 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

  8. 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

  9. Endoscopic Ultrasound-guided Bilio-pancreatic Drainage

    OpenAIRE

    Giovannini, Marc; Bories, Erwan; Téllez-Ávila, Félix I.

    2012-01-01

    The echoendoscopic biliary drainage is an option to treat obstructive jaundices when endoscopic retrograde cholangiopancreatography (ERCP) drainage fails. These procedures compose alternative methods to the side of surgery and percutaneous transhepatic biliary drainage, and it was only possible by the continuous development and improvement of echoendoscopes and accessories. The development of linear sectorial array echoendoscopes in early 1990 brought a new approach to diagnostic and therapeu...

  10. 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

  11. 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.

  12. 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

  13. The role of radiotherapy for carcinomas of the gall bladder and extrahepatic biliary duct : retrospective analysis

    International Nuclear Information System (INIS)

    Carcinomas arising in the gall bladder(GB) or extrahepatic biliary ducts are uncommon and generally have a poor prognosis. The overall 5-year survival rates are less than 10%. Early experiences with the external radiation therapy demonstrated a good palliation with occasional long-term survival. The present report describes our experience over the past decade with irradiation of primary carcinomas of the gallbladder and extrahepatic biliary duct. From Feb. 1984 to Nov. 1995, thirty-three patients with carcinoma of the GB and extrahepatic biliary duct were treated with external beam radiotherapy with curative intent at our institution. All patients were treated with 4-MV linear accelerator and radiation dose ranged from 31.44Gy to 54.87Gy(median 44.25Gy), and three patients received additional intraluminal brachytherapy(range, 25Gy to 30Gy). Twenty-seven patients received postoperative radiation. Among 27 patients, Sixteen patients underwent radical operation with curative aim and the rest of the patients either had bypass surgery or biopsy alone. In seventeen patients, adjuvant chemotherapy was used and eleven patients were treated with 5-FU, mitomycin and leucovorin. Median follow up period was 8.5 months(range 2-97 months). The overall 2-year and 5-year survival rates in all patients were 29.9% and 13.3% respectively. In patients with GB and extrahepatic biliary duct carcinomas, the 2-year survival rates were 34.5% and 27.8% respectively. Patients who underwent radical operation showed better 2-year survival rates than those who underwent palliative operation(43.8% vs. 20.7%), albeit statistically insignificant(p>0.05). The 2-year survival rates in Stage I and II were higher than in Stage III and IV with statistical significance(p0.05). The survival of patients with relatively lower stage and/or initial good performance was significantly superior to that of others. We found an statistically insignificant trend toward better survival in patients with radical

  14. Analysis of the Prognostic Factors for Patients with Malignant Biliary Obstruction after Interventional Therapy%介入治疗恶性梗阻性黄疸的预后因素分析

    Institute of Scientific and Technical Information of China (English)

    张军喜; 李发中; 柴健; 马颖辉; 董玮

    2014-01-01

    目的探讨经皮肝穿刺胆道引流术及胆管金属支架植入术治疗恶性梗阻性黄疸预后的影响因素。方法回顾性采集102例行经皮肝穿刺胆道引流术和胆道支架放置术患者的临床和病理资料,随访1年,Cox比例风险回归进行生存分析。结果①中位生存时间6.89依2.58月,6月和12月生存率分别是54.14%和27.81%;②单因素分析:并发症、梗阻段、瘤体体积、肿瘤分期、白细胞总数等是影响恶性梗阻性黄疸姑息术预后的主要因素(约0.05),性别、年龄、总胆红素、谷草转氨酶、谷丙转氨酶、碱性磷酸酶、γ-谷氨酸转肽酶、血红蛋白含量等因素与恶性梗阻性黄疸姑息术预后无关(跃0.05);③多因素分析:并发症(RR=1.874)、梗阻段(RR=2.140)、瘤体体积(RR=1.051)和白细胞总数(RR=1.023)肿瘤分期(RR=2.296)是影响预后的独立因素。结论并发症、梗阻段、瘤体体积和白细胞总数肿瘤分期是影响预后的独立因素。%Objective To explore the prognostic factors of malignant biliary obstruction patients after percutaneous transhepatic cholangial drainage (PTCD)or biliary metal stent implantation. Methods The clinical and pathological and 1 years of fol ow-up data for 102 patients with malignant biliary obstruction who underwent PTCD or biliary metal stent implantation were retrospectively col ected. The prognostic factors of malignant biliary obstruction patients after interventional therapy were analyzed by Cox proportional hazards regression model. Results 1.The median survival time was 6.89 ±2.58 months, and the 6mo and 12mo cumulative survival rates were 54.14% and 27.81%. 2. Univariate analysis showed that complication, obstruct, tumor size, tumor stage and the total number of white blood cells were the main prognosis factors in these patients ( 0.05). 3. Multivariate analysis showed that complication (RR=1.874), obstruct (RR=2.140), tumor size (RR=1.051), the total

  15. Muscle fatigue in women with primary biliary cirrhosis: Spectral analysis of surface electromyography

    Institute of Scientific and Technical Information of China (English)

    Maria Rosa Biagini; Alessandro Tozzi; Antonello Grippo; Andrea Galli; Stefano Milani; Aldo Amantini

    2006-01-01

    AIM: To evaluate the myoelectric manifestations of peripheral fatigability in patients with primary biliary cirrhosis in comparison to healthy subjects. METHODS: Sixteen women with primary biliary cirrhosis without comorbidity and 13 healthy women matched for age and body mass index (BMI) completed the self reported questionnaire fatigue impact scale. All subjects underwent surface electromyography assessment of peripheral fatigability. Anterior tibial muscle isometric voluntary contraction was executed for 20 s at 80% of maximal voluntary isometric contraction. During the exercise electromyographic signal series were recorded and root mean square (expression of central drive) as well as mean and median of electromyographic signal frequency spectrum (estimates of muscle fatigability) were computed. Each subject executed the trial two times. EMG parameters were normalized, then linear regression was applied and slopes were calculated. RESULTS: Seven patients were fatigued (median fatigue impact scale score: 38, range: 26-66) and 9 were not fatigued (median fatigue impact scale score: 7, range: 0-17). The maximal voluntary isometric contraction was similar in patients (82, 54-115 N) and controls (87,74-101 N), and in patients with high (81, 54-115 N) and low fatigue impact scale scores (86, 65-106 N). Root mean square as well as mean and median of frequency spectrum slopes were compared with the Mann-Whitney U test, and no significant difference was found between fatigued and non-fatigued patients and controls. CONCLUSION: No instrumental evidence of peripheral fatigability can be found in women with primary biliary cirrhosis but no comorbidity, suggesting that fatigue in such patients may be of central origin.

  16. 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)

  17. Data-driven urban drainage analysis: An alternative to hydrodynamic models?

    NARCIS (Netherlands)

    ten Veldhuis, J.A.E.; Tait, S.J.

    2011-01-01

    In the past, there has been an emphasis on the use of hydrodynamic models as a tool for urban drainage analysis. Limited availability of monitoring data and the perceived more limited resource requirements of models led to a preference for this approach. The last decade has seen a gradual developmen

  18. Nonlinear analysis of drainage systems to examine surface deformation: an example from Potwar Plateau (Northern Pakistan

    Directory of Open Access Journals (Sweden)

    F. Shahzad

    2010-03-01

    Full Text Available We devise a procedure in order to characterize the relative vulnerability of the Earth's surface to tectonic deformation using the geometrical characteristics of drainage systems. The present study focuses on the nonlinear analysis of drainage networks extracted from Digital Elevation Models in order to localize areas strongly influenced by tectonics. We test this approach on the Potwar Plateau in northern Pakistan. This area is regularly affected by damaging earthquakes. Conventional studies cannot pinpoint the zones at risk, as the whole region is characterized by a sparse and diffuse seismicity. Our approach is based on the fact that rivers tend to linearize under tectonic forcing. Thus, the low fractal dimensions of the Swan, Indus and Jehlum Rivers are attributed to neotectonic activity. A detailed textural analysis is carried out to investigate the linearization, heterogeneity and connectivity of the drainage patterns. These textural aspects are quantified using the fractal dimension, as well as lacunarity and succolarity analysis. These three methods are complimentary in nature, i.e. objects with similar fractal dimensions can be distinguished further with lacunarity and/or succolarity analysis. We generate maps of fractal dimensions, lacunarity and succolarity values using a sliding window of 2.5 arc minutes by 2.5 arc minutes (2.5'×2.5'. These maps are then interpreted in terms of land surface vulnerability to tectonics. This approach allowed us to localize several zones where the drainage system is highly structurally controlled on the Potwar Plateau. The region located between Muree and Muzaffarabad is found to be prone to destructive events whereas the area westward from the Indus seems relatively unaffected. We conclude that a nonlinear analysis of the drainage system is an efficient additional tool to locate areas likely to be affected by massive destructing events affecting the Earth's surface and therefore threaten human

  19. Comparison of plastic and self-expandable metal stents in the palliative treatment of malignant biliary obstruction:a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Kui Li; Zhongyin Zhou; Ximing Xu; Hesheng Luo

    2014-01-01

    Stent-placement-is-one-of-the-main-methods-in-the-pal-iative-treatment-of-malignant-biliary-obstruc-tion,-including-plastic-and-self-expandable-metal-stents.-The-comparison-of-stent-patency-between-self-expandable-metal-and-plastic-stents-in-pal-iation-of-malignant-biliary-obstruction-is-meaningful.-We-carried-out-a-meta-analysis-to-summarize-current-evidence-for-clinical-ef-icacy-of-self-expandable-metal-and-plastic-stents-in-the-treatment-of-malignant-biliary-obstruc-tion.-Methods:A-comprehensive-search-of-several-databases-including-CNKI,-Wanfang-Data,-Sino-MED.-A-fixed-ef-ects-or-random-ef-ects-model-was-used-to-pool-data-of-al-study-endpoint.-Sensitivity-analysis-was-also-performed.-Results:Eight-randomized-clinical-trials-were-identified,-including-633-patients.-These-results-suggested-that-the-self-expandable-metal-stents-were-associated-with-a-significantly-longer-stent-patency-(OR=8.15;95%CI:2.80-23.76;I2=85%).-No-publication-bias-was-observed.-Conclusion:Self-expanding-metal-stents-have-a-longer-patency-than-plastic-stents-and-of-er-adequate-pal-iation-in-patients-with-malignant-biliary-obstruction.

  20. Morphometry Governs the Dynamics of a Drainage Basin: Analysis and Implications

    Directory of Open Access Journals (Sweden)

    Atrayee Biswas

    2014-01-01

    Full Text Available Mountainous rivers are the most significant source of water supply in the Himalayan provinces of India. The drainage basin dynamics of these rivers are controlled by the tectonomorphic parameters, which include both surface and subsurface characteristics of a basin. To understand the drainage basin dynamics and their usefulness in watershed prioritisation and management in terms of soil erosion studies and groundwater potential assessment and flood hazard risk reduction in mountainous rivers, morphometric analysis of a Himalayan River (Supin River basin has been taken as a case study. The entire Supin River basin has been subdivided into 27 subwatersheds and 36 morphometric parameters have been calculated under four broad categories: drainage network, basin geometry, drainage texture, and relief characteristics, each of which is further grouped into five different clusters having similar morphometric properties. The various morphometric parameters have been correlated with each other to understand their underlying relationship and control over the basin hydrogeomorphology. The result thus generated provides adequate knowledge base required for decision making during strategic planning and delineation of prioritised hazard management zones in mountainous terrains.

  1. Subsurface old drainage detection and paleoenvironment analysis using spaceborne radar images in Alxa Plateau

    Institute of Scientific and Technical Information of China (English)

    郭华东; 刘浩; 王心源; 邵芸; 孙岩

    2000-01-01

    For geological and environmental research in an arid area, a unique advantage of radar remote sensing is that radar wave can penetrate a certain layer of dry sand (a few centimeters to meters thick) to reach the buried bedrock. The penetration capability is able to reveal the subsurface geological structure and old drainage paths. Based on the analysis of SIR-A, SIR-B, SIR-C, Radarsat ScanSAR, Landsat MSS and Landsat TM images acquired on different dates and the investigations made in several field trips in Alxa Plateau of Inner Mongolia, a number of old river valley and lake basins buried by wind-blown sand were recognized. Two parallel old drainage systems in the north and middle of the study area are delineated. The study suggests that the moving sand belts mainly follow the old drainage courses. This study also establishes a preliminary drainage evolution model for an area of about 300 000 km2 since the Tertiary, and finds that the Alxa Plateau was once an area with many rivers and lakes with a warm

  2. Subsurface old drainage detection and paleoenvironment analysis using spaceborne radar images in Alxa Plateau

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    For geological and environmental research in an arid area, a unique advantage of radar remote sensing is that radar wave can penetrate a certain layer of dry sand (a few centimeters to meters thick) to reach the buried bedrock. The penetration capability is able to reveal the subsurface geological structure and old drainage paths. Based on the analysis of SIR-A, SIR-B, SIR-C, Radarsat ScanSAR, Landsat MSS and Landsat TM images acquired on different dates and the investigations made in several field trips in Alxa Plateau of Inner Mongolia, a number of old river valley and lake basins buried by wind-blown sand were recognized. Two parallel old drainage systems in the north and middle of the study area are delineated. The study suggests that the moving sand belts mainly follow the old drainage courses. This study also establishes a preliminary drainage evolution model for an area of about 300 000 km2 since the Tertiary, and finds that the Alxa Plateau was once an area with many rivers and lakes with a warm and humid climate. The relief reversion caused by neotectonic movement since "Qinghai-Tibet movement" is also analyzed.

  3. Statewide analysis of the drainage-area ratio method for 34 streamflow percentile ranges in Texas

    Science.gov (United States)

    Asquith, William H.; Roussel, Meghan C.; Vrabel, Joseph

    2006-01-01

    The drainage-area ratio method commonly is used to estimate streamflow for sites where no streamflow data are available using data from one or more nearby streamflow-gaging stations. The method is intuitive and straightforward to implement and is in widespread use by analysts and managers of surface-water resources. The method equates the ratio of streamflow at two stream locations to the ratio of the respective drainage areas. In practice, unity often is assumed as the exponent on the drainage-area ratio, and unity also is assumed as a multiplicative bias correction. These two assumptions are evaluated in this investigation through statewide analysis of daily mean streamflow in Texas. The investigation was made by the U.S. Geological Survey in cooperation with the Texas Commission on Environmental Quality. More than 7.8 million values of daily mean streamflow for 712 U.S. Geological Survey streamflow-gaging stations in Texas were analyzed. To account for the influence of streamflow probability on the drainage-area ratio method, 34 percentile ranges were considered. The 34 ranges are the 4 quartiles (0-25, 25-50, 50-75, and 75-100 percent), the 5 intervals of the lower tail of the streamflow distribution (0-1, 1-2, 2-3, 3-4, and 4-5 percent), the 20 quintiles of the 4 quartiles (0-5, 5-10, 10-15, 15-20, 20-25, 25-30, 30-35, 35-40, 40-45, 45-50, 50-55, 55-60, 60-65, 65-70, 70-75, 75-80, 80-85, 85-90, 90-95, and 95-100 percent), and the 5 intervals of the upper tail of the streamflow distribution (95-96, 96-97, 97-98, 98-99 and 99-100 percent). For each of the 253,116 (712X711/2) unique pairings of stations and for each of the 34 percentile ranges, the concurrent daily mean streamflow values available for the two stations provided for station-pair application of the drainage-area ratio method. For each station pair, specific statistical summarization (median, mean, and standard deviation) of both the exponent and bias-correction components of the drainage-area ratio

  4. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline.

    Science.gov (United States)

    Dumonceau, J-M; Tringali, A; Blero, D; Devière, J; Laugiers, R; Heresbach, D; Costamagna, G

    2012-03-01

    This article is part of a combined publication that expresses the current view of the European Society of Gastrointestinal Endoscopy about endoscopic biliary stenting. The present Clinical Guideline describes short-term and long-term results of biliary stenting depending on indications and stent models; it makes recommendations on when, how, and with which stent to perform biliary drainage in most common clinical settings, including in patients with a potentially resectable malignant biliary obstruction and in those who require palliative drainage of common bile duct or hilar strictures. Treatment of benign conditions (strictures related to chronic pancreatitis, liver transplantation, or cholecystectomy, and leaks and failed biliary stone extraction) and management of complications (including stent revision) are also discussed. A two-page executive summary of evidence statements and recommendations is provided. A separate Technology Review describes the models of biliary stents available and the stenting techniques, including advanced techniques such as insertion of multiple plastic stents, drainage of hilar strictures, retrieval of migrated stents and combined stenting in malignant biliary and duodenal obstructions.The target readership for the Clinical Guideline mostly includes digestive endoscopists, gastroenterologists, oncologists, radiologists, internists, and surgeons while the Technology Review should be most useful to endoscopists who perform biliary drainage.

  5. Percutaneous placement of biliary stent for treatment of malignant obstructive jaundice

    International Nuclear Information System (INIS)

    Objective: To introduce the techniques of percutaneous biliary stenting and intraarterial embolization for treatment in patients with hepatocellular carcinoma and biliary obstruction accompanying the evaluation of the therapeutic effect. Methods: Percutaneous biliary metallic stent placement and intraarterial embolization were performed in 12 patients with hepatocellular carcinoma and obstructive jaundice, with mean age of 52.3 years old. Results: Fourteen stents and 3 external biliary drainage catheters were placed in 12 patients. One stent for each was inserted in 7 patients with communication between right and left hepatic ducts; right and left biliary drainages were separately performed with stents or external biliary drainage catheters in 5 with no communication. The serum total bilirubin decreased from 405.3 ± 175.4 μmol/L before the procedure to 188.3 ± 101.5 μmol/L one week after the procedure (P<0.01), and both alkaline phosphatase and transaminase decreased significantly (P<0.05). Percutaneous transarterial chemoembolization for treatment of hepatocellular carcinoma was done one to four time with average of 2.1 times after biliary drainage. There were no severe complications related to the interventional procedure. All patients were followed up with an average of 9.5 months, including 5 patients alive. Conclusions: The percutaneous biliary stenting and intraarterial embolization are safe and effective palliative therapies in patients with hepatocellular carcinoma and obstructive jaundice. It can alleviate jaundice and improve the liver function with longer survival rate

  6. Biliary strictures and recurrence after liver transplantation for primary sclerosing cholangitis: A retrospective multicenter analysis.

    Science.gov (United States)

    Hildebrand, Tatiana; Pannicke, Nadine; Dechene, Alexander; Gotthardt, Daniel N; Kirchner, Gabriele; Reiter, Florian P; Sterneck, Martina; Herzer, Kerstin; Lenzen, Henrike; Rupp, Christian; Barg-Hock, Hannelore; de Leuw, Philipp; Teufel, Andreas; Zimmer, Vincent; Lammert, Frank; Sarrazin, Christoph; Spengler, Ulrich; Rust, Christian; Manns, Michael P; Strassburg, Christian P; Schramm, Christoph; Weismüller, Tobias J

    2016-01-01

    Liver transplantation (LT) is the only definitive treatment for patients with end-stage liver disease due to primary sclerosing cholangitis (PSC), but a high rate of biliary strictures (BSs) and of recurrent primary sclerosing cholangitis (recPSC) has been reported. In this multicenter study, we analyzed a large patient cohort with a long follow-up in order to evaluate the incidence of BS and recPSC, to assess the impact on survival after LT, and to identify risk factors. We collected clinical, surgical, and laboratory data and records on inflammatory bowel disease (IBD), immunosuppression, recipient and graft outcome, and biliary complications (based on cholangiography and histology) of all patients who underwent LT for PSC in 10 German transplant centers between January 1990 and December 2006; 335 patients (68.4% men; mean age, 38.9 years; 73.5% with IBD) underwent transplantation 8.8 years after PSC diagnosis with follow-up for 98.8 months. The 1-, 5-, and 10-year recipient and graft survival was 90.7%, 84.8%, 79.4% and 79.1%, 69.0%, 62.4%, respectively. BS was diagnosed in 36.1% after a mean time of 3.9 years, and recPSC was diagnosed in 20.3% after 4.6 years. Both entities had a significant impact on longterm graft and recipient survival. Independent risk factors for BS were donor age, ulcerative colitis, chronic ductopenic rejection, bilirubin, and international normalized ratio (INR) at LT. Independent risk factors for recPSC were donor age, IBD, and INR at LT. These variables were able to categorize patients into risk groups for BS and recPSC. In conclusion, BS and recPSC affect longterm graft and patient survival after LT for PSC. Donor age, IBD, and INR at LT are independent risk factors for BS and recPSC and allow for risk estimation depending on the recipient-donor constellation.

  7. 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)

  8. Data-driven urban drainage analysis: An alternative to hydrodynamic models?

    OpenAIRE

    Ten Veldhuis, J.A.E.; Tait, S.J.

    2011-01-01

    In the past, there has been an emphasis on the use of hydrodynamic models as a tool for urban drainage analysis. Limited availability of monitoring data and the perceived more limited resource requirements of models led to a preference for this approach. The last decade has seen a gradual development of water quantity and quality monitoring systems through the development of reliable and increasingly cost-efficient water level sensors, continuous water quality sensors and data communication a...

  9. The role of sonography in imaging of the biliary tract.

    Science.gov (United States)

    Foley, W Dennis; Quiroz, Francisco A

    2007-06-01

    Sonography is the recommended initial imaging test in the evaluation of patients presenting with right upper quadrant pain or jaundice. Dependent upon clinical circumstances, the differential diagnosis includes choledocholithiasis, biliary stricture, or tumor. Sonography is very sensitive in detection of mechanical biliary obstruction and stone disease, although less sensitive for detection of obstructing tumors, including pancreatic carcinoma and cholangiocarcinoma. In patients with sonographically documented cholelithiasis and choledocholithiasis, laparoscopic cholecystectomy with operative clearance of the biliary stone disease is usually performed. In patients with clinically suspected biliary stone disease, without initial sonographic documentation of choledocholithiasis, endoscopic ultrasound or magnetic resonance cholangiopancreatography is the next logical imaging step. Endoscopic ultrasound documentation of choledocholithiasis in a postcholecystectomy patient should lead to retrograde cholangiography, sphincterotomy, and clearance of the ductal calculi by endoscopic catheter techniques. In patients with clinical and sonographic findings suggestive of malignant biliary obstruction, a multipass contrast-enhanced computed tomography (CT) examination to detect and stage possible pancreatic carcinoma, cholangiocarcinoma, or periductal neoplasm is usually recommended. Assessment of tumor resectability and staging can be performed by CT or a combination of CT and endoscopic ultrasound, the latter often combined with fine needle aspiration biopsy of suspected periductal tumor. In patients whose CT scan suggests hepatic hilar or central intrahepatic biliary tumor, percutaneous cholangiography and transhepatic biliary stent placement is usually followed by brushing or fluoroscopically directed fine needle aspiration biopsy for tissue diagnosis. Sonography is the imaging procedure of choice for biliary tract intervention, including cholecystostomy, guidance for

  10. Technical Analysis of In-Valley Drainage Management Strategies for the Western San Joaquin Valley, California

    Science.gov (United States)

    Presser, Theresa S.; Schwarzbach, Steven E.

    2008-01-01

    The western San Joaquin Valley is one of the most productive farming areas in the United States, but salt-buildup in soils and shallow groundwater aquifers threatens this area?s productivity. Elevated selenium concentrations in soils and groundwater complicate drainage management and salt disposal. In this document, we evaluate constraints on drainage management and implications of various approaches to management considered in: *the San Luis Drainage Feature Re-Evaluation (SLDFRE) Environmental Impact Statement (EIS) (about 5,000 pages of documentation, including supporting technical reports and appendices); *recent conceptual plans put forward by the San Luis Unit (SLU) contractors (i.e., the SLU Plans) (about 6 pages of documentation); *approaches recommended by the San Joaquin Valley Drainage Program (SJVDP) (1990a); and *other U.S. Geological Survey (USGS) models and analysis relevant to the western San Joaquin Valley. The alternatives developed in the SLDFRE EIS and other recently proposed drainage plans (refer to appendix A for details) differ from the strategies proposed by the San Joaquin Valley Drainage Program (1990a). The Bureau of Reclamation (USBR) in March 2007 signed a record of decision for an in-valley disposal option that would retire 194,000 acres of land, build 1,900 acres of evaporation ponds, and develop a treatment system to remove salt and selenium from drainwater. The recently proposed SLU Plans emphasize pumping drainage to the surface, storing approximately 33% in agricultural water re-use areas, treating selenium through biotechnology, enhancing the evaporation of water to concentrate salt, and identifying ultimate storage facilities for the remaining approximately 67% of waste selenium and salt. The treatment sequence of reuse, reverse osmosis, selenium bio-treatment, and enhanced solar evaporation is unprecedented and untested at the scale needed to meet plan requirements. All drainage management strategies that have been proposed

  11. 经皮经肝胆道引流治疗转移性胃癌并发阻塞性黄疸的疗效与并发症%Percutaneous transhepatic biliary drainage for obstructive jaundice caused by metastatic gastric cancer:efficacy and complications

    Institute of Scientific and Technical Information of China (English)

    Wenchang Yu; Kongzhi Zhang; Shiguang Chen; Mingzhi Hao

    2011-01-01

    Objective:The aim of our study was to evaluate the efficacy and incidence of complications of percutaneous transhepatic biliary drainage (PTBD) as palliative treatment of obstructive jaundice caused by metastatic gastric cancer.Methods:Hospital records were reviewed for 32 consecutive patients with biliary obstruction caused by metastatic gastric cancer who underwent PTBD at our institution between October 2004 and April 2010.Patients (23 males and 9 females) age ranged from 35 to 72 years.The indexes of hepatic function before PTBD and within one month after PTBD were compared.The incidence of complications and corresponding treatments were also documented.Results:The level of obstruction was defined as the distal bile duct (beyond the level of the liver hilum) in 22 patients (group 1) and the liver hilum in 10 patients (group 2).Successful decompression of the biliary system after PTBD was defined by a total bilirubin decrease of more than 30% of the baseline value.Success rates were 100% (22/22) for group 1,70% (7/10) for group 2,and 90.6% (29/32) for all patients.Differences in success rates between group 1 and group 2 were significant (P = 0.024).Serum TBIL,ALT,and AST significantly decreased from (292.8 ± 179.9) μmol/L,(174.5 ± 107.4) IU/L,(159.9 ± 103.9) IU/L before PTBD to (111.5 ± 92.5) μmol/L,(58.5 ± 46.3) IU/L,(59.6 ± 48.9) IU/L,respectively within one month after PTBD (P < 0.05).Complications associated with PTBD included cholangitis in 13 patients (40.5%),drainage tube displacement in 6 patients (18.8%),hemobilia in 4 patients (12.5%),tube occlusion in 2 patients (6.3%),and pancreatitis in 1 patient (3.1%).All complications were successfully treated with appropriate measures.Conclusion:Hepatic function can be improved by PTBD without serious complications in patients with obstructive jaundice caused by metastatic gastric cancer.

  12. 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...

  13. Adaption to Extreme Rainfall with Open Urban Drainage System: An Integrated Hydrological Cost-Benefit Analysis

    DEFF Research Database (Denmark)

    Zhou, Qianqian; Panduro, Toke Emil; Thorsen, Bo Jellesmark;

    2013-01-01

    amenity effects, an integration of open drainage basins in urban recreational areas is likely the best adaptation strategy, followed by pipe enlargement and local infiltration strategies. All three were improvements compared to the fourth strategy of no measures taken....... with extreme rainfalls is evaluated using a quantitative flood risk approach based on urban inundation modeling and socio-economic analysis of corresponding costs and benefits. A hedonic valuation model is applied to capture the local economic gains or losses from more water bodies in green areas....... The framework was applied to the northern part of the city of Aarhus, Denmark. We investigated four adaptation strategies that encompassed laissez-faire, larger sewer pipes, local infiltration units, and open drainage system in the urban green structure. We found that when taking into account environmental...

  14. VALUE CHAIN ANALYSIS FOR LIVESTOCK FEED PRODUCTION USING SALINE IRRIGATION DRAINAGE WATER IN TURKMENISTAN

    Directory of Open Access Journals (Sweden)

    Stanley JOHNSON

    2013-01-01

    Full Text Available Irrigation return flows increase the salt concentrations of receiving water bodies and cause water logging which affect agricultural productivity in Turkmenistan. Flooding irrigation drainage water using on natural pastures has also had adverse effects on the long-term productivity of desert ranges. This study examines the economics of halophytes as feed for sheep using saline irrigation water from drainage collector systems on a representative farm. Cost-benefit and rate of return analyses show that the project is economically feasible for reused water with 1400 mg/l mineralization levels or less. At higher mineral concentrations in water, or in more saline soils, bioremediation through halophyte fodder production can be profitably implemented if new market incentives exist. Value chain analysis is applied to evaluate alternative incentive systems for sheep operations based on saline water irrigated halophyte fodder production.

  15. Dissemination of regional rainfall analysis in design and analysis of urban drainage at un-gauged locations

    DEFF Research Database (Denmark)

    Arnbjerg-Nielsen, K.; Harremoes, Poul; Mikkelsen, Peter Steen

    2002-01-01

    A research program in Denmark on statistical modelling of rainfall has resulted in a model for regional distribution of rainfall extremes. The results show that extreme rainfalls critical to the hydraulic function of urban drainage systems and the pollution discharge are subject to a significant...... regional variation of extreme rainfalls throughout the country. This has implications for design and analysis of all practical problems related to urban drainage, since the rainfall data so far recommended as input to engineering analyses underestimates the problems. Consequently, the Danish Water...

  16. Technical Tips and Issues of Biliary Stenting, Focusing on Malignant Hilar Obstruction

    OpenAIRE

    Lee, Tae Hoon

    2013-01-01

    Although there is no survival advantage, inoperable hilar cholangiocarcinoma managed by palliative drainage may benefit from symptomatic improvement. In general, biliary drainage is divided into endoscopic or percutaneous approaches and surgical drainage. Plastic or metal stent is the most preferred device for palliative drainage in endoscopic approach. Considering cost-effectiveness, use of metallic stent is preferred than plastic stents in patients with more than 3 months of life expectancy...

  17. Covered versus Uncovered Self-Expandable Metal Stents for Managing Malignant Distal Biliary Obstruction: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Jinjin Li

    Full Text Available To compare the efficacy of using covered self-expandable metal stents (CSEMSs and uncovered self-expandable metal stents (UCSEMSs to treat objective jaundice caused by an unresectable malignant tumor.We performed a comprehensive electronic search from 1980 to May 2015. All randomized controlled trials comparing the use of CSEMSs and UCSEMSs to treat malignant distal biliary obstruction were included.The analysis included 1417 patients enrolled in 14 trials. We did not detect significant differences between the UCSEMS group and the CSEMS group in terms of cumulative stent patency (hazard ratio (HR 0.93, 95% confidence interval (CI 0.19-4.53; p = 0.93, I2 = 0%, patient survival (HR 0.77, 95% CI 0.05-10.87; p = 0.85, I2 = 0%, overall stent dysfunction (relative ratio (RR 0.85, M-H, random, 95% CI 0.57-1.25; p = 0.83, I2 = 63%, the overall complication rate (RR 1.26, M-H, fixed, 95% CI 0.94-1.68; p = 0.12, I2 = 0% or the change in serum bilirubin (weighted mean difference (WMD -0.13, IV fixed, 95% CI 0.56-0.3; p = 0.55, I2 = 0%. However, we did detect a significant difference in the main causes of stent dysfunction between the two groups. In particular, the CSEMS group exhibited a lower rate of tumor ingrowth (RR 0.25, M-H, random, 95% CI 0.12-0.52; p = 0.002, I2 = 40% but a higher rate of tumor overgrowth (RR 1.76, M-H, fixed, 95% CI 1.03-3.02; p = 0.04, I2 = 0%. Patients with CSEMSs also exhibited a higher migration rate (RR 9.33, M-H, fixed, 95% CI 2.54-34.24; p = 0.008, I2 = 0% and a higher rate of sludge formation (RR 2.47, M-H, fixed, 95% CI 1.36-4.50; p = 0.003, I2 = 0%.Our meta-analysis indicates that there is no significant difference in primary stent patency and stent dysfunction between CSEMSs and UCSEMSs during the period from primary stent insertion to primary stent dysfunction or patient death. However, when taking further management for occluded stents into consideration, CSEMSs is a better choice for patients with malignant biliary

  18. 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)

  19. 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

  20. 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.

  1. 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.

  2. A meta-analysis of the biliary complications in adult living donor liver transplantation to compare duct-to-duct hepaticocholedochostomy with Roux-en-Y hepaticojejunostomy biliary reconstruction%成人活体肝移植R-Y吻合术与D-D吻合术对术后胆道并发症影响的Meta分析

    Institute of Scientific and Technical Information of China (English)

    张崇; 张佳林; 张成硕; 孙宁; 李鑫

    2015-01-01

    Objective To compare the incidences of biliary complication after adult living donor liver transplantation (ALDLT) using Roux-en-Y hepaticojejunostomy (R-Y HJ) with duct-to-duct hepaticocholedochostomy (D-D HC).Methods A meta-analysis was conducted by searching the Medline-PubMed,EMBASE,Scielo-LILACS,and Cochrane Databases.A comparison using 95% confidence intervals was performed on different biliary reconstruction techniques in liver transplantation with regard to occurrence of biliary complications.Results According to our predetermined inclusion and exclusion criteria,seven clinical studies were selected to compare D-D HC with R-Y HJ.The overall biliary comphcation rates,biliary stricture rates and biliary leakage rates were compared.The overall biliary complication rate and the biliary stricture rate of R-Y HJ were significantly less than D-D HC,but the biliary leakage rate of R-Y HJ was similar with the D-D HC (overall biliary complication rate P < 0.05,OR =0.35,95% CI:0.15 ~ 0.81,I2 =28% ; biliary stricture rate P < 0.05,OR =0.43,95% CI:0.29 ~ 0.65,I2 =49% ; biliary leakage rate P=0.05,OR=1.62,95% CI:1.01 ~2.60,I2 =19%).Conclusions The meta-analysis showed that biliary reconstruction in ALDLT should be performed using R-Y HJ.%目的 比较胆管空肠R-Y吻合术(Roux-en-Y hepaticojejunostomy,R-Y HJ)与胆管端端吻合术(duct-to-duct hepaticocholedochostomy,D-D HC)在成人活体肝移植中的并发症发生率.方法 检索Medline-PubMed、EMBASE、Scielo-LILACS数据库相关文献,使用Cochrane Databases进行数据处理,计算其在95%可信区间时的并发症例数.结果 依据纳入标准和排除标准,共筛选出7篇文献,均为有关成人活体肝移植R-Y HJ与D-D HC术后胆道并发症的临床研究.对两种方法总体并发症率、胆道狭窄率和胆汁漏率三项指标进行分析比较,显示总体并发症率和胆道狭窄率,R-Y HJ组均低于D-D HC组的治疗模式.胆漏发生率R-Y HJ

  3. WATER DRAINAGE MODEL

    Energy Technology Data Exchange (ETDEWEB)

    J.B. Case

    2000-05-30

    The drainage of water from the emplacement drift is essential for the performance of the EBS. The unsaturated flow properties of the surrounding rock matrix and fractures determine how well the water will be naturally drained. To enhance natural drainage, it may be necessary to introduce engineered drainage features (e.g. drilled holes in the drifts), that will ensure communication of the flow into the fracture system. The purpose of the Water Drainage Model is to quantify and evaluate the capability of the drift to remove water naturally, using the selected conceptual repository design as a basis (CRWMS M&O, 1999d). The analysis will provide input to the Water Distribution and Removal Model of the EBS. The model is intended to be used to provide postclosure analysis of temperatures and drainage from the EBS. It has been determined that drainage from the EBS is a factor important to the postclosure safety case.

  4. 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.

  5. [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

  6. Contrast-free endoscopic stent insertion in malignant biliary obstruction

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To present a case series of MRCP-guided endoscopic biliary stent placement, performed entirely without contrast injection.METHODS: Contrast-free endoscopic biliary drainage was attempted in 20 patients with malignant obstruction,unsuitable for resection on the basis of tumor extent or medical illness. MRCP images were used to confirm the diagnosis of tumor, to exclude other biliary diseases and to demonstrate the stenoses as well as dilation of proximal liver segments. The procedure was carried out under conscious sedation. Patients were placed in the left lateral decubitus position. The endoscope was inserted, the papilla identified and cannulated by a papillotome. A guide wire was inserted and guided deeply into the biliary tree, above the stenosis, by fluoroscopy. A papillotomy approximately 1 cm. long was performed and the papillotome was exchanged with a guiding-catheter. A 10 Fr, Amsterdam-type plastic stent,7 to 15 cm long, was finally inserted over the guide wire/guiding catheter by a pusher tube system.RESULTS: Successful stent insertion was achieved in all patients. There were no major complications. Successful drainage, with substantial reduction in bilirubin levels,was achieved in all patients.CONCLUSION: This new method of contrast-free endoscopic stenting in malignant biliary obstruction is a safe and effective method of palliation. However, a larger, randomized study comparing this new approach with the standard procedure is needed to confirm the findings of the present study.

  7. Subglottic Secretion Drainage for Preventing Venti-lator Associated Pneumonia: A Meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Rong Wang; Xiang Zhen; Bao-Yi Yang; Xue-Zhen Guo; Xue Zeng; Chun-Yan Deng

    2015-01-01

    Objective: Ventilator associated pneumonia ( VAP) has been shown to be associated with signifi-cant morbidity and mortality( Chastre and Fagon, 2002;klompas, 2007) among mechanically venti-lated patients in the intensive care unit ( ICU ) , with the incidence ranging from 9% to 27%;crude mortality ranges from 25% to 50%. 1-3 A meta-analysis of published studies was undertaken to combine information regarding the effect of subglottic secretion drainage ( SSD ) on the inci-dence of ventilated associated pneumonia in adult ICU patients. Methods: Reports of studies on SSD were identified by searching the PUBMED, EMBASE, and COCHRANCE LIBRARY databases ( December 30, 2010) . Randomized trials of SSD compared to usual care in adult mechanically ventilated ICU patients were included in this meta-analysis. Results: Ten RCTs with 2, 314 patients were identified. SSD significantly reduced the incidence of VAP [ relative risk ( RR)=0. 52, 95% confidence interval ( CI): 0. 42-0. 64, P<0. 000 01] . When SSD was compared with the control groups, the overall RR for ICU mortality was 1. 00 ( 95% CI, 0. 84-1. 19) and for hospital mortality was 0. 95 ( 95% CI, 0. 80-1. 13) . Overall, the subglottic drainage effect on the days of mechanical ventilation was -1. 52 days ( 95% CI, -2. 94 to -0. 11) and on the ICU length of stay ( LOS) was -0. 81days ( 95% CI, -2. 33 to -0. 7) . Conclusions: In this meta-analysis, when an endotracheal tube ( ETT) with SSD was compared with an ETT without SSD, there was a highly significant reduction in the VAP rate of approxi-mately 50%. Time on mechanical ventilation ( MV) and the ICU LOS may be reduced, but no re-duction in ICU or hospital mortality has been observed in published trials.

  8. 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

  9. Lie Symmetry Analysis and Conservation Laws of a Generalized Time Fractional Foam Drainage Equation

    Science.gov (United States)

    Wang, Li; Tian, Shou-Fu; Zhao, Zhen-Tao; Song, Xiao-Qiu

    2016-07-01

    In this paper, a generalized time fractional nonlinear foam drainage equation is investigated by means of the Lie group analysis method. Based on the Riemann—Liouville derivative, the Lie point symmetries and symmetry reductions of the equation are derived, respectively. Furthermore, conservation laws with two kinds of independent variables of the equation are performed by making use of the nonlinear self-adjointness method. Supported by the National Training Programs of Innovation and Entrepreneurship for Undergraduates under Grant No. 201410290039, the Fundamental Research Funds for the Central Universities under Grant Nos. 2015QNA53 and 2015XKQY14, the Fundamental Research Funds for Postdoctoral at the Key Laboratory of Gas and Fire Control for Coal Mines, the General Financial Grant from the China Postdoctoral Science Foundation under Grant No. 2015M570498, and Natural Sciences Foundation of China under Grant No. 11301527

  10. 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

  11. Drainage-basis-scale geomorphic analysis to determine refernce conditions for ecologic restoration-Kissimmee River, Florida

    Science.gov (United States)

    Warne, A.G.; Toth, L.A.; White, W.A.

    2000-01-01

    Major controls on the retention, distribution, and discharge of surface water in the historic (precanal) Kissimmee drainage basin and river were investigated to determine reference conditions for ecosystem restoration. Precanal Kissimmee drainage-basin hydrology was largely controlled by landforms derived from relict, coastal ridge, lagoon, and shallow-shelf features; widespread carbonate solution depressions; and a poorly developed fluvial drainage network. Prior to channelization for flood control, the Kissimmee River was a very low gradient, moderately meandering river that flowed from Lake Kissimmee to Lake Okeechobee through the lower drainage basin. We infer that during normal wet seasons, river discharge rapidly exceeded Lake Okeechobee outflow capacity, and excess surface water backed up into the low-gradient Kissimmee River. This backwater effect induced bankfull and peak discharge early in the flood cycle and transformed the flood plain into a shallow aquatic system with both lacustrine and riverine characteristics. The large volumes of surface water retained in the lakes and wetlands of the upper basin maintained overbank flow conditions for several months after peak discharge. Analysis indicates that most of the geomorphic work on the channel and flood plain occurred during the frequently recurring extended periods of overbank discharge and that discharge volume may have been significant in determining channel dimensions. Comparison of hydrogeomorphic relationships with other river systems identified links between geomorphology and hydrology of the precanal Kissimmee River. However, drainage-basin and hydraulic geometry models derived solely from general populations of river systems may produce spurious reference conditions for restoration design criteria.

  12. Risk factors of severe ischemic biliary complications after liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Ming-FengWang; Zhong-Kui Jin; Da-Zhi Chen; Xian-Liang Li; Xin Zhao; Hua Fan

    2011-01-01

    BACKGROUND: Ischemia-related biliary tract complications remain high after orthotopic liver transplantation. Severe ischemic biliary complications often involve the hepatic duct bifurcation and left hepatic duct, resulting finally in obstructive jaundice. Prevention and management of such complications remain a challenge for transplant surgeons. METHODS: All 160 patients were followed up for at least 180 days after transplantation. One-way analysis of variance (ANOVA) and comparative univariate analysis were made using 3 groups (no complications; mild complications;severe complications), to analyze risk factors associated with biliary complications. Multiple logistic regression and linear regression analysis were used to analyze independent risk factors for severe ischemic biliary complications, after excluding other confounding factors. RESULTS: By ANOVA and comparative univariate analysis, the risk factors associated with biliary complications were preoperative bilirubin level (P=0.007) and T-tube stenting of the anastomosis (P=0.016). Multiple logistic regression analysis showed that the use of T-tube and preoperative serum bilirubin were not independent risk factors for severe ischemic biliary complications after orthotopic liver transplantation. Chi-square analysis indicated that in the incidence of severe ischemic biliary lesions, bile duct second warm ischemic time longer than 60 minutes was a significant risk factor. Linear regression demonstrated a negative correlation between cold preservation time and warm ischemia time. CONCLUSIONS: Preoperative serum bilirubin level and the use of T-tube stenting of the anastomosis were independent risk factors for biliary complications after liver transplantation, but not for severe ischemic biliary complications. The second warm ischemia time of bile duct longer than 60 minutes and prolonged bile duct second warm ischemia time combined with cold preservation time were significant risk factors for severe

  13. Network meta-analysis of randomized controlled trials: efficacy and safety of UDCA-based therapies in primary biliary cirrhosis.

    Science.gov (United States)

    Zhu, Gui-Qi; Shi, Ke-Qing; Huang, Sha; Huang, Gui-Qian; Lin, Yi-Qian; Zhou, Zhi-Rui; Braddock, Martin; Chen, Yong-Ping; Zheng, Ming-Hua

    2015-03-01

    Major ursodeoxycholic acid (UDCA)-based therapies for primary biliary cirrhosis (PBC) include UDCA only, or combined with either methotrexate (MTX), corticosteroids (COT), colchicine (COC), or bezafibrate (BEF). As the optimum treatment regimen is unclear and warrants exploration, we aimed to compare these therapies in terms of patient mortality or liver transplantation (MOLT) and adverse events (AE).PubMed, the Cochrane Library, and Scopus were searched for randomized controlled trials up to August 31, 2014. We estimated the hazard ratios (HRs) for MOLT and odds ratios (ORs) for AE. A sensitivity analysis based on the dose of UDCA was also executed.Thirty-one eligible articles were included. Compared with COT plus UDCA, UDCA (HR 0.38, 95% confidence interval [CI] 0.09-1.39), BEF plus UDCA (HR 0.29, 95% CI 0.02-4.83), COC plus UDCA (HR 0.39, 95% CI 0.07-2.25), MTX plus UDCA (HR 0.28, 95% CI 0.05-1.63), or OBS (HR 0.49, 95% CI 0.11-2.01) all provided an increased risk of MOLT. With respect to drug AE profile, although not differing appreciably, BEF plus UDCA was associated with more AEs compared with UDCA (OR 3.16, 95% CI 0.59-20.67), COT plus UDCA (OR 2.27, 95% CI 0.15-33.36), COC plus UDCA (OR 1.00, 95% CI 0.09-12.16), MTX plus UDCA (OR 2.03, 95% CI 0.23-17.82), or OBS (OR 3.00, 95% CI 0.53-20.75). The results of sensitivity analyses were highly consistent with previous analyses.COT plus UDCA was the optimal UDCA-based regimen for both MOLT and AEs. BEF plus UDCA was most likely to cause AEs, whereas monotherapy with UDCA and coadministriation of COT plus UDCA appeared to be associated with the fewest AEs for PBC treatment. PMID:25789951

  14. 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...

  15. 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....

  16. Treatment of anastomotic stricture after biliary-intestinal anastomosis with percuta-neous transhepatic cholangial drainage and balloon dilatation%经皮经肝球囊扩张治疗胆肠吻合术后吻合口狭窄

    Institute of Scientific and Technical Information of China (English)

    贾宝雷; 梁峰; 李虎城

    2015-01-01

    目的:探讨经皮经肝胆管穿刺引流术( PTCD)联合球囊扩张术治疗胆肠吻合术后吻合口狭窄的可行性及疗效。方法回顾性分析军事医学科学院附属医院普外科2009年3月至2011年12月采用PTCD联合球囊扩张术治疗胆肠吻合术后吻合口狭窄23例的疗效,评估胆道通畅程度、黄疸指数及肝功能。结果本组行PTCD联合球囊扩张术23例,19例治疗效果明显,1例植入金属支架。术后胆肠吻合口狭窄、黄疸指数及肝功能均明显改善,无严重并发症发生。结论 PTCD联合球囊扩张术治疗胆肠吻合术后吻合口狭窄疗效好,并发症发生率低,是较为安全可行的微创治疗措施。%Objective To evaluate the effect and feasibility of balloon dilatation for treatment of anastomotic stricture after biliary-intestinal anastomosis with percutaneous transhepatic cholangial drainage( PTCD) .Methods A total of 23 pa-tients with anastomotic stricture after biliary-intestinal anastomosis who had undergone PTCD+balloon dilatation were ana-lyzed retrospectively between Mar 2009 to Dec 2011.The patency of bile duct, jaundice index and liver function were recor-ded.Results PTCD+balloon dilatation was completed successfully in all cases, and a metallic stent was implanted in one case.Anastomotic stricture, postoperative jaundice index and liver function were improved significantly after operation.No serious complications occurred.Conclusion PTCD+balloon dilatation has good curative effect on anastomotic stricture. The complication rate is low.It is a safe, feasible and effective minimally invasive treatment.

  17. Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage-related bacterial meningitis

    NARCIS (Netherlands)

    Schade, RP; Schinkel, J; Roelandse, FWC; Geskus, RB; Visser, L.G.; van Dijk, J.M.C.; Voormolen, JHC; van Pelt, H; Kuijper, EJ

    2006-01-01

    Object. Routine microbiological and chemical analysis of cerebrospinal fluid (CSF) is often performed to diagnose external drainage-related bacterial meningitis (ED-BM) at an early stage. A cohort study was performed to investigate the value of several commonly used CSF parameters For the prediction

  18. Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage-related bacterial meningitis.

    NARCIS (Netherlands)

    Schade, R.P.; Schinkel, J.; Roelandse, F.W.; Geskus, R.B.; Visser, L.G.; Dijk, M.C.R.F. van; Voormolen, J.H.; Pelt, H. van; Kuijper, E.J.

    2006-01-01

    OBJECT: Routine microbiological and chemical analysis of cerebrospinal fluid (CSF) is often performed to diagnose external drainage-related bacterial meningitis (ED-BM) at an early stage. A cohort study was performed to investigate the value of several commonly used CSF parameters for the prediction

  19. Surface Water & Surface Drainage

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This data set contains boundaries for all surface water and surface drainage for the state of New Mexico. It is in a vector digital data structure digitized from a...

  20. 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)

  1. Removal of an embedded "covered" biliary stent by the "stent-in-stent" technique

    OpenAIRE

    Menon, Shyam

    2013-01-01

    A 46-year-old man was admitted with obstructive jaundice and cross-sectional imaging with computed tomography suggested distal biliary obstruction. A distal common bile duct stricture was found at endoscopic retrograde cholangiopancreatography (ERCP) and cytology was benign. A 6 cm fully covered self-expanding metal stent (SEMS) was inserted across the stricture to optimize biliary drainage. However, the SEMS could not be removed at repeat ERCP a few months later. A further fully covered SEMS...

  2. Covered Self-Expanding Transhepatic Biliary Stents:Clinical Pilot Study

    International Nuclear Information System (INIS)

    Purpose: We report our preliminary results with a new type of self-expanding covered stent for treatment of malignant biliary obstruction. Methods: Wallstents, fully covered with high elasticity polyurethane, with an unconstrained diameter of 10 mm and a total length of 69 mm, were placed transhepatically under fluoroscopic guidance in five patients. The length of the biliary obstruction varied between 30-50 mm. At 1 and 3 months (82-98 days) clinical assessment, serum bilirubin measurement, and ultrasound examination of the biliary tree were performed. Results: Initial uncomplicated deployment of the stents and internal drainage was possible in all patients. Distal stent migration resulted in early biliary reobstruction in one patient. At 3-month follow-up, partial reobstruction, most probably due to sludge formation, was found in another patient. Conclusion: Our initial results indicate that the covered, self-expanding Wallstent endoprosthesis can be reliably and safely deployed transhepatically for malignant biliary obstruction

  3. Endoscopic treatment of malignant biliary strictures.

    Science.gov (United States)

    Rustagi, Tarun; Jamidar, Priya A

    2015-01-01

    Endoscopic stenting is a widely accepted strategy for providing effective drainage in both extrahepatic and intrahepatic malignant strictures. In patients with extrahepatic malignancies, uncovered self-expanding metal stents (SEMS) provide excellent palliation. Hilar malignancies are probably best palliated by placement of uncovered SEMS although some disagreement exists among experts regarding the type and number of stents for optimal palliation. Preoperative biliary drainage (PBD) is commonly performed although a higher risk of complications and the lack of clear benefit raise questions about this practice. Certain groups of patients such as those with markedly elevated bilirubin levels, and in those in whom neoadjuvant therapy is planned, are good candidates for PBD. Considerable controversy exists regarding the optimal method as well as type of stent for PBD in patients with hilar malignancies. Novel endoscopic therapies, including photodynamic therapy and radiofrequency ablation, have emerged as potential adjuvant therapies in the management of malignant bile duct strictures but need further long-term evaluation to establish survival benefit. This review focuses on the current status of endoscopic therapies for malignant biliary obstructions.

  4. 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

  5. Phylogeographic Analysis of Blastomyces dermatitidis and Blastomyces gilchristii Reveals an Association with North American Freshwater Drainage Basins

    Science.gov (United States)

    McTaggart, Lisa R.; Brown, Elizabeth M.; Richardson, Susan E.

    2016-01-01

    Blastomyces dermatitidis and Blastomyces gilchristii are dimorphic fungal pathogens that cause serious pulmonary and systemic infections in humans. Although their natural habitat is in the environment, little is known about their specific ecologic niche(s). Here, we analyzed 25 microsatellite loci from 169 strains collected from various regions throughout their known endemic range in North America, representing the largest and most geographically diverse collection of isolates studied to date. Genetic analysis of multilocus microsatellite data divided the strains into four populations of B. dermatitidis and four populations of B. gilchristii. B. dermatitidis isolates were recovered from areas throughout North America, while the B. gilchristii strains were restricted to Canada and some northern US states. Furthermore, the populations of both species were associated with major freshwater drainage basins. The four B. dermatitidis populations were partitioned among (1) the Nelson River drainage basin, (2) the St. Lawrence River and northeast Atlantic Ocean Seaboard drainage basins, (3) the Mississippi River System drainage basin, and (4) the Gulf of Mexico Seaboard and southeast Atlantic Ocean Seaboard drainage basins. A similar partitioning of the B. gilchristii populations was observed among the more northerly drainage basins only. These associations suggest that the ecologic niche where the sexual reproduction, growth, and dispersal of B. dermatitidis and B. gilchristii occur is intimately linked to freshwater systems. For most populations, sexual reproduction was rare enough to produce significant linkage disequilibrium among loci but frequent enough that mating-type idiomorphic ratios were not skewed from 1:1. Furthermore, the evolutionary divergence of B. dermatitidis and B. gilchristii was estimated at 1.9 MYA during the Pleistocene epoch. We suggest that repeated glaciations during the Pleistocene period and resulting biotic refugia may have provided the

  6. Phylogeographic Analysis of Blastomyces dermatitidis and Blastomyces gilchristii Reveals an Association with North American Freshwater Drainage Basins.

    Science.gov (United States)

    McTaggart, Lisa R; Brown, Elizabeth M; Richardson, Susan E

    2016-01-01

    Blastomyces dermatitidis and Blastomyces gilchristii are dimorphic fungal pathogens that cause serious pulmonary and systemic infections in humans. Although their natural habitat is in the environment, little is known about their specific ecologic niche(s). Here, we analyzed 25 microsatellite loci from 169 strains collected from various regions throughout their known endemic range in North America, representing the largest and most geographically diverse collection of isolates studied to date. Genetic analysis of multilocus microsatellite data divided the strains into four populations of B. dermatitidis and four populations of B. gilchristii. B. dermatitidis isolates were recovered from areas throughout North America, while the B. gilchristii strains were restricted to Canada and some northern US states. Furthermore, the populations of both species were associated with major freshwater drainage basins. The four B. dermatitidis populations were partitioned among (1) the Nelson River drainage basin, (2) the St. Lawrence River and northeast Atlantic Ocean Seaboard drainage basins, (3) the Mississippi River System drainage basin, and (4) the Gulf of Mexico Seaboard and southeast Atlantic Ocean Seaboard drainage basins. A similar partitioning of the B. gilchristii populations was observed among the more northerly drainage basins only. These associations suggest that the ecologic niche where the sexual reproduction, growth, and dispersal of B. dermatitidis and B. gilchristii occur is intimately linked to freshwater systems. For most populations, sexual reproduction was rare enough to produce significant linkage disequilibrium among loci but frequent enough that mating-type idiomorphic ratios were not skewed from 1:1. Furthermore, the evolutionary divergence of B. dermatitidis and B. gilchristii was estimated at 1.9 MYA during the Pleistocene epoch. We suggest that repeated glaciations during the Pleistocene period and resulting biotic refugia may have provided the

  7. Phylogeographic Analysis of Blastomyces dermatitidis and Blastomyces gilchristii Reveals an Association with North American Freshwater Drainage Basins.

    Directory of Open Access Journals (Sweden)

    Lisa R McTaggart

    Full Text Available Blastomyces dermatitidis and Blastomyces gilchristii are dimorphic fungal pathogens that cause serious pulmonary and systemic infections in humans. Although their natural habitat is in the environment, little is known about their specific ecologic niche(s. Here, we analyzed 25 microsatellite loci from 169 strains collected from various regions throughout their known endemic range in North America, representing the largest and most geographically diverse collection of isolates studied to date. Genetic analysis of multilocus microsatellite data divided the strains into four populations of B. dermatitidis and four populations of B. gilchristii. B. dermatitidis isolates were recovered from areas throughout North America, while the B. gilchristii strains were restricted to Canada and some northern US states. Furthermore, the populations of both species were associated with major freshwater drainage basins. The four B. dermatitidis populations were partitioned among (1 the Nelson River drainage basin, (2 the St. Lawrence River and northeast Atlantic Ocean Seaboard drainage basins, (3 the Mississippi River System drainage basin, and (4 the Gulf of Mexico Seaboard and southeast Atlantic Ocean Seaboard drainage basins. A similar partitioning of the B. gilchristii populations was observed among the more northerly drainage basins only. These associations suggest that the ecologic niche where the sexual reproduction, growth, and dispersal of B. dermatitidis and B. gilchristii occur is intimately linked to freshwater systems. For most populations, sexual reproduction was rare enough to produce significant linkage disequilibrium among loci but frequent enough that mating-type idiomorphic ratios were not skewed from 1:1. Furthermore, the evolutionary divergence of B. dermatitidis and B. gilchristii was estimated at 1.9 MYA during the Pleistocene epoch. We suggest that repeated glaciations during the Pleistocene period and resulting biotic refugia may have

  8. Indocyanine-green-loaded microballoons for biliary imaging in cholecystectomy

    Science.gov (United States)

    Mitra, Kinshuk; Melvin, James; Chang, Shufang; Park, Kyoungjin; Yilmaz, Alper; Melvin, Scott; Xu, Ronald X.

    2012-11-01

    We encapsulate indocyanine green (ICG) in poly[(D,L-lactide-co-glycolide)-co-PEG] diblock (PLGA-PEG) microballoons for real-time fluorescence and hyperspectral imaging of biliary anatomy. ICG-loaded microballoons show superior fluorescence characteristics and slower degradation in comparison with pure ICG. The use of ICG-loaded microballoons in biliary imaging is demonstrated in both biliary-simulating phantoms and an ex vivo tissue model. The biliary-simulating phantoms are prepared by embedding ICG-loaded microballoons in agar gel and imaged by a fluorescence imaging module in a Da Vinci surgical robot. The ex vivo model consists of liver, gallbladder, common bile duct, and part of the duodenum freshly dissected from a domestic swine. After ICG-loaded microballoons are injected into the gallbladder, the biliary structure is imaged by both hyperspectral and fluorescence imaging modalities. Advanced spectral analysis and image processing algorithms are developed to classify the tissue types and identify the biliary anatomy. While fluorescence imaging provides dynamic information of movement and flow in the surgical region of interest, data from hyperspectral imaging allow for rapid identification of the bile duct and safe exclusion of any contaminant fluorescence from tissue not part of the biliary anatomy. Our experiments demonstrate the technical feasibility of using ICG-loaded microballoons for biliary imaging in cholecystectomy.

  9. 地面抽采与井下抽采煤层气成本分析研究%Study on Cost Analysis of Coal Bed Methane from Surface Borehole Gas Drainage and Underground Mine Gas Drainage

    Institute of Scientific and Technical Information of China (English)

    王成

    2013-01-01

    为对比研究地面抽采煤层气成本与井下抽采瓦斯成本,以焦坪矿区下石节井田地面煤层气试验井储层测试参数和历史排采数据为基础,利用目前国际上较为先进的煤层气储层数值模拟软件CBM-SIM,对煤层气井的产能和抽采效果进行了预测分析,进而研究分析了在达到同样抽采效果的前提下,地面抽采与井下抽采煤层气的成本费用.结果显示:为了使瓦斯含量降至1 m3/t以下,地面抽采需要12.5a,成本9.09元/t;井下抽采成本16元/t,地面抽采成本远远低于井下抽采.%In order to compare and study the cost of the coal bed methane from the surface borehole gas drainage and the underground mine gas drainage,based on the reservoir measured parameters of the surface coal bed methane test well and the historical gas drainage data of Xiashijie Minefield in Jiaoping Mining Area as a base,with the application of the international advanced coal bed methane reservoir numerical simulation software CBM-SIM,a prediction analysis was conducted on the production capacity and the gas drainage effect of the coal bed methane well.On the premise of same gas drainage effect reached,the cost of the surface borehole gas drainage and underground mine gas drainage were studied and analyzed.The results showed that in order to make the gas content reduced to below 1 m3/t,the surface gas drainage would need 12.5 year,the cost would be 9.09 RMB/t.The underground mine gas drainage cost would be 16 RMB/t and the surface gas drainage cost would be far less than the underground mine gas drainage cost.

  10. Effect of internal and external biliary drainage on liver regeneration of the obstructive jaundice rats following PH%术前不同引流方式减黄对梗阻性黄疸大鼠部分肝切除术后肝功能和肝再生的影响

    Institute of Scientific and Technical Information of China (English)

    袁晟光; 梁科伟; 刘杰; 廖维甲; 覃理灵; 何松青

    2012-01-01

    目的 了解术前不同引流方式减黄对梗阻性黄疸(OJ) SD大鼠部分肝切除术(PH)术后肝功能和肝再生的影响.方法 建立OJ不同引流方式减黄70%部分肝切除SD大鼠动物模型.并在术后0、1、2、4、12、24、48和72h收集大鼠血液及肝脏组织标本,测定血清TBIL、ALB、ALT、AST水平,计算残肝重量、肝再生率,免疫组化法观察肝脏组织PCNA表达,ELISA法检测血清TNF-α水平.结果 PH术后各时段内引流(ID)组和外引流(ED)组TBIL、ALT、AST水平较OJ组均偏低.各时段ID组ALB水平较OJ组、ED组偏高.72 h肝再生率ID组高于ED组,ED组高于OJ组.3组PCNA水平均于12 h明显升高,ID组于24 h达高峰,OJ组、ED组高峰延迟至48 h且峰值偏低.PH术后各组血清TNF-α水平均呈上升趋势,ID组于12 h达高峰,OJ组、ED组均于24 h达高峰,各时段OJ组、ED组血清TNF-α水平较ID组均偏高.结论 内外引流术均可改善OJ所致的高胆红素血症和肝功能,并改善OJ大鼠残肝再生能力,但内引流效果更明显,且内引流术可以有效降低血清TNF-α水平.%Objective To evaluate the effect of internal and external biliary drainage on liver regeneration of the obstructive jaundice (OJ) rats following partial hepatectomy (PH) and to provide a theoretical basis for clinical application. Methods We established the model of OJ SD rats drainaged internally and externally following PH. At Oh, 1 h, 2 h, 4 h, 12 h, 24 h, 48 h and 72 h after PH, the rats were succumbed and the specimens of blood and liver were collected. The levels of TBIL, ALB, ALT, AST in serum and liver regeneration rates were determined. The expression of PCNA in residual liver tissues were analyzed by immunohistological technology. The levels of TNF-a in serum were measured by ELISA. Results After PH, the levels of TBIL, ALT and AST in OJ group were significantly higher than those in ID group and ED group at every moment. The level of ALB in ID group was significantly

  11. Foam drainage

    Energy Technology Data Exchange (ETDEWEB)

    Kraynik, A.M.

    1983-11-01

    Transient drainage from a column of persistent foam has been analyzed theoretically. Gravity-driven flow was assumed to occur through an interconnected network of Plateau borders that define the edges of foam cells taken to be regular pentagonal dodecahedrons. A small liquid volume fraction and monodisperse cell size distribution were assumed. In the basic model, it is assumed that all liquid is contained in Plateau borders that are bounded by rigid gas-liquid interfaces. The predicted half life, the time required for one half of the liquid to drain from the foam, is inversely proportional to the square of the cell diameter, illustrating the importance of foam structure in drainage. Liquid hold up in the films separating adjacent cells, nonuniform initial liquid volume fraction distribution and interfacial mobility are explored. Border suction due to reduced pressure in the Plateau borders provides a mechanism for film drainage. Simultaneous film drainage and flow through the Plateau borders are analyzed. Sufficient conditions for neglecting film drainage kinetics are obtained. The results indicate that improved foam stability is related to small cells, liquid hold up in the films and slow film drainage kinetics.

  12. Regional maximum rainfall analysis using L-moments at the Titicaca Lake drainage, Peru

    Science.gov (United States)

    Fernández-Palomino, Carlos Antonio; Lavado-Casimiro, Waldo Sven

    2016-07-01

    The present study investigates the application of the index flood L-moments-based regional frequency analysis procedure (RFA-LM) to the annual maximum 24-h rainfall (AM) of 33 rainfall gauge stations (RGs) to estimate rainfall quantiles at the Titicaca Lake drainage (TL). The study region was chosen because it is characterised by common floods that affect agricultural production and infrastructure. First, detailed quality analyses and verification of the RFA-LM assumptions were conducted. For this purpose, different tests for outlier verification, homogeneity, stationarity, and serial independence were employed. Then, the application of RFA-LM procedure allowed us to consider the TL as a single, hydrologically homogeneous region, in terms of its maximum rainfall frequency. That is, this region can be modelled by a generalised normal (GNO) distribution, chosen according to the Z test for goodness-of-fit, L-moments (LM) ratio diagram, and an additional evaluation of the precision of the regional growth curve. Due to the low density of RG in the TL, it was important to produce maps of the AM design quantiles estimated using RFA-LM. Therefore, the ordinary Kriging interpolation (OK) technique was used. These maps will be a useful tool for determining the different AM quantiles at any point of interest for hydrologists in the region.

  13. 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

  14. Geomorphological analysis of the drainage system on the active convergent system in Azerbaijan, NW Iran

    Science.gov (United States)

    Kaveh Firouz, Amaneh; Burg, Jean-Pierre; Giachetta, Emanuele

    2016-04-01

    Rivers are important landforms to reconstruct recent tectonic history because they are sensitive to surface movements, especially uplift and tilting. The most important drainage basins of NW Iran are, from north to south, the Arax River, the Urmia Lake and the Ghezel Ozan River catchment. The morphology of the two adjacent catchments draining into the Caspian Sea, the Arax and Ghezel Ozan were studied to better understand the active tectonics and the effect of fault activity on morphology and erosion rate of NW Iran. We performed a quantitative analysis of channel steepness and concavity, from slope-area plots calculated from digital elevation model. This information has been combined with GPS velocity vectors and seismicity. Both catchments developed under uniform climate conditions. Results show that the two rivers are in morphological disequilibrium; they exhibit profiles with prominent convexities and knickpoints. The Arax River shows higher channel steepness and concavity index in downstream part of the profile. Distribution of knickpoints show scattered elevation between 700m and 3000m. GPS rates display shortening 10 ± 2 mma‑1 and 14 ± 2 mma‑1 in upstream and downstream, respectively. The river profiles of Ghezel Ozan River and its tributaries reveal more disequilibrium downstream where channel steepness and concavity index are higher than upstream. Most knickpoints occur between 1000m and 2000m. The amount of shortening by GPS measurement changes from upstream 13 ± 2 mma‑1to downstream 14 ± 2 mma‑1. Recorded earthquakes, such as Rudbar earthquake (Mw=7.3, 1990), are more frequent downstream. The Urmia Lake is surrounded by many small and large catchments. Only major catchments were considered for the analysis. One of the most active faults, the north Tabriz fault, corresponds to a major knickpoints on the Talkhe rud River. Concordance between river profile analysis, GPS and seismotectonic records suggests that the characteristics of the river

  15. Flood frequency analysis for nonstationary annual peak records in an urban drainage basin

    Science.gov (United States)

    Villarini, G.; Smith, J.A.; Serinaldi, F.; Bales, J.; Bates, P.D.; Krajewski, W.F.

    2009-01-01

    Flood frequency analysis in urban watersheds is complicated by nonstationarities of annual peak records associated with land use change and evolving urban stormwater infrastructure. In this study, a framework for flood frequency analysis is developed based on the Generalized Additive Models for Location, Scale and Shape parameters (GAMLSS), a tool for modeling time series under nonstationary conditions. GAMLSS is applied to annual maximum peak discharge records for Little Sugar Creek, a highly urbanized watershed which drains the urban core of Charlotte, North Carolina. It is shown that GAMLSS is able to describe the variability in the mean and variance of the annual maximum peak discharge by modeling the parameters of the selected parametric distribution as a smooth function of time via cubic splines. Flood frequency analyses for Little Sugar Creek (at a drainage area of 110 km2) show that the maximum flow with a 0.01-annual probability (corresponding to 100-year flood peak under stationary conditions) over the 83-year record has ranged from a minimum unit discharge of 2.1 m3 s- 1 km- 2 to a maximum of 5.1 m3 s- 1 km- 2. An alternative characterization can be made by examining the estimated return interval of the peak discharge that would have an annual exceedance probability of 0.01 under the assumption of stationarity (3.2 m3 s- 1 km- 2). Under nonstationary conditions, alternative definitions of return period should be adapted. Under the GAMLSS model, the return interval of an annual peak discharge of 3.2 m3 s- 1 km- 2 ranges from a maximum value of more than 5000 years in 1957 to a minimum value of almost 8 years for the present time (2007). The GAMLSS framework is also used to examine the links between population trends and flood frequency, as well as trends in annual maximum rainfall. These analyses are used to examine evolving flood frequency over future decades. ?? 2009 Elsevier Ltd.

  16. Treatment of malignant stenosis of biliary tract with introduction of percutaneous selfexpandible metallic stent

    International Nuclear Information System (INIS)

    On a case of a female patients with malignant biliary stenosis the author presents his first experiences with selfexpandible metallic stent. The main indications of percutaneous insertion of stents are inoperable malignant biliary stenoses. In this case, there was an inoperable ventricular carcinoma with metastatic involvement of porta hepatitis and left lobe of the liver with extrahepatic bile duct stenosis, diagnosed by ERCP (endoscopic retrograde cholangio-pancreaticography) USG (ultrasonography) and PTC (percutaneous transhepatic cholangiography). Despite of repeated attempts the endoscopic internal drainage has failed. Because of malignant jaundice - PTC had been performed and just then, PTBD (percutaneous transhepatic biliary drainage) without direst communication between the biliary tree and duodenum. Twelve days after the procedure we performed an external-internal (combinated) drainage by pushing the catheter to duodenum and thus - outflow of bile to the duodenum was secured even throughout the extrahepatic portion of the bile duct. Ten days later, after these initial drainage procedures a selfexpendible metallic stent has been inserted into the extrahepatic bile duct and sufficient drainage to duodenum has been reached. (author)

  17. Drainage investment and wetland loss: an analysis of the national resources inventory data

    Science.gov (United States)

    Douglas, Aaron J.; Johnson, Richard L.

    1994-01-01

    The United States Soil Conservation Service (SCS) conducts a survey for the purpose of establishing an agricultural land use database. This survey is called the National Resources Inventory (NRI) database. The complex NRI land classification system, in conjunction with the quantitative information gathered by the survey, has numerous applications. The current paper uses the wetland area data gathered by the NRI in 1982 and 1987 to examine empirically the factors that generate wetland loss in the United States. The cross-section regression models listed here use the quantity of wetlands, the stock of drainage capital, the realty value of farmland and drainage costs to explain most of the cross-state variation in wetland loss rates. Wetlands preservation efforts by federal agencies assume that pecuniary economic factors play a decisive role in wetland drainage. The empirical models tested in the present paper validate this assumption.

  18. 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.

  19. 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 ...

  20. 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

  1. Are extreme rainfall intensities more frequent? Analysis of trends in rainfall patterns relevant to urban drainage systems.

    Science.gov (United States)

    De Toffol, S; Laghari, A N; Rauch, W

    2009-01-01

    The fact that climate change is affecting the intensity and frequency of rainfall is well accepted in the scientific community. This is backed by a multitude of reports on the basis of daily rainfall series analysis; however, little research is available for short duration intensities. Due to its significant influence on the behaviour of urban drainage, it is critical to investigate the changes in short duration rainfall intensities. In this study different intensities relevant for the urban drainage and the total rainfall per rain event are analysed. The trend is investigated using the Mann-Kendall test. The rainfall series analysed are from the alpine region Tyrol. The results present differences depending on the duration of the intensity and the series considered, however an increase in the number of extreme events is detectable for short durations for the most series.

  2. Morphometric analysis of the drainage system and its hydrological implications in the rain shadow regions, Kerala, India

    Institute of Scientific and Technical Information of China (English)

    Jobin THOMAS; Sabu JOSEPH; K.P. THRIVIKRAMJI; George ABE

    2011-01-01

    The rain shadow regions requisite a comprehensive watershed development and management plan for sustainable water resources management.The Pambar River Basin (PRB) lies on the rain shadow region of the southern Western Ghats,India,where climate showed marked intra-basin variation.A morphometric analysis was done to evaluate the drainage characteristics of PRB using topographical maps and digital elevation data.PRB was divided into eighteen 4th order basins (SB1-SB18),distributed along various climatic gradients.Lower order streams mostly dominate PRB and drainage pattern is a function of relief and structure.The terrain is highly dissected and prone to soil erosion during heavy storms and the elongated shape of PRB enables easier flood management.The influence of climate on drainage characteristics was evidently emphasized in basin morphometry.Four distinctively different classes were identified based on the morphometric similarities.The significance of morphometric analysis on the hydrological characterization is discussed and the relevance of the present study in water harvesting has been explicated.

  3. MECHANICAL ANALYSIS OF SHAFT LINING WHEN THE STRATUM SETTLEMENT RESULTING FROM WATER DRAINAGE

    Institute of Scientific and Technical Information of China (English)

    蒋斌松

    1997-01-01

    Based on the stratum settlement resulting from water drainage, this paper establishes the calculating method of stresses and displacements of shaft lining and stratum by using Fourier integration, obtains the calculating formulas of tangiential load which shaft lining is subjected to, and provides theoretical basis for design of shaft lining.

  4. Percutaneous transluminal biopsy using 7F forceps for diagnosing malignant biliary obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Bahn, Young Eun; Kim, Young Hwan; An, Eun Jung; Kim, See Hyung [Keimyung Univ. College of Medicine, Daegu (Korea, Republic of)

    2012-07-15

    To evaluate the usefulness of the percutaneous transluminal biopsy using 7-F forceps for diagnosing malignant biliary obstruction. One hundred and seven consecutive patients with obstructive jaundice underwent transluminal forceps biopsy. The lesions involved the common bile duct (n = 33), common hepatic duct (n = 13), hilum (n = 17), right or left intrahepatic bile duct (n = 32), multiple sites (extra and intrahepatic ducts, n = 7), or anastomotic sites (n = 5). In each patient, an average of three specimens was taken with 7F biopsy forceps through a transhepatic biliary drainage tract. The final diagnosis was confirmed with pathologic findings, or a clinical and radiologic follow up. The final diagnoses showed malignancies in 75 patients and benign biliary obstructions in 32 patients. Pathologic classifications of malignancies established by forceps biopsy included 67 adenocarcinomas, 1 adenosquamous cell carcinoma, and 1 hepatocelluar carcinoma. There were 6 false-negative diagnoses. The diagnostic performance of transluminal forceps biopsy in malignant biliary obstruction had a sensitivity of 92%, specificity of 100%, positive predictive value of 100%, a negative predictive value of 84.2%, and an accuracy of 94.2%. Percutaneous transluminal forceps biopsy is a safe procedure that is easy to perform through a transhepatic biliary drainage tract. It is a highly accurate technique for diagnosing malignant biliary obstructions.

  5. Drainage basin and topographic analysis of a tropical landscape: Insights into surface and tectonic processes in northern Borneo

    Science.gov (United States)

    Mathew, Manoj Joseph; Menier, David; Siddiqui, Numair; Ramkumar, Mu.; Santosh, M.; Kumar, Shashi; Hassaan, Muhammad

    2016-07-01

    We investigated the recent landscape development of Borneo through geomorphic analysis of two large drainage basins (Rajang and Baram basins). The extraction of morphometric parameters utilizing digital terrain data in a GIS environment, focusing on hydrography (stream length-gradient index, ratio of valley floor width to valley height, and transverse topographic symmetry factor) and topography (local relief and relief anomaly), was carried out in order to elucidate processes governing drainage and landscape evolution. Anomalously high and low values of stream length-gradient indices of main tributary streams associated with faults and multiple knick-points along the channel profiles are linked to deformation events. The development of deeply incised V-shaped valleys show enhanced incision capability of streams in response to steepening of hillslope gradients following tectonic inputs. Deflection of streams and probable dynamic reorganization of the drainage system through stream capture processes as feedbacks to tectonic uplift and orographic effect are observed. Local relief and relief anomaly maps highlight the presence of preserved elevation-accordant relict portions of landscapes characterized by low amplitude relief, nested between ridgelines in regions of complex folding. Our results reveal dynamic geomorphic adjustment of the landscape due to perturbations in tectonic and climatic boundary conditions. The implication is that the landscape of north Borneo experienced a tectonic phase of rapid uplift after 5 Ma and undergoes active folding of the Rajang Group thrust belts in the present-day. Active shortening combined with high rates of denudation in Sarawak, demonstrates transience emphasized by the drainage system attempting to adjust to tectonic and climatic forcing.

  6. Uncertainty Analysis in the Evaluation of Extreme Rainfall Trends and Its Implications on Urban Drainage System Design

    Directory of Open Access Journals (Sweden)

    Vincenza Notaro

    2015-12-01

    Full Text Available Future projections provided by climate models suggest that the occurrence of extreme rainfall events will increase and this is evidence that the climate is changing. Because the design of urban drainage systems is based on the statistical analysis of past events, variations in the intensity and frequency of extreme rainfall represent a critical issue for the estimation of rainfall. For this reason, the design criteria of drainage systems should take into account the trends in the past and the future climate changes projections. To this end, a Bayesian procedure was proposed to update the parameters of depth–duration–frequency (DDF curves to assess the uncertainty related to the estimation of these values, once the evidence of annual maximum rainfall trends was verified. Namely, in the present study, the historical extreme rainfall series with durations of 1, 3, 6, 12 and 24 h for the period of 1950–2008, recorded by the rain gauges located near the Paceco urban area (southern Italy, were analyzed to detect statistically significant trends using the non‐parametric Mann‐Kendall test. Based on the rainfall trends, the parameters of the DDF curves for a five‐year return period were updated to define some climate scenarios. Finally, the implications of the uncertainty related to the DDF parameters estimation on the design of a real urban drainage system was assessed to provide an evaluation of its performance under the assumption of climate change. Results showed that the future increase of annual maximum precipitation in the area of study would affect the analyzed drainage system, which could face more frequent episodes of surcharge.

  7. Classification of worldwide drainage basins through the multivariate analysis of variables controlling their hydrosedimentary response

    Science.gov (United States)

    Raux, Julie; Copard, Yoann; Laignel, Benoît; Fournier, Matthieu; Masseï, Nicolas

    2011-04-01

    Quality and amount of waters and sediments conveyed within large drainage basins are crucial for human societies and biodiversity concerns. This work aims to determine the factors controlling the hydrosedimentary response (water discharge and sediment load) of 24 worldwide large drainage basins. In this respect, eleven geomorphologic and climatic variables routinely used in the literature were considered and others as fractal dimension, elongation and mean channel slope are novel for such an issue. In addition, two variables, land cover and lithology indexes, somewhat different from the literature in terms of calculation principles, were also included. All these variables were then subjected to multivariate statistical analyses (CA and PCA) and confronted in a matrix correlation. On the whole, our results display that water discharge is controlled by runoff, precipitation, basin area, elongation and fractal dimension while sediment load is governed by runoff, precipitation and maximum elevation. Mean channel slope and land-use have a minor role while other parameters (hypsometry, lithology, length, slope, mean elevation and temperature) do not play a significant role in the hydrosedimentary response. Such statistical analyses also bring out a classification of these drainage basins, comprising five to six main clusters which are ranged according to the main variables ruling their hydrosedimentary response. Two clusters are essentially governed by geomorphometric parameters (area, elongation, fractal dimension, mean elevation and hypsometry) while one cluster is rather controlled by transfer processes (runoff) and by active tectonic (maximum elevation). Hydrosedimentary response of arctic and continental rivers is controlled by low temperature while two drainage basins show any trend. A comparison of our results with other previous works dealing with this same issue points to some significant disagreements essentially based on the number of drainage basins

  8. Air cholangiography in endoscopic bilateral stent-in-stent placement of metallic stents for malignant hilar biliary obstruction

    Science.gov (United States)

    Lee, Jae Min; Lee, Sang Hyub; Jang, Dong Kee; Chung, Kwang Hyun; Park, Jin Myung; Paik, Woo Hyun; Lee, Jun Kyu; Ryu, Ji Kon; Kim, Yong-Tae

    2016-01-01

    Background: Although endoscopic bilateral stent-in-stent (SIS) placement of self-expandable metallic stents (SEMS) is one of the major palliative treatments for unresectable malignant hilar biliary obstruction, post-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis can occur frequently due to inadequate drainage, especially after contrast injection into the biliary tree. The aim of this study is to evaluate the efficacy and safety of air cholangiography-assisted stenting. Methods: This study included 47 patients with malignant hilar biliary obstruction who underwent endoscopic bilateral SEMS placement using the SIS technique. They were divided into two groups, air (n = 23) or iodine contrast (n = 24) cholangiography. We retrospectively compared comprehensive clinical and laboratory data of both groups. Results: There were no significant differences found between the two groups with respect to technical success (87% versus 87.5%, air versus contrast group, respectively), functional success (95% versus 95.2%), 30-day mortality (8.3% versus 8.7%) and stent patency. Post-ERCP adverse events occurred in 5 (21.7%) of the patients in the air group and 8 (33.3%) of the patients in the contrast group. Among these, the rate of cholangitis was significantly lower in the air group (4.8% versus 29.2%, p = 0.048). In multivariate analysis, air cholangiography, technical success and a shorter procedure time were significantly associated with a lower incidence of post-ERCP cholangitis. Conclusions: Air cholangiography-assisted stenting can be a safe and effective method for endoscopic bilateral SIS placement of SEMS in patients with malignant hilar biliary obstruction. PMID:26929781

  9. Time resolved analysis of water drainage in porous asphalt concrete using neutron radiography

    International Nuclear Information System (INIS)

    Porous asphalt as a road surface layer controls aquaplaning as rain water can drain through its highly porous structure. The process of water drainage through this permeable layer is studied using neutron radiography. Time-resolved water configuration and distribution within the porous structure are reported. It is shown that radiography depicts the process of liquid water transport within the complex geometry of porous asphalt, capturing water films, filled dead end pores and water islands. - Highlights: ► The water drainage process in porous asphalt was studied using neutron radiography. ► Despite similar mix designs, different processes of water transport were established. ► Water transport within porous asphalt showed filled dead end pores and water islands

  10. Time resolved analysis of water drainage in porous asphalt concrete using neutron radiography.

    Science.gov (United States)

    Poulikakos, L D; Sedighi Gilani, M; Derome, D; Jerjen, I; Vontobel, P

    2013-07-01

    Porous asphalt as a road surface layer controls aquaplaning as rain water can drain through its highly porous structure. The process of water drainage through this permeable layer is studied using neutron radiography. Time-resolved water configuration and distribution within the porous structure are reported. It is shown that radiography depicts the process of liquid water transport within the complex geometry of porous asphalt, capturing water films, filled dead end pores and water islands.

  11. Time resolved analysis of water drainage in porous asphalt concrete using neutron radiography.

    Science.gov (United States)

    Poulikakos, L D; Sedighi Gilani, M; Derome, D; Jerjen, I; Vontobel, P

    2013-07-01

    Porous asphalt as a road surface layer controls aquaplaning as rain water can drain through its highly porous structure. The process of water drainage through this permeable layer is studied using neutron radiography. Time-resolved water configuration and distribution within the porous structure are reported. It is shown that radiography depicts the process of liquid water transport within the complex geometry of porous asphalt, capturing water films, filled dead end pores and water islands. PMID:23500651

  12. 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

  13. 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....

  14. Azathioprine for primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Gong, Yanzhang; Christensen, E; Gluud, C

    2007-01-01

    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....

  15. 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...

  16. 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.

  17. Management of patients after recovering from acute severe biliary pancreatitis.

    Science.gov (United States)

    Dedemadi, Georgia; Nikolopoulos, Manolis; Kalaitzopoulos, Ioannis; Sgourakis, George

    2016-09-14

    Cholelithiasis is the most common cause of acute pancreatitis, accounting 35%-60% of cases. Around 15%-20% of patients suffer a severe attack with high morbidity and mortality rates. As far as treatment is concerned, the optimum method of late management of patients with severe acute biliary pancreatitis is still contentious and the main question is over the correct timing of every intervention. Patients after recovering from an acute episode of severe biliary pancreatitis can be offered alternative options in their management, including cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy, or no definitive treatment. Delaying cholecystectomy until after resolution of the inflammatory process, usually not earlier than 6 wk after onset of acute pancreatitis, seems to be a safe policy. ERCP and sphincterotomy on index admission prevent recurrent episodes of pancreatitis until cholecystectomy is performed, but if used for definitive treatment, they can be a valuable tool for patients unfit for surgery. Some patients who survive severe biliary pancreatitis may develop pseudocysts or walled-off necrosis. Management of pseudocysts with minimally invasive techniques, if not therapeutic, can be used as a bridge to definitive operative treatment, which includes delayed cholecystectomy and concurrent pseudocyst drainage in some patients. A management algorithm has been developed for patients surviving severe biliary pancreatitis according to the currently published data in the literature. PMID:27678352

  18. Plasma Lipidomics as a Tool for Diagnosis of Extrahepatic Cholangiocarcinoma in Biliary Strictures: a Pilot Study.

    Science.gov (United States)

    Prachayakul, Varayu; Thearavathanasingha, Phataraphong; Thuwajit, Chanitra; Roytrakul, Sittiruk; Jaresitthikunchai, Janthima; Thuwajit, Peti

    2016-01-01

    Biliary obstruction is a common clinical manifestation of various conditions, including extrahepatic cholangiocarcinoma. However, a screening test for diagnosis of extrahepatic cholangiocarcinoma in patients with biliary obstruction is not yet available. According to the rationale that the biliary system plays a major role in lipid metabolism, biliary obstruction may interfere with lipid profiles in the body. Therefore, plasma lipidomics may help indicate the presence or status of disease in biliary obstruction suspected extrahepatic cholangiocarcinoma. This study aimed to use plasma lipidomics for diagnosis of extrahepatic cholangiocarcinoma in patients with biliary obstruction. Plasma from healthy volunteers, patients with benign biliary obstruction extrahepatic cholangiocarcinoma, and other related cancers were used in this study. Plasma lipids were extracted and lipidomic analysis was performed using matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Lipid profiles from extrahepatic cholangiocarcinoma patients showed significant differences from both normal and benign biliary obstruction conditions, with no distinction between the latter two. Relative intensity of the selected lipid mass was able to successfully differentiate all extrahepatic cholangiocarcinoma samples from patient samples taken from healthy volunteers, patients with benign biliary obstruction, and patients with other related cancers. In conclusion, lipidomics is a non-invasive method with high sensitivity and specificity for identification of extrahepatic cholangiocarcinoma in patients with biliary obstruction. PMID:27644677

  19. Risk of Post-ERCP Pancreatitis after placement of Covered versus Uncovered Self-Expandable Biliary Metal Stents: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Yaseen Alastal

    2008-09-01

    Full Text Available Background Self-expandable metal stents are commonly used in the management of malignant biliary obstruction due to higher patency rates compared to plastic stents. Development of covered self-expandable metal stents has led to extended stent patency compared to uncovered self-expandable metal stents. However, there are concerns that deployment of covered self-expandable metal stents may be associated with higher risk of post-endoscopic retrograde cholangio-pancreatography pancreatitis, acute cholecystitis and stent migration. Objective We performed this meta-analysis to assess the risk of post-endoscopic retrograde cholangio-pancreatography pancreatitis and other adverse events (acute cholecystitis and stent migration with biliary covered self-expandable metal stents compared to uncovered self-expandable metal stents. We also assessed the proportion of stent patency at 6 and 12 months between the two groups. Methods We searched MedLine, EMBASE, Cochrane database, ISI Web of Science and Scopus from January 1989 through June, 2014, to identify randomized controlled trials and observational studies that provided data on the risk of post-endoscopic retrograde cholangio-pancreatography pancreatitis and other adverse events following the placement of covered self-expandable metal stents versus uncovered self-expandable metal stents in patients with biliary obstruction. The Mantel–Haenszel method was used to pool data of post-endoscopic retrograde cholangio- pancreatography pancreatitis, acute cholecystitis, stent migration and proportion of stent patency over 6 and 12 months into fixed or random effect model of meta-analyses. Odds ratio was used to generate an overall effect estimate of the outcome. Results Eight studies (6 randomized controlled trials and 2 observational studies with a total of 1078 patients were included in the meta-analysis. The pooled odds ratio with 95% confidence intervals for risk of post-endoscopic retrograde cholangio

  20. Ursodeoxycholic acid for primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Gong, Yan; Huang, Zhi Bi; Christensen, Erik;

    2008-01-01

    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.......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....

  1. Treatment of Malignant Biliary Obstruction with a PTFE-Covered Self-Expandable Nitinol Stent

    Energy Technology Data Exchange (ETDEWEB)

    Han, Young-Min; Kwak, Hyo-Sung; Jin, Gong-Yong; Lee, Seung-Ok; Chung, Gyung-Ho [Chonbuk National University Medical School and Hospital, Chonju (Korea, Republic of)

    2007-10-15

    We wanted to determine the technical and clinical efficacy of using a PTFE-covered self-expandable nitinol stent for the palliative treatment of malignant biliary obstruction. Thirty-seven patients with common bile duct strictures caused by malignant disease were treated by placing a total of 37 nitinol PTFE stents. These stents were covered with PTFE with the exception of the last 5 mm at each end; the stent had an unconstrained diameter of 10 mm and a total length of 50 80 mm. The patient survival rate and stent patency rate were calculated by performing Kaplan-Meier survival analysis. The bilirubin, serum amylase and lipase levels before and after stent placement were measured and then compared using a Wilcoxon signed-rank test. The average follow-up duration was 27.9 weeks (range: 2 81 weeks). Placement was successful in all cases. Seventy-six percent of the patients (28/37) experienced adequate palliative drainage for the remainder of their lives. There were no immediate complications. Three patients demonstrated stent sludge occlusion that required PTBD (percutaneous transhepatic biliary drainage) irrigation. Two patients experienced delayed stent migration with stone formation at 7 and 27 weeks of follow-up, respectively. Stent insertion resulted in acute elevations of the amylase and lipase levels one day after stent insertion in 11 patients in spite of performing endoscopic sphincterotomy (4/6). The bilirubin levels were significantly reduced one week after stent insertion (p < 0.01). The 30-day mortality rate was 8% (3/37), and the survival rates were 49% and 27% at 20 and 50 weeks, respectively. The primary stent patency rates were 85%, and 78% at 20 and 50 weeks, respectively. The PTFE-covered self-expandable nitinol stent is safe to use with acceptable complication rates. This study is similar to the previous studies with regard to comparing the patency rates and survival rates.

  2. Drainage Analysis of the South American Landscape and its Tectonic Implications

    Science.gov (United States)

    Rodríguez Tribaldos, Verónica; White, Nicholas J.; Roberts, Gareth G.

    2016-04-01

    The majority of studies aimed at investigating topographic growth and landscape evolution have limited spatial coverage. Frequently, spot measurements of uplift and denudation are only available, which hampers spatial resolution of the growth of regional topographic features. This limitation can be overcome by quantitatively analysing substantial, continent-wide, drainage networks. The shapes of long wavelength longitudinal river profiles appear to be mainly controlled by regional uplift and moderated by erosional processes, both of which can vary as a function of space and time. By parametrizing erosional histories, it is feasible to develop inverse models that permit spatial and temporal patterns of regional uplift to be reliably retrieved. Here, a drainage inventory for South America consisting of 1827 rivers has been inverted. River profiles were extracted from the SRTM topographic dataset and modelled using a simplified version of the stream-power law, in which erosional processes are described using a linear advective formulation. The inverse problem is then solved by seeking smooth uplift rate histories that minimize the misfit between observed and calculated river profiles using a linearized, damped, non-negative, least squares algorithm. Calibration of erosional processes is achieved by inverting the complete drainage inventory and seeking a calculated uplift history that best honours independent geological observations from the Borborema Province of northeast Brazil. This province experienced regional Cenozoic uplift. Calculated uplift rate histories for South America suggest that the bulk of its topography developed during Cenozoic times. The model suggests, for instance, that the Andean mountain chain mostly arose in late Eocene-Oligocene (i.e. 40-28 Ma) times with an increase in elevation during Miocene times (i.e. the last 20 Ma). Uplift of the Central Andean Altiplano from an elevation of ~ 1 km to its present-day height of ~ 4 km occurred within the

  3. Interventional radiology of malignant biliary obstruction complication and treatment

    International Nuclear Information System (INIS)

    Intervetional therapy as an important therapeutic method for malignant biliary obstruction has been used extensively, but there still remain some problems worthy for our emphasis and research. We retrospectively reviewed more than 800 patients with malignant obstructive jaundice during 12 years. Indications, contraindications, complications and corresponding treatment methods were studied. Furthermore, discussion including methods of biliary drainage, proper time of stent implantation, methods of anesthesia, usage of antibiotics and haemostat were also carded out. Use of analgesics (pain-suppressal) pre- and post procedure, development of acute pancreatitis and its management, and peri-operative mortality were further investigated in detail. We hope our experiences and lessons would give interventional doctors some help in their career. (authors)

  4. 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

  5. DRAINAGE NETWORKS AFTER WILDFIRE

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Predicting runoff and erosion from watersheds burned by wildfires requires an understanding of the three-dimensional structure of both hillslope and channel drainage networks. We investigate the small- and large-scale structures of drainage networks using field studies and computer analysis of 30-m digital elevation model. Topologic variables were derived from a composite 30-m DEM, which included 14 order 6 watersheds within the Pikes Peak batholith. Both topologic and hydraulic variables were measured in the field in two smaller burned watersheds (3.7 and 7.0 hectares) located within one of the order 6 watersheds burned by the 1996 Buffalo Creek Fire in Central Colorado. Horton ratios of topologic variables (stream number, drainage area, stream length, and stream slope) for small-scale and large-scale watersheds are shown to scale geometrically with stream order (i.e., to be scale invariant). However, the ratios derived for the large-scale drainage networks could not be used to predict the rill and gully drainage network structure. Hydraulic variables (width, depth, cross-sectional area, and bed roughness) for small-scale drainage networks were found to be scale invariant across 3 to 4 stream orders. The relation between hydraulic radius and cross-sectional area is similar for rills and gullies, suggesting that their geometry can be treated similarly in hydraulic modeling. Additionally, the rills and gullies have relatively small width-to-depth ratios, implying sidewall friction may be important to the erosion and evolutionary process relative to main stem channels.

  6. Drainage networks after wildfire

    Science.gov (United States)

    Kinner, D.A.; Moody, J.A.

    2005-01-01

    Predicting runoff and erosion from watersheds burned by wildfires requires an understanding of the three-dimensional structure of both hillslope and channel drainage networks. We investigate the small-and large-scale structures of drainage networks using field studies and computer analysis of 30-m digital elevation model. Topologic variables were derived from a composite 30-m DEM, which included 14 order 6 watersheds within the Pikes Peak batholith. Both topologic and hydraulic variables were measured in the field in two smaller burned watersheds (3.7 and 7.0 hectares) located within one of the order 6 watersheds burned by the 1996 Buffalo Creek Fire in Central Colorado. Horton ratios of topologic variables (stream number, drainage area, stream length, and stream slope) for small-scale and large-scale watersheds are shown to scale geometrically with stream order (i.e., to be scale invariant). However, the ratios derived for the large-scale drainage networks could not be used to predict the rill and gully drainage network structure. Hydraulic variables (width, depth, cross-sectional area, and bed roughness) for small-scale drainage networks were found to be scale invariant across 3 to 4 stream orders. The relation between hydraulic radius and cross-sectional area is similar for rills and gullies, suggesting that their geometry can be treated similarly in hydraulic modeling. Additionally, the rills and gullies have relatively small width-to-depth ratios, implying sidewall friction may be important to the erosion and evolutionary process relative to main stem channels.

  7. Safety analysis of stability of surface gas drainage boreholes above goaf areas

    Institute of Scientific and Technical Information of China (English)

    LIU Yu-zhou; LI Xiao-hong

    2007-01-01

    As longwall caving mining method prevails rapidly in China coal mines, amount of gas emission from longwall faces and goaf area increased significantly. Using traditional gas drainage methods, such as drilling upward holes to roof strata in tailgate or drilling inseam and cross-measure boreholes, could not meet methane drainage requirements in a gassy mine. The alternative is to drill boreholes from surface down to the longwall goaf area to drain the gas out. As soon as a coal seam is extracted out, the upper rock strata above the goaf start to collapse or become fractured depending upon the rock characteristics and the height above the coal seam. During overlying rock strata being fractured,boreholes in the area may be damaged due to ground movement after the passage of the longwall face. The sudden damage of a borehole may cause a longwall production halt or even a serious mine accident. A theoretical calculation of the stability of surface boreholes in mining affected area is introduced along with an example of determination of borehole and casing diameters is given for demonstration. By using this method for the drilling design, the damage of surface boreholes caused by excessive mining induced displacement can be effectively reduced if not totally avoided. Borehole and casing diameters as well as characteristics of filling materials can be determined using the proposed method by calculating the horizontal movement and vertical stain at different borehole depths.

  8. Glucocorticosteroids for primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Prince, M; Christensen, E; Gluud, C

    2005-01-01

    Primary biliary cirrhosis is a chronic progressive cholestatic liver disease of presumed autoimmune etiology, characterised by the destruction of small intrahepatic bile ducts and the eventual development of cirrhosis and liver failure. Its progression may be influenced by immunosuppression...

  9. Biliary atresia: pathogenesis and treatment.

    Science.gov (United States)

    Bates, M D; Bucuvalas, J C; Alonso, M H; Ryckman, F C

    1998-01-01

    Biliary atresia is a disorder of infants in which there is obliteration or discontinuity of the extrahepatic biliary system, resulting in obstruction of bile flow. Untreated, the resulting cholestasis leads to progressive conjugated hyperbilirubinemia, cirrhosis, and hepatic failure. Biliary atresia has an incidence of approximately one in 10,000 live births worldwide. Evidence to date supports a number of pathogenic mechanisms for the development of biliary atresia. An infectious cause, such as by a virus, would seem most pausible in many cases. The clinical observation that biliary atresia is rarely encountered in premature infants would support an agent acting late in gestation. However, no infectious or toxic agent has been conclusively implicated in biliary atresia. Genetic mechanisms likely play important roles, even regarding susceptibility to other specific causes, but no gene whose altered function would result in obstruction or atresia of the biliary tree has been identified. The variety of clinical presentations support the notion that the proposed mechanisms are not mutually exclusive but may play roles individually or in combination in certain patients. Biliary atresia, when untreated, is fatal within 2 years, with a median survival of 8 months. The natural history of biliary atresia has been favorably altered by the Kasai portoenterostomy. Approximately 25 to 35% of patients who undergo a Kasai portoenterostomy will survive more than 10 years without liver transplantation. One third of the patients drain bile but develop complications of cirrhosis and require liver transplantation before age 10. For the remaining one third of patients, bile flow is inadequate following portoenterostomy and the children develop progressive fibrosis and cirrhosis. The portoenterostomy should be done before there is irreversible sclerosis of the intrahepatic bile ducts. Consequently, a prompt evaluation is indicated for any infant older than 14 days with jaundice to

  10. Case-based knowledge formalization and reasoning method for digital terrain analysis - application to extracting drainage networks

    Science.gov (United States)

    Qin, Cheng-Zhi; Wu, Xue-Wei; Jiang, Jing-Chao; Zhu, A.-Xing

    2016-08-01

    Application of digital terrain analysis (DTA), which is typically a modeling process involving workflow building, relies heavily on DTA domain knowledge of the match between the algorithm (and its parameter settings) and the application context (including the target task, the terrain in the study area, the DEM resolution, etc.), which is referred to as application-context knowledge. However, existing DTA-assisted tools often cannot use application-context knowledge because this type of DTA knowledge has not been formalized to be available for inference in these tools. This situation makes the DTA workflow-building process difficult for users, especially non-expert users. This paper proposes a case-based formalization for DTA application-context knowledge and a corresponding case-based reasoning method. A case in this context consists of a series of indices that formalize the DTA application-context knowledge and the corresponding similarity calculation methods for case-based reasoning. A preliminary experiment to determine the catchment area threshold for extracting drainage networks has been conducted to evaluate the performance of the proposed method. In the experiment, 124 cases of drainage network extraction (50 for evaluation and 74 for reasoning) were prepared from peer-reviewed journal articles. Preliminary evaluation shows that the proposed case-based method is a suitable way to use DTA application-context knowledge to achieve a marked reduction in the modeling burden for users.

  11. 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.

  12. 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...

  13. 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.

  14. 法尼酯衍生物X受体与不同引流方式下梗阻性黄疸大鼠部分肝切除术后肝再生的关系%Relationship between farnesoid X receptor and liver regeneration of obstructive jaundice rats following partial hepatectomy with different biliary drainages

    Institute of Scientific and Technical Information of China (English)

    鲁育民; 袁晟光; 梁科伟; 孙彦浩; 廖维甲; 何松青

    2014-01-01

    目的 探讨法尼酯衍生物X受体(FXR)与不同引流方式下梗阻性黄疸(OJ)大鼠部分肝切除术(PH)后肝再生差异的关系.方法 120只健康雄性大鼠随机分为4组:正常大鼠70%肝切除组(Control组)、梗阻性黄疸未引流切除组(OJ组)、梗阻性黄疸内引流切除组(ID组)、梗阻性黄疸外引流切除组(ED组).术后0、4、12、24、48、72 h等时间点检测大鼠血清总胆汁酸(TBA)含量,残肝组织FXR mRNA和蛋白表达、胆固醇7α-羟化酶(CYP7A1) mRNA表达.结果 ED组PH后12~72 h各时点增殖细胞核抗原(PCNA)阳性表达率为(19.52±1.87)%、(30.16 ±2.65)%、(46.44±2.66)%、(44.36±3.82)%,均明显低于ID组和Control组(P <0.05);ED组TBA含量各时点分别为(20.38 ±4.33)、(25.87±8.68)、(35.05±6.87)、(49.66±6.65)、(60.44±7.66)、(52.36±8.82) μmol/L,均低于Control组和ID组(P<0.05);CYP7A1 mRNA相对表达量ED组各时段分别为1.75±0.09、1.68±0.14、1.53±0.16、1.25±0.16、1.17±0.18、1.24±0.16,均高于Control组和ID组(P<0.05),ID组各时点FXR mRNA相对表达量分别为1.52±0.18、1.80 ±0.12、1.89±0.12、2.56±0.09、2.39±0.20、2.02±0.24,均高于ED组(P<0.05),FXR蛋白表达与FXR mRNA基本一致;各项指标ID组与Control组各时点差异无统计学意义(P>0.05).结论 经外引流的梗阻性黄疸大鼠部分肝切除后肝再生较内引流明显抑制的原因与胆酸丢失有关,可能机制为低表达的FXR抑制了肝再生.%Objective To evaluate the relationship between farnesoid X receptor (FXR) and liver regeneration of obstructive jaundice (OJ) rats following partial hepatectomy (PH) with different biliary drainages.Methods 120 male Sprague-Dawley rats were randomly allocated into 4 groups:control group,normal rats subjected to PH (70% hepatectomy) ; OJ group,OJ rats without drainage subjected to PH; internal drainage (ID) group,OJ rats with ID subjected to PH; external drainage (ED) group,OJ rats with ED

  15. Biliary Surgery Via Minilaparotomy — A Limited Procedure for Biliary Lithiasis

    Directory of Open Access Journals (Sweden)

    Takukazu Nagakawa

    1993-01-01

    Full Text Available Cholelithiasis until now has been treated using solvents, lithotripsy via a biliary endoscope, laser or shock wave lithotripsy, and laparoscopic cholecystectomy. have developed a new surgical treatment for cholelithiasis in which a cholecystectomy is performed through a minilaparotomy. This paper presents this new technique and discusses the principles of surgery for cholelithiasis using this technique. This procedure is performed by a 2 to 3 cm subcostal skin incision in the right hypochondrium. More than 400 patients were treated by this technique. This procedure is not different in terms of blood loss .or operation time from conventional methods, and no significant complications have occurred. Intraoperative X-ray examination is performed routinely because of easy insertion of a tube from the cystic duct into the bile duct. Reduction of the length of the incision greatly facilitates postoperative recovery, shortening the hospital length-of-stay to within 3 days. The surgical manipulation of only a limited area of the upper abdomen is unlikely to induce postoperative syndromes, such as adhesions or ileus. Following this experience, a biliary drainage procedure based on cholangionmanomery and primary closure of the choledochotomy was introduced. This approach allowed even patients with choledocholithiasis to undergo a minilaparotomy and be discharged within one week.

  16. Analysis of factors influencing recurrent occlusion of metallic stents in malignant biliary obstruction%恶性梗阻性黄疸支架再梗阻的多因素分析

    Institute of Scientific and Technical Information of China (English)

    刘长富; 郭志; 司同国; 邢文阁; 刘方; 于海鹏

    2009-01-01

    Objective To analyze the clinical and pathological factors which can influence the occurrence of the recurrent occlusion of metallic stents in patients with malignant biliary obstruction. Methods The clinical data of 50 patients with malignant biliary obstruction, who suffered repeated metallic stents obstruction and were admitted to authors" hospital during the period of March 2006-September 2008, were retrospectively analyzed. Of 50 patients, liver carcinoma was diagnosed in 12, pancreatic carcinoma in 17 and carcinoma of bile duct in 21. The relevant factors which might bear a relation to the occurrence of repeated metallic stents obstruction were evaluated. Results Single factor analysis of variance indicated that the denomination of carcinoma, clinical stage of carcinoma, location of obstruction, whether infection being accompanied or not, and the anti-tumor therapy after biliary stenting treatment were the significant factors closely linked to the occurrence of repeated metallic stents obstruction in patients with malignant biliary obstruction, Logistic regression analysis demonstrated that clinical stage of carcinoma, location of obstruction and whether infection being accompanied or not were the important factors that determined the occurrence of repeated metallic stents obstruction. Conclusion Clinical stage of carcinoma, location of obstruction and whether infection being accompanied or not are important reference factors for judging the occurrence of occlusion of metallic stents in malignant biliary obstruction.%目的 探讨恶性梗阻性黄疸支架置入后再梗阻的相关危险因素.方法 回顾性分析发生胆道内支架再梗阻资料完整的50例恶性梗阻性黄疸患者,分析影响胆道支架再梗阻的相关危险因素.结果 单因素分析表明原发肿瘤类型、肿瘤临床分期、梗阻部位、是否合并感染、支架治疗后是否应用抗肿瘤治疗是影响日日道支架再梗阻的相关因素;多因素分析

  17. Endoscopic management of occluded metal biliary stents:Metal versus 10F plastic stents

    Institute of Scientific and Technical Information of China (English)

    Won; Jae; Yoon; Ji; Kon; Ryu; Jung; Won; Lee; Dong-Won; Ahn; Yong-Tae; Kim; Yong; Bum; Yoon; Sang; Myung; Woo; Woo; Jin; Lee

    2010-01-01

    AIM:To compare the efficacy of self-expandable metal stents(SEMSs) with 10F plastic stents(PSs) in the endoscopic management of occluded SEMSs.METHODS:We retrospectively reviewed the medical records of 56 patients who underwent SEMS insertion for palliation of unresectable malignant biliary obstruction between 2000 and 2007 and subsequent endoscopic retrograde biliary drainage(ERBD) with SEMS or PS for initial SEMS occlusion between 2000 and 2008.RESULTS:Subsequent ERBD with SEMS was performed in 29 patient...

  18. Percutaneous Intraductal Radiofrequency Ablation is a Safe Treatment for Malignant Biliary Obstruction: Feasibility and Early Results

    Energy Technology Data Exchange (ETDEWEB)

    Mizandari, Malkhaz [Tbilisi State Medical University, Department of Radiology (Georgia); Pai, Madhava, E-mail: madhava.pai@imperial.ac.uk; Xi Feng [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom); Valek, Vlastimil; Tomas, Andrasina [University Hospital Brno Bohunice, Department of Radiology (Czech Republic); Quaretti, Pietro [IRCCS Policlinico San Matteo, Department of Radiology (Italy); Golfieri, Rita; Mosconi, Cristina [University of Bologna, Department of Radiology, Policlinico S. Orsola-Malpighi (Italy); Ao Guokun [The 309 Hospital of Chinese PLA, Department of Radiology (China); Kyriakides, Charis [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom); Dickinson, Robert [Imperial College London, Department of Bioengineering (United Kingdom); Nicholls, Joanna; Habib, Nagy, E-mail: nagy.habib@imperial.ac.uk [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom)

    2013-06-15

    Purpose. Previous clinical studies have shown the safety and efficacy of this novel radiofrequency ablation catheter when used for endoscopic palliative procedures. We report a retrospective study with the results of first in man percutaneous intraductal radiofrequency ablation in patients with malignant biliary obstruction. Methods. Thirty-nine patients with inoperable malignant biliary obstruction were included. These patients underwent intraductal biliary radiofrequency ablation of their malignant biliary strictures following external biliary decompression with an internal-external biliary drainage. Following ablation, they had a metal stent inserted. Results. Following this intervention, there were no 30-day mortality, hemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the 39 patients, 28 are alive and 10 patients are dead with a median survival of 89.5 (range 14-260) days and median stent patency of 84.5 (range 14-260) days. One patient was lost to follow-up. All but one patient had their stent patent at the time of last follow-up or death. One patient with stent blockage at 42 days postprocedure underwent percutaneous transhepatic drain insertion and restenting. Among the patients who are alive (n = 28) the median stent patency was 92 (range 14-260) days, whereas the patients who died (n = 10) had a median stent patency of 62.5 (range 38-210) days. Conclusions. In this group of patients, it appears that this new approach is feasible and safe. Efficacy remains to be proven in future, randomized, prospective studies.

  19. Percutaneous Intraductal Radiofrequency Ablation is a Safe Treatment for Malignant Biliary Obstruction: Feasibility and Early Results

    International Nuclear Information System (INIS)

    Purpose. Previous clinical studies have shown the safety and efficacy of this novel radiofrequency ablation catheter when used for endoscopic palliative procedures. We report a retrospective study with the results of first in man percutaneous intraductal radiofrequency ablation in patients with malignant biliary obstruction. Methods. Thirty-nine patients with inoperable malignant biliary obstruction were included. These patients underwent intraductal biliary radiofrequency ablation of their malignant biliary strictures following external biliary decompression with an internal-external biliary drainage. Following ablation, they had a metal stent inserted. Results. Following this intervention, there were no 30-day mortality, hemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the 39 patients, 28 are alive and 10 patients are dead with a median survival of 89.5 (range 14–260) days and median stent patency of 84.5 (range 14–260) days. One patient was lost to follow-up. All but one patient had their stent patent at the time of last follow-up or death. One patient with stent blockage at 42 days postprocedure underwent percutaneous transhepatic drain insertion and restenting. Among the patients who are alive (n = 28) the median stent patency was 92 (range 14–260) days, whereas the patients who died (n = 10) had a median stent patency of 62.5 (range 38–210) days. Conclusions. In this group of patients, it appears that this new approach is feasible and safe. Efficacy remains to be proven in future, randomized, prospective studies.

  20. 内镜诊治急性胆源性胰腺炎的临床分析%Clinical Analysis of Endoscopy in Diagnosis and Treatment of Acute Biliary Pancreatitis

    Institute of Scientific and Technical Information of China (English)

    覃华; 李德民; 王波; 李荣香; 张敏; 胡继芬; 刘南植; 赵秋

    2011-01-01

    目的:评价内镜诊治急性胆源性胰腺炎(ABP)的临床价值.方法:回顾性分析内镜治疗的114例ABP患者以及内科常规治疗的106例ABP患者的临床资料,评价内镜诊治ABP的临床价值.结果:内镜治疗组114例均顺利完成逆行胰胆管造影(ERCP)检查并确诊,其中107例同时经内镜分别进行十二指肠乳头括约肌切开、胆管取石/蛔虫/血凝块、鼻胆管引流、胆管内置管/金属支架引流等治疗,术后所有患者均治愈出院,无明显并发症发生;与常规治疗组相比内镜治疗组平均住院时间明显缩短(12.1±4.2d vs.18.7±8.9d,P<0.05),平均住院费用明显降低(P<0.05).结论:内镜治疗ABP是一项安全、有效的措施;早期ERCP检查可明确ABP的病因,同时内镜治疗可及时去除其病因.可明显缩短患者平均住院时间、降低平均住院费用.%Objective: To evaluate the clinical value of endoscopy in diagnosis and treatment of acute biliary pancreatitis (ABP). Methods; Clinical data of 114 cases with ABP underwent endoscopic therapy and 106 cases treated with routine treatments were analyzed retrospectively. The clinical value of endoscopy in diagnosis and treatment of ABP were evaluated. Results: Endoscopic retrograde cholangio-pancreatography (ERCP) was carried out successfully in all 114 patients, among which 107 cases underwent endoscopic treatments (endoscopic sphincterotomy, endoscopic retrograde biliary drainage, endoscopic biliary metallic stent drainage, or endoscopic nasobiliary drainage). All 114 cases were cured after ERCP without obvious complications. The average length of hospital stay was significantly shorter (12. 1 ± 4. 2 d vs 18. 7 ±8. 9 d,P <0. 05) and the costs were markedly lower in patients treated with ERCP compared with those with routine treatment (P<0. 05). Conclusions: Endoscopic therapy is a safe and effective measure for patients with ABP. Early ERCP can confirm and eliminate the cause of ABP at one time

  1. Water-table-dependent hydrological changes following peatland forestry drainage and restoration: Analysis of restoration success

    Science.gov (United States)

    Menberu, Meseret Walle; Tahvanainen, Teemu; Marttila, Hannu; Irannezhad, Masoud; Ronkanen, Anna-Kaisa; Penttinen, Jouni; Kløve, Bjørn

    2016-05-01

    A before-after-control approach was used to analyze the impact of peatland restoration on hydrology, based on high temporal resolution water-table (WT) data from 43 boreal peatlands representative of a south-boreal to north-boreal climate gradient. During the study, 24 forestry drained sites were restored and 19 pristine peatlands used as control sites. Different approaches were developed and used to analyze WT changes (mean WT position, WT fluctuation, WT hydrograph, recession, and storage characteristics). Restoration increased WT in most cases but particularly in spruce mires, followed by pine mires and fens. Before restoration, the WT fluctuation (WTF) was large, indicating peat temporary storage gain (SG). After restoration, the WT hydrograph recession limb slopes and SG coefficients (Rc) declined significantly. Drainage or restoration did not significantly affect mean diurnal WT fluctuations, used here as a proxy for evapotranspiration. Overall, the changes in WT characteristics following restoration indicated creation of favorable hydrological conditions for recovery of functional peatland ecosystems in previously degraded peatland sites. This was supported by calculation of bryophyte species abundance thresholds for WT. These results can be used to optimize restoration efforts in different peatland systems and as a qualitative conceptual basis for future restoration operations.

  2. Combined treatment with metallic stent placement and radiotherapy in malignant biliary obstruction

    International Nuclear Information System (INIS)

    To evaluate the efficacy of combined treatment of metallic biliary stent placement and radiotherapy in malignant biliary obstruction. Between January 1992 and February 1994, 22 patients with malignant biliary obstruction were treated with metallic biliary stent placement and radiotherapy. The causes of the obstruction included cholangio carcinoma(n=14), gallbladder carcinoma(n=4), colon cancer(n=2), pancreatic head cancer (n=1), and stomach cancer(n=1). According to the sites of obstruction level, patient were divided into 2 groups; hilar obstruction(n=18) and common bile duct obstruction(n=4). The patients received dose of 45 Gray/18 fraction by external radiotherapy and 20Gy/8f by high dose rate brachytherapy with iridium-192 source through percutaneous transhepatic biliary drainage(PTBD) catheter. The duration of stent patency after placement, survival period and survival rate by Kaplan Meier method were calculated in dead and alive patients, respectively. In all 22 patients, the duration of stent patency was 5.5(1.3-18.5)months. Survival periods after stent placement and PTBD were 5.3(2.0-8.5 )months and 7.9(4.0-14.7)months respectively in 9 dead patients and 7.7(1.3-21.0)months and 9.5(2.3-23.0)months in 13 alive patients. In all 22 patients, the survival rates in 6, 12 and 18 months were 78.9%, 47.5% and 35.6 %, respectively. The results with combined metallic biliary stent placement and radiotherapy for the palliative treatment of malignant biliary obstruction in this study was more favorable, as compared with those of the other authors with only metallic biliary stent placement

  3. Percutaneous unilateral biliary metallic stent placement in patients with malignant obstruction of the biliary hila and contralateral portal vein steno-occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Son, Rak Chae; Gwon, Dong Il; Ko, Heung Kyu; Kim, Jong Woo; Ko, Gi Young [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2015-06-15

    To investigate the outcomes of percutaneous unilateral metallic stent placement in patients with a malignant obstruction of the biliary hila and a contralateral portal vein steno-occlusion. Sixty patients with a malignant hilar obstruction and unilobar portal vein steno-occlusion caused by tumor invasion or preoperative portal vein embolization were enrolled in this retrospective study from October 2010 to October 2013. All patients were treated with percutaneous placement of a biliary metallic stent, including expanded polytetrafluoroethylene (ePTFE)-covered stents in 27 patients and uncovered stents in 33 patients. A total of 70 stents were successfully placed in 60 patients. Procedural-related minor complications, including self-limiting hemobilia (n = 2) and cholangitis (n = 4) occurred in six (10%) patients. Acute cholecystitis occurred in two patients. Successful internal drainage was achieved in 54 (90%) of the 60 patients. According to a Kaplan-Meier analysis, median survival time was 210 days (95% confidence interval [CI], 135-284 days), and median stent patency time was 133 days (95% CI, 94-171 days). No significant difference in stent patency was observed between covered and uncovered stents (p = 0.646). Stent dysfunction occurred in 16 (29.6%) of 54 patients after a mean of 159 days (range, 65-321 days). Unilateral placement of ePTFE-covered and uncovered stents in the hepatic lobe with a patent portal vein is a safe and effective method for palliative treatment of patients with a contralateral portal vein steno-occlusion caused by an advanced hilar malignancy or portal vein embolization. No significant difference in stent patency was detected between covered and uncovered metallic stents.

  4. Percutaneous unilateral biliary metallic stent placement in patients with malignant obstruction of the biliary hila and contralateral portal vein steno-occlusion

    International Nuclear Information System (INIS)

    To investigate the outcomes of percutaneous unilateral metallic stent placement in patients with a malignant obstruction of the biliary hila and a contralateral portal vein steno-occlusion. Sixty patients with a malignant hilar obstruction and unilobar portal vein steno-occlusion caused by tumor invasion or preoperative portal vein embolization were enrolled in this retrospective study from October 2010 to October 2013. All patients were treated with percutaneous placement of a biliary metallic stent, including expanded polytetrafluoroethylene (ePTFE)-covered stents in 27 patients and uncovered stents in 33 patients. A total of 70 stents were successfully placed in 60 patients. Procedural-related minor complications, including self-limiting hemobilia (n = 2) and cholangitis (n = 4) occurred in six (10%) patients. Acute cholecystitis occurred in two patients. Successful internal drainage was achieved in 54 (90%) of the 60 patients. According to a Kaplan-Meier analysis, median survival time was 210 days (95% confidence interval [CI], 135-284 days), and median stent patency time was 133 days (95% CI, 94-171 days). No significant difference in stent patency was observed between covered and uncovered stents (p = 0.646). Stent dysfunction occurred in 16 (29.6%) of 54 patients after a mean of 159 days (range, 65-321 days). Unilateral placement of ePTFE-covered and uncovered stents in the hepatic lobe with a patent portal vein is a safe and effective method for palliative treatment of patients with a contralateral portal vein steno-occlusion caused by an advanced hilar malignancy or portal vein embolization. No significant difference in stent patency was detected between covered and uncovered metallic stents.

  5. 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.

  6. Prognostic impact of hepatobiliary scintigraphy in diagnosis and postoperative follow-up of newborns with biliary atresia

    International Nuclear Information System (INIS)

    Aim: To investigate the prognostic relevance of hepatobiliary scintigraphy (HBS) in newborns suffering from biliary atresia (BA) for establishing the primary diagnosis and in the postoperative follow-up after portoenterostomy (Kasai). Methods: Twenty newborns with direct hyperbilirubinemia and 6 children after operative treatment of BA (Kasai) underwent HBS with Tc-99m-DEIDA. In patients without intestinal drainage, hepatocellular extraction was estimated visually and calculated semiquantitatively by means of liver/heart-ratio 5 min p.i. Results: 10/20 patients with hyperbilirubinemia did not display biliary drainage; 6 had BA, 3 intrahepatic hypoplasia, and one showed a bile plug syndrom. 4/6 with BA but none of the 4 children with diagnoses other than BA presented with a good extraction. All of the 4 children with BA, who had either pre- or postoperatively a bad extraction, needed liver transplantation due to liver failure. Both of the two newborns with BA and favourable outcome after Kasai had a good extraction in the preoperative HBS and demonstrated good intestinal drainage in the postoperative scan. Conclusion: HBS rules out BA with high accuracy by demonstrating drainage of bile into the intestine. In newborns without drainage a good extraction favours the diagnosis of BA. In newborns with BA a bad extraction seems to indicate a poor postoperative prognosis after Kasai operation. HBS might therefore help to select those children who will not benefit from portoenterostomy. Postoperatively, HBS can easily and quickly confirm the successful hepatobiliary anastomosis by demonstrating biliary drainage into the intestine. (orig.)

  7. Interventional management for biliary tract complications following liver transplantation

    International Nuclear Information System (INIS)

    Objective: To investigate the role of interventional procedures in the management of biliary tract complications following liver transplantation, and so as the effect of t-tube indwelling. Methods: A review was made of data collected from 55 patients in two groups designated according to t-tube indwelling (28)or not (27). Data were retrospectively analyzed in terms of interventional procedures performed, and outcomes. Results: A total of 55 liver transplantation patients survived more than 1 month after interventional treatment for biliary tract complications, including 11 only with a drainage T-tube, the other 44 (80.0%) with one or more interventional procedures such as PTBD, balloon dilation to cure obstructive jaundice. Additionally 8 cases undertook stenting for hepatic artery, hepatic vein or portal vein stenosis. Conclusions: Interventional procedures are safe and effective for most patients with biliary tract complications following liver transplantation, with easy repetition in performance, including T-tube indwelling to provide a route for further diagnosis and treatment. Yet it is necessary to have other various interventional managements for the whole intact satisfaction of patients. (authors)

  8. 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.

  9. 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 ...

  10. Endoscopic ultrasound guided drainage of pancreatic fluidcollections: Assessment of the procedure, technical detailsand review of the literature

    Institute of Scientific and Technical Information of China (English)

    Rajesh Puri; Ragesh Babu Thandassery; Abdulrahman A Alfadda; Saad Al Kaabi

    2015-01-01

    Endoscopic ultrasound (EUS) guided drainage ofpancreatic fluid collections (PFC) has become increasinglypopular and become first line managementoptionin many centers. Use of therapeutic echoendoscopeshas greatly increased the applicability of EUS guidedtransmural drainage. Drainage is indicated insymptomatic PFCs, PFC related infection, bleed, luminalobstruction, fistulization and biliary obstruction. EUSguided transmural drainage of PFCs is preferred inpatients with non bulging lesions, portal hypertension,bleeding tendency and in those whom conventionaldrainage has failed. In the present decade significantprogress has been made in minimally invasive endoscopictechniques. There are newer stent designs,access devices and techniques for more efficientdrainage of PFCs. In this review, we discuss the EUSguided drainage of PFCs in acute pancreatitis.

  11. Cost-Effectiveness Analysis of Surface Flow Constructed Wetlands (SFCW) for Nutrient Reduction in Drainage Discharge from Agricultural Fields in Denmark

    Science.gov (United States)

    Gachango, F. G.; Pedersen, S. M.; Kjaergaard, C.

    2015-12-01

    Constructed wetlands have been proposed as cost-effective and more targeted technologies in the reduction of nitrogen and phosphorous water pollution in drainage losses from agricultural fields in Denmark. Using two pig farms and one dairy farm situated in a pumped lowland catchment as case studies, this paper explores the feasibility of implementing surface flow constructed wetlands (SFCW) based on their cost effectiveness. Sensitivity analysis is conducted by varying the cost elements of the wetlands in order to establish the most cost-effective scenario and a comparison with the existing nutrients reduction measures carried out. The analyses show that the cost effectiveness of the SFCW is higher in the drainage catchments with higher nutrient loads. The range of the cost effectiveness ratio on nitrogen reduction differs distinctively with that of catch crop measure. The study concludes that SFCW could be a better optimal nutrients reduction measure in drainage catchments characterized with higher nutrient loads.

  12. Cost-Effectiveness Analysis of Surface Flow Constructed Wetlands (SFCW) for Nutrient Reduction in Drainage Discharge from Agricultural Fields in Denmark.

    Science.gov (United States)

    Gachango, F G; Pedersen, S M; Kjaergaard, C

    2015-12-01

    Constructed wetlands have been proposed as cost-effective and more targeted technologies in the reduction of nitrogen and phosphorous water pollution in drainage losses from agricultural fields in Denmark. Using two pig farms and one dairy farm situated in a pumped lowland catchment as case studies, this paper explores the feasibility of implementing surface flow constructed wetlands (SFCW) based on their cost effectiveness. Sensitivity analysis is conducted by varying the cost elements of the wetlands in order to establish the most cost-effective scenario and a comparison with the existing nutrients reduction measures carried out. The analyses show that the cost effectiveness of the SFCW is higher in the drainage catchments with higher nutrient loads. The range of the cost effectiveness ratio on nitrogen reduction differs distinctively with that of catch crop measure. The study concludes that SFCW could be a better optimal nutrients reduction measure in drainage catchments characterized with higher nutrient loads.

  13. Endoscopic drainage in patients with inoperable hilar cholangiocarcinoma

    OpenAIRE

    Park, Ye Jin; Kang, Dae Hwan

    2012-01-01

    Hilar cholangiocarcinoma has an extremely poor prognosis and is usually diagnosed at an advanced stage. Palliative management plays an important role in the treatment of patients with inoperable hilar cholangiocarcinoma. Surgical, percutaneous, and endoscopic biliary drainage are three modalities available to resolve obstructive jaundice. Plastic stents were widely used in the past; however, self-expanding metal stents (SEMS) have become popular recently due to their long patency and reduced ...

  14. Molecular analysis of benthic biofilms from acidic coal mine drainage, Pennsylvania, USA

    Science.gov (United States)

    Mills, D. B.; Jones, D. S.; Burgos, W. D.; Macalady, J. L.

    2010-12-01

    Acid mine drainage (AMD) is a common environmental problem in Pennsylvania that results from the oxidation of sulfide minerals exposed at abandoned coal mines. In these systems, acidophilic microorganisms catalyze the oxidation of ferrous (Fe2+) to ferric iron (Fe3+), which precipitates as iron-hydroxide minerals. To develop and improve low-pH bioremediation strategies, characterization of the microbiology of AMD systems is essential. An acidic (pH 2-4) AMD spring known as ‘Lower Red Eyes’ in Gallitzan State Forest, PA, is fed by anoxic groundwater with ferrous iron concentrations above 550 mg/L. More than half of the total iron is removed after the springwater flows downstream over 80 m of stagnant pools and iron-oxide terraces. We used fluorescence in situ hybridization (FISH) and 16S rDNA cloning to characterize the microbial communities from orange sediments and green benthic biofilms. 16S rDNA sequences were extracted from a green biofilm found in a pH 3.5 pool 10 m downstream of the emergence. Based on chloroplast 16S rDNA sequences and morphological characteristics, we found that Euglena mutabilis was the dominant eukaryotic organism from this location. Euglena mutabilis is a photosynthetic protozoan common in acidic and heavy metal affected environments, and likely contributes to the precipitation of iron oxides through the production of molecular oxygen. Bacterial 16S rDNA sequences were cloned from iron-oxide sediments with orange cauliflower morphology 27 m downstream from the spring emergence. More than 60% of bacterial sequences retrieved from the orange sediment sample are related to the iron-oxidizing Betaproteobacterium Ferrovum myxofaciens. Other bacterial sequences include relatives of iron-oxidizing genera in the Gammaproteobacteria, Betaproteobacteria, and Actinobacteria. FISH analyses show that Betaproteobacteria-dominated communities are associated with Euglena in multiple upstream locations where pH is above 3.0. Using light microscopy

  15. Primary biliary cirrhosis

    Directory of Open Access Journals (Sweden)

    Heathcote E Jenny

    2008-01-01

    Full Text Available Abstract Primary biliary cirrhosis (PBC is a chronic and slowly progressive cholestatic liver disease of autoimmune etiology characterized by injury of the intrahepatic bile ducts that may eventually lead to liver failure. Affected individuals are usually in their fifth to seventh decades of life at time of diagnosis, and 90% are women. Annual incidence is estimated between 0.7 and 49 cases per million-population and prevalence between 6.7 and 940 cases per million-population (depending on age and sex. The majority of patients are asymptomatic at diagnosis, however, some patients present with symptoms of fatigue and/or pruritus. Patients may even present with ascites, hepatic encephalopathy and/or esophageal variceal hemorrhage. PBC is associated with other autoimmune diseases such as Sjogren's syndrome, scleroderma, Raynaud's phenomenon and CREST syndrome and is regarded as an organ specific autoimmune disease. Genetic susceptibility as a predisposing factor for PBC has been suggested. Environmental factors may have potential causative role (infection, chemicals, smoking. Diagnosis is based on a combination of clinical features, abnormal liver biochemical pattern in a cholestatic picture persisting for more than six months and presence of detectable antimitochondrial antibodies (AMA in serum. All AMA negative patients with cholestatic liver disease should be carefully evaluated with cholangiography and liver biopsy. Ursodeoxycholic acid (UDCA is the only currently known medication that can slow the disease progression. Patients, particularly those who start UDCA treatment at early-stage disease and who respond in terms of improvement of the liver biochemistry, have a good prognosis. Liver transplantation is usually an option for patients with liver failure and the outcome is 70% survival at 7 years. Recently, animal models have been discovered that may provide a new insight into the pathogenesis of this disease and facilitate appreciation for

  16. Combination Therapy of Ursodeoxycholic Acid and Corticosteroids for Primary Biliary Cirrhosis with Features of Autoimmune Hepatitis: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Yan Zhang

    2013-01-01

    Full Text Available A meta-analysis was performed of RCTs comparing therapies that combine UDCA and corticosteroids with UDCA monotherapy. In this paper, we found that the combination therapy of UDCA and corticosteroids was more effective for PBC-AIH.

  17. 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.

  18. The value of the hepatobiliaric function scintigraphy with Tc-99m-DAIDA for post-operative biliary tract function diagnosis

    International Nuclear Information System (INIS)

    The goal of this work was the examination of the value of biliary tract scintigraphy with 99m Tc DAIDA for post-operative supervision after biliary tract operations. The subjects were made up of 22 patients, who between 1969 and 1980 had undergone a choledochus revision with the insertion of a T drainage. In all cases with cholestase-specific laboratory findings the intra- and extrahepatic biliary tracts were expanded and in 71% of the cases were combined with an organically dependent drainage retardation which was scintigraphically proven. The proof of an organically dependent drainage retardation in scintigraphy coincided almost always with expanded biliary paths and in almost half the cases with blockage-specific changes in the laboratory values. Conclusion: By patients with operations on the biliary tracts the indication for biliary tract scintigraphy with 99m Tc DAIDA is always given, if with cholestase- oder liver-specifically changed laboratory values no concretions using sonography or preliminary radiographs could be proven. (TRV)

  19. Endoscopic management of benign biliary strictures

    Institute of Scientific and Technical Information of China (English)

    Kavel; H; Visrodia; James; H; Tabibian; Todd; H; Baron

    2015-01-01

    Endoscopic management of biliary obstruction has evolved tremendously since the introduction of flexible fiberoptic endoscopes over 50 years ago. For the last several decades, endoscopic retrograde cholangiopancreatography(ERCP) has become established as the mainstay for definitively diagnosing and relieving biliary obstruction. In addition, and more recently, endoscopic ultrasonography(EUS) has gained increasing favor as an auxiliary diagnostic and therapeutic modality in facilitating decompression of the biliary tree. Here, we provide a review of the current and continually evolving role of gastrointestinal endoscopy, including both ERCP and EUS, in the management of biliary obstruction with a focus on benign biliary strictures.

  20. Risk of Post-ERCP Pancreatitis after placement of Covered versus Uncovered Self-Expandable Biliary Metal Stents: A Systematic Review and Meta-Analysis

    OpenAIRE

    Yaseen Alastal; Tariq Hammad; Muhammad Ali Khan; Khalil, Basmah W.; Sobia Khan; Mohammad Kashif Ismail; Ali Nawras; Aijaz Sofi

    2008-01-01

    Background Self-expandable metal stents are commonly used in the management of malignant biliary obstruction due to higher patency rates compared to plastic stents. Development of covered self-expandable metal stents has led to extended stent patency compared to uncovered self-expandable metal stents. However, there are concerns that deployment of covered self-expandable metal stents may be associated with higher risk of post-endoscopic retrograde cholangio-pancreatography pancreatitis, acute...

  1. Chemical ablation of the gallbladder using alcohol in cholecystitis after palliative biliary stenting

    Institute of Scientific and Technical Information of China (English)

    Tae Hoon Lee; Sang-Heum Park; Sang Pil Kim; Ji-Young Park; Chang Kyun Lee; Il-Kwun Chung; Hong Soo Kim; Sun-Joo Kim

    2009-01-01

    Chemical ablation of the gallbladder is effective in patients at high risk of complications after surgery.Percutaneous gallbladder drainage is an effective treatment for cholecystitis; however, when the drain tube cannot be removed because of recurrent symptoms, retaining it can cause problems. An 82-year-old woman presented with cholecystitis and cholangitis caused by biliary stent occlusion and suspected tumor invasion of the cystic duct. We present successful chemical ablation of the gallbladder using pure alcohol, through a percutaneous gallbladder drainage tube, in a patient who developed intractable cholecystitis with obstruction of the cystic duct after receiving a biliary stent. Our results suggest that chemical ablation therapy is an effective alternative to surgical therapy for intractable cholecystitis.

  2. New development of biliary surgery in China

    Institute of Scientific and Technical Information of China (English)

    Zhi Qiang Huang

    2000-01-01

    @@CHARACTERISTICS OF BILIARY CALCULOUS DISEASES IN CHINA: THE CHANGING SCOPE Diseases of the biliary tract in China is complicated with the prevalence of primary infection of the bile duct system. In the middle of the 20th century, biliary infection, biliary parasitic infestation, and biliary stones made up the three chief components of biliary diseases in China. As to the calculous diseases of the biliary tract, the relative incidence of primary bile duct stones accounted for 50% of the total cases. Therefore, calculous disease accounted for 60.1% among 228 surgical cases in the Chongqing Southwest Hospital, and 60 of the 80 common bile duct stones were primary bile duct origin ( including primary intrahepatic duct stones)[1,2].

  3. 金属支架、内涵管置入术治疗恶性胆道梗阻的成本-效果分析(多中心研究)%The Cost-effectiveness Analysis of Percutaneous Transhepatic Metal Versus Plastic Biliary Stent Implantation for Treating Malignant Biliary Obstruction (Multiple Center Investigation)

    Institute of Scientific and Technical Information of China (English)

    郭元星; 李彦豪; 陈勇; 陈平雁; 罗鹏飞; 李勇; 单鸿; 姜在波

    2004-01-01

    目的比较金属支架与塑料支架(内涵管)置入术治疗恶性胆道梗阻成本-效果比.方法调查广东省三家医院95例实施经皮穿肝胆总管支架置入术的恶性胆道梗阻患者,其中61例置入自膨式金属支架(支架组),34例置入10F塑料内涵管(内涵管组).所有患者均回访至死亡或至少术后1年.用Kaplan-Meier方法分析比较两组患者的生存及支架开通率,并计算两组的成本-效果比(Cost-effective rations,CER),即CER中位生存期=总成本/中位生存期,CER中位开通期=总成本/中位开能期.结果两组总成本无差异,分别为53177±3139元和43564±4950(P<0.05).支架组的CER中位生存期=237.4元/d、CER中仪开通期=231.2 元/d,低于内涵管组(分别为CER中位生存期=452.6元/d、CER中位开通期=472.9 元/d.结论金属支架置入术治疗恶性胆道梗阻的成本效果比优于内涵管.%Objective: To compare metal versus plastic biliary stent implantation for treatment of malignant biliary obstruction in cost-effectiveness ratio (CER). Methods: Percutaneous transhepatic self-expandable metal stent (MS, n=61) or 10F plastic stent (PS, n=34) implantation was performed in 95 patients with malignant biliary obstruction in three hospitals of Guangdong province. All patients were followed up until death or at least one year after the procedure. Kaplan-Meier analysis was used to compare the survival and stent patency rates of the patients in the two groups. CERs of two groups were calculated.The main indexes were CERsurvival period (total cost/median survival period), CERpatency period (total cost/median patency period). Results: The total costs of treatment were 53177±3139 yuan (RMB) in MS group and 42564±4950 yuan (RMB) in PS group respectively (P>0.05). CER in MS group was superior to that in PS group (CERsurvival period was 237.4 yuan/d vs 452.6 yuan/d, respectively; CERpatency period was 231.2 yuan/d vs 472.9 yuan/d, respectively). Conclusion: The

  4. 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

  5. Evaluation of awake burr hole drainage for chronic subdural hematoma in geriatric patients: a retrospective analysis of 3 years

    OpenAIRE

    Serdal Albayrak; ibrahim Burak Atci; Necati Ucler; Hakan Yilmaz; Metin Kaplan

    2016-01-01

    Purpose: The goal of this research was to evaluate the effectiveness of burr hole drainage under local anesthesia in geriatric patients with chronic subdural hematoma. Material and Methods: This retrospective study involved 21 geriatric patients with chronic subdural hematoma who applied to the department of neurosurgery in an education and research hospital between 2011 and 2014. Sedoanalgesia was performed on 21 patients, then awake burr hole drainage was performed after scalp and perios...

  6. Salt crust development in paddy fields owing to soil evaporation and drainage : contribution of chloride and deuterium profile analysis

    OpenAIRE

    Grunberger, Olivier; Macaigne, P.; Michelot, J. L.; Hartmann, Christian; Sukchan, S.

    2008-01-01

    In Northeast Thailand lowlands with shallow saline watertable, rainfed paddy fields often present high salt concentration in the dry season, forming patches or spots of salt crusts on the soil surface. In this context, the mechanisms implied in salt concentration during dry season were studied by establishing salt budget with evaporation and drainage estimates inside and outside a saline patch. Drainage was estimated by Hydrus-1D modelling constrained by an hydrodynamic characterization and t...

  7. Modified gianturco biliary stent in benign and malignant obstruction: Results of long-term follow up

    International Nuclear Information System (INIS)

    Modified biliary gianturco stents were placed in 27 patients with obstructive jaundice. From July 1990 to October 1992, 46 two-seven connected stents of 8-12 mm in diameter (Myungsung Meditech, Seoul, Korea) were placed in 5 patients with benign biliary stricture and 22 patients with malignant biliary stricture in three university hospitals; 12 in Chonbuk National University Hospital, 12 in Wonkwang University Hospital, and 3 in Chonnam National University Hospital. Nineteen were men and eight were women, ranged in age from 34 to 76 years (average, 55 years). The stents were placed percutaneously through a transhepatic approach using a 8.5 Fr. introducing sheath. All stents were placed successfully without any technical failures or procedural morbidity or mortality. All patients complained dull abdominal pain for 1 to 3 days after the stent placement. In a follow-up period of 7-46 weeks, reocclusions were observed in one of the patients with benign stricture (20%) and three of the patients with malignant stricture (16%). Two patients with recurrent jaundice due to the obstruction of the stent were treated with placement of additional stent, one patient was treated with external catheter drainage. Migration of stent occurred in one patient. The application of the expandable biliary metallic stent is suggested as an effective treatment for benign and malignant biliary obstructive jaundice

  8. Acute renal failure in obstructive diseases of the extrahepatic biliary ducts.

    Science.gov (United States)

    Acalovschi, I; Chirileanu, T

    1984-01-01

    A series of 46 patients with obstructive disease of the bile ducts complicated by acute renal failure (ARF) is presented. The patients exhibited obstructive jaundice with prevalence of conjugated bilirubine. In 80% of the cases biliary obstruction was associated with cholangitis. Disturbances of the liver function (from mild cholestasis to biliary cirrhosis) were also present. The renal damage was due to biliary disorders and was either present on admission (33 cases) or developed postoperatively (13 cases). Most of the patients presented nonoliguric ARF as well as poor perfusion resulting from decreased circulating blood volume (dehydration and electrolyte loss). Among the criteria used to determine the type of ARF, the urinary/plasma creatinine ratio less than 10 and urinary/plasma osmolarity ratio less than 1.1 were the most valuable. Management of ARF by dialysis alone was not satisfactory. Attention is called to the surgical treatment of the biliary disorder as being essential to prognosis. Patients not treated by radical surgery died in proportion of 87 to 100%. From the rest of 18 patients in whom the operation provided an adequate biliary drainage, in 15 the renal function was restored and 12 survived. Better prognosis in these patients was dependent not only on the ability to cure the cholestasis and infection, but on the early surgical treatment. The ultimate prognosis depends on the improvement of the liver function.

  9. Modified gianturco biliary stent in benign and malignant obstruction: Results of long-term follow up

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Jin Young; Song, Ho Young; Han, Hyun Young; Han, Young Min; Chung, Gyung Ho; Kim, Chong Soo; Choi, Ki Chul; Roh, Byung Suk; Kim, Jae Kyu [College of Medicine, Chonbuk National University, Chonju (Korea, Republic of)

    1993-05-15

    Modified biliary gianturco stents were placed in 27 patients with obstructive jaundice. From July 1990 to October 1992, 46 two-seven connected stents of 8-12 mm in diameter (Myungsung Meditech, Seoul, Korea) were placed in 5 patients with benign biliary stricture and 22 patients with malignant biliary stricture in three university hospitals; 12 in Chonbuk National University Hospital, 12 in Wonkwang University Hospital, and 3 in Chonnam National University Hospital. Nineteen were men and eight were women, ranged in age from 34 to 76 years (average, 55 years). The stents were placed percutaneously through a transhepatic approach using a 8.5 Fr. introducing sheath. All stents were placed successfully without any technical failures or procedural morbidity or mortality. All patients complained dull abdominal pain for 1 to 3 days after the stent placement. In a follow-up period of 7-46 weeks, reocclusions were observed in one of the patients with benign stricture (20%) and three of the patients with malignant stricture (16%). Two patients with recurrent jaundice due to the obstruction of the stent were treated with placement of additional stent, one patient was treated with external catheter drainage. Migration of stent occurred in one patient. The application of the expandable biliary metallic stent is suggested as an effective treatment for benign and malignant biliary obstructive jaundice.

  10. Bile Culture and Susceptibility Testing of Malignant Biliary Obstruction via PTBD

    Energy Technology Data Exchange (ETDEWEB)

    Yu Haipeng; Guo Zhi, E-mail: jieruke@yahoo.com.cn; Xing Wenge; Guo Xiuying; Liu Fang; Li Baoguo [Tinajin Medical University Cancer Institute and Hospital, Department of Interventional Therapy, Tianjin Key Cancer Prevention and Treatment Laboratory (China)

    2012-10-15

    Purpose: To assess the information obtained by bile culture and susceptibility testing for malignant biliary obstruction by a retrospective one-center study. Methods: A total of 694 patients with malignant biliary obstruction received percutaneous transhepatic biliary drainage during the period July 2003 to September 2010, and subsequently, bile specimens were collected during the procedure. Among the 694 patients, 485 were men and 209 were women, ranging in age from 38 to 78 years (mean age 62 years). Results: A total of 42.9% patients had a positive bile culture (298 of 694). Further, 57 species of microorganisms and 342 strains were identified; gram-positive bacteria accounted for 50.9% (174 of 342) and gram-negative bacteria accounted for 41.5% (142 of 342) of these strains. No anaerobes were obtained by culture during this study. The most common microorganisms were Enterococcus faecalis (41 of 342, 11.9%), Escherichia coli (34 of 342, 9.9%), Klebsiella pneumoniae (28 of 342, 8.2%), Staphylococcus epidermidis (19 of 342, 5.5%), Enterococcus (18 of 342, 5.3%), and Enterobacter cloacae (16 of 342, 4.7%). The percentage of {beta}-lactamase-producing gram-positive bacteria was 27.6% (48 of 174), and the percentage of gram-negative bacteria was 19.7% (28 of 142). The percentage of enzyme-producing Escherichia coli was 61.7% (21 of 34). Conclusion: The bile cultures in malignant biliary obstruction are different from those in the Tokyo Guidelines and other benign biliary obstruction researches, which indicates that a different antibacterial therapy should be applied. Thus, knowledge of the antimicrobial susceptibility data could aid in the better use of antibiotics for the empirical therapy of biliary infection combined with malignant biliary obstruction.

  11. Bile Culture and Susceptibility Testing of Malignant Biliary Obstruction via PTBD

    International Nuclear Information System (INIS)

    Purpose: To assess the information obtained by bile culture and susceptibility testing for malignant biliary obstruction by a retrospective one-center study. Methods: A total of 694 patients with malignant biliary obstruction received percutaneous transhepatic biliary drainage during the period July 2003 to September 2010, and subsequently, bile specimens were collected during the procedure. Among the 694 patients, 485 were men and 209 were women, ranging in age from 38 to 78 years (mean age 62 years). Results: A total of 42.9% patients had a positive bile culture (298 of 694). Further, 57 species of microorganisms and 342 strains were identified; gram-positive bacteria accounted for 50.9% (174 of 342) and gram-negative bacteria accounted for 41.5% (142 of 342) of these strains. No anaerobes were obtained by culture during this study. The most common microorganisms were Enterococcus faecalis (41 of 342, 11.9%), Escherichia coli (34 of 342, 9.9%), Klebsiella pneumoniae (28 of 342, 8.2%), Staphylococcus epidermidis (19 of 342, 5.5%), Enterococcus (18 of 342, 5.3%), and Enterobacter cloacae (16 of 342, 4.7%). The percentage of β-lactamase-producing gram-positive bacteria was 27.6% (48 of 174), and the percentage of gram-negative bacteria was 19.7% (28 of 142). The percentage of enzyme-producing Escherichia coli was 61.7% (21 of 34). Conclusion: The bile cultures in malignant biliary obstruction are different from those in the Tokyo Guidelines and other benign biliary obstruction researches, which indicates that a different antibacterial therapy should be applied. Thus, knowledge of the antimicrobial susceptibility data could aid in the better use of antibiotics for the empirical therapy of biliary infection combined with malignant biliary obstruction.

  12. Anatomy-shaped design of a fully-covered, biliary, self-expandable metal stent for treatment of benign distal biliary strictures

    OpenAIRE

    Weigt, Jochen; Kandulski, Arne; Malfertheiner, Peter

    2015-01-01

    Background and study aims: The treatment success of benign biliary strictures with fully covered metal stents (CSEMS) is altered by high stent dislocation rates. We aimed to evaluate a new stent design to prevent dislocation. Patients and methods: Patients with benign biliary strictures were treated with a newly designed double-coned stent (dcSEMS). Mechanical analysis of the new stent was performed and it was compared with a cylindrical stent. Results: A total of 13 dcCSEMS were implanted in...

  13. 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.

  14. Applications of network analysis for adaptive management of artificial drainage systems in landscapes vulnerable to sea level rise

    Science.gov (United States)

    Poulter, Benjamin; Goodall, Jonathan L.; Halpin, Patrick N.

    2008-08-01

    SummaryThe vulnerability of coastal landscapes to sea level rise is compounded by the existence of extensive artificial drainage networks initially built to lower water tables for agriculture, forestry, and human settlements. These drainage networks are found in landscapes with little topographic relief where channel flow is characterized by bi-directional movement across multiple time-scales and related to precipitation, wind, and tidal patterns. The current configuration of many artificial drainage networks exacerbates impacts associated with sea level rise such as salt-intrusion and increased flooding. This suggests that in the short-term, drainage networks might be managed to mitigate sea level rise related impacts. The challenge, however, is that hydrologic processes in regions where channel flow direction is weakly related to slope and topography require extensive parameterization for numerical models which is limited where network size is on the order of a hundred or more kilometers in total length. Here we present an application of graph theoretic algorithms to efficiently investigate network properties relevant to the management of a large artificial drainage system in coastal North Carolina, USA. We created a digital network model representing the observation network topology and four types of drainage features (canal, collector and field ditches, and streams). We applied betweenness-centrality concepts (using Dijkstra's shortest path algorithm) to determine major hydrologic flowpaths based off of hydraulic resistance. Following this, we identified sub-networks that could be managed independently using a community structure and modularity approach. Lastly, a betweenness-centrality algorithm was applied to identify major shoreline entry points to the network that disproportionately control water movement in and out of the network. We demonstrate that graph theory can be applied to solving management and monitoring problems associated with sea level rise

  15. Mine drainage treatment

    OpenAIRE

    Golomeova, Mirjana; Zendelska, Afrodita; Krstev, Boris; Golomeov, Blagoj; Krstev, Aleksandar

    2012-01-01

    Water flowing from underground and surface mines and contains high concentrations of dissolved metals is called mine drainage. Mine drainage can be categorized into several basic types by their alkalinity or acidity. Sulfide rich and carbonate poor materials are expected to produce acidic drainage, and alkaline rich materials, even with significant sulfide concentrations, often produce net alkaline water. Mine drainages are dangerous because pollutants may decompose in the environment. In...

  16. Drainage of radioactive areas

    International Nuclear Information System (INIS)

    This Code of Practice covers all the drainage systems which may occur in the radioactive classified area of an establishment, namely surface water, foul, process and radioactive drainage. It also deals with final discharge lines. The Code of Practice concentrates on those aspects of drainage which require particular attention because the systems are in or from radioactive areas and typical illustrations are given in appendices. The Code makes references to sources of information on conventional aspects of drainage design. (author)

  17. Transient drainage summary report

    International Nuclear Information System (INIS)

    This report summarizes the history of transient drainage issues on the Uranium Mill Tailings Remedial Action (UMTRA) Project. It defines and describes the UMTRA Project disposal cell transient drainage process and chronicles UMTRA Project treatment of the transient drainage phenomenon. Section 4.0 includes a conceptual cross section of each UMTRA Project disposal site and summarizes design and construction information, the ground water protection strategy, and the potential for transient drainage

  18. 持续灌洗引流治疗慢性骨髓炎护理分析%Continuous lavage drainage treatment of chronic osteomyelitis nursing analysis

    Institute of Scientific and Technical Information of China (English)

    郭云清

    2015-01-01

    目的:观察分析持续灌洗引流治疗慢性骨髓炎护理对术后恢复情况的影响,为临床治疗提供可靠依据。方法随机选取2012年—2014年分析30例慢性骨髓炎患者资料,本组患者均是先行病灶彻底清除手术,关闭创面之后进行敏感抗生素的持续灌洗引流。结果30例慢性脊髓炎经过持续灌洗引流之后,康复情况良好,并且对护理的满意度较高。结论在持续灌洗引流期间进行良好的护理,可以有效降低引流导管堵塞的概率,减少患者治疗时间,对患者康复具有积极意义。%Objective To observe the analysis of continuous irrigation drainage for the treatment of chronic osteomyelitis nursing effect on postoperative recovery, to provide reliable basis for clinical treatment.Methods Randomly selected from 2012-2014 to analyze the data of 30 cases of chronic osteomyelitis patients, all patients in the group is the first complete focal cleaning operation,continuous lavage closed wound drainage after the sensitive antibiotics.Results 30 cases of chronic inflammation of the spinal cord after continuous drainage,recovering well, and higher satisfaction with care.Conclusion Good nursing care during continuous lavage drainage, can effectively reduce the probability of the drainage catheter jam,reduce patient treatment time,the patient rehabilitation has a positive meaning.

  19. Establishment of a rat liver transplantation model with prolonged biliary warm ischemia time

    Institute of Scientific and Technical Information of China (English)

    Xin-Hua Zhu; Jun-Ping Pan; Ya-Fu Wu; Yi-Tao Ding

    2012-01-01

    AIM:To investigate the impact of different time points of secondary warm ischemia on bile duct in a rat autologous liver transplantation model with external bile drainage.METHODS:One hundred and thirty-six male inbred SD rats were randomly assigned to one of four groups (Ⅰ-Ⅳ) according to the secondary warm ischemia time of 0,10,20 and 40 min.A rat model of autologous liver transplantation with continuous external biliary drainage under ether anesthesia was established.Ten rats in each group were used to evaluate the one-week survival rate.At 6 h,24 h,3 d and 7 d after reperfusion of the hepatic artery,6 rats were killed in each group to collect the blood sample via the infrahepatic vena cava and the median lobe of liver for assay.Warm ischemia time of liver,cold perfusion time,anhepatic phase,operative duration for biliary external drainage and survival rates in the four groups were analyzed for the establishment of models.RESULTS:No significant difference was shown in warm ischemia time,anhepatic phase and operative duration for biliary external drainage among the four groups.Five of the 40 rats in this study evaluated for the one-week survival rate died,including three deaths of severe pulmonary infection in group Ⅳ.A significant decrease of one-week survival rate in group Ⅳ was noted compared with the other three groups.With the prolongation of the biliary warm ischemia time,the indexes of the liver function assessment were significantly elevated,and biliary epithelial cell apoptosis index also increased.Pathological examinations showed significantly aggravated inflammation in the portal area and bile duct epithelial cell injury with the prolonged secondary warm ischemia time.Microthrombi were found in the micrangium around the biliary tract in some sections from groups Ⅲ and Ⅳ.CONCLUSION:The relationship between secondary warm ischemia time and the bile duct injury degree is time-dependent,and 20 min of secondary warm ischemia time is feasible for

  20. Impact of Intraluminal Brachytherapy on Survival Outcome for Radiation Therapy for Unresectable Biliary Tract Cancer: A Propensity-Score Matched-Pair Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Yoshioka, Yasuo [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka (Japan); Ogawa, Kazuhiko, E-mail: kogawa@radonc.med.osaka-u.ac.jp [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka (Japan); Oikawa, Hirobumi [Department of Radiology, Iwate Medical University, Iwate (Japan); Onishi, Hiroshi [Department of Radiology, University of Yamanashi, Yamanashi (Japan); Kanesaka, Naoto [Department of Radiology, Tokyo Medical University, Tokyo (Japan); Tamamoto, Tetsuro [Department of Radiation Oncology, Nara Medical University of Medicine, Nara (Japan); Kosugi, Takashi [Department of Radiology, Hamamatsu University School of Medicine, Shizuoka (Japan); Hatano, Kazuo [Department of Radiation Oncology, Chiba Cancer Center, Chiba (Japan); Kobayashi, Masao [Department of Radiology, Jikei University School of Medicine, Tokyo (Japan); Ito, Yoshinori [Department of Radiation Oncology, National Cancer Center Hospital, Tokyo (Japan); Takayama, Makoto [Department of Radiology, Kyorin University School of Medicine, Tokyo (Japan); Takemoto, Mitsuhiro [Department of Radiology, Okayama University, Okayama (Japan); Karasawa, Katsuyuki [Department of Radiation Oncology, Tokyo Metropolitan Komagome Hospital, Tokyo (Japan); Nagakura, Hisayasu [Department of Radiology, KKR Sapporo Medical Center, Hokkaido (Japan); Imai, Michiko [Department of Radiation Oncology, Iwata City Hospital, Shizuoka (Japan); Kosaka, Yasuhiro [Department of Radiation Oncology, Kobe City Medical Center General Hospital, Hyogo (Japan); Yamazaki, Hideya [Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto (Japan); Isohashi, Fumiaki [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka (Japan); Nemoto, Kenji [Department of Radiation Oncology, Yamagata University, Yamagata (Japan); Nishimura, Yasumasa [Department of Radiation Oncology, Kinki University Faculty of Medicine, Osaka (Japan)

    2014-07-15

    Purpose: To determine whether adding intraluminal brachytherapy (ILBT) to definitive radiation therapy (RT) for unresectable biliary tract cancer has a positive impact on survival outcome. Methods and Materials: The original cohort comprised 209 patients, including 153 who underwent external beam RT (EBRT) alone and 56 who received both ILBT and EBRT. By matching propensity scores, 56 pairs (112 patients) consisting of 1 patient with and 1 patient without ILBT were selected. They were well balanced in terms of sex, age, performance status, clinical stage, jaundice, and addition of chemotherapy. The impact of ILBT on overall survival (OS), disease-specific survival (DSS), and local control (LC) was investigated. Results: The 2-year OS rates were 31% for the ILBT+ group and 40% for theILBT– group (P=.862). The 2-year DSS rates were 42% for the ILBT+ group and 41% for the ILBT– group (P=.288). The 2-year LC rates were 65% for the ILBT+ group and 35% for the ILBT– group (P=.094). Three of the 4 sensitivity analyses showed a significantly better LC for the ILBT+ group (P=.010, .025, .049), and another showed a marginally better LC (P=.068), and none of the sensitivity analyses showed any statistically significant differences in OS or DSS. Conclusions: In the treatment for unresectable biliary tract cancer, the addition of ILBT to RT has no impact on OS or DSS but is associated with better LC. Therefore, the role of ILBT should be addressed by other measures than survival benefit, for example, by less toxicity, prolonged biliary tract patency decreasing the need for further palliative interventions, or patient quality of life.

  1. Three-dimensional drip infusion CT cholangiography in patients with suspected obstructive biliary disease: a retrospective analysis of feasibility and adverse reaction to contrast material.

    Directory of Open Access Journals (Sweden)

    Smedby Ö

    2006-04-01

    Full Text Available Abstract Background Computed Tomography Cholangiography (CTC is a fast and widely available alternative technique to visualise hepatobiliary disease in patients with an inconclusive ultrasound when MRI cannot be performed. The method has previously been relatively unknown and sparsely used, due to concerns about adverse reactions and about image quality in patients with impaired hepatic function and thus reduced contrast excretion. In this retrospective study, the feasibility and the frequency of adverse reactions of CTC when using a drip infusion scheme based on bilirubin levels were evaluated. Methods The medical records of patients who had undergone upper abdominal spiral CT with subsequent three-dimensional rendering of the biliary tract by means of CTC during seven years were retrospectively reviewed regarding serum bilirubin concentration, adverse reaction and presence of visible contrast media in the bile ducts at CT examination. In total, 153 consecutive examinations in 142 patients were reviewed. Results Contrast media was observed in the bile ducts at 144 examinations. In 110 examinations, the infusion time had been recorded in the medical records. Among these, 42 examinations had an elevated bilirubin value (>19 umol/L. There were nine patients without contrast excretion; 3 of which had a normal bilirubin value and 6 had an elevated value (25–133 umol/L. Two of the 153 examinations were inconclusive. One subject (0.7% experienced a minor adverse reaction – a pricking sensation in the face. No other adverse effects were noted. Conclusion We conclude that drip infusion CTC with an infusion rate of the biliary contrast agent iotroxate governed by the serum bilirubin value is a feasible and safe alternative to MRC in patients with and without impaired biliary excretion. In this retrospective study the feasibility and the frequency of adverse reactions when using a drip infusion scheme based on bilirubin levels has been evaluated.

  2. Three-dimensional drip infusion CT cholangiography in patients with suspected obstructive biliary disease: a retrospective analysis of feasibility and adverse reaction to contrast material

    International Nuclear Information System (INIS)

    Computed Tomography Cholangiography (CTC) is a fast and widely available alternative technique to visualise hepatobiliary disease in patients with an inconclusive ultrasound when MRI cannot be performed. The method has previously been relatively unknown and sparsely used, due to concerns about adverse reactions and about image quality in patients with impaired hepatic function and thus reduced contrast excretion. In this retrospective study, the feasibility and the frequency of adverse reactions of CTC when using a drip infusion scheme based on bilirubin levels were evaluated. The medical records of patients who had undergone upper abdominal spiral CT with subsequent three-dimensional rendering of the biliary tract by means of CTC during seven years were retrospectively reviewed regarding serum bilirubin concentration, adverse reaction and presence of visible contrast media in the bile ducts at CT examination. In total, 153 consecutive examinations in 142 patients were reviewed. Contrast media was observed in the bile ducts at 144 examinations. In 110 examinations, the infusion time had been recorded in the medical records. Among these, 42 examinations had an elevated bilirubin value (>19 umol/L). There were nine patients without contrast excretion; 3 of which had a normal bilirubin value and 6 had an elevated value (25–133 umol/L). Two of the 153 examinations were inconclusive. One subject (0.7%) experienced a minor adverse reaction – a pricking sensation in the face. No other adverse effects were noted. We conclude that drip infusion CTC with an infusion rate of the biliary contrast agent iotroxate governed by the serum bilirubin value is a feasible and safe alternative to MRC in patients with and without impaired biliary excretion. In this retrospective study the feasibility and the frequency of adverse reactions when using a drip infusion scheme based on bilirubin levels has been evaluated

  3. Initial study of sediment antagonism and characteristics of silver nanoparticle-coated biliary stents in an experimental animal model

    Directory of Open Access Journals (Sweden)

    Tian Y

    2016-04-01

    Full Text Available Yigeng Tian,1,* Mingfeng Xia,2,* Shuai Zhang,3 Zhen Fu,4 Qingbin Wen,2 Feng Liu,4 Zongzhen Xu,4 Tao Li,4 Hu Tian4 1Department of Physics, School of Physics and Technology, University of Jinan, Jinan, Shandong, People’s Republic of China; 2Department of Surgery, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People’s Republic of China; 3Department of General Surgery, Sixth People’s Hospital of Jinan, Jinan, Shandong, People’s Republic of China; 4Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, People’s Republic of China *These authors contributed equally to this work Objective: Plastic biliary stents used to relieve obstructive jaundice are frequently blocked by sediment, resulting in loss of drainage. We prepared stents coated with silver nanoparticles (AgNPs and compared their ability to resist sedimentation with Teflon stents in a beagle model of obstructive jaundice.Methods: AgNP-coated Teflon biliary stents were prepared by chemical oxidation–reduction and evaluated in an obstructive jaundice model that was produced by ligation of common bile duct (CBD; animals were randomized to two equal groups for placement of AgNP-coated or Teflon control stents. Liver function and inflammatory index were found to be similar in the two groups, and the obstruction was relieved. Stents were removed 21 days after insertion and observed by scanning and transmission electron microscopy. The AgNP coating was analyzed by energy dispersive X-ray analysis (EDXA, and the composition of sediment was assayed by Fourier-transform infrared (FTIR spectroscopy.Results: Electron microscopy revealed a black, closely adherent AgNP stent coating, with thicknesses of 1.5–6 µm. Sediment thickness and density were greater on Teflon than on AgNP-coated stents. EDXA confirmed the stability and integrity of the AgNP coating before and after in vivo animal experimentation. FTIR

  4. An Open Source approach to automated hydrological analysis of ungauged drainage basins in Serbia using R and SAGA

    Science.gov (United States)

    Zlatanovic, Nikola; Milovanovic, Irina; Cotric, Jelena

    2014-05-01

    Drainage basins are for the most part ungauged or poorly gauged not only in Serbia but in most parts of the world, usually due to insufficient funds, but also the decommission of river gauges in upland catchments to focus on downstream areas which are more populated. Very often, design discharges are needed for these streams or rivers where no streamflow data is available, for various applications. Examples include river training works for flood protection measures or erosion control, design of culverts, water supply facilities, small hydropower plants etc. The estimation of discharges in ungauged basins is most often performed using rainfall-runoff models, whose parameters heavily rely on geomorphometric attributes of the basin (e.g. catchment area, elevation, slopes of channels and hillslopes etc.). The calculation of these, as well as other paramaters, is most often done in GIS (Geographic Information System) software environments. This study deals with the application of freely available and open source software and datasets for automating rainfall-runoff analysis of ungauged basins using methodologies currently in use hydrological practice. The R programming language was used for scripting and automating the hydrological calculations, coupled with SAGA GIS (System for Automated Geoscientivic Analysis) for geocomputing functions and terrain analysis. Datasets used in the analyses include the freely available SRTM (Shuttle Radar Topography Mission) terrain data, CORINE (Coordination of Information on the Environment) Land Cover data, as well as soil maps and rainfall data. The choice of free and open source software and datasets makes the project ideal for academic and research purposes and cross-platform projects. The geomorphometric module was tested on more than 100 catchments throughout Serbia and compared to manually calculated values (using topographic maps). The discharge estimation module was tested on 21 catchments where data were available and compared

  5. Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials

    OpenAIRE

    Huang Tsai-Wei; Tseng Sung-Hui; Lin Chia-Chin; Bai Chyi-Huey; Chen Ching-Shyang; Hung Chin-Sheng; Wu Chih-Hsiung; Tam Ka-Wai

    2013-01-01

    Abstract Background Lymphedema is a common complication of axillary dissection for breast cancer. We investigated whether manual lymphatic drainage (MLD) could prevent or manage limb edema in women after breast-cancer surgery. Methods We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) to evaluate the effectiveness of MLD in the prevention and treatment of breast-cancer-related lymphedema. The PubMed, EMBASE, CINAHL, Physiotherapy Evidence Datab...

  6. Spatial and Temporal Analysis of the Microbial Community in the Tailings of a Pb-Zn Mine Generating Acidic Drainage ▿ †

    Science.gov (United States)

    Huang, Li-Nan; Zhou, Wen-Hua; Hallberg, Kevin B.; Wan, Cai-Yun; Li, Jie; Shu, Wen-Sheng

    2011-01-01

    Analysis of spatial and temporal variations in the microbial community in the abandoned tailings impoundment of a Pb-Zn mine revealed distinct microbial populations associated with the different oxidation stages of the tailings. Although Acidithiobacillus ferrooxidans and Leptospirillum spp. were consistently present in the acidic tailings, acidophilic archaea, mostly Ferroplasma acidiphilum, were predominant in the oxidized zones and the oxidation front, indicating their importance to generation of acid mine drainage. PMID:21705549

  7. Analysis of Highway Subgrade Pavement Drainage Design%浅析公路路基路面排水设计

    Institute of Scientific and Technical Information of China (English)

    袁丹

    2014-01-01

    在公路设计中,路基、路面的排水设计对公路的质量及寿命有重大影响。本文首先阐述了地下水及地表水对公路路基、路面的影响和危害,分析了公路路基和路面排水设计的准则,进而探讨了公路路基路面的排水设计。%In the highway design, the drainage design of highway roadbed and pavement has a significant impact on the quality and life. This paper first elaborates the groundwater and surface water influence and harmful of highway roadbed and road pavement, analyzes the criterion of highway subgrade and pavement drainage design, and then discusses the design of highway roadbed drainage.

  8. 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

  9. Percutaneous Intraductal Radiofrequency Ablation for Clearance of Occluded Metal Stent in Malignant Biliary Obstruction: Feasibility and Early Results

    Energy Technology Data Exchange (ETDEWEB)

    Pai, Madhava, E-mail: madhava.pai@imperial.ac.uk [Hammersmith Hospital, Imperial College, HPB Unit, Department of Surgery (United Kingdom); Valek, Vlastimil; Tomas, Andrasina [University Hospital Brno Bohunice, Department of Radiology (Czech Republic); Doros, Attila [Semmelweis University, Radiology Unit, Department of Transplantation and Surgery (Hungary); Quaretti, Pietro [IRCCS Policlinico San Matteo, Department of Radiology (Italy); Golfieri, Rita; Mosconi, Cristina [University of Bologna, Department of Radiology, Policlinico S. Orsola-Malpighi (Italy); Habib, Nagy, E-mail: nagy.habib@imperial.ac.uk [Hammersmith Hospital, Imperial College, HPB Unit, Department of Surgery (United Kingdom)

    2013-07-11

    PurposeThe major complication occurring with biliary stents is stent occlusion, frequently seen because of tumour in-growth, epithelial hyperplasia, and sludge deposits, resulting in recurrent jaundice and cholangitis. We report a prospective study with the results of first in man percutaneous intraductal radiofrequency (RF) ablation to clear the blocked metal stents in patients with malignant biliary obstruction using a novel bipolar RF catheter.MethodsNine patients with malignant biliary obstruction and blocked metal stents were included. These patients underwent intraductal biliary RF ablation through the blocked metal stent following external biliary decompression with an internal–external biliary drainage.ResultsAll nine patients had their stent patency restored successfully without the use of secondary stents. Following this intervention, there was no 30-day mortality, haemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the nine patients, six are alive and three patients are dead with a median follow-up of 122 (range 50–488) days and a median stent patency of 102.5 (range 50–321) days. Six patients had their stent patent at the time of last follow-up or death. Three patients with stent blockage at 321, 290, and 65 days postprocedure underwent percutaneous transhepatic drain insertion and repeat ablation.ConclusionsIn this selective group of patients, it appears that this new approach is safe and feasible. Efficacy remains to be proven in future, randomized, prospective studies.

  10. Percutaneous Intraductal Radiofrequency Ablation for Clearance of Occluded Metal Stent in Malignant Biliary Obstruction: Feasibility and Early Results

    International Nuclear Information System (INIS)

    PurposeThe major complication occurring with biliary stents is stent occlusion, frequently seen because of tumour in-growth, epithelial hyperplasia, and sludge deposits, resulting in recurrent jaundice and cholangitis. We report a prospective study with the results of first in man percutaneous intraductal radiofrequency (RF) ablation to clear the blocked metal stents in patients with malignant biliary obstruction using a novel bipolar RF catheter.MethodsNine patients with malignant biliary obstruction and blocked metal stents were included. These patients underwent intraductal biliary RF ablation through the blocked metal stent following external biliary decompression with an internal–external biliary drainage.ResultsAll nine patients had their stent patency restored successfully without the use of secondary stents. Following this intervention, there was no 30-day mortality, haemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the nine patients, six are alive and three patients are dead with a median follow-up of 122 (range 50–488) days and a median stent patency of 102.5 (range 50–321) days. Six patients had their stent patent at the time of last follow-up or death. Three patients with stent blockage at 321, 290, and 65 days postprocedure underwent percutaneous transhepatic drain insertion and repeat ablation.ConclusionsIn this selective group of patients, it appears that this new approach is safe and feasible. Efficacy remains to be proven in future, randomized, prospective studies

  11. 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.

  12. 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. ...

  13. 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...

  14. Relative tectonics and debris flow hazards in the Beijing mountain area from DEM-derived geomorphic indices and drainage analysis

    Science.gov (United States)

    Cheng, Weiming; Wang, Nan; Zhao, Min; Zhao, Shangmin

    2016-03-01

    The geomorphic setting of the tectonically active area around Beijing is a result of complex interactions involving Yanshan neotectonic movements and processes of erosion and deposition. The Beijing Mountain study area contains the junction of two mountain ranges (the Yanshan Mountains and the Taihang Mountains). Tectonic activity has significantly influenced the drainage system and the geomorphic situation in the area, leading to a high probability of the development of debris flows, which is one of the major abrupt geological disasters in the region. Based on 30-m-resolution ASTER GDEM data, a total of 752 drainage basins were extracted using ArcGIS software. A total of 705 debris flow valleys were visually interpreted from ALOS satellite images and published documents. Seven geomorphic indices were calculated for each basin including the relief amplitude, the hypsometric integral, the stream length gradient, the basin shape indices, the fractal dimension, the asymmetry factor, and the ratio of the valley floor width to the height. These geomorphic indices were divided into five classes and the ratio of the number of the debris flow valleys to the number of the drainage basins for each geomorphic index was computed and analyzed for every class. Average class values of the seven indices were used to derive an index of relative active tectonics (IRAT). The ratio of the number of the debris flow valleys to the number of the drainage basins was computed for every class of IRAT. The degree of probable risk level was then defined from the IRAT classes. Finally, the debris flow hazard was evaluated for each drainage basin based on the combined effect of probable risk level and occurrence frequency of the debris flows. The result showed a good correspondence between IRAT classes and the ratio of the number of the debris flow valleys to the number of the drainage basins. Approximately 65% of the drainage basins with occurred debris flow valleys are at a high risk level

  15. 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...

  16. 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...

  17. Hyperspectral analysis for qualitative and quantitative features related to acid mine drainage at a remediated open-pit mine

    Science.gov (United States)

    Davies, G.; Calvin, W. M.

    2015-12-01

    The exposure of pyrite to oxygen and water in mine waste environments is known to generate acidity and the accumulation of secondary iron minerals. Sulfates and secondary iron minerals associated with acid mine drainage (AMD) exhibit diverse spectral properties in the ultraviolet, visible and near-infrared regions of the electromagnetic spectrum. The use of hyperspectral imagery for identification of AMD mineralogy and contamination has been well studied. Fewer studies have examined the impacts of hydrologic variations on mapping AMD or the unique spectral signatures of mine waters. Open-pit mine lakes are an additional environmental hazard which have not been widely studied using imaging spectroscopy. A better understanding of AMD variation related to climate fluctuations and the spectral signatures of contaminated surface waters will aid future assessments of environmental contamination. This study examined the ability of multi-season airborne hyperspectral data to identify the geochemical evolution of substances and contaminant patterns at the Leviathan Mine Superfund site. The mine is located 24 miles southeast of Lake Tahoe and contains remnant tailings piles and several AMD collection ponds. The objectives were to 1) distinguish temporal changes in mineralogy at a the remediated open-pit sulfur mine, 2) identify the absorption features of mine affected waters, and 3) quantitatively link water spectra to known dissolved iron concentrations. Images from NASA's AVIRIS instrument were collected in the spring, summer, and fall seasons for two consecutive years at Leviathan (HyspIRI campaign). Images had a spatial resolution of 15 meters at nadir. Ground-based surveys using the ASD FieldSpecPro spectrometer and laboratory spectral and chemical analysis complemented the remote sensing data. Temporal changes in surface mineralogy were difficult to distinguish. However, seasonal changes in pond water quality were identified. Dissolved ferric iron and chlorophyll

  18. Helicobacter species are associated with possible increase in risk of biliary lithiasis and benign biliary diseases

    Directory of Open Access Journals (Sweden)

    Pandey Manoj

    2007-08-01

    Full Text Available Abstract Background Hepato-biliary tract lithiasis is common and present either as pain or as asymptomatic on abdominal ultrasonography for other causes. Although the DNA of Helicobacter species are identified in the gallbladder bile, tissue or stones analyzed from these cases, still a causal relationship could not be established due to different results from different geographical parts. Methods A detailed search of pubmed and pubmedcentral was carried out with key words Helicobacter and gallbladder, gallstones, hepaticolithiasis, cholelithiasis and choledocholithiasis, benign biliary diseases, liver diseases. The data was entered in a data base and meta analysis was carried out. The analysis was carried out using odds ratio and a fixed effect model, 95% confidence intervals for odds ratio was calculated. Chi square test for heterogeneity was employed. The overall effect was calculated using Z test. Results A total of 12 articles were identified. One study used IgG for diagnosis while others used the PCR for Ure A gene, 16 S RNA or Cag A genes. A couple of studies used culture or histopathology besides the PCR. The cumulative results show a higher association of Helicobacter with chronic liver diseases (30.48%, and stone diseases (42.96%(OR 1.77 95% CI 1.2–2.58; Z = 2.94, p = 0.003, the effect of each could not be identified as it was difficult to isolate the effect of helicobacter due to mixing of cases in each study. Conclusion The results of present meta analysis shows that there is a slight higher risk of cholelithiasis and benign liver disease (OR 1.77, however due to inherent inability to isolate the effect of stone disease from that of other benign lesions it is not possible to say for sure that Helicobacter has a casual relationship with benign biliary disease or stone disease or both.

  19. 急性胆源性胰腺炎不同治疗方法的疗效分析%Analysis of therapeutic effect of different therapies for acute biliary pancreatitis

    Institute of Scientific and Technical Information of China (English)

    秦静; 赵振林

    2011-01-01

    surgery to relieve bile duct obstruction. The time to relief of abdominal pain, the time of serum amylase returned to normal level, days of hospital stay, recovery rate, incidence of complications and fatality rate in the four groups with different therapeutic protocol were analyzed and compared. Results The clinical manifeslations of 95 cases without bile duct obstruction were improved after receiving conservative treatment, and there was no significant difference of the tested indexes between the mild group and severe group ( P > 0.05 ). All of the 64 cases with bile duct obstruction undergoing emergency operation, there was significant improvement of monitored indexes in the endoscopic therapy group (38 cases) in comparison with the open surgery group (26 cases)(P < 0.05 ). Conclusions The treatment of ABP should be selected according to the type of ABP. The non-operation protocol is effective for mild cases without bile duct obstruction; for the cases with bile duct obstruction, conservative treatment should be followed by either endoscopic biliary drainage or open surgery, and the endoscopic drainage should be preferred because of its mini-invasive advantage.

  20. DRAINAGE AND FLEXIBLE PAVEMENT PERFORMANCE

    Directory of Open Access Journals (Sweden)

    SIDDHARTHA ROKADE

    2012-04-01

    Full Text Available Providing adequate drainage to a pavement system has been considered as an important design consideration to prevent premature failures due to water related problems such as pumping action, loss of support, and rutting, among others. Most water in pavements is due to rainfall infiltration into unsaturated pavement layers, throughjoints, cracks, shoulder edges, and various other defects, especially in older deteriorated pavements. Water also seep upward from a high groundwater table due to capillary suction or vapour movements, or it may flow laterally from the pavement edges and side ditches. Providing adequate drainage to a pavement system has been considered as an important design consideration to ensure satisfactory performance of the pavement, particularly from the perspective of life cycle cost and serviceability. To minimize premature pavement distresses and to enhance the pavement performance, it is imperative to provide adequate drainage to allow infiltrated water to drain out from the base and sub-base, thus avoiding saturation of base and subgrade soils. This paper deals with the analysis of the impact of subsurface drainage on pavement system performance. The requirement ofeffective subsurface drainage for pavement performance is also discussed.

  1. Biodiversity value of agricultural drainage ditches; a comparative analysis of the aquatic invertebrate fauna of ditches and small lakes.

    NARCIS (Netherlands)

    Verdonschot, R.C.M.; Keizer-Vlek, H.E.; Verdonschot, P.F.M.

    2011-01-01

    1. Drainage ditches are a common aquatic habitat in the lowland agricultural landscape of north-western Europe. The invertebrate fauna of these waters is poorly known compared with that of the semi-natural wetland fragments found in this region. While most wetlands are designated as nature reserves,

  2. Antibiotic resistance and community analysis of surface and subsurface drainage waters in the South Fork Iowa River watershed

    Science.gov (United States)

    The Midwest is a center for swine production leading to application of swine manure onto lands that have artificial subsurface drainage. Previous reports have indicated elevated levels of antibiotic resistance genes (ARGs) in surface water and groundwater around confined animal feeding operations w...

  3. 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

  4. Percutaneous Placement of Metallic Stents in Malignant Biliary Obstruction: One-Stage or Two-Stage Procedure? Pre-Dilate or Not?

    International Nuclear Information System (INIS)

    The aim of this paper was to evaluate the necessity of percutaneous transhepatic catheter drainage and balloon dilation procedures performed before stent insertion. One hundred and twenty-six patients with unresectable malignant biliary obstruction underwent palliative therapy by means of percutaneous transhepatic placement of 183 metallic biliary endoprotheses. Forty-four (35%) patients underwent metallic stent insertion in a one-stage procedure and 82(65%) had undergone percutaneous transhepatic catheter drainage before stent insertion. Balloon dilation of the stenosis before stent placement (pre-dilation) was performed in 53 (42%) of 126 patients. The rate of the 30-day mortality was 11%, with no procedure-related deaths. The total rate of early complications was 29%, and 84% of these complications were due to percutaneous transhepatic catheter drainage and pre-dilation procedures. Percutaneous transhepatic catheter drainage and pre-dilation had no clinical or statistically significant effect on the patients' survival and stent patency rate. Percutaneous transhepatic catheter drainage and balloon dilation increased the cost of stent placement 18% and 19%, respectively. Palliation of malignant biliary obstruction with percutaneous transhepatic stent insertion should be done directly, in the simplest way, without performing percutaneous transhepatic catheter drainage and balloon dilation before stent placement. It is more useful, safe, and cost-effective

  5. Groove Pancreatitis with Biliary and Duodenal Stricture: An Unusual Cause of Obstructive Jaundice

    OpenAIRE

    Marta Gravito-Soares; Elisa Gravito-Soares; Ana Alves; Dário Gomes; Nuno Almeida; Guilherme Tralhão; Carlos Sofia

    2016-01-01

    Introduction: Groove pancreatitis is an uncommon cause of chronic pancreatitis that affects the groove anatomical area between the head of the pancreas, duodenum, and common bile duct. Clinical case: A 67-year-old man with frequent biliary colic and an alcohol consumption of 30–40 g/day was admitted to the hospital complaining of jaundice and pruritus. Laboratory analysis revealed cholestasis and the ultrasound scan showed intra-hepatic biliary ducts dilatation, middle third cystic dilatat...

  6. Engineering evaluation/cost analysis for the proposed removal action at the Southeast Drainage near the Weldon Spring Site, Weldon Spring, Missouri

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-08-01

    The engineering evaluation/cost analysis (EE/CA) has been prepared to support the proposed removal of contaminated sediment from selected portions of the Southeast Drainage as part of cleanup activities being conducted at the Weldon Spring site in St. Charles County, Missouri, by the U.S. Department of Energy (DOE). The cleanup activities are conducted in accordance with the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), as amended, incorporating the values of the National Environmental Policy Act (NEPA). The Weldon Spring site is located near the town of Weldon Spring, about 48 km (30 mi) west of St. Louis. It consists of two noncontiguous areas: the chemical plant area and a limestone quarry about 6.4 km (4 mi) south-southwest of the chemical plant area. The Southeast Drainage is a natural 2.4-km (1.5-mi) channel that carries surface runoff to the Missouri River from the southern portion of the chemical plant area and a small portion of the ordnance works area (part of the Weldon Spring Training Area) south of the groundwater divide. The drainage became contaminated as a result of past activities of the U.S. Army and the DOE (and its predecessors).

  7. Engineering evaluation/cost analysis for the proposed removal action at the Southeast Drainage near the Weldon Spring Site, Weldon Spring, Missouri

    International Nuclear Information System (INIS)

    The engineering evaluation/cost analysis (EE/CA) has been prepared to support the proposed removal of contaminated sediment from selected portions of the Southeast Drainage as part of cleanup activities being conducted at the Weldon Spring site in St. Charles County, Missouri, by the U.S. Department of Energy (DOE). The cleanup activities are conducted in accordance with the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), as amended, incorporating the values of the National Environmental Policy Act (NEPA). The Weldon Spring site is located near the town of Weldon Spring, about 48 km (30 mi) west of St. Louis. It consists of two noncontiguous areas: the chemical plant area and a limestone quarry about 6.4 km (4 mi) south-southwest of the chemical plant area. The Southeast Drainage is a natural 2.4-km (1.5-mi) channel that carries surface runoff to the Missouri River from the southern portion of the chemical plant area and a small portion of the ordnance works area (part of the Weldon Spring Training Area) south of the groundwater divide. The drainage became contaminated as a result of past activities of the U.S. Army and the DOE (and its predecessors)

  8. Fluid accumulation in thin-film fl ows driven by surface tension and gravity (I): Rigorous analysis of a drainage equation

    CERN Document Server

    Cuesta, C M

    2011-01-01

    We derive a boundary layer equation describing accumulation regions within a thin-film approximation framework where gravity and surface tension balance. As part of the analysis of this problem we investigate in detail and rigorously the 'drainage' equation (phi"'+1)phi^3=1. In particular, we prove that all solutions that do not tend to 1 as the independent variable goes to infinity are oscillatory, and that they oscillate in a very specific way. This result and the method of proof will be used in the analysis of solutions of the afore mentioned boundary layer problem.

  9. [Gadolinium as an alternative radiocontrast agent in patients with allergy to iodine-based contrast provide for useful diagnostic imagings and safely treatment of biliary tract diseases].

    Science.gov (United States)

    Natsume, Makoto; Sano, Hitoshi; Fukusada, Shigeki; Kachi, Kenta; Inoue, Tadahisa; Anbe, Kaiki; Nishie, Hirotada; Nishi, Yuji; Yoshimura, Norihiro; Mizushima, Takashi; Okumura, Fumihiro; Miyabe, Katsuyuki; Naitoh, Itaru; Hayashi, Kazuki; Nakazawa, Takahiro

    2013-05-01

    Diagnosis and treatment of biliary tract disease requires an intraductal radiocontrast agent. Although iodine-based contrast medium is commonly used, some patients show severe allergy to iodinated contrast agent. We have retrospectively reviewed the usefulness and safety of gadolinium as an alternative radiocontrast agent in 3 patients with allergy to iodine-based contrast medium in the diagnosis and treatment of biliary tract diseases. In case 1, percutaneous transhepatic biliary drainage and cholangiography were performed successfully and it was possible to visualize an intrahepatic bile duct stone. Percutaneous transhepatic cholangioscopic lithotomy was performed and the intrahepatic bile duct stone was removed. In case 2, endoscopic biliary lithotripsy was performed. In case 3, percutaneous transhepatic cholangiography and cholangioscopy provided a diagnosis of moderately differentiated carcinoma. He underwent pancreatoduodenectomy. Postoperative cholangiograms were also obtained successfully. Gadolinium contrast agent is an alternative to iodine-based cholangiography for the patients with allergy to iodine.

  10. 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

  11. Cyclosporin A for primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Gong, Yanzhang; Christensen, E; Gluud, C

    2007-01-01

    Cyclosporin A has been used for patients with primary biliary cirrhosis, but the therapeutic responses in randomised clinical trials have been heterogeneous.......Cyclosporin A has been used for patients with primary biliary cirrhosis, but the therapeutic responses in randomised clinical trials have been heterogeneous....

  12. D-penicillamine for primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Gong, Yanzhang; Frederiksen, S L; Gluud, C

    2004-01-01

    D-penicillamine is used for patients with primary biliary cirrhosis due to its hepatic copper decreasing and immunomodulatory potentials. The results from randomised clinical trials have been inconsistent.......D-penicillamine is used for patients with primary biliary cirrhosis due to its hepatic copper decreasing and immunomodulatory potentials. The results from randomised clinical trials have been inconsistent....

  13. Current status and evaluation of endoscopic treatment of biliary strictures%胆管狭窄内镜治疗的现状与评价

    Institute of Scientific and Technical Information of China (English)

    姚礼庆; 钟芸诗; 周嘉敏

    2012-01-01

    For the characteristics including minimal invasion,low incidence of complication and better postoperative prognosis,endoscopic therapy is widely accepted to be the first line therapy for most biliary strictures.At present,repeated progressive dilation combined with multiple plastic stents placement is the main therapy for benign biliary strictures.The long-term effective rate is relatively high in surgery related strictures,but in the non-surgery related strictures,its long-term effective rate is limited and the optimal therapy should be chosen cautiously according to patients' condition.In malignent biliary stricutes,dilation combined with metallic stents placement is recommended to treat both of preoperative long-term drainage in patients with resectable tumor and palliative treatment in patients with unresectable tumor,while nosobiliary drainage is recommended in preoperative short-term drainage. The choice of unilateral or bilateral drainage depends on patients' conditons in malignent hilar biliary strictures.The merits and demerits of stents should be mastered before they are placed in stricture sections.Recently,a lot of new endoscopic technologies and methods are applied in clinical practice,but their curative effect should be tested.Therefore,accumulative evidence-based data are needed to make them more rational and more standard.

  14. Liver and Biliary System

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    2010440 Analysis of the T lymphocyte receptor beta chain complementarity determining region 3 spectra-typing in the peripheral blood and hepatic tissue of patients with chronic hepatitis B.WU Shaoqiang(伍绍强), et al.Dept Infect Dis, Affil Hosp, Zunyi Med Coll, Zunyi 563003.Chin J

  15. Use of fully covered self-expanding metal stents for the management of benign biliary conditions Utilización de prótesis metálicas autoexpandibles totalmente recubiertas en procesos biliares benignos

    OpenAIRE

    García-Cano, J; L. Taberna Arana; C. Jimeno Ayllón; R. Martínez Fernández; L. Serrano Sánchez; A.K. Reyes Guevara; M. Viñuelas Chicano; C. J. Gómez Ruiz; M. J. Morillas Ariño; J. I. Pérez García; G. Pérez Vigara; A Pérez Sola

    2010-01-01

    Background and aim: biliary self-expanding metal stents (SEMS) have the advantage of being inserted undeployed with very small sizes and provide, when fully opened, large diameters for biliary drainage. However, their use in benign conditions has been very limited, mainly because of difficulty in their extraction. We present our initial experience with a fully covered SEMS (Wallflex) for the management of benign problems of the bile duct. Patients and methods: in a prospective study, stents o...

  16. Bilhemia after trans-jugular intra-hepatic porto-systemic shunt and its management with biliary decompression

    Institute of Scientific and Technical Information of China (English)

    Ashwani K Singal; Manoj K Kathuria; Advitya Malhotra; Richard W Goodgame; Roger D Soloway

    2009-01-01

    Bilhemia or bile mixing with blood is a rare clinical problem. The clinical presentation is usually transient self-resolving hyperbilirubinemia, progressive and rapidly rising conjugated hyperbilirubinemia, or recurrent cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) plays an important role in diagnosis and management. Biliary decompression with endoscopic sphincterotomy is useful in treating these patients. If not recognized and treated in time, the condition can be fatal in a significant proportion of patients. This usually occurs after blunt or penetrating hepatic trauma due to a fistulous connection between the biliary radicle and portal or hepatic venous radical. Cases have been described due to iatrogenic trauma such as liver biopsy and percutaneous biliary drainage. However, the occurrence after trans-jugular intra-hepatic porto-systemic shunt (TIPS) is very rare. We report a case of bilhemia presenting as rapidly rising bilirubin after TIPS. The patient was managed successfully with ERCP and removal of a blood clot from the common bile duct.

  17. Biliary hemostasis using an endoscopic plastic stent placement for uncontrolled hemobilia caused by transpapillary forceps biopsy (with video).

    Science.gov (United States)

    Shinjo, Kunihiro; Matsubayashi, Hiroyuki; Matsui, Toru; Kawata, Noboru; Uemura, Sunao; Yamamoto, Yusuke; Ono, Hiroyuki

    2016-04-01

    A 78-year-old woman was referred to our hospital for the examination and treatment of jaundice. A transpapillary forceps biopsy for a long distal bile duct stricture was performed using endoscopic retrograde cholangiopancreatography. Immediately after the biopsy, massive bleeding was observed from the orifice of the papilla. Although hemobilia was pulsatile, an endoscopic biliary plastic stent placement was very effective in achieving hemostasis. However, a nasal biliary catheter was required because a blood clot clogged the stent on the following day. Although covered self-expandable metal stent (CSEMS) placement has been reported for achieving endoscopic hemostasis for bleeding, we chose to use a plastic stent to reduce the risk of post-procedure pancreatitis. The placement of both an endoscopic biliary plastic stent and a nasobiliary drainage catheter can be an alternative hemostatic tool to CSEMSs. PMID:26960930

  18. The Successful Treatment of Chronic Cholecystitis with SpyGlass Cholangioscopy-Assisted Gallbladder Drainage and Irrigation through Self-Expandable Metal Stents

    OpenAIRE

    Gutkin, Ellen; Hussain, Syed A; Kim, Sang H

    2012-01-01

    A 34-year-old female with a history of advanced pulmonary sarcoidosis and right-sided heart failure presented with chronic, postprandial right upper quadrant pain, and weight loss. Endoscopic biliary drainage was deemed to be the most appropriate therapeutic option for her chronic cholecystitis. Endoscopic retrograde cholangiopancreatography utilizing the SpyGlass cholangioscopy system allowed us to access the cystic duct through which the gallbladder was ultimately decompressed, via biliary ...

  19. 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

  20. 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

  1. [COMPARATIVE CHARACTERISTIC OF VARIOUS METHODS OF SIMULATION OF BILIARY PERITONITIS IN EXPERIMENT].

    Science.gov (United States)

    Nichitaylo, M Yu; Furmanov, Yu O; Gutsulyak, A I; Savytska, I M; Zagriychuk, M S; Goman, A V

    2016-02-01

    In experiment on rabbits a comparative analysis of various methods of a biliary peritonitis simulation was conducted. In 6 animals a biliary peritonitis was simulated, using perforation of a gallbladder, local serous-fibrinous peritonitis have occurred in 50% of them. In 7 animals biliary peritonitis was simulated, applying intraabdominal injection of medical sterile bile in a 5-40 ml volume. Diffuse peritonitis with exudates and stratification of fibrin was absent. Most effective method have appeared that, when intraabdominal injection of bile was done together with E. coli culture in the rate of 0.33 microbal bodies McF (1.0 x 10(8) CFU/ml) on 1 kg of the animal body mass. Diffuse biliary peritonitis have occurred in all 23 animals, including serous-fibrinous one--in 17 (76%), and purulent-fibrinous--in 6 (24%).

  2. Placement of percutaneous transhepatic biliary stent using a silicone drain with channels

    Institute of Scientific and Technical Information of China (English)

    Hiroshi Yoshida; Yasuhiro Mamada; Nobuhiko Taniai; Sho Mineta; Yoshiaki Mizuguchi; Yoichi Kawano; Junpei Sasaki; Yoshiharu Nakamura; Takayuki Aimoto; Takashi Tajiri

    2009-01-01

    This report describes a method for percutaneous transhepatic biliary stenting with a BLAKE Silicone Drain, and discusses the usefulness of placement of the drain connected to a J-VAC Suction Reservoir for the treatment of stenotic hepaticojejunostomy.Percutaneous transhepatic biliary drainage was performed under ultrasonographic guidance in a patient with stenotic hepaticojejunostomy after hepatectomy for hepatic hilum malignancy. The technique used was as follows. After dilatation of the drainage root, an 11-Fr tube with several side holes was passed through the stenosis of the hepaticojejunostomy. A 10-Fr BLAKE Silicone Drain is flexible, which precludes onestep insertion. One week after insertion of the 11-Fr tube, a 0.035-inch guidewire was inserted into the tube. After removal of the 11-Fr tube, the guidewire was put into the channel of a 10-Fr BLAKE Silicone Drain. The drain was inserted into the jejunal limb through the intrahepatic bile duct and was connected to a J-VAC Suction Reservoir. Low-pressure continued suction was applied. Patients can be discharged after insertion of the 10-Fr BLAKE Silicone Drain connected to the J-VAC Suction Reservoir. Placement of a percutaneous transhepatic biliary stent using a 10-Fr BLAKE Silicone Drain connected to a J-VAC Suction Reservoir is useful for the treatment of stenotic hepaticojejunostomy.

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

    Directory of Open Access Journals (Sweden)

    A. Vasilescu

    2009-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Darío Martínez-Baena

    2013-03-01

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

  5. Biliary tract obstruction secondary to cancer: management guidelines and selected literature review.

    Science.gov (United States)

    Lokich, J J; Kane, R A; Harrison, D A; McDermott, W V

    1987-06-01

    Malignant biliary tract obstruction (MBTO) due to either primary biliary tract cancer or metastasis to the porta hepatis is a common clinical problem. The most common metastatic tumors causing MBTO in order of frequency are gastric, colon, breast, and lung cancers. Radiographic diagnostic procedures should proceed in a cost-effective sequence from ultrasonography, computerized tomography (CT), percutaneous transhepatic cholangiography (PTHC), and endoscopic retrograde pancreatography with the goal of establishing the site of the biliary tract obstruction. The identification of the site of obstruction could be established by ultrasound 70% to 80%, CT scan 80% to 90%, PTHC 100%, and endoscopic retrograde cholangiography (ERCP) 85%. Therapeutic intervention by radiographic decompression (PTHC or endoscopic prosthesis), surgical bypass, or radiation therapy with or without chemotherapy may be selectively used based on (1) the site of obstruction; (2) the type of primary tumor; and (3) the presence of specific symptoms related to the obstruction. ("Prophylactic" biliary tract decompression to prevent ascending cholangitis is not supported by the literature in that the frequency of sepsis in the face of malignant obstruction is small (in contrast to sepsis associated with stone disease). Furthermore, PTHC with drainage as a long-term procedure is associated with a substantial frequency of sepsis and is unnecessary and possibly problematic as a preoperative procedure simply to reduce the bilirubin level. The use of radiation therapy in conjunction with chemotherapy for patients not deemed suitable for a surgical bypass because of the presence of proximal obstruction is an important alternative to PTHC. PMID:3295131

  6. 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.

  7. Hepatic por tal cholangiocarcinoma:a clinical analysis of 70 cases

    Institute of Scientific and Technical Information of China (English)

    Hong-Yi Zhang; Zhi-Qiang Feng; Ya-Lin Kong; Hong-Yi Zhang; Xiao-Jun He; Hui Zhang; Cheng-Li Liu; Gang Zhao; Mei Xiao; Xi-Dong Zhang

    2008-01-01

    BACKGROUND: The incidence of hepatic portal cholangiocarcinoma is increasing and it is always associated with poor survival. This study analyzed an effective therapeutic method. METHODS: A retrospective analysis was made on 70 patients with hepatic portal cholangiocarcinoma admitted between January 2004 and February 2007 to the General Hospital of Air Force PLA. RESULTS: Forty-seven patients had hepatic duct-jejunum anastomosis after resection of hepatic portal cholangiocarcinoma. Internal or external biliary drainage and canals for internal radiation were performed in those patients unift for operation. Among the 70 patients, 5 died within 15 months, 27 survived more than 24 months, and the others survived 4-18 months. CONCLUSION: Surgery is the primary therapeutic method for hepatic portal cholangiocarcinoma. Internal or external biliary drainage can prolong the life-span.

  8. Analysis of drug resistance of extended spectrum β-lactamases-producing strains in biliary tract infection%胆道感染产超广谱β-内酰胺酶菌的耐药性分析

    Institute of Scientific and Technical Information of China (English)

    唐双意; 刘滔滔; 蒋霞; 万瑞融; 钟小斌

    2014-01-01

    目的:探讨医院近5年胆道感染产超广谱β‐内酰胺酶(ESBLs)菌的耐药性和其危险因素,并为临床经验性治疗用药提供参考依据。方法对2007-2011年收集的216例胆汁细菌培养结果为革兰阴性菌的胆道感染患者进行分析,其中产ESBLs菌胆道感染患者97例作为观察组,非产ESBLs菌胆道感染患者119例作为对照组,对两组胆道感染细菌的耐药性进行比较,并采用单因素分析和多因素 logistic回归分析ESBLs菌株致胆道感染的危险因素。结果216株革兰阴性菌中大肠埃希菌155株占71.76%;检出产ESBLs菌97株,其中大肠埃希菌82株占84.54%;产ESBLs组对头孢菌素等多种抗菌药物的耐药性均显著高于非产ESBLs组,差异有统计学意义(P<0.01)。结论胆道产ESBLs菌株的耐药比率较高,临床上要严格掌握ERCP操作治疗的适应证,合理应用抗菌药物,注意控制第三代头孢菌素类抗菌药物的应用,可减少产ESBLs细菌感染的发生。%OBJECTIVE To explore drug resistance and risk factors of extended spectrum β‐lactamases (ESBLs)‐producing strains in biliary tract infection in our hospital during last five years and provide a basis for clinical em‐pirical treatment .METHODS The data of 216 patients with biliary tract infection whose bile bacterial culture showed gram -negative bacteria infection from 2007 to 2011 were analyzed .The 97 patients with bile infection caused by ESBLs‐producing bacteria were set as the observation group ,the 119 patients with bile infection caused by non ESBLs‐producing bacteria were set as the control group .The drug resistance was compared between the two groups ,and the logistic regression analysis was adopted to investigate the clinical risk factors for biliary tract infection caused by ESBLs‐producing strains .RESULTS Most of gram‐negative bacteria were Escherichiacoli (155 strains ,71 .76% ) .The positive rate

  9. 住宅工程中给排水工程技术问题的分析%Analysis on Technical Problems on Residential of Water Supply and Drainage Engineering

    Institute of Scientific and Technical Information of China (English)

    张瑞林

    2012-01-01

    It focuses on the residential project in the construction of water supply and drainage engineering of technical problems,a concrete analysis of water supply and drainage system design.%重点讨论了住宅工程建设过程中给排水工程的技术问题,具体分析了给水工程与排水系统的设计。

  10. 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.

  11. Cost-Effectiveness Analysis of Surface Flow Constructed Wetlands (SFCW) for Nutrient Reduction in Drainage Discharge from Agricultural Fields in Denmark

    DEFF Research Database (Denmark)

    Gachango, Florence Gathoni; Pedersen, S M; Kjærgaard, Charlotte

    2015-01-01

    Constructed wetlands have been proposed as cost-effective and more targeted technologies in the reduction of nitrogen and phosphorous water pollution in drainage losses from agricultural fields in Denmark. Using two pig farms and one dairy farm situated in a pumped lowland catchment as case studies......, this paper explores the feasibility of implementing surface flow constructed wetlands (SFCW) based on their cost effectiveness. Sensitivity analysis is conducted by varying the cost elements of the wetlands in order to establish the most cost-effective scenario and a comparison with the existing nutrients...

  12. EVALUATION OF CATROSAT 1PAN STEREO AND RESOURCESAT LISS 4 MSS MERGED DATA FOR MORPHOMETRIC ANALYSIS, DELINEATION OF DRAINAGE BASINS AND CODIFICATION IN TAMIL NADU, INDIA AND AUSTRALIA

    Directory of Open Access Journals (Sweden)

    G. S. Mohamed

    2012-07-01

    Full Text Available The Topographic maps and Aerial Photographs are used for morphometric analysis of drainage basins and mapping contours with drainage. The stereo pairs of 2.5 m resolution Cartosat 1, Indian satellite 2 and merged data with 5.5 m resolution P6 Resourcesat 1 LISS 4 Indian satellite of 2001 is used to map, rills, gullies, and streams of first order to evaluate part of drainage basin of Cooum and Poondi Reservoir in Thiruvallur taluk of Tamil Nadu state. The Geo Eye latest 2011data is also used with Catrosat 1Stereo data to study present morphology of tiny micro watersheds to study the use of High resolution data for delineation and codification of watersheds. This study area is in an inter fluvial drainage basin of Cooum and Kusasthalai rivers. Kusasthalai river drains in Poondi reservoir which is about 50 km from Chennai. The excess water from Kosasthalai is also diverted through Kesawaram weir to Cooum river which passes through Thiruvallur and Chennai city before it's confluence with Bay of Benegal in the east. As Cooum basin is at higher elevation, water for irrigation is again diverted through chain of tanks to Kusasthalai river basin to drain in Poondi reservoir. Delineation of water sheds in this fluvial basin is difficult by manual survey as man made irrigation channels, natural drainage streams etc., have to be clearly identified. The streams of various orders are identified based on Strahler stream order hierarchy of tributaries, slops and contours using large scale satellite data. The micro water sheds are delinated identifying the ridges from Catrosat data for this interfluves basin which has mild slop. To illustrate this research, parts of two micro watersheds which were delineated using 1:50000 data for Tamil Nadu watershed Atlas up to 7th order streams are taken up for a detailed study using high resolution data. 19 Micro watersheds with streams up to 10th order are mapped. The capability of high resolution satellite data for digital

  13. Evaluation of Catrosat 1PAN Stereo and Resourcesat Liss 4 MSS Merged Data for Morphometric Analysis, Delineation of Drainage Basins and Codification in Tamil Nadu, India and Australia

    Science.gov (United States)

    Mohamed, G. S.; Srinivasan, S.; Pandian, R.; Gummidipoondi, R. J.; Venkatchalam, R. V.; Swaminathan. S, S.

    2012-07-01

    The Topographic maps and Aerial Photographs are used for morphometric analysis of drainage basins and mapping contours with drainage. The stereo pairs of 2.5 m resolution Cartosat 1, Indian satellite 2 and merged data with 5.5 m resolution P6 Resourcesat 1 LISS 4 Indian satellite of 2001 is used to map, rills, gullies, and streams of first order to evaluate part of drainage basin of Cooum and Poondi Reservoir in Thiruvallur taluk of Tamil Nadu state. The Geo Eye latest 2011data is also used with Catrosat 1Stereo data to study present morphology of tiny micro watersheds to study the use of High resolution data for delineation and codification of watersheds. This study area is in an inter fluvial drainage basin of Cooum and Kusasthalai rivers. Kusasthalai river drains in Poondi reservoir which is about 50 km from Chennai. The excess water from Kosasthalai is also diverted through Kesawaram weir to Cooum river which passes through Thiruvallur and Chennai city before it's confluence with Bay of Benegal in the east. As Cooum basin is at higher elevation, water for irrigation is again diverted through chain of tanks to Kusasthalai river basin to drain in Poondi reservoir. Delineation of water sheds in this fluvial basin is difficult by manual survey as man made irrigation channels, natural drainage streams etc., have to be clearly identified. The streams of various orders are identified based on Strahler stream order hierarchy of tributaries, slops and contours using large scale satellite data. The micro water sheds are delinated identifying the ridges from Catrosat data for this interfluves basin which has mild slop. To illustrate this research, parts of two micro watersheds which were delineated using 1:50000 data for Tamil Nadu watershed Atlas up to 7th order streams are taken up for a detailed study using high resolution data. 19 Micro watersheds with streams up to 10th order are mapped. The capability of high resolution satellite data for digital as well as visual

  14. Management of biliary perforation in children

    Directory of Open Access Journals (Sweden)

    Mirza Bilal

    2010-01-01

    Full Text Available Background: To study the aetiology, management and outcome of biliary perforations in paediatric age group. Patients and Methods: In a retrospective study, the records of patients presented with biliary peritonitis due to biliary perforations, managed from March 2006 to July 2009, are reviewed. Results: Eight male patients with biliary peritonitis due to biliary perforation were managed. These patients were divided in two groups, A and B. Group A, (n = 3 patients, had common bile duct (CBD perforation, and Group B (n=5 patients had gallbladder perforation. The presenting features were abdominal pain, fever, abdominal distension, vomiting, constipation, jaundice and signs of peritonism. The management of CBD perforations in Group A was by draining the site of perforation and biliary diversion (tube cholecystostomy. In Group B, the gallbladder perforations were managed by tube cholecystostomy in four patients and cholecystectomy in one patient, however, one patient had to be re-explored and cholecystectomy performed due to complete necrosis of gall bladder. There was no mortality in our series. All patients were asymptomatic on regular follow-up. Conclusion: Early optimal management of biliary perforations remarkably improved the very high mortality and morbidity that characterised this condition in the past.

  15. 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.

  16. 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.

  17. Fine-mapping analysis revealed complex pleiotropic effect and tissue-specific regulatory mechanism of TNFSF15 in primary biliary cholangitis, Crohn's disease and leprosy.

    Science.gov (United States)

    Sun, Yonghu; Irwanto, Astrid; Toyo-Oka, Licht; Hong, Myunghee; Liu, Hong; Andiappan, Anand Kumar; Choi, Hyunchul; Hitomi, Yuki; Yu, Gongqi; Yu, Yongxiang; Bao, Fangfang; Wang, Chuan; Fu, Xian; Yue, Zhenhua; Wang, Honglei; Zhang, Huimin; Kawashima, Minae; Kojima, Kaname; Nagasaki, Masao; Nakamura, Minoru; Yang, Suk-Kyun; Ye, Byong Duk; Denise, Yosua; Rotzschke, Olaf; Song, Kyuyoung; Tokunaga, Katsushi; Zhang, Furen; Liu, Jianjun

    2016-01-01

    Genetic polymorphism within the 9q32 locus is linked with increased risk of several diseases, including Crohn's disease (CD), primary biliary cholangitis (PBC) and leprosy. The most likely disease-causing gene within 9q32 is TNFSF15, which encodes the pro-inflammatory cytokine TNF super-family member 15, but it was unknown whether these disparate diseases were associated with the same genetic variance in 9q32, and how variance within this locus might contribute to pathology. Using genetic data from published studies on CD, PBC and leprosy we revealed that bearing a T allele at rs6478108/rs6478109 (r(2) = 1) or rs4979462 was significantly associated with increased risk of CD and decreased risk of leprosy, while the T allele at rs4979462 was associated with significantly increased risk of PBC. In vitro analyses showed that the rs6478109 genotype significantly affected TNFSF15 expression in cells from whole blood of controls, while functional annotation using publicly-available data revealed the broad cell type/tissue-specific regulatory potential of variance at rs6478109 or rs4979462. In summary, we provide evidence that variance within TNFSF15 has the potential to affect cytokine expression across a range of tissues and thereby contribute to protection from infectious diseases such as leprosy, while increasing the risk of immune-mediated diseases including CD and PBC. PMID:27507062

  18. Radiation therapy for patients with obstructive jaundice caused by carcinoma of the extrahepatic biliary system

    Energy Technology Data Exchange (ETDEWEB)

    Kawamura, Masashi; Nakagawa, Hirofumi (National Shikoku Cancer Center Hospital, Ehime (Japan)); Kataoka, Masaaki (and others)

    1992-04-01

    From February 1980 through September 1990, 92 patients with obstructive jaundice resulting from biliary tract cancer were registered at Shikoku Cancer Center Hospital or Ehime University Hospital. Radiation therapy (RT) was used to treat 38 of these patients (30 with carcinoma of the extrahepatic bile duct, excluding ampulla of Vater, and eight patients with carcinoma of the gallbladder). Of 38 patients, 11 underwent intraoperative radiation therapy (IORT), and 27 were treated by external radiation therapy (ERT) alone. In contrast, 54 patients (39 with carcinoma of the extrahepatic bile duct and eight with carcinoma of the gallbladder) were not treated by RT. All jaundiced patients received external and/or internal biliary drainage of some kind. Among patients undergoing biliary drainage with a catheter, 21 patients who underwent RT (four with IORT) survived significantly longer than 19 patients who did not (generalized Wilcoxon test: p<0.05). There were no significant differences in survival between 7 patients with recanalization and 11 patients with no recanalization. Concerning the survival of laparotomized patients, excluding those with complete resection or perioperative death, eight patients treated with postoperative ERT survived longer than 12 patients who did not have postoperative ERT (not significant). Eleven patients underwent IORT. A patient with unresectable carcinoma of the hilar bile duct survived 2 years and 3 months after a combination treatment of ERT and IOTR. In four of eight autopsied patients, radiation effects of Grade II were observed (Oboshi and Shimosato's evaluation system for the histological effects of radiation therapy). Our experience suggests that RT is effective in patients with obstructive jaundice caused by carcinoma of the biliary system. (author).

  19. The Analysis on Subsurface Drainage System of Yunnan Road Engineering%云南高等级公路路基路面排水研究

    Institute of Scientific and Technical Information of China (English)

    彭越

    2011-01-01

    实际调查表明,云南省高等级公路路面在使用一段时间后,出现各种病害,都不同程度地与地表水和地下水的侵蚀有关.如路基沉陷、坍塌、翻浆;沥青路面松散、剥落、龟裂;水泥混凝土路面唧泥、错台、断裂等.水的作用加剧路基路面结构损坏和路面使用性能的恶化.因此,做好道路的内部排水是影响路面使用性能和使用寿命的一个重要因素.%The analysis on some highway drainage status and drainage facilities' setting shows that after a period of using time, all kinds of diseases are inevitably to emerge in the high-type highway pavement, especially the water damage, which is the main natural factors. Many kinds of diseases such as subgrade depression, water scouring, slide, mudding, asphalt pavement raveling, stripping, map cracking, and cement concrete pavement pumping, faulting,fracture are to do with the erosion of surfaceand underground water to some extent. Water intensifies the damage of subgrade and pavement structure, accelerates the deterioration of pavement service ability, which shorten their service life. Therefore, whether the road drainage is unobstructed affects pavement operational performance and service life, which becomes an important factor.

  20. Etiopathogenesis of primary biliary cirrhosis

    Institute of Scientific and Technical Information of China (English)

    Ana Lleo; Pietro Invernizzi; Ian R Mackay; Harry Prince; Ren-Qian Zhong; M Eric Gershwin

    2008-01-01

    Primary biliary cirrhosis (PBC) is an autoimmune disease of the liver characterized by progressive bile duct destruction eventually leading to cirrhosis and liver failure.The serological hallmark of the disease is the presence of circulating antimitochondrial antibodies (AMA).These reflect the presence of autoreactive T and B cells to the culprit antigens,the E2 subunits of mitochondrial 2-oxo-acid dehydrogenase enzymes,chiefly pyruvate dehydrogenase (PDC-E2).The disease results from a combination of genetic and environmental risk factors.Genetic predisposition is indicated by the higher familial incidence of the disease particularly among siblings and the high concordance rate among monozygotic twins.Environmental triggering events appear crucial to disrupt a preexisting unstable immune tolerance of genetic origin allowing,after a long latency,the emergence of clinical disease.Initiating mimetopes of the vulnerable epitope of the PDC-E2 autoantigen can be derived from microbes that utilize the PDC enzyme or,alternatively,environmental xenobiotics/chemical compounds that modify the structure of native proteins to make them immunogenic.A further alternative as a source of antigen is PDC-E2 derived from apoptotic cells.In the effector phase the biliary ductular cell,by reason of its proclivity to express the antigen PDC-E2 in the course of apoptosis,undergoes a multilineage immune attack comprised of CD4+ and CD8+ T cells and antibody.In this article,we critically review the available evidence on etiopathogenesis of PBC and present interpretations of complex data,new developments and theories,and nominate directions for future research.

  1. 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.

  2. A STUDY OF VARIABLES CHARACTERIZING DRAINAGE PATTERNS IN RIVER NETWORKS

    Directory of Open Access Journals (Sweden)

    L. Zhang

    2012-07-01

    Full Text Available In GIS and in terrain analysis, drainage systems are important components. Due to local topography and subsurface geology, a drainage system achieves a particular drainage pattern based on the form and texture of its network of stream channels and tributaries. Drainage pattern recognition helps to provide a qualitative description of the terrain for analysis and classification and is useful for terrain modelling and visualization and applications in environment. Much research has been done on the description of drainage patterns in geography and hydrology. However automatic drainage pattern recognition in river networks is not well developed. This paper introduces a method based on geometric quantitative indicators to recognize drainage patterns in a river network automatically. Experiment results are presented and discussed.

  3. 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...

  4. Adenocarcinoma of the extrahepatic biliary tree.

    OpenAIRE

    Anderson, J B; Cooper, M J; Williamson, R. C.

    1985-01-01

    Increasing survival rates for carcinoma of the biliary tree could reflect the selection of patients for referral to a specialist centre as well as modern improvements in diagnosis and treatment. To determine the true incidence and outcome of biliary cancer, the records of 243 unselected Bristol patients were reviewed retrospectively over a 15-year period. Mean age was 64 years. Gallstones were associated in 38% of cases. Sixty-nine of 87 patients with gallbladder carcinoma were submitted to l...

  5. Postprocedural percutaneous transhepatic billiary drainage alterations of right hemidiaphragm: Clinical significance

    International Nuclear Information System (INIS)

    The radiographic findings, occurrence, and clinical significance of altered right hemidiaphragm dynamics in percutaneous transhepatic biliary drainage (PBD) patients was evaluated. Preprocedural and postprocedural chest radiographs, PBD procedural notes, and medical records were reviewed in 87 PBD patients. Radiographically, 37 patients had immediate post-PBD elevation of the right hemidiaphragm that failed to resolve in 28 patients with chronic external catheters. Clinically, 15 of 37 patients developed right lower lobe pneumonia or right pleural effusion on the initial or subsequent hospital admissions. Ten of these 15 patients had diabetes, chronic renal failure, or were immunosuppressed and had prolonged hospital stays. The authors' initial data suggest percutaneous transhepatic biliary drainage may cause unfavorable alteration in right hemidiaphragm dynamics, and alternative methods including left-sided PBD, endoscopic, or combined PBD/endoscopic catheter placement may be advisable in certain clinical situations

  6. Intraluminal radiation therapy in the management of malignant biliary obstruction

    International Nuclear Information System (INIS)

    Fifteen patients with malignant biliary obstruction from carcinoma of the bile ducts, gallbladder, and pancreas (Group I) or metastatic disease (Group II) were treated with intraluminal radiation therapy (ILRT) at Memorial Sloan-Kettering Cancer Center. In 11 cases ILRT was used as a central boost in combination with 3000 cGy external beam radiation therapy (ERT). No significant treatment toxicity was observed. Cholangiographic response was observed in 2 of 12 evaluable patients. In no patient was long-term relief of jaundice without indwelling biliary stent achieved. Survival from treatment in eight Group I patients treated with ILRT +/- ERT was 3 to 13 months (median, 4.5). Survival in seven similarly treated Group II patients was 0.5 to 8 months (median, 4.0). Additional data for ten similar patients referred for ILRT but treated with ERT alone are presented. Analysis of this and other reports indicate the need for prospective controlled trials of the role of this regimen in the management of malignant biliary obstruction before wider application can be recommended

  7. Diagnosis of biliary strictures after liver transplantation: Which is the best tool?

    Institute of Scientific and Technical Information of China (English)

    Thomas Zoepf; Evelyn J. Maldonado-Lopez; Philip Hilgard; Alexander Dechêne; Massimo Malago; Christoph E. Broelsch; Joerg Schlaak; Guido Gerken

    2005-01-01

    AIM: To evaluate the diagnostic value of different indirect methods like biochemical parameters, ultrasound (US) analysis, CT-scan and MRI/MRCP in comparison with endoscopic retrograde cholangiography (ERC), for diagnosis of biliary complications after liver transplantation. METHODS: In 75 patients after liver transplantation, who received ERC due to suspected biliary complications, the result of the cholangiography was compared to the results of indirect imaging methods performed prior to ERC. The cholangiography showed no biliary stenosis (NoST) in 25 patients, AST in 27 and ITBL in 23 patients. RESULTS: Biliary congestion as a result of AST was detected with a sensitivity of 68.4% in US analysis (specificity 91%), of 71% in MRI (specificity 25%) and of 40% in CT (specificity 57.1%). In ITBL, biliary congestion was detected with a sensitivity of 58.8% in the US, 88.9%in MRI and of 83.3% in CT. However, as anastomotic or ischemic stenoses were the underlying cause of biliary congestion, the sensitivity of detection was very low. InMRI detected the dominant stenosis at a correct localization in 22% and CT in 10%, while US failed completely. The biochemical parameters, showed no significant difference in bilirubin (median 5.7; 4,1; 2.5 mg/dL), alkaline phosphatase (median 360; 339; 527 U/L) or gamma glutamyl transferase (median 277; 220; 239 U/L) levels between NoST, AST and ITBL.CONCLUSION: Our data confirm that indirect imaging methods to date cannot replace direct cholangiography for diagnosis of post transplant biliary stenoses. However MRI may have the potential to complement or precede imaging by cholangiography. Optimized MRCP-processing might further improve the diagnostic impact of this method.

  8. Endoscopic transpapillary gallbladder drainage with replacement of a covered self-expandable metal stent

    OpenAIRE

    Kawakubo, Kazumichi; Isayama, Hiroyuki; Sasahira, Naoki; Nakai, Yousuke; Kogure, Hirofumi; Sasaki, Takashi; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

    2011-01-01

    Endoscopic self-expandable metal stent (SEMS) placement has become a standard palliative therapy for patients with malignant biliary obstruction. Acute cholecystitis after SEMS placement is a serious complication. We report a patient with an acute cholecystitis after covered SEMS placement, who was managed successfully with endoscopic transpapillary gallbladder drainage (ETGBD) and replacement of the covered SEMS. An 85-year-old man with pancreatic cancer suffered from acute cholecystitis aft...

  9. The Clinical Analysis on Biliary Operation Among 267 Old People%267例老年人胆道手术临床分析

    Institute of Scientific and Technical Information of China (English)

    罗国斌

    2014-01-01

      Objective:Purpose:Discussthesafetyofperformingoperationsofbiliarytractforoldpeopleinprimaryhospitals. Methods:Retrospective analyses 267 clinical data of performing operations of biliary tract for over65-year-oldpeopleinourtownclinic.Results:Ourgroupperforms69casesoflaparoscopiccholecystectomy,124casesofopencholecystectomy,56casesofcholedocholithotomy,18casesofcholedocholithotomyforasecondtime.Allthesurgeriesgowell.Thereare5casesofpostoperativewoundinfection,1caseofwounddehiscence,1caseofincision-al hernia and 5 cases of acute bronchitis. Conclusion:Foroldpeople,chronicdiseaseisnormal.Weshouldpayattentionto patients' perioperative treatment. Performing operations of biliary tract for old people in primary hospitals is safe.%目的:探讨基层医院实施老年人胆道手术的安全性。方法:回顾性分析267例65周岁以上老年人行胆道手术的临床资料。结果:实施腹腔镜胆囊切除术69例,开腹胆囊切除术124例,开腹胆囊切除+胆总管切开取石“T”管引流术56例,再次胆总管切开取石“T”管引流术18例,手术过程均顺利,术后并发切口感染5例,切口裂开1例,切口疝1例,急性支气管炎5例。结论:老年人并发慢性病较多,重视围手术期处理,在基层医院实施胆道手术是安全的。

  10. 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

  11. Biliary cholesterol secretion : More than a simple ABC

    NARCIS (Netherlands)

    Dikkers, Arne; Tietge, Uwe J. F.

    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 final step for the elimination of cholesterol originat

  12. Usefulness of multiplanar reformatted images of multi-detector row helical CT in assessment of biliary stent patency

    International Nuclear Information System (INIS)

    To evaluate the usefulness of multi-detector row helical CT (MDCT), multiplanar reformatted images for the noninvasive assessment of biliary stent patency, and for the planning for management in patients with a sele-expandable metallic stent due to malignant biliary obstruction. Among 90 consecutive patients, from August 1999 to July 2003, 26 cases in 23 patients with malignant biliary obstruction who underwent self-expandable metaIlic stent insertion in the biliary system and percutaneous transhepatic biliary drainage within 7 days after CT were enrolled in this study. On CT images, the complete and functional obstruction of the stent and the precise level of obstruction were evaluated. The presence of an enhancing intraluminal mass or wall thickening around stent was determined, and the causes of obstruction were evaluated. These findings were then compared with percutaneous transhepatic cholangiography. Multi-detector row helical CT correctly demonstrated the patency of a stent in 24 cases (92.3%). It was adequate in helping to depict the precise level of stent occlusion in 23 cases (88.5%). Multi-detector row helical CT also revealed the extent of tumor that represented as an enhancing intraluminal mass or wall thickening around the stent in 23 cases, and this was represented as complete obstruction on percutaneous transhepatic cholangiography. In the case of functional obstruction, MDCT predicted the possible cause of the obstruction. Multiplanar reformatted images of multi-detector row helical CT is a useful imaging modality for the noninvasive assessment of stent patency and the precise level of obstruction when stent obstruction is suspected in the patients with self-expandable metallic stent due to malignant biliary obstruction. It can also predict the possible cause of the obstruction and allows adequate planning for the medical management of such cases

  13. Biliary Leak in Post-Liver-Transplant Patients: Is There Any Place for Metal Stent?

    Directory of Open Access Journals (Sweden)

    Fernanda P. Martins

    2012-01-01

    Full Text Available Objectives. Endoscopic management of bile leak after orthotopic liver transplant (OLT is widely accepted. Preliminary studies demonstrated encouraging results for covered self-expandable metal stents (CSEMS in complex bile leaks. Methods. Thirty-one patients with post-OLT bile leaks underwent endoscopic temporary placement of CSEMS (3 partially CSEMS , 18 fully CSEMS with fins and 10 fully CSEMS with flare ends between December 2003 and December 2010. Long-term clinical success and safety were evaluated. Results. Median stent indwelling and follow-up were 89 and 1,353 days for PCSEMS, 102 and 849 for FCSEMS with fins and 98 and 203 for FCSEMS with flare ends. Clinical success was achieved in 100%, 77.8%, and 70%, respectively. Postplacement complications: cholangitis (1 and proximal migration (1, both in the FCSEMS with fins. Postremoval complications were biliary strictures requiring drainage: PCSEMS (1, FCSEMS with fins (6 and with flare ends (1. There was no significant differences in the FCSEMS groups regarding clinical success, age, gender, leak location, previous treatment, stent indwelling, and complications. Conclusion. Temporary placement of CSEMS is effective to treat post-OLT biliary leaks. However, a high number of post removal biliary strictures occurred especially in the FCSEMS with fins. CSEMS cannot be recommended in this patient population.

  14. Management of ischemic-type biliary injury induced by hepatic artery stricture after orthotopic liver transplantation

    International Nuclear Information System (INIS)

    Objective: To discuss the treatment of ischemic-type biliary injury due to hepatic artery stricture after orthotopic liver transplantation and to estimate its prognosis. Methods: The clinical data of 11 patients with ischemic-type biliary injury due to hepatic artery stricture after orthotopic liver transplantation encountered during the period of June 2004-June 2008, who underwent hepatic artery stenting together with endoscopic retrograde cholangiopancreatography (ERCP) and/or percutaneous transhepatic cholangial drainage (PTCD), were retrospectively analyzed. Results: A total of 12 balloon-expandable coronary stents was successfully implanted in 11 patients. In 5 patients only ERCP was adopted and in 3 patients only PTCD was used. The remaining 3 patients received PTCD after they failed to respond to ERCP. During a follow-up period of 4 months-4 years, 6 cases died of infection, of which 5 died within one year. Three patients accepted liver transplantation once more. The other 2 patients survived so far. Conclusion: The overall therapeutic result of ischemic-type biliary injury due to hepatic artery stricture after orthotopic liver transplantation is not ideal at present. Hepatic artery stenting combined with longstanding PTCD may prolong the survival time of the grafted liver and, therefore, provide opportunity for re-transplantation. (authors)

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

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

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

  16. Package Drainage Analysis of East Area in Taizhou Circular Economy Industrial Zones%台州湾循环经济产业集聚区台州市区东部组团排涝研究

    Institute of Scientific and Technical Information of China (English)

    黄若秋

    2011-01-01

    随着台州湾循环经济产业集聚区台州市区东部组团开发建设的迅速推进,区域排涝问题的解决成为保障其社会经济发展的重要因素.通过分析区域及所在流域现有排涝形势、区域发展规划定位及流域整体排涝要求,提出河、湖、闸等排涝治理措施,并建立河网数学模型,合理推算治理措施的规模,实现区域20年一遇的城市排涝标准.%With the rapid development and construction of eastern groups in Taizhou Circular Economy Industrial Zone,the solutions of regional water drainage have become the key factors of socio-economic development.The drainage improvement measures for rivers,lakes and gates should be taken based on the analysis of regional existing drainage situation at basin area,local development planning and positioning,as well as the requirements of the overall drainage area.In additional,mathematical models of watercourse and reasonable scale of improvement should also be established and calculated for the purpose of urban water drainage standards for the worst flood in 20 years.

  17. Failed biliary cannulation: Clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    Michael P Swan; Michael J Bourke; Stephen J Williams; Sina Alexander; Alan Moss; Rick Hope; David Ruppin

    2011-01-01

    AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center.METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP.RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary cannulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identifiable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 na?ve papilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or post-ERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017).CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures.

  18. 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...

  19. 胆石症患者胆道感染的病原学分析与治疗探讨%Etiological analysis and treatment of biliary tract infections suffered by cholelithiasis patients

    Institute of Scientific and Technical Information of China (English)

    马红梅; 戴丐国; 连建安; 姜斌骅

    2014-01-01

    OBJECTIVE To investigate the etiological status of biliary tract infections among cholelithiasis patients and offer corresponding measures for treatment so as to improve the level of clinical treatment .METHODS The clinical data of 370 cases of cholelithiasis patients from Jan 2010 to Jan 2013 were retrospectively analyzed ,and the pathogen distribution and drug resistance were analyzed among those patients who suffered from biliary tract infec-tions ;PPMS software was adopted for statistical analysis ,t-test was adopted for testing measurement data and Chi-square was adopted for testing enumeration data .RESULTS Totally ,79 cases of the 370 cases of cholelithiasis patients suffered from biliary tract infections ,with the infection rate of 21 .35% ;a total of 79 strains of pathogens were detected ,gram-positive bacteria were 32 strains ( 40 .51% ) with the top 3 pathogens of Enterococcus f aeca-lis ,Streptococcus pyogenes and Staphylococcus aureus ,accounting for 13 .92% ,11 .39% and 11 .39% respective-ly ;gram-negative strains were 47 strains (59 .49% ) ,with the top 3 pathogens of Escherichia coli ,K lebsiella and Pseudomonas aeruginoosa ,accounting for 18 .99% ,16 .46% and 11 .39% respectively ;all the drug resistance rates of dominant gram-negative bacteria to meropenem ,imipenem and ceftriaxone were between 0-11 .11% ,be-sies ,the resistance rates of E .coli ,and P .aeruginosa to cefotaxime were 13 .33% and 22 .22% respectively ,and the drug resistance rate of K lebsiella to levofloxacin was 15 .38% ;the dominant gram-positive bacteria had low drug resistance rate between 0 and 11 .11% to vancomycin ,teicoplanin and cefminox ,the drug resistance rates of E .f aecalis and Staphylococcus aureus to cefotaxime were 18 .18% and 11 .11% respectively ,and the drug resist-ance rates of S .pyogenes to ampicillin-sulbactam was 11 .11% .CONCLUSION Gram-negative bacteria are the dom-inant pathogens causing biliary tract infection to cholelithiasis patients ,and it is

  20. Clinical analysis of continuous external ventricular drainage of bilateral ventricle combined with lumbar cisterna drainage on treatment of intraventricular hemorrhage%腰大池引流治疗脑室出血临床分析

    Institute of Scientific and Technical Information of China (English)

    施小龙; 左春生; 朱田生

    2014-01-01

    Objective To investigate the clinical effect of the continuous external ventricular drainage of bilateral ventricle combined with lumbar cisterna drainage on the treatment of intraventricular hemorrhage .Methods Ninety-two cases of brain trauma in our hospital were divided into control group and treatment group according to the table of random digit .All the cases were treated with continuous external drainage of bilateral ventricle ,and combined with lumbar cisterna drainage on the treatment of treatment group .The efficacy was evaluated with ADL and the postoperative complications were recorded .The incidence rate of intracranial infection ,hydrocephalus,cerebral hernia of treat-ment group was lower than that of the control group .Results The difference between treatment group and observation group was statistically significant,including the death,cured and handicapped cases.The incidence of complications of observation group and treatment group was 43.48%and 4.35%,respectively,and the difference was statistically significant (P<0.05).Conclusion The continuous external drainage of bilateral ventricle combined with lumbar cisterna drainage on the treatment of intraventricular hemorrhage has important clinical significance in degrading the complications .%目的:探讨双侧侧脑室外引流联合腰大池引流治疗脑室出血的临床效果。方法选取2009年2月至2013年11月在我院就诊的脑室出血患者92例,按照随机数字表法分为对照组和治疗组,每组各46例。对照组患者使用双侧脑室外引流并使用尿激酶灌注,治疗组在对照组的基础上加行腰大池置管持续外引流。使用日常生活能力量表( ADL)评价患者的治疗效果,记录患者术后并发症发生情况。结果治疗组患者死亡病例、完全正常和明显功能障碍的病例数与对照组比较,差异有统计学意义(P<0.05);治疗组颅内感染、脑积水、脑疝发生的例数均少于对照组

  1. Current endoscopic approach to indeterminate biliary strictures

    Institute of Scientific and Technical Information of China (English)

    David W Victor; Stuart Sherman; Tarkan Karakan; Mouen A Khashab

    2012-01-01

    Biliary strictures are considered indeterminate when basic work-up,including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing,are non-diagnostic.Indeterminate biliary strictures can easily be mischaracterized which may dramatically affect patient's outcome.Early and accurate diagnosis of malignancy impacts not only a patient's candidacy for surgery,but also potential timely targeted chemotherapies.A significant portion of patients with indeterminate biliary strictures have benign disease and accurate diagnosis is,thus,paramount to avoid unnecessary surgery.Current sampling strategies have suboptimal accuracy for the diagnosis of malignancy.Emerging data on other diagnostic modalities,such as ancillary cytology techniques,single operator cholangioscopy,and endoscopic ultrasonography-guided fine needle aspiration,revealed promising results with much improved sensitivity.

  2. 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

  3. 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.

  4. 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.

  5. 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

  6. 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.)

  7. 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.

  8. 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)

  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. Percutaneous transcholecystic approach for an experiment of biliary stent placement: an experimental study in dogs

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Tae Seok [Medical School of Gachon, Inchon (Korea, Republic of); Song, Ho Young; Lim, Jin Oh; Ko, Gi Young; Sung, Kyu Bo; Kim, Tae Hyung; Lee, Ho Jung [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)

    2002-06-01

    To determine, in an experimental study of biliary stent placement, the usefulness and safety of the percutaneous transcholecystic approach and the patency of a newly designed biliary stent. A stent made of 0.15-mm-thick nitinol wire, and 10 mm in diameter and 2 cm in length, was loaded in an introducer with an 8-F outer diameter. The gallbladders of seven mongrel dogs were punctured with a 16-G angiocath needle under sonographic guidance, and cholangiography was performed. After anchoring the anterior wall of the gallbladder to the abdominal wall using a T-fastener, the gallbladder body was punctured again under fluoroscopic guidance. The cystic and common bile ducts were selected using a 0.035-inch guide wire and a cobra catheter, and the stent was placed in the common bile duct. Post-stenting cholangiography was undertaken, and an 8.5-F drainage tube was inserted in the gallbladder. Two dogs were followed-up and sacrificed at 2,4 and 8 weeks after stent placement, respectively, and the other expired 2 days after stent placement. Follow-up cholangiograms were obtained before aninmal was sacrified, and a pathologic examination was performed. Stent placement was technically successful in all cases. One dog expired 2 days after placement because of bile peritonitis due to migration of the drainage tube into the peritoneal cavity, but the other six remained healthy during the follow-up period. Cholangiography performed before the sacrifice of each dog showed that the stents were patent. Pathologic examination revealed the proliferation of granulation tissue at 2 weeks, and complete endothelialization over the stents by granulation tissue at 8 weeks. Percutaneous transcholecystic biliary stent placement appears to be safe, easy and useful. After placement, the stent was patent during the follow-period.

  11. Simulation of groundwater drainage into a tunnel in fractured rock and numerical analysis of leakage remediation, Romeriksporten tunnel, Norway

    Science.gov (United States)

    Kitterød, N.-O.; Colleuille, H.; Wong, W. K.; Pedersen, T. S.

    2000-09-01

    Standard geostatistical methods for simulation of heterogeneity were applied to the Romeriksporten tunnel in Norway, where water was leaking through high-permeable fracture zones into the tunnel while it was under construction, causing drainage problems on the surface. After the tunnel was completed, artificial infiltration of water into wells drilled from the tunnel was implemented to control the leakage. Synthetic heterogeneity was generated at a scale sufficiently small to simulate the effects of remedial actions that were proposed to control the leakage. The flow field depends on the variance of permeabilities and the covariance model used to generate the heterogeneity. Flow channeling is the most important flow mechanism if the variance of the permeability field is large compared to the expected value. This condition makes the tunnel leakage difficult to control. The main effects of permeability changes due to sealing injection are simulated by a simple perturbation of the log-normal probability density function of the permeability. If flow channeling is the major transport mechanism of water into the tunnel, implementation of artificial infiltration of water to control the leakage requires previous chemical-sealing injection to be successful. Résumé. Des méthodes géostatistiques standard ont été employées pour simuler l'hétérogénéité des zones de fractures à fortes perméabilitées dans lesquelles, au cours de la construction du tunnel ferroviaire de Romeriksporten (Norvège), l'eau s'est écoulée, causant des problèmes de drainage en surface. Quand les travaux ont été terminés, l'injection d'eau dans des puits forés à partir du tunnel a été réalisée pour contrôler ces infiltrations. Une hétérogénéité synthétique a été créée à une échelle suffisamment petite pour simuler les effets de l'injection d'eau. Le champ des écoulements dépend de la variance des perméabilités et de la covariance du modèle utilisé pour g

  12. Biliary cystadenoma and choledochal polyp: a rare association

    Directory of Open Access Journals (Sweden)

    A.Y. Lakshmi

    2013-01-01

    Full Text Available Biliary cystadenomas are rare, potentially malignant neoplasms of biliary origin occurring predominantly in middle aged women. Here we report a case of biliary cystadenoma in a young female who presented with an epigastric mass and features of obstructive jaundice. Imaging studies showed a mass in the left lobe of liver with dilated intra hepatic biliary ducts, right hepatic duct and common bile duct. Patient was subjected to left hepatectomy and hepatico-jejunostomy. Histopathology confirmed the lesion as biliary cystadenoma with choledochal polyp.

  13. S100A9 is a biliary protein marker of disease activity in primary sclerosing cholangitis.

    Directory of Open Access Journals (Sweden)

    Lisa Reinhard

    Full Text Available BACKGROUND AND AIMS: Bile analysis has the potential to serve as a surrogate marker for inflammatory and neoplastic disorders of the biliary epithelium and may provide insight into biliary pathophysiology and possible diagnostic markers. We aimed to identify biliary protein markers of patients with primary sclerosing cholangitis (PSC by a proteomic approach. METHODS: Bile duct-derived bile samples were collected from PSC patients (n = 45 or patients with choledocholithiasis (n = 24, the control group. Liquid chromatography-tandem mass spectrometry (LC-MS/MS was performed to analyse the proteins, 2-D-gel patterns were compared by densitometry, and brush cytology specimens were analysed by RT-PCR. RESULTS: A reference bile-duct bile proteome was established in the control group without signs of inflammation or maligancy comprising a total of 379 non-redundant biliary proteins; 21% were of unknown function and 24% had been previously described in serum. In PSC patients, the biliary S100A9 expression was elevated 95-fold (p<0.005, serum protein expression was decreased, and pancreatic enzyme expression was unchanged compared to controls. The S100A9 expression was 2-fold higher in PSC patients with high disease activity than in those with low activity (p<0.05. The brush cytology specimens from the PSC patients with high disease activity showed marked inflammatory activity and leukocyte infiltration compared to the patients with low activity, which correlated with S100A9 mRNA expression (p<0.05. CONCLUSIONS: The bile-duct bile proteome is complex and its analysis might enhance the understanding of cholestatic liver disease. Biliary S100A9 levels may be a useful marker for PSC activity, and its implication in inflammation and carcinogenesis warrants further investigation.

  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. Wound Drainage Culture (For Parents)

    Science.gov (United States)

    ... Melon Smoothie Pregnant? Your Baby's Growth Wound Drainage Culture KidsHealth > For Parents > Wound Drainage Culture Print A A A Text Size What's in ... de heridas What It Is A wound drainage culture is a test to detect germs such as ...

  16. Will intraoperative cholangiography prevent biliary duct injury inlaparoscopic cholecystectomy?

    Institute of Scientific and Technical Information of China (English)

    Li Bo Li; Xiu Jun Cai; Jun Da Li; Yi Ping Mu; Yue Dong Wang; Xiao Ming Yuan; Xian Fa Wang; Urs Bryner; Robert K.Finley Jr

    2000-01-01

    AIM To evaluate the role of intraoperative cholangiogram (IOC) in preventing biliary duct injury duringlaparoscopic cholecystectomy.METHODS Injury location, mechanism, time of detection, treatment outcome, and whether anintraoperative cholangiogram was performed were evaluated in 31 cases of bile duct injuries.RESULTS Cholangiograms were done in 22 cases, but they were misinterpreted in 3 of them. In 12 of 19misidentified cases, the cholangiogram was interpreted correctly, and the injury detected intraoperatively.Primary laparoscopic repair or open repair and T-tube drainage solved the problem. No long-termcomplications occurred. However, in 3 of the 19 cases the cholangiogram was misinterpreted and in 4 of the19 cases no cholangiogram was performed. Three of the seven patients required a cholangioentericanastomosis. In 2 cases the diagnosis was delayed and one of these required a two-stage procedure. Morbiditywas increased. Three cases of clim impingement of the common duct had delayed diagnoses, and two of themhad injuries. Thermal injury developed in 4 cases who had cholangiograms.CONCLUSION Routine IOC plays no role in inducing, preventing, detecting, or minimizing any of theinjuries due to clips, lacerations, or electrocautery, IOC does not prevent injuries due to ductmisidentification either. Careful interpretation of IOC would prevent injuries and avoid an open operation.

  17. Brain abscess in hepatopulmonary syndrome associated with biliary atresia.

    Science.gov (United States)

    Morita, Keiichi; Fukuzawa, Hiroaki; Maeda, Kosaku

    2015-12-01

    The first-choice therapy for biliary atresia (BA) is Kasai hepatoportoenterostomy, which has been shown to greatly improve outcome. Various long-term complications, however, such as portal hypertension and hepatopulmonary syndrome (HPS), can occur in patients with native liver. A rare case of brain abscess in an 11-year-old girl with HPS associated with BA is reported. The patient underwent hepatoportoenterostomy for BA at 53 days of age, with resolution of hyperbilirubinemia. At 10 years of age, she was diagnosed with severe HPS with right-to-left shunting, and preparations for liver transplantation proceeded. Three months after the diagnosis, she had a right parietal brain abscess. Given that the brain abscess enlarged in size, surgical drainage of the brain abscess was performed. The postoperative course was uneventful, but a slight left hemiplegia remained at discharge. The presumed mechanism of abscess formation in HPS may be right-to-left bacterial transit through intrapulmonary vascular dilatations and/or arteriovenous fistulae. PMID:26711920

  18. Current status of peroral cholangioscopy in biliary tractdiseases

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Peroral cholangioscopy (POC) is an important toolfor the management of a selected group of biliarydiseases. Because of its direct visualization, POC allowstargeted diagnostic and therapeutic procedures. POCcan be performed using a dedicated cholangioscopethat is advanced through the accessory channel of aduodenoscope or via the insertion of a small-diameterendoscope directly into the bile duct. POC was firstdescribed in the 1970s, but the use of earlier generationdevices was substantially limited by the cumbersomeequipment setup and high repair costs. For nearlyten years, several technical improvements, includingthe single-operator system, high-quality images, thedevelopment of dedicated accessories and the increasedsize of the working channel, have led to increaseddiagnostic accuracy, thus assisting in the differentiationof benign and malignant intraductal lesions, targetingbiopsies and the precise delineation of intraductaltumor spread before surgery. Furthermore, lithotripsyof difficult bile duct stones, ablative therapies forbiliary malignancies and direct biliary drainage can beperformed under POC control. Recent developmentsof new types of conventional POCs allow feasible, safeand effective procedures at reasonable costs. In thecurrent review, we provide an updated overview ofPOC, focusing our attention on the main current clinicalapplications and on areas for future research.

  19. 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...

  20. Osteopathic manipulative treatment in the management of biliary dyskinesia.

    Science.gov (United States)

    Heineman, Katherine

    2014-02-01

    Biliary dyskinesia is a functional gastrointestinal disorder of the gallbladder and sphincter of Oddi. Diagnosis is made on the basis of symptoms of biliary colic in the absence of cholelithiasis and gallbladder inflammation. Palpatory findings of tissue texture changes at midthoracic levels (T6-T9) may correspond to visceral dysfunction related to the biliary system. Osteopathic manipulative treatment (OMT) of the T6-T9 segments can remove the feedback related to the somatic component, thereby affecting nociceptive facilitation at the spinal level and allowing the body to restore autonomic balance. Few reports in the current literature provide examples of treatment for patients with biliary dyskinesia using OMT. The author describes the case of a 51-year-old woman who presented with symptoms consistent with biliary dyskinesia. Her biliary colic completely resolved after OMT. Osteopathic evaluation and OMT should be considered a safe and effective option for conservative management of biliary dyskinesia.

  1. Acute biliary pancreatitis and cholecystolithiasis in a child:one time treatment with laparoendoscopic "Rendez-vous" procedure

    Institute of Scientific and Technical Information of China (English)

    Gaetano La Greca; Michele Di Blasi; Francesco Barbagallo; Manuela Di Stefano; Saverio Latteri; Domenico Russello

    2006-01-01

    Acute biliary pancreatitis (ABP) is rare in childhood and endoscopic sphincterotomy should be avoided in the child due to the risk of both early and late complications but, when necessary, the optimal timing between endoscopic procedure and cholecystectomy is still uncertain.A nine years old child with acute biliary pancreatitis underwent successfull laparo-endoscopic "Rendez-Vous" procedure in which endoscopic drainage of the common bile duct and laparoscopic cholecystectomy were performed simultaneously. This is the first case reported of laparo-endoscopic Rendez-Vous in a child. The excellent outcome of this patient and the review of the literature concerning other available options for the treatment of such cases suggest that this procedure offers great advantages, especially in children, of reducing the required number of treatments, the risk of ineffectiveness, the number of anaesthesia, the length of hospital stay and the risk of iatrogenic morbidity.

  2. Partial stent-in-stent placement of biliary metallic stents using a short double-balloon enteroscopy

    Institute of Scientific and Technical Information of China (English)

    Koichiro Tsutsumi; Hironari Kato; Takeshi Tomoda; Kazuyuki Matsumoto; Ichiro Sakakihara; Naoki Yamamoto; Yasuhiro Noma

    2012-01-01

    Endoscopic intervention is less invasive than percutaneous or surgical approaches and should be considered the primary drainage procedure in most cases with obstructive jaundice.Recently,therapeutic endoscopic retrograde cholangiopancreatography (ERCP) using double-balloon enteroscopy (DBE) has been shown to be feasible and effective,even in patients with surgically altered anatomies.On the other hand,endoscopic partial stent-in-stent (PSIS) placement of selfexpandable metallic stents (SEMSs) for malignant hilar biliary obstruction in conventional ERCP has also been shown to be feasible,safe and effective.We performed PSIS placement of SEMSs for malignant hilar biliary obstruction due to liver metastasis using a short DBE in a patient with Roux-en-Y anastomosis and achieved technical and clinical success.This procedure can result in quick relief from obstructive jaundice in a single session and with short-term hospitalization,even in patients with surgically altered anatomies.

  3. ETIOLOGY, PATHOGENESIS AND MORPHOLOGY OF BILIARY ATRESIA

    Directory of Open Access Journals (Sweden)

    O. E. Iryshkin

    2012-01-01

    Full Text Available Biliary atresia is an inflammatory fibrosing process, which invades both extrahepatic and intrahepatic bile ducts. There are two forms of biliary atresia: embryonic form, associated with another visceral malformations, and perinatal form, which is an isolated disease. Biliary atresia is a heterogeinc disease which may appear as a result of different etiological factors, the most important of them are genetics, viral infection, vascular factors, toxins and disregulation of immune system. The characteristic morphological features of biliaryatresia are: intracellular and ductular cholestasis, ductular proliferation, giant cell transformation, portal and perilobular oedema and/or fibrosis. As the patalogical process progresses, ductopenia appears, and fibrosis turns to cirrhosis. Embryonic form mophologically manifests with ductal plate malformation is, what is an important diagnostic criterion. Pro- gnosis of biliary atresia depends on form of disease, age of patient and type of surgical operation. Today surgical treatment includes two steps: palliative portoenterostomia, performed in neonatal period and further liver trans- plantation. However liver transplantation is more preferable as first and single-step treatment. 

  4. 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

  5. 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.

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

    Institute of Scientific and Technical Information of China (English)

    何贵金; 高沁怡; 莫宾; 戴显伟; 姜维国; 孙铎; 陈平健

    2004-01-01

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

  7. 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)

  8. Giant retroperitoneal abscess following necrotizing pancreatitis treated with internal drainage

    Institute of Scientific and Technical Information of China (English)

    Ludmil Marinov Veltchev; Manol Anastasov Kalniev

    2009-01-01

    BACKGROUND: Retroperitoneal abscess is a dangerous complication of the inflammatory process in organs. The pancreas reacts by enzymatic autodigestion and inflammation to external and internal factors: alcohol abuse, trauma, biliary stones, and viral infections. Chronic pancreatitis and formation of pseudocysts are late complications. The diffuse spread of pancreatic inflammation may form a retroperitoneal phlegmon. A better outcome is the limitation of the process by capsule formation-retroperitoneal abscess. METHODS: A 62-year-old man, with a history of alcohol abuse, was admitted for intermittent abdominal pain, fever, and significant weight loss. Previous medical consultations (laboratory tests, US, CT) confirmed chronic pancreatitis with pseudocyst formation. A new CT depicted a giant retroperitoneal abscess. RESULTS: After preoperative preparation with antibiotics, laparotomy and internal drainage-longitudinal cystoje-junostomy with Roux-en-Y loop were performed. At the 8th postoperative day the patient was in good condition. CONCLUSIONS: Giant retroperitoneal abscess is a dangerous pathology with significant mortality and morbidity. Diagnosis strongly necessitates operative intervention in order to evacuate and drain the space. These conditions include one internal drainage (in the GI tract) with the stomach, duodenum, or jejunum, which does not cause early and late GI discomfort and will gradually liquidate the cavity. We propose internal drainage with Roux-en-Y jejunal loop as the only method for accomplishing these conditions in cases of giant retroperitoneal abscesses.

  9. The Drainage Consolidation Modeling of Sand Drain in Red Mud Tailing and Analysis on the Change Law of the Pore Water Pressure

    OpenAIRE

    Chuan-sheng Wu

    2014-01-01

    In order to prevent the occurring of dam failure and leakage, sand-well drainages systems were designed and constructed in red mud tailing. It is critical to focus on the change law of the pore water pressure. The calculation model of single well drainage pore water pressure was established. The pore water pressure differential equation was deduced and the analytical solution of differential equation using Bessel function and Laplace transform was given out. The impact of parameters such as d...

  10. Drainage in a rising foam.

    Science.gov (United States)

    Yazhgur, Pavel; Rio, Emmanuelle; Rouyer, Florence; Pigeonneau, Franck; Salonen, Anniina

    2016-01-21

    Rising foams created by continuously blowing gas into a surfactant solution are widely used in many technical processes, such as flotation. The prediction of the liquid fraction profile in such flowing foams is of particular importance since this parameter controls the stability and the rheology of the final product. Using drift flux analysis and recently developed semi-empirical expressions for foam permeability and osmotic pressure, we build a model predicting the liquid fraction profile as a function of height. The theoretical profiles are very different if the interfaces are considered as mobile or rigid, but all of our experimental profiles are described by the model with mobile interfaces. Even the systems with dodecanol are well known to behave as rigid in forced drainage experiments. This is because in rising foams the liquid fraction profile is fixed by the flux at the bottom of the foam. Here the foam is wet with higher permeability and the interfaces are not in equilibrium. These results demonstrate once again that it is not only the surfactant system that controls the mobility of the interface, but also the hydrodynamic problem under consideration. For example liquid flow through the foam during generation or in forced drainage is intrinsically different. PMID:26554500

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

    International Nuclear Information System (INIS)

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

  12. Phylogeographical Analysis on Squalidus argentatus Recapitulates Historical Landscapes and Drainage Evolution on the Island of Taiwan and Mainland China

    Directory of Open Access Journals (Sweden)

    Hung-Du Lin

    2012-01-01

    Full Text Available Phylogeographical analyses on Squalidus argentatus samples from thirteen localities within mainland China and Taiwan were conducted for biogeographic studies, as their dispersal strictly depends on geological evolution of the landmasses. A total of 95 haplotypes were genotyped for mtDNA cyt b gene in 160 specimens from nine river systems. Relatively high levels of haplotype diversity (h = 0.984 and low levels of nucleotide diversity (π = 0.020 were detected in S. argentatus. Two major phylogenetic haplotype groups, A and B, were revealed via phylogenetic analysis. The degree of intergroup divergence (3.96% indicates that these groups diverged about 4.55 myr (million years ago. Haplotype network and population analyses indicated significant genetic structure (FST = 0.775, largely concordant with the geographical location of the populations. According to SAMOVA analysis, we divided these populations into four units: Yangtze-Pearl, Qiantang-Minjiang, Jiulong-Beijiang and Taiwan groups. Mismatch distribution analysis, neutrality tests and Bayesian skyline plots indicated a significant population expansion for lineage A and B, approximately dated 0.35 and 0.04 myr ago, respectively. We found strong geographical organization of the haplotype clades across different geographic scales that can be explained by episodes of dispersal and population expansion followed by population fragmentation and restricted gene flow.

  13. 检测胆汁糖蛋白糖链结构变化鉴别良恶性胆道疾病分析%Detection and analysis of biliary glycoprotein glycan structure changes in differential diagnosis of benign and malignant biliary disease

    Institute of Scientific and Technical Information of China (English)

    候鹏; 高峰; 马树民

    2014-01-01

    目的:探讨胆汁糖蛋白糖链结构变化对于鉴别良恶性胆道疾病的作用。方法选取青岛市海慈医疗集团普外科收治的胆道疾病患者100例,按照良、恶性将其分为对照组(良性胆道疾病)和观察组(胆管癌),每组各50例。取两组患者胆汁滴于硝酸纤维膜上,通过比较麦胚凝集素( WGA )、欧曼陀罗凝集素( DSA)、小扁豆凝集素( LCA)、刀豆凝集素( CONA)试验阳性率,探讨胆汁糖蛋白糖链结构变化与良恶性胆道疾病的关系。结果对照组 WGA、DSA、LCA、CONA 凝集素试验阳性率分别为22.0%、14.0%、2.0%、76.0%,观察组分别为76.0%、66.0%、76.0%、82.0%。两组CONA凝集素试验阳性率差异无统计学意义(P>0.05),观察组WGA、LCA、DSA凝集试验阳性率均明显高于对照组,差异均有统计学意义(χ2=29.17、28.17、57.55,均P<0.05)。结论胆汁糖蛋白糖链结构变化与胆道疾病良、恶性密切相关,可以通过WGA、LCA、DSA凝集试验阳性率判断胆管疾病良、恶性,值得在临床上广泛推广。%Objective To investigate the effects of changes in protein bile sugar chain structure for differen-tiating benign and malignant biliary tract disease .Methods 100 patients with biliary tract diseases who were treated in Department of General Surgery ,Qingdao Haici Medical Group were selected in this study .According to benign or malignant biliary disease ,the patients were divided into control group ( benign biliary tract disease ) and observation group ( cholangiocarcinoma ) ,50 cases in each group .Two groups of patients with bile drops on the nitrocellulose mem-brane,through the comparison of wheat germ agglutinin (WGA),Datura stramonium agglutinin (DSA),lentil lectin (LCA),concanavalin A(CONA) positive rate of test,to explore the relationship between sugar chain of glycoprotein in bile and bile duct benign and

  14. 妇科恶性肿瘤术后行盆腔引流管置入效果的Meta分析%A comparison of outcomes without drainage tube and drainage following gynecological malignant tumor oper-ation:a Meta analysis

    Institute of Scientific and Technical Information of China (English)

    马蓉; 孙正伟; 马杰; 赵卫东

    2015-01-01

    Objective To systematically evaluate the outcomes of retroperitoneal drainage versus no drainage after pelvic lymphadenectomy in gynaecological cancer patients.Methods Databases such as Medline, EMBASE, Science Direct,Springer link,CBM,CNKI,PUBMED、Wan fang and VIP databases were searched comprehensively. We retrieval the articles which reporting outcomes compared no drainage with drainage following lymphadeneetomy,the latest searches were performed on 31 December 2014.Based on the including and excluding criteria,literatures that were eligible were screened and data were retrieved.RevMan 5.2.7 software was applied to perform the Meta-analy-sis.Results A total of 10 articles were eligible for the Meta-analysis,involving 1238 patients ,including 6 English articles and 4 Chinese article.The meta-analysis showed that the patients postoperative with drainage tube bearing lon-ger of bowel sounds recovery (P<0.01),but there were no statistically significant differences in the febrile morbidity and lymphcyst formation.After the eradicative resection of gynecological malignant tumor,drainage tube, s placement donnot reduce febrile morbidity,lymphcyst formation,but prolong the recovery time of gastrointestinal tract.Conclu-sion When the pelvic peritoneum was left open,and surgery without a lot of bleeding or exudation ,drainage is not needed.%目的比较妇科恶性肿瘤术后有无放置盆腔引流管的临床转归。方法全面检索2014年12月31日前在Medline、EMBASE、Science Direct、Springer link、CBM、中国知网、PUBMED、万方以及维普数据库公开发表关于妇科恶性肿瘤术后无引流管与置引流管患者比较的文献,按纳入排除标准由2位研究者独立进行文献筛选、资料提取和方法学质量评价后,采用RevMan 5.2.7软件进行Meta分析。结果共纳入10篇研究,其中包含6篇英文文献,4篇中文文献,共包含妇科恶性肿瘤术后患者1238例,Meta分析结果显示:术后无

  15. Circulating MicroRNAs as Biomarkers in Biliary Tract Cancers

    Science.gov (United States)

    Letelier, Pablo; Riquelme, Ismael; Hernández, Alfonso H.; Guzmán, Neftalí; Farías, Jorge G.; Roa, Juan Carlos

    2016-01-01

    Biliary tract cancers (BTCs) are a group of highly aggressive malignant tumors with a poor prognosis. The current diagnosis is based mainly on imaging and intraoperative exploration due to brush cytology havinga low sensitivity and the standard markers, such as carcinoembryonic antigen (CEA) and carbohydrate 19-9 (CA19-9), not having enough sensitivity nor specificity to be used in a differential diagnosis and early stage detection. Thus, better non-invasive methods that can distinguish between normal and pathological tissue are needed. MicroRNAs (miRNAs) are small, single-stranded non-coding RNA molecules of ~20–22 nucleotides that regulate relevant physiological mechanisms and can also be involved in carcinogenesis. Recent studies have demonstrated that miRNAs are detectable in multiple body fluids, showing great stability, either free or trapped in circulating microvesicles, such as exosomes. miRNAs are ideal biomarkers that may be used in screening and prognosis in biliary tract cancers, aiding also in the clinical decisions at different stages of cancer treatment. This review highlights the progress in the analysis of circulating miRNAs in serum, plasma and bile as potential diagnostic and prognostic markers of BTCs. PMID:27223281

  16. Are Dysregulated Inflammatory Responses to Commensal Bacteria Involved in the Pathogenesis of Hepatobiliary-Pancreatic Autoimmune Disease? An Analysis Using Mice Models of Primary Biliary Cirrhosis and Autoimmune Pancreatitis

    OpenAIRE

    Naoko Yanagisawa; Ikuko Haruta; Ken Kikuchi; Noriyuki Shibata; Junji Yagi

    2011-01-01

    The etiopathogenesis of many autoimmune disorders has not been identified. The aim of this paper is to focus on the involvement of bacterial exposure in the pathogenesis of primary biliary cirrhosis (PBC) and autoimmune pancreatitis (AIP), both of which are broadly categorized as autoimmune disorders involving hepatobiliary-pancreatic lesions. Avirulent and/or commensal bacteria, which may have important role(s) as initiating factors in the pathogenesis of autoimmune disorders such as PBC and...

  17. 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.

  18. Endoscopic management of benign biliary strictures.

    Science.gov (United States)

    Rustagi, Tarun; Jamidar, Priya A

    2015-01-01

    Benign biliary strictures are a common indication for endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic management has evolved over the last 2 decades as the current standard of care. The most common etiologies of strictures encountered are following surgery and those related to chronic pancreatitis. High-quality cross-sectional imaging provides a road map for endoscopic management. Currently, sequential placement of multiple plastic biliary stents represents the preferred approach. There is an increasing role for the treatment of these strictures using covered metal stents, but due to conflicting reports of efficacies as well as cost and complications, this approach should only be entertained following careful consideration. Optimal management of strictures is best achieved using a team approach with the surgeon and interventional radiologist playing an important role.

  19. 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.

  20. 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.

  1. 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

  2. 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

  3. 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...

  4. 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...

  5. 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 (...

  6. Current Therapy and Future Directions in Biliary Tract Malignancies

    OpenAIRE

    Ciombor, Kristen K; Goff, Laura W.

    2013-01-01

    Cancers of the biliary tree represent a rare group of diseases with a devastating impact on patients. Gallbladder cancer is often associated with cholelithiasis. Cholangiocarcioma may arise in the setting of biliary inflammation such as primary sclerosing cholangitis but most commonly occurs in patients without a particular risk factor. Surgical removal of biliary cancer is essential for cure, but it is associated with a very high rate of recurrence and for many patients is not possible at th...

  7. 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.

  8. 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...

  9. 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...

  10. 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

  11. 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...

  12. 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, ...

  13. Excretion of biliary compounds during intrauterine life

    Science.gov (United States)

    Macias, Rocio IR; Marin, Jose JG; Serrano, Maria A

    2009-01-01

    In adults, the hepatobiliary system, together with the kidney, constitute the main routes for the elimination of several endogenous and xenobiotic compounds into bile and urine, respectively. However, during intrauterine life the biliary route of excretion for cholephilic compounds, such as bile acids and biliary pigments, is very 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. PMID:19230042

  14. 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.

  15. Malignant obstructive jaundice treated by endoscopic biliary stent insertion:An analysis of 21 cases%经内镜胆管支架引流术治疗恶性梗阻性黄疸21例

    Institute of Scientific and Technical Information of China (English)

    王宝友; 魏文俊; 潘宏年; 汪发勇

    2014-01-01

    目的:探讨经内镜胆管支架引流术治疗恶性梗阻性黄疸的疗效。方法回顾性分析21例经内镜胆管支架引流术治疗的恶性胆管梗阻性黄疸患者的临床资料。结果18例患者插管成功,插管成功率为85.71%,其中2例置入金属支架,16例置入塑料支架。成功置入支架的18例患者术后黄疸逐渐消退,皮肤瘙痒等症状明显缓解或消失,血清总胆红素从(230.85±83.81)μmol·L-1下降到术后1周(121.88±52.27)μmol·L-1(P<0.01),转氨酶也显著下降(P<0.01)。结论经内镜胆管支架引流术是姑息治疗恶性梗阻性黄疸的重要手段,疗效确切。%Objective To evaluate the clinical efficacy of endoscopic placement of biliary stents in the management of malignant ob-structive jaundice.Methods The clinical data of 21 patients who underwent placement of biliary stents for palliation of malignant bili-ary obstruction between 2010 and 2013 were retrospectively reviewed.Results The stents were placed successfully in 18 patients (85.71%).Two cases were successfully embedded with metal stents,16 cases were embedded with plastic stents.The serum level of totalbilirubin decreased from (230.85 ±83.81)μmol·L -1 to (121.88 ±52.27)μmol·L -1 after treatment (P <0.01).This was accom-panied by a significant decrease in aminotransferase.Conclusion Endoscopic placement of biliary stent is an effective palliation treat-ment for malignant biliary obstruction.

  16. 经空肠襻内镜处理胆肠吻合后胆道并发症的临床分析%Clinical analysis on the treatment of biliary complications after bilioenteric anastomosis via jejunal loop endoscopy

    Institute of Scientific and Technical Information of China (English)

    刘国平; 程广明; 麻树人; 朱闻溪

    2011-01-01

    目的 总结经空肠襻内镜处理胆肠吻合后胆道并发症的经验和体会.方法 回顾性分析沈阳军区总医院内窥镜科2005年12月-2011年7月9例(共12次)以输胆空肠襻为入路,通过内镜处理胆肠吻合术后胆道并发症的临床资料.结果 手术成功率100%(12/12);术中见吻合口狭窄发生率88.9%(8/9);术后胆管炎缓解及无发作者7例,胆红素水平明显下降者6例;胆结石取净率100%(3/3);放置胆道金属支架2例,塑料支架5例,鼻胆管2例;术后肠瘘1例,肝脓肿1例,切口感染3例.结论 经空肠襻内镜处理胆肠吻合后胆道并发症是一项切实有效的微创方法,值得在临床上推广应用.%Objective The present study summarizes the treatment of biliary complications after bilioenteric anastomosis via jejunal loop endoscopy. Methods The clinical data of nine cases (12 times) of biliary complications after bilioenteric anastomosis were retrospectively analyzed. The patients were admitted to the Endoscopy Department of the General Hospital of the Shenyang Military Area from December 2005 to July 2011 and were treated via jejunal loop endoscopy. Results The success probability of the operation was 100% (12/12), and the incidence rate of anastomotic stenosis during operation was 88.9% (8/9). Seven cases experienced alleviation or no recurrence of reflux cholangitis after the operation. Bilirubin decreased significantly in six cases, and the stone clearance rate was 100% (3/ 3). Biliary metal stents were implanted in two cases, plastic stems were employed in five, and naso-biliary tubes were used in the other two. After operation, intestinal fistula occurred in one case, liver abscess occurred in another, and incision infection occurred in three other cases. Conclusion Jejunal loop endoscopy is a highly effective and minimally invasive treatment for biliary complications after bilioenteric anastomosis and, thus, should be widely applied in clinical practice.

  17. Analysis of Water-saving Measures of Building Water Supply and Drainage Design%建筑给排水设计节水措施的分析

    Institute of Scientific and Technical Information of China (English)

    杨沁

    2014-01-01

    The water-saving design of drainage system is an important measure to save energy. This paper analyzes the present situation of water consumption of water drainage de- sign, clarifying the necessity of water saving design, and pu- ting forward some measures for water saving in design of water supply and drainage.%建筑给排水系统的节水设计是一项重要的节能措施。本文分析了建筑给排水设计的用水现状,明确了了节水设计的必要性,并提出了一些给排水设计中的节水措施。

  18. ERCP胆管支架在恶性胆管梗阻中的临床应用#%Clinical Application of ERCP Biliary Stents in Malignant Biliary Obstruction

    Institute of Scientific and Technical Information of China (English)

    曾安祥; 刘波颖; 张德强; 曾德辉

    2014-01-01

    目的:为了进一步研究和探讨在采用胆管支架引流术治疗恶性胆管梗阻的实践过程中,分别采用金属支架和塑料支架实施治疗后的临床治疗效果差异,从而为临床实践研究提供可靠依据。方法:本文选取了我院2006年6月至2013年12月期间收治恶性胆管梗阻患者88例为研究对象,根据患者所采用支架的不同进行分组,分成金属支架组(16例)和塑料支架组(72例),观察两组患者采用不同临床治疗方法后的TBIL、ALT、ALP、GGT、TNF-α和30d后死亡发生率及支架阻塞发生率。结果:(1)在ALP、GGT、TNF-α等三项指标上,组间比较,金属支架组患者的指标水平均显著的优于塑料支架组;(2)在平均生存时间、支架开通时间两项指标上,组间比较,金属支架组患者均长于塑料支架组。结论:与采用塑料支架相比较,采用金属支架实施ERCP胆管支架术治疗的效果更好,是临床针对恶性胆管梗阻实施胆管支架引流治疗的可靠选择。%To further study and discuss the differences of the clinical treatment of the application of metal stents and plastic stents in the course of malignant biliary stent drainage of bile duct obstruction, so as to provide reliable basis for clinical practice research.Methods:88 patients of malignant biliary obstruction from June 2006 to December 2013 in our hospital were chosen as the research object. According to the differences of stents, they were divided into the metal stent group (16 cases) and the plastic stent group (72 cases). The TBIL, ALT, ALP, GGT, TNF-α, and the incidence of mortality and incidence of stent occlusion after 30 days for the two groups after different clinical treatment methods were observed.Results: (1) In the three indicators of ALP, GGT, TNF-α, etc compared between the two groups, the indicator of the metal stents was signiifcantly better than the plastic stent group.(2) In the

  19. Drainage hydraulics of permeable friction courses

    Science.gov (United States)

    Charbeneau, Randall J.; Barrett, Michael E.

    2008-04-01

    This paper describes solutions to the hydraulic equations that govern flow in permeable friction courses (PFC). PFC is a layer of porous asphalt approximately 50 mm thick that is placed as an overlay on top of an existing conventional concrete or asphalt road surface to help control splash and hydroplaning, reduce noise, and enhance quality of storm water runoff. The primary objective of this manuscript is to present an analytical system of equations that can be used in design and analysis of PFC systems. The primary assumptions used in this analysis are that the flow can be modeled as one-dimensional, steady state Darcy-type flow and that slopes are sufficiently small so that the Dupuit-Forchheimer assumptions apply. Solutions are derived for cases where storm water drainage is confined to the PFC bed and for conditions where the PFC drainage capacity is exceeded and ponded sheet flow occurs across the pavement surface. The mathematical solutions provide the drainage characteristics (depth and residence time) as a function of rainfall intensity, PFC hydraulic conductivity, pavement slope, and maximum drainage path length.

  20. Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Huang Tsai-Wei

    2013-01-01

    Full Text Available Abstract Background Lymphedema is a common complication of axillary dissection for breast cancer. We investigated whether manual lymphatic drainage (MLD could prevent or manage limb edema in women after breast-cancer surgery. Methods We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs to evaluate the effectiveness of MLD in the prevention and treatment of breast-cancer-related lymphedema. The PubMed, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro, SCOPUS, and Cochrane Central Register of Controlled Trials electronic databases were searched for articles on MLD published before December 2012, with no language restrictions. The primary outcome for prevention was the incidence of postoperative lymphedema. The outcome for management of lymphedema was a reduction in edema volume. Results In total, 10 RCTs with 566 patients were identified. Two studies evaluating the preventive outcome of MLD found no significant difference in the incidence of lymphedema between the MLD and standard treatment groups, with a risk ratio of 0.63 and a 95% confidence interval (CI of 0.14 to 2.82. Seven studies assessed the reduction in arm volume, and found no significant difference between the MLD and standard treatment groups, with a weighted mean difference of 75.12 (95% CI, −9.34 to 159.58. Conclusions The current evidence from RCTs does not support the use of MLD in preventing or treating lymphedema. However, clinical and statistical inconsistencies between the various studies confounded our evaluation of the effect of MLD on breast-cancer-related lymphedema.

  1. Efficacy and safety of fully covered self-expandable metallic stents in biliary complications after liver transplantation: a preliminary study.

    Science.gov (United States)

    Traina, Mario; Tarantino, Ilaria; Barresi, Luca; Volpes, Riccardo; Gruttadauria, Salvatore; Petridis, Ioannis; Gridelli, Bruno

    2009-11-01

    After liver transplantation, the most common biliary complication is the anastomotic stricture, which is followed by biliary leakage. Studies have focused on the endoscopic treatment of biliary complications in transplanted patients with duct-to-duct reconstruction, showing a success rate of 70% to 80% after orthotopic liver transplantation and of 60% after living-related liver transplantation. Once the endoscopic approach fails, surgical treatment with a Roux-en-Y choledochojejunostomy is the sole alternative treatment. The aim of this prospective observational study was to analyze the efficacy and safety of fully covered self-expandable metallic stents for the treatment of posttransplant biliary stenosis and leaks in patients in whom conventional endoscopic retrograde cholangiopancreatography (ERCP) failed. From January 2008 to January 2009, 16 patients met the criteria of endoscopic treatment failure, and instead of surgery, a fully covered stent was placed. All patients had at least 6 months of follow-up (mean follow-up of 10 months). After removal, 14 patients showed immediate resolution of both the biliary stenosis and leak. After a mean of 10 months of follow-up, only 1 patient showed biliary stenosis recurrence. No major complications occurred in any of the patients, except for stent migration in 6 patients, although these presented with no clinical consequences. In conclusion, in patients not responding to standard endoscopic treatment, the placement of fully covered metal stents is a valid alternative to surgery. A cost analysis should be performed in order to evaluate whether to treat transplanted patients suffering from biliary complications with covered self-expandable metallic stent placement as first-line therapy. PMID:19877248

  2. Treatment of drainage solution from hydroponic greenhouse production with microalgae.

    Science.gov (United States)

    Hultberg, Malin; Carlsson, Anders S; Gustafsson, Susanne

    2013-05-01

    This study investigated treatment of the drainage solution from greenhouse production with microalgae, through inoculation with Chlorella vulgaris or through growth of the indigenous microalgal community. A significant reduction in nitrogen, between 34.7 and 73.7 mg L(-1), and particularly in phosphorus concentration, between 15.4 and 15.9 mg L(-1), was observed in drainage solution collected from commercial greenhouse production. The large reduction in nutrients was achieved through growth of the indigenous microalgal community i.e., without pre-treatment of the drainage solution or inoculation with the fast growing green microalgae C. vulgaris. Analysis of the fatty acid composition of the algal biomass revealed that compared with a standard growth medium for green algae, the drainage solution was inferior for lipid production. Despite the biorefinery concept being less promising, microalgae-based treatment of drainage solution from greenhouse production is still of interest considering the urgent need for phosphorus recycling.

  3. Grain- and Pore-level Analysis of Drainage in Fractionally-wet Granular Media using Synchrotron X-ray Computed Microtomography

    Science.gov (United States)

    Willson, C. S.; Bradley, S.; Thompson, K. E.

    2011-12-01

    Numerous lab- and field-scale experimental studies have shown the strong impact of wettability on multiphase flow constitutive relations and how increased water repellency can lead to preferential flow paths and a heterogeneous water distribution. In conjunction, theoretical and pore-scale modeling work has been performed seeking to improve our understanding of the impact of grain-level wettability properties. Advances in high-resolution X-ray computed tomography (XCT) techniques now make it possible to nondestructively image opaque materials providing previously hard-to-observe qualitative and quantitative data and information. Furthermore, the characteristics of synchrotron X-rays make it possible to monochromatize the incident energy allowing for both k-edge absorption differencing and segmentation of fluids and materials that have even slightly different chemical composition. Concurrent with these advances has been the development of methods to extract granular packing and pore network structure data from XCT images. In this talk, we will present results from a series of experiments designed to obtain grain-, pore- and fluid-scale details during the drainage of water in fractionally-wet glass bead systems. Here, two sets of glass beads were used each having slightly different chemical compositions and thus, different X-ray absorption properties. One set was treated so that the bead surface was water neutral while the other set remained hydrophilic. Three sets of drainage experiments were conducted on three fractionally-wet systems: 100, 90, and 75% hydrophilic by weight. First, traditional lab-scale drainage experiments were performed to obtain a baseline set of characteristic drainage curves for the three systms. Next, a set of tomography-scale (i.e., 5.5 mm inner diameter column) drainage experiments were conducted in the lab to ensure that the drainage curves in the smaller columns were consistent with the lab-scale curves. Finally, tomography-scale drainage

  4. 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

  5. Evaluation of the anatomical correlation between biliary branches of the left lobe of the liver and the umbilical portion of the portal vein (UP) by CT with injection of contrast material into biliary tract

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Hiroshi; Watanabe, Kazuo [Chiba Cancer Center Hospital (Japan); Shinohara, Yasushi; Amano, Hodaka; Okazumi, Shinichi; Asano, Takehide; Isono, Kaichi; Ryu, Munemasa

    1995-12-01

    We analyzed anatomical correlation between biliary trees of the left lobe of the liver and the umbilical portion of the portal vein (UP) by CT with injection of contrast material into biliary tract through the percutaneous transhepatic biliary drainage tube (Cholangio-CT). Cholangio-CT was performed in 27 patients with obstructive jaundice. In 15 cases out of these 27 cases, left lateral superior subsegment branch (B2) and left lateral inferior subsegment branch (B3) originated in the right side of UP and ran in the cranial side of UP. In 6 cases, B2 and B3 arose in the cranial side of UP from the common duct of B2 and B3. In 5 cases, B2 and B3 arose in the left side of UP from the common duct which ran in the cranial side of UP. In one patient, B3 ran in the caudate side of UP. In 10 out of 27 cases, a bile duct branch which originated and ran in the cranial side of UP was depicted. It was not clear whether this branch belonged to medial segment branch or B3. (author).

  6. 胆道及十二指肠恶性梗阻多支架置入治疗及体会%Experience of multiple biliary and duodenal stenting in the treatment of malignant biliary and duodenal obstruction

    Institute of Scientific and Technical Information of China (English)

    施云星; 王广勇; 曾晓虹; 吕礁; 周国中; 刘长云; 覃林花

    2014-01-01

    Objective To investigate the therapeutic effects of combined biliary and duodenal stenting in the treatment of ma-lignant biliary and duodenal obstruction.Methods Medical data concerning 3 cases of malignant biliary and duodenal obstruction trea-ted with combined biliary and duodenal stenting in our hospital were summarized.PTCD biliary metallic stent placement was first per-formed in one patient with recurrent gastric tumor, and then duodenal stent insertion was done under gastroscopy.Biliary metallic stent and duodenal metal stenting was performed concurrently under duodenoscopy in one patient with periampullary cancer.Due to jaundice after surgery, biliary plastic stenting through duodenal metal stent mesh was performed in the patient.There was one patient with duode-nal cancer, who was first treated with inner and outer biliary drainage through PTCD, and then biliary metallic stent was placed through the sinus, and finally duodenal metal stenting was performed under duodenoscopy.Results Total bilirubin after stenting in the 3 pa-tients decreased significantly, and symptoms of upper digestive obstruction were improved considerably, and no serious complications occurred in the 3 patients.Conclusion Multiple metal stenting was an effective method for the treatment of malignant biliary and duo-denal obstruction, and could improve the life quality of patients as well.Methods for the placement of multiple stents could be different in one patient from another.%目的:探讨联合应用胆道支架及十二指肠支架治疗胆道及十二指肠恶性梗阻的疗效。方法总结我院3例胆道及十二指肠恶性梗阻患者行胆道及十二指肠支架治疗的资料。1例胃癌复发患者,先经皮经肝穿刺胆道引流术( PTCD)下胆道金属支架置入,然后行胃镜下胃十二指肠支架置入;1例壶腹周围癌患者,十二指肠镜下胆道金属支架及十二指肠内金属支架同时置入,术后因再次黄疸,经十二

  7. Biliary microlithiasis, sludge, crystals, microcrystallization,andusefulnessof assessmentofnucleationtime

    Institute of Scientific and Technical Information of China (English)

    Vasitha Abeysuriya; Kemal I Deen; Navarathne MM Navarathne

    2010-01-01

    BACKGROUND:The process of microcrystallization, its sequel and the assessment of nucleation time is ignored. This systematic review aimed to highlight the importance of biliary microlithiasis, sludge, and crystals, and their association with gallstones, unexplained biliary pain, idiopathic pancreatitis, and sphincter of Oddi dysfunction. DATA SOURCES:Three reviewers performed a literature search of the PubMed database. Key words used were"biliary microlithiasis","biliary sludge","bile crystals","cholesterol crystallisation","bile microscopy","microcrystal formation of bile", "cholesterol monohydrate crystals", "nucleation time of cholesterol", "gallstone formation", "sphincter of Oddi dysfunction"and"idiopathic pancreatitis". Additional articles were sourced from references within the studies from the PubMed search. RESULTS:We found that biliary microcrystals account for almost all patients with gallstone disease, 7% to 79% with idiopathic pancreatitis, 83% with unexplained biliary pain, and 25%to 60%with altered biliary and pancreatic sphincter function. Overall, the detection of biliary microcrystals in gallstone disease has a sensitivity ranging from 55%to 87%and a speciifcity of 100%. In idiopathic pancreatitis, the presence of microcrystals ranges from 47%to 90%. A nucleation time less than 10 days in hepatic bile or ultra-ifltered gallbladder bile has a speciifcity of 100%for cholesterol gallstone disease. CONCLUSIONS:Biliary crystals are associated with gallstone disease, idiopathic pancreatitis, sphincter of Oddi dysfunction, unexplained biliary pain, and post-cholecystectomy biliary pain. Pathways of cholesterol super-saturation, crystallisation, and gallstone formation have been described with scientiifc support. Bile microscopy is a useful method to detect microcrystals and the assessment of nucleation time is a good method of predicting the risk of cholesterol crystallisation.

  8. WTAQ version 2-A computer program for analysis of aquifer tests in confined and water-table aquifers with alternative representations of drainage from the unsaturated zone

    Science.gov (United States)

    Barlow, Paul M.; Moench, Allen F.

    2011-01-01

    The computer program WTAQ simulates axial-symmetric flow to a well pumping from a confined or unconfined (water-table) aquifer. WTAQ calculates dimensionless or dimensional drawdowns that can be used with measured drawdown data from aquifer tests to estimate aquifer hydraulic properties. Version 2 of the program, which is described in this report, provides an alternative analytical representation of drainage to water-table aquifers from the unsaturated zone than that which was available in the initial versions of the code. The revised drainage model explicitly accounts for hydraulic characteristics of the unsaturated zone, specifically, the moisture retention and relative hydraulic conductivity of the soil. The revised program also retains the original conceptualizations of drainage from the unsaturated zone that were available with version 1 of the program to provide alternative approaches to simulate the drainage process. Version 2 of the program includes all other simulation capabilities of the first versions, including partial penetration of the pumped well and of observation wells and piezometers, well-bore storage and skin effects at the pumped well, and delayed drawdown response of observation wells and piezometers.

  9. Pyogenic liver abscess after choledochoduodenostomy for biliary obstruction caused by autoimmune pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Nobuyuki Toshikuni; Hirofumi Morishita; Koichi Uesaka; Shiro Yuasa; Kyohei Kai; Shizo Sato; Motoko Kitano; Masayoshi Fujisawa; Hiroaki Okushin; Kazuhiko Morii; Shinjiro Takagi; Masahiro Takatani

    2006-01-01

    A 68-year-old man underwent cholecystectomy and choledochoduodenostomy for biliary obstruction and nephrectomy for a renal tumor. Based on clinical and histopathologic findings, autoimmune pancreatitis (AIP) was diagnosed. The renal tumor was diagnosed as a renal cell cancer. Steroid therapy was started and thereafter pancreatic inflammation improved. Five years after surgery, the patient was readmitted because of pyrexia in a preshock state. A Klebsiella pneumoniae liver abscess complicated by sepsis was diagnosed. The patient recovered with percutaneous abscess drainage and administration of intravenous antibiotics. Liver abscess recurred 1 mo later but was successfully treated with antibiotics. There has been little information on long-term outcomes of patients with AIP treated with surgery. To our knowledge, this is the second case of liver abscess after surgical treatment of AIP.

  10. Efficacy of preoperative biliary tract decompression in patients with obstructive jaundice.

    Science.gov (United States)

    Gundry, S R; Strodel, W E; Knol, J A; Eckhauser, F E; Thompson, N W

    1984-06-01

    Fifty consecutive matched patients with benign or malignant biliary tract obstruction were compared to determine the efficacy of preoperative percutaneous biliary drainage (PBD). Twenty-five patients underwent PBD for an average of nine days before operation; 25 patients underwent percutaneous transhepatic cholangiography ( PTHC ) followed immediately by operation. Serum bilirubin levels before PTHC were 16.5 +/- 7.6 mg/dL and 14.9 +/- 7.6 mg/dL in PBD and non-PBD groups, respectively. Serum bilirubin levels decreased to 6.5 +/- 6.2 mg/dL preoperatively in patients having PBD. One week after operation, bilirubin levels were 4.2 +/- 4.3 mg/dL and 9.0 +/- 5.2 mg/dL in the PBD and non-PBD groups, respectively. Major morbidity (sepsis, abscess, renal failure, or bleeding) occurred in two patients (8%) having PBD and in 13 patients (52%) without PBD. One patient (4%) with PBD, and five patients (20%) without PBD, died. The mean hospital stay was shorter for the PBD group. Preoperative PBD reduces operative mortality and morbidity and results in a more rapid resolution of hyperbilirubinemia during the postoperative period. PMID:6428380

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

    Science.gov (United States)

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

    1992-01-01

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

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

    Science.gov (United States)

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

    1992-01-01

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

  13. Triple bypass for advanced pancreatic head cancer associated with biliary stricture, duodenal stenosis, and recurrent obstructive pancreatitis.

    Science.gov (United States)

    Kudo, Yuzan; Sato, Norihiro; Tamura, Toshihisa; Hirata, Keiji

    2016-12-01

    Bypass surgery for cancer of the pancreatic head is usually done to palliate the obstructive symptoms in the biliary and/or digestive system. However, it is uncommon for patients to require pancreatic duct drainage for recurrent obstructive pancreatitis. In this article, we report a surgical technique of triple bypass consisting of Roux-en-Y hepaticojejunostomy, gastrojejunostomy, and pancreaticojejunostomy for advanced pancreatic cancer. A 76-year-old male patient with locally advanced and metastatic pancreatic head cancer was referred to our department for biliary stricture, duodenal stenosis, and recurrent obstructive pancreatitis associated with persistent pancreatic pseudocyst. In an attempt to resolve all these problems simultaneously, a triple bypass was performed. The patient survived and continued to receive chemotherapy for almost 1 year after surgery without any serious complications. Thus, triple bypass is a useful surgical technique that could relief symptoms and offer better quality of life to patients with advanced pancreatic cancer presenting with biliary stricture, duodenal stenosis, and severe obstructive pancreatitis difficult to treat by medication or endoscopic procedures. PMID:27495991

  14. Monitoring Hepatocyte Dysfunction and Biliary Complication After Liver Transplantation Using Quantitative Hepatobiliary Scintigraphy

    Science.gov (United States)

    Zou, Si-Juan; Chen, Dong; Li, Yan-Zhao; Du, Dun-Feng; Chen, Zhi-Shui; Zhu, Xiao-Hua

    2015-01-01

    Abstract The significance of hepatobiliary scintigraphy (HBS) for hepatic graft function assessment was established mostly on retrospective studies and was not widely recognized due to the lack of quantitative data and variation in accuracy. This prospective study was performed to investigate the effectiveness of quantitative HBS for assessing hepatocyte dysfunction and biliary complication in liver transplant recipients. In 57 recipients who had undergone orthotopic liver transplantation, a total of 67 dynamic 99mTc-EHIDA scans were performed and quantitative parameters including the hepatocyte extraction fraction (HEF), time to maximum hepatic radioactivity (Tmax), and time for peak activity to decrease by 50% (T1/2) were calculated. The scintigraphic results based on the 3 parameters were compared against the final diagnosis. A ROC curve analysis was carried out to identify the cutoff value of Tmax for diagnosis of biliary stricture. Correlation between the parameters of postoperative HBS and conventional biochemical liver function indices were also analyzed. Quantitative 99mTc-EHIDA HBS had an overall sensitivity of 94.12% (16/17), specificity of 93.33% (42/45), and diagnostic accuracy of 93.55% (58/62) for detecting hepatocyte dysfunction and biliary complication in liver transplant recipients. The recommended cutoff value of Tmax for diagnosis of post-transplant biliary stricture was set at 15.75 min with a sensitivity of 100.0% and a specificity of 94.0%. The scintigraphic parameters (HEF, Tmax) were statistically significantly associated with the conventional liver function parameters. Quantitative 99mTc-EHIDA HBS offers a noninvasive imaging modality with high sensitivity and specificity to diagnose hepatocyte dysfunction as well as distinguish between patients with or without biliary stricture following liver transplantation. Furthermore, HEF and Tmax values obtained from dynamic HBS show good correlation with conventional liver function parameters

  15. Monitoring Hepatocyte Dysfunction and Biliary Complication After Liver Transplantation Using Quantitative Hepatobiliary Scintigraphy.

    Science.gov (United States)

    Zou, Si-Juan; Chen, Dong; Li, Yan-Zhao; Du, Dun-Feng; Chen, Zhi-Shui; Zhu, Xiao-Hua

    2015-11-01

    The significance of hepatobiliary scintigraphy (HBS) for hepatic graft function assessment was established mostly on retrospective studies and was not widely recognized due to the lack of quantitative data and variation in accuracy. This prospective study was performed to investigate the effectiveness of quantitative HBS for assessing hepatocyte dysfunction and biliary complication in liver transplant recipients.In 57 recipients who had undergone orthotopic liver transplantation, a total of 67 dynamic Tc-EHIDA scans were performed and quantitative parameters including the hepatocyte extraction fraction (HEF), time to maximum hepatic radioactivity (Tmax), and time for peak activity to decrease by 50% (T1/2) were calculated. The scintigraphic results based on the 3 parameters were compared against the final diagnosis. A ROC curve analysis was carried out to identify the cutoff value of Tmax for diagnosis of biliary stricture. Correlation between the parameters of postoperative HBS and conventional biochemical liver function indices were also analyzed.Quantitative Tc-EHIDA HBS had an overall sensitivity of 94.12% (16/17), specificity of 93.33% (42/45), and diagnostic accuracy of 93.55% (58/62) for detecting hepatocyte dysfunction and biliary complication in liver transplant recipients. The recommended cutoff value of Tmax for diagnosis of post-transplant biliary stricture was set at 15.75 min with a sensitivity of 100.0% and a specificity of 94.0%. The scintigraphic parameters (HEF, Tmax) were statistically significantly associated with the conventional liver function parameters.Quantitative Tc-EHIDA HBS offers a noninvasive imaging modality with high sensitivity and specificity to diagnose hepatocyte dysfunction as well as distinguish between patients with or without biliary stricture following liver transplantation. Furthermore, HEF and Tmax values obtained from dynamic HBS show good correlation with conventional liver function parameters. PMID:26559297

  16. The use of self expandable metallic stent in the management of malignant biliary obstruction

    International Nuclear Information System (INIS)

    Self expandable metallic stent is a good alternative of percutaneous transhepatic biliary drainage because it can eliminate numerous problems caused by external drainage catheter, such as tube dislodgement, bile leakage and psychotic problems. Authors analyzed initial results of self expandable metallic stents used in the patient with malignant biliary obstruction to evaluate the efficacy of the procedure and to find the technical problems in the procedure. Self expandable metallic stents were inserted in 14 patients: three with recurrent stomach cancer: three with gallbladder cancer: seven with Klaskin tumor: one with common duct cancer. Gianturco type stent was used in 9 cases ans Wallstent was used in 2 cases. In remaining three case, both Z-stent and Wallstent were used in the same patient. The average period of follow up was 104 days (4-409 days). In 13 cases, the patency of the bile duct was restored by the stent (technical success: 92.9%). Occlusions of the stent were found in two cases, after two and 13 months, respectively. Causes of failure and stent occlusion were associated duodenal obstruction, tumor overgrowth and shortening of Wallstent. In remaining 11 patients, one patient was lost to follow up an 10 patients did not show recurrent jaundice until death or last follow up. There was no major complication related to the procedure. The insertion of self expandable metallic stent is a safe procedure and can eliminate major disadvantages of PTBD. Overstenting, overlapping and evaluation of associated GI tract obstruction is crucial for obtaining technical success and long-term patency

  17. Postoperative bile leakage managed successfully by intrahepatic biliary ablation with ethanol

    Institute of Scientific and Technical Information of China (English)

    Tetsuya Shimizu; Takashi Tajiri; Hiroshi Yoshida; Yasuhiro Mamada; Nobuhiko Taniai; Satoshi Matsumoto; Yoshiaki Mizuguchi; Shigeki Yokomuro; Yasuo Arima; Koho Akimaru

    2006-01-01

    We report a case of postoperative refractory bile leakage managed successfully by intrahepatic biliary ablation with ethanol. A 75-year-old man diagnosed with hepatocellular carcinoma underwent extended posterior segmentectomy including the caudate lobe and a part of the anterior segment. The hepatic tumor attached to the anterior branch of the bile duct was detached carefully and resected. Fluid drained from the liver surface postoperatively contained high concentrations of total bilirubin, at a constant volume of 150 mL per day. On d 32 after surgery, a fistulogram of the drainage tube demonstrated an enhancement of the anterior bile duct.Endoscopic retrograde cholangiography demonstrated complete obstruction of the proximal anterior bile duct and no enhancement of the peripheral anterior bile duct.On d 46 after surgery, a retrograde transhepatic biliary drainage (RTBD) tube was inserted into the anterior bile duct under open surgery. However, a contrast study of RTBD taken 7 mo post-surgery revealed that the fistula remained patent despite prolonged conservative management, so we decided to perform ethanol ablation of the isolated bile duct. Four mL pure ethanol was injected into the isolated anterior bile duct for ten minutes, the procedure being repeated five times a week. Following 23 attempts, the volume of bile juice reached less than 10 mL per day. The RTBD was clamped and removed two days later. After RTBD removal, the patient had no complaints or symptoms. Follow-up magnetic resonance imaging demonstrated atrophy of the ethanol-injected anterior segment without liver abscess formation.

  18. Asystole to cross-clamp period predicts development of biliary complications in liver transplantation using donation after cardiac death donors.

    Science.gov (United States)

    Taner, C Burcin; Bulatao, Ilynn G; Perry, Dana K; Sibulesky, Lena; Willingham, Darrin L; Kramer, David J; Nguyen, Justin H

    2012-08-01

    This study sought to determine the procurement factors that lead to development of intrahepatic bile duct strictures (ITBS) and overall biliary complications in recipients of donation after cardiac death (DCD) liver grafts. Detailed information for different time points during procurement (withdrawal of support; SBP mandatory wait period; asystole; incision; aortic cross clamp) and their association with the development of ITBS and overall biliary complications were examined using logistic regression. Two hundred and fifteen liver transplants using DCD donors were performed between 1998 and 2010 at Mayo Clinic Florida. Of all the time periods during procurement, only asystole-cross clamp period was significantly different between patients with ITBS versus no ITBS (P = 0.048) and between the patients who had overall biliary complications versus no biliary complications (P = 0.047). On multivariate analysis, only asystole-cross clamp period was significant predictor for development of ITBS (P = 0.015) and development of overall biliary complications (P = 0.029). Hemodynamic changes in the agonal period did not emerge as risk factors. The results of the study raise the possibility of utilizing asystole-cross-clamp period in place of or in conjunction with donor warm ischemia time in determining viability or quality of liver grafts. PMID:22703372

  19. European biliary atresia registries: summary of a symposium

    DEFF Research Database (Denmark)

    Petersen, C.; Harder, D.; Abola, Z.;

    2008-01-01

    Biliary atresia (BA) is a rare but potentially devastating disease. The European Biliary Atresia Registry (EBAR) was set up to improve data collection and to develop a pan-national and interdisciplinary strategy to improve clinical outcomes. From 2001 to 2005, 100 centers from 22 countries...

  20. 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.)

  1. 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.)

  2. 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....

  3. Census Ideas and Method Analysis of Urban Drainage and Preventing Waterlog Facilities%城市排水防涝设施普查思路及方法分析

    Institute of Scientific and Technical Information of China (English)

    林勤

    2015-01-01

    城市排水防涝设施普查工作对城市内涝问题的解决具有重要意义。首先分析开展城市排水防涝设施普查工作的总体思路,通过普查内容、现状数据分析及普查实施等方面来阐述数据采集方法,概括数据采集工作要点,分析普查数据在城市建设与规划工作中的应用,最后提出城市排水防涝设施普查工作的重要性。%Urban drainage and preventing waterlog facility census is very significant for solving urban waterlog prob -lems.Firstly, it analyzes and develops the general ideas of urban drainage and preventing waterlog facility census work . Secondly , it illustrates aspects of the census data collection methods by content , the implementation status of the census and other data analysis and summarizes the main points of data collection and analyzes application of census data in ur -ban construction and planning work .Finally, it puts forward the importance of urban drainage and preventing waterlog facility census work .

  4. 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.

  5. 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

  6. Management of malignant biliary obstruction: Technical and clinical results using an expanded polytetrafluoroethylene fluorinated ethylene propylene (ePTFE/FEP)-covered metallic stent after 6-year experience

    International Nuclear Information System (INIS)

    To evaluate the efficacy and safety of an expanded polytetrafluoroethylene-fluorinated ethylene-propylene (ePTFE/FEP)-covered metallic stent in the management of malignant biliary obstruction. Eighty consecutive patients with malignant common bile duct strictures were treated by placement of 83 covered metallic stents. The stent-graft consists of an inner ePTFE/FEP lining and an outer supporting structure of nitinol wire. Clinical evaluation, assessment of serum bilirubin and liver enzyme levels were analyzed before biliary drainage, before stent-graft placement and during the follow-up period at 1, 3, 6, 9 and 12 months. Technical success was obtained in all cases. After a mean follow-up of 6.9±4.63 months, the 30-day mortality rate was 14.2%. Survival rates were 40% and 20.2% at 6 and 12 months, respectively. Stent-graft patency rates were 95.5%, 92.6% and 85.7% at 3, 6 and 12 months, respectively. Complications occurred in five patients (6.4%); among these, acute cholecystitis was observed in three patients (3.8%). A stent-graft occlusion rate of 9% was observed. The percentage of patients undergoing lifetime palliation (91%) and the midterm patency rate suggest that placement of this ePTFE/FEP-covered stent-graft is safe and highly effective in achieving biliary drainage in patients with malignant strictures of the common bile duct. (orig.)

  7. Management of malignant biliary obstruction: Technical and clinical results using an expanded polytetrafluoroethylene fluorinated ethylene propylene (ePTFE/FEP)-covered metallic stent after 6-year experience

    Energy Technology Data Exchange (ETDEWEB)

    Fanelli, Fabrizio; Orgera, Gianluigi; Bezzi, Mario; Rossi, Plinio; Allegritti, Massimiliano; Passariello, Roberto [University of Rome, Department of Radiological Sciences, Rome (Italy)

    2008-05-15

    To evaluate the efficacy and safety of an expanded polytetrafluoroethylene-fluorinated ethylene-propylene (ePTFE/FEP)-covered metallic stent in the management of malignant biliary obstruction. Eighty consecutive patients with malignant common bile duct strictures were treated by placement of 83 covered metallic stents. The stent-graft consists of an inner ePTFE/FEP lining and an outer supporting structure of nitinol wire. Clinical evaluation, assessment of serum bilirubin and liver enzyme levels were analyzed before biliary drainage, before stent-graft placement and during the follow-up period at 1, 3, 6, 9 and 12 months. Technical success was obtained in all cases. After a mean follow-up of 6.9{+-}4.63 months, the 30-day mortality rate was 14.2%. Survival rates were 40% and 20.2% at 6 and 12 months, respectively. Stent-graft patency rates were 95.5%, 92.6% and 85.7% at 3, 6 and 12 months, respectively. Complications occurred in five patients (6.4%); among these, acute cholecystitis was observed in three patients (3.8%). A stent-graft occlusion rate of 9% was observed. The percentage of patients undergoing lifetime palliation (91%) and the midterm patency rate suggest that placement of this ePTFE/FEP-covered stent-graft is safe and highly effective in achieving biliary drainage in patients with malignant strictures of the common bile duct. (orig.)

  8. The treatment for malignant obstructive jaundice by biliary stent placement by ERCP or PTCD (an analysis of 68 cases)%经皮逆行胰胆管造影术或经皮经肝胆管引流术放置胆管支架治疗恶性梗阻性黄疸(附68例分析)

    Institute of Scientific and Technical Information of China (English)

    张皞; 黄平; 张啸

    2011-01-01

    目的 探讨经内镜逆行胰胆管造影术(ERCP)联合改良法经皮经肝胆管引流术(PTCD)治疗恶性梗阻性黄疸的优越性.方法 68例恶性梗阻性黄疸患者先通过EKCP放置胆道支架,ERCP不成功则通过改良法PTCD窦道放置.观察其操作成功率、退黄效果、并发症发生情况、支架通畅期及患者生存期.结果 68例患者中58例通过ERCP成功置入内支架,8例行PTCD经窦道放入金属支架,2例均未能成功,成功率97.1%;所有患者术后瘙瘁、腹痛及发热等临床症状明显改善,肝功能各项转氨酶指标及胆红素水平迅速下降;7例患者支架再次阻塞,1例患者反复发作胆管炎,并发症发生率为11.8%;塑料支架通畅期平均为112 d;金属支架通畅期平均为212 d;患者生存期最短为68d,最长为540d,平均为238d.结论 ERCP及改良法PTCD创伤小,疗效好,可作为无法手术切除或不愿手术的恶性梗阻性黄疸患者的首选治疗.%[Objective]To investigated the superiority of ERCP (endoscopic retrograde cholangiopancreatography) combining improved PTCD (percutaneous transhepatic biliary drainage) in the treatment of the patients with malignant obstructive jaundice.[Methods]68 patients with malignant obstructive jaundice were placed biliary stents through ERCP firstly, and PTCD after ERCP is unsuccessful.The operation success rate, the palliative level of jaundice, the rate of complication, the stent patency period and the survival period of patientswere observed.[Results]Of 68 patients with malignant obstructive jaundice, 58 cases were placed biliary stents via ERCP; 8 via PTCD after it faied.The success rate was 97.1%.Two failed in the stent implantation via either ERCP or PTCD.The clinical symptoms such as pruritus, abdominal pain and fever were improved obviously and the liver function indicators of transaminase and bilirubin levels decreased rapidly in all patients; Stent obstruction happened on 7 cases, recurrent cholangitis

  9. Amylase creatinine clearance ratio after biliary surgery.

    Science.gov (United States)

    Donaldson, L A; McIntosh, W; Joffe, S N

    1977-01-01

    The amylase creatinine clearance ratio (ACCR) is considered to be a more sensitive index of acute pancreatitis than the serum amylase level. Serial ACCR estimations were undertaken in 25 patients undergoing an elective cholecystectomy. Using accepted criteria, 28% of these patients developed, in the postoperative period, biochemical evidence of pancreatic gland damage, although the serum amylase level remained normal. This raised ACCR was particularly noted in patients who had undergone an exploration of the common bile duct. The ACCR would appear to be a more sensitive index of pancreatic gland disruption secondary to biliary surgery than the serum amylase level.

  10. Amylase creatinine clearance ratio after biliary surgery.

    Science.gov (United States)

    Donaldson, L A; McIntosh, W; Joffe, S N

    1977-01-01

    The amylase creatinine clearance ratio (ACCR) is considered to be a more sensitive index of acute pancreatitis than the serum amylase level. Serial ACCR estimations were undertaken in 25 patients undergoing an elective cholecystectomy. Using accepted criteria, 28% of these patients developed, in the postoperative period, biochemical evidence of pancreatic gland damage, although the serum amylase level remained normal. This raised ACCR was particularly noted in patients who had undergone an exploration of the common bile duct. The ACCR would appear to be a more sensitive index of pancreatic gland disruption secondary to biliary surgery than the serum amylase level. PMID:402305

  11. 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...

  12. Treatment of malignant obstructive jaundice by percutaneous transhepatic cholangio-drainage: retrospective analysis of 60 cases%经皮经肝胆道内置引流术治疗恶性梗阻性黄疸60例回顾性分析

    Institute of Scientific and Technical Information of China (English)

    王华; 汪涛; 刘炼炼

    2011-01-01

    目的 探讨经皮经肝胆道穿刺引流(PTCD)后植入胆道金属支架姑息性治疗恶性梗阻性黄疸的临床应用价值.方法 对60例失去根治性手术机会的恶性梗阻性黄疸患者先行超声引导下经皮经肝胆道穿刺引流术(PTCD),再在DSA下经PTCD窦道植入胆道金属支架,将外引流转变为内引流.结果 60例术前血清总胆红素(449.6±189.1)μmol/L,术后1 w与1个月时,血清总胆红素分别下降到(213.6±43.7)μmol/L与(174.2±51.5)μmol/L(P<0.05),碱性磷酸酶与丙氨酸转氨酶也下降明显(P<0.05).出现并发症27例(45.0%).结论 经皮经肝胆道内置引流术是一种治疗恶性梗阻性黄疸的有效方法,具有安全、简便、可重复等优点.%Objective To explore the clinical value of biliary metalic stent implantation following percutaneous transhepatic cholangio - drainage ( PTCD ) in the palliative treatment of malignant obstructive jaundice. Methods 60 patients who lost opportunities for radical surgery with malignant obstructive jaundice underwent PTCD firstly. Then a metal stent was implanted through PTCD sinus under ultrasound guidance replacing the internal drainage with the external drainage. Results Preoperative serum total bilirubin was (449.6 ±189. 1 ) μmol/L,and it decreased to ( 213.6 ±43.7 ) and ( 174.2 ±51. 5 ) μmol/L in 1 w and 1 month after operation, respectively ( P <0. 05 ). The level of alkaline phosphatase and alanine aminotransferase decreased significantly as well ( P <0. 05 ). Complications were found in 27 cases ( 45.0% ). Conclusion PTCD combined with biliary metalic stent implantation is an effective and safe therapy for malignant obstructive jaundice with convenience and repeatability.

  13. Analysis on the ICD Code of Vacuum Sealing Drainage%封闭式负压引流技术ICD编码分析

    Institute of Scientific and Technical Information of China (English)

    徐俊

    2015-01-01

    封闭式负压引流技术(VSD)是一种在皮肤大面积缺损,骨科创伤及感染创面有效的治疗方法,广泛运用于骨科临床。通过对某院VSD编码情况的统计分析,找出编码过程中出现的问题。根据VSD的操作步骤,工作原理及作用,结合ICD-9-CM-3,总结出该操作正确编码应为86.04和86.01。提示编码员VSD引流术不能仅以一种操作编码进行说明。编码员在编码工作中,不仅要掌握疾病分类知识,还要结合临床,学习临床知识进行疾病和操作的分类。%Vacuum sealing drainage(VSD) is an effective method applied in the treatment of large area defect of skin,trauma and infectious wound in orthopaedics department,which has widely used in the clinical work. Through conducting statistical analysis on the code situation of VSD in a hospital,we tried to find out the problems in the code process.According to the working steps,principle and function,combined with ICD-9-CM-3,we summarized that the right code of the operations were 86.04 and 86.01,which indicated that the VSD technology could not be elaborated by only one kind of operating code.The coders should not only master the knowledge on diseases classification,and also study clinical knowledge to conduct the classification of diseases and operations to connect with clinic in their code work.

  14. Pancreatico-biliary endoscopic ultrasound: A systematic review of the levels of evidence, performance and outcomes

    Institute of Scientific and Technical Information of China (English)

    Pietro Fusaroli; Dimitrios Kypraios; Giancarlo Caletti; Mohamad A Eloubeidi

    2012-01-01

    Our aim was to record pancreaticobiliary endoscopic ultrasound (EUS) literature of the past 3 decades and evaluate its role based on a critical appraisal of published studies according to levels of evidence (LE).Original research articles (randomized controlled trials,prospective and retrospective studies),meta-analyses,reviews and surveys pertinent to gastrointestinal EUS were included.All articles published until September 2011 were retrieved from PubMed and classified according to specific disease entities,anatomical subdivisions and therapeutic applications of EUS.The North of England evidencebased guidelines were used to determine LE.A total of 1089 pertinent articles were reviewed.Published research focused primarily on solid pancreatic neoplasms,followed by disorders of the extrahepatic biliary tree,pancreatic cystic lesions,therapeutic-interventional EUS,chronic and acute pancreatitis.A uniform observation in all six categories of articles was the predominance of LE Ⅲ studies followed by LE Ⅳ,Ⅱb,Ⅱa,Ⅰb and Ⅰ a,in descending order.EUS remains the most accurate method for deteding small (< 3 cm) pancreatic tumors,ampullary neoplasms and small (< 4 mm) bile duct stones,and the best test to define vascular invasion in pancreatic and peri-ampullary neoplasms.Detailed EUS imaging,along with biochemical and molecular cyst fluid analysis,improve the differentiation of pancreatic cysts and help predict their malignant potential.Early diagnosis of chronic pancreatitis appears feasible and reliable.Novel imaging techniques (contrast-enhanced EUS,elastography) seem promising for the evaluation of pancreatic cancer and autoimmune pancreatitis.Therapeutic applications currently involve pancreaticobiliary drainage and targeted fine needle injection-guided antitumor therapy.Despite the ongoing development of extra-corporeal imaging modalities,such as computed tomography,magnetic resonance imaging,and positron emission tomography,EUS still holds a leading

  15. Uncertainty Assessment in Long Term Urban Drainage Modelling

    DEFF Research Database (Denmark)

    Thorndahl, Søren

    The thesis covers a general introduction and a combilation of seven papers on the subject of uncertainty assessment in urban drainage modelling. Urban drainage models applied for design and analysis of urban drainage systems are uncertain due to uncertainty in parameter assessment and especially...... the probability of system failures (defined as either flooding or surcharge of manholes or combined sewer overflow); (2) an application of the Generalized Likelihood Uncertainty Estimation methodology in which an event based stochastic calibration is performed; and (3) long term Monte Carlo simulations...

  16. The Drainage Consolidation Modeling of Sand Drain in Red Mud Tailing and Analysis on the Change Law of the Pore Water Pressure

    Directory of Open Access Journals (Sweden)

    Chuan-sheng Wu

    2014-01-01

    Full Text Available In order to prevent the occurring of dam failure and leakage, sand-well drainages systems were designed and constructed in red mud tailing. It is critical to focus on the change law of the pore water pressure. The calculation model of single well drainage pore water pressure was established. The pore water pressure differential equation was deduced and the analytical solution of differential equation using Bessel function and Laplace transform was given out. The impact of parameters such as diameter d, separation distance l, loading rate q, and coefficient of consolidation Cv in the function on the pore water pressure is analyzed by control variable method. This research is significant and has great reference for preventing red mud tailings leakage and the follow-up studies on the tailings stability.

  17. 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)

  18. Trends in pediatric ostomy surgery: intestinal diversion for necrotizing enterocolitis and biliary diversion for biliary hypoplasia syndromes.

    Science.gov (United States)

    Bastawrous, A A; Torosian, M B; Statter, M B; Arensman, R M

    1995-11-01

    Ostomies are placed in children for different indications than in the older population. Many ostomies of childhood are placed because of congenital or neonatal problems that require temporary or long-term diversion to stabilize the neonatal patient. Necrotizing enterocolitis, the most common reason for placement of neonatal colostomies and ileostomies, is increasing in frequency as more prematurely born infants survive. Recently, there has been an increase in treatment of various biliary hypoplasia syndromes with biliary cutaneous diversion. Children with biliary hypoplasia syndromes are a challenging group of patients who frequently can be helped by ostomies. This article reviews current information on biliary cutaneous diversion for the biliary hypoplasia syndromes and intestinal diversion for necrotizing enterocolitis.

  19. Clinicopathological Characteristics and Prognostic Factors of Intrahepatic Biliary Cystadenocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Ming-Yue Xu; Xian-Jie Shi; Tao Wan; Yu-Rong gang; Hong-Guang Wang; Wen-Zhi Zhang; Lei He

    2015-01-01

    Background:Surgical resection is generally considered the main curative treatment for intrahepatic biliary cystadenocarcinoma (IBCA) or suspected IBCAs,but controversy exists regarding the prognosis for IBCAs.This study aimed to describe the clinicopathological characteristics of IBCA and identify prognostic factors that may influence the survival of patients treated with surgical procedures.Methods:Thirty-four patients with histologically confirmed IBCA treated between January 2000 and June 2014 were included.The clinical characteristics of patients with IBCA were compared with those of 41 patients with intrahepatic biliary cystadenoma (IBC);factors that significant difference were analyzed for prognosis analysis of IBCA using multivariate/univariate Cox proportional hazards regression models.Survival curves were constructed using the Kaplan-Meier method and compared using the log-rank test.Results:IBCAs had a strong female predominance,and the most common presenting symptoms were abdominal pain or discomfort.Compared with IBCs,IBCAs occurred in older patients,in more male patients,and were associated statistically significant abnormal increase in alanine aminotransferase (P =0.01) and total bilirubin (P =0.04).Mural nodules were more frequently seen with IBCAs and may associate with malignancy.It was difficult to differentiate between IBC and IBCA based on laboratory examination and imaging findings.Although complete resection is recommended,enucleation with negative margins also achieved good outcomes.Median overall patient survival was 76.2 months;survival at 1,3,and 5 years was 88.0%,68.7%,and 45.8%,respectively.Radical resection and noninvasive tumor type were independent prognostic factors for overall survival.Conclusions:It remains difficult to distinguish between cystadenomas and cystadenocarcinomas based on laboratory examination and image findings.Complete resection is recommended for curative treatment,and patients should be closely followed

  20. Clinicopathological Characteristics and Prognostic Factors of Intrahepatic Biliary Cystadenocarcinoma

    Directory of Open Access Journals (Sweden)

    Ming-Yue Xu

    2015-01-01

    Full Text Available Background: Surgical resection is generally considered the main curative treatment for intrahepatic biliary cystadenocarcinoma (IBCA or suspected IBCAs, but controversy exists regarding the prognosis for IBCAs. This study aimed to describe the clinicopathological characteristics of IBCA and identify prognostic factors that may influence the survival of patients treated with surgical procedures. Methods: Thirty-four patients with histologically confirmed IBCA treated between January 2000 and June 2014 were included. The clinical characteristics of patients with IBCA were compared with those of 41 patients with intrahepatic biliary cystadenoma (IBC; factors that significant difference were analyzed for prognosis analysis of IBCA using multivariate/univariate Cox proportional hazards regression models. Survival curves were constructed using the Kaplan-Meier method and compared using the log-rank test. Results: IBCAs had a strong female predominance, and the most common presenting symptoms were abdominal pain or discomfort. Compared with IBCs, IBCAs occurred in older patients, in more male patients, and were associated statistically significant abnormal increase in alanine aminotransferase (P = 0.01 and total bilirubin (P = 0.04. Mural nodules were more frequently seen with IBCAs and may associate with malignancy. It was difficult to differentiate between IBC and IBCA based on laboratory examination and imaging findings. Although complete resection is recommended, enucleation with negative margins also achieved good outcomes. Median overall patient survival was 76.2 months; survival at 1, 3, and 5 years was 88.0%, 68.7%, and 45.8%, respectively. Radical resection and noninvasive tumor type were independent prognostic factors for overall survival. Conclusions: It remains difficult to distinguish between cystadenomas and cystadenocarcinomas based on laboratory examination and image findings. Complete resection is recommended for curative treatment

  1. Endoscopic transpapillary gallbladder drainage with replacement of a covered self-expandable metal stent.

    Science.gov (United States)

    Kawakubo, Kazumichi; Isayama, Hiroyuki; Sasahira, Naoki; Nakai, Yousuke; Kogure, Hirofumi; Sasaki, Takashi; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

    2011-02-16

    Endoscopic self-expandable metal stent (SEMS) placement has become a standard palliative therapy for patients with malignant biliary obstruction. Acute cholecystitis after SEMS placement is a serious complication. We report a patient with an acute cholecystitis after covered SEMS placement, who was managed successfully with endoscopic transpapillary gallbladder drainage (ETGBD) and replacement of the covered SEMS. An 85-year-old man with pancreatic cancer suffered from acute cholecystitis after covered SEMS placement. It was impossible to perform percutaneous transhepatic gallbladder drainage. After removal of the covered SEMS with a snare, a 7Fr double pigtail stent was placed between the gallbladder and duodenum, subsequently followed by another covered SEMS insertion into the common bile duct beside the gallbladder stent. The cholecystitis improved immediately after ETGBD. ETGBD with replacement of the covered SEMS thus proved to be effective for treatment of patients with acute cholecystitis after covered SEMS placement. PMID:21403817

  2. Risk Factors for Development of Biliary Stricture in Patients Presenting with Bile Leak after Cholecystectomy

    OpenAIRE

    Lokesh, Hosur Mayanna; Pottakkat, Biju; Prakash, Anand; Singh, Rajneesh Kumar; Behari, Anu; Kumar, Ashok; Kapoor, Vinay Kumar; Saxena, Rajan

    2013-01-01

    Background/Aims This study was aimed at determining the factors associated with the development of benign biliary stricture (BBS) in patients who had sustained a bile duct injury (BDI) at cholecystectomy and developed bile leaks. Methods A retrospective analysis of 214 patients with BDI who were referred to our center between January 1989 and December 2009 was done. Results One hundred fifty-three (71%) patients developed BBS (group I), and 61 (29%) were normal (group II). By univariate analy...

  3. Percutaneous interventional therapy for anastomotic biliary strictures after orthotopic liver transplantation%原位肝移植术后胆管吻合口狭窄的介入治疗

    Institute of Scientific and Technical Information of China (English)

    李名安; 姜在波; 黄明声; 钱结胜; 李征然; 庞鹏飞; 张有用; 单鸿

    2011-01-01

    Objective To describe the technique, efficacy, and safety of percutaneous interventional therapy for anastomotic biliary strictures after orthotopic liver transplantation (OLT).Methods From May 2004 to December 2009, 25 patients with anastomotic biliary strictures afte OLT were enrolled in our study. The modalities of biliary drainage included external drainage in 22patients, and external-internal drainage in 3 patients who underwent re-transplantation. All patients accepted percutaneous interventional therapy in our hospital, including single PTBD in 4 patients,PTBD combined with balloon dilation in 14 patients, balloon dilation and plastic stent implantation in 5 patients, balloon dilation and metallic stent implantation in 2 patients. The drainage catheters were exchanged every 1 to 3 months. Results The success rate of PTBD was 100%. Of the all 25patients, 15 (60 %) patients were cured, and 10 (40 %) patients were improved. The effective rate was 100 %. The drainage catheters failed to pass through the narrow bile duct when initial PTBD in 7 patients, and success was achieved in 3 patients by operation again after biliary drainage for one week.In the other 4 patients, anastomotic bile ducts were occluded, which was confirmed by cholangiography after biliary drainage for 4 to 8 weeks. The rate of biliary tract infection was 24 % (6/25). No serious procedure-related complications occurred in the all 25 patients. Conclusion PTBD combined with balloon dilation and biliary stenting is a effective and safe therapeutic modality for anastomotic biliary strictures after OLT, which can improve the patients' clinical symptoms and elevate patients' quality of life. To avoid bile duct occlusion, the drainage catheters should be passed through the narrow segments of bile duct when initial PTBD.%目的 总结经皮介入技术治疗原位肝移植(OLT)术后胆管吻合口狭窄的经验.方法 回顾性分析2004年5月至2009年12月间25例OLT术后胆管吻合

  4. 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.

  5. Biliary atresia: Clinical advances and perspectives.

    Science.gov (United States)

    Nizery, Laure; Chardot, Christophe; Sissaoui, Samira; Capito, Carmen; Henrion-Caude, Alexandra; Debray, Dominique; Girard, Muriel

    2016-06-01

    Biliary atresia (BA) is a rare and severe inflammatory and obliterative cholangiopathy that affects both extra- and intrahepatic bile ducts. BA symptoms occur shortly after birth with jaundice, pale stools and dark urines. The prognosis of BA has dramatically changed in the last decades: before the Kasai operation most BA patients died, while nowadays with the sequential treatment with Kasai operation±liver transplantation BA patient survival is close to 90%. Early diagnosis is very important since the chances of success of the Kasai procedure decrease with time. The causes of BA remain actually unknown but several mechanisms including genetic and immune dysregulation may probably lead to the obliterative cholangiopathy. Current research focuses on the identification of blood or liver factors linked to the pathogenesis of BA that could become therapeutic targets and avoid the need for liver transplantation. No similar disease leading to total obstruction of the biliary tree exists in older children or adults. But understanding the physiopathology of BA may highlight the mechanisms of other destructive cholangiopathies, such as sclerosing cholangitis. PMID:26775892

  6. 经内镜逆行性胰胆管造影与经皮肝穿刺胆道引流金属支架置入治疗恶性阻塞性黄疸的疗效比较%Comparison of the efficacy of endoscopic retrograde pancreatic angiography and percutaneous liver puncture ;biliary drainage metal stent implantation in the treatment of malignant obstructive jaundice

    Institute of Scientific and Technical Information of China (English)

    王昱良; 郑永青; 杜睿; 杨少宾; 韦亚娜

    2015-01-01

    目的:比较经内镜逆行性胰胆管造影(ERCP)与经皮肝穿刺胆道引流(PTCD)胆道金属支架置入治疗恶性阻塞性黄疸的临床效果。方法选取经 ERCP 胆道金属支架成功置入治疗恶性阻塞性黄疸患者42例,设为 ERCP 组;经 PTCD 胆道金属支架成功置入治疗恶性阻塞性黄疸患者38例,设为 PTCD 组。比较两组患者丙氨酸氨基转移酶、天冬氨酸氨基转移酶、直接胆红素、总胆红素含量的变化和并发症发生情况。结果ERCP 组术后3 d 丙氨酸氨基转移酶、天冬氨酸氨基转移酶、直接胆红素、总胆红素含量分别为(203.94±12.53)U /L、(180.94±17.53)U /L、(185.63±17.53)μmol/L、(240.41±18.79)μmol/L,PTCD 组患者术后3 d丙氨酸氨基转移酶、天冬氨酸氨基转移酶、直接胆红素、总胆红素含量分别为(230.63±13.95)U /L、(209.19±19.74)U /L、(192.52±16.93)μmol/L、(266.83±20.73)μmol/L,与术前比较明显降低(均 P <0.05);ERCP组并发症发生率为4.76%,低于 PTCD 组的23.68%(χ2=6.02,P <0.05)。结论经 ERCP 与经 PTCD 胆道金属支架置入治疗恶性阻塞性黄疸均能有效解除梗阻,PTCD 的并发症发生率稍高。%Objective To compare the clinical effect of ERCP and PTCD metal stent implantation in the treatment of malignant obstructive jaundice.Methods 42 patients who were treated successfully with ERCP biliary metal stent implantation in the treatment of malignant obstructive jaundice were selected as the ERCP group,38 patients who were successfully treated with PTCD biliary metal stent implantation in the treatment of malignant obstructive jaundice,were selected as the PTCD group.The changes of alanine aminotransferase,aspartate aminotransferase,direct bilirubin,total bilirubin content and complications of patients were compared between two groups.Results On the

  7. 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...

  8. Successful endoscopic treatment of biliary stricture following mesenteric tear caused by blunt abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    Dong O Kang; Tae Hyo Kim; Seung Suk You; Hyun Ju Min; Hyun Jin Kim; Woon Tae Jung; Ok Jae Lee

    2008-01-01

    Biliary duct injuries are frequently iatrogenic, being associated with surgery for gallbladder stones. However,blunt abdominal trauma such as a motor vehicle crash is a rare cause of extrahepatic biliary stricture. A few reports have been published on biliary strictures treated with endoscopic therapy. In the present study, we describe a suprapancreatic biliary stricture associated with mesenteric tear following road traffic accident.We performed endoscopic stent placement, which was successful in relieving the biliary stricture.

  9. Diabetes mellitus, insulin treatment, diabetes duration, and risk of biliary tract cancer and hepatocellular carcinoma in a European cohort

    NARCIS (Netherlands)

    Schlesinger, S.; Aleksandrova, K.; Pischon, T.; Jenab, M.; Fedirko, V.; Trepo, E.; Overvad, K.; Roswall, N.; Tjonneland, A.; Boutron-Ruault, M. C.; Fagherazzi, G.; Racine, A.; Kaaks, R.; Grote, V. A.; Boeing, H.; Trichopoulou, A.; Pantzalis, M.; Kritikou, M.; Mattiello, A.; Sieri, S.; Sacerdote, C.; Palli, D.; Tumino, R.; Peeters, P. H.; Bueno-de-Mesquita, H. B.; Weiderpass, E.; Quiros, J. R.; Zamora-Ros, R.; Sanchez, M.J.; Arriola, L.; Ardanaz, E.; Tormo, M. J.; Nilsson, P.; Lindkvist, B.; Sund, M.; Rolandsson, O.; Khaw, K. T.; Wareham, N.; Travis, R. C.; Riboli, E.; Noethlings, U.

    2013-01-01

    Evidence on associations between self-reported diabetes mellitus, diabetes duration, age at diabetes diagnosis, insulin treatment, and risk of biliary tract cancer (BTC) and hepatocellular carcinoma (HCC), independent of general and abdominal obesity is scarce. We conducted a prospective analysis in

  10. Improved Accuracy of Percutaneous Biopsy Using “Cross and Push” Technique for Patients Suspected with Malignant Biliary Strictures

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Prashant, E-mail: p.patel@bham.ac.uk [University of Birmingham, School of Cancer Sciences, Vincent Drive (United Kingdom); Rangarajan, Balaji; Mangat, Kamarjit, E-mail: kamarjit.mangat@uhb.nhs.uk, E-mail: kamarjit.mangat@nhs.net [University