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Sample records for biliary drainage analysis

  1. 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

  2. Percutaneous transhepatic biliary drainage: analysis of 175 cases

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    Suh, Kyung Jin; Lee, Sang Kwon; Kim, Tae Hun; Kim, Yong Joo; Kang, Duk Sik [College of Medicine, Kyungpook National Univ., Daegu (Korea, Republic of)

    1990-10-15

    Percutaneous transhepatic biliary drainage is a safe, effective and palliative means of treatment in biliary obstruction, especially in cases with malignant obstruction which are inoperable. 175 cases of transhepatic biliary drainage were performed on 119 patients with biliary obstruction from January 1985 to June 1989 at Kyung-pook National University Hospital. The causes of obstructive jaundice were 110 malignant diseases and 9 benign diseases. The most common indication for drainage was palliative intervention of obstruction secondary to malignant tumor in 89 cases. 86 cases of external drainage were performed including 3 cases of left duct approach, 29 cases of external-internal drainage and 60 cases of endoprosthesis. In external and external-internal drainages, immediate major complications (11.9%) occurred, including not restricted to, but sepsis, bile peritonitis and hemobilia. Delayed major complications (42.9%) were mainly catheter related. The delayed major complication of endoprosthesis resulted from obstruction of the internal stent. The mean time period to reobstruction of the internal stent was about 12 weeks. To improve management status, regular follow-up is required, as is education of both patients and their families as to when immediate clinical attention is mandated. Close communication amongst the varying medical specialities involved will be necessary to provide optional treatment for each patient.

  3. 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

  4. Percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

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

  5. Percutaneous transhepatic biliary drainage

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

    1983-12-15

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

  6. Percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

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

  7. Percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

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

  8. Percutaneous transhepatic biliary drainage - an analysis on 72 cases of internal drainage

    International Nuclear Information System (INIS)

    A total of 72 cases of internal biliary drainage procedure has been done percutaneously at Department of Radiology, Seoul National University Hospital for recent 4 and half years since August 1981. Five different types of internal drainage including endoprosthesis were applied to various conditions with different obstruction levels. The different method of procedure in each type of internal drainage was described and the results were analysed. 1. Among the clinical diagnosis in 72 cases, carcinoma of bile duct was in 37 cases as the most frequent one. The next was pancreas head carcinoma in 16 cases, followed by metastatic carcinoma and other diseases. 2. Type I internal drainage, classical internal and external type with distal end in duodenum, was applied in 43 cases as the most common one. Type II, modification of type I with distal end in CBD, was applied in 17 cases. Tyep III, endoprosthesis distal end into duodenum, was applied in 7 cases. Type IV, endoprosthesis just across the obstruction on bile duct, was applied in 2 cases, Type V, combined type of any internal drainage with external drainage, was applied in 3 cases. 3. According to various obstruction level, preferred type could be selected. For proximal obstruction type II and IV were preferred and for distal obstruction type III was chosen. However, type I could be applied in any situation. 4. Early complication occurred in 9 cases (12.5%). Clinical improvement with decrease in bilirubin level was observed in 17 of 21 cases in which follow-up data was available over 2 months. 5. Through the experience with those 72 cases it is recommended that appropriate type of internal biliary drainage should be selected according to prognosis, obstruction level and clinical findings of each patient.

  9. Percutaneous transhepatic biliary drainage - an analysis on 72 cases of internal drainage

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    Park, Jae Hyung; Choi, Byung Ihn; Park, Chan Sup; Sung, Kyu Bo; Lee, Byung Hee; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1986-06-15

    A total of 72 cases of internal biliary drainage procedure has been done percutaneously at Department of Radiology, Seoul National University Hospital for recent 4 and half years since August 1981. Five different types of internal drainage including endoprosthesis were applied to various conditions with different obstruction levels. The different method of procedure in each type of internal drainage was described and the results were analysed. 1. Among the clinical diagnosis in 72 cases, carcinoma of bile duct was in 37 cases as the most frequent one. The next was pancreas head carcinoma in 16 cases, followed by metastatic carcinoma and other diseases. 2. Type I internal drainage, classical internal and external type with distal end in duodenum, was applied in 43 cases as the most common one. Type II, modification of type I with distal end in CBD, was applied in 17 cases. Tyep III, endoprosthesis distal end into duodenum, was applied in 7 cases. Type IV, endoprosthesis just across the obstruction on bile duct, was applied in 2 cases, Type V, combined type of any internal drainage with external drainage, was applied in 3 cases. 3. According to various obstruction level, preferred type could be selected. For proximal obstruction type II and IV were preferred and for distal obstruction type III was chosen. However, type I could be applied in any situation. 4. Early complication occurred in 9 cases (12.5%). Clinical improvement with decrease in bilirubin level was observed in 17 of 21 cases in which follow-up data was available over 2 months. 5. Through the experience with those 72 cases it is recommended that appropriate type of internal biliary drainage should be selected according to prognosis, obstruction level and clinical findings of each patient.

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

    OpenAIRE

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

    2015-01-01

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

  11. Preoperative biliary drainage for biliary tract and ampullary carcinomas

    OpenAIRE

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

    2008-01-01

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

  12. 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.

  13. 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.

  14. 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.

  15. Clinical analysis and management of infections relative to percutaneous biliary drainage or stenting dilation

    International Nuclear Information System (INIS)

    Objective: To analyze the occurrence of infectious relative to percutaneous biliary drainage (PTBD)or stenting for malignant obstructive jaundice and explore the therapy and prevention. Methods: 181 patients (130 male and 51 female; median age 64.5 years old) with malignant biliary obstructive jaundice were investigated including 81 hepatobiliary cancers, 42 pancreatico-ampullae tumors, 58 gestro-intestinal portal lymphatic metastasis. All cases accepted PTBD or placement of metallic stents and the perioperative complications were recorded and analysed including the occurance and treatment. Results: All cases accepted PTBD or stenting successfully. The perioperative biliary infection was the major complication including 50 out of 62 preoperative infected cases (34.25%). 18 cases (15.13%)suffered from biliary infection after operation with 13 under control, 5 without control, 4 complicated with pulmonary infection and 17 (9.39%)died of serious biliary infections. Gram-negative bacilli and endotoxin were the main cause of the severe biliary infection. Postoperative mild pancreatitis occurred in 65 cases (35.91%)without severe necrotic changes and were cured alter anti-inflammatory treatment. Hepatic abscess due to biliary leak occurred in 1 case (0.55%), and was cured by CT-guided drainage. Conclusion: Biliary infection is the most common complication after interventional therapy and should be promptly under control for preventing mortality and prolonging survival. Simultaneously, acute pancreatitis should also be on alert but good prognosis would be obtained with apt therapy. (authors)

  16. Quantitative analysis of liver function in percutaneous transhepatic biliary drainage patients

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    Velchik, M.G.; Schwartz, W.; London, J.W.; Makler, P.T. Jr.; Alavi, A.

    1985-02-01

    The diagnostic usefulness of Tc-99m DISIDA cholescintigraphy as a predictor of eventual catheter and hepatic function in patients who have undergone percutaneous transhepatic biliary drainage (PTBD) for extrahepatic biliary obstruction was evaluated. Twenty-nine cholescintigrams were performed in 14 patients. The examinations were divided into two groups: Group A (N = 17), in which the patient's clinical status deteriorated within two to three days post-PTBD, and Group B (N = 12), in which the patients did well clinically post-PTBD. No significant difference between the two groups was demonstrated by visual analysis of the analog images or by analysis of serum bilirubin levels. A computer program, developed by the authors, quantitates several parameters of DISIDA kinetics, reflecting hepatic function based upon compartmental analysis. A significant difference (P less than .001) was demonstrated between the mean transport constants (blood clearance constant = k1; hepatic clearance constant = k2) for the two groups. It is concluded that serum bilirubin levels and visual inspection of analog images are inadequate independent predictors of hepatic function in patients post PTBD. The transport constants k1 and k2 are quantitative parameters of hepatic function that may be of prognostic value in patients post PTBD.

  17. Quantitative analysis of liver function in percutaneous transhepatic biliary drainage patients

    International Nuclear Information System (INIS)

    The diagnostic usefulness of Tc-99m DISIDA cholescintigraphy as a predictor of eventual catheter and hepatic function in patients who have undergone percutaneous transhepatic biliary drainage (PTBD) for extrahepatic biliary obstruction was evaluated. Twenty-nine cholescintigrams were performed in 14 patients. The examinations were divided into two groups: Group A (N = 17), in which the patient's clinical status deteriorated within two to three days post-PTBD, and Group B (N = 12), in which the patients did well clinically post-PTBD. No significant difference between the two groups was demonstrated by visual analysis of the analog images or by analysis of serum bilirubin levels. A computer program, developed by the authors, quantitates several parameters of DISIDA kinetics, reflecting hepatic function based upon compartmental analysis. A significant difference (P less than .001) was demonstrated between the mean transport constants (blood clearance constant = k1; hepatic clearance constant = k2) for the two groups. It is concluded that serum bilirubin levels and visual inspection of analog images are inadequate independent predictors of hepatic function in patients post PTBD. The transport constants k1 and k2 are quantitative parameters of hepatic function that may be of prognostic value in patients post PTBD

  18. 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

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

    Science.gov (United States)

    Park, Do Hyun

    2015-09-01

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

  20. 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

  1. 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.

  2. Persistent high serum bilirubin level after percutaneous transhepatic biliary drainage: analysis of 32 cases

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    Choo, In Wook; Choi, Byung Ihn; Park, Jae Hyung; Han, Man Chung; Kim, Chu Wan [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1986-12-15

    The aim of percutaneous transhepatic biliary drainage (PTBD) is to decrease serum bilirubin level and promote liver function in patient with biliary tract disease, especially obstruction by malignant disease. But some patients showed persistent high serum bilirubin level or higher than pre-PTBD level. Percutaneous transhepatic biliary drainage was performed in 341 patients of obstructive jaundice for 5 years form July, 1981 to July, 1986 at department of radiology, Seoul National University Hospital. Follow up check of the serum bilirubin level was possible in 188 patients. Among them the authors analysed 32 patients who showed persistent high serum bilirubin level after PTBD. The results were as follows: 1. The male to female ratio was 3.4:1 and the age ranged from 33 to 75. 2. The causes of obstructive jaundice included 30 malignant diseases and 2 benign diseases. Malignant disease were 16 cases of bile duct carcinoma, 7 cases of pancreatic cancer and 7 cases of metastasis from stomach, colon and uterine cervix. Benign disease were 1 case of common hepatic duct stone and 1 case of intrahepatic duct stones. 3. The most common level of obstruction was trifurcation in 17 cases. 4. The most common indication of PTBD was palliative drainage of obstruction secondary to malignant tumor in 28 cases. 5. Change of serum bilirubin level ratio (post-PTBD level/pre-PTBD level) was 1.28, 1.22, 1.38, 1.51 in serial period of 1-3 days, 4-6 days, 1-2 week 2-3 week after PTBD. 6. Causes of persistent high serum bilirubin level after PTBD were 12 cases of partial drainage of intrahepatic bile, 13 cases of hepatic dysfunction including 9 cases of metastatic nodule, 2 cases of biliary cirrhosis, 2 cases of multiple liver abscess, and 7 cases of poor function of catheter including 4 cases of hemobilia, 1 case of multiple intrahepatic stones, pyobilia and intrahepatic Clonorchis sinensis.

  3. Persistent high serum bilirubin level after percutaneous transhepatic biliary drainage: analysis of 32 cases

    International Nuclear Information System (INIS)

    The aim of percutaneous transhepatic biliary drainage (PTBD) is to decrease serum bilirubin level and promote liver function in patient with biliary tract disease, especially obstruction by malignant disease. But some patients showed persistent high serum bilirubin level or higher than pre-PTBD level. Percutaneous transhepatic biliary drainage was performed in 341 patients of obstructive jaundice for 5 years form July, 1981 to July, 1986 at department of radiology, Seoul National University Hospital. Follow up check of the serum bilirubin level was possible in 188 patients. Among them the authors analysed 32 patients who showed persistent high serum bilirubin level after PTBD. The results were as follows: 1. The male to female ratio was 3.4:1 and the age ranged from 33 to 75. 2. The causes of obstructive jaundice included 30 malignant diseases and 2 benign diseases. Malignant disease were 16 cases of bile duct carcinoma, 7 cases of pancreatic cancer and 7 cases of metastasis from stomach, colon and uterine cervix. Benign disease were 1 case of common hepatic duct stone and 1 case of intrahepatic duct stones. 3. The most common level of obstruction was trifurcation in 17 cases. 4. The most common indication of PTBD was palliative drainage of obstruction secondary to malignant tumor in 28 cases. 5. Change of serum bilirubin level ratio (post-PTBD level/pre-PTBD level) was 1.28, 1.22, 1.38, 1.51 in serial period of 1-3 days, 4-6 days, 1-2 week 2-3 week after PTBD. 6. Causes of persistent high serum bilirubin level after PTBD were 12 cases of partial drainage of intrahepatic bile, 13 cases of hepatic dysfunction including 9 cases of metastatic nodule, 2 cases of biliary cirrhosis, 2 cases of multiple liver abscess, and 7 cases of poor function of catheter including 4 cases of hemobilia, 1 case of multiple intrahepatic stones, pyobilia and intrahepatic Clonorchis sinensis.

  4. US and RTG guided percutaneous biliary drainage

    International Nuclear Information System (INIS)

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

  5. Reality named endoscopic ultrasound biliary drainage

    OpenAIRE

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

    2015-01-01

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

  6. PERCUTAENOUS BILIARY DRAINAGE IN MALIGNANT OBSTRUCTIVE JAUNDICE

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    V. Fotea

    2008-10-01

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

  7. Percutaneous Transhepatic Biliary Drainage Complicated by Bilothorax

    OpenAIRE

    Kim, Stephanie H.; Zangan, Steven M.

    2015-01-01

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

  8. Percutaneous Transhepatic Biliary Drainage Complicated by Bilothorax.

    Science.gov (United States)

    Kim, Stephanie H; Zangan, Steven M

    2015-03-01

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

  9. Percutaneous transhepatic biliary drainage using endoprosthesis

    International Nuclear Information System (INIS)

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

  10. Percutaneous transhepatic biliary drainage using endoprosthesis

    Energy Technology Data Exchange (ETDEWEB)

    Golder, W.; Rupp, N.

    1986-06-01

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

  11. Technical problems during percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

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

  12. Technical problems during percutaneous transhepatic biliary drainage

    Energy Technology Data Exchange (ETDEWEB)

    Weber, J.; Hoever, S.

    1985-11-01

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

  13. Percutaneous transhepatic biliary drainage in 107 patients

    International Nuclear Information System (INIS)

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

  14. Percutaneous transhepatic biliary drainage in 107 patients

    Energy Technology Data Exchange (ETDEWEB)

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

    1984-06-15

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

  15. The results of percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

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

  16. Results of percutaneous transhepatic biliary drainage

    Energy Technology Data Exchange (ETDEWEB)

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

    1985-06-01

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

  17. Percutaneous transhepatic biliary drainage in malignant extrahepatic cholestasis

    Energy Technology Data Exchange (ETDEWEB)

    Hoevels, J.

    1985-03-01

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

  18. Endoscopic ultrasound guided biliary drainage

    OpenAIRE

    2012-01-01

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

  19. Reality named endoscopic ultrasound biliary drainage.

    Science.gov (United States)

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

    2015-10-25

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

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

    Science.gov (United States)

    Sano, Atsushi; Yotsumoto, Takuma

    2016-01-01

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

  1. [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

  2. Prognostic factors after percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

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

  3. 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)

  4. Arterial Complications of Percutaneous Transhepatic Biliary Drainage

    International Nuclear Information System (INIS)

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

  5. Percutaneous transhepatic biliary drainage in malignant extrahepatic cholestasis

    International Nuclear Information System (INIS)

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

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

    OpenAIRE

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

    2007-01-01

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

  7. Percutaneous vs. endoscopic pre-operative biliary drainage in hilar cholangiocarcinoma – a systematic review and meta-analysis

    Science.gov (United States)

    Hameed, Ahmer; Pang, Tony; Chiou, Judy; Pleass, Henry; Lam, Vincent; Hollands, Michael; Johnston, Emma; Richardson, Arthur; Yuen, Lawrence

    2016-01-01

    Background The strategy for preoperative management of biliary obstruction in hilar cholangiocarcinoma (HCCA) patients with regards to drainage by endoscopic (EBD) or percutaneous (PTBD) methods is not clearly defined. The aim of this study was to investigate the utility, complications and therapeutic efficacy of these methods in HCCA patients, with a secondary aim to assess the use of portal vein embolization (PVE) in patients undergoing drainage. Methods Studies incorporating HCCA patients undergoing biliary drainage prior to curative resection were included (EMBASE and Medline databases). Analyses included baseline drainage data, procedure-related complications and efficacy, post-operative parameters, and meta-analyses where applicable. Results Fifteen studies were included, with EBD performed in 536 patients (52%). Unilateral drainage of the future liver remnant was undertaken in 94% of patients. There was a trend towards higher procedure conversion (RR 7.36, p = 0.07) and cholangitis (RR 3.36, p = 0.15) rates in the EBD group. Where specified, 134 (30%) drained patients had PVE, in association with a major hepatectomy in 131 patients (98%). Post-operative hepatic failure occurred in 22 (11%) of EBD patients compared to 56 (13%) of PTBD patients, whilst median 1-year survival in these groups was 91% and 73%, respectively. Discussion The accepted practice is for most jaundiced HCCA patients to have preoperative drainage of the future liver remnant. EBD may be associated with more immediate procedure-related complications, although it is certainly not inferior compared to PTBD in the long term. PMID:27154803

  8. Tumor extension along percutaneous transhepatic biliary drainage tracts

    International Nuclear Information System (INIS)

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

  9. Tumor extension along percutaneous transhepatic biliary drainage tracts

    Energy Technology Data Exchange (ETDEWEB)

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

    1986-11-01

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

  10. 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

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1983-09-01

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

  13. 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.

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

    OpenAIRE

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

    2007-01-01

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

  15. 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.

  16. 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.

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

    OpenAIRE

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

    2016-01-01

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

  18. Percutaneous Biliary Drainage with Emphasis on Hilar Lesions

    OpenAIRE

    1990-01-01

    The mortality rates of surgery and percutaneous transhepatic biliary drainage (PTHBD) are comparable. Long tenn studies show that delayed complications occur in the majority of cases of PTHBD and survival is not improved compared to surgery. The many recent advances in endoscopic and percutaneous drainage techniques and the recognition that the patient is best served by a noncompetitive multidisciplinary approach will ensure that virtually every patient obtains the most satisfactory drainage ...

  19. Suggestions on the guidelines for percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-03-01

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

  1. Permanent external percutaneous transhepatia biliary drainage in inoperable patients

    International Nuclear Information System (INIS)

    The authors refer about their experiences with percutaneous transhepatic biliary drainage (PTBD) which they have performed in a group of 20 patients. In all of these cases the indications for procedures were malignant biliary obstructions with jaundice. Since 1992 till now they have performed 20 external PTBD-s with a success rate of 85%. In their group of patients they had one serious complication. In three cases the catheter was withdrawned and the drainage had to be repeated. (authors). 5 figs., 9 refs

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-12-15

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

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

    International Nuclear Information System (INIS)

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

  4. Endoscopic ultrasound-guided biliary drainage as an alternative to percutaneous drainage and surgical bypass.

    Science.gov (United States)

    Prachayakul, Varayu; Aswakul, Pitulak

    2015-01-16

    Endoscopic retrograde cholangiopancreatography had been a treatment modality of choice for both benign and malignant biliary tract obstruction for more than half century, with a very high clinical success rate and low complications. But in certain circumstances, such as advanced and locally advanced pancreatobiliary malignancies (pancreatic cancer, cholangiocarcinoma, ampullary tumor) and tight benign strictures, endoscopic retrograde cholangiopancreatography (ERCP) fails. Up to this point, the only alternative interventions for these conditions were percutaneous transhepatic biliary drainage or surgery. Endoscopic ultrasound guided interventions was introduced for a couple decades with the better visualization and achievement of the pancreatobiliary tract. And it's still in the process of ongoing development. The inventions of new techniques and accessories lead to more feasibility of high-ended procedures. Endoscopic ultrasound guided biliary drainage was a novel treatment modality for the patient who failed ERCP with the less invasive technique comparing to surgical bypass. The technical and clinical success was high with acceptable complications. Regarded the ability to drain the biliary tract internally without an exploratory laparotomy, this treatment modality became a very interesting procedures for many endosonographers, worldwide, in a short period. We have reviewed the literature and suggest that endoscopic ultrasound-guided biliary drainage is also an option, and one with a high probability of success, for biliary drainage in the patients who failed conventional endoscopic drainage. PMID:25610532

  5. Preoperative biliary drainage before resection for cholangiocarcinoma (Pro)

    OpenAIRE

    Nimura, Y.

    2008-01-01

    Three types of preoperative biliary drainage (BD): percutaneous transhepatic (PTBD), endoscopic (EBD), and endoscopic nasobiliary (ENBD) can be indicated before resection of cholangiocarcinoma. However, three randomized controlled trials (RCTs) have revealed that preoperative PTBD does not improve perioperative results. Other RCTs have revealed that preoperative EBD for malignant obstructive jaundice has no demonstrable benefit and after EBD for hilar cholangiocarcinoma there are highly devel...

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

    OpenAIRE

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

    2016-01-01

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

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

    OpenAIRE

    Tiing Leong Ang; Eng Kiong Teo; Kwong Ming Fock

    2007-01-01

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

  8. Percutaneous Transhepatic Endobiliary Drainage of Hepatic Hydatid Cyst with Rupture into the Biliary System: An Unusual Route for Drainage

    International Nuclear Information System (INIS)

    The most common and serious complication of hydatid cyst of the liver is rupture into the biliary tract causing obstructive jaundice, cholangitis and abscess. The traditional treatment of biliary-cystic fistula is surgery and recently endoscopic sphincterotomy. We report a case of complex heterogeneous cyst rupture into the biliary tract causing biliary obstruction in which the obstruction and cyst were treated successfully by percutaneous transhepatic endobiliary drainage. Our case is the second report of percutaneous transbiliary internal drainage of hydatid cyst with rupture into the biliary duct in which the puncture and drainage were not performed through the cyst cavity

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

    Directory of Open Access Journals (Sweden)

    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.

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

    International Nuclear Information System (INIS)

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

  11. Preoperative percutaneous transhepatic biliary drainage in obstructive jaundice

    International Nuclear Information System (INIS)

    The operative mortality in our patients with malignant obstructive jaundice was 35%. It decreased to 5% (1 patient of 20) by means of preoperative PTCD after biliary drainage. This corresponds to the experience of others. We recommend the preoperative PTCD in all patients with malignant obstructive jaundice who have a relative good prognosis. In all other patients PTCD as definitive procedure should be performed. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Tiing Leong Ang

    2007-07-01

    Full Text Available Context Endoscopic transpapillary biliary drainage is the procedure of choice for biliary decompression in patients with unresectable pancreatic cancer. When ERCP is unsuccessful, the usual alternative is percutaneous transhepatic biliary drainage. Recently, the use of EUS-guided biliary drainage has been reported, but it is not clear whether it is feasible for this technique to find more widespread use as an alternative to failed ERCP. We herein describe our experience with two cases of unresectable pancreatic cancer associated with obstructive jaundice treated by EUS-guided biliary drainage. Case report Two men presented with obstructive jaundice due to unresectable pancreatic cancer. ERCP was unsuccessful in both cases because of complete tumor obstruction at the distal common bile duct. Both patients rejected the standard option of percutaneous transhepatic biliary drainage and EUS-guided biliary drainage was performed. The obstructed biliary system was successfully decompressed by the creation of a choledochoduodenal fistula and the insertion of a transduodenal biliary stent. Conclusion EUS-guided biliary drainage has the potential of replacing percutaneous transhepatic biliary drainage in unresectable pancreatic cancer with obstructive jaundice when ERCP is unsuccessful

  13. 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.

  14. 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.

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

    International Nuclear Information System (INIS)

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

  16. 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...

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

    OpenAIRE

    Ali Aminian; Ali, Fouzeyah A. H.

    2008-01-01

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

  18. 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...

  19. 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

  20. 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

  1. Endoscopic and Percutaneous Preoperative Biliary Drainage in Patients with Suspected Hilar Cholangiocarcinoma

    OpenAIRE

    Kloek, Jaap J.; van der Gaag, Niels A.; Aziz, Yalda; Rauws, Erik A. J.; van Delden, Otto M.; Lameris, Johan S; Busch, Olivier R.C.; Gouma, Dirk J; van Gulik, Thomas M.

    2009-01-01

    Introduction Controversy exists over the preferred technique of preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCCA) requiring major liver resection. The current study compared outcomes of endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) in patients with resectable HCCA. Methods One hundred fifteen consecutive patients were explored for HCCA between 2001 and July 2008 and assigned by initial PBD procedure to either EBD or ...

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

    Directory of Open Access Journals (Sweden)

    Ali Aminian

    2008-05-01

    Full Text Available When advanced biliary or pancreatic malignancies preclude application of surgery or stent placement for relief of jaundice, the remaining option is percutaneous transhepatic biliary drainage (PTBD. However, it is associated with problems such as loss of biliary fluid and minerals, malabsorption of fat, and discomfort. A new surgical method for palliative biliary drainage in malignant obstructive jaundice consists of connection of PTBD catheter to a jejunostomy catheter. With this configuration, external drainage converts to internal drainage type. This is a safe method with minimal morbidities and several advantages. It will improve the patients quality of life, minimize loss of fluid and electrolytes and permit normal enterohepatic circulation.

  3. Percutaneous transhepatic biliary drainage using large needle: Complications and usefulness

    International Nuclear Information System (INIS)

    To analyse complications and to review usefulness of large needle(18G) in percutaneous transhepatic biliary drainage(PTBD). 46 patients underwent PTBD in 52 occasions using large needle. 44 of 46 patients had either definite or suspicious malignant biliary obstruction, and most patients were poor in general condition. Complications were classified as acute type if developed within 30 days and as delayed type if developed after 30 days. Acute type was subdivided into severe and mild forms. Severe forms of complications were death(5.8%), septicemia(3.8%), and bile peritonitis(1.9%). There were not different from the rate of complication in PTBD using fine needle but the procedure was much more simple. We PTBD using large needle is a simple and safe procedure for prompt bile decompression

  4. Percutaneous transhepatic biliary drainage using large needle: Complications and usefulness

    Energy Technology Data Exchange (ETDEWEB)

    Park, Noh Kyoung; Lim, Hyun Yang; Lee, Ji Yeon; Lee, Kil Jun; Tae, Seok; Shin, Kyoung Ja; Lee, Sang Chun [Seoul Red Cross Hospital, Seoul (Korea, Republic of)

    1994-06-15

    To analyse complications and to review usefulness of large needle(18G) in percutaneous transhepatic biliary drainage(PTBD). 46 patients underwent PTBD in 52 occasions using large needle. 44 of 46 patients had either definite or suspicious malignant biliary obstruction, and most patients were poor in general condition. Complications were classified as acute type if developed within 30 days and as delayed type if developed after 30 days. Acute type was subdivided into severe and mild forms. Severe forms of complications were death(5.8%), septicemia(3.8%), and bile peritonitis(1.9%). There were not different from the rate of complication in PTBD using fine needle but the procedure was much more simple. We PTBD using large needle is a simple and safe procedure for prompt bile decompression.

  5. Factors relating to the short term effectiveness of percutaneous biliary drainage for hilar cholangiocarcinoma

    OpenAIRE

    TSAI, HONG-MING; Chuang, Chiao-Hsiung; Lin, Xi-Zhang; Chen, Chiung-Yu

    2009-01-01

    AIM: To identify factors that were related to the short term effectiveness of percutaneous transhepatic biliary drainage in cholangiocarcinoma patients and to evaluate the impact of palliative drainage on their survival.

  6. Preoperative endoscopic versus percutaneous transhepatic biliary drainage in potentially resectable perihilar cholangiocarcinoma (DRAINAGE trial): design and rationale of a randomized controlled trial

    OpenAIRE

    Wiggers, Jimme K; Coelen, Robert J.S.; Rauws, Erik A. J.; van Delden, Otto M.; van Eijck, Casper H. J.; Jonge, Jeroen; Porte, Robert J.; Buis, Carlijn I; Cornelis H. C. Dejong; Molenaar, I. Quintus; Besselink, Marc G.H.; Busch, Olivier R.C.; Dijkgraaf, Marcel G. W.; van Gulik, Thomas M.

    2015-01-01

    Background Liver surgery in perihilar cholangiocarcinoma (PHC) is associated with high postoperative morbidity because the tumor typically causes biliary obstruction. Preoperative biliary drainage is used to create a safer environment prior to liver surgery, but biliary drainage may be harmful when severe drainage-related complications deteriorate the patients’ condition or increase the risk of postoperative morbidity. Biliary drainage can cause cholangitis/cholecystitis, pancreatitis, hemorr...

  7. Methods and timing of biliary drainage for acute cholangitis: Tokyo Guidelines

    OpenAIRE

    Nagino, Masato; Takada, Tadahiro; Kawarada, Yoshifumi; Nimura, Yuji; Yamashita, Yuichi; Tsuyuguchi, Toshio; Wada, Keita; Mayumi, Toshihiko; Yoshida, Masahiro; Miura, Fumihiko; Steven M. Strasberg; Henry A. Pitt; Belghiti, Jacques; Fan, Sheung-Tat; Liau, Kui-Hin

    2007-01-01

    Biliary drainage is a radical method to relieve cholestasis, a cause of acute cholangitis, and takes a central part in the treatment of acute cholangitis. Emergent drainage is essential for severe cases, whereas patients with moderate and mild disease should also receive drainage as soon as possible if they do not respond to conservative treatment, and their condition has not improved. Biliary drainage can be achieved via three different routes/procedures: endoscopic, percutaneous transhepati...

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

    OpenAIRE

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

    2015-01-01

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

  9. 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.)

  10. The effects of different preoperative biliary drainage methods on complications following pancreaticoduodenectomy.

    Science.gov (United States)

    Huang, Xin; Liang, Bin; Zhao, Xiang-Qian; Zhang, Fu-Bo; Wang, Xi-Tao; Dong, Jia-Hong

    2015-04-01

    The objective of this study was to investigate the effects of different preoperative biliary drainage (PBD) methods on complications in jaundiced patients following pancreaticoduodenectomy. We retrospectively analyzed 270 extrahepatic bile duct cancer patients who underwent pancreaticoduodenectomy. A total of 170 patients without PBD treatment were defined as the non-PBD group. According to different PBD methods, 45, 18, and 37 patients were classified into the percutaneous transhepatic biliary drainage (PTBD), endoscopic nasobiliary drainage (ENBD), and endoscopic retrograde biliary stent (ERBS) groups, respectively. Clinical characteristics and complications were compared among the 4 groups. Preoperative cholangitis occurred in 14 (8.2%) and 8 (21.6%) patients in the non-PBD and ERBS group, respectively (P = 0.04). Compared with the non-PBD group, delayed gastric emptying (DGE) and wound infection occurred significantly more often in the ERBS group. The incidence of severe complications was significantly lower in the PTBD group than the non-PBD group (P = 0.03). Postoperative hospital stay and complication rates were significantly higher in the ERBS group than the PTBD group. There were no significant differences in complications between ENBD and other groups. In conclusion, PTBD can improve surgical outcomes by reducing severe complication rate in jaundiced patients following pancreaticoduodenectomy. ERBS increased the rates of DGE and wound infection due to high incidence of cholangitis before operative intervention and should be avoided. ENBD carried no special effect on complications and needs further analysis. PMID:25860221

  11. 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.

  12. 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.

  13. 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

  14. 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.

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

    International Nuclear Information System (INIS)

    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

  16. US and RTG guided percutaneous biliary drainage; Przezskorny drenaz drog zolciowych monitorowany usg i rtg

    Energy Technology Data Exchange (ETDEWEB)

    Bukowski, J. [Pomorska Akademia Medyczna, Szczecin (Poland)

    1994-12-31

    Under combined US and fluoroscopic guidance from anterior approach through left liver lobe a Seldinger technique was used for biliary drainage in 46 patients with nonresectable malignant biliary obstruction. In 9 cases of hilar tumor separating both hepatic ducts a second catheter was inserted through right liver lobe. In 11 cases an internal-external drainage was established. In 3 cases the externally drained bile was recycled by connecting the transhepatic catheter to a percutaneous gastrostomy also performed under US guidance. No severe complications were observed. A described drainage technique provides an effective palliative intervention for advanced biliary malignancies. (author). 18 refs, 6 figs.

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

    OpenAIRE

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

    1988-01-01

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

  18. 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...

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

    International Nuclear Information System (INIS)

    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

  20. 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

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

    OpenAIRE

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

    1981-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-04-15

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

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

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

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

  5. 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...

  6. Advances in Endoscopic Ultrasound-Guided Biliary Drainage: A Comprehensive Review

    OpenAIRE

    Sarkaria, Savreet; Lee, Ho-Su; Gaidhane, Monica; Kahaleh, Michel

    2012-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) has become the first-line therapy for bile duct drainage. In the hands of experienced endoscopists, conventional ERCP results in a failed cannulation rate of 3% to 5%. This failure can occur more commonly in the setting of altered anatomy or technically difficult cases due to either duodenal or biliary obstruction. In cases of ERCP failure, patients have traditionally been referred for either percutaneous transhepatic biliary drainage (PTB...

  7. Percutaneous transhepatic biliary drainage in an infant with obstructive jaundice caused by neuroblastoma.

    Science.gov (United States)

    Saettini, Francesco; Agazzi, Roberto; Giraldi, Eugenia; Foglia, Carlo; Cavalleri, Laura; Morali, Laura; Fasolini, Giorgio; Spotti, Angelica; Provenzi, Massimo

    2015-04-01

    Neuroblastoma presenting with obstructive jaundice is a rare event. Management of this condition includes surgery, chemotherapy, radiotherapy, temporary cholecystostomy tube, endoscopic retrograde cholangiopancreatography (ERCP), and internal biliary drainage (IBD). We herein describe our experience with one infant affected by neuroblastoma presenting with jaundice, who successfully underwent percutaneous transhepatic biliary drainage (PTBD). This report introduces PTBD as a viable treatment option for neuroblastoma and obstructive jaundice and provides a review of the pertinent literature. PMID:25551550

  8. 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.

  9. 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

  10. Sequential computerized hepatobiliary imaging during percutaneous transhepatic biliary drainage

    Energy Technology Data Exchange (ETDEWEB)

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

    1985-04-01

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

  11. Sequential computerized hepatobiliary imaging during percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

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

  12. 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

  13. 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.

  14. 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)

  15. Percutaneous transhepatic cholangiography and drainage for treatment of biliary complications after liver transplantation

    International Nuclear Information System (INIS)

    Objective: To evaluate the value of interventional biliary drainage for the treatment of biliary complications after liver transplantation (LT). Methods: The clinical data of 6 patients with biliary complications after LT from October 1999 to October 2005 were retrospectively analyzed, including common bile duct stenosis (n=2), common bile duct with fistula (n=1), bile leaks (n=1), biloma (n=2). Results: Percutaneous transhepatic cholangiography and drainage in 5 cases and 1 case of stent placement were identified as biliary tract complications after LT. The procedures were successful with clinical symptomatic improvement of the patients. Conclusion: Interventional therapy is an effective modality for biliary complications after LT with reduction of reoperation and improvement of the living quality and survival rate. The short term effects were satisfied. (authors)

  16. Effect of cisapride on symptoms and biliary drainage in patients with postcholecystectomy syndrome

    International Nuclear Information System (INIS)

    The study evaluates the effect of 20 mg cisapride twice daily on symptoms and biliary drainage in patients with the postcholecystectomy syndrome. 19 patients, all female, went through a randomized, double-blind, placebo-controlled, crossover trial with two 4-week treatment periods separated by a 2-week washout period. Symptoms were registered on diary cards. Biliary drainage was studied with dynamic cholescinitigraphy. The down slope of the time-activity curve was used as a measure of the biliary drainage. More symptoms were registered during cisapride therapy than with placebo. This unfavourable effect of cisapride was statistically significant in a subgroup of patients with postcholecystectomy complaints identical to the biliary pain they experienced during injection of contrast at the endoscopic retrograde cholangiopancreatographic examination. Cisapride statistically significantly hastened biliary drainage. The median T1/2 values were 24 and 28 min after cisapride and placebo, respectively. In conclusion, cisapride promoted biliary drainage in patients with the postcholecystectomy syndrome, but had an unfavourable symptomatic effect in those with bile duct triggered postcholecystectomy complaints. 22 refs., 3 figs

  17. 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...

  18. 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.

  19. 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.)

  20. Percutaneous Transhepatic Biliary Drainage Using a Ligated Catheter for Recurrent Catheter Obstruction: Antireflux Technique

    OpenAIRE

    Hamada, Tsuyoshi; Tsujino, Takeshi; Isayama, Hiroyuki; Hakuta, Ryunosuke; ITO Yukiko; Nakata, Ryo; Koike, Kazuhiko

    2013-01-01

    Percutaneous transhepatic biliary drainage (PTBD) is an established procedure for biliary obstruction. However, duodenobiliary or jejunobiliary reflux of the intestinal contents through a PTBD catheter sometimes causes recurrent catheter obstruction or cholangitis. A 64-year-old female patient with a history of choledochojejunostomy was referred to our department with acute cholangitis due to choledochojejunal anastomotic obstruction. Emergent PTBD was performed, but frequent obstructions of ...

  1. Role of Endoscopic Retrograde Cholangiography and Nasobiliary Drainage in the Management of Postoperative Biliary Leak

    OpenAIRE

    Goenka, M. K.; Kochhar, R; BHASIN, D; Nagi, B.; Wig, J. D.; Singh, G; Sriram, P. V. J.; Singh, K.

    1997-01-01

    In order to assess the role of endoscopic retrograde cholangiography in evaluating the patients with post-operative biliary leak and of endoscopic nasobiliary drainage in its management, 36 patients with biliary leak seen over a period of 9 years were studied. Thirty-two had biliary leak following cholecystectomy, 3 following repair of liver trauma and 1 following choledochoduodenostomy. Patients presented at an interval of 4 days to 210 days (mean ± SEM, 32.4 ± 6.7 days) following laparotomy...

  2. Incidence of Important Hemobilia Following Transhepatic Biliary Drainage: Left-Sided Versus Right-Sided Approaches

    International Nuclear Information System (INIS)

    Our purpose here is to describe our experience with important hemobilia following PTBD and to determine whether left-sided percutaneous transhepatic biliary drainage (PTBD) is associated with an increased incidence of important hemobilia compared to right-sided drainages. We reviewed 346 transhepatic biliary drainages over a four-year period and identified eight patients (2.3%) with important hemobilia requiring transcatheter embolization. The charts and radiographic files of these patients were reviewed. The side of the PTBD (left versus right), and the order of the biliary ductal branch entered (first, second, or third) were recorded. Of the 346 PTBDs, 269 were right-sided and 77 were left-sided. Of the eight cases of important hemobilia requiring transcatheter embolization, four followed right-sided and four followed left-sided PTBD, corresponding to a bleeding incidence of 1.5% (4/269) for right PTBD and 5.2% (4/77) for left PTBD. The higher incidence of hemobilia associated with left-sided PTBD approached, but did not reach the threshold of statistical significance (p = 0.077). In six of the eight patients requiring transcatheter embolization, first or second order biliary branches were accessed by catheter for PTBD. All patients with left-sided bleeding had first or proximal second order branches accessed by biliary drainage catheters. In conclusion, a higher incidence of hemobilia followed left- versus right-sided PTBD in this study, but the increased incidence did not reach statistical significance

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

    International Nuclear Information System (INIS)

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

  4. Evaluation of percutaneous cholangiography and percutaneous biliary drainage in obstructive jaundice

    International Nuclear Information System (INIS)

    104 patients with obstructive jaundice were referred for percutaneous transhepatic cholangiography (PTC) and percutaneous transhepatic biliary drainage (PTBD). The effects of PTBD on postoperative morbidity and mortality were evaluated as well as the occurrence of complications. The results were compared to a group of 33 patients with malignant bile duct obstruction operated without preoperative bile drainage. There was no significant difference in the rate of postoperative complications and mortality between these two groups. (orig.)

  5. Clinical outcomes and prediction of survival following percutaneous biliary drainage for malignant obstructive jaundice

    OpenAIRE

    Zhang, Guang Yuan; LI, WEN TAO; PENG, WEI JUN; LI, GUO DONG; HE, XIN HONG; XU, LI CHAO

    2014-01-01

    The present study aimed to investigate the clinical outcomes of percutaneous transhepatic biliary drainage in patients with obstructive jaundice and identify potential predictors of patient survival. Clinical data from 102 patients (66 males and 36 females; median age, 63.50 years; range, 29–84 years) with a mean (± standard deviation) pre-drainage serum bilirubin level of 285.4 (±136.7 μmol/l), were retrospectively studied. Technical and clinical success, complications and survival time were...

  6. Evaluation of percutaneous cholangiography and percutaneous biliary drainage in obstructive jaundice

    Energy Technology Data Exchange (ETDEWEB)

    Lukes, P.; Ceder, S.; Wihed, A.; Falk, A.; Gamklou, R.

    1985-11-01

    104 patients with obstructive jaundice were referred for percutaneous transhepatic cholangiography (PTC) and percutaneous transhepatic biliary drainage (PTBD). The effects of PTBD on postoperative morbidity and mortality were evaluated as well as the occurrence of complications. The results were compared to a group of 33 patients with malignant bile duct obstruction operated without preoperative bile drainage. There was no significant difference in the rate of postoperative complications and mortality between these two groups.

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

    OpenAIRE

    Fujita, Naotaka; Noda, Yutaka; Kobayashi, Go; Ito, Kei; Obana, Takashi; Horaguchi, Jun; Takasawa, Osamu; Nakahara, Kazunari

    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 hepatobiliar...

  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. 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

  10. Percutaneous transhepatic cholangiography and biliary drainage by antegrade puncture technique : technical note

    Energy Technology Data Exchange (ETDEWEB)

    Hahn, Seong Tai; Lee, Jae Mun; Kim, Choon Yul; Shinn, Kyung Sub [Catholic Medical Coll., Seoul (Korea, Republic of); Cho, Kyung Jae [Michigan Univ., Ann Arbor, MI (United States). Medical Center

    1998-02-01

    The antergrade puncture technique represents a new approach to percutaneous transhepatic cholangiography and biliary drainage. With this technique, ductal puncture begins with the liver capsule toward the hepatic parenchyma. This report briefly describes this new technique, and its safety and feasibility. (author). 5 refs., 1 fig.

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

    OpenAIRE

    SAKATA, JUN; Shirai, Yoshio; Wakai, Toshifumi; Nomura, Tatsuya; Sakata, Eiko; Hatakeyama, Katsuyoshi

    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.

  12. Percutaneous transhepatic cholangiography and biliary drainage by antegrade puncture technique : technical note

    International Nuclear Information System (INIS)

    The antergrade puncture technique represents a new approach to percutaneous transhepatic cholangiography and biliary drainage. With this technique, ductal puncture begins with the liver capsule toward the hepatic parenchyma. This report briefly describes this new technique, and its safety and feasibility. (author). 5 refs., 1 fig

  13. 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.

  14. Initial clinical experience on improved percutaneous transhepatic biliary drainage in the treatment of malignant obstruction of the proximal biliary

    International Nuclear Information System (INIS)

    Objective: To investigate feasibility and clinical application value of improved percutaneous transhepatic biliary internal-external drainage (PTBIED). Methods: Consecutive patients from April 2007 to April 2010 with malignant obstructive jaundice were diagnosed by medical imaging or pathological confirmation whenever possible. The patients with proximal malignant biliary obstruction and intact inferior common bile ducts > 3 cm in length, and a bilirubin of 70 μmol/L or higher, were included in the experimental group. The control group included patients with low malignant biliary obstruction, and those who met the criteria for the exper/mental group but refused to receive the altered method of PTBIED. The patients underwent traditional PTBIED in control group. The patients in the experimental group received the procedure as following: according to percutaneous transhepatic cholangiography, a biliary external drainage catheter was modified by adding side-holes. Then under fluoroscopic guidance, the loop tip of the modified biliary drainage catheter was positioned in the inferior common hepatic duct/common bile duct, while the additional side-holes were located in the expanded hepatic duct. Technical success rate, complications, hepatic function and white cell count (WBC) were recorded pre- and post-procedure. All patients were followed-up until death. A t-test was used to compare continuous variable data changes, the Chi-square test was used to compare categorical variable data in two groups, and survival time was assessed using the Kaplan-Meier method. Results: Forty-six patients were included in the study, with 21 in the experimental group and 25 in the control group. The procedures were successfully performed in all patients in the two groups. There was no procedure-related death in the two groups. Symptoms were improved similarly after procedures in the two groups. The mean quantity of drained bile per day [experimental group (521±136) ml/d, control group (606

  15. 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

  16. 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.

  17. Endoscopic ultrasonography-guided biliary drainage: Who, when, which, and how?

    Science.gov (United States)

    Hara, Kazuo; Yamao, Kenji; Mizuno, Nobumasa; Hijioka, Susumu; Imaoka, Hiroshi; Tajika, Masahiro; Tanaka, Tutomu; Ishihara, Makoto; Okuno, Nozomi; Hieda, Nobuhiro; Yoshida, Tukasa; Niwa, Yasumasa

    2016-01-21

    Both endoscopic ultrasonography (EUS)-guided choledochoduodenostomy (EUS-CDS) and EUS-guided hepaticogastrostomy (EUS-HGS) are relatively well established as alternatives to percutaneous transhepatic biliary drainage (PTBD). Both EUS-CDS and EUS-HGS have high technical and clinical success rates (more than 90%) in high-volume centers. Complications for both procedures remain high at 10%-30%. Procedures performed by endoscopists who have done fewer than 20 cases sometimes result in severe or fatal complications. When learning EUS-guided biliary drainage (EUS-BD), we recommend a mentor's supervision during at least the first 20 cases. For inoperable malignant lower biliary obstruction, a skillful endoscopist should perform EUS-BD before EUS-guided rendezvous technique (EUS-RV) and PTBD. We should be select EUS-BD for patients having altered anatomy from malignant tumors before balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography, EUS-RV, and PTBD. If both EUS-CDS and EUS-HGS are available, we should select EUS-CDS, according to published data. EUS-BD will potentially become a first-line biliary drainage procedure in the near future. PMID:26811666

  18. Management of post-surgical biliary leakage with percutaneous transhepatic biliary drainage (PTBD) and occlusion balloon (OB) in patients without dilatation of the biliary tree: preliminary results

    International Nuclear Information System (INIS)

    To compare the outcome of patients affected by biliary leak after major biliary surgery and treated with percutaneous transhepatic biliary drainage (PTBD) alone with that of similar patients treated with PTBD and concurrent positioning of an occlusion balloon (PTBD-OB). We retrospectively reviewed the results of the use of PTBD or PTBD-OB performed at our institution from 2004 to 2008 in patients with post-surgical biliary leak. Sixteen patients entered the evaluation. PTDB alone was performed in 9 men (age 59.7 ± 13.4 years [mean ± standard deviation]; median 60 years), while PTBD-OB was performed in 7 patients (5 men, 2 women, age 71.3 ± 9.3 years; median 68 years). No significant difference between groups was found regarding age (p = 0.064) and sex (p = 0.175) distribution, number of procedures (3.1 ± 1.62; 2 vs 1.7 ± 1.1; 1, p = 0.151), and days of disease before recovery, death or modification of treatment (51.6 ± 66.8; 23 vs 18.6 ± 15.1; 14, p = 0.266). The number of patients treated with PTBD-OB who fully recovered (7/7, 100%) was significantly higher than that of patients treated with PTBD alone (4/9, 44%, p = 0.034). This procedure appears to be clinically effective, being associated with a higher probability of recovery in patients treated for post-surgical biliary leak. Further studies are needed to confirm these preliminary results. (orig.)

  19. Management of post-surgical biliary leakage with percutaneous transhepatic biliary drainage (PTBD) and occlusion balloon (OB) in patients without dilatation of the biliary tree: preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Pedicini, Vittorio; Poretti, Dario; Brambilla, Giorgio [Humanitas Clinical Institute, Department of Diagnostic Imaging, Rozzano, Milan (Italy); Mauri, Giovanni; Trimboli, Manuela [Humanitas Clinical Institute, Department of Diagnostic Imaging, Rozzano, Milan (Italy); University of Milan School of Medicine, Unit of Radiology, Ospedale San Paolo, Milan (Italy); Sconfienza, Luca Maria; Sardanelli, Francesco [University of Milan School of Medicine, Unit of Radiology, IRCCS Policlinico San Donato, Department of Medical and Surgical Sciences, Milan (Italy); Cornalba, Gianpaolo [University of Milan School of Medicine, Unit of Radiology, Ospedale San Paolo, Milan (Italy)

    2010-05-15

    To compare the outcome of patients affected by biliary leak after major biliary surgery and treated with percutaneous transhepatic biliary drainage (PTBD) alone with that of similar patients treated with PTBD and concurrent positioning of an occlusion balloon (PTBD-OB). We retrospectively reviewed the results of the use of PTBD or PTBD-OB performed at our institution from 2004 to 2008 in patients with post-surgical biliary leak. Sixteen patients entered the evaluation. PTDB alone was performed in 9 men (age 59.7 {+-} 13.4 years [mean {+-} standard deviation]; median 60 years), while PTBD-OB was performed in 7 patients (5 men, 2 women, age 71.3 {+-} 9.3 years; median 68 years). No significant difference between groups was found regarding age (p = 0.064) and sex (p = 0.175) distribution, number of procedures (3.1 {+-} 1.62; 2 vs 1.7 {+-} 1.1; 1, p = 0.151), and days of disease before recovery, death or modification of treatment (51.6 {+-} 66.8; 23 vs 18.6 {+-} 15.1; 14, p = 0.266). The number of patients treated with PTBD-OB who fully recovered (7/7, 100%) was significantly higher than that of patients treated with PTBD alone (4/9, 44%, p = 0.034). This procedure appears to be clinically effective, being associated with a higher probability of recovery in patients treated for post-surgical biliary leak. Further studies are needed to confirm these preliminary results. (orig.)

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

    OpenAIRE

    Kim, Ji Hyung

    2009-01-01

    Objective To evaluate the feasibility of CT fluoroscopy (CTF)-guided percutaneous transhepatic biliary drainage (PTBD) in emergency patients with acute obstructive cholangitis. Materials and Methods 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 pe...

  1. 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...

  2. Endoscopic ultrasonography-guided biliary drainage: Who, when, which, and how?

    OpenAIRE

    Hara, Kazuo; Yamao, Kenji; Mizuno, Nobumasa; Hijioka, Susumu; Imaoka, Hiroshi; Tajika, Masahiro; Tanaka, Tutomu; Ishihara, Makoto; Okuno, Nozomi; Hieda, Nobuhiro; Yoshida, Tukasa; Niwa, Yasumasa

    2016-01-01

    Both endoscopic ultrasonography (EUS)-guided choledochoduodenostomy (EUS-CDS) and EUS-guided hepaticogastrostomy (EUS-HGS) are relatively well established as alternatives to percutaneous transhepatic biliary drainage (PTBD). Both EUS-CDS and EUS-HGS have high technical and clinical success rates (more than 90%) in high-volume centers. Complications for both procedures remain high at 10%-30%. Procedures performed by endoscopists who have done fewer than 20 cases sometimes result in severe or f...

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

    OpenAIRE

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

    2014-01-01

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

  4. Application of DSA guidance combined with ultrasound localization in performing percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Objective: To investigate the application of DSA guidance combined with ultrasound localization in performing percutaneous transhepatic biliary drainage (PTBD). Methods: A total of 32 cases with malignant obstructive jaundice were enrolled in this study. The primary malignancy included primary liver cancer (n=4), bile duct carcinoma (n=21), gallbladder carcinoma with hepatic hilar metastases (n=2), metastatic carcinoma (n=3) and adenocarcinoma of the head of pancreas (n=2). Palliative biliary tract external and/or internal drainage were carried out under DSA guidance together with ultrasonic localization. After the treatment, all the routine biochemical items were reexamined. The results were analyzed. Results: Successful puncturing and drainage with single manipulation was achieved in all the 32 patients, and the success rate was 100%. External drainage was employed in 21 cases, while external together with internal drainage was adopted in 11 cases. After the operation, the jaundice was reduced, the liver function and clinical symptoms were relieved, and the patient's living quality was improved. Conclusion: With the help of DSA guidance combined with ultrasound localization the technical success rate of PTBD can be greatly improved and the operation time can be shortened. This technique is safe and effective, and it is very helpful in reducing patient's suffering. Meanwhile, the exposure dose of irradiation can be lessened to a large extent. (authors)

  5. Techniques of biliary drainage for acute cholecystitis: Tokyo Guidelines

    OpenAIRE

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

    2007-01-01

    The principal management of acute cholecystitis is early cholecystectomy. However, percutaneous transhepatic gallbladder drainage (PTGBD) may be preferable for patients with moderate (grade II) or severe (grade III) acute cholecystitis. For patients with moderate (grade II) disease, PTGBD should be applied only when they do not respond to conservative treatment. For patients with severe (grade III) disease, PTGBD is recommended with intensive care. Percutaneous transhepatic gallbladder aspira...

  6. Interventional therapy of hepatic arterial hemorrhage occurred after percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Objective: To analyze the causes and clinical manifestations of hepatic arterial hemorrhage which occurred after percutaneous transhepatic biliary drainage and to summarize the practical experience in its diagnosis and treatment in order to decrease its incidence and mortality. Methods: During the period from June 2007 to June 2010, percutaneous transhepatic biliary drainage was carried out in 622 cases, of which DSA-proved postoperative hepatic arterial hemorrhage occurred in 11, including bile duct hemorrhage (n=6), abdominal cavity bleeding (n=3) and combination of bile duct and abdominal cavity (n=2). Interventional embolization of the bleeding branches of hepatic artery with Gelfoam and coils was carried out in all 11 patients. The clinical data such as clinical manifestations and therapeutic results were retrospectively analyzed. Results: After interventional embolization therapy for postoperative hepatic arterial hemorrhage the bleeding stopped in ten patients, who were discharged from hospital when the clinical conditions were alleviated. The remaining one patient died of sustained deterioration in hepatic and renal functions although the bleeding was ceased. Conclusion: Though hepatic arterial hemorrhage occurred after percutaneous transhepatic biliary drainage is a rare complication, it is dangerous and fatal. Hepatic arterial angiography together with interventional embolization is a sate and effective therapy for hepatic arterial hemorrhage. (authors)

  7. Risk factors for percutaneous transhepatic biliary drainage-related cholangitis in patients with malignant obstructive jaundice: a prospective study

    International Nuclear Information System (INIS)

    Objective: To investigate the risk factors for percutaneous transhepatic biliary drainage (PTBD) related cholangitis in patients with malignant obstructive jaundice. Methods: One hundred and fifty-four consecutive patients with malignant obstructive jaundice and without leukocytosis, fever and other manifestations of biliary tract infection received initial PTBD drainage. They were enrolled in this study. An uncontrolled prospective study was conducted of cholangitis occurrence within 30 days after PTBD. Twenty potential preoperative risk factors were assessed by univariate and multivariate analysis. Results: Fifty-five patients (55/154, 35.7%) developed PTBD-related cholangitis, which composed of cholangitis group. Other patients composed of non-cholangitis group (99/154). The cholangitis-related mortality rate was 2.6% (4/154). Intraoperative bile culture were performed for 131 patients (131/154), including 45 in cholangitis group and 86 in non-cholangitis group. Positive result occurred in 26 patients (26/45) in cholangitis group and 17 patients (17/86) in non-cholangitis group. There was statistical significant difference between these two groups (χ2=19.357, P2= 10.470, P2=36.324, P2=9.540, P2=9.856, P2=14.196, P2=6.190, P2=5.439, P<0.05) were significantly different between cholangitis group and non-cholangitis group. By multivariate analysis, diabetes (OR=5.093, P<0.01), Child-Pugh C grade (OR=13.412, P<0.01), undrained biliary duct (OR=3.348, P<0.05), external-internal drainage (OR=3.168, P<0.05) and history of ERCP or cholangiojejunostomy (OR=8.330, P<0.01) remained significant difference. Conclusions: PTBD is an effective and safe palliative treatment for patients with malignant obstructive jaundice. Sufficient preoperative preparation and effective control of risk factors may reduce the incidence of cholangitis after PTCD. (authors)

  8. 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.

  9. 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

  10. Paravertebral Block: An Improved Method of Pain Control in Percutaneous Transhepatic Biliary Drainage

    International Nuclear Information System (INIS)

    Background and Purpose. Percutaneous transhepatic biliary drainage remains a painful procedure in many cases despite the routine use of large amounts of intravenous sedation. We present a feasibility study of thoracic paravertebral blocks in an effort to reduce pain during and following the procedure and reduce requirements for intravenous sedation. Methods. Ten consecutive patients undergoing biliary drainage procedures received fluoroscopically guided paravertebral blocks and then had supplemental intravenous sedation as required to maintain patient comfort. Levels T8-T9 and T9-T10 on the right were targeted with 10-20 ml of 0.5% bupivacaine. Sedation requirements and pain levels were recorded. Results. Ten biliary drainage procedures in 8 patients were performed for malignancy in 8 cases and for stones in 2. The mean midazolam use was 1.13 mg IV, and the mean fentanyl requirement was 60.0 μg IV in the block patients. Two episodes of hypotension, which responded promptly to volume replacement, may have been related to the block. No serious complications were encountered. The mean pain score when traversing the chest wall, liver capsule, and upon entering the bile ducts was 0.1 on a scale of 0 to 10, with 1 patient reporting a pain level of 1 and 9 reporting 0. The mean peak pain score, encountered when manipulating at the common bile duct level or when addressing stones there, was 5.4 and ranged from 0 to 10. Conclusions. Thoracic paravertebral block with intravenous sedation supplementation appears to be a feasible method of pain control during biliary interventions

  11. Endoscopic ultrasound-guided biliary drainage as an alternative to percutaneous drainage and surgical bypass

    OpenAIRE

    Prachayakul, Varayu; Aswakul, Pitulak

    2015-01-01

    Endoscopic retrograde cholangiopancreatography had been a treatment modality of choice for both benign and malignant biliary tract obstruction for more than half century, with a very high clinical success rate and low complications. But in certain circumstances, such as advanced and locally advanced pancreatobiliary malignancies (pancreatic cancer, cholangiocarcinoma, ampullary tumor) and tight benign strictures, endoscopic retrograde cholangiopancreatography (ERCP) fails. Up to this point, t...

  12. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-12-15

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

  14. 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)

  15. Obstructive Jaundice in Hepatocellular Carcinoma: Response after Percutaneous Transhepatic Biliary Drainage and Prognostic Factors

    International Nuclear Information System (INIS)

    Purpose: To evaluate the therapeutic effect of percutaneous transhepatic biliary drainage (PTBD) in patients with obstructive jaundice caused by biliary involvement of hepatocellular carcinomas (HCC) and to determine the prognostic factors. Methods: We retrospectively analyzed the data of 22 consecutive patients (M:F = 20:2, mean age 52.8 years).Inclusion criteria were the patient having obstructive jaundice caused by HCC that invaded the bile ducts and having at least 4 weeks of follow-up data after the PTBD. We defined 'good response' and 'poor response' as whether the level of total bilirubin decreased more than 50% in 4 weeks or not. Total bilirubin level (T-bil),Child-Pugh score and the location of biliary obstruction for the two groups were compared. In addition, the interval between clinical onset of jaundice and PTBD, the degree of parenchymal atrophy and the size of the primary tumor were compared. Results: Of the 22 patients, 13 (59.1%) showed good response. T-bil was significantly lower in the good response group than in the poor (14.2 ± 6 mg/dlvs 25.9 ± 13.8 mg/dl, p = .017). In the five patients with T-bil 20 mg/dl, only three (33%)showed good response. Although statistically not significant, patients with Child score <10 showed better results [good response rate of 66.7% (12/18)] than patients with Child score ?10 [good response rate of 25% (1/4)]. Involvement of secondary confluence of the bile duct also served as a poor prognostic factor (p =0.235). The interval between clinical onset of jaundice and PTBD, the presence of parenchymal atrophy and the size of the tumor did not show significant effect. Conclusion: Early and effective biliary drainage might be necessary in this group of patients with limited hepatic function

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-10-15

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

  2. 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。

  3. Bile Acid Analysis in Biliary Tract Cancer

    OpenAIRE

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

    2006-01-01

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

  4. Solitary percutaneous transhepatic biliary drainage tract metastasis after curative resection of perihilar cholangiocarcinoma: report of a case

    OpenAIRE

    Hwang, Shin; Jung, Sung-Won; Namgoong, Jung-Man; Yoon, Sam-Youl; Park, Gil-Chun; Jung, Dong-Hwan; Song, Gi-Won; Ha, Tae-Yong; Ko, Gi-Young; Suh, Dong-Wan; Lee, Sung-Gyu

    2011-01-01

    Percutaneous transhepatic biliary drainage (PTBD) has been widely used, but it has a potential risk of tumor spread along the catheter tract. We herein present a case of solitary PTBD tract metastasis after curative resection of perihilar cholangiocarcinoma. Initially, endoscopic nasobiliary drainage was done on a 65 year-old female patient, but the cholangitis did not resolve. Thus a PTBD catheter was inserted into the right posterior duct. Right portal vein embolization was also performed. ...

  5. Animal experimental study of percutaneous transhepatic cholangiogastric drainage for the management of biliary tract obstruction

    International Nuclear Information System (INIS)

    Objective: To evaluate the feasibility, safety and efficacy of percutaneous transhepatic cholangio-gastric drainage (PTCGD) for the management of obstructive jaundice, especially, for the refractory cases. Methods: The ligations of common bile ducts were performed in 20 healthy pigs, including 9 males and 11 females. They were randomly divided into two groups after 14 days of ligation. Group A (n=10) underwent PTCGD, and Croup B (n=10) served as control group (without management). Liver function, including TBIL, DBIL, ALT and ALB in plasma; and furthermore with CT of liver were carried out in different period for comparison between the 2 groups consisting those before and after the ligation. The changes were demonstrated on CT and the pathology was investigated through hematoxylin and eosin stain under microscopy. Results: The technical success rate reached 100% in Group A, with complications occurred mainly of biliary hemobilia and fever. TBIL,DBIL and ALT continuously increased after the ligation but obviously decreased after PTCGD, with rebuilt of the damaged liver tissue. On the contrary, all animals in Group B died on the 23 rd to 32nd day after the ligation of common bile duct. The mean survival time was 28.3 days. TBIL, DBIL and ALT continuously increased from ligation until death. The intra-and extra-hepatic ducts were obviously dilated on the cholangiograms. Severe necrosis of hepatic cells and bile stasis of infra-lobule biliary ducts appeared under microscopy. Conclusions: PTCGD is a safe, microinvasive and effective palliative therapy for biliary obstruction, especially the refractory cases in the experimental animals. (authors)

  6. 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.)

  7. 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.)

  8. Diagnosis and treatment of arteriobiliary hemorrhage occurring after percutaneous biliary drainage

    International Nuclear Information System (INIS)

    Hemorrhage due to arteriobiliary communication occurred in 15 of 500 patients after percutaneous biliary drainage (PBD). Hemorrhage produced a distinct clinical syndrome and occurred sooner after PBD in patients with benign disease (eight patients, mean of 1.5 weeks) than in patients with neoplastic obstruction (seven patients, mean of 11.5 weeks). In eight patients the author identified the bleeding vessel by contrast agent injection into the transhepatic tract, and in four we were able to embolize this vessel via the transhepatic tract. Eleven patients underwent hepatic arteriography, which identified contrast agent extravasation or arterial abnormality. Angiographic embolization was possible in eight of the 11. Embolization via the transhepatic tube tract should be attempted first, with angiographic embolization as a backup

  9. 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.

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

    International Nuclear Information System (INIS)

    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(ρ < 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

  11. 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

  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. Resolution of biliary stricture after living donor liver transplantation in a child by percutaneous trans-hepatic cholangiography and drainage: a case report

    OpenAIRE

    Putzer, Gabriel; Paal, Peter; Chemelli, Andreas P; Mark, Walter; Lederer, Wolfgang; Wiedermann, Franz J.

    2013-01-01

    Introduction Intra-hepatic cholestasis arising from biliary strictures is a frequent complication in pediatric patients after liver transplantation. Minimally invasive procedures such as percutaneous drainage placement and balloon dilation are the preferred diagnostic and therapeutic modalities. Case presentation We report the case of a 12-month-old Caucasian boy with biliary atresia who was initially treated with hepatoportoenterostomy. In the following months, he developed biliary cirrhosis...

  14. Computer tomography (CT) in the choice of treatment and the planning of percutaneous transhepatic biliary drainage in obstructive jaundice due to tumour

    International Nuclear Information System (INIS)

    We have performed percutaneous transhepatic biliary drainage on 27 patients; of these, thirteen were examined by CT before and after the procedure. Our experience suggests that CT or sonography is indicated in every case of obstruction due to tumour in order to: 1. Decide on treatment by a non-invasive method, thereby saving the patient an unnecessary laparotomy and 2. Plan the biliary drainage accurately, leading to the lowest possible number of complications. (orig.)

  15. Transhepatic anterograde biliary drainage using a self-expandable metallic stent: a therapeutic alternative after hepaticojejunostomy with Roux-en-Y reconstruction

    OpenAIRE

    Fernando Macías-García; Julio Iglesias-García; José Lariño-Noia; J. Enrique Domínguez-Muñoz

    2013-01-01

    Endoscopic drainage is the procedure of choice in cases of obstructive jaundice. However, in patients with a surgical biliary reconstruction, this technique cannot be often satisfactorily used. In these cases, the best alternative has usually been the percutaneous biliary drainage. Since the introduction of endoscopic ultrasound-guided therapy, some new techniques have been proposed to solve these technical problems related to postsurgical disturbed anatomy. In this case report, we describe o...

  16. 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

  17. Percutaneous transhepatic biliary drainage under fluoroscopic and ultrasound guidance for the treatment of obstructive jaundice: its clinical application

    International Nuclear Information System (INIS)

    Objective: To investigate the technical and clinical value of percutaneous transhepatic biliary drainage (PTBD) in treating patients of obstructive jaundice with the help of fluoroscopic and real-time ultrasound monitoring. Methods: A total of 78 patients with obstructive jaundice were enrolled in this study. The primary lesions included malignant diseases (n=70) and benign diseases (n=8). PTBD was carried out in all patients. Under fluoroscopic and real-time ultrasonography guidance, the biliary duct of the right hepatic lobe (n=52) or the biliary duct of the left hepatic lobe was punctured and the cholangiography was routinely performed. The drainage procedure was carried out. Results: PTBD was successfully accomplished in all patients. No severe complications, such as massive bleeding or biliary peritonitis, occurred. After the treatment the symptoms and signs of obstructive jaundice were gradually improved. The serum levels of both bilirubin and transaminase determined 1-2 weeks after the treatment were decreased, and the reductions were statistically significant when compared with the preoperative data (P<0.01). Conclusion: For the obstructive jaundice, PTBD under the guidance of fluoroscopy and real-time ultrasonography is an effective, safe, simple and economical treatment with fewer complications. (authors)

  18. 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...

  19. 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

  20. 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

  1. Percutaneous Transhepatic Cholangiography and Biliary Drainage After Liver Transplantation: A Five-Year Experience

    OpenAIRE

    Zajko, Albert B.; Bron, Klaus M.; Campbell, William L.; Behal, Rajan; VAN THIEL, DAVID H.; Starzl, Thomas E.

    1987-01-01

    Evaluation of the biliary tract by percutaneous transhepatic cholangiography (PTC) is often required in liver transplant patients with an abnormal postoperative course. Indications for PTC include failure of liver enzyme levels to return to normal postoperatively, an elevation of serum bilirubin or liver enzyme levels, suspected bile leak, biliary obstructive symptoms, cholangitis, and sepsis.

  2. 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

  3. Transhepatic anterograde biliary drainage using a self-expandable metallic stent: a therapeutic alternative after hepaticojejunostomy with Roux-en-Y reconstruction

    Directory of Open Access Journals (Sweden)

    Fernando Macías-García

    2013-06-01

    Full Text Available Endoscopic drainage is the procedure of choice in cases of obstructive jaundice. However, in patients with a surgical biliary reconstruction, this technique cannot be often satisfactorily used. In these cases, the best alternative has usually been the percutaneous biliary drainage. Since the introduction of endoscopic ultrasound-guided therapy, some new techniques have been proposed to solve these technical problems related to postsurgical disturbed anatomy. In this case report, we describe our successful experience in the performance of a transhepatic anterograde biliary drainage using a self-expandable metallic stent in the context of a patient who previously had undergone a hepaticojejunostomy with Roux-en-Y reconstruction because of a resected hilar cholangiocarcinoma.

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

    OpenAIRE

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

    2014-01-01

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

  5. 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.

  6. A Comparative Study of CT Fluoroscopy Combined with Fluoroscopy Versus Fluoroscopy Alone for Percutaneous Transhepatic Biliary Drainage

    International Nuclear Information System (INIS)

    Purpose: We compared CT fluoroscopy (CTF) for the initial puncture of bile ducts with conventional fluoroscopic guidance in patients with malignant jaundice in whom percutaneous transhepatic biliary drainage (PTBD) was planned.Methods: Forty consecutive patients were randomized to two study groups: group A underwent PTBD under CTF and fluoroscopic guidance, group B underwent PTBD under fluoroscopic guidance alone. CTF-guided PTBD was performed using a combination of a helical CT scanner of the latest generation and a mobile C-arm; conventional PTBD was performed under fluoroscopic guidance in the angiographic unit. End points of the study were the success (a puncture that enabled safe placement of a guidewire in a suitable bile duct) and the complication rate (hemobilia, bile fistula, biliary peritonitis), the number of punctures required, the time needed for successful puncture of a suitable bile duct, and the patient's radiation exposure.Results: CTF-guided puncture of peripheral bile ducts suitable for PTBD was successful at the first attempt in 16 cases, under conventional fluoroscopic guidance, in only two cases. We found a significantly different number of punctures (1.2 in group A vs 2.9 in group B), a significantly shorter time for puncture in group A (mean 39 sec), but also a significantly higher skin exposure dosage in group A (mean 49.5 mSv surface dosage). There was no significant difference regarding the total procedure time. Only one complication occurred in group B (portobiliary fistula).Conclusion: CTF-guided initial puncture of bile ducts allowed a significantly reduced number of punctures and puncture times compared with puncture under conventional fluoroscopic guidance for placement of percutaneous transhepatic biliary drainage catheters

  7. [Long-Term Multidisciplinary Therapy for Multiple Liver Metastases from Colorectal Cancer with Biliary Drainage for Occlusive Jaundice--A Case Report].

    Science.gov (United States)

    Okamura, Shu; Mikami, Koji; Murata, Kohei; Nushijima, Yoichirou; Okada, Kazuyuki; Yanagisawa, Tetsu; Fukuchi, Nariaki; Ebisui, Chikara; Yokouchi, Hideoki; Kinuta, Masakatsu

    2015-11-01

    Here, we report the case of a 43-year-old man who was diagnosed with sigmoid colon cancer with synchronous multiple liver metastases following resection of a primary lesion. Subsequent mFOLFOX+BV therapy elicited a marked response in the liver metastases, which led to the patient undergoing hepatic (S7) radiofrequency ablation (RFA), hepatic resection (lateral segmentectomy and partial [S5] resection), and cholecystectomy. Six months later, transluminal RFA was repeated because liver (S7) metastasis recurred, and 8 courses of XELOX plus BV therapy were administered. As obstructive jaundice due to recurrence of the liver metastases developed after a 6 months hiatus in chemotherapy, we endoscopically inserted a biliary stent. Despite reducing IRIS plus BV therapy, obstructive jaundice developed again, and 3 intrahepatic biliary stents were inserted with percutaneous transhepatic biliary drainage. To date, the patient has been alive for 4 years since the initial resection of the primary lesion after undergoing consecutive systemic chemotherapy with different regimens. Some studies have shown that in cases of obstructive jaundice caused by advanced gastrointestinal cancer, longer survival could be expected by reducing the severity of jaundice, suggesting that resuming chemotherapy as well as improving the severity of jaundice could contribute to better outcomes. The patient in the present case was successfully treated twice with biliary drainage for occlusive jaundice and chemotherapy, suggesting that a combination of multidisciplinary therapy and adequate local therapy such as biliary drainage could be important for the treatment of metastatic liver cancer. PMID:26805157

  8. 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)

  9. 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.

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

    International Nuclear Information System (INIS)

    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

  11. 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

  12. 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...

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

    Directory of Open Access Journals (Sweden)

    Nikolaos Chatzis

    2013-01-01

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

  14. 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.

  15. 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

  16. 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 ...

  17. 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.

  18. 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.

  19. 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.

  20. 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...

  1. 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.

  2. 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 ...

  3. Percutaneous transhepatic removal of biliary stones: Clinical analysis of 16 cases

    International Nuclear Information System (INIS)

    Percutaneous transhepatic biliary drainage (PTBD) is widely used to control cholangitis, sepsis, or jaundice caused by biliary tree obstruction. The PTBD tract can be used in percutaneous biliary stone extraction in pre- or post-operative state when ERCP is failed or operation is contraindicated. We performed 16 cases of percutaneous transhepatic biliary stone removal. Locations of biliary stones are combined intrahepatic and extrahepatic in 8 cases(50%), only extrahepatic in 7 cases (44%), and only intrahepatic in 1 cases(6%). The number of stones was single in 6 cases and multiple in 10 cases. Over all success rate was 81% (13/16), 93% (14/15) in extrahepatic stones and 78% (7/9) in intrahepatic stones. In 5 of 6 caes, complete stone removed was impossible due to marked tortuosity of T-tube tract or peripherally located stones, complete removal of biliary stones was achieved via a new PTBD tract. No significant pre- or post-procedure complication was occurred. Percutaneous removal of biliary stones via PTBD tract is an effective and safe alternative method in difficult cases in the management of biliary tract stones

  4. Percutaneous transhepatic removal of biliary stones: Clinical analysis of 16 cases

    Energy Technology Data Exchange (ETDEWEB)

    Ryeom, Hun Kyu; Sim, Jae In; Park, Auh Whan; Kim, Yong Joo [Kyungpook National University College of Medicine, Taegu (Korea, Republic of); Kim, Hee Jin [Taegu Fatima Hospital, Taegu (Korea, Republic of)

    1993-11-15

    Percutaneous transhepatic biliary drainage (PTBD) is widely used to control cholangitis, sepsis, or jaundice caused by biliary tree obstruction. The PTBD tract can be used in percutaneous biliary stone extraction in pre- or post-operative state when ERCP is failed or operation is contraindicated. We performed 16 cases of percutaneous transhepatic biliary stone removal. Locations of biliary stones are combined intrahepatic and extrahepatic in 8 cases(50%), only extrahepatic in 7 cases (44%), and only intrahepatic in 1 cases(6%). The number of stones was single in 6 cases and multiple in 10 cases. Over all success rate was 81% (13/16), 93% (14/15) in extrahepatic stones and 78% (7/9) in intrahepatic stones. In 5 of 6 caes, complete stone removed was impossible due to marked tortuosity of T-tube tract or peripherally located stones, complete removal of biliary stones was achieved via a new PTBD tract. No significant pre- or post-procedure complication was occurred. Percutaneous removal of biliary stones via PTBD tract is an effective and safe alternative method in difficult cases in the management of biliary tract stones.

  5. 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.

  6. 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

  7. 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.

  8. ADAPT-A Drainage Analysis Planning Tool

    OpenAIRE

    Boelee, Leonore; Kellagher, Richard

    2015-01-01

    HR Wallingford are a partner in the EU funded TRUST project. They are involved in Work package 4.3 Wastewater and stormwater systems, to produce a model and report on a system sustainability analysis and potential for improvements for stormwater systems as Deliverable 4.3.2. This report is deliverable 4.3.2. It details the development of the tool ADAPT (A Drainage Analysis and Planning Tool). The objective of the tool is to evaluate the improvement requirements to a stormwat...

  9. Percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    In the present series of 296 PTBDs in 281 patients, 103 complcations of different degree developed (34.7%). Early complications directly connected to the procedure (32/296=10.8%) and late complications generally due to malfunctioning of the catheter or progression of the disease (71/296=23.9%) are analyzed. Caveats to prevent complications, therapeutic procedures to resolve them, as well as obtained results are reported. On the whole, major complications directly related to the procedure are present in a small percentage and the procedure appear well tolerated also in patients with poor general conditions

  10. Percutaneous Transcatheteral Biliary Biopsy (PTBB)

    OpenAIRE

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

    1989-01-01

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

  11. 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

  12. 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

  13. 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

  14. 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

  15. Biliary endoprosthesis

    International Nuclear Information System (INIS)

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

  16. 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...

  17. 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.

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

    OpenAIRE

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

    1984-01-01

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

  19. 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...

  20. 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...

  1. 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.

  2. 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.

  3. 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.

  4. 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

  5. Biliary tract duplication cyst with gastric heterotopia

    International Nuclear Information System (INIS)

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

  6. Biliary tract duplication cyst with gastric heterotopia

    Energy Technology Data Exchange (ETDEWEB)

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

    1988-05-01

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

  7. Radiological interventions in malignant biliary obstruction.

    Science.gov (United States)

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

    2016-05-28

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

  8. [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

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

    Directory of Open Access Journals (Sweden)

    Dipanjan Panda

    2016-06-01

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

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

    OpenAIRE

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-06-01

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

  12. 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

  13. 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.

  14. 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

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

    OpenAIRE

    Wadhawan, Manav; Kumar, Ajay

    2016-01-01

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

  16. Biliary ascariasis

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

    Fidelman, Nicholas

    2015-12-01

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

  18. Percutaneous drainage of pancreatic pseudocysts : Analysis of 16 cases

    Energy Technology Data Exchange (ETDEWEB)

    Ryeom, Hun Kyu; Kim, Yong Joo [Kyungpook Natioanl University Hospital, Daegu (Korea, Republic of)

    1994-05-15

    We reviewed 13 cases of pancreatic pseudocysts treated by percutaneous catheter drainage to determine the value and effectiveness of the procedure. Sixteen pancreatic pseudocysts(nine infected, seven noninfected) were drained 13 patients. Access routes were determined by images on CT scan and procedures were performed under fluoroscopic guidance. Ultrasonogram was used as a guide for drainage when there were bowel loops near the access routes. Various access routes were used for catheter drainage : transperitoneal (10), retroperitoneal (3), transsplenic (2), transhepatic (1). Percutaneous catheter drainage cured 15 of 16 pancreatic pseudocysts (93.8%). No recurrence was encountered in the clinical follow-up 7 to 69 months (mean 35 months). The mean duration of drainage was 29 days (infected, 24 days ; noninfected, 39 days). Five pseudocysts (31%) were communicated with pancreatic duct. The mean duration of drainage in these cases was 38 days. Spontaneous of the pancreatic pseudocysts to the gasintestinal tract was occurred in 3 pseudocysts. Mean duration of drainage in pseudocysts with fistulas was 19 days. Percutaneous catheter drainage is a safe and effective front-line treatment method in most pancreatic pseudocysts if drainage is done with a adequate follow-up and catheter care.

  19. Percutaneous drainage of pancreatic pseudocysts : Analysis of 16 cases

    International Nuclear Information System (INIS)

    We reviewed 13 cases of pancreatic pseudocysts treated by percutaneous catheter drainage to determine the value and effectiveness of the procedure. Sixteen pancreatic pseudocysts(nine infected, seven noninfected) were drained 13 patients. Access routes were determined by images on CT scan and procedures were performed under fluoroscopic guidance. Ultrasonogram was used as a guide for drainage when there were bowel loops near the access routes. Various access routes were used for catheter drainage : transperitoneal (10), retroperitoneal (3), transsplenic (2), transhepatic (1). Percutaneous catheter drainage cured 15 of 16 pancreatic pseudocysts (93.8%). No recurrence was encountered in the clinical follow-up 7 to 69 months (mean 35 months). The mean duration of drainage was 29 days (infected, 24 days ; noninfected, 39 days). Five pseudocysts (31%) were communicated with pancreatic duct. The mean duration of drainage in these cases was 38 days. Spontaneous of the pancreatic pseudocysts to the gasintestinal tract was occurred in 3 pseudocysts. Mean duration of drainage in pseudocysts with fistulas was 19 days. Percutaneous catheter drainage is a safe and effective front-line treatment method in most pancreatic pseudocysts if drainage is done with a adequate follow-up and catheter care

  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. Biliary ascariasis

    Energy Technology Data Exchange (ETDEWEB)

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

    1986-06-01

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

  3. 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

  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. 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.

  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. 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

  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. Percutaneous transhepatic biliary endoprostheses

    International Nuclear Information System (INIS)

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

  12. Percutaneous transhepatic biliary endoprostheses

    Energy Technology Data Exchange (ETDEWEB)

    Lammer, J.

    1985-03-01

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

  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 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.

  15. 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)

  16. Percutaneous transhepatic biliary biopsy using gastrofiberscopic biopsy forceps.

    OpenAIRE

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

    1992-01-01

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

  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. Management of Biliary Complications in the Liver Transplant Patient

    OpenAIRE

    James W. Ostroff

    2010-01-01

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

  19. Interventional radiology of the biliary system and pancreas

    Energy Technology Data Exchange (ETDEWEB)

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

    1984-02-01

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

  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. Influence of DEM resolution on drainage network extraction: A multifractal analysis

    Science.gov (United States)

    Ariza-Villaverde, A. B.; Jiménez-Hornero, F. J.; Gutiérrez de Ravé, E.

    2015-07-01

    Different hydrological algorithms have been developed to automatically extract drainage networks from digital elevation models (DEMs). D8 is the most widely used algorithm to delineate drainage networks and catchments from a DEM. This algorithm has certain advantages such as simplicity, the provision of a reasonable representation for convergent flow conditions and consistency among flow patterns, calculated contributing areas and the spatial representation of subcatchments. However, it has limitations in selecting suitable flow accumulation threshold values to determine the pixels that belong to drainage networks. Although the effects of DEM resolution on some terrain attributes, stream characterisation and watershed delineation have been studied, analyses of the influence of DEM resolution on flow accumulation threshold values have been limited. Recently, multifractal analyses have been successfully used to find appropriate flow accumulation threshold values. The application of this type of analysis to evaluate the relationship between DEM resolution and flow accumulation threshold value needs to be explored. Therefore, this study tested three DEM resolutions for four drainage basins with different levels of drainage network distribution by comparing the Rényi spectra of the drainage networks that were obtained with the D8 algorithm against those determined by photogrammetric restitution. According to the results, DEM resolution influences the selected flow accumulation threshold value and the simulated network morphology. The suitable flow accumulation threshold value increases as the DEM resolution increases and shows greater variability for basins with lower drainage densities. The links between DEM resolution and terrain attributes were also examined.

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

    OpenAIRE

    1995-01-01

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

  3. 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

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

    Science.gov (United States)

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

    2015-10-01

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

  5. 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...

  6. 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

  7. 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.)

  8. 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.)

  9. Risk analysis of ischemic-type biliary lesions after liver transplant using octogenarian donors.

    Science.gov (United States)

    Ghinolfi, Davide; De Simone, Paolo; Lai, Quirino; Pezzati, Daniele; Coletti, Laura; Balzano, Emanuele; Arenga, Giuseppe; Carrai, Paola; Grande, Gennaro; Pollina, Luca; Campani, Daniela; Biancofiore, Gianni; Filipponi, Franco

    2016-05-01

    The use of octogenarian donors to increase the donor pool in liver transplantation (LT) is controversial because advanced donor age is associated with a higher risk of ischemic-type biliary lesions (ITBL). The aim of this study was to investigate retrospectively the role of a number of different pre-LT risk factors for ITBL in a selected population of recipients of octogenarian donor grafts. Between January 2003 and December 2013, 123 patients underwent transplantation at our institution with deceased donor grafts from donors of age ≥80 years. Patients were divided into 2 groups based on the presence of ITBL in the posttransplant course. Exclusion criteria were retransplantations, presence of vascular complications, and no availability of procurement liver biopsy. A total of 88 primary LTs were included, 73 (83.0%) with no posttransplant ITBLs and 15 (17.0%) with ITBLs. The median follow-up after LT was 2.1 years (range, 0.7-5.4 years). At multivariate analysis, donor hemodynamic instability (hazard ratio [HR], 7.6; P = 0.005), donor diabetes mellitus (HR, 9.5; P = 0.009), and donor age-Model for End-Stage Liver Disease (HR, 1.0; P = 0.04) were risk factors for ITBL. Transplantation of liver grafts from donors of age ≥80 years is associated with a higher risk for ITBL. However, favorable results can be achieved with accurate donor selection. Donor hemodynamic instability, a donor history of diabetes mellitus, and allocation to higher Model for End-Stage Liver Disease score recipient all increase the risk of ITBL and are associated with worse graft survival when octogenarian donors are used. Liver Transplantation 22 588-598 2016 AASLD. PMID:26784011

  10. 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

  11. 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

  12. International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways.

    Science.gov (United States)

    Cordell, Heather J; Han, Younghun; Mells, George F; Li, Yafang; Hirschfield, Gideon M; Greene, Casey S; Xie, Gang; Juran, Brian D; Zhu, Dakai; Qian, David C; Floyd, James A B; Morley, Katherine I; Prati, Daniele; Lleo, Ana; Cusi, Daniele; Gershwin, M Eric; Anderson, Carl A; Lazaridis, Konstantinos N; Invernizzi, Pietro; Seldin, Michael F; Sandford, Richard N; Amos, Christopher I; Siminovitch, Katherine A

    2015-01-01

    Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4,261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombined<5 × 10(-8)) and used pathway analysis to identify JAK-STAT/IL12/IL27 signalling and cytokine-cytokine pathways, for which relevant therapies exist. PMID:26394269

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

    Science.gov (United States)

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

    2014-01-01

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

  14. Biliary ascariasis

    OpenAIRE

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

    2007-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-03-01

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

  16. 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

  17. 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

  18. 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.

  19. 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

  20. Radiologic diagnosis and treatment of biliary complications after hepatic transplantation in children

    International Nuclear Information System (INIS)

    The authors reviewed biliary complications that occurred in 20 of 58 pediatric hepatic transplant recipients, to assess the role of radiologic procedures in their diagnosis and treatment. Twelve transhepatic cholangiograms, 26 transheptic drainages, 11 balloon dilations, and one basketing procedures were done. Biliary obstruction occurred in 16 children and was most common with cholecystojejunostomies and choledochojejunostomies. Biliary leaks were identified in eight patients, four of whom also had obstruction. Three patients with bilomas underwent percutaneous catheter drainage. Biliary complications occur in approximately one-third of pediatric liver transplant recipients; aggressive radiologic techniques can be used in the diagnosis and treatment of these problems

  1. 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

  2. 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

  3. 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

  4. A GIS-based approach in drainage morphometric analysis of Kanhar River Basin, India

    Science.gov (United States)

    Rai, Praveen Kumar; Mohan, Kshitij; Mishra, Sameer; Ahmad, Aariz; Mishra, Varun Narayan

    2014-11-01

    The study indicates that analysis of morphometric parameters with the help of geographic information system (GIS) would prove a viable method of characterizing the hydrological response behaviour of the watershed. It is also well observed that remote sensing satellite data is emerging as the most effective, time saving and accurate technique for morphometric analysis of a basin. This technique is found relevant for the extraction of river basin and its stream networks through ASTER (DEM) in conjunction with remote sensing satellite data (Landsat etm+, 2013 and georeferenced survey of Indian toposheet, 1972). In this study, Kanhar basin a tributaries of Son River has been selected for detailed morphometric analysis. Seven sub-watersheds are also delineated within this basin to calculate the selected morphometric parameters. Morphometric parameters viz; stream order, stream length, bifurcation ratio, drainage density, stream frequency, form factor, circulatory ratio, etc., are calculated. The drainage area of the basin is 5,654 km2 and shows sub-dendritic to dendritic drainage pattern. The stream order of the basin is mainly controlled by physiographic and lithological conditions of the area. The study area is designated as seventh-order basin with the drainage density value being as 1.72 km/km2. The increase in stream length ratio from lower to higher order shows that the study area has reached a mature geomorphic stage.

  5. 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.

  6. 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)

  7. Eclectic use of cholecystostomy in biliary tract procedures

    International Nuclear Information System (INIS)

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

  8. Cholecystobronchocolic Fistula: A Late Complication of Biliary Sepsis

    OpenAIRE

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

    1994-01-01

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

  9. 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.

  10. 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.

  11. 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

  12. Local drainage analysis of the Paducah and Portsmouth Gaseous Diffusion Plants during an extreme storm

    International Nuclear Information System (INIS)

    Local drainage analysis has been performed for the Paducah and Portsmouth Gaseous Diffusion Plants during an extreme storm having an approximate 10,000-yr recurrence interval. This review discusses the methods utilized to accomplish the analysis in accordance with U.S. Department of Energy (DOE) design and evaluation guidelines, and summarizes trends, results, generalizations, and uncertainties applicable to other DOE facilities. Results indicate that some culverts may be undersized, and that the storm sewer system cannot drain the influx of precipitation from the base of buildings. Roofs have not been designed to sustain ponding when the primary drainage system is clogged. Some underground tunnels, building entrances, and ground level air intakes may require waterproofing

  13. 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...

  14. 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

  15. 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

  16. 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

    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...... 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....

  17. 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)

  18. 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. PMID:26438008

  19. 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.

  20. 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...

  1. 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...

  2. Malignant biliary obstruction

    International Nuclear Information System (INIS)

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

  3. 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

  4. Ursodeoxycholic acid for primary biliary cirrhosis

    DEFF Research Database (Denmark)

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

    2008-01-01

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

  5. 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)

  6. 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.

  7. Comparative Analysis of the outflow water quality of two sustainable drainage systems

    OpenAIRE

    Andrés Valeri, Valero Carlos Alessio; Castro Fresno, Daniel; Sañudo Fontaneda, Luis Ángel; Rodríguez Hernández, Jorge

    2014-01-01

    Three different drainage systems were built in a roadside car park located on the outskirts of Oviedo (Spain); two Sustainable Urban Drainage Systems (SUDS), a swale and a filter drain, and one conventional drainage system, a concrete ditch, which is representative of the most frequently used roadside drainage system in Spain. The concentrations of pollutants were analyzed in the outflow of all three systems in order to compare their capacity to improve water quality. Physicochemical water qu...

  8. 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.

  9. 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.

  10. Biliary leaks after laparoscopic cholecystectomy:timetostentortimetodrain

    Institute of Scientific and Technical Information of China (English)

    Haim Pinkas; Patrick G. Brady

    2008-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-04-15

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

  12. 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.

  13. 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...... Pollution Control Committee has issued a statement recommending a new engineering practice. The dissemination of the research results proved to be difficult due to lack of understanding of the concepts of the new paradigm by practitioners. The traditional means of communication was supplemented by user...

  14. [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

  15. 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.

  16. 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

  17. A simple model analysis of terrestrial radioactivity balance in a drainage basin in Central Japan

    International Nuclear Information System (INIS)

    In-situ measurements of terrestrial gamma-ray dose rates were carried out at 252 locations for soil samples and 47 locations for rock outcrops in the Shonai River drainage region to understand the transport of soil mass and terrestrial radioactivity. The basin was divided into two parts, a bedrock and a sediment (diluvium and alluvium) for compartment analysis. A set of balance equations for soil mass and radioactivity was derived for each region to obtain the transport rate of soils from bedrock to sediment region, the removal rates from land to ocean through rivers and the leaching rates of radioactivity. The relative values of the above parameters to the production rate of soil from bedrock could be estimated from the observed gamma-ray dose rates. (author). 7 refs., 2 figs., 5 tabs

  18. A simple model analysis of terrestrial radioactivity balance in a drainage basin in Central Japan

    International Nuclear Information System (INIS)

    In-situ measurements of terrestrial gamma-ray dose rates were carried out at 252 locations for soil samples and 47 locations for rock outcrops in the Shonai River drainage region to understand the transport of soil mass and terrestrial radioactivity. The basin was divided into two parts, a bedrock and a sediment (diluvium and alluvium), for compartment analysis. A set of balance equations for soil mass and radioactivity was derived for each region to obtain the transport rate of soils from bedrock to sediment region, the removal rates from land to ocean through rivers and the leaching rates of radioactivity. The relative values of the above parameters to the production rate of soil from bedrock could be estimated from the observed gamma-ray dose rates

  19. Button self-retaining drainage catheter

    International Nuclear Information System (INIS)

    To help improve patient acceptance of long-term internal/external catheter access to the biliary tract in those with benign biliary obstruction, a simple design allows the catheter end to remain flush with the skin. It consists of a clothes button affixed to the drainage catheter with a wood screw after the catheter has been cut off at the skin exit. This button/screw device has been used successfully in 22 patients over the last 10 years; catheter exchanges were easily accomplished

  20. 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.

  1. 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

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

    Science.gov (United States)

    Wadhawan, Manav; Kumar, Ajay

    2016-04-01

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

  3. 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

    Pollution Control Committee has issued a statement recommending a new engineering practice. The dissemination of the research results proved to be difficult due to lack of understanding of the concepts of the new paradigm by practitioners. The traditional means of communication was supplemented by user...... 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...

  4. Comparative analysis of the outflow water quality of two sustainable linear drainage systems.

    Science.gov (United States)

    Andrés-Valeri, V C; Castro-Fresno, D; Sañudo-Fontaneda, L A; Rodriguez-Hernandez, J

    2014-01-01

    Three different drainage systems were built in a roadside car park located on the outskirts of Oviedo (Spain): two sustainable urban drainage systems (SUDS), a swale and a filter drain; and one conventional drainage system, a concrete ditch, which is representative of the most frequently used roadside drainage system in Spain. The concentrations of pollutants were analyzed in the outflow of all three systems in order to compare their capacity to improve water quality. Physicochemical water quality parameters such as dissolved oxygen, total suspended solids, pH, electrical conductivity, turbidity and total petroleum hydrocarbons were monitored and analyzed for 25 months. Results are presented in detail showing significantly smaller amounts of outflow pollutants in SUDS than in conventional drainage systems, especially in the filter drain which provided the best performance. PMID:25353938

  5. Leakage tests reduce the frequency of biliary fistulas following hydatid liver cyst surgery

    Science.gov (United States)

    Kayaalp, Cuneyt; Aydin, Cemalettin; Olmez, Aydemir; Isik, Sevil; Yilmaz, Sezai

    2011-01-01

    BACKGROUND AND AIM: Biliary fistulas are the most common morbidity (8.2-26%) following hydatid liver surgery. The aim of our study was to reduce the incidence of postoperative biliary fistulas after the suturing of cystobiliary communications by applying a bile leakage test. PATIENTS AND METHODS: A total of 133 hydatid liver cysts from 93 patients were divided into two groups, according to whether the test was performed. Tests were performed on 56 cysts from 34 patients, and the remaining 77 cysts from 59 patients were treated without the test. In both groups, all visible biliary orifices in the cysts were suture ligated, and drains were placed in all cysts. The visibility of the biliary orifices and postoperative biliary drainage through the drains were recorded. Patients in both groups were also compared with respect to the number of days living with the drains, the length of the hospital stay, and secondary interventions related to biliary complications. RESULTS: Biliary orifices were more visible in the tested cysts (13% vs. 48%; P <0.001). Fewer biliary complications occurred in the tested patients (8.8% vs. 27.7%, P = 0.033). The mean drain removal time (4.1±3.3 days vs. 6.8±8.9 days, P<0.05) and the length of the hospital stay (6.7±2.7 days vs. 9.7±6.3 days, P<0.01) were shorter for the tested patients. None of the patients in the test group required postoperative Endoscopic retrograde cholangiopancreaticography (ERCP) or nasobiliary drainage (0.0% vs. 8.4%, P  =  0.09). There were no long-term biliary complications for either group after three years of follow-up. CONCLUSIONS: Identification of biliary orifices with a bile leakage test and the suturing of cystobiliary communications significantly reduced postoperative biliary complications following hydatid liver surgery. PMID:21552666

  6. Leakage tests reduce the frequency of biliary fistulas following hydatid liver cyst surgery

    Directory of Open Access Journals (Sweden)

    Cuneyt Kayaalp

    2011-01-01

    Full Text Available BACKGROUND AND AIM: Biliary fistulas are the most common morbidity (8.2-26% following hydatid liver surgery. The aim of our study was to reduce the incidence of postoperative biliary fistulas after the suturing of cystobiliary communications by applying a bile leakage test. PATIENTS AND METHODS: A total of 133 hydatid liver cysts from 93 patients were divided into two groups, according to whether the test was performed. Tests were performed on 56 cysts from 34 patients, and the remaining 77 cysts from 59 patients were treated without the test. In both groups, all visible biliary orifices in the cysts were suture ligated, and drains were placed in all cysts. The visibility of the biliary orifices and postoperative biliary drainage through the drains were recorded. Patients in both groups were also compared with respect to the number of days living with the drains, the length of the hospital stay, and secondary interventions related to biliary complications. RESULTS: Biliary orifices were more visible in the tested cysts (13% vs. 48%; P <0.001. Fewer biliary complications occurred in the tested patients (8.8% vs. 27.7%, P = 0.033. The mean drain removal time (4.1±3.3 days vs. 6.8±8.9 days, P<0.05 and the length of the hospital stay (6.7±2.7 days vs. 9.7±6.3 days, P,0.01 were shorter for the tested patients. None of the patients in the test group required postoperative Endoscopic retrograde cholangiopancreaticography (ERCP or nasobiliary drainage (0.0% vs. 8.4%, P = 0.09. There were no long-term biliary complications for either group after three years of follow-up. CONCLUSIONS: Identification of biliary orifices with a bile leakage test and the suturing of cystobiliary communications significantly reduced postoperative biliary complications following hydatid liver surgery.

  7. Vascular complications in biliary atresia patients undergoing living donor liver transplantation: Analysis of 110 patients over 10 years

    Science.gov (United States)

    Vasavada, Bhavin; Chen, Chao Long

    2015-01-01

    Introduction: Vascular complications are very common in pediatric living donor liver transplants. We present our experience in vascular complications in biliary atresia patients undergoing liver transplantation. Materials and Methods: All the patients who have undergone living donor liver transplant for biliary atresia from January 2003 to March 2013 were retrospectively analyzed. P value managed with redo hepatic artery anastomosis and one patient managed with radial artery interposition graft. Five patients developed portal vein stenosis and were managed by portal vein stenting. Five patients developed portal vein thrombosis and portal vein thrombectomy and re-anastomosis were done. One patient developed stenosis at the site of venous anastomosis and was managed by stenting. One patient developed both hepatic artery thrombosis and portal vein thrombosis and eventually succumbed to these complications. Out of five cases who died in this study, two had vascular complications. Graft/recipient weight ratio (GRWR) greater than 2.5 was significantly associated with vascular complications (P = 0.017). Conclusion: Vascular complications are frequently seen in liver transplantation for biliary atresia. Large for size grafts, weight less than 10 kg, age less than 1 year, and prolonged warm ischemia time is significantly associated with vascular complications. PMID:26166981

  8. 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

  9. 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

  10. 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

  11. 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

  12. The role of interventional radiology in biliary complications after orthotopic liver transplantation: a single-center experience

    International Nuclear Information System (INIS)

    This study evaluated interventional radiological experience in the management of biliary complications of OLT at the National Cancer Institute of Milan. Seventeen patients who had undergone orthotopic liver transplantation in various hospital were referred to our unit with biliary complications. Group I consisted of 8 patients with anastomotic biliary fistula who came to our attention a short time after transplantation. Group II consisted of 9 patients with anastomotic strictures who came to our attention in a longer period. Two different interventional radiological approaches were used: (a) percutaneous transhepatic biliary drainage (PTBD) in the presence of fistulas in patients of group I; and (b) percutaneous transhepatic biliary drainage combined with dilatation of the strictures with a balloon catheter in patients of group II. On the whole resolution of the biliary complications was achieved in 13 of the 17 cases treated (76.5%), 5 of 8 in group I and 8 of 9 in group II. No secondary stenosis after PTBD were observed in group I, whereas two patients of group II needed a second dilatation. Percutaneous biliary drainage is indicated as a valid treatment in the management of biliary complications, either to allow closure of the fistula either to perform balloon dilatation of stenosis. (orig.)

  13. The role of interventional radiology in biliary complications after orthotopic liver transplantation: a single-center experience

    Energy Technology Data Exchange (ETDEWEB)

    Civelli, Enrico Maria; Cozzi, Guido; Milella, Marco; Suman, Laura; Severini, Aldo [Dipartimento di Immagini per Diagnosi e Terapia, Istituto Nazionale dei Tumori Milano, Via Venezian 1, 20133, Milan (Italy); Meroni, Roberta; Vercelli, Ruggero [Universita degli Studi di Milano, Milan (Italy)

    2004-04-01

    This study evaluated interventional radiological experience in the management of biliary complications of OLT at the National Cancer Institute of Milan. Seventeen patients who had undergone orthotopic liver transplantation in various hospital were referred to our unit with biliary complications. Group I consisted of 8 patients with anastomotic biliary fistula who came to our attention a short time after transplantation. Group II consisted of 9 patients with anastomotic strictures who came to our attention in a longer period. Two different interventional radiological approaches were used: (a) percutaneous transhepatic biliary drainage (PTBD) in the presence of fistulas in patients of group I; and (b) percutaneous transhepatic biliary drainage combined with dilatation of the strictures with a balloon catheter in patients of group II. On the whole resolution of the biliary complications was achieved in 13 of the 17 cases treated (76.5%), 5 of 8 in group I and 8 of 9 in group II. No secondary stenosis after PTBD were observed in group I, whereas two patients of group II needed a second dilatation. Percutaneous biliary drainage is indicated as a valid treatment in the management of biliary complications, either to allow closure of the fistula either to perform balloon dilatation of stenosis. (orig.)

  14. 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.

  15. Our experience of biliary ascariasis in children

    Directory of Open Access Journals (Sweden)

    Wani M

    2006-01-01

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

  16. 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...

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

    OpenAIRE

    Yoshida, Hiroshi; Mamada, Yasuhiro; Taniai, Nobuhiko; Mineta, Sho; Mizuguchi, Yoshiaki; Kawano, Yoichi; SASAKI, JUNPEI; Nakamura, Yoshiharu; Aimoto, Takayuki; Tajiri, Takashi

    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 dr...

  18. Decreased biliary excretion of piperacillin after percutaneous relief of extrahepatic obstructive jaundice.

    OpenAIRE

    Blenkharn, J I; Habib, N; Mok, D; John, L; McPherson, G. A.; Gibson, R. N.; Blumgart, L. H.; Benjamin, I. S.

    1985-01-01

    The biliary excretion of piperacillin has been assessed in 11 patients with obstructive jaundice due to hilar cholangiocarcinoma. After a 1-g intravenous dose administered 30 min before preliminary percutaneous transhepatic cholangiography, no drug was detected in the bile of seven patients; in four others, drug concentrations were far below the corresponding level in serum. After a period of external biliary drainage of up to 28 days, levels of antibiotic in bile after intravenous administra...

  19. 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)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-07-01

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

  1. Bezafibrate for primary biliary cirrhosis

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  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. 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

  4. Malignant biliary obstruction: From palliation to treatment.

    Science.gov (United States)

    Boulay, Brian R; Birg, Aleksandr

    2016-06-15

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

  5. A severe case of hemobilia and biliary fistula following an open urgent cholecystectomy

    Directory of Open Access Journals (Sweden)

    Del monaco Pamela

    2009-11-01

    Full Text Available Abstract Background Cholecystectomy has been the treatment of choice for symptomatic gallstones, but remains the greatest source of post-operative biliary injuries. Laparoscopic approach has been recently preferred because of short hospitalisation and low morbidity but has an higher incidence of biliary leakages and bile duct injuries than open one due to a technical error or misinterpretation of the anatomy. Even open cholecystectomy presents a small number of complications especially if it was performed in urgency. Hemobilia is one of the most common cause of upper gastrointestinal bleeding from the biliary ducts into the gastrointestinal tract due to trauma, advent of invasive procedures such as percutaneous liver biopsy, transhepatic cholangiography, and biliary drainage. Methods We report here a case of massive hemobilia in a 60-year-old man who underwent an urgent open cholecystectomy and a subsequent placement of a transhepatic biliary drainage. Conclusion The management of these complications enclose endoscopic, percutaneous and surgical therapies. After a diagnosis of biliary fistula, it's most important to assess the adequacy of bile drainage to determine a controlled fistula and to avoid bile collection and peritonitis. Transarterial embolization is the first line of intervention to stop hemobilia while surgical intervention should be considered if embolization fails or is contraindicated.

  6. 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.

  7. 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

  8. New device for dilatation of percutaneous biliary tract

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Sung-Gwon; Lim, Myung-Gwan; Cho, Young-Kook; Suh, Chang-Hae [Inha Univ. Hospital, Inchon (Korea, Republic of); Yoon, Hyun Ki; Song, Ho-Young; Sung, Kyu Bo [Asan Medical Center, Ulsan Univ. College of Medicine, Ulsan (Korea, Republic of); Shin, Joo-Won [Ulgi Hospital, Seoul (Korea, Republic of)

    1997-06-01

    To evaluate the usefulness of percutaneous transhepatic biliary drainage (PTBD) tract dilatation using a Nipro set. We dilated 28 percutaneous biliary drainage tracts up to 18F; 26 procedures involved PTBD, and two, cholecystostomy. A Nipro set was used for dilatation, the purposes of which were stone removal (n=18) and choledochoscopic biopsy (n=10). For dilatation, local anesthesia was used in all cases. In all patients, tract dilatation was successful. In 21 of 28 cases, dilatation of the right PTBD tract was involved, and in five of 28, dilatation of the left tract. In two cases, tract dilatation was done in cholecystostomy tracts. Complications encountered were pain (n=17), bradycardia (n=2), hemobilia (n=2), bleeding (n=1), and fever (n=1). In choledocoscopy, tract dilatation using a Nipro set is safe and simple.

  9. 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.

  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. 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

  12. Biliopleural fistula: A rare complication of percutaneous transhepatic gallbladder drainage

    OpenAIRE

    Lee, Ming-Tsung; Hsi, Sheng-Chuan; Hu, Philip; Liu, Kuang-Yi

    2007-01-01

    A 79-year-old previously healthy man presented with acute acalculous cholecystitis with obstruction of the biliary tract. He was successfully treated with antibiotics and percutaneous transhepatic gallbladder drainage, but returned to the hospital two days after discharge with a rare complication of this technique, biliopleural fistula. A thoracostomy tube was inserted to drain the pleural effusion, and the patient’s previous antibiotics reinstated. After two weeks of drainage and antibiotics...

  13. Transhepatic cholangiography in the jaundiced patient. Extracorporeal drainage and endoprosthesis

    Energy Technology Data Exchange (ETDEWEB)

    Olbert, F.; Schlegl, A.; Muzika, N. (Krankenhaus der Stadt Wien-Lainz (Austria). 1. Chirurgische Abt.)

    1984-01-01

    Percutaneous transhepatic cholangiographpy, as well as the therapeutic possibility of extracorporeal biliary tract drainage and insertion of an endoprosthesis are discussed in this paper. The results are presented of 19 patients treated by extracorporeal drainage and of 12 patients treated by insertion of an endoprosthesis, with a successful outcome in each group. The clinical parameters, the reduction in bilirubin values after treatment and improvement in the patient's condition and general well-being are discussed.

  14. Palliative percutaneous transhepatic drainage for inoperable obstructive jaundice.

    OpenAIRE

    Baxter-Smith, D. C.; Temple, J G; Howarth, F.

    1982-01-01

    A technique of percutaneous transhepatic drainage under local anaesthesia is described for the relief of intractable pruritus in patients with obstructive jaundice due to inoperable carcinoma. After standard percutaneous transhepatic cholangiography a polyethylene catheter is introduced into one of the large dilated bile ducts and left in situ, thereby establishing external retrograde biliary drainage. The technique has been used successfully in 6 cases with reduction in serum bilirubin level...

  15. Analysis of a Municipal Landfill Drainage Layer Using Tyre Shreds and Rubble

    Directory of Open Access Journals (Sweden)

    Kristina Bazienė

    2012-12-01

    Full Text Available Municipal waste landfill leachate is formed at different stages of landfill operation and has a negative impact on a natural environment. According to the recently implemented waste management policy, landfill leachate in modern solid waste disposal sites has been monitored. Due to a complex composition of components for filtrate, over a long period of time, the processes of commutation in a drainable layer have been taking place, thereby reducing the porosity and permeability of the layer. Calcium, silicon and iron compounds are the main elements influencing a decrease in conductivity. Filtrate has formed in landfills and waste water and involved the process of precipitation percolating through waste. For 3 months, studies on two different drainage layers of filtration have been carried out. The obtained results have showed that for forming the landfill leachate drainage layer, a drainage rubble layer of 40% mixed with counter rubber waste can be successfully used.

  16. Role of hepatobiliary scintigraphy in biliary ascariasis

    International Nuclear Information System (INIS)

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

  17. Percutaneous drainage of abdominal abcess

    Energy Technology Data Exchange (ETDEWEB)

    Men, Sueleyman E-mail: suleyman.men@deu.edu.tr; Akhan, Okan; Koeroglu, Mert

    2002-09-01

    The mortality in undrained abdominal abscesses is high with a mortality rate ranging between 45 and 100%. The outcome in abdominal abscesses, however, has improved due to advances in image guided percutaneous interventional techniques. The main indications for the catheter drainage include treatment or palliation of sepsis associated with an infected fluid collection, and alleviation of the symptoms that may be caused by fluid collections by virtue of their size, like pancreatic pseudocele or lymphocele. The single liver abscesses may be drained with ultrasound guidance only, whereas the multiple abscesses usually require computed tomography (CT) guidance and placement of multiple catheters. The pancreatic abscesses are generally drained routinely and urgently. Non-infected pancreatic pseudocysts may be simply observed unless they are symptomatic or cause problems such as pain or obstruction of the biliary or the gastrointestinal tract. Percutaneous routes that have been described to drain pelvic abscesses include transrectal or transvaginal approach with sonographic guidance, a transgluteal, paracoccygeal-infragluteal, or perineal approach through the greater sciatic foramen with CT guidance. Both the renal and the perirenal abscesses are amenable to percutaneous drainage. Percutaneous drainage provides an effective and safe alternative to more invasive surgical drainage in most patients with psoas abscesses as well.

  18. Trace metals of an acid mine drainage stream using a chemical model (WATEQ) and sediment analysis

    International Nuclear Information System (INIS)

    The high metal contents common to the discharge of acid-mine drainage (AMD) from mines and mine spoils is an environmental concern to both government and industry. This paper reports the results of investigation of the behavior of metals in an AMD system at a former surface coal mine in Tuscarawas County, Oh. AMD discharges from seeps travels, in respective order through a laminar flow stream; a Typha-dominated wetland; a turbulent flow stream; and a sediment retention pond. Dissolved metals (Fe, Mn, Zn, Cr, Cd, Cu, and Al) major and minor components, and other parameters (pH, dissolved oxygen and Eh) were measured in the AMD water at each sample location. A chemical mineral equilibrium model (WATEQ) was used to predict the minerals which should precipitate at each site. Results suggest that the seeps are supersaturated and should be precipitating hematite, goethite and magnetite (iron oxides), and siderite (iron carbonate), whereas water of the other downstream sites were at or below equilibrium conditions for these minerals. The hydrogeochemistry of the AMD was further studied using sequential chemical attacks on the precipitate sediment surface coatings, in order to determine metal concentrations in the exchangeable, carbonate, Fe-Mn oxyhydroxide, and oxidizable fractions. The carbonate and exchangeable fractions of the precipitate are dominated by Ca and Fe, as well as Mg in the carbonate fraction. The Fe-Mn oxyhydroxide fraction contained Fe, Al, Mn, Mg, and trace metals, and also contained the greatest concentration of total elements in the system. The Fe-Mn oxyhydroxide is therefore, the major sink for metals of this AMD system. The decrease in the concentration of metals in the sediment precipitates in the downstream locations, is consistent with WATEQ and water analysis results

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

    International Nuclear Information System (INIS)

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

  20. 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)

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

    Science.gov (United States)

    Tian, Yigeng; Xia, Mingfeng; Zhang, Shuai; Fu, Zhen; Wen, Qingbin; Liu, Feng; Xu, Zongzhen; Li, Tao; Tian, Hu

    2016-01-01

    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 spectroscopy identified stent sediment components including bilirubin, cholesterol, bile acid, protein, calcium, and other substances. Conclusion AgNP-coated biliary stents resisted sediment accumulation in this canine model of obstructive jaundice caused by ligation of the CBD.

  2. Acute pancreatitis in obstructive jaundice following combined internal and external percutaneous transhepatic bile duct drainage (PTBD)

    International Nuclear Information System (INIS)

    Percutaneous transhepatic biliary drainage (PTBD) was performed on 85 patients with obstructive jaundice. Four patients developed an acute pancreatitis after internal drainage of which one died. To our knowledge this serious complication has not yet been described in detail. These four cases are, therefore, reported and the possible causes are discussed. (orig.)

  3. 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.

  4. Left hepatic trisectionectomy for hilar cholangiocarcinoma presenting with an aberrant biliary duct of segment 5: a case report

    Directory of Open Access Journals (Sweden)

    Ozawa Fumiaki

    2010-08-01

    Full Text Available Abstract Introduction Management of the biliary ducts during liver resection is one of the most important challenges for hepatobiliary surgeons. Here, we report the case of a left hepatic trisectionectomy for hilar cholangiocarcinoma with a rare aberrant biliary duct of segment 5, which, to the best of our knowledge, has never been reported in previous literature. Case presentation A 56-year-old Asian female initially presented with intrahepatic bile duct dilatation in the left lateral sector, left paramedian sector, and right paramedian sector. Simultaneous cholangiography from a percutaneous transhepatic biliary drainage tube in biliary duct of segment 8 and endoscopic nasobiliary drainage tube in biliary duct of segment 3 revealed drainage of the right lateral sectoral branch into the common hepatic duct and the aberrant drainage of segment 5 into the right lateral sectoral branch. The left hepatic duct, right paramedian sectoral duct, and the confluence of the right lateral sectoral duct were narrowed. Left hepatic trisectionectomy was successfully performed with careful dissection and division of the aberrant biliary duct of segment 5. Conclusion For safe liver resection, it is important to perform a detailed anatomic evaluation of the intrahepatic ducts, both preoperatively and intraoperatively.

  5. Percutaneous Embolization of Transhepatic Tracks for Biliary Intervention

    International Nuclear Information System (INIS)

    Significant pain can occur after removing transhepatic catheters from biliary access tracks, after percutaneous biliary drainage (PBD) or stenting. We undertook a randomized prospective study to ascertain whether track embolization decreases the amount of pain or analgesic requirement after PBD. Fifty consecutive patients (M:F, 22:28; age range:29-85 years; mean age: 66.3 years) undergoing PBD were randomized to receive track embolization or no track embolization after removal of biliary drainage catheters. A combination of Lipoidol and n-butyl cyanoacrylate were used to embolize transhepatic tracks using an 8F dilator. The patients who did not have track embolization performed had biliary drainage catheters removed over a guide wire. A visual analog scoring (VAS) system was used to grade pain associated with catheter removal, 24 h afterward. A required analgesic score (RAS) was devised to tabulate the analgesia required. No analgesia had a score of 0, oral or rectal nonopiate analgesics had a score of 1, oral opiates had a score of 2, and parenteral opiates had a score of 3. The average VAS and RAS for both groups were calculated and compared.Seven patients were excluded for various reasons, leaving 43 patients in the study group. Twenty-one patients comprised the embolization group and 22 patients comprised the nonembolization group. The mean biliary catheter dwell time was not significantly different (p > 0.05) between the embolization group and nonembolization (mean: 5.4 days vs 6.9 days, respectively). In the nonembolization group, the mean VAS was 3.4. Eight patients required parenteral opiates, three patients required oral opiates, and five patients required oral or rectal analgesics, yielding a mean RAS of 1.6. In the embolization group, the mean VAS was 0.9. No patient required parenteral opiates, six patients required oral opiates, and two patients had oral analgesia. The average RAS was 0.6. Both the VAS and the RAS were significantly lower in the

  6. Complementary role of helical CT cholangiography to MR cholangiography in the evaluation of biliary function and kinetics

    Energy Technology Data Exchange (ETDEWEB)

    Eracleous, Eleni; Genagritis, Marios; Kontou, Allayioti Maria [Diagnostic Center of Ayios Therissos, Department of Radiology, Nicosia (Cyprus); Papanikolaou, Nicos; Prassopoullos, P.; Chrysikopoulos, Haris; Gourtsoyiannis, Nicholas [University of Crete, Department of Radiology, Heraklion (Greece); Allan, Paul [Royal Infirmary of Edinburgh, Department of Radiology, Edinburgh (United Kingdom)

    2005-10-01

    To explore the potential role of computed tomographic cholangiography (CTC) in relation to magnetic resonance cholangiography (MRC) in cases in which knowledge of biliary kinetics and functional information are important for therapeutic decisions, 31 patients (14 men and 17 women) underwent MRC followed by CTC. We examined nine post-cholecystectomy cases with right upper quadrant abdominal pain, six cases with a previous biliary-enteric anastomosis and clinical evidence of cholangitis, eight biliary strictures with pain or symptoms of cholangitis, four cases with strong clinical evidence of sclerosing cholangitis, three cases with suspected post-laparoscopic cholecystectomy bile leakage, and one case with chronic pancreatitis and a common bile duct stent associated with cholangitis. In relation to MRC, CTC provided additional biliary functional information as follows: abnormal biliary drainage through the ampulla in 7/9 cholecystectomy cases, impaired drainage in 3/6 biliary-enteric anastomoses, and complete obstruction in 2/8 biliary strictures. CTC diagnosed early sclerosing cholangitis in 4/4 cases and confirmed suspected bile leakage in 1/3 post-laparoscopic cholecystectomy patients, and the patency of the biliary stent in the patient with chronic pancreatitis. Thus, CTC provides clinically important information about the function and kinetics of bile and complements findings obtained by MRC. (orig.)

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

    Science.gov (United States)

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

    2015-09-01

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

  8. 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.

  9. 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 ...

  10. 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

  11. The procedure success rate and medium-term curative effect of percutaneous transhepatic cholangic drainage: a review of 5-year clinical practice

    International Nuclear Information System (INIS)

    Objective: To improve the procedure success rate and the medium-term curative effects of Percutaneous Transhepatic Cholangic Drainage (PTCD). Methods: Four hundred and twenty-eight cases of obstructive.jaundice resulting from various etiologies underwent PTCD, including internal and external catheter drainage in 326 cases, simply external drainage in 49 cases, single stent placement in 29 cases and double-stent placement in 14 cases. A retrospective analysis of the procedure success rate and the medium-term curative effects were made. And the strategy, which ensured the procedure success rate and the medium-term curative effects, was discussed. Results: In 428 cases, success rate in 331 cases of evidently dilated biliary tract was 96.7% (320/331). Success rate in 97 cases of non-dilated biliary tract or segmental dilatation of bile duct was 55.7% (54/97). The observed medium-term curative effects of PTCD were noted as the followings: CR 25.9%, PR 55.8%, and DR 18.5%. Conclusions: PTCD is an important approach to alleviate jaundice. A rational drainage track is essential for the medium-term curative effects. The synthetical curative effects correlate with multiple factors, such as the timing of the interventions and the etiology of obstructive jaundice. Careful pre-operative study of the cases and accurate selection of candidates help to improve the curative effects. (authors)

  12. 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.

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

    International Nuclear Information System (INIS)

    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

  14. 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

  15. 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

  16. Hepatic and Biliary Ascariasis

    OpenAIRE

    Anup K Das

    2014-01-01

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

  17. Choledochorraphy (primary repair) versus t-tube drainage after open choledochotomy

    International Nuclear Information System (INIS)

    Background: T-tube drainage used to be standard practice after surgical choledochotomy, but there is now a tendency in some canters to close the common bile duct primarily. This study was designed to compare the clinical results of primary closure with T-tube drainage after open choledocotomy and assess the safety of primary closure for future application. Methods: This study was conducted at surgical Unit-3, ward 26 Jinnah Postgraduate Medical Centre Karachi, from January 2007 to January 2008. Forty patients were included in this study out of which 20 underwent primary closure and 20 T-tube placements. It was Quasi-experimental, non-probability, purposive sampling. Main outcome measures were operating time, duration of hospital stay, and postoperative complications. SPSS-10 was used for data analysis. Results: The age of patients in the study ranged from 29-83 years. There were 3 male while 37 female patients. Group-1 consisted of 20 patients underwent primary closure after choledocotomy, while Group-2 also consisted of 20 patients underwent T-tube drainage after duct exploration. Mean hospital stay in Group-1 patients was 7.63 days while in group 2 it was 13.6 days. Overall complication rate in group 1 was 15%, biliary leakage in 1 (5%), jaundice in 1 (5%), wound infection in 1 (5%). No re-exploration was required in Group-1. In Group-2 overall complication rate was 30%, biliary leakage in 2 (2%), jaundice in 1 (5%), dislodgement of T-tube in 1 (5%), wound infection in 1 (5%), and sepsis in 1 (5%) patients. Re-exploration was done in one patient. Conclusion: Primary closure of Common Bile Duct (CBD) is a safe and cost-effective alternative procedure to routine T-tube drainage after open choledocotomy. (author)

  18. Endoscopic Nasobiliary Drainage in the Management of Acute Cholangitis: An Experience in 143 Patients

    OpenAIRE

    Goenka, M. K.; Bhasin, D K; Kochhar, R; Nagi, B.; Rungta, U.; Das, K; Singh, K.

    1997-01-01

    Acute cholangitis is associated with a high mortality and morbidity and often requires drainage of the obstructed biliary system. The purpose of this study was to evaluate the usefulness and safety of endoscopic nasobiliary drainage in the treatment and prevention of acute cholangitis due to diverse etiology. During a 32-month period, 143 patients (67 males, 76 females) with age range of 15 to 84 years underwent urgent fluoroscopy guided endoscopic nasobiliary drainage using a 7 Fr catheter e...

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

    OpenAIRE

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

    2013-01-01

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

  20. 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

  1. Drainage-system development in consecutive melt seasons at a polythermal, Arctic glacier, evaluated by flow-recession analysis and linear-reservoir simulation

    OpenAIRE

    Hodgkins, Richard; Cooper, Richard; Tranter, Martyn; Wadham, Jemma

    2013-01-01

    [1] The drainage systems of polythermal glaciers play an important role in high-latitude hydrology, and are determinants of ice flow rate. Flow-recession analysis and linear-reservoir simulation of runoff time series are here used to evaluate seasonal and inter-annual variability in the drainage system of the polythermal Finsterwalderbreen, Svalbard, in 1999 and 2000. Linear-flow recessions are pervasive, with mean coefficients of a fast reservoir varying from 16 (1999) to 41 h (2000), and me...

  2. Biliary interventional radiology in pediatric liver transplant recipients

    International Nuclear Information System (INIS)

    Pediatric liver transplant recipients with postoperative complications may require biliary intervention procedures. The authors have performed 26 procedures on nine livers in seven children (aged 9 months to 8 years). Percutaneous transhepatic cholangiography (PTC) was performed in 13 cases, followed by drainage in eight. In four patients, the drainage catheter was advanced into the Roux-en-Y, achieving internal drainage of two bilomas and dilation of three strictures. Following graft artery occlusion, noninvasive imaging provided insufficient information as to the integrity of the bile ducts. These patients have been followed up with serial PTC, which has shown normal ducts, bile duct necrosis, multiple intrahepatic strictures, and an anastomotic stricture. Nonsurgical management provided an opportunity to observe the long-term follow-up (5,14, and 19 months and 3 years) after graft artery occlusion

  3. The Hemodynamics of the Portal Venous System in Malignant Biliary Obstruction : Doppler US Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Rhim, Hyun Chul; Kim, Youn Soo; Koh, Byung Hee; Cho, On Koo; Seo, Heung Suk; Hahm, Chang Kok; Choi, Ho Soon [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    1996-12-15

    With Doppler ultrasound, we evaluated the hemodynamics of the portal venous systems in malignant biliary obstruction, and the effect of biliary decompression on the portal hemodynamics after percutaneous transhepatic biliary drainage (PTBD). Thirty-four patients with malignant biliary obstruction, 15 normal volunteers, and 20 patients with liver cirrhosis were included. One US specialist measured the portal blood flow using the mean velocity and the diameter of the portal vein. In 24 patients who underwent PTBD, follow-up Doppler US examinations were available until one (n = 24) and two (n = 10) weeks after the procedure. The portal blood flow of normal control, biliary obstruction, and liver cirrhosis group were 734 {+-} 123 ml / min, 622 {+-} 211 ml / min, 578 {+-} 248 ml / min, respectively (p < 0.05). After PTBD, the portal blood flow showed a tendency to increase : 632 {+-} 195 ml / min to 708 {+-} 208 ml / min at 1 week (p > 0.05) : 638 {+-} 183 ml / min to 865 {+-} 279 ml / min at 2 weeks follow-up (p < 0.05). Doppler ultrasound evaluation revealed that the portal blood flow in malignant biliary obstruction had a tendency to decrease than the normal control. The increase of portal flow after PTBD may be understood as one of the factors of hepatic function restoration after biliary decompression

  4. 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

  5. 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

  6. 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...

  7. 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

  8. Methotrexate for primary biliary cirrhosis

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  9. 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....

  10. Azathioprine for primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Gong, Yanzhang; Christensen, E; Gluud, C

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

  11. Biliary scintigraphy in acute pancreatitis

    International Nuclear Information System (INIS)

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

  12. Biliary scintigraphy in acute pancreatitis

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

    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

  14. 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.

  15. 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.

  16. Analysis of properties of synthetic mineral microparticles for retention and drainage system

    Science.gov (United States)

    Lee, Sa Yong

    Over the past 20 years there has been a revolution involving the use of nano- or macro-sized particles as a component of drainage and retention systems during the manufacture of paper. More recently a group of patented technologies called Synthetic Mineral Microparticles (SMM) has been invented and developed. This system has potential to further promote the drainage of water and retention of fine particles during papermaking. Prior research, as well as our own preliminary research showed that the SMM system has advantages in both of drainage and retention, compared with montmorillonite (bentonite), which is one of the most popular materials presently used in this kind of application. In spite of the demonstrated advantages of this SMM system, the properties and activity of SMM particles in the aqueous state have not been elucidated yet. To help understand the molecular mechanisms involved in SMM technology, streaming current and potentiometric titration were employed to characterize the charge behavior of SMM, depending on the synthetic conditions, which included variation of the Al/Si ratio, partial neutralization of Al species, salt addition and shear rate. Surface area of SMM and the distribution of SMM particle size were investigated with scanning electron microscopy in order to elucidate the relationship between the morphology and coagulation behavior of SMM, versus the pre-stated synthetic conditions, as well as to estimate the optimal conditions to produce SMM as a retention and drainage aid for use during papermaking. Through the streaming current titration experiments it was found that pH variation, caused by the change of Al/Si ratio and partial neutralization of aluminum's acidity, profoundly affects the charge properties of SMM. These effects can be attributed to the variation of Al-ion speciation and the influence ionizable groups on the Si-containing particle surfaces. The relationship between Al/Si ratio and isoelectric pH, measured by potentiometric

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

    OpenAIRE

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

    2016-01-01

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

  18. 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)

  19. Runoff analysis by means of multiple isotope tracers in Iwami river drainage, Akita, Japan

    International Nuclear Information System (INIS)

    By means of three isotope tracer techniques, proportion of direct runoff and characters of groundwater runoff were studied in the Iwami River drainage during a high runoff period for about 3 days, caused by a heavy rainfall of 85 mm for 17 hours. The proportion of direct runoff is 15 % or less of the total runoff caused by the rainfall, while 65 % of river water at the peak of runoff. Differences observed in the runoff manners among 18O, 2H, and 3H are interpreted as a result of preferential runoff of previous precipitations stored in some unsaturated zone above the saturated groundwater zone. Cl- content is not conservative as a tracer to study runoff mechanisms. (author)

  20. IATROGENIC BILIARY LESIONS

    Directory of Open Access Journals (Sweden)

    J. M. Schiappa

    2007-10-01

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

  1. 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

  2. Outcome of patients with acute, necrotizing pancreatitis requiring drainage-does drainage size matter?

    Directory of Open Access Journals (Sweden)

    T Bruennler, J Langgartner, S Lang, CE Wrede, F Klebl, S Zierhut, S Siebig, F Mandraka, F Rockmann, B Salzberger, S Feuerbach, J Schoelmerich, OW Hamer

    2008-02-01

    Full Text Available AIM: To assess the outcome of patients with acute necrotizing pancreatitis treated by percutaneous drainage with special focus on the influence of drainage size and number.METHODS: We performed a retrospective analysis of 80 patients with acute pancreatitis requiring percutaneous drainage therapy for infected necroses. Endpoints were mortality and length of hospital stay. The influence of drainage characteristics such as the median drainage size, the largest drainage size per patient and the total drainage plane per patient on patient outcome was evaluated.RESULTS: Total hospital survival was 66%. Thirty-four patients out of all 80 patients (43% survived acute necrotizing pancreatitis with percutaneous drainage therapy only. Eighteen patients out of all 80 patients needed additional percutaneous necrosectomy (23%. Ten out of these patients required surgical necrosectomy in addition, 6 patients received open necrosectomy without prior percutaneous necrosectomy. Elective surgery was performed in 3 patients receiving cholecystectomy and one patient receiving resection of the parathyroid gland. The number of drainages ranged from one to fourteen per patient. The drainage diameter ranged from 8 French catheters to 24 French catheters. The median drainage size as well as the largest drainage size used per patient and the total drainage area used per patient did not show statistically significant influence on mortality.CONCLUSION: Percutaneous drainage therapy is an effective tool for treatment of necrotizing pancreatitis. Large bore drainages did not prove to be more effective in controlling the septic focus.

  3. Outcome of patients with acute, necrotizing pancreatitis requiring drainage-does drainage size matter?

    Science.gov (United States)

    Bruennler, T; Langgartner, J; Lang, S; Wrede, CE; Klebl, F; Zierhut, S; Siebig, S; Mandraka, F; Rockmann, F; Salzberger, B; Feuerbach, S; Schoelmerich, J; Hamer, OW

    2008-01-01

    AIM: To assess the outcome of patients with acute necrotizing pancreatitis treated by percutaneous drainage with special focus on the influence of drainage size and number. METHODS: We performed a retrospective analysis of 80 patients with acute pancreatitis requiring percutaneous drainage therapy for infected necroses. Endpoints were mortality and length of hospital stay. The influence of drainage characteristics such as the median drainage size, the largest drainage size per patient and the total drainage plane per patient on patient outcome was evaluated. RESULTS: Total hospital survival was 66%. Thirty-four patients out of all 80 patients (43%) survived acute necrotizing pancreatitis with percutaneous drainage therapy only. Eighteen patients out of all 80 patients needed additional percutaneous necrosectomy (23%). Ten out of these patients required surgical necrosectomy in addition, 6 patients received open necrosectomy without prior percutaneous necrosectomy. Elective surgery was performed in 3 patients receiving cholecystectomy and one patient receiving resection of the parathyroid gland. The number of drainages ranged from one to fourteen per patient. The drainage diameter ranged from 8 French catheters to 24 French catheters. The median drainage size as well as the largest drainage size used per patient and the total drainage area used per patient did not show statistically significant influence on mortality. CONCLUSION: Percutaneous drainage therapy is an effective tool for treatment of necrotizing pancreatitis. Large bore drainages did not prove to be more effective in controlling the septic focus. PMID:18205262

  4. Obstructive Biliary Tract Disease

    OpenAIRE

    White, Thomas Taylor

    1982-01-01

    The techniques that have come into general use for diagnosing problems of obstructive jaundice, particularly in the past ten years, have been ultrasonography, computerized tomography, radionuclide imaging, transhepatic percutaneous cholangiography using a long thin needle, transhepatic percutaneous drainage for obstructive jaundice due to malignancy, endoscopic retrograde cannulation of the papilla (ERCP), endoscopic sphincterotomy and choledochoscopy. It is helpful to review obstructive jaun...

  5. 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.

  6. 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.

  7. Pre- and post-construction analysis of a wetland used for mine drainage control

    International Nuclear Information System (INIS)

    A 0.39 ha constructed wetland in Athens County, Ohio is being evaluated for its ability to remove contaminants from acidic mine drainage. The wetland receives water flow from Lick run stream which is contaminated by two major abandoned underground mine seeps. The wetland effluent is then directed back into Lick Run, a tributary of the Hocking River. Data were collected 1.5 years prior to construction and 11 months following completion of the passive wetland system. Preconstruction data reported average spring quarter 1991 and 1992 iron concentrations in the stream at the future wetland influent and effluents sites to be 330 and 106 mg/l, while spring quarter 1993 showed iron levels at the wetland influent and effluent to be 64 and 3 mg/l, respectively. Iron removal percentages were 68% prior to the construction of the wetland and 95% following its completion. Preconstruction data were analyzed using a dynamic computer model and preliminary comparison with the first 11 months of the wetland data show the actual iron removal rates to be 4 g/m2 day1 compared to the predicted value of 6.5 g/m2 day1 (based on data collected from April 1991--March 1992, under similar hydrologic conditions)

  8. Primary biliary cirrhosis.

    Science.gov (United States)

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

    2010-10-01

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

  9. 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

  10. Biliary hypoplasia in Williams syndrome

    OpenAIRE

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

    2006-01-01

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

  11. 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.

  12. 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...

  13. 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...

  14. 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

  15. 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.

  16. 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.

  17. Morphometric analysis of the Koros drainage basin (Hungary/Romania) using historical topographic maps

    Science.gov (United States)

    Petrovszki, J.

    2009-04-01

    The Körös River drainage basin is located in the eastern part of the Great Hungarian Plain, west of the Apuseni Mts., in the middle of the Pannonian Basin. The channels of the river and its tributaries are mostly meandering. The channel sinuosity of this river system is analyzed in order to draw conclusions on the neotectonic activity of this area. The meandering rivers can demonstrate changes, which occurred recently, and cannot be seen with other methods. The changing sinuosity indicates the location of the vertical movements of the surface. The sinuosity calculations were made on the natural, uncontrolled riverbeds. These beds were digitized from the maps of the Second Military Survey of the Habsburg Empire, which were measured before or during river control implementation. Digitized features were made on the geo-referred maps, which are in the Hungarian National Grid (EOV) coordinate system. The estimated accuracy of the map sheets to the modern system is 50-100 m, but the accuracy in Hungary remains under 30 m. In the study area, we identified several points of sinuosity change. To prove, that these are of neotectonic origin, seismic sections crossing the study area, were also analyzed. Five fault lines are indicated to be neotectonically active according to the river planform changes. Activity of two of these five faults, and the subsidence in-between them caused the formation of the Nagy-Sárrét marshland. A Romanian river section, characterized by anastomosed planform, instead of meandering, indicates recent activity of another fault.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Rho, Taek Soo; Kim, Yun Hwan; Lee, Chang Hee; Jung, Hoe Seok; Kim, Chul Yong [College of Medicine, Korea University, Seoul (Korea, Republic of)

    1994-12-15

    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.

  4. 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.)

  5. 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

  6. 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 ...

  7. The Radiological Management of Biliary Complications Following Liver Transplantation

    International Nuclear Information System (INIS)

    Purpose: Biliary complications contribute significantly to morbidity and mortality in the liver transplant recipient. Surgery has been the mainstay of therapy, but interventional radiological techniques have made significant progress. Methods: Diagnostic percutaneous transhepatic cholangiography (PTC) was performed in 12 patients; percutaneous transhepatic drainage (PTD) was performed in 10 patients. Additional interventional procedures included laser lithotripsy, biopsy, dilatation, and stent implantation. Results: In 6 patients PTC revealed anastomotic, and in 6 patients nonanastomotic biliary strictures. Four patients had intrahepatic stones. Biliary strictures were treated by implantation of Palmaz stents in 5 of 6 patients with anastomotic strictures, and in 3 of 6 patients with nonanastomotic strictures. The intrahepatic stones were fragmented with dye laser lithotripsy under cholangioscopic control in 3 of 4 patients. One spontaneous stent migration after 24 months and one stent occlusion were observed; the remaining stents are still patent. Patients with anastomotic strictures had a more favorable outcome: 5 of 6 of these patients are still alive and symptom-free after an average of 27.4 months, but only 3 of 6 patients with nonanastomotic strictures are alive after an average of 9.8 months. Conclusion: The different outcomes in patients with anastomotic versus nonanastomotic strictures may be explained by the different causes of these types of stricture

  8. 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)

  9. Percutaneous Transhepatic Biliary Interventions in Benign Diseases of Children

    Directory of Open Access Journals (Sweden)

    Medih Celiktas

    2015-06-01

    Materials and Methods: In this retrospective study, percutaneous biliary interventions were performed in fifteen children with a mean age of 10.2 years (range 14 days-14 years. Patients presented with jaundice (n=5 and/or cholangitis (n=10. Percutaneous transhepatic biliary drainage (PTBD performed in 10 patients, PTBD plus balloon dilation in 3, percutaneous cholecystostomy (PC in 1, PTBD following PC in 1. Results: All procedures were technically successful. No procedure-related mortality occurred in patients. Serum bilirubin levels returned to normal or near normal in ten of twelve cases. Preexisting cholangitis and acute cholecystitis resolved in all patients. Six patients underwent surgery following percutaneous management. Nine patients cured primarily with percutaneous interventions with no further treatment. Conclusion: Percutaneous biliary interventions can be performed effectively in benign diseases of children. It can be performed either as a primary treatment modality or as a bridge prior to surgery. In most of cases, percutaneous treatment is sufficient and unnecessary surgery is prevented. [Cukurova Med J 2015; 40(2.000: 298-305

  10. Scintigraphy with 99mTc-HIDA in assessment of the postoperative course after traumatic lesions of the liver and biliary tract

    DEFF Research Database (Denmark)

    Rasmussen, L; Oster-Jörgensen, E; Hovendal, C P;

    1990-01-01

    99mTc-HIDA scintigraphy was used as a diagnostic procedure in five children with liver and biliary tract injuries following blunt abdominal trauma. The method was used in patients after surgical intervention. The children fell into three groups. The first, focal reduction in activity with or......-tube drainage. This method is also recommended preoperatively in children who are clinically stable and in whom trauma to the liver and biliary tract is suspected....

  11. 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.

  12. 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.

  13. 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 ...

  14. Polyurethane-Covered Nitinol Strecker Stents as Primary Palliative Treatment of Malignant Biliary Obstruction

    International Nuclear Information System (INIS)

    Purpose: To evaluate the clinical efficacy of the polyurethane-covered Nitinol Strecker stent in the treatment of patients with malignant biliary obstruction.Methods: Twenty-three covered stents produced by us were placed in 18 patients with malignant biliary obstruction. Jaundice was caused by cholangiocarcinoma (n = 5), pancreatic cancer (n = 6), gallbladder cancer (n = 4), metastatic lymph nodes (n = 2), and tumor of the papilla (n 1).Results: The mean patency period of the stents was 37.5 weeks (5-106 weeks). Recurrent obstructive jaundice occurred in two patients (11%). Adequate biliary drainage over 50 weeks or until death was achieved in 17 of 18 patients (94.4%). Late cholangitis was observed in two patients whose stents bridged the ampulla of Vater. Other late severe complications were not encountered.Conclusion: Although more study is necessary, our results suggest the clinical efficacy of our covered Nitinol Strecker stent in the management of obstructive jaundice caused by malignant diseases

  15. 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)

  16. 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...

  17. 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...

  18. Histologic assessment of biliary obstruction with different percutaneous endoluminal techniques

    Directory of Open Access Journals (Sweden)

    Guido Giampiero

    2004-08-01

    Full Text Available Abstract Background Despite the sophisticated cross sectional image techniques currently available, a number of biliary stenosis or obstructions remain of an uncertain nature. In these pathological conditions, an "intrinsic" parietal alteration is the cause of biliary obstruction and it is very difficult to differentiate benign from malignant lesions using cross-sectional imaging procedures alone. We evaluated the efficacy of different endoluminal techniques to achieve a definitive pathological diagnosis in these situations. Methods Eighty patients underwent brushing, and or biopsy of the biliary tree through an existing transhepatic biliary drainage route. A subcoort of 12 patients needed balloon-dilatation of the bile duct and the material covering the balloon surface was also sent for pathological examination (balloon surface sampling. Pathological results were compared with surgical findings or with long-term clinical and instrumental follow-ups. Success rates, sensitivity, specificity, accuracy, confidential intervals, positive predictive value and negative predictive value of the three percutaneous techniques in differentiating benign from malignant disease were assessed. The agreement coefficient of biopsy and brushing with final diagnosis was calculated using the Cohen's "K" value. Results Fifty-six patients had malignant strictures confirmed by surgery, histology, and by clinical follow-ups. Success rates of brushing, balloon surface sampling, and biopsy were 90.7, 100, and 100%, respectively. The comparative efficacy of brushing, balloon-surface sampling, and biopsy resulted as follows: sensitivity of 47.8, 87.5, and 92.1%, respectively; specificity of 100% for all the techniques; accuracy of 69.2, 91.7 and 93.6%, Positive Predictive Value of 100% for all the procedures and Negative Predictive Value of 55, 80, and 75%, respectively. Conclusions Percutaneous endoluminal biopsy is more accurate and sensitive than percutaneous bile duct

  19. Histologic assessment of biliary obstruction with different percutaneous endoluminal techniques

    International Nuclear Information System (INIS)

    Despite the sophisticated cross sectional image techniques currently available, a number of biliary stenosis or obstructions remain of an uncertain nature. In these pathological conditions, an 'intrinsic' parietal alteration is the cause of biliary obstruction and it is very difficult to differentiate benign from malignant lesions using cross-sectional imaging procedures alone. We evaluated the efficacy of different endoluminal techniques to achieve a definitive pathological diagnosis in these situations. Eighty patients underwent brushing, and or biopsy of the biliary tree through an existing transhepatic biliary drainage route. A subcoort of 12 patients needed balloon-dilatation of the bile duct and the material covering the balloon surface was also sent for pathological examination (balloon surface sampling). Pathological results were compared with surgical findings or with long-term clinical and instrumental follow-ups. Success rates, sensitivity, specificity, accuracy, confidential intervals, positive predictive value and negative predictive value of the three percutaneous techniques in differentiating benign from malignant disease were assessed. The agreement coefficient of biopsy and brushing with final diagnosis was calculated using the Cohen's 'K' value. Fifty-six patients had malignant strictures confirmed by surgery, histology, and by clinical follow-ups. Success rates of brushing, balloon surface sampling, and biopsy were 90.7, 100, and 100%, respectively. The comparative efficacy of brushing, balloon-surface sampling, and biopsy resulted as follows: sensitivity of 47.8, 87.5, and 92.1%, respectively; specificity of 100% for all the techniques; accuracy of 69.2, 91.7 and 93.6%, Positive Predictive Value of 100% for all the procedures and Negative Predictive Value of 55, 80, and 75%, respectively. Percutaneous endoluminal biopsy is more accurate and sensitive than percutaneous bile duct brushing in the detection of malignant

  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. 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.

  2. Halogenated hydrocarbon solvent-related cholangiocarcinoma risk: biliary excretion of glutathione conjugates of 1,2-dichloropropane evidenced by untargeted metabolomics analysis.

    Science.gov (United States)

    Toyoda, Yu; Takada, Tappei; Suzuki, Hiroshi

    2016-01-01

    Recently, the International Agency for Research on Cancer issued a warning about the carcinogenicity of 1,2-dichloropropane (1,2-DCP) to humans based on an epidemiological study suggesting a relationship between the incidence of cholangiocarcinoma and occupational exposure to halogenated hydrocarbon solvent comprised mostly of 1,2-DCP. Although this dihaloalkane has been used in various industrial fields, there has been no biological evidence explaining the cholangiocarcinoma latency, as well as little understanding of general cholangiocarcinoma risk. In the present study, we explored the biliary excretion of 1,2-DCP metabolites by an untargeted metabolomics approach and the related molecular mechanism with in vitro and in vivo experiments. We hypothesized that the biliary excretion of carcinogens derived from 1,2-DCP contribute to the increased cholangiocarcinoma risk. We found that 1,2-DCP was conjugated with glutathione in the liver, and that the glutathione-conjugated forms of 1,2-DCP, including a potential carcinogen that contains a chloride atom, were excreted into bile by the bile canalicular membrane transporter, ABCC2. These results may reflect a risk in the backfiring of biliary excretion as a connatural detoxification systems for xenobiotics. Our findings would contribute to uncover the latent mechanism by which the chronic exposure to 1,2-DCP increases cholangiocarcinoma risk and future understanding of cholangiocarcinoma biology. PMID:27087417

  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. 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

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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.

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

    Directory of Open Access Journals (Sweden)

    Ota T

    2004-06-01

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

  11. 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

  12. Quantitative microbial community analysis of three different sulfidic mine tailing dumps generating acid mine drainage.

    Science.gov (United States)

    Kock, Dagmar; Schippers, Axel

    2008-08-01

    The microbial communities of three different sulfidic and acidic mine waste tailing dumps located in Botswana, Germany, and Sweden were quantitatively analyzed using quantitative real-time PCR (Q-PCR), fluorescence in situ hybridization (FISH), catalyzed reporter deposition-FISH (CARD-FISH), Sybr green II direct counting, and the most probable number (MPN) cultivation technique. Depth profiles of cell numbers showed that the compositions of the microbial communities are greatly different at the three sites and also strongly varied between zones of oxidized and unoxidized tailings. Maximum cell numbers of up to 10(9) cells g(-1) dry weight were determined in the pyrite or pyrrhotite oxidation zones, whereas cell numbers in unoxidized tailings were significantly lower. Bacteria dominated over Archaea and Eukarya at all tailing sites. The acidophilic Fe(II)- and/or sulfur-oxidizing Acidithiobacillus spp. dominated over the acidophilic Fe(II)-oxidizing Leptospirillum spp. among the Bacteria at two sites. The two genera were equally abundant at the third site. The acidophilic Fe(II)- and sulfur-oxidizing Sulfobacillus spp. were generally less abundant. The acidophilic Fe(III)-reducing Acidiphilium spp. could be found at only one site. The neutrophilic Fe(III)-reducing Geobacteraceae as well as the dsrA gene of sulfate reducers were quantifiable at all three sites. FISH analysis provided reliable data only for tailing zones with high microbial activity, whereas CARD-FISH, Q-PCR, Sybr green II staining, and MPN were suitable methods for a quantitative microbial community analysis of tailings in general. PMID:18586975

  13. [Little Dry Creek Drainage

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Map of the drainage boundary, direction of flow, canals and ditches, and streets for the drainage study plan and profile for Little Dry Creek sub area in the North...

  14. 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

  15. 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...

  16. 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

  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. 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...

  19. 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)

  20. 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...

  1. Percutaneous Intraductal Radiofrequency Ablation Combined with Biliary Stent Placement for Nonresectable Malignant Biliary Obstruction Improves Stent Patency but not Survival

    Science.gov (United States)

    Wang, Jianfeng; Zhao, Lizhen; Zhou, Chuanguo; Gao, Kun; Huang, Qiang; Wei, Baojie; Gao, Jun

    2016-01-01

    Abstract Although radiofrequency (RF) ablation has been accepted as a curative treatment modality for solid organ tumors, intraductal RF ablation for malignant biliary obstruction has not been widely described. The aim of this study was to evaluate the feasibility, safety, and efficacy (in terms of stent patency and survival) of intraductal RF ablation combined with biliary stent placement for nonresectable malignant biliary obstruction. A search of the nonresectable malignant extrahepatic biliary obstruction database (179 patients) identified 18 consecutive patients who were treated with biliary intraluminal RF ablation during percutaneous transhepatic cholangiodrainage and inner stent placement (RF ablation group) and 18 patients who underwent inner stent placement without biliary intraluminal RF ablation (control group). The patients were matched for tumor type, location of obstruction, tumor stage, and Child–Pugh class status. Primary endpoints included safety, stent patency time, and survival rates. The secondary endpoint was effectiveness of the technique. The RF ablation and control groups were closely matched in terms of age, diagnosis, presence of metastases, presence of locally advanced tumor, American Society of Anesthesiologists (ASA) grade, and chemotherapy regimen (all P > 0.05). The technical success rate for both groups was 100%. The median time of stent patency in the RF ablation and control groups were 5.8 (2.8–11.5) months and 4.5 (2.4–8.0) months, respectively (Kaplan–Meier analysis: P = 0.03). The median survival times in the RF ablation and control groups were 6.1 (4.8–15.2) months and 5.8 (4.2–16.5) months, with no significant difference according to Kaplan–Meier analysis (P = 0.45). In univariate and multivariate analyses, poorer overall survival was associated with advanced age and presence of metastases (P < 0.05). Intraductal RF ablation combined with biliary stent placement for nonresectable malignant

  2. 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

  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. Geochemical analysis of soils and sediments, Coeur d'Alene drainage basin, Idaho: sampling, analytical methods, and results

    Science.gov (United States)

    Box, Stephen E.; Bookstrom, Arthur A.; Ikramuddin, Mohammed; Lindsay, James

    2001-01-01

    This report presents the locations, descriptions, analytical procedures used, and an inter-lab comparison of over 1100 geochemical analyses of samples of soil and sediment in and downstream of a major lead-zinc-silver mining district in the Coeur d'Alene (CdA) drainage basin of northern Idaho. The samples fall in 3 broad categories: (1) samples from vertical profiles of floodplain soils in the valley of the main stem of the CdA River (767 samples) and of the South Fork of the CdA River (38 samples), (2) size fractionated surficial samples of sediment bedload within the channel of the South Fork of the CdA River (68 samples), and (3) samples from vertical profiles of sediment bedload within the channel of the main stem of the CdA River (260 samples). Five different laboratories contributed geochemical data for this report. Four of the five laboratories employed analytical methods that require sample dissolution prior to analysis; one laboratory (US Geological Survey) used analytical instrumentation (energy dispersive x-ray fluorescence [EDXRF]) that is applied to pulverized samples. Some dissolution procedures use four acids (hydrochloric, nitric, perchloric, and hydrofluoric; Eastern Washington University [EWU] Geochemical Laboratory and XRAL Laboratories, Inc.), others use two acids (nitric acid and aqua regia; CHEMEX Labs, Inc.), and some use only concentrated nitric acid (ACZ Laboratories, Inc.). Most analyses of dissolved samples were done by Inductively Coupled Plasma - Atomic Emission Spectroscopy (ICP-AES) or by ICP - MS (Mass Spectroscopy). Some analyses for Ag and K were done by Flame Atomic Absorption (FAA). Inter-laboratory comparisons are made for 6 elements: lead (Pb), zinc (Zn), iron

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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

  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. 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.

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

    International Nuclear Information System (INIS)

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

  13. 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. ...

  14. 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...

  15. 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.

  16. 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

  17. 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)

  18. 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.

  19. GWAS in Primary Biliary Cirrhosis

    OpenAIRE

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

    2015-01-01

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

  20. 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...

  1. 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...

  2. 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

  3. 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.

  4. 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 ...

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

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

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

  6. 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...

  7. Biliary complications after transplantation in children: Role of imaging modalities

    International Nuclear Information System (INIS)

    Among a series of 140 liver transplantations in children, 21 biliary complications (BC) (15%) are reported. BC were identified from 2 days to 3 months after LT. Positive US findings were present in 20 cases. Cholangiography was obtained by opacification of a surgical drain in 3 cases, per-operatively in 3 and by PTC in 15. Drainage was placed in 9 and ballon dilatation performed in 2. Causes of BC include hepatic artery (HA) thrombosis in 7, HA stenosis in 1, anastomosis stricture in 7, anastomosis kink in 3, mucocele of cystic duct remnant in 2 and sludge in 1. Treatment was surgical in all, but 2 cases were treated percutaneously. There is a great difference in severity of prognosis between complications secondary to HA thrombosis and isolated BC. Role of US in diagnosis and of PTC and interventional radiology in treatment are emphasized. (orig.)

  8. Biliary complications after transplantation in children: Role of imaging modalities

    Energy Technology Data Exchange (ETDEWEB)

    Pariente, D.; Bihet, M.H.; Tammam, S.; Riou, J.Y.; Chaumont, P. (Centre Hospitalier de Bicetre, 94 (France). Service de Radiologie); Bernard, O. (Centre Hospitalier de Bicetre, 94 (France). Service d' Hepatologie); Devictor, D. (Centre Hospitalier de Bicetre, 94 (France). Service de Reanimation); Gauthier, F. (Centre Hospitalier de Bicetre, 94 (France). Service de Chirurgie); Houssin, D. (Hopital Cochin, 75 - Paris (France). Service de Chirurgie Digestive)

    1991-04-01

    Among a series of 140 liver transplantations in children, 21 biliary complications (BC) (15%) are reported. BC were identified from 2 days to 3 months after LT. Positive US findings were present in 20 cases. Cholangiography was obtained by opacification of a surgical drain in 3 cases, per-operatively in 3 and by PTC in 15. Drainage was placed in 9 and ballon dilatation performed in 2. Causes of BC include hepatic artery (HA) thrombosis in 7, HA stenosis in 1, anastomosis stricture in 7, anastomosis kink in 3, mucocele of cystic duct remnant in 2 and sludge in 1. Treatment was surgical in all, but 2 cases were treated percutaneously. There is a great difference in severity of prognosis between complications secondary to HA thrombosis and isolated BC. Role of US in diagnosis and of PTC and interventional radiology in treatment are emphasized. (orig.).

  9. 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.

  10. 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...

  11. 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。

  12. 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

  13. 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.

  14. 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...

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

    Science.gov (United States)

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

    2012-01-01

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

  16. 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.

  17. Percutaneous biliary interventions through the gallbladder and the cystic duct: What radiologists need to know.

    Science.gov (United States)

    Hatzidakis, A; Venetucci, P; Krokidis, M; Iaccarino, V

    2014-12-01

    Percutaneous cholecystostomy is an established drainage procedure for the management of high-risk patients with acute cholecystitis. However, percutaneous image-guided access to the gallbladder may not be limited to the simple placement of a drain, but may also be used as an alternative approach to the biliary tree through the catheterization of the cystic duct, for a variety of other more complicated conditions. Percutaneous transcholecystic interventions may be performed in both malignant and benign disease. In the case of malignant jaundice, the transcholecystic route may be used when the liver parenchyma is occupied by metastatic lesions and transhepatic access is not possible. In benign conditions, access through the gallbladder may offer a solution if the biliary tree is not dilated. The transcholecystic access may then be route of insertion of large sheaths, internal drainage catheters, lithotripsy devices, stone retrieval baskets, and stents. The purpose of this review is to illustrate the techniques and to discuss the indications, complications, and technical difficulties of this alternative access to the biliary tree. PMID:25172204

  18. 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

  19. Biliary ascariasis: radiological clue to diagnosis

    OpenAIRE

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

    2015-01-01

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

  20. 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