WorldWideScience

Sample records for biliary tract cancer

  1. Diet and biliary tract cancer risk in Shanghai, China

    Science.gov (United States)

    Nelson, Shakira M.; Gao, Yu-Tang; Nogueira, Leticia M.; Shen, Ming-Chang; Wang, Bingsheng; Rashid, Asif; Hsing, Ann W.; Koshiol, Jill

    2017-01-01

    Trends in biliary tract cancer incidence rates have increased in Shanghai, China. These trends have coincided with economic and developmental growth, as well as a shift in dietary patterns to a more Westernized diet. To examine the effect of dietary changes on incident disease, we evaluated associations between diet and biliary tract cancers amongst men and women from a population-based case-control study in Shanghai, China. Biliary tract cancer cases were recruited from 42 collaborating hospitals in urban Shanghai, and population-based controls were randomly selected from the Shanghai Household Registry. Food frequency questionnaire data were available for 225 gallbladder, 190 extrahepatic bile duct, and 68 ampulla of Vater cancer cases. A total of 39 food groups were created and examined for associations with biliary tract cancer. Interestingly, only four food groups demonstrated a suggested association with gallbladder, extrahepatic bile duct, or ampulla of Vater cancers. The allium food group, consisting of onions, garlic, and shallots showed an inverse association with gallbladder cancer (OR: 0.81, 95% CI: 0.68–0.97). Similar trends were seen in the food group containing seaweed and kelp (OR: 0.79, 95% CI: 0.67–0.96). In contrast, both preserved vegetables and salted meats food groups showed positive associations with gallbladder cancer (OR:1.27, 95% CI: 1.06–1.52; OR: 1.18, 95% CI: 1.02–1.37, respectively). Each of these four food groups showed similar trends for extrahepatic bile duct and ampulla of Vater cancers. The results of our analysis suggest intake of foods with greater anti-inflammatory properties may play a role in decreasing the risk of biliary tract cancers. Future studies should be done to better understand effects of cultural changes on diet, and to further examine the impact diet and inflammation have on biliary tract cancer incidence. PMID:28288186

  2. Nal-IRI With 5-fluorouracil (5-FU) and Leucovorin or Gemcitabine Plus Cisplatin in Advanced Biliary-tract Cancer

    Science.gov (United States)

    2017-02-03

    Adenocarcinoma Metastatic; Biliary Tract Cancer; Adenocarcinoma of the Biliary Tract; Adenocarinoma Locally Advanced; Non-Resectable Hepatocellular Carcinoma; Intrahepatic Bile Duct Carcinoma; Extrahepatic Bile Duct Carcinoma

  3. Cancers of the pancreas and biliary tract: epidemiological considerations.

    Science.gov (United States)

    Fraumeni, J F

    1975-11-01

    The epidemiological patterns for pancreatic and biliary cancers reveal more differences than similarities. Pancreatic carcinoma is common in western countries, although 2 Polynesian groups (New Zealand Maoris and native Hawaiians) have the highest rates internationally. In the United States the disease is rising in frequency, predominating in males and in blacks. The rates are elevated in urban areas, but geographic analysis uncovered no clustering of contiguous counties except in southern Louisiana. The origin of pancreatic cancer is obsure, but a twofold increased risk has been documented for cigarette smokers and diabetic patients. Alcohol, occupational agents, and dietary fat have been suspected, but not proven to be risk factors. Except for the rare hereditary form of pancreatitis, there are few clues to genetic predisposition. In contrast, the reported incidence of biliary tract cancer is highest in Latin American populations and American Indians. The tumor predominates in females around the world, except for Chinese and Japanese who show a male excess. In the United States the rates are higher in whites than blacks, and clusters of high-risk counties have been found in the north central region, the southwest, and Appalachia. The distribution of biliary tumors parallels that of cholesterol gallstones, the major risk factor for biliary cancer. Insights into biliary carcinogenesis depend upon clarification of lithogenic influences, such as pregnancy, obesity, and hyperlipoproteinemia, exogenous estrogens, familial tendencies, and ethnic-geographic factors that may reflect dietary habits. Noncalculous risk factors for biliary cancer include ulcerative colitis, clonorchiasis, Gardner's syndrome, and probably certain industrial exposures. Within the biliary tract, tumors of the gallbladder and bile duct show epidemiological distinctions. In contrast to gallbladder cancer, bile duct neoplasms predominate in males; they are less often associated with stones and more

  4. New and emerging treatment options for biliary tract cancer

    Directory of Open Access Journals (Sweden)

    Noel MS

    2013-10-01

    Full Text Available Marcus S Noel, Aram F Hezel James P Wilmot Cancer Center, University of Rochester, Rochester, NY, USA Abstract: Biliary tract cancer (BTC is a group of relatively rare tumors with a poor prognosis. The current standard of care consists of doublet chemotherapy (platinum plus gemcitabine; however, even with cytotoxic therapy, the median overall survival is less than 1 year. The genetic basis of BTC is now more clearly understood, allowing for the investigation of targeted therapy. Combinations of doublet chemotherapy with antiepidermal growth factor receptor agents have provided modest results in Phase II and Phase III setting, and responses with small molecule inhibitors are limited. Moving forward as we continue to characterize the genetic hallmarks of BTC, a stepwise, strategic, and cooperative approach will allow us to make progress when developing new treatments. Keywords: biliary tract cancer, cholangiocarcinoma, genetics, targeted therapy

  5. 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 ...

  6. Targeting Angiogenesis in Biliary Tract Cancers: An Open Option

    Directory of Open Access Journals (Sweden)

    Valeria Simone

    2017-02-01

    Full Text Available Biliary tract cancers (BTCs are characterized by a bad prognosis and the armamentarium of drugs for their treatment is very poor. Although the inflammatory status of biliary tract represents the first step in the cancerogenesis, the microenvironment also plays a key role in the pathogenesis of BTCs, promoting tumor angiogenesis, invasion and metastasis. Several molecules, such as vascular endothelial growth factor (VEGF and fibroblast growth factor (FGF, are involved in the angiogenesis process and their expression on tumor samples has been explored as prognostic marker in both cholangiocarcinoma and gallbladder cancer. Recent studies evaluated the genomic landscape of BTCs and evidenced that aberrations in several genes enrolled in the pro-angiogenic signaling, such as FGF receptor-2 (FGFR-2, are characteristic of BTCs. New drugs targeting the signaling pathways involved in angiogenesis have been tested in preclinical studies both in vitro and in vivo with promising results. Moreover, several clinical studies tested monoclonal antibodies against VEGF and tyrosine kinase inhibitors targeting the VEGF and the MEK/ERK pathways. Herein, we evaluate both the pathogenic mechanisms of BTCs focused on angiogenesis and the preclinical and clinical data available regarding the use of new anti-angiogenic drugs in these malignancies.

  7. Targeted therapy in biliary tract cancer: 2009 update.

    Science.gov (United States)

    Tonini, Giuseppe; Virzì, Vladimir; Fratto, Maria Elisabetta; Vincenzi, Bruno; Santini, Daniele

    2009-12-01

    Biliary tract cancers (BTCs) include cholangiocarcinoma (intrahepatic, perihilar and extrahepatic), carcinoma of the gall bladder and ampullary carcinoma. In patients with advanced disease the prognosis is poor. There is not a consensus regarding treatment strategy. Chemotherapy has only limited efficacy. This review summarizes the new approaches for BTC patients and the rationale for targeted therapies. The prognostic factors and the molecular features of BTC are analyzed. The clinical trials evaluating the targeted agents are accurately described, especially those assessing the role of anti-EGFR and antiangiogenic drugs. The ongoing trials are also analyzed. In fact, only the results of these trials will establish which is the most effective agent or combination for this setting.

  8. The Emerging Role of miRNAs and Their Clinical Implication in Biliary Tract Cancer

    Science.gov (United States)

    Ferreira Martins, Nina Nayara; da Silva Oliveira, Kelly Cristina; Braga Bona, Amanda; de Arruda Cardoso Smith, Marília; Ishak, Geraldo; Assumpção, Paulo Pimentel; Burbano, Rommel Rodríguez

    2016-01-01

    Biliary tract cancers are aggressive malignancies that include gallbladder cancer and tumors of intra- and extrahepatic ducts and have a poor prognosis. Surgical resection remains the main curative therapy. Nevertheless, numerous patients experience recurrence even after radical surgery. This scenario drives the research to identify biliary tract cancer biomarkers despite the limited progress that has been made. Recently, a large number of studies have demonstrated that deregulated expression of microRNAs is closely associated with cancer development and progression. In this review, we highlight the role and importance of microRNAs in biliary tract cancers with an emphasis on utilizing circulating microRNAs as potential biomarkers. Additionally, we report several single-nucleotide polymorphisms in microRNA genes that are associated with the susceptibility of biliary tract tumors. PMID:28115929

  9. Molecular profiling of biliary tract cancer: a target rich disease

    Science.gov (United States)

    Jain, Apurva

    2016-01-01

    Biliary tract cancers (BTCs) are relatively uncommon orphan tumors that have an aggressive disease course and a poor clinical outcome. Surgery is the only curative treatment, but most patients present with advanced disease and therefore have a limited survival. Gemcitabine and cisplatin based chemotherapy has been the only widely accepted standard systemic therapy regimen in these patients but these tumors can be chemoresistant, further complicating their management. In recent times, there has been considerable research in the genetics of BTC and with the advent of new, advanced technologies like next-generation sequencing (NGS) we are achieving a greater understanding of its disease biology. With the help of NGS, we have now been able to identify actionable mutations such as in the isocitrate dehydrogenase 1 (IDH1), FGFR2, BRAF and HER2/neu genes for targeted therapeutics and correlate the genetic variations with distinct clinical prognoses. This recent genetic information has the potential to make precision medicine a part of routine clinical practice for the management of BTC patients. PMID:27747093

  10. MicroRNA markers for the diagnosis of pancreatic and biliary-tract cancers.

    Science.gov (United States)

    Kojima, Motohiro; Sudo, Hiroko; Kawauchi, Junpei; Takizawa, Satoko; Kondou, Satoshi; Nobumasa, Hitoshi; Ochiai, Atsushi

    2015-01-01

    It is difficult to detect pancreatic cancer or biliary-tract cancer at an early stage using current diagnostic technology. Utilizing microRNA (miRNA) markers that are stably present in peripheral blood, we aimed to identify pancreatic and biliary-tract cancers in patients. With "3D-Gene", a highly sensitive microarray, we examined comprehensive miRNA expression profiles in 571 serum samples obtained from healthy patients, patients with pancreatic, biliary-tract, or other digestive cancers, and patients with non-malignant abnormalities in the pancreas or biliary tract. The samples were randomly divided into training and test cohorts, and candidate miRNA markers were independently evaluated. We found 81 miRNAs for pancreatic cancer and 66 miRNAs for biliary-tract cancer that showed statistically different expression compared with healthy controls. Among those markers, 55 miRNAs were common in both the pancreatic and biliary-tract cancer samples. The previously reported miR-125a-3p was one of the common markers; however, it was also expressed in other types of digestive-tract cancers, suggesting that it is not specific to cancer types. In order to discriminate the pancreato-biliary cancers from all other clinical conditions including the healthy controls, non-malignant abnormalities, and other types of cancers, we developed a diagnostic index using expression profiles of the 10 most significant miRNAs. A combination of eight miRNAs (miR-6075, miR-4294, miR-6880-5p, miR-6799-5p, miR-125a-3p, miR-4530, miR-6836-3p, and miR-4476) achieved a sensitivity, specificity, accuracy and AUC of 80.3%, 97.6%, 91.6% and 0.953, respectively. In contrast, CA19-9 and CEA gave sensitivities of 65.6% and 40.0%, specificities of 92.9% and 88.6%, and accuracies of 82.1% and 71.8%, respectively, in the same test cohort. This diagnostic index identified 18/21 operable pancreatic cancers and 38/48 operable biliary-tract cancers in the entire cohort. Our results suggest that the assessment of

  11. Investigation of Spatial Clustering of Biliary Tract Cancer Incidence in Osaka, Japan: Neighborhood Effect of a Printing Factory

    Directory of Open Access Journals (Sweden)

    Yuri Ito

    2016-09-01

    Full Text Available Background: In 2013, an unusually high incidence of biliary tract cancer among current or former workers of the offset color proof printing department of a printing company in Osaka, Japan, was reported. The purpose of this study was to examine whether distance from the printing factory was associated with incidence of biliary tract cancer and whether incident biliary tract cancer cases clustered around the printing factory in Osaka using population-based cancer registry data. Methods: We estimated the age-standardized incidence ratio of biliary tract cancer according to distance from this printing factory. We also searched for clusters of biliary tract cancer incidence using spatial scan statistics. Results: We did not observe statistically significantly high or low standardized incidence ratios for residents in each area categorized by distance from the printing factory for the entire sample or for either sex. The scan statistics did not show any statistically significant clustering of biliary tract cancer incidence anywhere in Osaka prefecture in 2004–2007. Conclusions: There was no statistically significant clustering of biliary tract cancer incidence around the printing factory or in any other areas in Osaka, Japan, between 2004 and 2007. To date, even if some substances have diffused outside this source factory, they do not appear to have influenced the incidence of biliary tract cancer in neighboring residents.

  12. Clinical implications of APEX1 and Jagged1 as chemoresistance factors in biliary tract cancer

    Science.gov (United States)

    Kim, Hong-Beum; Cho, Won Jin; Choi, Nam Gyu; Kim, Sung-Soo; Park, Jun Hee; Lee, Hee-Jeong

    2017-01-01

    Purpose Biliary cancer is a highly malignant neoplasm with poor prognosis and most patients need to undergo palliative chemotherapy, however major clinical problem associated with the use of chemotherapy is chemoresistance. So far, we aimed at investigating clinical implications of apurinic/apyrimidinic endodeoxyribonuclease 1 (APEX1) and Jagged1 as chemoresistance factors in biliary tract cancer. Methods We used 5 human biliary tract cancer cell lines (SNU-245, SNU-308, SNU-478, SNU-1079, and SNU-1196), and investigated the chemosensitivity of APEX1 and Jagged1 through 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay and Western blot. Alternately, the 10 patients of advanced biliary cancer consist of 2 group according to the chemotherapy response examined by immunohistochemistry using APEX1 and Jagged1 antibody, and protein expression level was scored for staining intensity and percent positive cell. Results The result of MTT assay after APEX1 knockdown showed that strong coexpression of APEX1 and Jagged1 cell line (SNU-245, SNU-1079, and SNU-1196) showed a greater decrease in IC50 of chemotherapeutic agent (5-fluorouracil, gemcitabine and cisplatin). The Western blot analysis of APEX1 and Jagged1 expression in biliary cancer cell lines after APEX1 knockdown definitively demonstrated decreased Jagged1 expression. The APEX1 and Jagged1expression level of immunohistochemistry represented that chemorefractory patients had higher than chemoresponsive patients. Conclusion These results demonstrate that simultaneous high expression of APEX1 and Jagged1 is associated with chemoresistance in biliary cancer and suggest that is a potential therapeutic target for chemoresistance in advanced biliary cancer. PMID:28090501

  13. 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.

  14. Inhibition of histone deacetylase for the treatment of biliary tract cancer: A new effective pharmacological approach

    Institute of Scientific and Technical Information of China (English)

    Thilo Bluethner; Manuel Niederhagen; Karel Caca; Frederik Serr; Helmut Witzigmann; Christian Moebius; Joachim Mossner; Marcus Wiedmann

    2007-01-01

    AIM: To investigate in vitro and in vivo therapeutic effects of histone deacetylase inhibitors NVP-LAQ824 and NVP-LBH589 on biliary tract cancer.METHODS: Cell growth inhibition by NVP-LAQ824 and NVP-LBH589 was studied in vitro in 7 human biliary tract cancer cell lines by MTT assay. In addition, the antitumoral effect of NVP-LBH589 was studied in a chimeric mouse model. Anti-tumoral drug mechanism was assessed by immunoblotting for acH4 and p21WAF-1/CIP-1,PARP assay, cell cycle analysis, TUNEL assay, and immunhistochemistry for MIB-1.RESULTS: In vitro treatment with both compounds significantly suppressed the growth of all cancer cell lines [mean IC50 (3 d) 0.11 and 0.05 μmol/L,respectively], and was associated with hyperacetylation of nucleosomal histone H4, increased expression of p21WAF-1/CIP-1, induction of apoptosis (PARP cleavage), and cell cycle arrest at G2/M checkpoint. After 28 d, NVPLBH589 significantly reduced tumor mass by 66% (bile duct cancer) and 87% (gallbladder cancer) in vivo in comparison to placebo, and potentiated the efficacy of gemcitabine. Further analysis of the tumor specimens revealed increased apoptosis by TUNEL assay and reduced cell proliferation (MIB-1).CONCLUSION: Our findings suggest that NVP-LBH589 and NVP-LAQ824 are active against human biliary tract cancer in vitro. In addition, NVP-LBH589 demonstrated significant in vivo activity and potentiated the efficacy of gemcitabine. Therefore, further clinical evaluation of this new drug for the treatment of biliary tract cancer is recommended.

  15. Targeted medical therapy of biliary tract cancer: Recent advances and future perspectives

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    The limited efficacy of cytotoxic therapy for advanced biliary tract and gallbladder cancers emphasizes the need for novel and more effective medical treatment options. A better understanding of the specific biological features of these neoplasms led to the development of new targeted therapies, which take the abundant expression of several growth factors and cognate tyrosine kinase receptors into account. This review will briefly summarize the status and future perspectives of antiangiogenic and growth factor receptor-based pharmacological approaches for the treatment of biliary tract and gallbladder cancers. In view of multiple novel targeted approaches, the rationale for innovative therapies, such as combinations of growth factor (receptor)-targeting agents with cytotoxic drugs or with other novel anticancer drugs will be highlighted.

  16. Prognostic factors for progression-free and overall survival in advanced biliary tract cancer

    DEFF Research Database (Denmark)

    Bridgewater, J; Lopes, A; Wasan, H

    2016-01-01

    BACKGROUND: Biliary tract cancer is an uncommon cancer with a poor outcome. We assembled data from the National Cancer Research Institute (UK) ABC-02 study and 10 international studies to determine prognostic outcome characteristics for patients with advanced disease. METHODS: Multivariable...... associated with PFS and OS. ROC analysis suggested the models generated from the ABC-02 study had a limited prognostic value [6-month PFS: area under the curve (AUC) 62% (95% CI 57-68); 1-year OS: AUC 64% (95% CI 58-69)]. CONCLUSION: These data propose a set of prognostic criteria for outcome in advanced...

  17. Phase II marker-driven trial of panitumumab and chemotherapy in KRAS wild-type biliary tract cancer

    DEFF Research Database (Denmark)

    Jensen, L H; Lindebjerg, J; Ploen, J;

    2012-01-01

    BACKGROUND: Combination chemotherapy has proven beneficial in biliary tract cancer and further improvements may be achieved by individualizing treatment based on biomarkers and by adding biological agents. We report the effect of chemotherapy with panitumumab as first-line therapy for KRAS wild-type......) and median overall survival was 10.0 months (95% CI 7.4-12.7 months). Toxicity was manageable including eight cases of epidermal growth factor receptor-related skin adverse events of grade 2 or more. CONCLUSIONS: Marker-driven patient selection is feasible in the systemic treatment of biliary tract cancer...... irresectable biliary tract cancer. PATIENTS AND METHODS: Patients were treated with gemcitabine 1000 mg/m(2), oxaliplatin 60 mg/m(2), and panitumumab 6 mg/kg i.v. every 2 weeks followed by two daily administrations of capecitabine 1000 mg/m(2) in 7 days. RESULTS: During 22 months, 46 patients were included...

  18. Adjuvant treatment after resection of biliary-tract cancer: yes or no?

    Directory of Open Access Journals (Sweden)

    Eveline Boucher

    2011-12-01

    Full Text Available Biliary-tract cancers are rare tumors and carry poor prognosis despite some aggressive surgical approach. The benefit of adjuvant treatment is under debate, and except one there is no phase III trial available. However, it appears that, in a large proportion, adjuvant therapy is proposed to patient. It could be chemotherapy or radiotherapy alone or both. Many publications are available on this topic. These are sometimes phase II studies, but mostly retrospective data about the experience of one center. All these studies have got many bias and the results must be interpreted with caution, even if patients could get some benefit of adjuvant therapy in case of adverse prognostic factors as positive resection margin and/or nodal involvement. In this review, we sum up the different therapies used as adjuvant treatment for biliary-tract cancer, and then we have studied what is done in clinical practice in order to propose a phase III clinical trial in this setting.

  19. Diabetes mellitus, insulin treatment, diabetes duration, and risk of biliary tract cancer and hepatocellular carcinoma in a European cohort

    NARCIS (Netherlands)

    Schlesinger, S.; Aleksandrova, K.; Pischon, T.; Jenab, M.; Fedirko, V.; Trepo, E.; Overvad, K.; Roswall, N.; Tjonneland, A.; Boutron-Ruault, M. C.; Fagherazzi, G.; Racine, A.; Kaaks, R.; Grote, V. A.; Boeing, H.; Trichopoulou, A.; Pantzalis, M.; Kritikou, M.; Mattiello, A.; Sieri, S.; Sacerdote, C.; Palli, D.; Tumino, R.; Peeters, P. H.; Bueno-de-Mesquita, H. B.; Weiderpass, E.; Quiros, J. R.; Zamora-Ros, R.; Sanchez, M.J.; Arriola, L.; Ardanaz, E.; Tormo, M. J.; Nilsson, P.; Lindkvist, B.; Sund, M.; Rolandsson, O.; Khaw, K. T.; Wareham, N.; Travis, R. C.; Riboli, E.; Noethlings, U.

    2013-01-01

    Evidence on associations between self-reported diabetes mellitus, diabetes duration, age at diabetes diagnosis, insulin treatment, and risk of biliary tract cancer (BTC) and hepatocellular carcinoma (HCC), independent of general and abdominal obesity is scarce. We conducted a prospective analysis in

  20. Consumption of soft drinks and juices and risk of liver and biliary tract cancers in a European cohort

    NARCIS (Netherlands)

    Stepien, Magdalena; Duarte-Salles, Talita; Fedirko, Veronika; Trichopoulou, Antonia; Lagiou, Pagona; Bamia, Christina; Overvad, Kim; Tjønneland, Anne; Hansen, Louise; Boutron-Ruault, Marie Christine; Fagherazzi, Guy; Severi, Gianluca; Kühn, Tilman; Kaaks, Rudolf; Aleksandrova, Krasimira; Boeing, Heiner; Klinaki, Eleni; Palli, Domenico; Grioni, Sara; Panico, Salvatore; Tumino, Rosario; Naccarati, Alessio; Bueno-de-Mesquita, H. Bas; Peeters, Petra H.; Skeie, Guri; Weiderpass, Elisabete; Parr, Christine L.; Quirós, José Ramón; Buckland, Genevieve; Molina-Montes, Esther; Amiano, Pilar; Chirlaque, Maria Dolores; Ardanaz, Eva; Sonestedt, Emily; Ericson, Ulrika; Wennberg, Maria; Nilsson, Lena Maria; Khaw, Kay Tee; Wareham, Nick; Bradbury, Kathryn E.; Ward, Heather A.; Romieu, Isabelle; Jenab, Mazda

    2016-01-01

    Purpose: The aim of the study was to assess associations between intake of combined soft drinks (sugar sweetened and artificially sweetened) and fruit and vegetable juices and the risk of hepatocellular carcinoma (HCC), intrahepatic bile duct (IHBC) and biliary tract cancers (GBTC) using data from t

  1. Anatomy and embryology of the biliary tract.

    Science.gov (United States)

    Keplinger, Kara M; Bloomston, Mark

    2014-04-01

    Working knowledge of extrahepatic biliary anatomy is of paramount importance to the general surgeon. The embryologic development of the extrahepatic biliary tract is discussed in this article as is the highly variable anatomy of the biliary tract and its associated vasculature. The salient conditions related to the embryology and anatomy of the extrahepatic biliary tract, including biliary atresia, choledochal cysts, gallbladder agenesis, sphincter of Oddi dysfunction, and ducts of Luschka, are addressed.

  2. Effect of histone deacetylase inhibitor on proliferation of biliary tract cancer cell lines

    Institute of Scientific and Technical Information of China (English)

    Li-Ning Xu; Xin Wang; Sheng-Quan Zou

    2008-01-01

    AIM: To explore the effect of histone deacetylase inhibitor, trichostatin A (TSA) on the growth of biliary tract cancer cell lines (gallbladder carcinoma cell line and cholangiocarcinoma cell line) in v/vo and in vitro,and to investigate the perspective of histone deacetylase inhibitor in its clinical application.METHODS: The survival rates of gallbladder carcinoma cell line (Mz-ChA-I cell line) and cholangiocarcinoma cell lines (QBC939, KMBC and OZ cell lines) treated with various doses of TSA were detected by methylthiazoy tetrazolium (MTT) assay.A nude mouse model of transplanted gallbladder carcinoma (Mz-ChA-I cell line)was successfully established, and changes in the growth of transplanted tumor after treated with TSAwere measured.RESULTS: TSA could inhibit the proliferation of gallbladder carcinoma cell line (Mz-ChA-I cell line) and cholangiocarcinoma cell lines (QBC939, KMBC and OZ cell lines) in a dose-dependent manner.After the nude mouse model of transplanted gallbladder carcinoma (Mz-ChA-I cell line) was successfully established, the growth of cancer was inhibited in the model, after treated with TSA.CONCLUSION: TSA can inhibit the growth of cholangiocarcinoma and gallbladder carcinoma cell lines in vitro and in vivo.

  3. BRCA/Fanconi anemia pathway implicates chemoresistance to gemcitabine in biliary tract cancer.

    Science.gov (United States)

    Nakashima, Shinsuke; Kobayashi, Shogo; Nagano, Hiroaki; Tomokuni, Akira; Tomimaru, Yoshito; Asaoka, Tadafumi; Hama, Naoki; Wada, Hiroshi; Kawamoto, Koichi; Marubashi, Shigeru; Eguchi, Hidetoshi; Doki, Yuichiro; Mori, Masaki

    2015-05-01

    The BRCA/Fanconi anemia (FA) pathway plays a key role in the repair of DNA double strand breaks. We focused on this pathway to clarify chemoresistance mechanisms in biliary tract cancer (BTC). We also investigated changes in the CD24(+)/44(+) population that may be involved in chemoresistance, as this population likely includes cancer stem cells. We used three BTC cell lines to establish gemcitabine (GEM)-resistant (GR) cells and evaluated the expression of BRCA/FA pathway components, chemoresistance, and the effect of BRCA/FA pathway inhibition on the CD24(+)/44(+) population. FANCD2 and CD24 expression were evaluated in 108 resected BTC specimens. GR cells highly expressed the BRCA/FA components. The BRCA/FA pathway was upregulated by GEM and cisplatin (CDDP) exposure. Inhibition using siRNA and RAD51 inhibitor sensitized GR cells to GEM or CDDP. The CD24(+)/44(+) population was increased in GR and parent BTC cells treated with GEM or CDDP and highly expressed BRCA/FA genes. FANCD2 was related to CD24 expression in resected BTC specimens. Inhibition of the BRCA/FA pathway under GEM reduced the CD24(+)/44(+) population in MzChA1-GR cells. Thus, high expression of the BRCA/FA pathway is one mechanism of chemoresistance against GEM and/or CDDP and is related to the CD24(+)/44(+) population in BTC.

  4. Adjuvant treatment in biliary tract cancer: To treat or not to treat?

    Institute of Scientific and Technical Information of China (English)

    Stefano Cereda; Carmen Belli; Michele Reni

    2012-01-01

    Biliary tract cancer is a rare malignant tumor.There is limited knowledge about biology and natural history of this disease and considerable uncertainty remains regarding its optimal diagnostic and therapeutic management.The role of adjuvant therapy is object of debate and controversy.Although resection is identified as the most effective and the only potentially curative treatment,there is no consensus on the impact of adjuvant chemotherapy and/or radiotherapy on the high incidence of disease recurrence and on survival.This is mainly due to the rarity of this disease and the consequent difficulty in performing randomized trials.The only two prospectively controlled trials concluded that adjuvant chemotherapy did not improve survival.Most of the retrospective trials,which had limited sample size and included heterogeneous patients population and non-standardized therapies,suggested a marginal benefit of chemoradiotherapy in reducing locoregional recurrence and an uncertain impact on survival.Welldesigned multi-institutional randomized trials are necessary to clarify the role of adjuvant therapy.Two ongoing phase Ⅲ trials may provide relevant information.

  5. 胆道肿瘤的免疫治疗%Immunotherapy of biliary tract cancer

    Institute of Scientific and Technical Information of China (English)

    刘秀峰; 秦叔逵

    2015-01-01

    胆道肿瘤(BTC)侵袭性强,早期诊断率仅为10%。研究显示,吉西他滨联合顺铂方案现已成为晚期 BTC 的标准一线化疗方案,但疗效仍不满意。免疫细胞的浸润以及免疫相关的微环境可以抑制多种不同类型的肿瘤。研究发现,肿瘤浸润性 CD8+细胞毒 T 细胞和 CD4+T 细胞数量与 BTC 的预后密切相关,提示 BTC 的免疫治疗可能是一种新的手段。%Biliary tract cancer (BTC)is one of the most aggressive malignancies with only 1 0% early-stage diagnosis rate.For advanced BTC,regimen of gemcitabine and cisplatin has been regarded as the first line standard combination,but the curative effect is still unsatisfied.Infiltration of immune cells and immune-related microenvironment can inhibit various types of cancers.In BTC,higher frequencies of tumor-infiltrating CD8 + cytotoxic T cells and CD4 + T cells are closely associated with favorable prognosis.These findings have provided the rationale for further development of immunotherapies as a novel treatment modality against BTC.

  6. Biliary tract infections caused by Aeromonas species.

    Science.gov (United States)

    Chao, C M; Lai, C C; Tang, H J; Ko, W C; Hsueh, P-R

    2013-02-01

    This study investigated the clinical and microbiological characteristics of patients with Aeromonas infections of the biliary tract. Patients with bile cultures positive for Aeromonas species during the period July 2004 to December 2011 were identified from a computerized database of a hospital in Taiwan. Patients with Aeromonas infections of the biliary tract were further identified. During the study period, a total of 1,142 isolates of Aeromonas species were obtained from 750 patients. Of those patients, 91 (12.1 %) had Aeromonas infections of the biliary tract. The annual incidence (episodes per 10,000 patient-days) of biliary tract infections caused by all Aeromonas species was 0.31 in 2007, 0.12 in 2010, and 0.27 in 2011. A. hydrophila was the most common species isolated (n = 41, 45.1 %), followed by A. caviae (n = 30, 33.0 %), A. veronii biovar sobria (n = 15, 16.5 %), and A. veronii biovar veronii (n = 5, 5.5 %). The majority of patients (n = 77, 84.6 %) had polymicrobial infections. Hepatobiliary stones (n = 50, 54.9 %) and hepatobiliary cancer (n = 38, 41.8 %) were the most common underlying diseases, followed by diabetes mellitus (n = 29, 31.9 %) and liver cirrhosis (n = 7, 7.7 %). The in-hospital mortality rate was 8.8 %. Infection-related mortality was associated with underlying immunocompromised condition (p = 0.044) and use of mechanical ventilation (p = 0.004), but was not associated with inappropriate antibiotic usage or concomitant bacteremia (n = 8, 8.8 %). In conclusion, biliary tract infections caused by Aeromonas species are not uncommon and can develop in both immunocompromised and immunocompetent patients; however, patients with underlying hepatobiliary diseases are particularly susceptible to these infections.

  7. MicroRNAs Associated with the Efficacy of Photodynamic Therapy in Biliary Tract Cancer Cell Lines

    Directory of Open Access Journals (Sweden)

    Andrej Wagner

    2014-11-01

    Full Text Available Photodynamic therapy (PDT is a palliative treatment option for unresectable hilar biliary tract cancer (BTC showing a considerable benefit for survival and quality of life with few side effects. Currently, factors determining the cellular response of BTC cells towards PDT are unknown. Due to their multifaceted nature, microRNAs (miRs are a promising analyte to investigate the cellular mechanisms following PDT. For two photosensitizers, Photofrin® and Foscan®, the phototoxicity was investigated in eight BTC cell lines. Each cell line (untreated was profiled for expression of n = 754 miRs using TaqMan® Array Human MicroRNA Cards. Statistical analysis and bioinformatic tools were used to identify miRs associated with PDT efficiency and their putative targets, respectively. Twenty miRs correlated significantly with either high or low PDT efficiency. PDT was particularly effective in cells with high levels of clustered miRs 25-93*-106b and (in case of miR-106b a phenotype characterized by high expression of the mesenchymal marker vimentin and high proliferation (cyclinD1 and Ki67 expression. Insensitivity towards PDT was associated with high miR-200 family expression and (for miR-cluster 200a/b-429 expression of differentiation markers Ck19 and Ck8/18. Predicted and validated downstream targets indicate plausible involvement of miRs 20a*, 25, 93*, 130a, 141, 200a, 200c and 203 in response mechanisms to PDT, suggesting that targeting these miRs could improve susceptibility to PDT in insensitive cell lines. Taken together, the miRNome pattern may provide a novel tool for predicting the efficiency of PDT and—following appropriate functional verification—may subsequently allow for optimization of the PDT protocol.

  8. Gemcitabine Plus Cisplatin for Advanced Biliary Tract Cancer: A Systematic Review.

    Science.gov (United States)

    Park, Joon Oh; Oh, Do-Youn; Hsu, Chiun; Chen, Jen-Shi; Chen, Li-Tzong; Orlando, Mauro; Kim, Jong Seok; Lim, Ho Yeong

    2015-07-01

    Evidence suggests that combined gemcitabine-cisplatin chemotherapy extends survival in patients with advanced biliary tract cancer (BTC). We conducted a systematic review in order to collate this evidence and assess whether gemcitabine-cisplatin efficacy is influenced by primary tumor site, disease stage, or geographic region, and whether associated toxicities are related to regimen. MEDLINE (1946-search date), EMBASE (1966-search date), ClinicalTrials. gov (2008-search date), and abstracts from major oncology conferences (2009- search date) were searched (5 Dec 2013) using terms for BTC, gemcitabine, and cisplatin. All study types reporting efficacy (survival, response rates) or safety (toxicities) outcomes of gemcitabine-cisplatin in BTC were eligible for inclusion; efficacy data were extracted from prospective studies only. Evidence retrieved from one meta-analysis (abstract), four randomized controlled trials, 12 nonrandomized prospective studies, and three retrospective studies supported the efficacy and safety of gemcitabine-cisplatin for BTC. Median overall survival ranged from 4.6 to 11.7 months, and response rate ranged from 17.1% to 36.6%. Toxicities were generally acceptable and manageable. Heterogeneity in study designs and data collected prevented formal meta-analysis, however exploratory assessments suggested that efficacy did not vary with primary tumor site (gallbladder vs. others), disease stage (metastatic vs. locally advanced), or geographic origin (Asia vs. other). Incidence of grade 3/4 toxicities was not related to gemcitabine dose or cisplatin frequency. Despite individual variation in study designs, the evidence presented suggests that gemcitabine-cisplatin is effective in patients from a diverse range of countries and with heterogeneous disease characteristics. No substantial differences in toxicity were observed among the different dosing schedules of gemcitabine and cisplatin.

  9. An overview of molecular epidemiologic studies in biliary tract cancer%肝外胆道癌分子流行病学研究的新进展

    Institute of Scientific and Technical Information of China (English)

    孟令勤; 刘金钢

    2012-01-01

    胆道癌是一种生存率极低的高致死性疾病,在世界范围内,胆道癌的发病率呈上升趋势.胆道癌不良的预后源于缺乏早期诊断和有效治疗的手段,因此,明确胆道癌的发病机制显得至关重要.基因多态性的关联分析将有助于阐明胆道癌的发生机制,有望发现有价值的肿瘤标记物以确定胆道癌高危人群并进行早期诊断和预后评估,进而成为基因治疗的新靶点.本文从分子流行病学角度对胆道癌基因多态性方面的最新研究进展进行综述.%Biliary tract cancer is a rare but highly fatal malignancy,with world -wide increasing incidence in recent years. The prognosis of biliary tract cancer is grim due to lack of early diagnostic modalities and effective treatments. It is important to explore the pathogenesis of biliary tract cancer. Molecular epidemiologic studies examining the associations between polymorphisms in several gene pathways and biliary tract cancer risk may provide insight into the etiology of this kind of cancer, and be helpful to discover validated biomarkers for early detection in asymptomatic individuals and present new targets of gene therepy in biliary tract cancer in the future. We present a broad overview of molecular epidemiologic studies that have addressed the relationship between biliary tract cancer risk and genetic polymorphisms in several candidate genes and suggest avenues for future research.

  10. Association between green tea/coffee consumption and biliary tract cancer: A population-based cohort study in Japan.

    Science.gov (United States)

    Makiuchi, Takeshi; Sobue, Tomotaka; Kitamura, Tetsuhisa; Ishihara, Junko; Sawada, Norie; Iwasaki, Motoki; Sasazuki, Shizuka; Yamaji, Taiki; Shimazu, Taichi; Tsugane, Shoichiro

    2016-01-01

    Green tea and coffee consumption may decrease the risk of some types of cancers. However, their effects on biliary tract cancer (BTC) have been poorly understood. In this population-based prospective cohort study in Japan, we investigated the association of green tea (total green tea, Sencha, and Bancha/Genmaicha) and coffee consumption with the risk for BTC and its subtypes, gallbladder cancer, and extrahepatic bile duct cancer. The hazard ratios and 95% confidence intervals were calculated using the Cox proportional hazard model. A total of 89 555 people aged 45-74 years were enrolled between 1995 and 1999 and followed up for 1 138 623 person-years until 2010, during which 284 cases of BTC were identified. Consumption of >720 mL/day green tea was significantly associated with decreased risk compared with consumption of ≤120 mL/day (hazard ratio = 0.67 [95% confidence interval, 0.46-0.97]), and a non-significant trend of decreased risk associated with increased consumption was observed (P-trend = 0.095). In the analysis according to the location of the primary tumor, consuming >120 mL green tea tended to be associated with decreased risk of gallbladder cancer and extrahepatic bile duct cancer. When Sencha and Bancha/Genmaicha were analyzed separately, we observed a non-significant trend of decreased risk of BTC associated with Sencha but no association with Bancha/Genmaicha. For coffee, there was no clear association with biliary tract, gallbladder, or extrahepatic bile duct cancer. Our findings suggest that high green tea consumption may lower the risk of BTC, and the effect may be attributable to Sencha consumption.

  11. Optimal dose of gemcitabine for the treatment of biliary tract or pancreatic cancer in patients with liver dysfunction.

    Science.gov (United States)

    Shibata, Takashi; Ebata, Tomoki; Fujita, Ken-ichi; Shimokata, Tomoya; Maeda, Osamu; Mitsuma, Ayako; Sasaki, Yasutsuna; Nagino, Masato; Ando, Yuichi

    2016-02-01

    A clear consensus does not exist about whether the initial dose of gemcitabine, an essential anticancer antimetabolite, should be reduced in patients with liver dysfunction. Adult patients with biliary tract or pancreatic cancer were divided into three groups according to whether they had mild, moderate, or severe liver dysfunction, evaluated on the basis of serum bilirubin and liver transaminase levels at baseline. As anticancer treatment, gemcitabine at a dose of 800 or 1000 mg/m(2) was given as an i.v. infusion once weekly for 3 weeks of a 4-week cycle. The patients were prospectively evaluated for adverse events during the first cycle, and the pharmacokinetics of gemcitabine and its inactive metabolite, difluorodeoxyuridine, were studied to determine the optimal initial dose of gemcitabine as monotherapy according to the severity of liver dysfunction. A total of 15 patients were studied. Liver dysfunction was mild in one patient, moderate in six, and severe in eight. All 15 patients had been undergoing biliary drainage for obstructive jaundice when they received gemcitabine. Grade 3 cholangitis developed in one patient with moderate liver dysfunction who received gemcitabine at the dose level of 1000 mg/m(2). No other patients had severe treatment-related adverse events resulting in the omission or discontinuation of gemcitabine treatment. The plasma concentrations of gemcitabine and difluorodeoxyuridine were similar among the groups. An initial dose reduction of gemcitabine as monotherapy for the treatment of biliary tract or pancreatic cancers is not necessary for patients with hyperbilirubinemia, provided that obstructive jaundice is well managed. (Clinical trial registration no. UMIN000005363.)

  12. Glycemic index, glycemic load, dietary carbohydrate, and dietary fiber intake and risk of liver and biliary tract cancers in Western Europeans

    NARCIS (Netherlands)

    Fedirko, V.; Lukanova, A.; Bamia, C.; Trichopolou, A.; Trepo, E.; Noethlings, U.; Schlesinger, S.; Aleksandrova, K.; Boffetta, P.; Tjonneland, A.; Johnsen, N. F.; Overvad, K.; Fagherazzi, G.; Racine, A.; Boutron-Ruault, M. C.; Grote, V.; Kaaks, R.; Boeing, H.; Naska, A.; Adarakis, G.; Valanou, E.; Palli, D.; Sieri, S.; Tumino, R.; Vineis, P.; Panico, S.; Bueno-de-Mesquita, H. B(as).; Siersema, P. D.; Peeters, P. H.; Weiderpass, E.; Skeie, G.; Engeset, D.; Quiros, J. R.; Zamora-Ros, R.; Sanchez, M.J.; Amiano, P.; Huerta, J. M.; Barricarte, A.; Johansen, D.; Lindkvist, B.; Sund, M.; Crowe, F.; Khaw, K. T.; Ferrari, P.; Romieu, I.; Chuang, S. C.; Riboli, E.; Jenab, M.; Werner, M.J.

    2013-01-01

    The type and quantity of dietary carbohydrate as quantified by glycemic index (GI) and glycemic load (GL), and dietary fiber may influence the risk of liver and biliary tract cancers, but convincing evidence is lacking. The association between dietary GI/GL and carbohydrate intake with hepatocellula

  13. Phenylethyl isothiocyanate reverses cisplatin resistance in biliary tract cancer cells via glutathionylation-dependent degradation of Mcl-1.

    Science.gov (United States)

    Li, Qiwei; Zhan, Ming; Chen, Wei; Zhao, Benpeng; Yang, Kai; Yang, Jie; Yi, Jing; Huang, Qihong; Mohan, Man; Hou, Zhaoyuan; Wang, Jian

    2016-03-01

    Biliary tract cancer (BTC) is a highly malignant cancer. BTC exhibits a low response rate to cisplatin (CDDP) treatment, and therefore, an understanding of the mechanism of CDDP resistance is urgently needed. Here, we show that BTC cells develop CDDP resistance due, in part, to upregulation of myeloid cell leukemia 1 (Mcl-1). Phenylethyl isothiocyanate (PEITC), a natural compound found in watercress, could enhance the efficacy of CDDP by degrading Mcl-1. PEITC-CDDP co-treatment also increased the rate of apoptosis of cancer stem-like side population (SP) cells and inhibited xenograft tumor growth without obvious toxic effects. In vitro, PEITC decreased reduced glutathione (GSH), which resulted in decreased GSH/oxidized glutathione (GSSG) ratio and increased glutathionylation of Mcl-1, leading to rapid proteasomal degradation of Mcl-1. Furthermore, we identified Cys16 and Cys286 as Mcl-1 glutathionylation sites, and mutating them resulted in PEITC-mediated degradation resistant Mcl-1 protein. In conclusion, we demonstrate for the first time that CDDP resistance is partially associated with Mcl-1 in BTC cells and we identify a novel mechanism that PEITC can enhance CDDP-induced apoptosis via glutathionylation-dependent degradation of Mcl-1. Hence, our results provide support that dietary intake of watercress may help reverse CDDP resistance in BTC patients.

  14. CT diagnosis of biliary tract diseases

    Energy Technology Data Exchange (ETDEWEB)

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

    1983-09-01

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

  15. Influence of Five Potential Anticancer Drugs on Wnt Pathway and Cell Survival in Human Biliary Tract Cancer Cells

    Directory of Open Access Journals (Sweden)

    Julia WACHTER, Daniel NEUREITER, Beate ALINGER, Martin PICHLER, Julia FUEREDER, Christian OBERDANNER, Pietro Di FAZIO, Matthias OCKER, Frieder BERR, Tobias KIESSLICH

    2012-01-01

    Full Text Available Background: The role of Wnt signalling in carcinogenesis suggests compounds targeting this pathway as potential anti-cancer drugs. Several studies report activation of Wnt signalling in biliary tract cancer (BTC thus rendering Wnt inhibitory drugs as potential candidates for targeted therapy of this highly chemoresistant disease.Methods: In this study we analysed five compounds with suggested inhibitory effects on Wnt signalling (DMAT, FH535, myricetin, quercetin, and TBB for their cytotoxic efficiency, mode of cell death, time- and cell line-dependent characteristics as well as their effects on Wnt pathway activity in nine different BTC cell lines.Results: Exposure of cancer cells to different concentrations of the compounds results in a clear dose-dependent reduction of viability for all drugs in the order FH535 > DMAT > TBB > myricetin > quercetin. The first three substances show high cytotoxicity in all tested cell lines, cause a direct cytotoxic effect by induction of apoptosis and inhibit pathway-specific signal transduction in a Wnt transcription factor reporter activity assay. Selected target genes such as growth-promoting cyclin D1 and the cell cycle progression inhibitor p27 are down- and up-regulated after treatment, respectively.Conclusions: Taken together, these data demonstrate that the small molecular weight inhibitors DMAT, F535 and TBB have a considerable cytotoxic and possibly Wnt-specific effect on BTC cell lines in vitro. Further in vivo investigation of these drugs as well as of new Wnt inhibitors may provide a promising approach for targeted therapy of this difficult-to-treat tumour.

  16. A randomized phase II trial of personalized peptide vaccine with low dose cyclophosphamide in biliary tract cancer.

    Science.gov (United States)

    Shirahama, Takahisa; Muroya, Daisuke; Matsueda, Satoko; Yamada, Akira; Shichijo, Shigeki; Naito, Masayasu; Yamashita, Takuto; Sakamoto, Shinjiro; Okuda, Koji; Itoh, Kyogo; Sasada, Tetsuro; Yutani, Shigeru

    2017-02-11

    Since the prognosis of advanced biliary tract cancer (aBTC) still remains very poor, new therapeutic approaches, including immunotherapies, need to be developed. In the current study, we conducted an open-label randomized phase II study to test whether low dose cyclophosphamide (CPA) could improve antigen-specific immune responses and clinical efficacy of personalized peptide vaccination (PPV) in 49 previously treated aBTC patients. Patients with aBTC refractory to at least one regimen of chemotherapies were randomly assigned to receive PPV with low dose CPA (100 mg/ day for 7 days before vaccination) (PPV/CPA, n=24) or PPV alone (n=25). A maximum of four HLA-matched peptides were selected based on the pre-existing peptide-specific IgG responses, followed by subcutaneous administration. T cell responses to the vaccinated peptides in the PPV/CPA arm tended to be greater than those in the PPV alone arm. The PPV/CPA arm showed significantly better progression-free survival (median time: 6.1 vs 2.9 months; hazard ratio (HR): 0.427; P = 0.008) and overall survival (median time: 12.1 vs 5.9 months; HR: 0.376; P = 0.004), compared to the PPV alone arm. The PPV alone arm, but not the PPV/CPA arm, showed significant increase in plasma IL-6 after vaccinations, which might be associated with inhibition of antigen-specific T cell responses. These results suggested that combined treatment with low dose CPA could provide clinical benefits in aBTC patients under PPV, possibly through prevention of IL-6-mediated immune suppression. Further clinical studies would be recommended to clarify the clinical efficacy of PPV/CPA in aBTC patients. This article is protected by copyright. All rights reserved.

  17. The correlation between LDH serum levels and clinical outcome in advanced biliary tract cancer patients treated with first line chemotherapy.

    Science.gov (United States)

    Faloppi, Luca; Del Prete, Michela; Casadei Gardini, Andrea; Santini, Daniele; Silvestris, Nicola; Bianconi, Maristella; Giampieri, Riccardo; Valgiusti, Martina; Brunetti, Oronzo; Bittoni, Alessandro; Andrikou, Kalliopi; Lai, Eleonora; Dessì, Alessandra; Cascinu, Stefano; Scartozzi, Mario

    2016-04-11

    LDH may represent an indirect marker of neo-angiogenesis and worse prognosis in many tumour types. We assessed the correlation between LDH and clinical outcome for biliary tract cancer (BTC) patients treated with first-line chemotherapy. Overall, 114 advanced BTC patients treated with first-line gemcitabine and cisplatin were included. Patients were divided into two groups (low vs. high LDH), according to pre-treatment LDH values. Patients were also classified according to pre- and post-treatment variation in LDH serum levels (increased vs. decreased). Median progression free survival (PFS) was 5.0 and 2.6 months respectively in patients with low and high pre-treatment LDH levels (p = 0.0042, HR = 0.56, 95% CI: 0.37-0.87). Median overall survival (OS) was 7.7 and 5.6 months (low vs. high LDH) (p = 0.324, HR = 0.81, 95% CI: 0.54-1.24). DCR was 71% vs. 43% (low vs. high LDH) (p = 0.002). In 38 patients with decreased LDH values after treatment, PFS and OS were respectively 6.2 and 12.1 months, whereas in 76 patients with post-treatment increased LDH levels, PFS and OS were respectively 3.0 and 5.1 months (PFS: p = 0.0009; HR = 0.49; 95% IC: 0.33-0.74; OS: p < 0.0001; HR = 0.42; 95% IC: 0.27-0.63). Our data seem to suggest that LDH serum level may predict clinical outcome in BTC patients receiving first-line chemotherapy.

  18. Biliary Tract Disorders, Gallbladder Disorders, and Gallstone Pancreatitis

    Science.gov (United States)

    ... of biliary disorders? What is the biliary tract? Enfermedades de la Vesicula y de la Via Biliar, ... Biliar - Ricardo Morgenstern, MD and Ruben Acosta, MD Enfermedades de la Vesicula y de la Via Biliar, ...

  19. Body Mass Index (BMI), Waist to Hip Ratio (WHR) and Risk of Biliary Tract Cancers: A Population-based Case-control Study in Shanghai, China

    Institute of Scientific and Technical Information of China (English)

    Xuehong Zhang; Ann W Hsing; Yutang Gao; Asif Rashid; Jie Deng; Enju Liu; Kai Wu; Lu Sun; Jiarong Cheng; Gloria Gridley

    2005-01-01

    OBJECTIVE To investigate the relationship between BMI, WHR and billary tract cancers (CBT).METHODS A population-based case-control study was conducted in urban Shanghai from June 1, 1997 to May 31, 2001 involving interviews with 627 new cases of biliary tract cancers aged 35 to 74 years and 959frequency-matched population controls by gender and age in five-year groups. All subjects were interviewed in person by trained interviewers using a structured questionnaire. An unconditional logistic regression was performed to calculate adjusted odds ratios (Ors) and 95% confidence intervals (Cis).RESULTS Obesity was associated with an increased risk of gallbladder cancer across adulthood at ages 20-29 and 30-39 in females. Compared with subjects in the lowest quartile of WHR, Ors for the highest quartile and P for trend for cancers of gallbladder and extrahepatic bile duct both reached significant levels among males and females.CONCLUSION Our observations in urban Shanghai suggested that obesity in early adult life may contribute to the risk of gallbladder cancer, and increased WHR may substantially elevated risk of cancers of the gallbladder and extrahepatic bile duct.

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

    Science.gov (United States)

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

    2016-01-01

    Biliary bacteria have been implicated in gallstone pathogenesis, though a clear understanding of their composition and source is lacking. Moreover, the effects of the biliary environment, which is known to be generally hostile to most bacteria, on biliary bacteria are unclear. Here, we investigated the bacterial communities of the biliary tract, duodenum, stomach, and oral cavity from six gallstone patients by using 16S rRNA amplicon sequencing. We found that all observed biliary bacteria were detectable in the upper digestive tract. The biliary microbiota had a comparatively higher similarity with the duodenal microbiota, versus those of the other regions, but with a reduced diversity. Although the majority of identified bacteria were greatly diminished in bile samples, three Enterobacteriaceae genera (Escherichia, Klebsiella, and an unclassified genus) and Pyramidobacter were abundant in bile. Predictive functional analysis indicated enhanced abilities of environmental information processing and cell motility of biliary bacteria. Our study provides evidence for the potential source of biliary bacteria, and illustrates the influence of the biliary system on biliary bacterial communities.

  1. FXR agonists enhance the sensitivity of biliary tract cancer cells to cisplatin via SHP dependent inhibition of Bcl-xL expression

    Science.gov (United States)

    Wang, Wei; Zhan, Ming; Li, Qi; Chen, Wei; Chu, Huiling; Huang, Qihong; Hou, Zhaoyuan; Man, Mohan; Wang, Jian

    2016-01-01

    Chemoresistance is common in patients with biliary tract cancer (BTC) including gallbladder cancer (GBC) and cholangiocarcinoma (CC). Therefore, it is necessary to identify effective chemotherapeutic agents for BTC. In the present study, we for the first time tested the effect of farnesoid X receptor (FXR) agonists GW4064 and CDCA (chenodeoxycholic acid) in combination with cisplatin (CDDP) on increasing the chemosensitivity in BTC. Our results show that co-treatment of CDDP with FXR agonists remarkably enhance chemosensitivity of BTC cells. Mechanistically, we found that activation of FXR induced expression of small heterodimer partner (SHP), which in turn inhibited signal transducer and activator of transcription 3 (STAT3) phosphorylation and resulted in down-regulation of Bcl-xL expression in BTC cells, leading to increased susceptibility to CDDP. Moreover, the experiments on tumor-bearing mice showed that GW4064/CDDP co-treatment inhibited the tumor growth in vivo by up-regulating SHP expression and down-regulating STAT3 phosphorylation. These results suggest CDDP in combination with FXR agonists could be a potential new therapeutic strategy for BTC. PMID:27127878

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

    Science.gov (United States)

    Foley, W Dennis; Quiroz, Francisco A

    2007-06-01

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

  3. Primary Sclerosing Cholangitis as a Premalignant Biliary Tract Disease: Surveillance and Management.

    Science.gov (United States)

    Rizvi, Sumera; Eaton, John E; Gores, Gregory J

    2015-11-01

    Primary sclerosing cholangitis (PSC) is a premalignant biliary tract disease that confers a significant risk for the development of cholangiocarcinoma (CCA). The chronic biliary tract inflammation of PSC promotes pro-oncogenic processes such as cellular proliferation, induction of DNA damage, alterations of the extracellular matrix, and cholestasis. The diagnosis of malignancy in PSC can be challenging because inflammation-related changes in PSC may produce dominant biliary tract strictures mimicking CCA. Biomarkers such as detection of methylated genes in biliary specimens represent noninvasive techniques that may discriminate malignant biliary ductal changes from PSC strictures. However, conventional cytology and advanced cytologic techniques such as fluorescence in situ hybridization for polysomy remain the practice standard for diagnosing CCA in PSC. Curative treatment options of malignancy arising in PSC are limited. For a subset of patients selected by using stringent criteria, liver transplantation after neoadjuvant chemoradiation is a potential curative therapy. However, most patients have advanced malignancy at the time of diagnosis. Advances directed at identifying high-risk patients, early cancer detection, and development of chemopreventive strategies will be essential to better manage the cancer risk in this premalignant disease. A better understanding of dysplasia definition and especially its natural history is also needed in this disease. Herein, we review recent developments in our understanding of the risk factors, pathogenic mechanisms of PSC associated with CCA, as well as advances in early detection and therapies.

  4. Personalized peptide vaccination for advanced biliary tract cancer: IL-6, nutritional status and pre-existing antigen-specific immunity as possible biomarkers for patient prognosis.

    Science.gov (United States)

    Yoshitomi, Munehiro; Yutani, Shigeru; Matsueda, Satoko; Ioji, Tetsuya; Komatsu, Nobukazu; Shichijo, Shigeki; Yamada, Akira; Itoh, Kyogo; Sasada, Tetsuro; Kinoshita, Hisafumi

    2012-03-01

    Considering that the prognosis of patients with advanced biliary tract cancer (BTC) remains very poor, with a median survival of less than 1 year, new therapeutic approaches need to be developed. In the present study, a phase II clinical trial of personalized peptide vaccination (PPV) was conducted in advanced BTC patients to evaluate the feasibility of this treatment and to identify potential biomarkers. A maximum of 4 human leukocyte antigen-matched peptides, which were selected based on the pre-existing host immunity prior to vaccination, were subcutaneously administered (weekly for 6 consecutive weeks and bi-weekly thereafter) to 25 advanced BTC patients without severe adverse events. Humoral and/or T cell responses specific to the vaccine antigens were substantially induced in a subset of the vaccinated patients. As shown by multivariate Cox regression analysis, lower interleukin-6 (IL-6) and higher albumin levels prior to vaccination and greater numbers of selected vaccine peptides were significantly favorable factors for overall survival [hazard ratio (HR)=1.123, 95% confidence interval (CI) 1.008-1.252, P=0.035; HR=0.158, 95% CI 0.029-0.860, P=0.033; HR=0.258, 95% CI 0.098-0.682, P=0.006; respectively]. Based on the safety profile and substantial immune responses to vaccine antigens, PPV could be a promising approach for refractory BTC, although its clinical efficacy remains to be investigated in larger-scale prospective studies. The identified biomarkers are potentially useful for selecting BTC patients who would benefit from PPV.

  5. Advanced biliary tract cancer: clinical outcomes with ABC-02 regimen and analysis of prognostic factors in a tertiary care center in the United States

    Science.gov (United States)

    Agarwal, Rishi; Sendilnathan, Arun; Siddiqi, Nabeela Iffat; Gulati, Shuchi; Ghose, Abhimanyu; Xie, Changchun

    2016-01-01

    Background Gemcitabine plus cisplatin (GC) is currently the standard regimen for advanced biliary tract cancers (BTC) based on the outcomes in ABC-02 trial. Multiple factors can affect outcomes in these patients. This retrospective review evaluates the University of Cincinnati experience with GC in advanced intrahepatic (IHC)/extrahepatic cholangiocarcinoma (EHC) and gall bladder carcinoma (GBC). Methods In this study approved by University of Cincinnati IRB, retrospective analysis of advanced BTC patients seen between 01/2008 and 01/2015 was done. Kaplan Meyer method was used to calculate progression free survival (PFS), and overall survival (OS). Cox model was used to test the association between baseline variables and OS/PFS, adjusting for gender and age at diagnosis. Patients were identified using ICD code for BT tumors, 26 patients met inclusion criteria: histologically proven advanced BTC that received GC as their initial chemotherapy. GC was given as per ABC-02 protocol with appropriate modifications until disease progression or unacceptable toxicities. Results Median age at diagnosis was 62 years (range, 31–81 years). Eighteen (69%) were IHC, 5 EHC, 3 GBC, 61% male, 73% whites. Performance status (PS): 0–1: 69%, PS 2: 31%. Baseline CA19-9 data was available for 21 patients, (range 1 to 69,543), and abnormal CA19-9 was seen in 14 patients (54%). PFS was 4.5 months (95% CI: 3.1–8.9 months) and OS was 10.5 months (95% CI: 7.9–18.8 months). OS at 6 and 12 months was 69% (18/26) and 42% (11/26). Thirty-eight percent (10/26) received 2nd line chemotherapy, of these 9/10 received 5FU based chemotherapy. Eleven percent (3/26) received 3rd line chemotherapy. Increase in baseline carcinoembryonic antigen (CEA), alanine aminotransferase, alkaline phosphatase (ALP) and total bilirubin was associated with increased risk of death while increase in baseline CEA and ALP was associated with increased risk of progression (P valve 3, and stage IVb), the median

  6. Activation or suppression of the immune response mediators in biliary tract cancer (BTC) patients: a systematic review and meta-analysis

    Science.gov (United States)

    Wang, Ying; Ding, Min; Zhang, Qian; Wang, Jinghan; Yang, Xijing; Zhou, Fuping; Li, Linfang; Yuan, Zhengang; Jin, Huajun; Qian, Qijun

    2017-01-01

    Background: Infiltration of immune cells and immune microenvironment determine the proliferative activity of the tumor and metastasis. The aim of this study was to analyze the influence of activation or suppression of the immune response mediators on the prognosis of biliary tract cancer (BTC). Methods: We searched Pubmed, Web of Science, Embase and The Cochrane Library for relevant literatures until June 2016. The quality of studies was assessed by QUADAS-2 and NOS tools. Forest and funnel plots and all statistical analyses were generated by using Review Manager 5.3. The bias of included studies was estimated by Egger's test using Meta R package. Results: A total of 2339 patients from 12 studies were finally enrolled in this meta-analysis. Patients with high expression of immune active factors, intraepithelial tumor-infiltrating CD4+ , CD8+, and Foxp3+ T lymphocytes, MHC I, NKG2D, showed a better overall survival (OS) than those with low expression (HR=0.52, 95% CI=0.41-0.67, P<0.00001). On the contrary, the high expression of immune suppressive factors (CD66b+ neutrophils, Neutrophil-lymphocyte ratio, Intratumoral IL-17+ cells and PD-1+/CD8+ TILs) was significantly associated with poor OS (HR=1.79, 95% CI=1.44-2.22, P<0.00001). A further analysis of therapies targeting tumor microenvironment modulation showed that the median progression free survival (PFS) for BTC patients who received adjuvant immunotherapy was longer than those who received surgery or chemotherapy alone, and the estimated pooled mean difference demonstrated a highly significant improvement (MD =2.33; 95% CI: 0.63-4.02, P=0.007). The total effect of PFS and OS was statistically longer in experimental group, compared to patients in control groups, respectively (PFS: RR=1.25; 95% CI: 1.08-1.46, P=0.004; OS: RR=1.16; 95% CI: 1.07-1.27, P=0.0006). In subgroup meta-analysis of studies on 6-, 12- and 18-month PFS and OS, it showed that adjuvant immunotherapy could improve the 6-month PFS (RR=1.23; 95

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1998-09-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2006-01-01

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

  9. Cryptosporidiosis of the biliary tract mimicking pancreatic cancer in an AIDS patient Criptosporidiose do trato biliar simulando câncer do pâncreas em paciente com AIDS

    Directory of Open Access Journals (Sweden)

    Lenice do Rosário de Souza

    2004-03-01

    Full Text Available Diarrhea caused by Cryptosporidium sp is frequent in patients with AIDS, but involvement of other organs of the digestive tract is uncommon. We report a case of Cryptosporidium-associated obstruction of the biliary tract mimicking cancer of the head of the pancreas in a 43-year-old woman with AIDS.A diarréia causada pelo Cryptosporidium sp é muito freqüente em pacientes com AIDS, mas o envolvimento de outros órgãos do aparelho digestivo é incomum. Relata-se o caso de uma mulher de 43 anos, que tinha AIDS, que apresentava obstrução das vias biliares associada ao Cryptosporidium, simulando câncer da cabeça do pâncreas.

  10. Simultaneous blockade of the epidermal growth factor receptor/mammalian target of rapamycin pathway by epidermal growth factor receptor inhibitors and rapamycin results in reduced cell growth and survival in biliary tract cancer cells.

    Science.gov (United States)

    Herberger, Beata; Berger, Walter; Puhalla, Harald; Schmid, Katharina; Novak, Sabine; Brandstetter, Anita; Pirker, Christine; Gruenberger, Thomas; Filipits, Martin

    2009-06-01

    The prognosis of patients with biliary tract adenocarcinomas (BTA) is still poor due to lack of effective systemic treatment options. Knowledge of the molecular mechanisms involved in the pathogenesis of this disease is of importance for the development of new treatment strategies. We determined the expression of epidermal growth factor receptor (EGFR) and activated mammalian target of rapamycin (p-mTOR) in paraffin-embedded surgical specimens of BTA (n = 89) by immunohistochemistry. Overall survival was analyzed with Cox models adjusted for clinical and pathologic factors. Combined EGFR/p-mTOR expression was significantly associated with relapse-free survival [adjusted hazard ratio for relapse, 2.20; 95% confidence interval (95% CI), 1.45-3.33; P BTA cell lines was tested in short-term 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays and long-term colony formation assays. Simultaneous blockade of EGFR and mTOR in biliary tract cancer cell lines results in a synergistic inhibition of both phosphatidylinositol-3-kinase and mitogen-activated protein kinase pathways, leading to reduced cell growth and survival. These results suggest that combined targeted therapy with EGFR and mTOR inhibitors may potentially benefit patients with BTAs and should be further evaluated in clinical trials.

  11. [The estimation of antioxidative vitamins concetrations in blood plasma of patients with neoplasms of gallblader and biliary tract].

    Science.gov (United States)

    Drozda, Rafał; Grzegorczyk, Krzysztof; Rutkowski, Maciej; Smigielski, Jacek; Kołomecki, Krzysztof

    2007-05-01

    Gallbladder and biliary tract cancer is a serious clinical problem. In-spite of wide range of new diagnostic and therapeutic methods, the significant improvement of treatment results, has not been noticed so far. The research about prevention methods, seems to be important, among the ways of improvement of the diagnosis and therapy outcomes of these diseases. It is related for example to study about one of the cause of biliary tract carcinogenesis--the imbalance between production of reactive oxygen species (ROS) and their inactivation by the antioxidative barrier. One of the components of this organism protection complex are antioxidative vitamins. The aim of this study was to measure the concentration of antioxidative vitamins (A, C, E, and beta-carotene) in serum, in patients with cancer of gallbladder and and biliary tract, in comparison to the results of healthy volunteers. The study groups comprised of 56 patients, both sexes with acute and chronic cholecystitis and with above-mentioned neoplasmas. The results shoved, that concentration of antioxidative vitamins in serum of patients with gallbladder and biliary tract cancer, was significantly decreased. The outcomes of this research, seem to confirm the participation of antioxidative barrier in inhibition of carcinogenesis of in those important parts of digestive system.

  12. Overexpression of β3/γ2 chains of laminin-5 and MMP7 in biliary cancer

    Institute of Scientific and Technical Information of China (English)

    Toshikuni Oka; Hiroyuki Yamamoto; Shigeru Sasaki; Masanori Ii; Keiichi Hizaki; Hiroaki Taniguchi; Yasushi Adachi; Kohzoh Imai; Yasuhisa Shinomura

    2009-01-01

    AIM: To clarify the clinicopathological significance of laminin-5 γ2 (LNγ2) and β3 (LNβ3) chains and MMP7 expression in biliary tract cancer.METHODS: We analyzed the association between immunohistochemically detected LNγ2, LNβ3, and MMP7 expression in biliary tract cancer and clinicopathological characteristics. Activity of MMP7 was analyzed by casein zymography. An in vitro invasion assay after treatment with MMP7-specific siRNA was performed. RESULTS: LNγ2 expression was predominantly observed in carcinoma cells at the invasive front. LNγ2 expression was seen in 57% of patients with biliary tract cancer, and was associated with depth of invasion,histologic type, and advanced stage. The expression pattern of LNβ3 was classified into two types: invasive front dominant type (38%) and diffuse type (28%).The invasive front dominant type was associated with histologic type and advanced stage. MMP7 positivity was correlated with LNγ2 or LNβ3 expression but not with clinicopathological characteristics. Active MMP7 detected by casein zymography was correlated with depth of invasion and advanced stage. Downregulation of MMP7 expression by siRNA resulted in a significant decrease in biliary tract cancer cell invasion in vitro.CONCLUSION: Our results suggest that LNγ2 and LNβ3, in conjunction with MMP7, play a key role in the progression of biliary tract cancer.

  13. Biliary peritonitis due to fistulous tract rupture following a T-tube removal.

    Science.gov (United States)

    Sakorafas, George H; Stafyla, Vania; Tsiotos, Gregory G

    2005-06-24

    We present a patient with biliary peritonitis following a T-tube removal. The patient underwent laparotomy; a rupture of the fistulous tract around the T-tube was found. A Nelaton catheter was inserted through this opening and advanced toward the biliary tree and secured in place by a suture ligature. Postoperative course was uneventful.

  14. Immunotherapeutic approaches in biliary tract carcinoma:Current status and emerging strategies

    Institute of Scientific and Technical Information of China (English)

    Eric; I; Marks; Nelson; S; Yee

    2015-01-01

    For biliary tract carcinoma(BTC),complete surgical resection of tumor is only feasible in a minority of patients,and the treatment options for patients with unresectable or metastatic disease are limited.Advances in cancer immunology have led to identification of tumor-infiltrating immune cells as indicators of prognosis and response to treatment in BTC.This has also facilitated development of immunotherapy that focuses on enhancing the immune system against biliary tumors.This includes peptide- and dendritic cell-based vaccines that stimulate in-vivo immune responses against tumorspecific antigens.Adoptive immunotherapy,which entails the ex-vivo expansion of tumor-infiltrating immune cells for subsequent reintroduction,and cytokinebased therapies have been developed in BTC.Clinical studies indicate that this type of therapy is generally well tolerated.Combination therapy with dendritic cell-based vaccines and adoptive immunotherapy has shown particularly good potential.Emerging strategies through discovery of novel antigen targets and by reversal of tumor-associated immunosuppression are expected to improve the efficacy of immunotherapy in BTC.Collaborative efforts by integration of targeted immunotherapeutics with molecular profiling of biliary tumor will hopefully make a positive impact on advancing towards the goal of developing precision treatment of patients with this highly lethal disease.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-01-15

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

  16. ADH-1, Gemcitabine Hydrochloride and Cisplatin in Treating Patients With Metastatic Pancreatic or Biliary Tract Cancer That Cannot Be Removed By Surgery

    Science.gov (United States)

    2013-05-07

    Acinar Cell Adenocarcinoma of the Pancreas; Adenocarcinoma of the Gallbladder; Adult Primary Cholangiocellular Carcinoma; Advanced Adult Primary Liver Cancer; Cholangiocarcinoma of the Gallbladder; Duct Cell Adenocarcinoma of the Pancreas; Localized Unresectable Adult Primary Liver Cancer; Periampullary Adenocarcinoma; Recurrent Adult Primary Liver Cancer; Recurrent Gallbladder Cancer; Recurrent Pancreatic Cancer; Stage II Gallbladder Cancer; Stage III Pancreatic Cancer; Stage IIIA Gallbladder Cancer; Stage IIIB Gallbladder Cancer; Stage IV Pancreatic Cancer; Stage IVA Gallbladder Cancer; Stage IVB Gallbladder Cancer

  17. 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.

  18. Biliary tract injury caused by different relative warm ischemia time in liver transplantation in rats

    Institute of Scientific and Technical Information of China (English)

    Hong-Feng Zhao; Guo-Wei Zhang; Jie Zhou; Jian-Hua Lin; Zhong-Lin Cui; Xiang-Hong Li

    2009-01-01

    BACKGROUND: There is a controversy over the degree of liver and biliary injury caused by the period of secondary warm ischemia. A liver autotransplantation model was adopted because it excludes the effects of infection and immunological rejection on bile duct injury. This study was undertaken to assess biliary tract injury caused by relative warm ischemia (secondary warm ischemia time in the biliary tract) and reperfusion. METHODS: One hundred and two rats were randomly divided into 5 groups: groupⅠ (control); groupsⅡ toⅤ, relative warm ischemia times of 0 minute, 30 minutes, 1 hour and 2 hours. In addition to the levels of serum alkaline phosphatase, and total bilirubin, pathomorphology assessment and TUNEL assay were performed to evaluate biliary tract damage. RESULTS: Under the conditions that there were no signiifcant differences in warm ischemia time, cold perfusion time and anhepatic phase, group comparisons showed statistically signiifcant differences. The least injury occurred in groupⅡ (portal vein and hepatic artery reperfused simultaneously) but the most severe injury occurred in groupⅤ (biliary tract relative warm ischemia time 2 hours). CONCLUSIONS: Relative warm ischemia is one of the factors that result in bile duct injury, and the relationship between relative warm ischemia time the bile injury degree is time-dependent. Simultaneous arterial and portal reperfusion is the best choice to avoid the bile duct injury caused by relative warm ischemia.

  19. The rise of the FGFR inhibitor in advanced biliary cancer: the next cover of time magazine?

    Science.gov (United States)

    Rizvi, Sumera; Borad, Mitesh J

    2016-10-01

    Cholangiocarcinomas (CCAs) are heterogeneous tumors arising from the biliary tract with features of cholangiocyte differentiation. CCAs are aggressive tumors with limited treatment options and poor overall survival. Only a subset of CCA patients with early stage disease can avail potentially curative treatment options. For advanced biliary tract tumors, currently there are limited effective treatment modalities. Recent advances have provided greater insight into the genomic landscape of CCAs. The fibroblast growth factor receptor (FGFR) pathway is involved in key cellular processes essential to survival and differentiation. Accordingly, aberrant FGFR signaling has significant oncogenic potential. Recent discovery of FGFR2 gene fusions in CCA has heightened interest in FGFR inhibition in advanced biliary tract cancer. These findings have served as a catalyst for ongoing clinical investigation of FGFR inhibition in CCA patients with various FGFR signaling abnormalities. Herein, we review FGFR aberrations in CCA and their prognostic implications, FGFR targeting as a viable therapeutic option in advanced biliary tract malignancies, and future directions for development of combination approaches utilizing FGFR inhibition.

  20. Empirical antibiotic treatment with piperacillin-tazobactam in patients with microbiologically-documented biliary tract infections

    Institute of Scientific and Technical Information of China (English)

    Gabrio Bassotti; Fabio Chistolini; Francis Sietchiping-Nzepa; Giuseppe de Roberto; Antonio Morelli

    2004-01-01

    AIM: To report our experience with empiric antimicrobial monotherapy (piperacillin/tazobactam, of which no data are available in such specific circumstances) in microbiologically-documented infections in patients with benign and malignant conditions of the biliary tract.METHODS: Twenty-three patients, 10 with benign and 13 with malignant conditions affecting the biliary tree and microbiologically-documented infections were recruited and the efficacy of empirical antibiotic therapy was assessed.RESULTS: The two groups featured similar demographic and clinical data. Overall, the infective episodes were most due to Gram negative agents, more than 60% of such episodes (mostly in malignant conditions) were preceded by invasive instrumental maneuvers. Empirical antibiotic therapy with a single agent (piperacillin/tazobactam) was effective in more than 80% of cases. No deaths were reported following infections.CONCLUSION: An empiric therapeutic approach with piperacillin/tazobactam is highly effective in biliary tract infections due to benign or malignant conditions.

  1. Predominant association of Raoultella bacteremia with diseases of the biliary tract.

    Science.gov (United States)

    de Jong, Eefje; Erkens-Hulshof, Sandra; van der Velden, Lieven B J; Voss, Andreas; Bosboom, Ron; Hodiamont, Caspar J; Wever, Peter C; Rentenaar, Rob J; Sturm, Patrick D

    2014-02-01

    A case series of 14 patients with Raoultella bacteremia was compared with 28 Klebsiella oxytoca and 28 Klebsiella pneumoniae bacteremia cases. Forty-three percent of Raoultella bacteremia cases were associated with biliary tract disease, compared to 32% and 22% of patients with K. oxytoca and K. pneumoniae bacteremia, respectively.

  2. Predominant association of Raoultella bacteremia with diseases of the biliary tract

    NARCIS (Netherlands)

    Jong, Eefje de; Erkens-Hulshof, S.; Velden, L.B. van der; Voss, A.; Bosboom, R.; Hodiamont, C.J.; Wever, P.C.; Rentenaar, R.J.; Sturm, P.D.J.

    2014-01-01

    A case series of 14 patients with Raoultella bacteremia was compared with 28 Klebsiella oxytoca and 28 Klebsiella pneumoniae bacteremia cases. Forty-three percent of Raoultella bacteremia cases were associated with biliary tract disease, compared to 32% and 22% of patients with K. oxytoca and K. pne

  3. Acute Pancreatitis due to Rupture of the Hydatid Cyst into the Biliary Tract: A Case Report

    Directory of Open Access Journals (Sweden)

    Zulfu Bayhan

    2014-02-01

    Full Text Available Hydatid disease is still endemic in our country and in many parts of the world. Liver is the most common site of hydatid disease. Rupture of hydatid cysts of liver into the biliary ducts can be seen as a complication. Obstructive jaundice, acute cholangitis and much more rarely acute pancreatitis may occur due to rupture of hydatid cysts into the biliary ducts. In this case report, a 38-year-old male patient with findings of acute pancreatitis and obstructive jaundice due to rupture of hydatid cyst into the biliary tract were presented . In our case, Endoscopic retrograde cholangiopancreatography (ERCP was performed to the patient with diagnostic and therapeutic purposes. Parts of germinative membrane located within the common bile duct and causing the obstruction of papillary orifice was seen in ERCP. Germinative membrane components were removed during the process. Endoscopic sphincterotomy was performed to the patient. After the procedure, the clinical findings and laboratory findings of the patient returned to normal rapidly. As a result, it should be noted that rupture of hepatic hydatid cysts into the bile ducts might be a rare cause of biliary pancreatitis. It must be kept in mind that endoscopic sphincterotomy and endoscopic removal of cyst membranes is a very important method for the diagnosis and treatment of the acute pancreatitis and obstructive jaundice due to rupture of hydatid cyst into the biliary tract. [Natl J Med Res 2014; 4(1.000: 92-94

  4. Rationale diagnostic approach to biliary tract imaging; Rationale Diagnostik der Gallenwege

    Energy Technology Data Exchange (ETDEWEB)

    Helmberger, H.; Huppertz, A.; Ruell, T. [Technische Univ. Muenchen (Germany). Inst. fuer Roentgendiagnostik; Zillinger, C.; Ehrenberg, C.; Roesch, T. [Technische Univ. Muenchen (Germany). 2. Medizinische Klinik und Poliklinik

    1998-04-01

    Since the introduction of MR cholangiography (MRC) diagnostic imaging of the biliary tract has been significantly improved. While percutaneous ultrasonography is still the primary examination, computed tomography (CT), conventional magnetic resonance imaging (MRI), as well as the direct imaging modalities of the biliary tract - iv cholangiography, endoscopic-retrograde-cholangiography (ERC), and percutaneous-transhepatic-cholangiography (PTC) are in use. This article discusses the clinical value of the different diagnostic techniques for the various biliary pathologies with special attention to recent developments in MRC techniques. An algorithm is presented offering a rational approach to biliary disorders. With further technical improvement shifts from ERC(P) to MRC(P) for biliary imaging could be envisioned, ERCP further concentrating on its role as a minimal invasive treatment option. (orig.) [Deutsch] Die Diagnostik der Gallenwege hat durch die Einfuehrung der MR-Cholangiographie (MRC) entscheidende neue Impulse erfahren. Neben der als Ausgangsuntersuchung zur Verfuegung stehenden perkutanen Sonographie kommen die Computertomographie (CT), die klassische Magnetresonanztomographie (MRT) sowie die Verfahren der direkten Gallengangsdarstellung, i.v. Cholangiographie, endoskopisch-retrograde Cholangiographie (ERC) und perkutane-transhepatische Cholangiographie (PTC), zum Einsatz. Der vorliegende Artikel analysiert die diagnostischen Wertigkeiten der einzelnen bildgebenden Verfahren fuer die unterschiedlichen Krankheitsgruppen des biliaeren Systems unter besonderer Beruecksichtigung der neuesten Entwicklungen auf dem Gebiet der MRC. In einem Strategiealgorithmus wird ein Vorschlag fuer das diagnostische Vorgehen bei Erkrankungen des biliaeren Gangsystems erarbeitet. Die bisherigen Ergebnisse lassen erwarten, dass die MRT einschliesslich MRC(P) in Kuerze die rein diagnostische ERC(P) ersetzen wird. (orig.)

  5. Expression of Bcl-2 and Bax in extrahepatic biliary tract carcinoma and dysplasia

    Institute of Scientific and Technical Information of China (English)

    Sheng-Mian Li; Shu-Kun Yao; Nobuyoshi Yamamura; Toshitsugu Nakamura

    2003-01-01

    AIM: To compare the difference of expression of Bcl-2 and Bax in extrahepatic biliary tract carcinoma and dysplasia, and to analyze the role of Bcl-2 and Bax proteins in the progression from dysplasia to carcinoma and to evaluate the correlation of Bcl-2/Bax protein expression with the biological behaviors.METHODS: Expressions of Bcl-2 and Bax were examined immunohistochemically in 27 cases of extrahepatic biliary tract carcinomas (bile duct carcinoma: n=21, carcinoma of ampulla of Vater: n=6), and 10 cases of atypical dysplasia.Five cases of normal biliary epithelial tissues were used as controls. A semiquantitative scoring system was used to assess the Bcl-2 and Bax reactivity.RESULTS: The expression of Bd-2 was observed in 10 out of 27 (37.0 %) invasive carcinomas, 1 out of 10 clysplasias, none out of 5 normal epithelial tissues. Bax expression rate was 74.1% (20/27) in invasive carcinoma, 30 % (3/10) in dysplasia,and 40 % (2/5) in normal biliary epithelium. Bcl-2 and Bax activities were more intense in carcinoma than in dysplasia,with no significant difference in Bcl-2 expression (P=0.1:10),and significant difference in Bax expression (P=0.038). Level of Bax expression was higher in invasive carcinoma than in dysplasia and normal tissue (P=0.012). Bcl-2 expression was correlated to Bax expression (P=0.0059). However, Bcl-2/Bax expression had no correlation with histological subtype,grade of differentiation, or level of invasion.CONCLUSION: Increased Bcl-2/Bax expression from dysplasia to invasive tumors supports the view that this is the usual route for the development of extrahepatic biliary tract carcinoma. Bcl-2/Bax may be involved, at least in part,in the apoptotic activity in extrahepatic biliary carcinoma.

  6. [Disturbances of gastrointestinal motility of the stomach in patients with chronic gastric erosions and biliary tract disease].

    Science.gov (United States)

    Svintsitskyĭ, A S; Solovĭova, H A

    2012-12-01

    Article dwells on comparison data about motor function of the stomach in the three groups of patients: with gastric erosions and biliary tract diseases, duodenal ulcer disease, chronic gastritis. It is shown, that patients with gastric erosions and biliary tract diseases are characterized by slower evacuation function of the stomach, hypotonus of the stomach. Frequency of duodenal reflux in this group of patients is very high (85,9 %).

  7. Primary cancers of extrahepatic biliary passages

    Energy Technology Data Exchange (ETDEWEB)

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

    1985-04-01

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

  8. Primary cancers of extrahepatic biliary passages.

    Science.gov (United States)

    Mittal, B; Deutsch, M; Iwatsuki, S

    1985-04-01

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

  9. Prognostic relevance of circulating CK19 mRNA in advanced malignant biliary tract diseases

    Institute of Scientific and Technical Information of China (English)

    Kawin Leelawat; Siriluck Narong; Wandee Udomchaiprasertkul; Jerasak Wannaprasert; Sa-ard Treepongkaruna; Somboon Subwongcharoen; Tawee Ratanashu-ek

    2012-01-01

    AIM: To determine the role of circulating tumor cells (CTCs) in prediction of the overall survival of patients with advanced malignant biliary tract obstruction. METHODS: We investigated the prognostic value of CTCs by examining two markers, cytokeratin (CK) 19 and human telomerase reverse transcriptase (hTERT) mRNA, in 40 patients diagnosed with advanced malignant biliary tract diseases. Quantitative real-time reverse transcription polymerase chain reaction was used to detect CK19 and hTERT mRNA in the peripheral blood of these patients. Overall survival was analyzed using the Kaplan-Meier method and Cox regression modeling. RESULTS: Positive CK19 and hTERT mRNA expression was detected in 45% and 60%, respectively, of the 40 patients. Univariable analysis indicated that positive CK19 mRNA expression was significantly associated with worse overall survival (P = 0.009). Multivariable analysis determined that positive CK19 mRNA expression, patient's age and serum bilirubin were each independently associated with overall survival. CONCLUSION: CK19 mRNA expression levels in peripheral blood appear to provide a valuable marker to predict the overall survival of patients with advanced malignant biliary tract obstruction.

  10. Frequency of Loss Exprssion of DPC4 Protein in Various Locations of Biliary Tract Carcinoma

    Institute of Scientific and Technical Information of China (English)

    TANGZhahohui; HAOYouhua; 等

    2002-01-01

    Objective To clarify the relationship between loss of expression of DPC4 proteins and pathogenesis of biliary tract carcinoma. Methods 71 primary biliary tract carcinomas(BTCa),including 38 common bile duct(CBD) carcinomas,18 gallbladder carcinomas,and 15 hilar bile ducts(HBD) carcinomas were examined by immunohistochemical staining .In addition,the CBD carcinomas were divid-ed into two groups,a trmor group with metastasis(M+ group ,27 cases)and a tumor group without metastasis(M-group,11 cases). Results The frequency of loss expression of DPC4 protein was 32.8% in BTCa ,47.3% in CBD carcinoma ,11% in gallbladder carcino-ma and 13% in HBD carcinoma.A comparison of the frequency of loss expression of DPC4 showed singnificantly statistical difference in the CBD carcinoma versus gallbladder carcinoma and HBD carcinoma (P0.05). Conclusion There is a close relationship between the pathogenesis of BTCa and inactivation of DPC4 with different frequencies of DPC4 gene alteration in various locations of the biliary tract,but inactivation of DPC4 is not related with tumor metastasis in BTCa.

  11. Sulphate-bicarbonate mineral waters in the treatment of biliary and digestive tract diseases.

    Science.gov (United States)

    Fraioli, A; Menunni, G; Petraccia, L; Fontana, M; Nocchi, S; Grassi, M

    2010-01-01

    The authors point out the therapeutic properties of sulphate-bicarbonate mineral waters. After summarizing the general mechanism of action of mineral waters, the main indications of such waters in thermal treatment are examined including: biliary sand, biliary dyskinesia, functional dyspepsia, irritable colon, chronic primitive constipation. The dysfunctions of biliary and digestive tracts are growing, mainly in the affluent world, because of the increase for stress, dietary habits, modern life style. Now they affect from 2,4% of general population to 7% of men and 20% of women, according to different studies. Mineral waters can improve symptoms and care some physiopathological underlying mechanisms. Authors stress the efficacy of sulphate-bicarbonate mineral waters in the therapy of biliary dyskinesias, namely gallbladder hypokinesia and Oddi's sphincter spasm, caused by their content in SO4 = anion and Mg++ cation and related effects on paracrine-endocrine gastrointestinal system. In addition, they report the effects of sulphate-bicarbonate mineral waters in the lithogenic bile (sand bile), because of their diluting and washing activity. Among the sulphate-bicarbonate mineral waters, the Authors outline the well-documented therapeutic activity of Acqua Santa and Fucoli of Chianciano Terme. Acqua Santa has stimulating effect on cholecystis's motility, as proved by controlled clinical trials. Finally, the therapeutic use of sulphate-bicarbonate mineral water is discussed in functional dyspepsia, chronic primitive constipation and irritable bowel syndrome.

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

    Directory of Open Access Journals (Sweden)

    Raveendran Subhash

    2014-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2005-01-01

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

  14. A randomised phase II trial of weekly high-dose 5-fluorouracil with and without folinic acid and cisplatin in patients with advanced biliary tract carcinoma: results of the 40955 EORTC trial.

    NARCIS (Netherlands)

    Ducreux, M.; Cutsem, E. van; Laethem, J. van; Gress, T.M.; Jeziorski, K.; Rougier, P.; Wagener, T.; Anak, O.; Baron, B.; Nordlinger, B.

    2005-01-01

    Previous small phase II trials have demonstrated that the combination of 5-fluorouracil (5FU) and cisplatin(CDDP) could have clinical activity in metastatic biliary tract cancer. This randomised phase II trial was designed to assess the activity and safety of a high-dose infusional weekly 5FU alone

  15. A randomised phase II trial of weekly high-dose 5-fluorouracil with and without folinic acid and cisplatin in patients with advanced biliary tract carcinoma : results of the 40955 EORTC trial

    NARCIS (Netherlands)

    Ducreux, M; van Cutsem, E; van Laethern, JL; Gress, TM; Jeziorski, K; Rougier, P; Wagener, T; Anak, O; Baron, B; Nordlinger, B

    2005-01-01

    Previous small phase II trials have demonstrated that the combination of 5-fluorouracil (5FU) and cisplatin(CDDP) could have clinical activity in metastatic biliary tract cancer. This randomised phase II trial was designed to assess the activity and safety of a high-dose infusional weekly 5FU alone

  16. Cooperative study with sup(99m)Tc diisopropyl-IDA on biliary tract diseases

    Energy Technology Data Exchange (ETDEWEB)

    Mitta, A.E.A.; Mollerach, F; Almeida, C.A. (Complejo Medico Policial Churruca Visca, Buenos Aires (Argentina). Servicio de Medicina Nuclear)

    1982-07-01

    The results of a cooperative study on the investigation of the biliary tract with sup(99m)Tc diisopropyl-IDA are presented. 15 normal volunteers and 75 patients with acute cholecystitis (AC), chronic cholecystitis (CC), hepatocellular jaundice (HCJ), incomplete extrahepatic biliary obstruction (IEBO) and complete extrahepatic biliary obstruction (CEBO) were studied. The biological behaviour of the radiopharmaceutical in the two groups was determined through the measurement of the uptake times and of the times of arrival in the hepatic parenchyma, in the intra and extrahepatic bile ducts, in the gallbladder, in the duodenum and in the kidneys. The pathophysiologic features found in the AC, CC, HCJ, IEBO and CEBO are described. It is concluded that the procedure has a selective indication in the AC, that its value is limited in the CC, and that in jaundice, except in very special situations, the method gives very little information of clinical value. The possibility of performing cooperative scientific studies between Latin-American Departments, increasing their efficiency, is emphasized.

  17. Elimination of biliary stones through the urinary tract: a complication of the laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Castro Maurício Gustavo Bravim de

    1999-01-01

    Full Text Available The introduction and popularization of laparoscopic cholecystectomy has been accompanied with a considerable increase in perforation of gallbladder during this procedure (10%--32%, with the occurrence of intraperitoneal bile spillage and the consequent increase in the incidence of lost gallstones (0.2%--20%. Recently the complications associated with these stones have been documented in the literature. We report a rare complication occurring in an 81-year-old woman who underwent laparoscopic cholecystectomy and developed cutaneous fistula to the umbilicus and elimination of biliary stones through the urinary tract. During the cholecystectomy, the gall bladder was perforated, and bile and gallstones were spilled into the peritoneal cavity. Two months after the initial procedure there was exteriorization of fistula through the umbilicus, with intermittent elimination of biliary stones. After eleven months, acute urinary retention occurred due to biliary stones in the bladder, which were removed by cystoscopy. We conclude that efforts should be concentrated on avoiding the spillage of stones during the surgery, and that no rules exist for indicating a laparotomy simply to retrieve these lost gallstones.

  18. Biliary tract schwannoma: A rare cause of obstructive jaundice in a young patient

    Institute of Scientific and Technical Information of China (English)

    Gilton Marques Fonseca; André Luis Montagnini; Manoel de Souza Rocha; Rosely Antunes Patzina; Mário Vinícius Angelete Alvarez Bernardes; Ivan Cecconello; José Jukemura

    2012-01-01

    Schwannoma is a tumor derived from Schwann cells which usually arises in the upper extremities,trunk,head and neck,retroperitoneum,mediastinum,pelvis,and peritoneum.However,it can arise in the gastrointestinal tract,including biliary tract.We present a 24-year-old male patient with obstructive jaundice,whose investigation with computed tomography abdomen showed focal wall thickening in the common hepatic duct,difficult to differentiate with hilar adenocarcinoma.He was diagnosed intraoperatively schwannoma of common bile duct and treated with local resection.The patient recovered well without signs of recurrence of the lesion after 12 mo.We also reviewed the common bile duct schwannoma related in the literature and evaluated the difficulty in pre and intraoperative differential diagnosis with adenocarcinoma hilar.Resection is the treatment of choice for such cases and the tumor did not recur in any of the resected cases.

  19. [Endoscopical features of precancer changes of the stomach in patients with chronic gastric erosions and biliary tract disease].

    Science.gov (United States)

    Solovĭova, H A

    2012-01-01

    Frequency of the precancer changes of the stomach, diagnosed by using zoom-endoscopy, NBI, chromoscopy, in the three groups of patients: with gastric erosions and biliary tract diseases, with gastric erosions and duodenal ulcer disease, with gastric erosions and chronic gastritis is compared in the article. It is shown, that patients with gastric erosions and biliary tract diseases are characterized by bigger spreading of precancer changes: atrophy, intestinal metaplasia with predominant smalluently intestine in gastric body, intestine metaplasia in antral part of the stomach is revealed more freq in these category of patients. A strong correlation between endoscopical and morphological methods of investigation was demonstrated.

  20. Catheterisation of the biliary tract and portal vein by Seldinger-technique following ultrasonic guided fine needle puncture

    Energy Technology Data Exchange (ETDEWEB)

    Elgeti, H.; Luska, G.; Kleine, P.

    1981-11-01

    The article describes an easier technique of biliary tract and portal vein catheterisation following fine needle puncture. Special biopsy equipment has been compiled for this purpose by the authors. Initial experiences revealed a considerable simplification of hepatic duct and portal vein puncture using a real time biopsy applicator. The procedure is explained by two characteristic cases.

  1. [The method of biliary tracts drainage of patients with biliodigestive anastomosis at obstructive jaundice and acute cholangitis].

    Science.gov (United States)

    Agaev, B A; Agaev, R M; Gasymov, R Sh

    2011-01-01

    The internal draining of biliary tracts of patients with obstructive jaundice and acute cholangitis is considered most acceptable, but deficiency of this method is anastomosis failure, stricture and purulent-septic complications hazard. The investigations performed on 79 patients with obstructive jaundice, 36 of which were included in control group, 43 - in main group. To patients of main group with internal draining intraoperatively through the nose and biliodigestive anastomosis into the biliary tract transmitted tube with quartz optical monofiber for endocholedocheal laser irradiation in one lumen and hollow other, serve for drainage and irrigation of bile-excreting way with ozonized physiological solution. The application of endocholedocheal laser radiation and ozonetherapy in combination with suggested at biliodigestive anastomosis biliary tract drainage method allowed to earlier elimination of inflammatory process biliary tract, correct the bile lipids per oxidations disturbances and elevate activity of antioxidant protection system, to reduced the time of patients stay at hospital after surgery period from 20,3±1,24 day in control group to 12,7±0,653 day in main group (pjaundice and acute cholangitis.

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

    Science.gov (United States)

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

    1984-06-01

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

  3. An increased risk of urinary tract infection precedes development of primary biliary cirrhosis

    Directory of Open Access Journals (Sweden)

    West Joe

    2011-08-01

    Full Text Available Abstract Background Primary Biliary Cirrhosis is known to be associated with Urinary Tract Infections (UTIs, but whether these precede or follow the liver disease is unclear. We have therefore attempted to determine whether UTIs are more common in people with Primary Biliary Cirrhosis (PBC prior to their diagnosis. Methods We conducted a case control study in the General Practice Research Database. All cases of PBC first recorded at least one year after entry to the dataset were selected along with up to 10 controls matched for age, sex. A second unmatched control group who had Chronic Liver Diseases but not PBC were chosen. The main exposures studied were the occurrence of Urinary tract infections and pyelonephritis at least one or at least five years before diagnosis. We also performed an analysis restricted to those younger than 55 at diagnosis, as we hypothesized the relationship to be stronger in the younger age group. Results PBC is associated with UTI prior to diagnosis, OR 1.50 (CI 1.26-1.78, which was similar 5 years prior to diagnosis and after adjusting for smoking. The strongest relationships were observed in pyelonephritis exposures five years before diagnosis in cases under 55 years: adjusted odds ratios were 2.60 (1.02-6.63 in comparison with matched general population controls and adjusted odds ratios were OR 2.45 (1.02-5.59 in the comparison with chronic liver disease controls. Conclusions We found that the association between urosepsis and PBC is specific to this disease and precedes the diagnosis of PBC in a manner not previously observed in human data. This is consistent with a causal relationship.

  4. Biliary ascariasis.

    Science.gov (United States)

    Arcilla, C A; Varilla, A

    1978-01-01

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

  5. Cell adhesion molecules P-cadherin and CD24 are markers for carcinoma and dysplasia in the biliary tract.

    Science.gov (United States)

    Riener, Marc-Oliver; Vogetseder, Alexander; Pestalozzi, Bernhard C; Clavien, Pierre-Alain; Probst-Hensch, Nicole; Kristiansen, Glen; Jochum, Wolfram

    2010-11-01

    P-cadherin (CDH3) and CD24 are cell adhesion molecules that control morphogenic processes, cell motility, and invasive growth of tumor cells. The aim of our study was to investigate P-cadherin and CD24 expression in carcinomas and dysplastic lesions of the biliary tract and to evaluate the potential diagnostic usefulness of these cell adhesion molecules. Using immunohistochemistry on tissue microarrays, we analyzed P-cadherin, CD24, and p53 expression in 117 carcinomas of the biliary tract (19 intrahepatic cholangiocarcinomas, 59 extrahepatic cholangiocarcinomas, and 39 gallbladder carcinomas) and correlated our findings with clinicopathologic parameters. We found P-cadherin positivity in 37% of intrahepatic cholangiocarcinomas, 73% of extrahepatic cholangiocarcinomas, and 64% of gallbladder carcinomas, respectively. CD24 reactivity was observed in 21% of intrahepatic cholangiocarcinomas, 58% of extrahepatic cholangiocarcinomas, and 42% of gallbladder carcinomas. Nuclear p53 expression was found in 37% of intrahepatic cholangiocarcinomas, 46% of extrahepatic cholangiocarcinomas, and 45% of gallbladder carcinomas. We also studied P-cadherin, CD24, and p53 expression in normal (n = 30), inflamed (n = 22), and dysplastic (n = 21) biliary epithelium of extrahepatic bile ducts. Dysplastic biliary epithelium was positive for P-cadherin in 91%, for CD24 in 71%, and for p53 in 24% of lesions, respectively. In contrast, normal and inflamed epithelia were negative for all 3 proteins. We conclude that P-cadherin and CD24 are expressed in carcinomas of the biliary tract with high frequency and at an early stage of carcinogenesis. Therefore, they may be useful markers for early detection and as targets for therapy of cholangiocarcinoma.

  6. Spontaneous biliary tract perforations: an unusual cause of peritonitis in pregnancy. Report of two cases and review of literature

    Directory of Open Access Journals (Sweden)

    Ravi Bina

    2006-07-01

    Full Text Available Abstract Spontaneous perforations of the biliary tract are rare in adults and even more so during pregnancy. Perforation of the gall bladder is a potentially fatal complication of cholecystitis. The infrequency of perforation in the setting of calculous disease of the gall bladder is probably due to the thickened wall of the organ that has long been the seat of chronic inflammation. Common bile duct perforations have been reported in adults most commonly in association with choledocholithiasis. The diagnosis of biliary tract perforations is often delayed due to their non specific symptoms, which results in high morbidity. Early diagnosis and aggressive therapy are mandatory to alleviate this condition. Delayed diagnoses and treatment may have more serious consequences for pregnant women than for other patients. Very few cases of biliary tract perforations have been reported in pregnant women. We report two such cases in pregnancy: first of a gall bladder perforation associated with cholelithiasis and the second of a common bile duct perforation in pregnancy in which no apparent cause was found.

  7. Development of automated extraction method of biliary tract from abdominal CT volumes based on local intensity structure analysis

    Science.gov (United States)

    Koga, Kusuto; Hayashi, Yuichiro; Hirose, Tomoaki; Oda, Masahiro; Kitasaka, Takayuki; Igami, Tsuyoshi; Nagino, Masato; Mori, Kensaku

    2014-03-01

    In this paper, we propose an automated biliary tract extraction method from abdominal CT volumes. The biliary tract is the path by which bile is transported from liver to the duodenum. No extraction method have been reported for the automated extraction of the biliary tract from common contrast CT volumes. Our method consists of three steps including: (1) extraction of extrahepatic bile duct (EHBD) candidate regions, (2) extraction of intrahepatic bile duct (IHBD) candidate regions, and (3) combination of these candidate regions. The IHBD has linear structures and intensities of the IHBD are low in CT volumes. We use a dark linear structure enhancement (DLSE) filter based on a local intensity structure analysis method using the eigenvalues of the Hessian matrix for the IHBD candidate region extraction. The EHBD region is extracted using a thresholding process and a connected component analysis. In the combination process, we connect the IHBD candidate regions to each EHBD candidate region and select a bile duct region from the connected candidate regions. We applied the proposed method to 22 cases of CT volumes. An average Dice coefficient of extraction result was 66.7%.

  8. Current research on the biliary tract diseases%胆道疾病的研究现状

    Institute of Scientific and Technical Information of China (English)

    张汝玲; 陆伦根

    2011-01-01

    临床上常见的胆道疾病主要包括胆道炎症、胆道结石、胆道肿瘤、胆道动力障碍性疾病及胆道自身免疫性疾病等.这类疾病多样化、发病率高并可导致死亡.各种检查技术、相关设备及研究手段的应用与改进提高了胆道疾病的诊疗水平,但目前仍面临很多问题,这需要多学科的相互协作来共同解决.%Biliary tract disorders are ubiquitous in clinical practices, including inflammation, calculus, neoplasms, motility disorders and autoimmune diseases of biliary tract. These disorders are complex and associated with significant morbidity and mortality. The diagnosis and treatment of the biliary tract disease are improved by the application and advances of the detection technology, device development and research methods. But issues still exist currently, which will be resolved by the collaboration of multidisciplines.

  9. Copper Cu 64 Anti-CEA Monoclonal Antibody M5A PET in Diagnosing Patients With CEA Positive Cancer

    Science.gov (United States)

    2016-09-12

    Breast Cancer; Colon Cancer; Extrahepatic Bile Duct Cancer; Gallbladder Cancer; Gastrointestinal Cancer; Liver and Intrahepatic Biliary Tract Cancer; Lung Cancer; Metastatic Cancer; Pancreatic Cancer; Rectal Cancer; Thyroid Gland Medullary Carcinoma; Unspecified Adult Solid Tumor, Protocol Specific

  10. "The choledocho-pancreatic long common channel disorders" in relation to the etiology of congenital biliary dilatation and other biliary tract disease.

    Science.gov (United States)

    Miyano, T; Suruga, K; Suda, K

    1981-10-01

    The amylase level of bile and various cholangiograms was studied in 36 cases of congenital biliary dilatation. (C.B.D.) The amylase level above 10000 U/L was considered to suggest the existence of choledocho-pancreatic long common channel formation. Radiologically, the dilatation of intrahepatic bile duct was seen in 9 out of 19 (47%) Type I cases and in all (100%) Type II cases. The cystic dilatation of intrahepatic bile duct was seen in all Type I cases which have cystic choledochal dilatation. On the other hand, fusiform dilatation was seen in all Type II cases with fusiform choledochal dilatation. End to side Choledocho-pancreatic anastomosis was performed to produce an experimental model of human choledocho-pancreatic long common channel disorders, thus leading to the dilatation of the common bile duct as well as the reflux of pancreatic juice into the bile duct. The reflux of Pancreatic juice and congenital stricture due to the choledocho-pancreatic long common channel formation were considered to be the important causative factors in the etiology of C.B.D.. Furthermore, pathology of the choledocho-pancreatic long common channel disorders was found to be important in relation to the etiology of both C.B.D. and other lesions of the biliary tract and pancreas.

  11. Chemical coding and chemosensory properties of cholinergic brush cells in the mouse gastrointestinal and biliary tract

    Directory of Open Access Journals (Sweden)

    Burkhard eSchütz

    2015-03-01

    Full Text Available The mouse gastro-intestinal and biliary tract mucosal epithelia harbor choline acetyltransferase (ChAT-positive brush cells with taste cell-like traits. With the aid of two transgenic mouse lines that express green fluorescent protein (EGFP under the control of the ChAT promoter (EGFPChAT and by using in situ hybridization and immunohistochemistry we found that EGFPChAT cells were clustered in the epithelium lining the gastric groove. EGFPChAT cells were numerous in the gall bladder and bile duct, and found scattered as solitary cells along the small and large intestine. While all EGFPChAT cells were also ChAT-positive, expression of the high-affinity choline transporter (ChT1 was never detected. Except for the proximal colon, EGFPChAT cells also lacked detectable expression of the vesicular acetylcholine transporter (VAChT. EGFPChAT cells were found to be separate from enteroendocrine cells, however they were all immunoreactive for cytokeratin 18 (CK18, transient receptor potential melastatin-like subtype 5 channel (TRPM5, and for cyclooxygenases 1 (COX1 and 2 (COX2. The ex vivo stimulation of colonic EGFPChAT cells with the bitter substance denatonium resulted in a strong increase in intracellular calcium, while in other epithelial cells such an increase was significantly weaker and also timely delayed. Subsequent stimulation with cycloheximide was ineffective in both cell populations. Given their chemical coding and chemosensory properties, EGFPChAT brush cells thus may have integrative functions and participate in induction of protective reflexes and inflammatory events by utilizing ACh and prostaglandins for paracrine signaling.

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

    Science.gov (United States)

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

    2013-05-01

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

  13. Restorative treatment program with physical exercise of patients with dysfunction of the biliary tract.

    Directory of Open Access Journals (Sweden)

    Parhotik I.I.

    2011-06-01

    Full Text Available In the thesis there has been shown that biliary dyskinesia takes a leading position among hepatobiliary diseases. 54 women and 14 men aged between 19 and 64 years old, who suffered from hypo kinetic and hyper kinetic forms of dyskinesia, took part in the research. Based on the character of the functional disorders, it was defined that at hyper kinetic form of dyskinesia the best rehabilitation effects were achieved at the application of physical exercises promoting relaxation of the gallbladder, sphincter and biliary duct musculature combined with the stimulation of bile formation. It was proved that means and methods of motion therapy for patients with hyper kinetic dyskenisia had to be aimed at the restoration of the gallbladder till its full reduction. It was defined that application of different forms of therapeutic physical training considering the type of biliary dyskinesia promoted the improvement of the patients' clinical condition, motor and evacuator function of the biliary ducts.

  14. A phase II study of LFP therapy (5-FU (5-fluorourasil continuous infusion (CVI and Low-dose consecutive (Cisplatin CDDP in advanced biliary tract carcinoma

    Directory of Open Access Journals (Sweden)

    Horimi Tadashi

    2006-05-01

    Full Text Available Abstract Background Unresectable biliary tract carcinoma is known to demonstrate a poor prognosis. We conducted a single arm phase II study of LFP therapy (5-FU (5-fluorourasil continuous infusion (CVI and Low-dose consecutive (Cisplatin CDDP for advanced biliary tract malignancies basically on an outpatient basis. Methods Between February 1996 and September 2003, 42 patients were enrolled in this trial. LFP therapy By using a total implanted CV-catheter system, 5-FU (160 mg/m2/day was continuously infused over 24 hours for 7 consecutive days and CDDP (6 mg/m2/day was infused for 30 minutes twice a week as one cycle. The administration schedule consisted of 4 cycles as one course. RESIST criteria (Response evaluation criteria for solid tumors and NCI-CTC (National Cancer Institute-Common Toxicity Criteria (ver.3.0 were used for evaluation of this therapy. The median survival time (MST and median time to treatment failure (TTF were calculated by the Kaplan-Meier method. Results Patients characteristics were: mean age 66.5(47–79: male 24 (54%: BDca (bile duct carcinoma 27 GBca (Gallbladder carcinoma 15: locally advanced 26, postoperative recurrence 16. The most common toxicity was anemia (26.2%. Neither any treatment related death nor grade 4 toxicity occurred. The median number of courses of LFP Therapy which patients could receive was two (1–14. All the patients are evaluable for effects with an over all response rates of 42.9% (95% confidence interval C.I.: 27.7–59.0 (0 CR, 18 PR, 13 NC, 11 PD. There was no significant difference regarding the anti tumor effects against both malignant neoplasms. Figure 2 Shows the BDca a longer MST and TTF than did GBca (234 vs 150, 117 vs 85, respectively, but neither difference was statistically significant. The estimated MST and median TTF were 225 and 107 days, respectively. The BDca had a longer MST and TTF than GBca (234 vs 150, 117 vs 85, respectively, but neither difference was statistically

  15. Risk factors for extrahepatic biliary tract carcinoma in men: medical conditions and lifestyle: results from a European multicentre case-control study

    DEFF Research Database (Denmark)

    Ahrens, Wolfgang; Timmer, Antje; Vyberg, Mogens;

    2007-01-01

    or smoking showed no clear association, whereas some increase in risk was suggested for consumption of 40-80 g alcohol per day and more. CONCLUSIONS: Our study corroborates gallstones as a risk indicator in extrahepatic biliary tract carcinoma. Permanent overweight and obesity in adult life was identified...... as a strong risk factor for extrahepatic biliary tract carcinoma, whereas we did not find any strong lifestyle-associated risk factors. Inconsistent results across studies concerning the association of extrahepatic biliary tract carcinoma with overweight and obesity may be explained by the different......-matched by age and region. Adjusted odds ratios and 95%-confidence intervals were estimated by logistic regression. RESULTS: The analysis included 153 patients and 1421 controls. The participation proportion was 71% for patients and 61% for controls. Gallstone disease was corroborated as a risk factor...

  16. Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Yogesh M Shastri; Nicolas M Hoepffner; Bora Akoglu; Christina Zapletal; Wolf O Bechstein; Wolfgang F Caspary; Dominik Faust

    2007-01-01

    AIA:To correlate the significance of liver biochemical tests in diagnosing post orthotopic liver transplantation (OLT) biliary complications and to study their profile before and after endoscopic therapy.METHODS: Patients who developed biliary complications were analysed in detail for the clinical information,laboratory tests, treatment offered, response to it,follow up and outcomes. The profile of liver enzymes was determined. The safety, efficacy and outcomes of endoscopic retrograde cholangiography (ERC) were also analysed.RESULTS: 40 patients required ERC for 70 biliary complications. GGT was found to be > 3 times (388.1± 70.9 U/mL vs 168.5 ± 34.2 U/L, P = 0.007) and SAP > 2 times (345.1 ± 59.1 U/L vs152.7 ± 21.4 U/L, P =0.003) the immediate post OLT values. Most frequent complication was isolated anastomotic strictures in 28 (40%).Sustained success was achieved in 26 (81%) patients.CONCLUSION: Biliary complications still remain an important problem post OLT. SAP and GGT can be used as early, non-invasive markers for diagnosis and also to assess the adequacy of therapy. Endoscopic management is usually effective in treating the majority of these biliary complications.

  17. 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.

  18. [The characteristics of the development of gallbladder and biliary tract pathology under the influence of vibration].

    Science.gov (United States)

    Preobrazhenskiĭ, V N; Merkulov, V M; Vasil'ev, A Iu; Ermakova, T I; Borisov, B P

    1995-01-01

    The examination of 86 helicopter pilots has shown that their exposure to vibration leads to biliary and gallbladder damage which aggravates with longer service. As indicated by spectroscopy and gas-liquid chromatography, vibration affects colloid-osmotic properties of bile: molecules grow in size, bile acids retention becomes longer.

  19. Magnetic resonance cholangiography: applications in patients with calculus disease of the biliary tract.

    Science.gov (United States)

    Liu, Terrence H; Organ, Claude H

    2004-04-01

    Magnetic resonance cholangiography (MRC) is a non-invasive imaging modality that has become widely available. In the short time since its introduction, MRC has been shown to possess excellent accuracy for the diagnosis of various biliary pathologies, including choledocholithiasis. Investigations of the clinical applications of MRC are ongoing. This review summarizes the diagnostic capabilities of MRC and discusses its application in the management of patients with gallstone diseases.

  20. Autoimmune pancreatitis with IgG4-positive plasma cell infiltration in salivary glands and biliary tract

    Institute of Scientific and Technical Information of China (English)

    Masashi Taguchi; Gentaro Aridome; Shintaro Abe; Keiichiro Kume; Mitsuo Tashiro; Mitsuyoshi Yamamoto; Yasuyuki Kihara; Hayato Nakamura; Makoto Otsuki

    2005-01-01

    A 62-year-old male was referred to our hospital because of liver dysfunction, diffuse pancreatic swelling, and trachelophyma. At admission, the patient was free of pain.Physical examination showed enlarged and palpable bilateral submandibular masses, but no palpable mass or organomegaly in the abdomen. Laboratory findings were as follows: total protein 90 g/L with γ-globulin of 37.3% (33 g/L), total bilirubin 4 mg/L, aspartate aminotransferase 39 IU/L, alanine aminotransferase 67 IU/L, γ-glutamyl transpeptidase 1 647 IU/L, and amylase 135 IU/L. Autoantibodies were negative, and tumor markers were within the normal range. Serum IgG4 level was markedly elevated (18 900 mg/L). Computed tomography (CT) showed diffuse swelling of the pancreas and dilatation of both common and intra-hepatic bile ducts. Endoscopic retrograde pancreatography (ERP) revealed diffuse irregular and narrow main pancreatic duct and stenosis of the lower common bile duct. Biopsy specimens from the pancreas, salivary gland and liver showed marked periductal IgG4-positive plasma cell infiltration with fibrosis. We considered this patient to be autoimmune pancreatitis (AIP) with fibrosclerosis of the salivary gland and biliary tract, prescribed prednisolone at an initial dose of 40 mg/d. Three months later, the laboratory data improved almost to normal. Abdominal CT reflected prominent improvement in the pancreatic lesion. Swelling of the salivary gland also improved. At present, the patient is on 10 mg/d of prednisolone without recurrence of the pancreatitis. We present here a case of AIP with fibrosclerosis of salivary gland and biliary tract.

  1. Prospective randomized controlled study of prophylaxis with cefamandole in high risk patients undergoing operations upon the biliary tract.

    Science.gov (United States)

    Cáinzos, M; Potel, J; Puente, J L

    1985-01-01

    In this study, 52 high risk patients who underwent operations upon the biliary tract were assigned to receive either antibiotic prophylaxis or no treatment with antibiotics. Twenty-seven patients were given 2 grams of cefamandole intramuscularly 30 minutes before operation and 2 grams every eight hours for two days postoperatively. The remaining patients were in the control group and did not receive antibiotics. Surgical wounds were inspected daily by a surgeon while the patients were in the hospital and a follow-up revision was done four weeks after discharge from the hospital. Samples of exudate or pus were taken when the wound appeared infected and cultures of aerobic and anaerobic organism done. Chi-square affinity test with Yate's correction was used for statistical results; only p values more than or equal to 0.5 were considered significant. Seven patients (28 per cent) in the control group had complications develop postoperatively; seven surgical wound infections, one of which included a subphrenic abscess. Postoperatively, there were no septic complications in the group who received cefamandole as a prophylaxis. The incidence of infection was higher for females than males. The organisms most frequently isolated were Escherichia coli and Klebsiella; only in one instance was Clostridum sporogenes found. Polymicrobial infections accounted for 42.8 per cent of the infections. No incidences were reported with the use of cefamandole in those patients who were treated prophylactically. In view of these results, we believe that cefamandole is an ideal antibiotic to be used in the prophylactic treatment of infections of high risk patients who undergo operations upon the biliary tract.

  2. Perfuração espontânea da via biliar principal na infância Spontaneous perforation of the main biliary tract in infancy

    Directory of Open Access Journals (Sweden)

    Pedro J. A. Aratanha

    2007-12-01

    Full Text Available The authors report a case of spontaneous perforation of the biliary tract (S.P.B.T in a three-month-old infant. The diagnosis was suspected before the operation by clinical signs and diagnostic tests. The importance of paracentesis and scintigraphy is stressed. A surgical approach was chosen and drainage procedure of the area around the perforation and a cholecystostomy were done. S.P.B.T. is rare and its etiology is controversial, but cannot be forgotten in association between biliary ascites and cholestatic jaundice during the first months of life.

  3. Endoscopic retrograde cholangiopancreatography in pancreatic and biliary tract disease in Korean children

    Institute of Scientific and Technical Information of China (English)

    Joo; Young; Jang; Chong; Hyun; Yoon; Kyung; Mo; Kim

    2010-01-01

    AIM:To assess the indications,findings,therapeutic procedures,safety,and complications of endoscopic retrograde cholangiopancreatography(ERCP) performed in Korean children.METHODS:The demographic characteristics,indications for ERCP,findings,therapeutic procedures,and complications of 122 pediatric patients who underwent 245 ERCPs in the Asan Medical Center between June 1994 and March 2008 were investigated.RESULTS:The mean age of the 122 patients was 8.0 ± 4.2 years.Indications were biliary pathology in 78...

  4. [Digestive tract, obesity and cancer].

    Science.gov (United States)

    Actis, Andrea; Outomuro, Delia

    2010-01-01

    Current statistics show that overweight and obesity are seriously increasing, mainly in occidental countries with high industrialization rate. Simultaneously sedentarism has increased as a consequence of technological comforts that the dominant market economy offers. Obesity, sedentarism, excessive adiposity, especially if centrally distributed, insulin resistance and hyperinsulinemia interact for cancer development. Visceral adipose tissue is considerate as an endocrine organ which produces and liberates cytokines and inflammatory peptides with hormonal and metabolic signals. Although there are several obesity-related types of cancer, in this paper we focus on digestive system tumors.

  5. 胆道恶性肿瘤中单胺氧化酶-A对肿瘤相关巨噬细胞抗肿瘤免疫功能的影响%Effect of monoamine oxidase-A on the anti-tumor immunity of tumor-associated macrophages in biliary tract cancers

    Institute of Scientific and Technical Information of China (English)

    赖佳明; 陈健聪; 陈伟; 张朝晖; 黄力; 梁力建

    2015-01-01

    Objective To investigate the effect of monoamine oxidase-A (MAO-A) in biliary tract cancers (BTCs) on the immunity of tumor-associated macrophages.Methods MAO-A expression plasmid and control plasmid were constructed and transiently transfected into BTC cell lines respectively.Macrophages were derived from peripheral blood mononuclear cells donated by healthy volunteers.Macrophages were then cocultured with aforementioned transfected cancer cell lines for 48 h respectively,Western blotting and enzyme linked immunosorbent assay (ELISA) were applied to assess the expression of immune effector proteins and the excretion of cytokines from cocultured macrophages.24 h priming of macrophages with human recombinant interferon-γ (IFN-γ) were performed after their first stage of coculture;then the second stage of coculture with corresponding transfected cancer cell lines for 48 h were followed.Flow cytometry was employed to detect necrosis and apotosis of cancer cells induced by cocultured macrophages.Results The expression of MAO-A was down-regulated in BTC cell lines,which polarized the cocultured macrophages into M2 type tumor-associated macrophages,and promoted their excretion of interleukin (IL)-10 and expression of PD-L1,while suppressed their excretion of tumor necrosis factor-α (TNF-α),IL-1β and IL-12p70 (18.8±2.3 vs.31.7±1.9,75.0±0.4 vs.150.2±17.0 and 49.1 ± 15.2 vs.135.2 ± 1.0,respectively,P < 0.05),as well as the expression of Human leukocyte antigen-DR (HLA-DR).On the contrary,however,macrophages cocultured with MAO-A overexpressing BTC cells exhibited pro-inflammatory phenotype (M1 type) which opposite to above suppressive immunity phenotype (M2 type).After priming of IFN-γ,macrophages cocultured with MAO-A overexpressing BTC cells induced tumor necrosis and apoptosis more effectively than those cocultured with control BTCcells [(84.85±5.66)% vs.(1.56±0.46)% and (76.73 ±6.31)% vs.(1.28±0.57)%,respectively,P < 0.05].Conclusion Down

  6. 胆道镜在胆道手术中的应用体会%Experience of application of choledochoscope in biliary tract operation

    Institute of Scientific and Technical Information of China (English)

    张佩荣; 李昱

    2015-01-01

    Objective:To investigate the application value of choledochoscope in biliary tract operation.Methods:41 patients with biliary surgery were selected from February to September 2014.The domestic CHF-P20 type fiber biliary tract were used to check.Results:The curative effect was satisfied,and the stone free rate was 99%.There was no bile leakage,hemorrhage and death and other complications.Conclusion:During the operation,biliary endoscopy was intuitive,safe and efficient,it had dual role of diagnosis and treatment,and it was worthy of popularization and application.%目的:探讨胆道镜在胆道手术中应用价值。方法:2014年2-9月收治胆道外科手术患者41例,应用国产CHF-P20型纤维胆道检查。结果:疗效满意,结石取净率99%,全组无胆汁渗漏、出血及死亡等并发症。结论:术中胆道镜检查直观、安全高效,具有诊断治疗双重作用,值得推广应用。

  7. Hepatic Tract Plug-Embolisation After Biliary Stenting. Is It Worthwhile?

    Energy Technology Data Exchange (ETDEWEB)

    Dale, Adam P., E-mail: adamdale@doctors.org.uk [Basingstoke and North Hampshire Hospital, Department of Medical Microbiology (United Kingdom); Khan, Rafeh, E-mail: rafeh.khan@yahoo.com; Mathew, Anup, E-mail: anup.mathew@sth.nhs.uk; Hersey, Naomi O., E-mail: Naomi.Hersey@sth.nhs.uk; Peck, Robert, E-mail: Robert.Peck@sth.nhs.uk; Lee, Frederick, E-mail: fred.lee@sth.nhs.uk [Northern General Hospital, Department of Radiology (United Kingdom); Goode, Stephen D., E-mail: S.Goode@sheffield.ac.uk [Northern General Hospital, Sheffield Vascular Institute (United Kingdom)

    2015-10-15

    PurposePTC and stenting procedures are associated with significant risks including life-threatening haemorrhage, sepsis, renal failure and high mortality rates. PTC tract closure methods are utilised to reduce haemorrhagic complications despite little evidence to support their use. The current study assesses the incidence of haemorrhagic complications following PTC and stenting procedures, both prior to and following the introduction of a dedicated expanding gelatin foam-targeted embolisation liver tract closure technique.Materials and MethodsHaemorrhagic complications were retrospectively identified in patients undergoing PTC procedures both prior to (subgroup 1) and following (subgroup 2) the introduction of a dedicated targeted liver tract closure method between 9/11/2010 and 10/08/2012 in a single tertiary referral centre. Mean blood Hb decrease following PTC was established in subgroups 1 and 2. Kaplan–Meier life-table analysis was performed to compare survival outcomes between subgroups using the log-rank test.ResultsHaemorrhagic complications were significantly reduced following the introduction of the targeted PTC tract closure method [(12 vs. 3 % of subgroups 1 (n = 101) and 2 (n = 92), respectively (p = 0.027)]. Mean blood Hb decrease following PTC was 1.40 versus 0.68 g/dL in subgroups 1 and 2, respectively (p = 0.069). 30-day mortality was 14 and 12 % in subgroups 1 and 2, respectively. 50 % of the entire cohort had died by 174 days post-PTC.ConclusionIntroduction of liver tract embolisation significantly reduced haemorrhagic complications in our patient cohort. Utilisation of this method has the potential to reduce the morbidity and mortality burden associated with post-PTC haemorrhage by preventing bleeding from the liver access tract.

  8. 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 with......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 without extravasation. The second, normal hepatic parenchymal phase with extravasation. The third, increased focal activity (biloma). We concluded that the use of 99mTc-HIDA scintigraphy supplies important information in the diagnostic work-up and informs about the proper time for removal of T...

  9. MR imaging of the biliary tract with Gd-EOB-DTPA: Effect of liver function on signal intensity

    Energy Technology Data Exchange (ETDEWEB)

    Takao, Hidemasa, E-mail: takaoh-tky@umin.ac.jp [Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 (Japan); Akai, Hiroyuki; Tajima, Taku [Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 (Japan); Kiryu, Shigeru [Department of Radiology, Institute of Medical Science, University of Tokyo, 74-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639 (Japan); Watanabe, Yasushi [Department of Radiological Technology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 (Japan); Imamura, Hiroshi [Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431 (Japan); Akahane, Masaaki; Yoshioka, Naoki [Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 (Japan); Kokudo, Norihiro [Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 (Japan); Ohtomo, Kuni [Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 (Japan)

    2011-02-15

    Objective: To quantitatively evaluate the signal intensity of the biliary tract in gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging and to investigate the effect of liver function on the signal intensity of the biliary tract. Materials and methods: A total of 32 patients with and without chronic liver disease (normal liver group, n = 15; chronic liver disease group, n = 17) were included in this study. All patients were prospectively enrolled for evaluation of known or suspected focal liver lesions. In the chronic liver disease group, the etiologies were chronic hepatitis C virus infection (n = 12) and chronic hepatitis B virus infection (n = 5). The median Child-Pugh score was 5 (range, 5-7). Each patient received the standard dose of Gd-EOB-DTPA (0.025 mmol/kg of body weight). Post-contrast T1-weighted MR images were obtained at 5, 10, 15, 20, 25, and 30 min after administration of Gd-EOB-DTPA. Maximum signal intensities (SIs) of the right and left hepatic ducts, common hepatic duct, and common bile duct were measured. Relative signal intensity was calculated as follows: relative SI = maximum SI{sub bileduct}/mean SI{sub muscle}. Serum albumin level, serum total bilirubin level, prothrombin time, indocyanine green retention rate at 15 min (ICG-R15), and estimated glomerular filtration rate were entered into regression analysis. Results: The signal intensity of the bile duct reached a peak 30 min after administration of Gd-EOB-DTPA. The mean relative signal intensity of the right and left hepatic ducts at the peak time point was not significantly different between the two groups, while increase in signal intensity was delayed in the chronic liver disease group. The mean relative signal intensity of the common hepatic duct and that of the common bile duct at the peak time point were significantly different between the two groups (Wilcoxon rank-sum test, P = 0.03, respectively). Stepwise regression

  10. Gemcitabine, Oxaliplatin, Tarceva &/or Cisplatin in HCC & Biliary Tree Cancers

    Science.gov (United States)

    2016-03-15

    Hepatocellular Carcinoma; Cholangiocellular Carcinoma; Cholangiocarcinoma of the Extrahepatic Bile Duct; Bile Duct Cancer; Periampullary Adenocarcinoma; Gallbladder Cancer; Extrahepatic Bile Duct Cancer

  11. Biliary tract obstruction secondary to Burkitt lymphoma; Linfoma de Burkitt associado a obstrucao de vias biliares

    Energy Technology Data Exchange (ETDEWEB)

    Mendes, Wellington L.; Bezerra, Alanna Mara P.S.; Carvalho Filho, Nevicolino P.; Coelho, Robson C. [Hospital do Cancer, Sao Paulo, SP (Brazil). Centro de Tratamento e Pesquisa. Dept. de Pediatria; Soares, Fernando A. [Hospital do Cancer, Sao Paulo, SP (Brazil). Centro de Tratamento e Pesquisa. Dept. de Patologia; Pecora, Marcela S. [Hospital do Cancer, Sao Paulo, SP (Brazil). Centro de Tratamento e Pesquisa. Dept. de Imagem; Chapchap, Paulo [Hospital do Cancer, Sao Paulo, SP (Brazil). Centro de Tratamento e Pesquisa. Servico de Cirurgia Pediatrica

    2004-09-01

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

  12. Hepato-biliary late effects in survivors of childhood and adolescent cancer: a report from the Children's Oncology Group.

    Science.gov (United States)

    Castellino, Sharon; Muir, Andrew; Shah, Ami; Shope, Sheila; McMullen, Kevin; Ruble, Kathy; Barber, Ashley; Davidoff, Andrew; Hudson, Melissa M

    2010-05-01

    Curative therapy for childhood and adolescent cancer translates to 1 in 640 young adults being a survivor of cancer. Although acute hepato-biliary toxicity occurs commonly during pediatric cancer therapy, the impact of antineoplastic therapy on long-term liver health in childhood/adolescent cancer survivors is unknown. This article reviews the medical literature on late liver dysfunction following treatment for childhood/adolescent cancer. We also outline the Children's Oncology Group (COG) guidelines for screening and follow-up of hepato-biliary sequelae. As the population of survivors grow and age, vigilance for risks to hepatic health needs to continue based on specific exposures during curative cancer therapy.

  13. Neonatal cholestasis mimicking biliary atresia: Could it be urinary tract infection?

    Science.gov (United States)

    Pereira, Noella Maria Delia; Shah, Ira

    2017-01-01

    Cholestasis can occur in newborns due to infections. However, the manifestations of the underlying infections usually dominate the presentation. We present a 2-month-old infant who presented with jaundice and no fever or signs of systemic illness. Liver biopsy was suggestive of cholangitis. He was subsequently detected to have urinary tract infection with Klebsiella pneumoniae. The child was treated with appropriate antibiotics for 2 weeks following which the cholestasis resolved. Thus, neonatal cholestasis due to infections can also occur in the post-neonatal period without clinical manifestations of an underlying infection.

  14. 胆道系统疾病手术患者术后胆道感染的CT诊断研究%CT diagnosis of biliary tract infections after surgery for biliary system diseases

    Institute of Scientific and Technical Information of China (English)

    胡明华; 翁媛英; 陈兰; 汪国余; 徐祖良

    2016-01-01

    目的:探讨胆道系统疾病手术患者术后胆道感染的CT 影像学,以提高胆道感染的早期诊断。方法选择2010年1月-2014年12月在医院行胆道系统手术且术后发生胆道感染的35例患者临床资料,所有患者均进行上腹部增强扫描,通过多种重建方式对胆道进行重建,分析胆道感染的CT 表现,总结术后胆道感染的影像学特征。结果35例患者行胆囊手术19例、胆管手术16例;其中因结石行手术的有22例,13例为其他胆道疾病的手术;开腹手术18例、腹腔镜下手术9例、介入手术8例;C T检查发现,胆道系统结石14例占40.00%,胆管壁增厚、毛糙28例占80.00%;肝内胆管扩张24例占68.57%,肝外胆管扩张29例占82.86%,胆管狭窄3例占8.57%,肝内外胆管积气的有18例占51.43%;胆道系统外改变中出现胆囊窝积液7例占20.00%,出现腹腔积液9例占25.71%,腹腔脓肿2例占5.71%,伴有淋巴结肿大4例占11.43%。结论胆道系统疾病术后易发生胆道的再次感染,胆管壁的增厚、肝内外胆管扩张、胆管积气是术后再发胆道感染CT诊断的征象。%OBJECTIVE To explore the CT features of recurrent biliary tract infections after surgery for biliary sys-tem diseases ,and improve the early diagnosis of biliary tract infections .METHODS The 35 cases were proven to have biliary tract infections after surgery for biliary system diseases from Jan .2010 to Dec .2014 and were checked by contrast-enhanced CT .Biliary was reconstructed by different kinds of reconstruction methods ,and all the CT images were analyzed to summarize the CT features of biliary tract infections .RESULTS There were 19 out of 35 cases that underwent gallbladder surgery and 16 cases that underwent bile duct surgery ;22 cases were operated because of biliary stones and 13 cases because of other diseases ;and 18 cases were open surgery ,9 cases were lap

  15. 胆道肿瘤:过去、现在和未来%Biliary tract tumors:past, present and future

    Institute of Scientific and Technical Information of China (English)

    Angela Lamarca; Enrique Espinosa; Jorge Barriuso; Jaime Feliu

    2013-01-01

    Tumors of the biliary tract (gallbladder tumors, cholangiocarcinomas and ampullary carcinomas) are low incidence tumors with poor prognosis. The five-year overall survival is 50% for stage I, 30% stage II, 10% stage III and 0% stage IV. Treatment is based on surgery for potentially resectable tumors. Chemotherapy and chemo-radiotherapy is the treatment of choice when surgery is not amenable, however it has not achieved encouraging results. These patients use to have very few symptoms, which is the reason for the delay in diagnosis and the poor prognosis. They frequently develop biliary obstruction:obstructive jaundice, right upper quadrant pain and weight loss. Ampullary carcinomas are frequently related to steatorrhea due to malabsorption. The most effective chemotherapy drugs used in monotherapy are 5FU (response rate 20%) and gemcitabine (response rate of 13%-60%), so they have been selected for further development in multiple phase II clinical trials to explore their efficacy and safety in combination with other agents. In a phase III clinical trial, combination of gemcitabine and cisplatin has been selected as the schedule of choice. Target therapies are also being developed in this malignancy. The present work reviews the most current knowledge of the pathogenesis, diagnosis and natural history of biliary tract tumors. Further, review of surgery, current adjuvant treatment and therapies for unresectable and advanced disease is provided. The most recent understanding for target therapies and molecular biology is also summarized.

  16. 医源性胆道损伤致胆汁渗漏74例诊治分析%Diagnosis and treatment of iatrogenic biliary tract damage

    Institute of Scientific and Technical Information of China (English)

    袁江涛; 李志清

    2013-01-01

    目的 探讨医源性胆道损伤致胆漏的常见原因、预防和早期诊治方法.方法 对74例医源性胆道损伤致胆漏病例的手术方式、损伤类型以及损伤时间进行回顾性分析,并采用手术治疗.手术方式:腹腔引流18例(24.3%),胆管修补并T管支撑引流22例(29.7%),胆总管端端吻合合并T管支撑引流14例(18.9%),胆管空肠Roux-en-Y吻合18例(24.3%),胆总管十二指肠吻合2例(2.7%).结果 全组术后无近期并发症,21例获3个月~3年随访,无远期并发症.结论 医源性胆道损伤致胆漏以胆囊切除术多见,多发生于胆囊三角区,主要原因为缺乏胆管影像学诊断,局部组织水肿坏死或粘连,手术器械缺乏或设备不规范,照明等条件差,暴露欠佳,术后经验缺乏等.早发现、早诊断的有效治疗是术中常规手术视野敷白纱布,疑有胆道损伤时即行胆道造影、胆总管探查术;常规手术区低位置引流管,术后1周严密观察腹腔引流液性状及量、胆汁性腹膜炎体征、巩膜、皮肤黄染情况,B起动态监测胆管直径及腹腔游离液体变化;术后2周常规T管胆管造影或ERCP等.适当进行结扎、引流胆管修补、胆肠吻合、胆管支撑等手术方式是有效的治疗措施.%Objective To evaluate the pathogeny precaution, early diagnosis and treatment of iatrogenic biliary tract damage. Methods The clinical data of 74 cases of iatrogenic biliary tract damage were retrospectively analyzed including the modus operandi the clinical manifestation and the final diagnosis time. The modus operandi of iatrogenic biliary tract damage included belly cavity drainage in 18 cases(24. 3%), biliary tract repair and T tube drainage in 22 cases (29. 7%) ,end-to-end bile duct anastomosis and T tube drainage in 14 cases(18. 9%) ,Roux-en-Y choledochojejunostomy in 18 cases(24. 3%) ,biliary pore-duodenum anastomosis in 2 cases(2. 7%). Results No complication in the near future or long

  17. Raoultella ornithinolytica bacteremia in cancer patients: report of three cases.

    Science.gov (United States)

    Hadano, Yoshiro; Tsukahara, Mika; Ito, Kenta; Suzuki, Jun; Kawamura, Ichiro; Kurai, Hanako

    2012-01-01

    Raoultella ornithinolytica is a Gram-negative aerobic bacillus reclassified in the new genus from the Klebsiella species based on new genetic approaches; however, human infections caused by R. ornithinolytica are rare. We herein report three cases of R. ornithinolytica bacteremia associated with biliary tract infections in cancer patients. R. ornithinolytica can be a causative pathogen of biliary tract infection in cancer patients.

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

    Institute of Scientific and Technical Information of China (English)

    Brian; Story; Michael; Gluck

    2010-01-01

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

  19. Biliary wound healing, ductular reactions, and IL-6/gp130 signaling in the development of liver disease

    Institute of Scientific and Technical Information of China (English)

    A J Demetris; John G Lunz Ⅲ; Susan Specht; Isao Nozaki

    2006-01-01

    Basic and translational wound healing research in the biliary tree lag significantly behind similar studies on the skin and gastrointestinal tract. This is at least partly attributable to lack of easy access to the biliary tract for study. But clinical relevance, more interest in biliary epithelial cell (BEC) pathophysiology, and widespread availability of BEC cultures are factors reversing this trend. In the extra-hepatic biliary tree, ineffectual wound healing,scarring and stricture development are pressing issues.In the smallest intra-hepatic bile ducts either impaired BEC proliferation or an exuberant response can contribute to liver disease. Chronic inflammation and persistent wound healing reactions in large and small bile ducts often lead to liver cancer. General concepts of wound healing as they apply to the biliary tract, importance of cellular processes dependent on IL-6/gp130/STAT3 signaling pathways, unanswered questions, and future directions are discussed.

  20. Feasibility of gemcitabine and oxaliplatin in patients with advanced biliary tract carcinoma and a performance status of 2.

    Science.gov (United States)

    Mir, Olivier; Coriat, Romain; Dhooge, Marion; Perkins, Géraldine; Boudou-Rouquette, Pascaline; Brezault, Catherine; Ropert, Stanislas; Durand, Jean-Philippe; Chaussade, Stanislas; Goldwasser, François

    2012-08-01

    The use of gemcitabine and oxaliplatin is well documented in selected patients with advanced biliary tract carcinoma (BTC), but little is known on the feasibility of systemic treatments in patients with a performance status (PS) of 2. We retrospectively examined the medical records of consecutive BTC patients with a PS of 2 receiving gemcitabine 1000 mg/m(2) plus oxaliplatin 100 mg/m(2) every 2 weeks from January 2003 to December 2011 in our institution. Body composition was analysed by computed tomography scan to detect sarcopenia. The primary evaluation criterion was safety. The secondary evaluation criteria were the response rate, progression-free survival (PFS) and overall survival (OS). Twenty-eight patients (median age: 63 years, range 41-83) received a total of 175 cycles (median per patient: 6, range 2-12). Ten patients (35.7%) had sarcopenia on the pretreatment computed tomography scan. The most frequent toxicities were thrombocytopenia (grades 2-4: n=4, 14.3%), peripheral neuropathy (grades 2-3: n=9, 32.1%) and cholangitis (n=4, 14.3%). The best response was a partial response in 10.7% of patients [95% confidence interval (CI): 0-22.2] and stable disease in 42.9% of patients. The median PFS and OS were 4.6 (95% CI: 2.5-6.3) and 7.5 (95% CI: 5.2-9.5) months, respectively. The median PFS and OS were significantly longer in patients without sarcopenia: 7.0 months (95% CI: 4.4-8.0) vs. 2.2 months (95% CI: 2.0-2.5), P less than 0.01, and 10.4 months (95% CI: 7.5-11.6) vs. 4.9 months (95% CI: 3.7-5.2), P less than 0.01, respectively. In our experience, gemcitabine-oxaliplatin was feasible and induced effective palliation in PS2 patients with advanced BTC. Further studies are warranted to confirm these findings.

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

    NARCIS (Netherlands)

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

    2010-01-01

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

  2. Loss of EBP50 stimulates EGFR activity to induce EMT phenotypic features in biliary cancer cells.

    Science.gov (United States)

    Clapéron, A; Guedj, N; Mergey, M; Vignjevic, D; Desbois-Mouthon, C; Boissan, M; Saubaméa, B; Paradis, V; Housset, C; Fouassier, L

    2012-03-15

    Scaffold proteins form multiprotein complexes that are central to the regulation of intracellular signaling. The scaffold protein ezrin-radixin-moesin-binding phosphoprotein 50 (EBP50) is highly expressed at the plasma membrane of normal biliary epithelial cells and binds epidermal growth factor receptor (EGFR), a tyrosine kinase receptor with oncogenic properties. This study investigated EBP50-EGFR interplay in biliary cancer. We report that in a collection of 106 cholangiocarcinomas, EBP50 was delocalized to the cytoplasm of tumor cells in 66% of the cases. Ectopic expression of EBP50 was correlated with the presence of satellite nodules and with the expression of EGFR, which was at the plasma membrane, implying a loss of interaction with EBP50 in these cases. In vitro, loss of interaction between EBP50 and EGFR was mimicked by EBP50 depletion using a small interfering RNA approach in human biliary carcinoma cells co-expressing the two proteins at their plasma membrane, and in which interaction between EBP50 and EGFR was validated. EBP50 depletion caused an increase in EGFR expression at their surface, and a sustained activation of the receptor and of its downstream effectors (extracellular signal-regulated kinase 1/2, signal transducer and activator of transcription 3) in both basal and EGF-stimulated conditions. Cells lacking EBP50 showed epithelial-to-mesenchymal transition-associated features, including reduction in E-cadherin and cytokeratin-19 expression, induction of S100A4 and of the E-cadherin transcriptional repressor, Slug, and loss of cell polarity. Accordingly, depletion of EBP50 induced the disruption of adherens junctional complexes, the development of lamellipodia structures and the subsequent acquisition of motility properties. All these phenotypic changes were prevented upon inhibition of EGFR tyrosine kinase by gefitinib. These findings indicate that loss of EBP50 at the plasma membrane in tumor cells may contribute to biliary carcinogenesis

  3. Sterol transporter adenosine triphosphate-binding cassette transporter G8, gallstones, and biliary cancer in 62,000 individuals from the general population

    DEFF Research Database (Denmark)

    Stender, Stefan; Frikke-Schmidt, Ruth; Nordestgaard, Børge G;

    2011-01-01

    Gallstone disease, a risk factor for biliary cancer, has a strong heritable component, but the underlying genes are largely unknown. To test the hypothesis that ABCG8 (adenosine triphosphate-binding cassette transporter G8) Asp19His (D19H) genotype predicted risk of gallstones and biliary cancer ...

  4. Current Status on Cholangiocarcinoma and Gallbladder Cancer

    Science.gov (United States)

    Ebata, Tomoki; Ercolani, Giorgio; Alvaro, Domenico; Ribero, Dario; Di Tommaso, Luca; Valle, Juan W.

    2016-01-01

    Background Cholangiocarcinomas (CC) as well as gallbladder cancers are relatively rare and intractable diseases. Clinical, pathological, and epidemiological studies on these tumors have been under investigation. The current status and/or topics on biliary tract cancers have been reported in the East West Association of Liver Tumor (EWALT), held in Milano, Italy in 2015. Summary All the authors, herein, specifcally reported the current status and leading-edge findings on biliary tract cancers as the following sequence: epidemiology of CC, surgical therapy for intrahepatic CC, surgical therapy for perihilar CC, surgical therapy for gallblad der cancer, chemotherapy for biliary tract cancers, and new histological features in CC. Key Message The present review article will update the knowledge on biliary tract cancers, en hancing the quality of daily clinical practice. However, many features about these cancers remain unknown; further studies are required to establish disease-specific optimal treatment strategies. PMID:27995089

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

    Science.gov (United States)

    Yamasaki, Shuuji

    2016-01-01

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

  6. IMP3 expression in lesions of the biliary tract: a marker for high-grade dysplasia and an independent prognostic factor in bile duct carcinomas.

    Science.gov (United States)

    Riener, Marc-Oliver; Fritzsche, Florian R; Clavien, Pierre-Alain; Pestalozzi, Bernhard C; Probst-Hensch, Nicole; Jochum, Wolfram; Kristiansen, Glen

    2009-10-01

    The oncofetal protein IMP3 (insulin-like growth factor II mRNA binding protein 3) is expressed during embryogenesis and carcinogenesis. Various tumor types have been analyzed for IMP3 expression, which was exclusively found in tumor cells and correlated with increased tumor aggressiveness and reduced overall survival. To our knowledge, IMP3 expression has not been investigated in bile duct carcinomas. Using large tissue sections from resection specimens of the extrahepatic biliary tract, we analyzed IMP3 in normal bile ducts (n = 36), bile ducts with acute inflammation and reactive epithelial changes (n = 26), low-grade dysplasia (n = 9), and high-grade dysplasia (n = 11). Furthermore, IMP3 expression was assessed in bile duct carcinoma (n = 115) using clinically well-characterized tissue microarrays. The findings were correlated with clinical-pathologic parameters including survival. High-grade dysplasia was strongly positive for IMP3 in all cases studied compared with no or weak expression in normal, inflamed, and low-grade dysplastic bile ducts. Of the bile duct carcinomas 58.3% (67/115) were strongly positive for IMP3, which was associated with a higher proliferation rate (P = .004) and p53 positivity (P = .022). Patients with strong IMP3 expression had significantly reduced overall survival (P = .037) similarly to the subgroup of pT3 carcinomas (P = .007). In multivariate analysis, IMP3 expression was an independent prognostic factor for overall survival (P = .040, RR = 1.809). This comprehensive study shows that IMP3 is an independent prognostic biomarker in bile duct carcinoma. In addition, it may be a marker for high-grade dysplasia in the extrahepatic biliary tract.

  7. Incidence of port-site metastasis after undergoing robotic surgery for biliary malignancies

    Institute of Scientific and Technical Information of China (English)

    Quan-Da Liu; Jun-Zhou Chen; Xiao-Ya Xu; Tao Zhang; Ning-Xin Zhou

    2012-01-01

    AIM:To investigate the incidence of clinically detected port-site metastasis (PSM) in patients who underwent robotic surgery for biliary malignancies.METHODS:Using a prospective database,the patients undergoing fully robotic surgery for biliary malignancies between January 2009 and January 2011 were included.Records of patients with confirmed malignancy were reviewed for clinicopathological data and information about PSM.RESULTS:Sixty-four patients with biliary tract cancers underwent robotic surgery,and sixty patients met the inclusion criteria.The median age was 67 year (range:40-85 year).During a median 15-mo follow-up period,two female patients were detected solitary PSM after robotic surgery.The incidence of PSM was 3.3%.Patient 1 underwent robotic anatomatic left hemihepatectomy and extraction of biliary tumor thrombi for an Klatskin tumor.She had a subcutaneous mass located at the right lateral abdominal wall near a trocar scar.Patient 2 underwent robotic pancreaticoduodenectomy for distal biliary cancer.She had two metachronous subcutaneous mass situated at the right lateral abdominal wall under a same trocar scar at 7 and 26 mo.The pathology of the excised PSM masses confirmed metastatic biliary adenocarcinoma.COMCLUSION:The incidence of PSMs after robotic surgery for biliary malignancies is relatively low,and biliary cancer can be an indication of robotic surgery.

  8. [Digestive tract cancer: after ten years in Santa Fe].

    Science.gov (United States)

    Jiménez, Félix; Elias, Roberto Emanuel; Osella, Francisco Javier; Padilla, Juan Francisco Antonio

    2009-12-01

    In our earlier paper we found that esophageal cancer was the most frequent localization among all the digestive tract cancers. Furthermore, in four departments belonging to our province we also observed a colon-esophagus relationship of virtually 1 to 1. In this study we aimed to: 1) estimate the prevalence of esophagus and stomach tumors: a) in the Endoscopy Department, b) in all the hospital, comparing it with colon cancer and, c) as causes of death in our region of influence, in relation to all the neoplastic pathologies. 2) analyze the histological lineage and the anatomical location, according to sex, age and origin. We evaluated: 3,396 upper digestive tract endoscopies, the diagnoses of digestive tract cancer from the Histopathology Service, the discharges from hospital as the result of digestive tract cancer from the General Archives, all of them from Cullen Hospital, and death register of the province of Santa Fe accounting for digestive tract cancer. A descriptive analysis was carried out and spreadsheet from the Open Office 2.2 version and SPSS 10.0 version were used. We observed that esophageal cancer is still very frequent in the Endoscopy Department and in the Histopathology Service but not in the diagnoses at discharge from hospital. It shares similar epidemiological features to the ones observed in the international literature. The reduction of the relationship between colon and esophageal cancer in the global mortality rate of the country turns out to be surprising. In three departments situated on the north of the province it was observed a colon-esophagus cancer relationship of 1:1.

  9. 研发胆道取石硬镜经T管瘘道治疗胆道术后残留结石%The management of biliary tract postoperative residual stones with hard choledochoscope through T-tube fistulous tract

    Institute of Scientific and Technical Information of China (English)

    顾思平; 蔡晓东; 游志远; 熊共鹏; 周晓明

    2012-01-01

    Objective To investigate the efficacy of the management of biliary tract postoperative residual stones with hard choledochoscope (or ureteroscopy) through T-tube fistulous tract.Methods A retrospective analysis 42 patients who had biliary tract postoperative residual stones received the management of exploratory and lithotripsy with hard choledochoscope which was inventived by us (or ureteroscopy) through T-tube fistulous tract.Results In the early to carry out this operation (before March 2010),10 of 20 were completed the exploration or lithotomy successfully,the other 10 cases were with fierce abdominal pains when explorating the lower segment of common bile duct,then switch to the exploration with choledochofiberscope;In the late to carry out this operation (after March 2010),19 of 22 were completed the exploration or lithotomy successfully,2 cases were with fierce abdominal pains when explorating the lower segment of common bile duct,then switch to the exploration with choledochofiberscope,One case of laparoscopic common bile duct postoperative 52 days to remove the T tube,through the fistula with hard choledochoscope we found that the fistula tract was not fully formed,and patient had bile peritonitis then received abdominal surgery to cure.The remaining cases had no complications.Conclusions The management of biliary tract postoperative residual stones with hard choledochoscope inventived by us (or ureteroscopy) through T-tube fistulous tract,is safe and effective,easy to operate,provides a new clinical method to treat the bile duct residual stones,has the value of the promotion.%目的 探讨胆道结石术后用研发胆道取石硬镜(或输尿管镜)经T管瘘道探查和治疗残余结石的疗效.方法 回顾性分析在利多卡因凝胶5 ~ 10 ml注入瘘道局部麻醉后采用研发的胆道取石镜(或输尿管镜)经T管瘘道探查和治疗42例胆道结石术后病例的资料.结果 全组42例患者中前期(2010年3月以前)20例中有10

  10. Biliary endoprosthesis

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Jung Hyeok; Kim, Yong Sun; Jang, Byung Won; Kim, Tae Hun; Kim, Yong Joo; Kang, Duk Sik [Kyungpook National University College of Medicine, Daegu (Korea, Republic of)

    1986-02-15

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

  11. Influence on early diagnosis of inflammatory cytokines abdominal cavity brainage inflammatory cytokines on biliary fistula after biliary tract surgery%胆道手术后腹腔引流液中炎性因子检测对胆瘘的早期诊断的影响

    Institute of Scientific and Technical Information of China (English)

    王长起

    2011-01-01

    Objective Biliary tract surgery is a serious life - threatening complications in patients , postoperative abdominal drainage fluid through the detection of inflammatory factors, early diagnosis of biliary fistula and timely manner. Methods January 2010 ~ January 2011 during the implementation of 200 patients with various types of biliary tract surgery. In the 1 ,3 and 5 days after the first detection of peritoneal drainage fluid inflammatory cytokines IL -6, IL -8, IL - 10, TNF - α changes. Results Totally 11 patients with biliary fistula, postoperative abdominal drainage fluid inflammatory cytokines were significantly higher than the group without biliary fistula. Conclusions The peritoneal drainage fluid levels of inflammatory cytokines detection can do early diagnosis for biliary fistula and avoid serious consequences.%目的 胆道手术后胆瘘是一种严重威胁患者生命的并发症,通过检测术后腹腔引流液炎性因子,对胆瘘进行早期诊断并及时处理.方法 2010年1月-2011年1月期间,200例患者实施各种类型胆道手术.在术后第1、3和5d检测腹腔引流液中炎性细胞因子IL-6、IL-8、IL-10、TNF-α的变化.结果 11例胆瘘患者术后腹腔引流液中,炎性细胞因子水平显著高于未胆瘘组.结论 腹腔引流液炎性细胞因子水平检测,可对胆瘘进行早期诊断,避免严重后果.

  12. Biliary cysts: Etiology, diagnosis and management

    Institute of Scientific and Technical Information of China (English)

    Beata Jablo(n)ska

    2012-01-01

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

  13. Mutagenicity of bile and pancreatic juice from patients with pancreatico-biliary maljunction.

    Science.gov (United States)

    Matsubara, T; Tsuji, T; Miyama, A; Yamaguchi, H; Funabiki, T

    1995-04-01

    We attempted to detect mutagenic activity in bile and pancreatic juice from patients with biliary tract disease using the spore rec assay and wild (H17) and mutant (M45) strains. Three bile samples out of 5 obtained from patients with pancreatico-biliary maljunction showed positive reaction in the spore rec assay, and all contained a high level of amylase activity, while 300 microliters of bile samples obtained from 10 control patients without pancreatico-biliary maljunction did not show any positive reaction. Moreover, 300 microliters of the in vitro mixture of bile with an equal volume of pancreatic juice also showed a positive reaction after treatment for 12 days at 37 degrees C or for 10 min at 100 degrees C, suggesting that they were very stable and long-acting in vivo. These data suggest that possible mutagens might be formed by the mixing of bile with pancreatic juice regurgitated into the biliary tract, and that there might be a relationship to biliary tract cancer which often accompanies pancreatico-biliary maljunction.

  14. New development of biliary surgery in China

    Institute of Scientific and Technical Information of China (English)

    Zhi Qiang Huang

    2000-01-01

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

  15. Clinical application of biliary duct defect repair of biliary tract in patients with Mirizzi syndrome%胆管大范围缺损Mirizzi综合征患者胆道修复术的临床应用研究

    Institute of Scientific and Technical Information of China (English)

    侯焱森; 张力; 吴云; 刘永国

    2014-01-01

    目的:本研究旨在探讨采用胆道修复术对胆管大范围缺损Mirizzi综合征患者进行治疗的临床疗效及安全性,为临床治疗提供参考意见。方法回顾性分析在本院行胆道修复术的22例胆管大范围缺损Mirizzi综合征患者的治疗手段和临床疗效,其中有12例采用带血管蒂胃瓣修补治疗,10例行带脐静脉瓣胆道修复术,对两组患者的一般资料、临床资料及治疗结果进行对比分析。结果两组患者的临床资料比较差异无显著性(P>0.05);胃瓣修补组和脐静脉瓣修复组发生的术后并发症主要为胆管炎症,分别为4例(33.33%)和3例(30%),各组不良反应分别相加得出胃瓣修补组8例,脐静脉瓣修复组5例,两组采用Fisher精确检验得出P>0.05,两组术后不良反应差异无显著性。结论对胆管大范围缺损Mirizzi综合征患者采取胆道修复术(脐静脉瓣胆道修复术、带血管蒂胃瓣修补术)均是行之有效的治疗措施,术后并发症状轻微,无死亡病例发生,可以作为Mirizzi综合征患者的首选治疗措施。%ObjectiveTo investigate the prosthesis operation of bile duct for clinical efifcacy and safety of treatment for bile duct defects in patients with Mirizzi syndrome, and provide a reference for the clinical treatment of bile duct defects in Mirizzi syndrome.MethodsA retrospective analysis of 22 cases of bile duct defects in Mirizzi under went biliary tract prosthesis syndrome treatment and clinical curative effect of the patients, including 12 cases with vascular pedicled gastriclfap for repair of treatment, 10 cases with umbilical vein graft repair of biliary tract, carries on the contrast analysis to the general data, clinical data of two groups of patients and treatment results.ResultsThe clinical data of two patients were not statistically signiifcant (P>0.05); gastric lfap in the repair group and umbilical venous lfap group

  16. Biliary ascariasis: a review.

    Science.gov (United States)

    Shah, Omar Javed; Zargar, Showkat Ali; Robbani, Irfan

    2006-08-01

    Ascariasis, a helminthic infection of humans, is the most common parasitic infestation of the gastrointestinal tract. It infects about 25% of the world's population; around 20 thousand deaths occur per year from an adverse clinical course of the disease. This review is focused on biliary ascariasis, examining in some detail the pathogenesis of the disease with special reference to postcholecystectomy ascariasis and related issues. Although an endemic disease of tropical and subtropical countries, increasing population migration facilitated by fast improving communication facilities demands that clinicians everywhere be familiar with the clinical profile and management of biliary ascariasis.

  17. 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.

  18. Biliary Atresia

    Science.gov (United States)

    ... Liver Disease & NASH Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Biliary Atresia Cirrhosis Hemochromatosis Hepatitis A through E (Viral Hepatitis) Hepatitis ...

  19. Limited Role for Biliary Stent as Surrogate Fiducial Marker in Pancreatic Cancer: Stent and Intratumoral Fiducials Compared

    Energy Technology Data Exchange (ETDEWEB)

    Horst, Astrid van der, E-mail: a.vanderhorst@amc.uva.nl [Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Lens, Eelco; Wognum, Silvia; Jong, Rianne de [Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Hooft, Jeanin E. van [Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Tienhoven, Geertjan van; Bel, Arjan [Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands)

    2014-07-01

    Purpose: Because of low soft-tissue contrast of cone beam computed tomography (CBCT), fiducial markers are often used for radiation therapy patient setup verification. For pancreatic cancer patients, biliary stents have been suggested as surrogate fiducials. Using intratumoral fiducials as standard for tumor position, this study aims to quantify the suitability of biliary stents for measuring interfractional and respiratory-induced position variations of pancreatic tumors. Methods and Materials: Eleven pancreatic cancer patients with intratumoral fiducials and a biliary stent were included in this study. Daily CBCT scans (243 in total) were registered with a reference CT scan, based on bony anatomy, on fiducial markers, and on the biliary stent, respectively. We analyzed the differences in tumor position (ie, markers center-of-mass position) among these 3 registrations. In addition, we measured for 9 patients the magnitude of respiratory-induced motion (MM) of the markers and of the stent on 4-dimensional CT (4DCT) and determined the difference between these 2 magnitudes (ΔMM). Results: The stent indicated tumor position better than bony anatomy in 67% of fractions; the absolute difference between the markers and stent registration was >5 mm in 46% of fractions and >10 mm in 20% of fractions. Large PTV margins (superior-inferior direction, >19 mm) would be needed to account for this interfractional position variability. On 4DCT, we found in superior-inferior direction a mean ΔMM of 0.5 mm (range, –2.6 to 4.2 mm). Conclusions: For respiratory-induced motion, the mean ΔMM is small, but for individual patients the absolute difference can be >4 mm. For interfractional position variations, a stent is, on average, a better surrogate fiducial than bony anatomy, but large PTV margins would still be required. Therefore, intratumoral fiducials are recommended for online setup verification for all pancreatic patients scheduled for radiation therapy, including

  20. Endocrine disruption of oestrogen action and female reproductive tract cancers.

    Science.gov (United States)

    Gibson, Douglas A; Saunders, Philippa T K

    2014-04-01

    Endocrine disrupting chemicals (EDC) are ubiquitous and persistent compounds that have the capacity to interfere with normal endocrine homoeostasis. The female reproductive tract is exquisitely sensitive to the action of sex steroids, and oestrogens play a key role in normal reproductive function. Malignancies of the female reproductive tract are the fourth most common cancer in women, with endometrial cancer accounting for most cases. Established risk factors for development of endometrial cancer include high BMI and exposure to oestrogens or synthetic compounds such as tamoxifen. Studies on cell and animal models have provided evidence that many EDC can bind oestrogen receptors and highlighted early life exposure as a window of risk for adverse lifelong effects on the reproductive system. The most robust evidence for a link between early life exposure to EDC and adverse reproductive health has come from studies on women who were exposed in utero to diethylstilbestrol. Demonstration that EDC can alter expression of members of the HOX gene cluster highlights one pathway that might be vulnerable to their actions. In summary, evidence for a direct link between EDC exposure and cancers of the reproductive system is currently incomplete. It will be challenging to attribute causality to any single EDC when exposure and development of malignancy may be separated by many years and influenced by lifestyle factors such as diet (a source of phytoestrogens) and adiposity. This review considers some of the evidence collected to date.

  1. Clinical analysis of postoperative delirium in elderly patients with biliary tract surgery%老年病人胆道术后发生谵妄的临床分析

    Institute of Scientific and Technical Information of China (English)

    温暖; 邬善敏; 陈辰; 蔡杰; 李蔚

    2012-01-01

    目的 探讨老年病人胆道术后发生谵妄的原因及防治.方法 100例老年胆道术后发生谵妄的10例,对其进行原因分析,通过积极控制原发疾病,充分吸氧,纠正水、电解质紊乱等支持治疗,以及给予地西泮或氟哌啶醇等药物治疗,观察其疗效.结果 经过积极治疗后10例(10%)胆道术后发生谵妄病人均于出现谵妄症状1周内逐渐恢复,临床效果满意.结论 高龄病人术后诱发谵妄因素较多,胆道术后的病人每日自T管丢失大量胆汁,易导致病人内环境紊乱,增加了术后谵妄的风险.加强病人原发疾病的治疗及诱发因素的控制,可减少术后谵妄的发生.%Objective To investigate reason and treatment of delirium in elderly patients with biliary tract surgery. Methods 100 eldly patients with biliary tract surgery were reviewed. In whom 10 (10 %) patients with delirium tract surgery were analyzed. To observe the effectiveness by giving positive control primary disease, regulating water-electrolyte disorder, providing sufficient oxygen and proper drug of diazepam and haloperidol. Results Ten patients who underwent delirium after biliary tract surgery were recovery within one week. Clinical results were satisfactory. Conclusion There are many factors for eldly patients with biliary tract surgery induce delirium, while we can reduce the occurrence of postoperative delirium by treating primary disease and controlling induce factors.

  2. Whole abdominal irradiation for peritoneal dissemination of alimentary tract cancers

    Energy Technology Data Exchange (ETDEWEB)

    Sugahara, Shinji; Ohara, Kiyoshi; Todoroki, Takeshi; Tatsuzaki, Hideo; Fuji, Hiroshi; Kawashima, Mitsuhiko; Fukao, Katsushi; Itai, Yuji [Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine

    1995-09-01

    Between January 1986 and August 1991, 19 patients with alimentary tract cancers complicated by peritoneal dissemination received whole abdominal irradiation combined with intraperitoneal chemotherapy postoperatively. Using a moving-strip technique of irradiation, 12.0 Gy was delivered in three fractions to the entire abdominal contents with partial liver and kidney shielding. The primary tumor sites were the stomach in 12 patients, the colorectum in five, and the gall bladder in two. Nine patients with gross residual disease also received a limited field boost of 30.6 Gy in 17 fractions after completion of treatment to the whole abdomen. None of the patients failed to complete the planned dose despite acute gastrointestinal toxicity (nausea and vomiting, 84%, diarrhea and cramping, 78%) and acute hematologic toxicity (leukocytopenia, 84%, thrombocytopenia, 68%). Our follow-up study revealed that the actuarial one-year survival rate was 28.4% and the median survival time was 9.0 months. Survival rates at one-year for patients with colorectal and gastric cancer were 75.0% and 16.7%, respectively. Patients with gastric cancer (n=12) had a poorer outcome than those with colorectal cancer (n=5) in the present study. One reason for this difference may have been the presence of cancerous pleuritis, which was frequently observed in patients with gastric cancer. Therefore, more intensive treatment to prevent cancerous pleuritis seems to be necessary to improve the efficacy of whole abdominal irradiation. (author).

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1993-11-15

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

  4. Recurrent urinary tract infection and risk of bladder cancer in the Nijmegen bladder cancer study

    NARCIS (Netherlands)

    Vermeulen, S.; Hanum, N.; Grotenhuis, A.J.; Castano-Vinyals, G.; Heijden, A.G. van der; Aben, K.K.H.; Mysorekar, I.U.; Kiemeney, L.A.L.M.

    2015-01-01

    BACKGROUND: Controversy exists on whether urinary tract infection (UTI) is a risk factor for urinary bladder cancer (UBC). Here, the association is investigated using data from one of the largest bladder cancer case-control studies worldwide. METHODS: Information on (i) history and age at onset of r

  5. Contemporary Evaluation and Management of Upper Tract Urothelial Cancer.

    Science.gov (United States)

    Mandalapu, Rao S; Matin, Surena F

    2016-08-01

    Radical nephroureterectomy with en bloc bladder cuff excision and regional lymphadenectomy is the gold standard for the management of high-grade and high-risk upper tract urothelial carcinomas. There are a few prospective randomized controlled studies in this uncommon and often aggressive disease to support level-1 management guidelines. However, recent developments in imaging, minimally invasive techniques, lymphatic dissemination, and bladder cancer prevention raise the hope for improved risk stratification and treatments without compromising, and hopefully improving, oncological outcomes. Multimodality approaches in terms of neoadjuvant, adjuvant topical, and systemic chemotherapeutic regimens are promising, with 2 prospective trials either open or in development.

  6. Assessment and management of biliary tract re-operation accompanied with hepatocirrhosis and portal hypertension%胆道多次手术合并肝硬化门静脉高压症的评估及处理

    Institute of Scientific and Technical Information of China (English)

    柏立山; 柴新群; 胡志坚; 冯贤松

    2011-01-01

    Objective To probe the assessment and management of biliary tract re-operation accompanied with hepatocirrhosis and portal hypertension. Methods The clinical data of 18 patients of bile duct re operation accompanied with hepatocirrhosis and portal hypertension from January 2005 to December 2008 were retro spectively analyzed. Results Of the 18 patients. 4 were grouped to Child A according to Child-Pugh classificalion. 10 were child B, another 4 were Child C. As to the causes of hepatoeirrhosis: 14 patients (77.8%)resulted from biliary cirrhosis. 2 posthepatitic cirrhosis. 2 schistosomiasis cirrhosis. Sixteen patients received simply hiliary tract re-operation. 2 received biliary tract re-operation with devascularization; the bleeding amount during operation was up to 800~1 600 mL. Three of whom had post operative complications: 1 with biliary fistula, I with intestinal fistula and 1 with upper gastrointestinal bleeding. The other patient died of multi-organ dysfunction in preoperative period. Conclusion To the patients of biliary tract re-operation accompanied with hepatocirrhosis and portal hypertension, surgical operation will get good results if the assessment of relevant pre-operative issues are enhanced and the appropriate treatments are executed. Child-Pugh classification is not appropriate to assess the patients of biliary tract re-operation accompanied with hepatocirrhosis and portal hypertension.%目的 探讨胆道多次手术同时合并肝硬化门静脉高压症的评估及处理.方法 回顾性分析2005年1月至2008年12月我院收治的18例胆道多次手术同时合并肝硬化门静脉高压症患者的临床资料.结果 18例胆道多次手术同时合并肝硬化门静脉高压症患者中,按照Child-Pugh分级,A级4例,B级10例,C级4例.肝硬化原因:胆汁性肝硬化14例(77.8%),肝炎后肝硬化2例,血吸虫性肝硬化2例.单独行胆道多次手术16例,联合行胆道多次手术和断流术2例;术中出血量达800

  7. Occupational exposure to endocrine-disrupting compounds and biliary tract cancer among men

    DEFF Research Database (Denmark)

    Ahrens, Wolfgang; Mambetova, Chinara; Bourdon-Raverdy, Nicole;

    2007-01-01

    between 1995 and 1997 in the frame of an international multicenter case-control study in six European countries (Denmark, France, Germany, Italy, Spain, and Sweden). Self-reported job descriptions were converted to semiquantitative variables (intensity, probability, and duration of exposure) for 14...

  8. 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.

  9. ENBD治疗ERCP后胆管感染及高淀粉酶血症疗效分析%Effects of ENBD Treating Post-ERCP Biliary Tract Infection and Hyperamylasemia

    Institute of Scientific and Technical Information of China (English)

    黄亚彬

    2012-01-01

    目的 评价内镜鼻胆管引流术(ENBD)治疗经内镜逆行胰胆管造影(ERCP)术后胆管感染和高淀粉酶血症疗效.方法 选择行ERCP胆总管结石患者120例,其中术后未给予ENBD60例作为对照组,术后给予ENBD60例作为治疗组.结果 治疗组和对照组血清淀粉酶值和C反应蛋白值在术前比较,差异无统计学意义(P>0.05),术后3h和24 h对比,差异有统计学意义(P<0.01),治疗组优于对照组.同时,治疗组胆管感染和高淀粉酶血症发生率均低于对照组,差异有统计学意义(P<0.05).结论 鼻胆管引流术对ERCP术后胆管感染和高淀粉酶血症均有一定的预防作用.%Objective To evaluate endoscopic naso-biliary drainage (ENBD) effect on post-ERCP biliar-y tract infection and hyperamylasemia. Methods 120 cases with common bile duct stones for routine ERCP were selected, among which 60 cases not given ENBD were set as the control group, the other 60 cases given ENBD were set as the treatment group. Results After observation, amylase and CRP levels of the two groups were not statistically significantly different from before surgery(P >0. 05) ,while significant differences were seen between 3 hours after surgery and 24 hours after surgery(P <0.01 ) ,the treatment group better than the control group. The biliary tract infection and hyperamylasemia rates in the treatment group were lower than that in the control group (P < 0. 05). Conclusion ENBD treatment has a certain preventive function on post-ERCP biliary tract infection and hyperamylasemia.

  10. Biliary atresia

    Science.gov (United States)

    ... Elsevier; 2016:chap 356. Suchy FJ. Anatomy, histology, embryology, developmental anomalies, and pediatric disorders of the biliary ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  11. Massive infestation by Ascaris lumbricoides of the biliary tract: report of a successfully treated case Infestação maciça por Ascaris lumbricoides nas vias biliares: relato de um caso tratado com sucesso

    Directory of Open Access Journals (Sweden)

    Dahir Ramos de Andrade Júnior

    1992-02-01

    Full Text Available This is a report of a 25 years old black woman from the city of São Paulo, Brazil, who developed acute obstructive cholangitis of Ascaris lumbricoides with septicemia and multiple hepatic abscesses. The patient had sickle cell trait and normal delivery 3 months ago. Massive infestation of the biliary tract by Ascaris lumbricoides was diagnosed by abdominal ultrasonography and endoscopic retrograde cholangiography. Sixty worms were removed from the common bile duct and hepatic abscesses were drained by surgery. The infectious process was polymicrobial. The patient's recovery was complete after a long evolution with a wide spectrum antibiotic therapy. New surgeries were needed to remove residual worms in the biliary tract. The diagnostic methods, clinical-biochemical features and also the clinical and surgical management are presented. The biliary ascariasis pathophysiology is commented.Descrito caso de mulher de 25 anos, negra, procedente da cidade de São Paulo - Brasil, que desenvolveu quadro agudo de colangite obstrutiva por Ascaris lumbricoides, com septicemia e múltiplos abscessos hepáticos. Era portadora de traço falciforme e tinha tido um parto normal há 3 meses. Foi estabelecido o diagnóstico de infestação maciça por Ascaris lumbricoides em vias biliares com ultrasonografia abdominal e colangiografia retrógrada endoscópica. Sessenta vermes foram retirados do colédoco e drenados os abscessos hepáticos por cirurgia. O quadro infeccioso era polimicrobiano. Houve recuperação total da paciente após longa evolução, com antibioticoterapia de amplo espectro e novas cirurgias com extração de vermes residuais. Os autores apresentam os métodos diagnósticos empregados, o quadro clínico-bioquímico e a abordagem terapêutica. A fisiopatologia da ascaridíase biliar é discutida.

  12. Screening for urinary tract cancer with urine cytology in Lynch syndrome and familial colorectal cancer

    DEFF Research Database (Denmark)

    Myrhøj, T; Andersen, M-B; Bernstein, I

    2008-01-01

    AIM: The aim of this study was to evaluate if Urine Cytology (UC) is an appropriate screening procedure for detecting urinary tract neoplasia at an early stage in persons at risk in Hereditary Non-Polyposis Colorectal Cancer families. METHOD: In the National Danish HNPCC-register persons at risk ...

  13. PET/MR Imaging in Cancers of the Gastrointestinal Tract.

    Science.gov (United States)

    Paspulati, Raj Mohan; Gupta, Amit

    2016-10-01

    PET/computed tomography (PET/CT) is an established hybrid imaging technique for staging and follow-up of gastrointestinal (GI) tract malignancies, especially for colorectal carcinoma. Dedicated hybrid PET/MR imaging scanners are currently available for clinical use. Although they will not replace regular use of PET/CT, they may have utility in selected cases of GI tract malignancies. The superior soft tissue contrast resolution and depiction of anatomy and the functional information obtained from diffusion-weighted imaging (DWI) provided by MR imaging in PET/MR imaging are advantages over CT of PET/CT for T staging and follow-up of rectal carcinoma and for better characterization of liver lesions. Functional information from DWI and use of liver-specific MR imaging contrast agents are an added advantage in follow-up of liver metastases after systemic and locoregional treatment. New radiotracers will improve the utility of PET/MR imaging in staging and follow-up of tumors, which may not be [18F]-2-fluoro-2-deoxy-d-glucose avid, such as hepatocellular carcinoma and neuroendocrine tumors. PET/MR imaging also has application in selected cases of cholangiocarcinoma, gallbladder cancer, and pancreatic carcinoma for initial staging and follow-up assessment.

  14. 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.

  15. Distribution and Antibiotic Sensitivity of Bacteria Isolated from Patients with Biliary Tract Disorders%胆道细菌感染的分布及药敏分析

    Institute of Scientific and Technical Information of China (English)

    刘适; 蔡瑞云; 李浩

    2012-01-01

    Objective To investigate the distribution of bacteria isolated from inpatients with biliary tract disorders (BTD) and their sensitivities to common antibiotics. Methods We retrospectively analyzed drug sensitivity results of 280 bacterial strains isolated from the bile samples of the inpatients with BTD in the People's Hospital of Hunan Province from January 1, 2011 to June 30, 2012. Results Altogether 195 strains of Gram - negative bacteria were isolated from the bile samples, and the top three bacteria were Escherkhia coli {21.9% , 78/195), Klebsiella pneumoniae (13. 9% , 39/195), and Pseudomonas aeruginosa (7.9% , 22/195). 83 strains of Gram - positive bacteria were isolated from the samples, and the top three bacteria were Enterococcus faecalis (10. 4% , 29/83), Enterococcus faecium (4.6% , 13/83), Streptococcus mutans (4.6% , 13/83). And 2 strains of Candida albicans were isolated from the samples. The Gram - negative bacteria were mostly sensitive to carbapenems and amikacin, while the Gram - negative bacteria were mostly sensitive to glycopeptides, nitrofurans and carbapenems. Conclusions The bacterial distribution and their sensitivities to antibiotics in the inpatients with BTD have been changed. It is necessary to perform bile culture so as to guide reasonable clinical prescription and reduce the production of drug-resistant strains.%目的 了解湖南省人民医院住院病人胆道感染细菌分布及其对目前常用抗生素的敏感性. 方法 对2011年1月1日-2012年6月30日245例胆道疾病患者胆汁培养阳性所检出的280株细菌及其药敏试验结果进行回顾性分析. 结果 检出革兰阴性细菌(G-菌)195株(69.6%),其中大肠杆菌78株(27.9%)、肺炎克雷伯菌39株(13.9%)和铜绿假单胞菌22株(7.9%)分列前三位;革兰阳性球菌(G+球菌)83株(29.6%),其中粪肠球菌29株(10.4%)、屎肠球菌13株(4.6%)和变异链球菌13株(4.6%)分列前三位;真菌(白色念珠菌)2株(0

  16. Spontaneous biliary peritonitis in children.

    Science.gov (United States)

    Kohli, Supreethi; Singhal, Anu; Arora, Anita; Singhal, Sanjeev

    2013-01-01

    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.

  17. 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.

  18. 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.

  19. A pilot study on respiratory and digestive tract cancer among woodworkers.

    Science.gov (United States)

    Esping, B; Axelson, O

    1980-09-01

    Cancer of the nose and paranasal sinuses is a known occupational hazard among workers in the furniture industry. An increased frequency of cancer at other sites has also been suggested to occur among different types of woodworkers in the United States, eg, cancer of the gastrointestinal tract and lung but also lymphatic and hematopoietic malignancies. This case-referent study is of a pilot character and was undertaken for the further elucidation of respiratory and digestive tract cancer among Swedish woodworkers. A four-fold excess of respiratory cancer, other than nasal cancer, was found, particularly in relation to furniture workers, whereas no definite excess of digestive tract cancer was indicated. Further studies seem worthwhile regarding cancer hazard in the woodworking industry.

  20. Biliary tract prosthesis combined with pancreatic duct stents in patients with periampullary carcinoma%晚期壶腹周围癌的胆胰管双支架治疗

    Institute of Scientific and Technical Information of China (English)

    韩树堂; 史伟; 张小琴; 张以洋; 张其德; 肖君; 周玉宏; 胡余美; 姜素峰

    2009-01-01

    目的 探讨晚期壶腹周围癌患者胆管和胰管双支架治疗的临床价值.方法 36例经病理学和(或)临床诊断为晚期壶腹周围癌患者,影像学表现为胰管和胆管均有狭窄,经内镜先在胰管内置入Teflon塑料支架,然后胆道内置入可膨胀式金属支架,不成功者改经皮经肝胆管内置入金属支架进行引流.观察支架置放前后患者的血清肝生化指标、胰酶水平和临床表现.结果 36例置入胰管塑料支架均顺利,29例内镜置入金属胆道支架成功,7例(2例Billroth Ⅱ术后)因导丝插入胆管困难改为经皮经肝胆管内支架置入.支架置放后肝ALT、AST、ALP、r-谷氨酰转肽酶以及总胆红素、直接胆红素均有明显的下降;15例出现血淀粉酶和血脂肪酶的升高,但经过治疗后均恢复正常;腹痛缓解率82.4%(28/34),腹泻改善有效率达88.2%(15/17).结论 胆、胰管联合支架可以解除壶腹周围癌患者的胆、胰管恶性狭窄与梗阻,安全有效.%Objective To evaluate the efficacy of biliary tract prosthesis and pancreatic duct stents for advanced periampullary carcinoma. Methods A total of 36 patients were diagnosed as advanced periampullary carcinoma pathologically or clinically, with strictures both in pancreatic and biliary ducts confirmed by imaging. Teflon stents were firstly implanted through endoscopy to the narrowed pancreatic ducts, expansible metal prosthesis were then implanted to the biliary tract. If failed, the metal stents were given through percutaneous transhepatic biliary drainage (PTCD) pathway. Serum levels of liver enzymes, amylase and clinical manifestations were observed before and after operation. Results Teflon stents were successfully implanted into pancreatic ducts in all patients. Metal prostheses into bile ducts were endoscopically implanted in 29 cases, and via PTCD in 7, including 2 cases of Billroth Ⅱ gastrectomy. The levels of liver enzymes significantly decreased (P<0.01) after

  1. Biliary cystadenoma

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

  2. Quantitative hepatobiliary scintigraphy and endoscopic sphincter of Oddi manometry in patients with suspected sphincter of Oddi dysfunction: assessment of flow-pressure relationship in the biliary tract

    DEFF Research Database (Denmark)

    Madácsy, L; Middelfart, H V; Matzen, Peter;

    2000-01-01

    OBJECTIVE: In the present study, the diagnostic efficacy of quantitative hepatobiliary scintigraphy (QHBS) was compared with that of endoscopic sphincter of Oddi (SO) manometry (ESOM) in patients with a suspected SO dysfunction (SOD) of biliary type II or III. METHODS: Twenty cholecystectomized...... patients with SOD biliary types II and III were investigated by QHBS and by ESOM. Twenty asymptomatic cholecystectomized patients served as controls for scintigraphy. ESOM was performed by applying the station pull-through method. Then SO basal pressure and phasic contraction characteristics were....... RESULTS: In patients with SOD and elevated SO basal pressure (> 40 mmHg), QHBS parameters, such as Tmax and T(1/2) calculated from regions of interest over the hepatic hilum and common bile duct, HDTT and DAT proved to be significantly increased compared to controls: 28.7 +/- 4.3 versus 21.1 +/- 4.6 min...

  3. Long-Term Lithium Use and Risk of Renal and Upper Urinary Tract Cancers

    DEFF Research Database (Denmark)

    Pottegård, Anton; Hallas, Jesper; Jensen, Boye L;

    2015-01-01

    -term use of lithium and risk of upper urinary tract cancer, including renal cell cancer and cancers of the renal pelvis or ureter. We identified all histologically verified upper urinary tract cancer cases in Denmark between 2000 and 2012 from the Danish Cancer Registry. A total of 6477 cases were matched...... stratified by stage and subtype of upper urinary tract cancer revealed slight but nonsignificant increases in the ORs for localized disease (OR, 1.6; 95% CI, 0.8-3.0) and for renal pelvis/ureter cancers (OR, 1.7; 95% CI, 0.5-5.4). In conclusion, in our nationwide case-control study, use of lithium......Lithium induces proliferation in the epithelium of renal collecting ducts. A recent small-scale cohort study reported a strong association between use of lithium and increased risk of renal neoplasia. We therefore conducted a large-scale pharmacoepidemiologic study of the association between long...

  4. Cancer of the genital tract among the Ibo women in Nigeria.

    Science.gov (United States)

    Megafu, U

    1979-11-01

    An analysis of female genital tract cancer among the Ibos of Nigeria has proven to be preponderantly cervical cancer. It is therefore obvious that the practice of ritual circumcision among the Ibo men does not protect the women from cervical cancer. The most important etiological factors contributing to cervical cancer among the Ibo women are early marriage, early age of coitus, and grand multiparity. Corpus cancer is relatively rare among the Ibo women.

  5. Manejo nutricional del paciente postcirugía de vías biliares y páncreas Nutritional management of the patient after surgery of the biliary tract and pancreas

    Directory of Open Access Journals (Sweden)

    C. Loinaz Segurola

    2008-05-01

    Full Text Available Gran parte de los pacientes con cirugía biliopancreática mayor sufren desnutrición preoperatoria, agravada por el ayuno perioperatorio y los tratamientos posteriores. La cirugía de páncreas y vías biliares puede ocasionar trastornos digestivos, fundamentalmente absortivos, sobre todo con malabsorción grasa. El soporte nutricional se ha demostrado útil en cirugía gastrointestinal en múltiples trabajos. En los últimos años ha habido un importante esfuerzo para comprobar cuáles son las mejores pautas en la nutrición perioperatoria en cirugía pancreatobiliar, sobre todo en el contexto de la duodenopancreatectomía. En líneas generales, la nutrición parenteral (NPT rutinaria parece desaconsejada, salvo en pacientes con desnutrición moderada-grave, siendo de elección la nutrición enteral. La inmunonutrición parece mejorar los resultados, y la infusión óptima podría ser la cíclica. De acuerdo con una encuesta enviada a Unidades de Cirugía Hepatopancreatobiliar de España, la pauta mayoritariamente utilizada de soporte en cirugía pancreatobiliar mayor es en la actualidad la NPT, con inicio de dieta oral a los 4-6 días. El uso de nutrición enteral es minoritario, y la alimentación oral precoz es excepcional.A big proportion of patients with biliary and pancreatic surgery present preoperative malnourishment aggravated by perioperative fasting and additional therapies. Surgery of the pancreas and the biliary tract may cause digestive impairments, mainly absorptive, especially with fat malabsorption. Many studies have shown the usefulness of nutritional support in gastrointestinal surgery. In the last years, there has been a remarkable effort in order to determine which are the best perioperative nutrition regimens in biliary and pancreatic surgery, particularly in the setting of duodenopancreatectomy. Generally, routinary parenteral nutrition (PNT is not recommended, excepting in moderate-severe hyponutrition, the first choice

  6. Systematic review of the epidemiology literature on formaldehyde and cancers of the upper respiratory tract

    Science.gov (United States)

    Background: EPA is currently drafting a Toxicological Review of formaldehyde. As part of the comprehensive evaluation of potential hazards associated with exposure to formaldehyde, the potential hazards for cancers of the upper respiratory tract are being evaluated. We are aware ...

  7. PET-CT in Determining the Radioembolization Dose Delivered to Patients With Liver Metastasis, Primary Liver Cancer, or Biliary Cancer

    Science.gov (United States)

    2017-01-24

    Adult Primary Hepatocellular Carcinoma; Advanced Adult Primary Liver Cancer; Metastatic Extrahepatic Bile Duct Cancer; Recurrent Adult Primary Liver Cancer; Recurrent Extrahepatic Bile Duct Cancer; Stage D Adult Primary Liver Cancer (BCLC); Unspecified Adult Solid Tumor, Protocol Specific

  8. Prediagnostic selenium status and hepatobiliary cancer risk in the European Prospective Investigation into Cancer and Nutrition cohort

    NARCIS (Netherlands)

    Hughes, David J.; Duarte-Salles, Talita; Hybsier, Sandra; Trichopoulou, Antonia; Stepien, Magdalena; Aleksandrova, Krasimira; Overvad, Kim; Tjønneland, Anne; Olsen, Anja; Affret, Aurélie; Fagherazzi, Guy; Boutron-Ruault, Marie Christine; Katzke, Verena; Kaaks, Rudolf; Boeing, Heiner; Bamia, Christina; Lagiou, Pagona; Peppa, Eleni; Palli, Domenico; Krogh, Vittorio; Panico, Salvatore; Tumino, Rosario; Sacerdote, Carlotta; Bueno de Mesquita, Hendrik Bastiaan; Peeters, Petra H.; Engeset, Dagrun; Weiderpass, Elisabete; Lasheras, Cristina; Agudo, Antonio; Sánchez, Maria José; Navarro, Carmen; Ardanaz, Eva; Dorronsoro, Miren; Hemmingsson, Oskar; Wareham, Nicholas J.; Khaw, Kay Tee; Bradbury, Kathryn E.; Cross, Amanda J.; Gunter, Marc; Riboli, Elio; Romieu, Isabelle; Schomburg, Lutz; Jenab, Mazda

    2016-01-01

    Selenium status is suboptimal in many Europeans and may be a risk factor for the development of various cancers, including those of the liver and biliary tract. Objective: We wished to examine whether selenium status in advance of cancer onset is associated with hepatobiliary cancers in the EPIC (Eu

  9. Quantitative hepatobiliary scintigraphy and endoscopic sphincter of Oddi manometry in patients with suspected sphincter of Oddi dysfunction: assessment of flow-pressure relationship in the biliary tract

    DEFF Research Database (Denmark)

    Madácsy, L; Middelfart, H V; Matzen, Peter;

    2000-01-01

    patients with SOD biliary types II and III were investigated by QHBS and by ESOM. Twenty asymptomatic cholecystectomized patients served as controls for scintigraphy. ESOM was performed by applying the station pull-through method. Then SO basal pressure and phasic contraction characteristics were...... patients with SOD, a statistically significant linear correlation was found between the SO basal pressure and the QHBS parameters. Although HDTT was the most sensitive scintigraphic parameter (89%), the combined sensitivity and specificity of Tmax and T(1/2) of the common bile duct reached 100...

  10. Long-Term Lithium Use and Risk of Renal and Upper Urinary Tract Cancers.

    Science.gov (United States)

    Pottegård, Anton; Hallas, Jesper; Jensen, Boye L; Madsen, Kirsten; Friis, Søren

    2016-01-01

    Lithium induces proliferation in the epithelium of renal collecting ducts. A recent small-scale cohort study reported a strong association between use of lithium and increased risk of renal neoplasia. We therefore conducted a large-scale pharmacoepidemiologic study of the association between long-term use of lithium and risk of upper urinary tract cancer, including renal cell cancer and cancers of the renal pelvis or ureter. We identified all histologically verified upper urinary tract cancer cases in Denmark between 2000 and 2012 from the Danish Cancer Registry. A total of 6477 cases were matched by age and sex to 259,080 cancer-free controls. Data on lithium use from 1995 to 2012 were obtained from the Danish Prescription Registry. We estimated the association between long-term use of lithium (≥5 years) and risk of upper urinary tract cancer using conditional logistic regression with adjustment for potential confounders. Long-term use of lithium was observed among 0.22% of cases and 0.17% of controls. This yielded an overall nonsignificant adjusted odds ratio (OR) of 1.3 (95% confidence interval [95% CI], 0.8-2.2) for upper urinary tract cancer associated with long-term use of lithium. Analyses stratified by stage and subtype of upper urinary tract cancer revealed slight but nonsignificant increases in the ORs for localized disease (OR, 1.6; 95% CI, 0.8-3.0) and for renal pelvis/ureter cancers (OR, 1.7; 95% CI, 0.5-5.4). In conclusion, in our nationwide case-control study, use of lithium was not associated with an increased risk of upper urinary tract cancer.

  11. Biliary peritonitis following percutaneous nephrolithotomy: Minimally invasive management

    OpenAIRE

    Yadav, Siddharth; Singh, Animesh; Singh, Prabhjot

    2015-01-01

    Percutaneous nephrolithotomy (PCNL) is a standard procedure for large renal calculi but has potential for complications. Rarely, biliary tract injury can occur during PCNL that can lead to biliary peritonitis with sepsis. Such cases are usually managed by emergent cholecystectomy. We present a case of biliary peritonitis resulting from gall bladder injury during PCNL, managed minimally invasively with an abdominal drain and endoscopic retrograde cholangiography with common bile duct stenting.

  12. Biliary peritonitis following percutaneous nephrolithotomy: Minimally invasive management.

    Science.gov (United States)

    Yadav, Siddharth; Singh, Animesh; Singh, Prabhjot

    2015-01-01

    Percutaneous nephrolithotomy (PCNL) is a standard procedure for large renal calculi but has potential for complications. Rarely, biliary tract injury can occur during PCNL that can lead to biliary peritonitis with sepsis. Such cases are usually managed by emergent cholecystectomy. We present a case of biliary peritonitis resulting from gall bladder injury during PCNL, managed minimally invasively with an abdominal drain and endoscopic retrograde cholangiography with common bile duct stenting.

  13. 饮水低张MSCT技术在胆管梗阻性疾病中的应用%Diagnosis of biliary tract obstructive diseases by multislice CT after low tension and drinking water

    Institute of Scientific and Technical Information of China (English)

    高飞; 程涛; 韦炜

    2012-01-01

    Objective To explore the value of the multi-slice CT(MSCT) after low tension and drinking water in the diagnosis of biliary tract obstructive diseases. Methods Seventy six patients planning to be diagnosed as obstructive jaundice clinically were examined by multi-slice CT after low tension and drinking water, and their pathologic results were analyzed and compared. Results The third period of bile duct was positioned with the highest accuracy; bile duct stones were found with the highest qualitative accuracy in benign biliary obstruction; vater ampulla carcinoma and extrahepatic bile duct carcinoma were found with the higher qualitative accuracy in malignant biliary obstruction; there was "progressive expansion" in 24 cases, 17 cases of which were benign lesion and 7 cases of which were malignant lesion; there was "segmental expansion" in 12 cases, 7 cases of which were benign lesion and 5 cases of which were malignant lesion; there was "soft rattan" in 38 cases, 1 case of which was benign lesion and 37cases of which were malignant lesion; there were 25 cases of "edge sample" narrow and 16 cases of " beak kind" narrow, which were malignant lesion; 7 cases of "target sign" were choledocholithiasis; there were 25 cases of vater ampulla carci- nom,7 cases of which had "half levy", 8 cases of which had "double loop levy", 12 cases of which had "double duct", and 12 cases of which had "finger sign". Conclusion By means of multi-slice CT after low tension and drinking water,there were some characteristics in benign and malignant biliary tract obstructive diseases in CT performance, and thus MSCT positioning accuracy and qualitative accuracy can be improved by combining the various signs.%目的 探讨饮水低张MSCT技术在胆管梗阻疾病中的应用价值.方法对76例临床拟诊梗阻性黄疸患者行饮水低张MSCT扫描,分析其CT表现,与病理结果对照.结果定位准确率最高的为第3段胆管;良性胆道病变定性准确率最高的是胆管

  14. A sex-specific association between a 15q25 variant and upper aerodigestive tract cancers.

    LENUS (Irish Health Repository)

    Chen, Dan

    2011-04-01

    Sequence variants located at 15q25 have been associated with lung cancer and propensity to smoke. We recently reported an association between rs16969968 and risk of upper aerodigestive tract (UADT) cancers (oral cavity, oropharynx, hypopharynx, larynx, and esophagus) in women (OR = 1.24, P = 0.003) with little effect in men (OR = 1.04, P = 0.35).

  15. Metastatic breast cancer to the gastrointestinal tract: A case series and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Jose Nazareno; Donald Taves; Harold G Preiksaitis

    2006-01-01

    Metastatic breast cancer involving the hepatobiliary tract or ascites secondary to peritoneal carcinomatosis has been well described. Luminal gastrointestinal tract involvement is less common and recognition of the range of possible presentations is important for early and accurate diagnosis and treatment. We report 6 patients with a variety of presentations of metastatic breast cancer of the luminal gastrointestinal tract. These include oropharyngeal and esophageal involvement presenting as dysphagia with one case of pseudoachalasia, a linitis plastica-like picture with gastric narrowing and thickened folds, small bowel obstruction and multiple strictures mimicking Crohn's disease, and a colonic neoplasm presenting with obstruction. Lobular carcinoma,representing only 10% of breast cancers is more likely to metastasize to the gastrointestinal tract. These patients presented with gastrointestinal manifestations after an average of 9.5 years and as long as 20 years from initial diagnosis of breast cancer. Given the increased survival of breast cancer patients with current therapeutic regimes, more unusual presentations of metastatic disease, including involvement of the gastrointestinal tract can be anticipated.

  16. 莱芜地区胆道感染患者胆汁细菌学及药敏结果分析%Analysis of bile bacteriology and drug sensitive results in patients with biliary tract infection in Laiwu area

    Institute of Scientific and Technical Information of China (English)

    苏爱美; 王云

    2015-01-01

    目的:研究莱芜地区胆道感染患者胆汁中细菌谱的变化及其药物敏感性变化,为本地区胆道感染患者合理应用抗生素提供理论依据。方法:对2009年1月-2014年12月间收治的262例本地区胆道感染患者的胆汁细菌培养阳性的231株病原菌分布及耐药情况作回顾性分析。结果:对于2009年1月-2011年12月、2012年1月-2014年12月两个时间段90、172份胆汁标本中各有63、132份病原菌培养阳性,分别检出病原菌73、158株;所分离的病原菌以革兰阴性杆菌为主,2个时间段分别占78.07%、73.48%,革兰阳性菌分别为20.56%、21.97%,真菌分别占1.37%、4.55%;革兰阴性菌在胆道感染中所占的比率下降,而革兰阳性菌及真菌的比率上升;大肠埃希氏菌仍占最大比例,2个时间段分别为34.21%、31.82%,大肠埃希氏菌中ESBLs阳性耐药株分别为16.0%(4/25),54.8%(23/42)(P<0.05),胆道感染的病原菌发生明显的变迁。结论:胆道感染的病原菌中主要以大肠埃希氏菌、肠球菌属等为主,6年来胆道感染的病原菌发生明显的变迁,临床应用广泛的抗菌药物耐药率增加。%Objective:To study the changes of biliary bacteria and drug sensitivity to antibiotics in patients with biliary tract infection in laiwu, to provide the theory basis for clinical medicaton.Methods:The data of 231 strains of microbes were found in 262 patients with positive bile culture from Jan 2001 to Dec 2006 and their sensitivity to antibiotics were retrospectively analyzed.Results: There were 63 and 132 positive samples respectively in 90 samples during the first half of this study (2009-2011)and 172 ones during the second half (2012-2014) as well as 73 and 158 strains cultured. Respectively, Gram-negative bacteria accounted for 78.07% and 73.48%, Gram-positive bacteria accounted for 20.56% and 21.97%, fungi accounted for 1.37% and 4.55%; Escherichia coli was the

  17. Surveillance for urinary tract cancer in Lynch syndrome

    DEFF Research Database (Denmark)

    Bernstein, Inge Thomsen; Myrhøj, Torben

    2013-01-01

    procedures are justifiable. The aim of this review was to elucidate the present knowledge from the literature on the risk of UTC in LS and highlight the pros and cons of screening for asymptomatic neoplasia in the urinary tract. The review is based on a systematic literature search in PubMed database...

  18. Targeting cancers in the gastrointestinal tract: role of capecitabine

    Directory of Open Access Journals (Sweden)

    Muhammad Wasif Saif

    2009-03-01

    Full Text Available Muhammad Wasif SaifYale Cancer Center, Yale University School of Medicine, New Haven, CT, USAAbstract: Capecitabine is currently the only novel, orally home-administered fluorouracil prodrug. It offers patients more freedom from hospital visits and less inconvenience and complications associated with infusion devices. The drug has been extensively studied in large clinical trials in many solid tumors, including breast cancer, colorectal cancer, gastric cancer, and many others. Furthermore, the drug compares favorably with fluorouracil in patients with such cancers, with a safe toxicity profile, consisting mainly of gastrointestinal and dermatologic adverse effects. Whereas gastrointestinal events and hand-foot syndrome occur often with capecitabine, the tolerability profile is comparatively favorable. Prompt recognition of severe adverse effects is the key to successful management of capecitabine. Ongoing and future clinical trials will continue to examine, and likely expand, the role of capecitabine as a single agent and/or in combination with other anticancer agents for the treatment of gastrointestinal as well as other solid tumors, both in the advanced palliative and adjuvant settings. The author summarizes the current data on the role of capecitabine in the management of gastrointestinal cancers. Keywords: 5-fluorouracil, capecitabine, chemotherapy, adjuvant, advanced, colon cancer, gastric cancer, hepatocellular cancer, pancreatic cancer, cholangiocarcinoma, rectal cancer, anal cancer

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

    Institute of Scientific and Technical Information of China (English)

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

    2008-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    马红梅; 戴丐国; 连建安; 姜斌骅

    2014-01-01

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

  1. 围肝门外科技术在胆道外科的应用%Application of perihilar surgical techniques in biliary tract surgery

    Institute of Scientific and Technical Information of China (English)

    王坚; 陈炜

    2015-01-01

    围肝门外科充满挑战性、风险性、变化性和不确定性.围肝门胆道外科疾病因解剖的变异性、病理生理的复杂性和疾病的侵袭性,具有手术难度大、切除率低、术中易出血、术后并发症多、疾病复发率和病死率高的特点.只有通过全面系统的围肝门影像学检查与肝功能评估,掌握正确的围肝门手术操作技术,包括正确的解剖路径、正确的病灶切除技术及肝门部胆管重建技术,才能提高围肝门疾病治愈的成功率与安全性.肝门部的解剖与暴露是围肝门技术的核心,包括肝门板解剖、肝中裂劈开、肝方叶切除与围肝门切除等.围肝门外科是一项涉及术前、术中和术后的综合技术.运用精准外科理念,为每一位患者制订最优化与个体化的手术方案,才能提高围肝门胆道外科疾病的治愈率.%Perihilar surgery is full of challenge,risk,variability and uncertainty.Because of the anatomic variability,the pathophysiological complexity and invasion of the diseases,hepatic hilar biliary surgery has the characteristics of high operative difficulties,low resection rate,easy intraoperative bleeding,more postoperative complications,high recurrence rate and mortality rate.The cure rate and safety of the operation can be improved only through comprehensive imaging examinations and preoperative evaluation of liver function as well as the correct use of surgical techniques of anatomic paths,lesions excision and hepatic hilar reconstruction.The core of perihilar surgical techniques is hepatic hilar anatomy and explosion,including hilar plate dissection,dissection of liver along the medial fissure,quadrate lobe of liver resection and perihilar resection.Perihilar surgery is a comprehensive technique involving preoperative,intraoperative and postoperative procedures.The cure rates of perihilar biliary diseases can be improved by a combination of enhanced recovery after surgery and optimized and

  2. Primary Biliary Cholangitis (Primary Biliary Cirrhosis)

    Science.gov (United States)

    ... Liver Disease & NASH Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Biliary Atresia Cirrhosis Hemochromatosis Hepatitis A through E (Viral Hepatitis) Hepatitis ...

  3. Socioeconomic factors associated with risk of upper aerodigestive tract cancer in Europe.

    LENUS (Irish Health Repository)

    Conway, D I

    2010-02-01

    In the European Union, there are 180,000 new cases of upper aerodigestive tract (UADT) cancer cases per year--more than half of whom will die of the disease. Socioeconomic inequalities in UADT cancer incidence are recognised across Europe. We aimed to assess the components of socioeconomic risk both independently and through their influence on the known behavioural risk factors of smoking, alcohol consumption and diet.

  4. Impact of endoscopic ultrasonography (EUS) on surgical decision-making in upper gastrointestinal tract cancer

    DEFF Research Database (Denmark)

    Mortensen, Michael Bau; Edwin, B; Hünerbein, M;

    2007-01-01

    BACKGROUND: Endoscopic ultrasonography (EUS) is an integrated part of the pretherapeutic evaluation program for patients with upper gastrointestinal (GI) tract cancer. Whether the clinical impact of EUS differs between surgeons from different countries is unknown. The same applies to the potential...

  5. The aetiology of upper aerodigestive tract cancers among young adults in Europe: the ARCAGE study.

    LENUS (Irish Health Repository)

    Macfarlane, Tatiana V

    2010-12-01

    The incidence of cancers of the upper aerodigestive tract (UADT) is increasing throughout the world. To date the increases have been proportionally greatest among young people. Several reports have suggested that they often do not have a history of tobacco smoking or heavy alcohol consumption.

  6. Usefulness of magnetic resonance cholangiography in the diagnosis of biliary tract lesions in patients with suspected complication following cholecystectomy; Valor da colangiopancreatografia por ressonancia magnetica no diagnostico de lesoes das vias biliares em pacientes com suspeita de complicacao pos-colecistectomia

    Energy Technology Data Exchange (ETDEWEB)

    Cecin, Alexandre de Oliveira [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil); Goldman, Suzan Menasce; Caetano, Simone; Rosas, George de Queiroz; Coelho, Rafael Darahem de Souza [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Diagnostico por Imagem; Lobo, Edson Jose [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Gastroenterologia Cirurgica; Abdalla, Nitamar; Szejnfeld, Jacob [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Diagnostico por Imagem

    2005-01-15

    Objective: to determine the usefulness of magnetic resonance cholangiopancreatography (MRCP) in the diagnoses of bile duct injuries following cholecystectomy. Material and method: MRCP was retrospectively evaluated in 40 patients with suspected bile duct injury after laparoscopic or conventional cholecystectomy. Eight of these patients had been submitted to biliary reconstruction. All patients were symptomatic (jaundice, fever and chills, weight loss and abdominal pain). The scans were independently reviewed by two radiologists. The results were confirmed by surgery, percutaneous drainage, endoscopic retrograde cholangiopancreatography and clinical follow-up. The level and severity of bile duct injury were rated according to the Bismuth classification. Results: in a total of 40 symptomatic patients, 10 (25%) had normal findings on MRCP; Postoperative complications were seen in 29 (72.5%) patients, seven of them with more than one finding. Pancreatic head neoplasia was diagnoses in one patient. The most frequent finding was sclerosing (41.4%) followed by biliary duct stenosis (34.5%), residual or recurrent biliary stones (31.0%) and fluid collections (17.2%). The images obtained by MRCP were considered of good quality. Conclusion: MRCP is an effective method for the evaluation of patients with suspected postcholecystectomy biliary tract complications. (author)

  7. Phase III study of 5FU, etoposide and leucovorin (FELV) compared to epirubicin, cisplatin and 5FU (ECF) in previously untreated patients with advanced biliary cancer.

    Science.gov (United States)

    Rao, S; Cunningham, D; Hawkins, R E; Hill, M E; Smith, D; Daniel, F; Ross, P J; Oates, J; Norman, A R

    2005-05-09

    The purpose of this study was to determine whether epirubicin, cisplatin and infused 5FU (ECF) improves overall survival (OS) compared to 5FU, etoposide and leucovorin (FELV) in patients with previously untreated advanced biliary cancer in a prospective randomised study. Patients were randomly assigned to receive epirubicin, cisplatin and infused 5FU ECF or bolus 5FU etoposide and leucovorin (FELV). The primary end point was OS with secondary end points of objective response rate (ORR), failure-free survival (FFS), quality of life (QOL) and toxicity. In all, 54 patients were recruited with 27 randomly assigned to each arm. The median OS for ECF was 9.02 months (95% confidence interval (CI): 6.46-11.51) and FELV 12.03 months (95% CI: 9.3-14.7), P=0.2059. Objective response rates were similar for both arms: ECF 19.2% (95% CI: 6.55-39.3); FELV 15% (95% CI: 3.2-37.9), P=0.72. There was significantly increased grade 3/4 neutropenia with FELV vs ECF (53.8 vs 29.5%, respectively, P=0.020). Symptom resolution was impressive for both regimens. This is the largest reported randomised study to date in this setting. ECF did not improve OS compared to FELV, but was associated with less acute toxicity. These data suggest that chemotherapy can prolong OS and achieve good symptomatic relief in advanced biliary cancer.

  8. Interventional Endoscopy Database for Pancreatico-biliary, Gastrointestinal and Esophageal Disorders

    Science.gov (United States)

    2017-02-16

    Ampullary Cancer; Duodenal Cancer; Bile Duct Cancer; Bile Duct Disorders; Gallstones; Obstructive Jaundice; Pancreatic Disorders (Noncancerous); Colorectal Cancer; Esophageal Cancer; Barrett's Esophagus; Gastric Malignancies; Pancreatic Cancer; Pediatric Gastroenterology; Cholangiocarcinoma; Pancreatic Pseudocysts; Acute and Chronic Pancreatitis; Recurrent Pancreatitis; Cholangitis; Bile Leak; Biliary Strictures; Pancreatic Divisum; Biliary and Pancreatic Stones; Choledocholithiasis

  9. Population attributable risk of tobacco and alcohol for upper aerodigestive tract cancer.

    LENUS (Irish Health Repository)

    Anantharaman, Devasena

    2011-08-01

    Tobacco and alcohol are major risk factors for upper aerodigestive tract (UADT) cancer and significant variation is observed in UADT cancer rates across Europe. We have estimated the proportion of UADT cancer burden explained by tobacco and alcohol and how this varies with the incidence rates across Europe, cancer sub-site, gender and age. This should help estimate the minimum residual burden of other risk factors to UADT cancer, including human papillomavirus. We analysed 1981 UADT cancer cases and 1993 controls from the ARCAGE multicentre study. We estimated the population attributable risk (PAR) of tobacco alone, alcohol alone and their joint effect. Tobacco and alcohol together explained 73% of UADT cancer burden of which nearly 29% was explained by smoking alone, less than 1% due to alcohol on its own and 44% by the joint effect of tobacco and alcohol. Tobacco and alcohol together explained a larger proportion of hypopharyngeal\\/laryngeal cancer (PAR=85%) than oropharyngeal (PAR=74%), esophageal (PAR=67%) and oral cancer (PAR=61%). Tobacco and alcohol together explain only about half of the total UADT cancer burden among women. Geographically, tobacco and alcohol explained a larger proportion of UADT cancer in central (PAR=84%) than southern (PAR=72%) and western Europe (PAR=67%). While the majority of the UADT cancers in Europe are due to tobacco or the joint effect of tobacco and alcohol, our results support a significant role for other risk factors in particular, for oral and oropharyngeal cancers and also for UADT cancers in southern and western Europe.

  10. Optical coherence tomography in detection of dysplasia and cancer of the gastrointestinal tract and bilio-pancreatic ductal system

    Institute of Scientific and Technical Information of China (English)

    Pier Alberto Testoni; Benedetto Mangiavillano

    2008-01-01

    Optical coherence tomography (OCT) is an optical imaging modality that performs high-resolution, cross-sectional, subsurface tomographic imaging of the microstructure of tissues. The physical principle of OCT is similar to that of B-mode ultrasound imaging, except that it uses infrared light waves rather than acoustic waves. The in vivo resolution is 10-25 times better (about 10 μm) than with high-frequency ultrasound imaging, but the depth of penetration is limited to 1-3 mm, depending upon tissue structure, depth of focus of the probe used, and pressure applied to the tissue surface. In the last decade, OCT technology has evolved from an experimental laboratory tool to a new diagnostic imaging modality with a wide spectrum of clinical applications in medical practice, including the gastrointestinal (GI) tract and pancreatic-biliary ductal system. OCT imaging from the GI tract can be done in humans by using narrow-diameter, catheter-based probes that can be inserted through the accessory channel of either a conventional front-view endoscope, for investigating the epithelial structure of the GI tract, or a side-view endoscope, inside a standard transparent ERCP catheter, for investigating the pancreatico-biliary ductal system. Esophagus and the esophago-gastric junction has been the most widely investigated organ so far; more recently, also duodenum, colon and pancreatico-biliary ductal system have been extensively investigated. OCT imaging of the gastro-intestinal wall structure is characterized by a multiple-layer architecture that permits an accurate evaluation of the mucosa, lamina propria, muscularis mucosae, and part of the submucosa. The technique may be, therefore, used to identify pre-neoplastic conditions of the GI tract, such as Barrett's epithelium and dysplasia, and evaluate the depth of penetration of early-stage neoplastic lesions. OCT imaging of the pancreatic and biliary ductal system could improve the diagnostic accuracy for ductal epithelial

  11. Changes in alcohol intake and risk of upper digestive tract cancer

    DEFF Research Database (Denmark)

    Thygesen, Lau C; Keiding, Niels; Johansen, Christoffer

    2007-01-01

    INTRODUCTION: Alcohol intake measured at one point in time is a strong predictor for later development of cancer of the oral cavity, pharynx, larynx and esophagus. In this prospective cohort study, we examined whether changes in individual alcohol intake resulted in subsequent altered risk...... of these cancers. MATERIAL AND METHODS: In the Copenhagen City Heart Study we assessed alcohol intake among 4 896 men and 6 239 women who participated at both the first (1976-1978) and second (1981-1983) examination of the study. Alcohol intake changes on risk of upper digestive tract cancer 1981-2002 were...

  12. 胆道探查术中胆总管下端穿通伤15例诊治分析%Diagnosis and treatment of penetrating injury in distal segment of common bile duct during biliary tract exploration

    Institute of Scientific and Technical Information of China (English)

    杜立学; 张煜; 吴武军; 耿西林; 李晖; 刘青光

    2009-01-01

    回顾性分析15例在胆道探查术中发牛胆道下端穿通伤患者的临床资料.9例为术中发现,行胆总管T形管引流并十二指肠侧后腹膜间隙引流,平均住院16 d,均痊愈;6例为术后发现,4例再次手术引流,住院8~12周痊愈,2例因感染性休克多脏器功能衰竭死亡.胆道穿通伤于术中及时发现、正确处理、充分引流,可获痊愈;术后早期发现,施以有效引流也可避免严重的并发症发生.%Clinical data of 15 patients with penetrating injury in the distal segment of the common bile duct during biliary tract exploration were retrospectively analyzed.Nine injuries were found during the surgical procedures and successfully treated with common bile duct T tube and peritoneal drainage before discharged from the hospital (mean hospitalization time 16 days).Six penetrating wounds were found post-operatively, and underwent another operation.Four patients were fully recovered at 8 to 12 weeks, and 2 died from multiple organ failure caused by infectious shock.Our investigation suggests that for the penetrating injury in the distal part of the common bile duct, early diagnosis, proper management and effective draining may improve the survival of the patients and avoid serious complications.

  13. 慢性泌尿系感染与原发性胆汁性肝硬化的关系%Association between chronic urinary tract infection and primary biliary cirrhosis

    Institute of Scientific and Technical Information of China (English)

    徐严; 王江滨; 王颂

    2016-01-01

    原发性胆汁性肝硬化(PBC)的病因尚不十分清楚,目前认为是遗传、感染与自身免疫以及环境因素共同作用而导致疾病.由于感染因素是诱发PBC的主要原因,因此研究者们近年来已经关注微生物慢性感染与PBC间的关系,并发现大肠埃希菌是最常见引起尿路感染(UTI)的细菌,而复发性UTI已被证实是自身免疫性肝病发生和发展的一个风险因素,尤其与PBC的关系更为密切.现就UTI与PBC的关系及相关机制进行进一步探讨.%The etiology of primary biliary cirrhosis (PBC) remains unclear,and at present,this disease is considered to be caused by the combined effect of genetic factors,infection,autoimmunity,and environmental factors.Since infection is the major cause for PBC,scholars have been focusing on the association between chronic microbial infection.Studies have shown that Escherichia coli is the most common bacterium for urinary tract infection (UTI),and recurrent UTI has been confirmed to be a risk factor for the development and progression of autoimmune fiver diseases and is closely associated with PBC.This article investigates the association between UTI and PBC and possible mechanisms.

  14. 胆道感染患者196例胆道细菌培养及耐药分析%Analysis of bacterial distribution and drug resistance in 196 patients with biliary tract infection

    Institute of Scientific and Technical Information of China (English)

    黄继续; 黄浩南

    2014-01-01

    目的:了解胆道感染患者胆汁中主要致病菌的分布及其抗生素敏感情况。方法对福建医科大学附属龙岩第一医院2008年1月至2012年1月间收治的196例胆道感染患者进行胆汁细菌培养和抗生素敏感情况分析。结果从164例患者的胆汁中共分离171株需氧菌,总阳性率为83.67%(164/196)。171株中革兰阴性菌112株,占65.50%;革兰阳性菌59株,占34.50%。革兰阴性菌的主要致病菌包括大肠埃希菌(35.00%)、肠球菌(27.49%)、肺炎克雷白菌(10.00%)和铜绿假单胞菌(4.00%)。革兰阴性菌对碳青酶烯类药物、阿米卡星、头孢哌酮/舒巴坦仍比较敏感,耐药率分别为低于1.8%、3.5%、11.1%;革兰阳性菌对氨苄西林、阿莫西林/克拉维酸钾的耐药率分别为低于6.1%、0。耐万古霉素的肠球菌(VRE)检出率依然较低,粪肠球菌、屎肠球菌对万古霉素的耐药率分别为2.6%、0。结论头孢哌酮/舒巴坦、阿米卡星可作为治疗胆道感染的首选用药。当革兰阳性菌如肠球菌或耐甲氧西林凝固酶阴性葡萄球菌为致病菌时,应根据胆汁培养结果选用窄谱抗生素。%Objective To find out the main pathogenic bacteria distribution and sensitivity to antibiotics in the bile of patients with biliary tract infection. Methods The distribution and antibiotic sensitivity of 196 patients with biliary tract infection in our hospital from January 2008 to January 2012 were reviewed and analyzed. Results From 171 strains of pathogenic bacteria of 164 patients, the total positive culture rate was 83.67%(164/196). There were 112 gram-negative bacteria (65.50%) and 59 gram-positive bacteria (34.50%). The positive pathogenic bacteria include e.coli (35.00%), enterococcus (27.49%), white fungus (10.00%), klebsiella pneumoniae and pseudomonas aeruginosa (4.00%). Gram-negative bacteria were still sensitive to carbon blue enzyme alkenes medicine, amikacin, and

  15. MINIINVASIVE METHODS IN THE TREATMENT OF BILIARY COMPLICATIONS AFTER LIVER TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    A. Y. Popov

    2011-01-01

    Full Text Available Complications of the biliary tract like bile leaks, strictures are an important cause of morbidity and mortality after liver transplantation. The frequency of such complications ranges from 5 to 25%. In most cases, biliary complications can be treated by endoscopy and/or methods of interventional radiology. This article is about the clinical case of liver transplantation with duct-to-duct biliary reconstruction, complicated by bile leaks, biliary tract stricture. Surgical correction of complications was ineffective. We used miniinvasive methods and got po- sitive clinical outcome after radiology intervention for prosthetics of the common bile duct. 

  16. EUS-Guided Biliary Drainage

    Directory of Open Access Journals (Sweden)

    Marc Giovannini

    2012-01-01

    Full Text Available The echoendoscopic biliary drainage is an option to treat obstructive jaundices when 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 setorial array echoendoscopes in early 1990 brought a new approach to diagnostic and therapeutic dimenion on echoendoscopy capabilities, opening the possibility to perform punction over direct ultrasonographic view. Despite of the high success rate and low morbidity of biliary drainage obtained by ERCP, difficulty could be found at the presence of stent tumor ingrown, tumor gut compression, periampulary diverticula, and anatomic variation. The echoendoscopic technique starts performing punction and contrast of the left biliary tree. When performed from gastric wall, the access is made through hepatic segment III. From duodenum, direct common bile duct punction. Dilatation is required before stent introduction, and a plastic or metallic stent is introduced. This phrase should be replaced by: diathermic dilatation of the puncturing tract is required using a 6F cystostome. The technical success of hepaticogastrostomy is near 98%, and complications are present in 36%: pneumoperitoneum, choleperitoneum, infection, and stent disfunction. To prevent bile leakage, we have used the 2 stent techniques, the first stent introduced was a long uncovered metallic stent (8 or 10 cm, and inside this first stent a second fully covered stent of 6 cm was delivered to bridge the bile duct and the stomach. Choledochoduodenostomy overall success rate is 92% and described complications include, in frequency order, pneumoperitoneum and focal bile peritonitis, present in 19%. By the last 10 years, the technique was especially performed in reference centers, by ERCP experienced groups, and this seems to be a general

  17. Nutritional support of patients with cancer of the gastrointestinal tract.

    Science.gov (United States)

    Daly, J M; Redmond, H P; Lieberman, M D; Jardines, L

    1991-06-01

    Malnutrition is extremely common in patients with malignant disease. Whereas the causes are multifactorial, the predominant factor is the imbalance between nutrient intake and host nutrient requirements. Furthermore, the evidence suggests that cachexia is related to abnormal changes in host intermediary metabolism induced by host-tumor interactions, and endogenous peptides such as TNF may be important mediators. The role of nutritional therapy in cancer patients remains to be defined. Clearly, patients with severe malnutrition benefit from nutritional intervention. However, the benefit of nutritional therapy in less severe cases of malnutrition as an adjuvant to oncologic therapy has yet to be established.

  18. Advanced endoscopic imaging of indeterminate biliary strictures

    Institute of Scientific and Technical Information of China (English)

    James; H; Tabibian; Kavel; H; Visrodia; Michael; J; Levy; Christopher; J; Gostout

    2015-01-01

    Endoscopic evaluation of indeterminate biliary stric-tures(IDBSs) has evolved considerably since the development of flexible fiberoptic endoscopes over 50 years ago. Endoscopic retrograde cholangiography pancreatography(ERCP) was introduced nearly a decade later and has since become the mainstay of therapy for relieving obstruction of the biliary tract. However, longstanding methods of ERCP-guided tissue acquisition(i.e., biliary brushings for cytology and intraductal forceps biopsy for histology) have demon-strated disappointing performance characteristics in distinguishing malignant from benign etiologies of IDBSs. The limitations of these methods have thus helped drive the search for novel techniques to enhance the evaluation of IDBSs and thereby improve diagnosis and clinical care. These modalities include, but are not limited to, endoscopic ultrasound, intraductal ultrasound, cholangioscopy, confocal endomicroscopy, and optical coherence tomography. In this review, we discuss established and emerging options in the evaluation of IDBSs.

  19. Role of medical history and medication use in the aetiology of upper aerodigestive tract cancers in Europe: the ARCAGE study.

    LENUS (Irish Health Repository)

    Macfarlane, T V

    2012-04-01

    The study aimed to investigate the role of medical history (skin warts, Candida albicans, herpetic lesions, heartburn, regurgitation) and medication use (for heartburn; for regurgitation; aspirin) in the aetiology of upper aerodigestive tract (UADT) cancer.

  20. Progress of chemoradiotherapy in management of extrahepatic biliary system cancer%肝外胆道系统肿瘤放化综合治疗进展

    Institute of Scientific and Technical Information of China (English)

    李金銮

    2008-01-01

    肝外胆道系统肿瘤是一种少见且预后差的疾病,诊断时多为晚期,丧失了根治手术切除的机会,放化综合治疗成为其主要治疗手段.近年来,放化综合治疗在可切除和不可切除的肝外胆道系统肿瘤治疗上取得了一定进展.%Extrahepatic biliary system cancer(EBSC)is an uncommon disease with a poor prognosis. There is no change to making radical resection in most patients because most of the diseases are diagnosed at late stage.Chemoradiotherapy has been a major therapeutic modality of EBSC.In recent year,the progress of chemoradiotherapy has been made in management of resectable and unresectable EBSC.

  1. Impact of the difference in surgical site on the physique in gastrointestinal tract cancer patients.

    Science.gov (United States)

    Hara, Tsuyoshi; Kubo, Akira; Kogure, Eisuke; Ishii, Takaya

    2016-01-01

    [Purpose] The purpose of the present study was to observe physical function, physique (only BMI), and nutrition status (evaluated by serum albumin levels) from before surgery to after discharge among perioperative patients with gastrointestinal tract cancer and to examine the effect of difference in surgical site (i.e., stomach, colon, and rectum) in these patients. [Subjects and Methods] The study subjects were 70 patients who underwent surgical treatment for gastrointestinal tract cancer [36 males and 34 females, aged 59.3 ± 11.4 years (mean ± SD)]. The subjects were classified into three levels according to surgical site (stomach, colon, and rectum). We evaluated patients' physical function, physique, and nutrition status in the three points: before surgery, after surgery, and after discharge. The 6-minute walk distance was measured for physical function. Body mass index was measured for physique. The serum albumin level was measured for nutrition status. [Results] Significant declines in 6-minute walk distance, body mass index, and serum albumin were observed after surgery among the study subjects. In addition, a significant decline in body mass index was observed after discharge compared with before surgery. Regarding body mass index, a significant interaction between surgical site and evaluation times was observed for ANOVA. [Conclusion] These results suggest that BMI after discharge is significantly less than that before surgery and that body mass index changes from before surgery to after surgery are efficacy the difference of surgical site in patients who undergo surgical treatment for gastrointestinal tract cancer.

  2. CALCIUM AND MAGNESIUM CONTENT IN CANCEROUS AND HEALTHY TISSUES OF GASTROINTESTINAL TRACT

    Directory of Open Access Journals (Sweden)

    Marta Głogowska

    2012-10-01

    Full Text Available Studies concerning concentration of biogenic metals in tissues of digestive system are sparse and diversified. The objectives of this study were to determine the mean concentration of biogenic metals: Mg and Ca, in cancerous and normal tissues of digestive system. Research was conducted on samples taken from different segments of human digestive tract. Tissues were taken during biopsy, surgery, and post-mortem from Military Hospital and PROSMED Health Center Patients’ located in Cracow. Samples were mineralized by wet digestion. First, they were dried and after dry mass were obtained the samples were put into digestion flasks and 1cm3 of nitric acid 65% was added to each of them. The samples were heated for about 2 hours, at 105°C. Mineralized material was moved to tubes with a capacity of 10 cm3 and filled with distilled water up to this volume. The resulting solutions were used to analyze the content of selected elements by FAAS method. The results are expressed in micrograms per gram of dry weight of tissue (µg•g-1d.m.. Average calcium content is higher in the tissues of the gastrointestinal tract of both healthy women (15890,28 µg•g-1d.m. and men (13040,24 µg•g-1d.m. in comparison with tumor tissues of the gastrointestinal tract of women (5365,19 µg•g-1 d.m. and men (2459,42 µg•g-1d.m.. Average magnesium content is higher in the tissues of the gastrointestinal tract of both healthy women (2887,19 µg•g-1 d.m. and men (1112,69 µg•g-1 d.m., in comparison with gastrointestinal cancerous tissues of women (1146,77 µg•g-1 d.m. and men (621,42 µg•g-1 d.m.. It was shown that differences between calcium and magnesium contents in the digestive tract tissues depend on the state of health - significantly higher contents of Ca and Mg were present in the tissues of healthy men and women in comparison to the tissues of men and women with digestive tract cancer. Magnesium and calcium have protective properties (they prevent the

  3. Complications of the extrahepatic biliary surgery in companion animals.

    Science.gov (United States)

    Mehler, Stephen J

    2011-09-01

    Surgery of the biliary tract is demanding and is associated with several potentially life-threatening complications. Veterinarians face challenges in obtaining accurate diagnosis of biliary disease, surgical decision-making, surgical hemostasis and bile peritonitis. Intensive perioperative monitoring is required to achieve early recognition of common postoperative complications. Proper treatment and ideally, avoidance of surgical complications can be achieved by gaining a clear understanding physiology, anatomy, and the indications for hepatobiliary surgery.

  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. Cancers of the upper gastro-intestinal tract: a review of somatic mutation distributions.

    Science.gov (United States)

    Abedi-Ardekani, Behnoush; Hainaut, Pierre

    2014-04-01

    Cancers of the upper gastro-intestinal tract (UGIT) comprise esophageal, esophago-gastric junction, stomach and duodenal cancers. Together, these cancers represent over 1.5 million cases and are the cause of about 1.25 million deaths annually. This group of cancers encompasses diseases with marked disparities in etiology, geographic distribution, histopathological features and frequency. Based on histological origin, squamous cell carcinoma of the esophagus (ESCC), which arises through a dysplasia-carcinoma sequence within the squamous mucosa, is a completely different cancer than junction, stomach and duodenal cancers, which develop within glandular epithelia through cascades involving inflammation, metaplasia, dysplasia and carcinoma. At the frontline between these two histological domains, cancers of the esophago-gastric junction constitute a mixed group of glandular tumors including distal esophageal adenocarcinomas and cancers arising within the most proximal part of the stomach - the cardia. Most of UGIT cancers are sporadic, although familial susceptibility genes have been identified for stomach and rare cases of ESCC. We have used the COSMIC database (http://www.sanger.ac.uk/genetics/CGP/cosmic/) to identify genes commonly mutated in UGIT cancers. Regardless of etiology and histopathology, three genes are mutated in at least 5% of UGIT cancers: TP53, CDKN2a and PIK3CA. Another three genes, NFE2L2, PTCH1 and NOTCH1, are mutated in ESCC only. Conversely, genes of the RAS family and of the CDH1/APC/CTNNB1 pathway are mutated only in non-squamous cancers, with differences in mutated genes according to topography. We review the potential functional significance of these observations for understanding mechanisms of UGIT carcinogenesis.

  6. Mohnarin2009年度报告:胆汁培养病原菌的构成及耐药性监测%Mohnarin 2009 annual report: Bacterial distribution and resistance surveillance in biliary tract infections

    Institute of Scientific and Technical Information of China (English)

    周春妹; 胡必杰; 吕媛

    2011-01-01

    目的 了解我国胆道感染病原菌分布和耐药现状.方法 按照卫生部全国细菌耐药监测网(Mohnarin)统一方案,2009年度由114所医院从胆汁分离的病原菌进行药敏测定;相关数据采用WHONET 5.4软件进行统计分析.结果 共分离2143株病原菌,其中革兰阴性杆菌1434株,占66.9%;最常见的是大肠埃希菌(25.7%)、肺炎克雷伯菌(9.2%)和铜绿假单胞菌(7.6%).革兰阳性球菌709株,占33.1%;最常见的是屎肠球菌(11.3%)和粪肠球菌(9.1%).药敏结果 显示,大肠埃希菌和肺炎克雷伯菌对第3代头孢菌素的耐药率以头孢噻肟的最高,达53.6%~40.4%;对头孢吡肟的耐药率分别为37.4%和25.8%;对左氧氟沙星耐药率分别为66.6%和44.2%.两者都出现了对碳青酶烯类药物耐药的菌株,为0.6%~1.1%.作为第3位常见革兰阴性杆菌的铜绿假单胞菌,对亚胺培南、头孢哌酮/舒巴坦和哌拉西林/他唑巴坦的耐药率分别为40.4%,38.7%和35.5%.屎肠球菌对糖肽类药物的耐药率1.7%~3.2%;粪肠球菌对替考拉宁的耐药率为0.9%;未出现对万古霉素耐药的菌株.结论 我国胆道感染病原菌以大肠埃希菌和肺炎克雷伯菌等肠杆菌科细菌最常见;对第3代头孢菌素和氟喹诺酮类药物耐药率较高;耐药率更高的屎肠球菌在胆汁中的检出率首次超过粪肠球菌;耐糖肽类的肠球菌分离率仍低.%Objective To understand the bacterial distribution and drug resistance of biliary tract infections in China currently and to provide data for selecting antimicrobial agents wisely. Methods Bile cultures and antimicrobial sensitivity tests for isolated strains were performed in 114 Mohnarin member hospitals using unified protocols from January 1 2009 to December 31 2009. WHONET 5.4 was used for analysis of all isolated bacteria. Results A total of 2143 bacterial strains were isolated during the study period, including

  7. 胆管内与胰腺导管内乳头状黏液性肿瘤的比较%Comparison between biliary tract intraductal papillary mucinous neoplasm and intraductal papillary mucinous neoplasm of the pancreas

    Institute of Scientific and Technical Information of China (English)

    王幸; 陈拥华; 蔡云强; 赵法之; 谭春露; 柯能文; 刘续宝

    2015-01-01

    Objective To compare biliary tract intraductal papillary mucinous neoplasm (BT-IPMN) with intraductal papillary mucinous neoplasm of the pancreas (P-IPMN).Methods From January 2008 to December 2013,eleven (6.0%) cases of BT-IPMNs were retrospectively identified from a total of 182 biliary tract tumors resected in our institution,while 50 cases underwent surgery for P-IPMN.The mean age of the 11 BT-IPMN cases was 57.3 years (range 40 to 74 years).There were 8 men (73.0%).The mean age of the 50 P-IPMN cases was 57.4 years (range 33 to 85 years).There were 34 men (68.0%).The clinical features,radiologic findings,pathology,surgical strategies,and long-term follow up outcomes between the 2 groups of patients were analyzed.Results There was no significant difference between BT-IPMN and P-IPMN in the following aspects:mean age,sex ratios and clinical presentation [including the most common presenting symptom abdominal pain (73.0% vs.68.0%),and elevated tumor markers (CEA and CA19-9)].The mean tumor size of BT-IPMN was significantly smaller than P-IPMN (1.7 vs.4.1 cm,P < 0.05).Macroscopically visible mucin was detected in all the 11 patients basing on the original surgical reports.The most common abnormal preoperative imaging findings for BT-IPMN were bile duct dilatation (100%) and intraluminal masses (55.0%).Most cases (82.0%) involved the intrahepatic bile duct and hilum.For tumor clearance,we conducted left hepatectomy in most cases (64.0%).Only one patient underwent biopsy and choledochojejunostomy for multiple tumors involving the extrahepatic,right and left bile ducts.BT-IPMN was likely to have a higher risk of malignancy (55.0% vs.44.0%) and poorer prognosis (median survival,57 vs.63 months),although there was no significant difference (P > 0.05).The patient without tumor resection died of liver failure 22 months after palliative surgery.Conclusions BT-IPMNs are very rare and they had some similarity with P-IPMN.Complete resection of BT

  8. Coffee and green tea consumption is associated with upper aerodigestive tract cancer in Japan.

    Science.gov (United States)

    Oze, Isao; Matsuo, Keitaro; Kawakita, Daisuke; Hosono, Satoyo; Ito, Hidemi; Watanabe, Miki; Hatooka, Shunzo; Hasegawa, Yasuhisa; Shinoda, Masayuki; Tajima, Kazuo; Tanaka, Hideo

    2014-07-15

    The impact of coffee and green tea consumption on upper aerodigestive tract (UADT) cancer risk has not been established. Evaluation of the possible anticarcinogenic properties of their ingredients is confounded by the potential increase in risk owing to the high temperatures at which these beverages are generally consumed. We conducted a case-control study to evaluate the association between coffee and tea consumption and the risk of UADT cancer. The study enrolled 961 patients with UADT cancer and 2,883 noncancer outpatients who visited Aichi Cancer Center between 2001 and 2005. Information on coffee and green tea consumption and other lifestyle factors was collected via a self-administered questionnaire. Consumption of three or more cups of coffee per day had a significant inverse association with UADT cancer [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.55-0.96]. In contrast, consumption of three or more cups of green tea per day had a significant positive association with UADT cancer (OR 1.39, 95% CI 1.13-1.70). These associations were evident for head and neck cancer but not for esophageal cancer. The association of coffee consumption with head and neck cancer was observed only among never smokers and alcohol drinkers. Similarly, the association of green tea consumption was observed among never smokers and never alcohol drinkers. No change in these associations was seen on stratification by each confounding factors. These findings suggest that consumption of coffee might be associated with a decreased risk of UADT cancer, whereas that of green tea might be associated with an increased risk.

  9. Antibiotic prophylaxis in biliary tract surgery

    NARCIS (Netherlands)

    W.S. Meijer (Willem)

    1992-01-01

    textabstractEven in health, man's environment is one of ubiquitous bacterial presence. As a consequence all wounds are, to a certain extent, contaminated, if only from the normal skin flora. Along with a number of other factors, the development of a wound infection is related to the degree of thls b

  10. Urinary Tract Cancer in Lynch Syndrome; Increased Risk in Carriers of MSH2 Mutations

    DEFF Research Database (Denmark)

    Joost, Patrick; Therkildsen, Christina; Dominguez-Valentin, Mev;

    2015-01-01

    OBJECTIVE: To evaluate the risk of urothelial cancer in the upper urinary tract and the bladder, determine the contribution from the different mismatch-repair genes, and define clinical characteristics of urothelial cancer in Lynch syndrome. MATERIALS AND METHODS: The national hereditary nonpolyp...

  11. Trends in cancer of the urinary bladder and urinary tract in elderly in Denmark, 2008-2012

    DEFF Research Database (Denmark)

    Jensen, Thor Knak; Jensen, Niels Viggo; Jørgensen, Simon Møller

    2016-01-01

    Background The aim of this study was to examine the trends in incidence, mortality, survival, and prevalence of cancers of the urinary bladder and urinary tract in Denmark from 1980 to 2012 with particular focus on elderly patients over age 70 years. Design Cancer of the urinary bladder and urinary...

  12. Diet and upper-aerodigestive tract cancer in Europe: the ARCAGE study.

    LENUS (Irish Health Repository)

    Lagiou, Pagona

    2009-06-01

    There is suggestive, but inconclusive, evidence that dietary factors may affect risk of cancers of the upper aerodigestive tract (UADT). In the context of the alcohol-related cancers and genetic susceptibility in Europe study, we have examined the association of dietary factors with UADT cancer risk. We have analyzed data from 2,304 patients with UADT cancer and 2,227 control subjects recruited in 14 centers in 10 European countries. Dietary data were collected through a semi-quantitative food frequency questionnaire that also assessed preferred temperature of hot beverages. Statistical analyses were conducted through multiple logistic regression controlling for potential confounding variables, including alcohol intake and smoking habits. Consumption of red meat (OR per increasing tertile = 1.14, 95% CI: 1.05-1.25), but not poultry, was significantly associated with increased UADT cancer risk and the association was somewhat stronger for esophageal cancer. Consumption of fruits (OR per increasing tertile = 0.68, 95% CI: 0.62-0.75) and vegetables (OR per increasing tertile = 0.73, 95% CI: 0.66-0.81) as well as of olive oil (OR for above versus below median = 0.78, 95% CI 0.67-0.90) and tea (OR for above versus below median = 0.83, 95% CI 0.69-0.98) were significantly associated with reduced risk of UADT cancer. There was no indication that an increase in tea or coffee temperature was associated with increased risk of UADT overall or cancer of the esophagus; in fact, the association was, if anything, inverse. In conclusion, the results of this large multicentric study indicate that diet plays an important role in the etiology of UADT cancer.

  13. Radium-contaminated water: a risk factor for cancer of the upper digestive tract.

    Science.gov (United States)

    Hirunwatthanakul, Phatcha; Sriplung, Hutcha; Geater, Alan

    2006-01-01

    There is a high incidence of oral, pharynx and esophagus cancer among males in Na Mom district in Songkhla Province in Thailand, an area where radium concentration in shallow well water is found to be higher than other areas in this province. A population-based case control study was conducted from June to November 2004 to determine the association of oral exposure to radium-contaminated water and cancer of the upper digestive tract in the district.Thirty-two confirmed cases and 128 sex and five-year birth cohort matched neighborhood controls were selected by multistage sampling from six villages in four sub-districts. All subjects were verified to have been permanent residents in the district for more than 10 years. Thirty cases were dead at the time of the study, thus their relatives were interviewed to determine their amount of water drinking, tobacco smoking, alcohol drinking, betel chewing and exposure to other potential risk factors in the past. The other two cases and all controls were directly interviewed. The concentration of radium in shallow well water at the subject's houses was estimated using a contour map of Ra-226 in the water at the location of their residence. The results showed a strong and dose-dependent associationb etween consumption of radium-contaminated shallow well water and cancer of the upper digestive tract. In multivariate analysis controlled for important risk factors of the cancer, the odds ratios for exposure to oral radium consumption 50-100 mBq/day and >100 mBq/day compared with <50 mBq/day were 2.83 (95% CI: 0.50-16.19) and 29.76 (95% CI: 4.39-201.6) respectively. The risk also increased with consumption of fresh water fish which might have been contaminated by dissolved radium in the water. This study offers the first evidence of the association between radium and cancer of the upper digestive tract to the world literature. Further studies with other methods such as area-wide correlation of radium-uranium concentration and the

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

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

  15. On the mechanical behavior of the human biliary system

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

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

  16. Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era

    Science.gov (United States)

    Crespi, M.; Montecamozzo, G.; Foschi, D.

    2016-01-01

    Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results. PMID:26819608

  17. Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era

    Directory of Open Access Journals (Sweden)

    M. Crespi

    2016-01-01

    Full Text Available Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results.

  18. A genome-wide association study of upper aerodigestive tract cancers conducted within the INHANCE consortium.

    Directory of Open Access Journals (Sweden)

    James D McKay

    2011-03-01

    Full Text Available Genome-wide association studies (GWAS have been successful in identifying common genetic variation involved in susceptibility to etiologically complex disease. We conducted a GWAS to identify common genetic variation involved in susceptibility to upper aero-digestive tract (UADT cancers. Genome-wide genotyping was carried out using the Illumina HumanHap300 beadchips in 2,091 UADT cancer cases and 3,513 controls from two large European multi-centre UADT cancer studies, as well as 4,821 generic controls. The 19 top-ranked variants were investigated further in an additional 6,514 UADT cancer cases and 7,892 controls of European descent from an additional 13 UADT cancer studies participating in the INHANCE consortium. Five common variants presented evidence for significant association in the combined analysis (p ≤ 5 × 10⁻⁷. Two novel variants were identified, a 4q21 variant (rs1494961, p = 1×10⁻⁸ located near DNA repair related genes HEL308 and FAM175A (or Abraxas and a 12q24 variant (rs4767364, p =2 × 10⁻⁸ located in an extended linkage disequilibrium region that contains multiple genes including the aldehyde dehydrogenase 2 (ALDH2 gene. Three remaining variants are located in the ADH gene cluster and were identified previously in a candidate gene study involving some of these samples. The association between these three variants and UADT cancers was independently replicated in 5,092 UADT cancer cases and 6,794 controls non-overlapping samples presented here (rs1573496-ADH7, p = 5 × 10⁻⁸; rs1229984-ADH1B, p = 7 × 10⁻⁹; and rs698-ADH1C, p = 0.02. These results implicate two variants at 4q21 and 12q24 and further highlight three ADH variants in UADT cancer susceptibility.

  19. A genome-wide association study of upper aerodigestive tract cancers conducted within the INHANCE consortium.

    LENUS (Irish Health Repository)

    McKay, James D

    2011-03-01

    Genome-wide association studies (GWAS) have been successful in identifying common genetic variation involved in susceptibility to etiologically complex disease. We conducted a GWAS to identify common genetic variation involved in susceptibility to upper aero-digestive tract (UADT) cancers. Genome-wide genotyping was carried out using the Illumina HumanHap300 beadchips in 2,091 UADT cancer cases and 3,513 controls from two large European multi-centre UADT cancer studies, as well as 4,821 generic controls. The 19 top-ranked variants were investigated further in an additional 6,514 UADT cancer cases and 7,892 controls of European descent from an additional 13 UADT cancer studies participating in the INHANCE consortium. Five common variants presented evidence for significant association in the combined analysis (p ≤ 5 × 10⁻⁷). Two novel variants were identified, a 4q21 variant (rs1494961, p = 1×10⁻⁸) located near DNA repair related genes HEL308 and FAM175A (or Abraxas) and a 12q24 variant (rs4767364, p =2 × 10⁻⁸) located in an extended linkage disequilibrium region that contains multiple genes including the aldehyde dehydrogenase 2 (ALDH2) gene. Three remaining variants are located in the ADH gene cluster and were identified previously in a candidate gene study involving some of these samples. The association between these three variants and UADT cancers was independently replicated in 5,092 UADT cancer cases and 6,794 controls non-overlapping samples presented here (rs1573496-ADH7, p = 5 × 10⁻⁸); rs1229984-ADH1B, p = 7 × 10⁻⁹; and rs698-ADH1C, p = 0.02). These results implicate two variants at 4q21 and 12q24 and further highlight three ADH variants in UADT cancer susceptibility.

  20. Field Cancerisation of the Upper Aerodigestive Tract: Screening for Second Primary Cancers of the Oesophagus in Cancer Survivors

    Directory of Open Access Journals (Sweden)

    Güllü Cataldegirmen

    2015-03-01

    Full Text Available Tobacco, alcohol, and betel quid are the main causes of squamous cell cancers of the upper aerodigestive tract. These substances can cause multifocal carcinogenesis leading to multiple synchronous or metachronous cancers of the oesophagus, head and neck region, and lungs (‘field cancerisation’. Globally there are several million people who have survived either head and neck squamous cell cancer (HNSCC or lung cancer (LC. HNSCC and LC survivors are at increased risk of developing second primary malignancies, including second primary cancers of the oesophagus. The risk of second primary oesophageal squamous cell cancer (OSCC ranges from 8-30% in HNSCC patients. LC and HNSCC survivors should be offered endoscopic surveillance of the oesophagus. Lugol chromoendoscopy is the traditional and best evaluated screening method to detect early squamous cell neoplasias of the oesophagus. More recently, narrow band imaging combined with magnifying endoscopy has been established as an alternative screening method in Asia. Low-dose chest computed tomography (CT is the best evidencebased screening technique to detect (second primary LC and to reduce LC-related mortality. Low-dose chest CT screening is therefore recommended in OSCC, HNSCC, and LC survivors. In addition, OSCC survivors should undergo periodic pharyngolaryngoscopy for early detection of second primary HNSCC. Secondary prevention aims at quitting smoking, betel quid chewing, and alcohol consumption. As field cancerisation involves the oesophagus, the bronchi, and the head and neck region, the patients at risk are best surveilled and managed by an interdisciplinary team.

  1. Smoking, alcohol, occupation, and hair dye use in cancer of the lower urinary tract.

    Science.gov (United States)

    Nomura, A; Kolonel, L N; Yoshizawa, C N

    1989-12-01

    This case-control study was based on 137 Caucasian and 124 Japanese cases of urinary tract cancer identified in Hawaii between 1977 and 1986. Each case was matched on sex, age, and race to two population-based controls. Heavy cigarette smokers (41 or more pack-years for men; 21 or more pack-years for women) had a significantly elevated risk compared with nonsmokers (odds ratio (OR) = 6.2, 95% confidence interval (CI) 3.4-11.1 for the men; OR = 2.8, 95% CI 1.2-6.3 for the women). When the men and women were combined, employment in high-risk industries (includes machinery, automotive, and textiles, among others) was significantly associated with cancer risk (OR = 1.6, 95% CI 1.1-2.3). Alcohol intake and hair dye use showed weaker positive associations with risk that were not statistically significant.

  2. Tumor markers for diagnosis, monitoring of recurrence and prognosis in patients with upper gastrointestinal tract cancer.

    Science.gov (United States)

    Jing, Jie-Xian; Wang, Yan; Xu, Xiao-Qin; Sun, Ting; Tian, Bao-Guo; Du, Li-Li; Zhao, Xian-Wen; Han, Cun-Zhi

    2014-01-01

    To evaluate the value of combined detection of serum CEA, CA19-9, CA24-2, AFP, CA72-4, SCC, TPA and TPS for the clinical diagnosis of upper gastrointestinal tract (GIT) cancer and to analyze the efficacy of these tumor markers (TMs) in evaluating curative effects and prognosis. A total of 573 patients with upper GIT cancer between January 2004 and December 2007 were enrolled in this study. Serum levels of CEA, CA19-9, CA24-2, AFP, CA72-4, SCC, TPA and TPS were examined preoperatively and every 3 months postoperatively by ELISA. The sensitivity of CEA, CA19-9, CA24-2, AFP, CA72-4, SCC, TPA and TPS were 26.8%, 36.2%, 42.9%, 2.84%, 25.4%, 34.6%, 34.2% and 30.9%, respectively. The combined detection of CEA+CA199+CA242+CA724 had higher sensitivity and specificity in gastric cancer (GC) and cardiac cancer, while CEA+CA199+CA242+SCC was the best combination of diagnosis for esophageal cancer (EC). Elevation of preoperative CEA, CA19-9 and CA24-2, SCC and CA72-4 was significantly associated with pathological types (pdiagnosis of EC; CEA+CA199+CA242+CA724 proved to be a better evaluation indicator for cardiac cancer and GC. CEA and CA19-9, CA24-2, CA72-4 and SCC, examined postoperatively during follow-up, were useful to find early tumor recurrence and metastasis, and evaluate prognosis. AFP, TPA and TPS have no significant value in diagnosis of patients with upper GIT cancer.

  3. Reality named endoscopic ultrasound biliary drainage

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

  4. Molecular Mechanism of Local Drug Delivery with Paclitaxel-Eluting Membranes in Biliary and Pancreatic Cancer: New Application for an Old Drug

    Directory of Open Access Journals (Sweden)

    Sookhee Bang

    2015-01-01

    Full Text Available Implantation of self-expanding metal stents (SEMS is palliation for patients suffering from inoperable malignant obstructions associated with biliary and pancreatic cancers. Chemotherapeutic agent-eluting stents have been developed because SEMS are susceptible to occlusion by tumor in-growth. We reported recently that paclitaxel-eluting SEMS provide enhanced local drug delivery in an animal model. However, little is known about the molecular mechanisms by which paclitaxel-eluting stents attenuate tumor growth. We investigated the signal transduction pathways underlying the antiproliferative effects of a paclitaxel-eluting membrane (PEM implanted in pancreatic/cholangiocarcinoma tumor bearing nude mice. Molecular and cellular alterations were analyzed in the PEM-implanted pancreatic/cholangiocarcinoma xenograft tumors by Western blot, immunoprecipitation, and immunofluorescence. The quantities of paclitaxel released into the tumor and plasma were determined by liquid chromatography-tandem mass spectroscopy. Paclitaxel from the PEM and its diffusion into the tumor inhibited angiogenesis, which involved suppression of mammalian target of rapamycin (mTOR through regulation of hypoxia inducible factor (HIF-1 and increased apoptosis. Moreover, implantation of the PEM inhibited tumor-stromal interaction-related expression of proteins such as CD44, SPARC, matrix metalloproteinase-2, and vimentin. Local delivery of paclitaxel from a PEM inhibited growth of pancreatic/cholangiocarcinoma tumors in nude mice by suppressing angiogenesis via the mTOR and inducing apoptosis signal pathway.

  5. An Unusual Presentation of Biliary Ascariasis

    Directory of Open Access Journals (Sweden)

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

    2007-01-01

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

  6. Occupation and risk of upper aerodigestive tract cancer: the ARCAGE study.

    LENUS (Irish Health Repository)

    Richiardi, Lorenzo

    2012-05-15

    We investigated the association between occupational history and upper aerodigestive tract (UADT) cancer risk in the ARCAGE European case-control study. The study included 1,851 patients with incident cancer of the oral cavity, oropharynx, hypopharynx, larynx or esophagus and 1,949 controls. We estimated odds ratios (OR) and 95% confidence intervals (CI) for ever employment in 283 occupations and 172 industries, adjusting for smoking and alcohol. Men (1,457 cases) and women (394 cases) were analyzed separately and we incorporated a semi-Bayes adjustment approach for multiple comparisons. Among men, we found increased risks for occupational categories previously reported to be associated with at least one type of UADT cancer, including painters (OR = 1.74, 95% CI: 1.01-3.00), bricklayers (1.58, 1.05-2.37), workers employed in the erection of roofs and frames (2.62, 1.08-6.36), reinforced concreters (3.46, 1.11-10.8), dockers (2.91, 1.05-8.05) and workers employed in the construction of roads (3.03, 1.23-7.46), general construction of buildings (1.44, 1.12-1.85) and cargo handling (2.60, 1.17-5.75). With the exception of the first three categories, risks both increased when restricting to long duration of employment and remained elevated after semi-Bayes adjustment. Increased risks were also found for loggers (3.56, 1.20-10.5) and cattle and dairy farming (3.60, 1.15-11.2). Among women, there was no clear evidence of increased risks of UADT cancer in association with occupations or industrial activities. This study provides evidence of an association between some occupational categories and UADT cancer risk among men. The most consistent findings, also supported by previous studies, were obtained for specific workers employed in the construction industry.

  7. Can circulated lung cancer cells pass to the urine without apparent urine tract metastases? A single centre series.

    Science.gov (United States)

    Kamposioras, Konstantinos; Pentheroudakis, George; Malamou-Mitsi, Vassiliki; Pappa, Lina; Bafa, Maria; Pavlidis, Nicholas

    2008-04-01

    Urine cytology has been a useful tool for the diagnosis of urinary tract malignancies. However, the presence of tumor cells in the urine sediment without an obvious urothelial metastatic deposit is a rare phenomenon and in patients with lung cancer has never been reported. We present five cases with metastatic lung cancer and positive urine cytology. The possible mechanisms underlining this phenomenon and its implications are discussed.

  8. CD74 in antigen presentation, inflammation, and cancers of the gastrointestinal tract

    Institute of Scientific and Technical Information of China (English)

    Ellen J Beswick; Victor E Reyes

    2009-01-01

    CD74 is a protein whose initial role in antigen presentation was recognized two decades ago. Recent studies have revealed that it has additional functions as a receptor for macrophage migration inhibitory factor and as a receptor for an important human pathogen, Helicobacter pylori ( H pylori). The role of CD74 as a receptor is important because after binding of migration inhibitory factor or H pylori, NF-kB and Erk1/2 activation occurs, along with the induction of proinflammatory cytokine secretion. This review provides an up-to-date account of the functions of CD74 and how it might be involved in inflammation and cancer within the gastrointestinal tract.

  9. 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....

  10. 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...

  11. Gallbladder cancer: epidemiology and outcome

    Directory of Open Access Journals (Sweden)

    Hundal R

    2014-03-01

    Full Text Available Rajveer Hundal, Eldon A Shaffer Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada Abstract: Gallbladder cancer, though generally considered rare, is the most common malignancy of the biliary tract, accounting for 80%-95% of biliary tract cancers. An early diagnosis is essential as this malignancy progresses silently with a late diagnosis, often proving fatal. Its carcinogenesis follows a progression through a metaplasia-dysplasia-carcinoma sequence. This comprehensive review focuses on and explores the risks, management, and outcomes for primary gallbladder carcinoma. Epidemiological studies have identified striking geographic and ethnic disparities – inordinately high occurrence in American Indians, elevated in Southeast Asia, yet quite low elsewhere in the Americas and the world. Age, female sex, congenital biliary tract anomalies, and a genetic predisposition represent important risk factors that are immutable. Environmental triggers play a critical role in eliciting cancer developing in the gallbladder, best exemplified by cholelithiasis and chronic inflammation from biliary tract and parasitic infections. Mortality rates closely follow incidence; those countries with the highest prevalence of gallstones experience the greatest mortality from gallbladder cancer. Vague symptoms often delay the diagnosis of gallbladder cancer, contributing to its overall progression and poor outcome. Surgery represents the only potential for cure. Some individuals are fortunate to be incidentally found to have gallbladder cancer at the time of cholecystectomy being performed for cholelithiasis. Such an early diagnosis is imperative as a late presentation connotes advanced staging, nodal involvement, and possible recurrence following attempted resection. Overall mean survival is a mere 6 months, while 5-year survival rate is only 5%. The dismal prognosis, in part, relates to the

  12. Biliary atresia Atresia de las vías biliares.

    Directory of Open Access Journals (Sweden)

    Pastor Thomas Olivares

    2005-12-01

    Full Text Available Biliary atresia is an obstructive and progressive process of unknown etiology that affects intra and/or extrahepatics biliary tracts and cause neonatal jaundice by serious obstruction of the biliary flow. It is presented with a frequency of 1 by each 10 000 – 15000 born alive. Is not hereditary and the most probable etiology is the progressive inflammatory illness of the biliary tracts. We presented the Good Clinical Practices Guideline for Biliary atresia, approved by consensus in the 4th National Good Clinical Practices Workshop in Pediatric Surgery (Las Tunas, Cuba, March, 2005.
    La atresia de vías biliares es un proceso obstructivo y progresivo de etiología desconocida que afecta las vías biliares intra y/o extrahepáticas y causa ictericia neonatal por obstrucción grave del flujo biliar. Se presenta con una frecuencia de 1 por cada 10 000 – 15 000 nacidos vivos. No es hereditaria y la etiología más probable es la enfermedad inflamatoria progresiva de las vías biliares. Se presenta la Guía de Buenas Prácticas Clínicas para Atresia intestinal yeyunoileal, aprobada por consenso en el 4º Taller Nacional de Buenas Prácticas Clínicas en Cirugía Pediátrica (Las Tunas, marzo 2005.

  13. Imaging and PET-CT evaluation of Gi tract cancers; Imagerie et TEP scanner dans les cancers du tube digestif

    Energy Technology Data Exchange (ETDEWEB)

    Laurent, V. [Hopital de Brabois-Vandoeuvre, Service de Radiologie Adultes, 54 - Nancy (France); Olivier, P. [Hopital de Brabois-Vandoeuvre, Service de Medecine Nucleaire, 54 - Nancy (France)

    2008-03-15

    Imaging plays a pivotal role in the management of G.I. tract cancers for diagnosis, characterization, locoregional staging, metastatic work-up and follow-up during and after curative or palliative treatment. The imaging protocols should be optimized and reproducible because of their impact on therapy. Thoracic, abdominal and pelvic CT is the cornerstone of the imaging work-up, optimized and reproducible because of their impact on therapy. Thoracic, abdominal and pelvic CT is the cornerstone of the imaging work-up, optimized and tailored to the specific G.I. segment involved, requiring good G.I. tract distension. Image interpretation of native axial and reformatted multiplanar images is routinely performed. In specific cases, additional targeted imaging with the US or MRI or whole body imaging with PET/CT or MRI may be valuable. PET/CT is a complement to morphological imaging. PET allows detection of lesions otherwise undetected on morphological imaging, usually due to poor contrast with surrounding tissues, and characterization of known lesions. PET/CT is best used as an integral part of a comprehensive imaging work-up. Radiologist and nuclear medicine specialists provide complementary information. each must be familiar with the clinical questions at hand and related stakes, and advantages and limitations of each modality to optimize treatment as part of a multidisciplinary management approach. (authors)

  14. [Postoperative biliary peritonitis].

    Science.gov (United States)

    Kurbonov, K M; Daminova, N M; Mukhiddinov, N D

    2008-01-01

    An analysis of results of surgical treatment of 91 patients with postoperative biliary peritonitis has shown that frequency of postoperative biliary peritonitis depended on the volume and character of operative interventions, as well as on technical errors made at the preoperative period and during operation. The presence of latent hepatic insufficiency made for the development of polyorganic insufficiency, had negative influence on the course of the disease and might be one of the causes of high postoperative lethality (up to 23.1%) in this category of patients.

  15. Elastic scattering spectroscopy in vivo: optical biopsies of cancers of the breast and GI tract

    Science.gov (United States)

    Pickard, David C. O.; Briggs, Gavin M.; Saunders, Christobel; Lakhani, Sunil; Ripley, Paul M.; Bigio, Irving J.; Bown, Stephen G.

    2000-04-01

    Elastic scattering or diffuse reflectance spectroscopy offers the possibility of distinguishing between normal and neoplastic tissue with a relatively simple optical measurement. The measurement of the reflection of light has previously been shown to be sensitive to the size and distribution of both intra and inter-cellular structures as well as absorption from chromatophores which are present in the tissue. By coupling a white light source and spectrometer to optic fibers it is possible to construct probes which can be inserted precutaneously or intra- operatively into breast tissue or which can pass down the channel of an endoscope and take in-vivo spectra of diseased and normal tissue in the Gastro-Intestinal tract. Spectra are reported from a large number of patients with a variety of benign, metaplastic, dysplastic and cancerous conditions. Some differences that have been observed in these spectra are discussed and the merits and disadvantages of 'optical biopsy' as an in-vivo diagnostic tool are examined. It is shown that to a relatively high degree of sensitivity and specificity it is possible to distinguish cancerous from normal tissue in a number of cases. The methods of distinguishing spectra and some possible modalities for their improvement are discussed.

  16. Biliary manometry in choledochal cyst with abnormal choledochopancreatico ductal junction.

    Science.gov (United States)

    Iwai, N; Tokiwa, K; Tsuto, T; Yanagihara, J; Takahashi, T

    1986-10-01

    Intraoperative manometry of the biliary tract and measurement of amylase levels in choledochal cysts were performed in seven patients, aged 14 months to 5 years, with choledochal cysts, in an investigation of the pathophysiology of the biliary tract. An abnormal choledochopancreatico ductal junction was observed in these seven patients by preoperative endoscopic retrograde cholangiopancreaticography (ERCP) or intraoperative cholangiograms. All six patients examined showed a high amylase level in the choledochal cyst (5,450 to 46,500 Somogyi Units). The intraoperative manometry of the biliary tract showed that a remarkable high pressure zone as was found in the area of sphincter of Oddi was not found in the area of abnormal choledochopancreatico ductal junction. The pressure recordings also demonstrated that the sphincter of Oddi pressure in the patient with choledochal cyst was increased by gastrin stimulation. On the contrary, no pressure reaction to gastrin or secretin was found in the area of abnormal choledochopancreatic ductal junction. From these results it seems that free reflux of pancreatic juice into the biliary system occurs, and the reflux stream depends upon the pressure gradient between pancreatic ductal pressure and common bile duct pressure because of the lack of a sphincter function at the choledochopancreatico ductal junction.

  17. [Congenital broncho-biliary fistula: a case report].

    Science.gov (United States)

    Pérez, Cinthia G; Reusmann, Aixa

    2016-10-01

    Congenital tracheo-or-bronchobiliary fistula or congenital he-patopulmonary fistula is a rare malformation with high morbidity and mortality if the diagnosis is not made early. The tracheo-or-bronchobiliary fistula is a communication between the respiratory (trachea or bronchus) and biliary tract. To date, only 35 cases have been published worldwide. We report a case of a neonate with right pneumonia and bilious fluid in the endotracheal tube. Diagnosis was made using bronchoscopy with fluoroscopy. Videothoracoscopy was used to remove the bronchobiliary fistula. Subsequently, a left he-patectomy with Roux-en-Y biliary-digestive anastomosis was performed as bile ductus hypoplasia was present.

  18. [Biliary peritonitis after traumatic rupture of a choledochal cyst].

    Science.gov (United States)

    Bouali, O; Trabanino, C; Abbo, O; Destombes, L; Baunin, C; Galinier, P

    2015-07-01

    Choledochal cysts are rare congenital malformations of the biliary tract. Traumatic rupture of a choledochal cyst can be misleading. An 11-year-old boy was admitted for peritonitis and intestinal occlusion after blunt abdominal trauma, evolving over 48 h. Laparotomy revealed bile ascites and a suspected duodenal perforation. After referral to our center, a CT scan showed a perforated choledochal cyst. Six months later, a complete excision of the cyst was successfully performed. This treatment is mandatory because of the risk of further complications such as lithiasis, pancreatitis, cholangitis, biliary cirrhosis, and malignant transformation (cholangiocarcinoma).

  19. The role of cholescintigraphy in the diagnosis of acute cholecystitis and other biliary tract emergencies; Place de la scintigraphie des voies biliaires dans la cholecystite aigue et les autres urgences bilio-digestives

    Energy Technology Data Exchange (ETDEWEB)

    Delcourt, A.

    1996-12-31

    Patients suspected of having acute cholecystitis can present a difficult diagnostic problem. Cholescintigraphy using {sup 99m}Tc-labeled analogues of imino-diacetic acid (IDA) is a sensitive and specific test for the early diagnosis of acute cholecystitis. The radiopharmaceutical enters the bilirubin metabolic pathway and follows the hepatic bile flow. A cystic duct obstruction is suspected if the gall-bladder does not take up the tracer 40 to 60 min after the injection, provided that the radiotracer is seen the small intestine. At that moment, morphine sulfate can be given intravenously. Acute cholecystitis is deemed present if the gall-bladder is still unseen 30 min after morphine injection or 4 hours after the radiotracer administration if morphine is contraindicated. Cholescintigraphy proves also useful in diagnosing post-surgical or post-traumatic biliary injuries. This test conveys complementary information to ultrasonography and computed tomography in cases of bile leakage, collected or free in the peritoneal cavity, in confirming the biliary origin of the collection. (author). 88 refs.

  20. Alcohol consumption in upper aerodigestive tract cancer: Role of head and neck surgeons' recommendations.

    Science.gov (United States)

    López-Pelayo, Hugo; Miquel, Laia; Altamirano, José; Blanch, José Luís; Gual, Antoni; Lligoña, Anna

    2016-03-01

    This study aims to describe the prevalence of alcohol consumption in patients diagnosed with an upper aerodigestive tract cancer (UADTC) and evaluate the clinical impact of head and neck surgeons' recommendations on alcohol intake. An observational, retrospective, and cross-sectional study was conducted. Socio-demographic data, type of cancer, psychiatric history, substance-use history, and DSM-IV-TR criteria for alcohol dependence were recorded. Patients were asked to report their alcohol consumption before UADTC diagnosis and during their follow-up. All patients were asked if they had received from the specialist any recommendation to reduce or stop their alcohol consumption. One hundred ninety-one patients were included. Laryngeal cancer was the most frequent. 85.3% of patients were alcohol consumers before being diagnosed, 39.8% were risky drinkers, and 13.1% had alcohol dependence. The prevalence of alcohol use decreased by 16.7% after the UADTC was diagnosed. The proportion of risky drinkers decreased from 46.6% to 24.5%. Almost half of the patients did not recall having received any recommendation regarding alcohol consumption. Receiving a recommendation was independently associated with a positive response (reduced or stopped alcohol consumption) with an Odds Ratio 3.7; p < 0.001. Prevalence of alcohol dependence and risky drinking (39.8%) is high in UADTC patients, compared to the general population. Otorhinolaryngologists and head and neck surgeons frequently provide recommendations about alcohol consumption, which has a relevant impact on the reduction of alcohol intake. Further prospective studies focused on brief advice should be performed in order to demonstrate effectiveness in this population.

  1. Liver and Biliary System

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    2010223 The characteristics of peripheral lymphocytic subsets and cytokines in primary biliary and their changes to drug treatment. TANG Min(唐敏),et al. Dept Rheumatol,PUMC Hosp,PUMC & CAMS,Beijing 100032.Chin J Intern Med 2010;49(2):129-133.

  2. 经皮经肝双极射频导管处理恶性胆道梗阻及胆道内支架再堵塞的初步临床观察%Preliminary clinical study of percutaneous transhepatic bipolar radiofrequency ablation catheter in the treatment for malignant biliary obstructive jaundice and biliary stent re-stenosis

    Institute of Scientific and Technical Information of China (English)

    席玮; 陈骏; 武贝; 陈世晞

    2013-01-01

    Objective To preliminary observe the feasibility and safety of bipolar radiofrequency ablation catheter in the treatment of malignant biliary obstructive jaundice and biliary stent re-stenosis.Methods Four patients with malignant obstructive jaundice caused by terminal cancer received ablation therapy for biliary obstruction by percutaneous transhepatic bipolar radiofrequency ablation catheter.The normal tunnel of biliary was reconstructed rapidly to restore the outflow tract of bile.The procedural practicality,clinical safety and operative complications were analyzed.Results The ablation therapy was successful for 4 patients.The mean operating duration was 40 min without any 30-day mortality.No postoperative complications such as massive hemorrhage,biliary fistula,biliary infection,hemothorax,pneumothorax,cholothorax,chole-heart syndrome,liver penetrating wound and biliary peritonitis etc.occurred.Cholangiectasis improved markedly after biliary tract reconstruction with general declines of serum total bilirubin and direct bilirubin.One case with biliary stent re-stenosis was re-blocked postoperatively.The average patency time of biliary tract and stent was 124 (90-171) days in 4 cases.Conditions were created for further anti-tumor treatment.Conclusion Percutaneous transhepatic bipolar radiofrequency ablation catheter can reestablish the canal rapidly for malignant biliary obstructive jaundice and stent restenosis so as to enhance the therapeutic efficacy.%目的 初步观察双极射频导管治疗恶性胆道梗阻及胆管内支架再堵塞的可行性和安全性.方法 江苏省肿瘤医院介入科2012年3至6月收治4例晚期肿瘤导致的恶性阻塞性黄疸患者,经皮经肝路径在胆管梗阻段使用经皮穿刺式双极射频导管消融治疗,功率6~8W,使用时间60-120 s,迅速重建通道,恢复胆汁流出路径,进行手术实用性、安全性评价及并发症观察.结果 4例患者消融手术顺利,平均手术时间40 min,30 d

  3. Effects of depression on parameters of cell-mediated immunity in patients with digestive tract cancers

    Institute of Scientific and Technical Information of China (English)

    Ke-Jun Nan; Yong-Chang Wei; Fu-Ling Zhou; Chun-Li Li; Chen-Guang Sui; Ling-Yun Hui; Cheng-Ge Gao

    2004-01-01

    AIM: To evaluate the effects of depression on parameters of cell-mediated immunity in patients with cancers of the digestive tract.METHODS: One hundred and eight adult patients of both sexes with cancers of the digestive tract admitted between March 2001 and February 2002 in the Department of Medical Oncology, First Affiliated Hospital of Xi'an Jiaotong University were randomly enrolled in the study. The Zung self-rating depression scale (SDS), Zung self-rating anxiety scale(SAS), numeric rating scale (NRS) and social support rating scale (SSRS) were employed to evaluate the degree of depression and their contributing factors. In terms of their SDS index scores, the patients were categorized into depression group (SDS≥50) and non-depression group(SDS<50). Immunological parameters such as T-lymphocyte subsets and natural killer (NK) cell activities in peripheral blood were determined and compared between the two groups of patients.RESULTS: The SDS index was from 33.8 to 66.2 in the 108 cases, 50% of these patients had a SDS index more than 50. Similarly, the SAS index of all the patients ranged from 35.0 to 62.0 and 46.3% of the cases had a SAS index above 50. Cubic curve estimation showed that the depression was positively correlated with anxiety and negatively with social support. Furthermore, the depression correlated with the tumor type, which manifested in a descending order as stomach, gallbladder, pancreas, intestine, esophagus,duodenum and rectum, according to their correlativity. Step-wise regression analysis suggested that hyposexuality,dispidtment, agitation, palpitation, low CD56 and anxiety were the significant factors contributing to depression. More severe anxiety (49.7±7.5 vs 45.3±6.9, P<0.05), pain (6.5±2.8 vs4.6±3.2, P<0.05), poor social support (6.8±2.0 vs 7.6±2.1,P<0.05), as well as decline of lymphocyte count (0.33±0.09vs0.39±0.87, P<0.05) and CD56 (0.26±0.11 vs0.29±0.11,P<0.05) were noted in the depression group compared

  4. Effects of anthocyanins and anthocyanin-rich extracts on the risk for cancers of the gastrointestinal tract.

    Science.gov (United States)

    Kocic, B; Filipovic, S; Nikolic, M; Petrovic, B

    2011-01-01

    Anthocyanins are the largest group of water-soluble pigments in the plant kingdom. Anthocyanins are responsible for most of the red, blue, and purple colors of fruits, vegetables, flowers, and other plant tissues or products. In recent years, numerous studies have shown that anthocyanins display a wide range of biological activities. This review summarises recent literature evidence on the association of anthocyanins and anthocyanin-rich extracts consumption with the risk for gastrointestinal tract cancer, concentrating on the results from in vivo animal model tumor systems, as well as data from human epidemiological studies. Potential cancer chemopreventive activities of anthocyanins were revealed from in vitro studies. In vivo animal model tumor systems showed that dietary anthocyanins inhibit cancers of the gastrointestinal tract. Some epidemiological studies have revealed protective effects of anthocyanins consumption on gastrointestinal cancer risk in humans. Pharmacokinetic data indicate that absorption of anthocyanins into the bloodstream of rodents and humans is minimal, suggesting that they may have little efficacy in tissues other than the gastrointestinal tract and skin. Future studies should be undertaken to determine if the anticancer effects of anthocyanins are due to the parent compounds and/or to their metabolites.

  5. Primary Biliary Mixed Adenoneuroendocrine Carcinoma (MANEC): A Short Review.

    Science.gov (United States)

    Acosta, Andres M; Wiley, Elizabeth Louise

    2016-10-01

    Mixed adenoneuroendocrine carcinomas (MANECs) are composite neoplasms with areas of adenocarcinoma or squamous cell carcinoma intermingled with neuroendocrine carcinoma or neuroendocrine tumor, each composing at least 30% of the neoplasm. MANECs are very infrequent overall, and they are more commonly diagnosed in the appendix, colon, and stomach. Biliary MANECs are particularly rare, and their histogenesis is debated because neuroendocrine cells are seldom identified in the normal biliary tract. They can show one of the 3 different architectural patterns described in Lewin's original classification: collision tumors, combined lesions, or amphicrine neoplasms. The neuroendocrine component is usually of a high grade, with small or large cell cytomorphology, whereas the adenocarcinoma component is either an intestinal or biliary type. Clinical presentation is characterized by locally advanced disease at the time of initial diagnosis. Recent studies suggest that treatment should be guided by the most aggressive histologic component.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1994-04-15

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

  7. Life course social mobility and risk of upper aerodigestive tract cancer in men.

    LENUS (Irish Health Repository)

    Schmeisser, N

    2010-03-01

    The aim of this study was to explore associations between social mobility and tumours of the upper aero-digestive tract (UADT), focussing on life-course transitions in social prestige (SP) based on occupational history. 1,796 cases diagnosed between 1993 and 2005 in ten European countries were compared with 1585 controls. SP was classified by the Standard International Occupational Prestige Scale (SIOPS) based on job histories. SIOPS was categorised in high (H), medium (M) and low (L). Time weighted average achieved and transitions between SP with nine trajectories: H --> H, H --> M, H --> L, M --> H, M --> M, M --> L, L --> H, L --> M and L --> L were analysed. Odds ratios (ORs) and 95%-confidence intervals [95%-CIs] were estimated with logistic regression models including age, consumption of fruits\\/vegetables, study centre, smoking and alcohol consumption. The adjusted OR for the lowest versus the highest of three categories (time weighted average of SP) was 1.28 [1.04-1.56]. The distance of SP widened between cases and controls during working life. The downward trajectory H --> L gave an OR of 1.71 [0.75-3.87] as compared to H --> H. Subjects with M --> M and L --> L trajectories ORs were also elevated relative to subjects with H --> H trajectories. The association between SP and UADT is not fully explained by confounding factors. Downward social trajectory during the life course may be an independent risk factor for UADT cancers.

  8. [The impact of natural history and genital tract distribution of human papillomavirus on technology for cervical cancer screening].

    Science.gov (United States)

    Wu, Z N; Chen, W

    2016-04-01

    Human papillomavirus (HPV) infection is the necessary cause of cervical cancer. There is a close relationship between the amount of DNA, mRNA and protein expression in the natural history of virus and the cervical lesion. This article is aimed to elaborate the natural history and genital tract distribution of high risk HPV, and also evaluate the HPV based cervical cancer screening technology from the perspective of the natural history of HPV, which is meaningful for screening and clinical practice in devising and utilizing different detection technology.

  9. Optical detection of cancer and precancerous lesions of the upper aerodigestive tract: methods for assessment of vertical extensions

    Science.gov (United States)

    Kraft, Marcel; Arens, Christoph

    2013-06-01

    Introduction: Endoscopic imaging can be used in the assessment of cancer and precancerous lesions of the upper aerodigestive tract. The objective of this presentation is to describe vertical imaging methods. Methods: The working principle and technique of optical coherence tomography (OCT) as well as endosonography (EUS) are briefly illustrated. Results: The main indications, normal and pathologic findings of each method, frequent pitfalls, and clinical results up to now are presented in detail. Conclusions: Endosonography helps in determining the exact extension of advanced carcinomas beyond 3 mm, while OCT, due to its better resolution, is superior in the assessment of precancerous and early cancerous lesions up to 2 mm thickness.

  10. Association between changing mortality of digestive tract cancers and water pollution: a case study in the Huai River Basin, China.

    Science.gov (United States)

    Ren, Hongyan; Wan, Xia; Yang, Fei; Shi, Xiaoming; Xu, Jianwei; Zhuang, Dafang; Yang, Gonghuan

    2014-12-23

    The relationship between the ever-increasing cancer mortality and water pollution is an important public concern in China. This study aimed to explore the association between serious water pollution and increasing digestive cancer mortality in the Huai River Basin (HRB) in China. A series of frequency of serious pollution (FSP) indices including water quality grade (FSPWQG), biochemical oxygen demand (FSPBOD), chemical oxygen demand (FSPCOD), and ammonia nitrogen (FSPAN) were used to characterize the surface water quality between 1997 and 2006. Data on the county-level changing mortality (CM) due to digestive tract cancers between 1975 and 2006 were collected for 14 counties in the study area. Most of investigated counties (eight) with high FSPWQG (>50%) distributed in the northern region of the HRB and had larger CMs of digestive tract cancers. In addition to their similar spatial distribution, significant correlations between FSP indices and CMs were observed by controlling for drinking water safety (DWS), gross domestic product (GDP), and population (POP). Furthermore, the above-mentioned partial correlations were clearly increased when only controlling for GDP and POP. Our study indicated that county-level variations of digestive cancer mortality are remarkably associated with water pollution, and suggested that continuous measures for improving surface water quality and DWS and hygienic interventions should be effectively implemented by local governments.

  11. Biliary ascariasis: an uncommon cause for recurrent biliary colic after biliary sphincterotomy and common bile duct stone removal.

    Science.gov (United States)

    Thandassery, Ragesh Babu; Jha, Ashish Kumar; Goenka, Mahesh Kumar

    2014-04-01

    Endoscopic retrograde cholangiography is the most commonly used technique for removal of common bile duct stones. Biliary sphincterotomy during the procedure facilitates stone retrieval from the common bile duct. However, sphincterotomy ablates the normal biliary sphincter mechanism. This facilitates duodeno-biliary reflex and can result in inward migration of luminal parasite into the biliary system. In areas where ascariasis is endemic there is an increased risk of biliary ascariasis in postbiliary sphincterotomy patients. We report an unusual case where a patient presented with recurrent biliary colic after cholecystectomy and common bile duct stone extraction and was diagnosed to have biliary ascariasis with the help of endoscopic ultrasound examination of the biliary system.

  12. 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.

  13. [Recommendation for guidelines in the treatment of squamous cell cancer of the upper aerodigestive tract].

    Science.gov (United States)

    Burian, Martin

    2008-01-01

    If we look at the historical development of the treatment of head and neck cancer, we can see that initially, decisions about therapy lay solely in the hands of the surgeons (Otorhinolaryngologists, oral and maxilla-facial surgeons) This was also true of the decision as to whether an operation was feasible or whether primary radio therapy was to be carried out. At the end of the last century, after chemotherapy had become an integral part of curative therapy, inter-disciplinary conferences (tumour boards) were set up so that the surgeons could make joint decisions about therapy together with radio oncologists and medical oncologists. In addition, the increasingly important role of chemotherapy in curative therapy in the last fifteen years has led to a marked increase in the number of clinical studies in head and neck cancer. Inter-disciplinary treatment decisions can be based only on current scientific knowledge and are geared towards a standard treatment as recommended for an individual tumour stage. It is precisely in the upper aerodigestive tract that there are various therapeutical procedures, due to the different site of primaries (oral cavity, oro-, hypoparynx and larynx) and the different grade of locoregional metastasis. One possible way to assure a high degree of transparency of these various therapies and making them available to a high number of colleagues is the development guidelines [1]. Many medical associations and organisations in Austria are currently engaged in the formulation and definition of guidelines, in order to provide the highest possible quality of medical treatment and care for each individual patient. By guidelines are meant recommendations for treatments which allow a certain amount of flexibility in the treatment and provide a medical consensus in line with current scientific knowledge. In principle, they are binding, but in exceptional but reasonable cases, they may (and even must) be departed from. The following proposal is

  14. Genital Tract HIV RNA Levels and Their Associations with Human Papillomavirus Infection and Risk of Cervical Pre-Cancer

    Science.gov (United States)

    GHARTEY, Jeny; KOVACS, Andrea; BURK, Robert D.; MASSAD, L. Stewart; MINKOFF, Howard; XIE, Xianhong; D’SOUZA, Gypsyamber; XUE, Xiaonan; WATTS, D. Heather; LEVINE, Alexandra M.; EINSTEIN, Mark H.; COLIE, Christine; ANASTOS, Kathryn; ELTOUM, Isam-Eldin; HEROLD, Betsy C.; PALEFSKY, Joel M.; STRICKLER, Howard D.

    2014-01-01

    Objective Plasma HIV RNA levels have been associated with risk of human papillomavirus (HPV) and cervical neoplasia in HIV-seropositive women. However, little is known regarding local genital tract HIV RNA levels and their relation with cervical HPV and neoplasia. Design/Methods In an HIV-seropositive women’s cohort with semi-annual follow-up, we conducted a nested case-control study of genital tract HIV RNA levels and their relation with incident high-grade squamous intraepithelial lesions sub-classified as severe (severe HSIL), as provided for under the Bethesda 2001 classification system. Specifically, 66 incident severe HSIL were matched to 130 controls by age, CD4+ count, HAART use, and other factors. We also studied HPV prevalence, incident detection, and persistence in a random sample of 250 subjects. Results Risk of severe HSIL was associated with genital tract HIV RNA levels (odds ratio comparing HIV RNA ≥ the median among women with detectable levels versus undetectable [ORVL] 2.96; 95% CI: 0.99–8.84; Ptrend=0.03). However, this association became non-significant (Ptrend=0.51) following adjustment for plasma HIV RNA levels. There was also no association between genital tract HIV RNA levels and the prevalence of any HPV or oncogenic HPV. However, the incident detection of any HPV (Ptrend=0.02) and persistence of oncogenic HPV (Ptrend=0.04) were associated with genital tract HIV RNA levels, after controlling plasma HIV RNA levels. Conclusion These prospective data suggest that genital tract HIV RNA levels are not a significant independent risk factor for cervical pre-cancer in HIV-seropositive women, but leave open the possibility that they may modestly influence HPV infection, an early stage of cervical tumoriogenesis. PMID:24694931

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

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

  16. [Long-term benefit of male circumcision to the reduction of urinary tract infections and genitourinary cancers in China].

    Science.gov (United States)

    Zhao, Fu-jun; Li, Philip S; Lü, Nian-qing; Lee, Richard; Peng, Yi-feng; Cheng, Feng; Li, Zheng; Xu, Hao-qin; Barone, Mark; Goldstein, Marc; Xia, Shu-jia

    2014-11-01

    Increasingly accumulated results from randomized controlled trials and other clinical studies have demonstrated that male circumcision reduces the risks of acquisition and transmission of HIV, HPV, HSV-2, and other sexually transmitted infections, and thus has a potential role in preventing cervical cancer, penile cancer and prostate cancer. The prevalence of male circumcision in China is currently less than 5%. The clinical evaluation studies and randomized controlled trials of the Shang Ring device showed excellent safety profiles, extremely high acceptability, and satisfaction among the participants and service providers in Africa and China. Given the recent recommendations by the World Health Organization and the Joint United Nations Program on HIV/AIDS (UNAIDS), voluntary medical male circumcision should be promoted in China at the national level as an important alternative intervention to reduce reproductive tract infections and prevent both males and females from reproductive tract cancers. More emphasis is required on the studies of the long-term health benefits of male circumcision in uro-andrology.

  17. Lymph Node Involvement In Upper Aerodigestive Tract Cancers - A Clinical Study at Specialities University Hospital of Rabat.

    Directory of Open Access Journals (Sweden)

    Rajae BORKI

    2014-12-01

    Full Text Available Introduction: Cervical lymph node involvement has a major impact on prognosis and treatment decisions in patients with upper aerodigestive tract (UADT cancer.Objective: The aim of this study was to assess the incidence and pattern of cervical lymph node (LN metastases in cancers of the upper aerodigestive tractMethods: This prospective study was conducted by the Department of ENT and Maxillofacial Surgery at Specialities University Hospital of Rabat, collecting data between October 2009 and December 2011. Lymph nodes were counted, clinically and radiologically localized, excised, then studied histologically.Results: During this period, 106 patients have been treated surgically with a recent diagnosis of UADT cancer. The average age of our patients was 55±13.3 years, while male/female ratio was 3.5 to 1. More than half of our patients were operated with cancer of the larynx (58.5%, n=62; 27.4% (n=29 of patients suffered from oral cavity cancer and 14.2% (n=15 had cancer of the hypopharinx. Cervical lymph node invasion was estimated at 31.2% clinically, and 38.7% radiologically and histologically, distributed in different sites.Although the percentage of the invasion is almost similar clinically, radiologically and histologically, the high number of false positives and true negatives according to clinical and radiological exams confirms that specificity and sensitivity of these two exams is still poor compared to histology.Conclusion: Thus, cervical metastases have to be diagnosed histologically. Moreover, the low percentage of lymph node invasions in the case of a UADT cancer suggests that the use of sentinel lymph node technique could be important, as it has been validated for small T1T2N0 tumors in the oral cavity. Further studies are needed to confirm its validity in case of other UADT tumor types.

  18. 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

  19. The association of pioglitazone and urinary tract disease in type 2 diabetic Taiwanese: bladder cancer and chronic kidney disease.

    Directory of Open Access Journals (Sweden)

    Mei-Yueh Lee

    Full Text Available OBJECTIVE: Although studies have shown an association between pioglitazone and bladder cancer, the associated factors have not been identified. The aim of this study was to investigate the factors that may link pioglitazone to bladder cancer. MATERIALS AND METHODS: In total, 34,970 study subjects were identified from the National Health Insurance Research Database in 2003 with follow-up from 2005 to 2009. The demographic characteristics of patients who had used and had never used pioglitazone, including age, sex, diabetes duration, urinary tract disease, nephropathy, bladder cancer, and cumulative dose and duration of pioglitazone therapy, were analyzed using the χ2 test. Cox proportional hazard regression models were used to determine the independent effects of pioglitazone on bladder cancer and newly developed chronic kidney disease. RESULTS: Among 3,497 ever users and 31,473 never users of pioglitazone, the respective incident cases of bladder cancer were 12 (0.4% and 72 (0.2%, and for newly developed chronic kidney disease 245 (8.1% and 663 (2.3%, respectively. Ever use of pioglitazone [1.59(1.32-1.91], cumulative dose of pioglitazone 10,500 mg [1.34 (1.04-1.73], and duration of therapy 12 months [1.39 (1.09-1.76] were associated with the development of chronic kidney disease. CONCLUSIONS: There was no association of pioglitazone use with bladder cancer development, however, there was an association with an increased risk of newly developed chronic kidney disease.

  20. Tea, coffee, carbonated soft drinks and upper gastrointestinal tract cancer risk in a large United States prospective cohort study

    Science.gov (United States)

    Ren, JS; Freedman, ND; Kamangar, F; Dawsey, SM; Hollenbeck, AR; Schatzkin, A; Abnet, CC

    2010-01-01

    The authors investigated the relationship between hot tea, iced tea, coffee and carbonated soft drinks consumption and upper gastrointestinal tract cancers risk in the NIH-AARP Study. During 2,584,953 person-years of follow-up on 481,563 subjects, 392 oral cavity, 178 pharynx, 307 larynx, 231 gastric cardia, 224 gastric noncardia cancer, 123 esophageal squamous cell carcinoma (ESCC) and 305 esophageal adenocarcinoma (EADC) cases were accrued. Hazard ratios (HRs) and 95% Confidence Intervals (95%CIs) were calculated by multivariate-adjusted Cox regression. Compared to non-drinking, the hazard ratio for hot tea intake of ≥1 cup/day was 0.37 (95%CI: 0.20, 0.70) for pharyngeal cancer. The authors also observed a significant association between coffee drinking and risk of gastric cardia cancer (compared to drinking >3 cups/day was 1.57 (95%CI: 1.03, 2.39)), and an inverse association between coffee drinking and EADC for the cases occurring in the last three years of follow-up (compared to drinking >3 cups/day was 0.54 (95%CI: 0.31, 0.92)), but no association in earlier follow-up. In summary, hot tea intake was inversely associated with pharyngeal cancer, and coffee was directly associated with gastric cardia cancer, but was inversely associated with EADC during some follow-up periods. PMID:20395127

  1. Genetic associations of 115 polymorphisms with cancers of the upper aerodigestive tract across 10 European countries: the ARCAGE project.

    LENUS (Irish Health Repository)

    Canova, Cristina

    2009-04-01

    Cancers of the upper aerodigestive tract (UADT) include malignant tumors of the oral cavity, pharynx, larynx, and esophagus and account for 6.4% of all new cancers in Europe. In the context of a multicenter case-control study conducted in 14 centers within 10 European countries and comprising 1,511 cases and 1,457 controls (ARCAGE study), 115 single nucleotide polymorphisms (SNP) from 62 a priori-selected genes were studied in relation to UADT cancer. We found 11 SNPs that were statistically associated with UADT cancers overall (5.75 expected). Considering the possibility of false-positive results, we focused on SNPs in CYP2A6, MDM2, tumor necrosis factor (TNF), and gene amplified in squamous cell carcinoma 1 (GASC1), for which low P values for trend (P trend<0.01) were observed in the main effects analyses of UADT cancer overall or by subsite. The rare variant of CYP2A6 -47A>C (rs28399433), a phase I metabolism gene, was associated with reduced UADT cancer risk (P trend=0.01). Three SNPs in the MDM2 gene, involved in cell cycle control, were associated with UADT cancer. MDM2 IVS5+1285A>G (rs3730536) showed a strong codominant effect (P trend=0.007). The rare variants of two SNPs in the TNF gene were associated with a decreased risk; for TNF IVS1+123G>A (rs1800610), the P trend was 0.007. Variants in two SNPs of GASC1 were found to be strongly associated with increased UADT cancer risk (for both, P trend=0.008). This study is the largest genetic epidemiologic study on UADT cancers in Europe. Our analysis points to potentially relevant genes in various pathways.

  2. Cholangiopathy with Respect to Biliary Innate Immunity

    Directory of Open Access Journals (Sweden)

    Kenichi Harada

    2012-01-01

    Full Text Available Biliary innate immunity is involved in the pathogenesis of cholangiopathies in cases of biliary disease. Cholangiocytes possess Toll-like receptors (TLRs which recognize pathogen-associated molecular patterns (PAMPs and play a pivotal role in the innate immune response. 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. Moreover, in primary biliary cirrhosis (PBC and biliary atresia, biliary innate immunity is closely associated with the dysregulation of the periductal cytokine milieu and the induction of biliary apoptosis and epithelial-mesenchymal transition (EMT, forming in disease-specific cholangiopathy. Biliary innate immunity is associated with the pathogenesis of various cholangiopathies in biliary diseases as well as biliary defense systems.

  3. Long-term effects of forgotten biliary stents: a case series and literature review

    Science.gov (United States)

    Odabasi, Mehmet; Arslan, Cem; Akbulut, Sami; Abuoglu, Haci Hasan; Ozkan, Erkan; Yildiz, Mehmet Kamil; Eris, Cengiz; Gunay, Emre; Tekesin, Kemal; Muftuoglu, Tolga

    2014-01-01

    There are many studies about the biliary stents, however there is a little information about the long-term stayed forgotten biliary stents except a few case reports. We have reported the results of a number of cases with biliary stents that were forgotten or omitted by the patient and the endoscopist. During February 2010 to May 2013, five patients were referred to the general surgery clinic of Haydarpasa Numune Training and Research Hospital, Istanbul Turkey. Past history and medical documents submitted by the patient did not indicate a replacement of the biliary stent in 3 patients. Two patients knew that they had biliary stents. We also conducted a literature review via the PubMed and Google Scholar databases of English language studies published until March 2014 on forgotten biliary stent. There were 3 men and 2 women ranging in age from 22 to 68 years (mean age 41.6 years). Patients presented with pain in the upper abdomen, jaundice, fever, abnormal liver function tests or dilatation of the biliary tract alone or in combination. Patients’ demographic findings are presented in Table 1. A review of three cases reported in the English medical literature also discussed. The mean duration of the patency of the stent is about 12 months. The biliary stenting is performed either with plastic or metal stents, studies recommending their replacement after 3-6 months. Patients with long stayed forgotten biliary stents are inevitably treated with surgical intervention. We recommend for all endoscopic retrograde cholangiopancreatography units provide a stent registry system that the stents placed for various therapeutic procedures are not forgotten both by the patient as well as the physician. There should be a deadline for biliary stents in the registry system for each patient. PMID:25232385

  4. Cholangiocyte anion exchange and biliary bicarbonate excretion

    Institute of Scientific and Technical Information of China (English)

    Jesús M Banales; Jesús Prieto; Juan F Medina

    2006-01-01

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

  5. Presence of CCK-A, B receptors and effect of gastrin and cholecystokinin on growth of pancreatobiliary cancer cell lines

    Institute of Scientific and Technical Information of China (English)

    Jin-Young Jang; Sun-Whe Kim; Ja-Lok Ku; Yong-Hyun Park; Jae-Gahb Park

    2005-01-01

    AIM: To investigate the effects of gastrin and cholecystokinin (CCK) and their specific antagonists on the growth of pancreatic and biliary tract cancer cell lines.METHODS: Five pancreatic and 6 biliary cancer cell lines with 2 conrtol cells were used in this study. Cell proliferation study was done using 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) test and direct cell count method. Reverse transcription-polymerase chain reaction (RT-PCR) and slot blot hybridization were performed to examine and quantify the expression of hormonal receptors in these cell lines.RESULTS: SNU-308 showed a growth stimulating effect by gastrin-17, as did SNU-478 by both gastrin-17 and CCK-8. The trophic effect of these two hormones was completely blocked by specific antagonists (L-365, 260for gastrin and L-364, 718 for CCK). Other cell lines did not respond to gastrin or CCK. In RT-PCR, the presence of CCK-A receptor and CCK-B/gastrin receptor mRNA was detected in all biliary and pancreatic cancer cell lines. In slot blot hybridization, compared to the cell lines which did not respond to hormones, those that responded to hormones showed high expression of receptor mRNA.CONCLUSION: Gastrin and CCK exert a trophic action on some of the biliary tract cancers.

  6. 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

  7. Effects of Inhibitor of Histone Deacetylase on Proliferation of Biliary Tract Cancer%TSA对胆道癌细胞系生长的影响

    Institute of Scientific and Technical Information of China (English)

    徐立宁

    2008-01-01

    目的:研究组蛋白去乙酰化酶抑制剂在体外和体内对胆囊癌细胞系和肝外胆管癌细胞系生长的影响,并探讨其临床应用价值.方法:用组蛋白去乙酰化酶抑制剂一曲古抑菌素A(trichostatin A,TSA)作用于胆囊癌细胞系(Mz-ChA-1)和肝外胆管癌细胞系(QBC啷、KMBC、OZ),用MTT法检测TSA对这些细胞系生长的影响.将Mz-ChA-l接种裸鼠皮下建立胆囊癌裸鼠种植模型,观察TSA处理前后体内种植瘤生长的变化.结果:TSA可以抑制Mz-ChA-l和QBC939、KMBC、OZ的增殖.以上作用与药物浓度在一定范围内呈正相关.成功建立胆囊癌裸鼠体内种植模型,TSA处理后裸鼠体内种植瘤生长受抑制.结论:TSA在体外能抑制胆囊癌细胞系和肝外胆管癌细胞系的增殖;TSA在体内能抑制胆囊癌细胞系的增殖.

  8. Role of cytopathology in the diagnosis and management of gastrointestinal tract cancers.

    Science.gov (United States)

    Conrad, Rachel; Cobb, Camilla; Raza, Anwar

    2012-09-01

    Cytology of gastro-intestinal (GI) tract lesions can be used successfully to diagnose neoplastic and non-neoplastic conditions, especially when combined with biopsies. Cytologic evaluation is widely accepted as a cost-effective method that allows rapid interpretation and triaging of material. Technical advances over the years have allowed simultaneous visualization of abnormal tissue and procurement of needle aspirates, brushings and biopsies from mucosal and deeper seated lesions. Successful cytologic examination of the GI tract is highly dependent on the skill of the endoscopist, specimen preparation, the expertise of the pathologist, and the recognition of the limitations of cytology. This article reviews the key cytologic features of important GI tract lesions, differential diagnoses, and pitfalls, and addresses the advantages and limitations of different collection techniques.

  9. Associations of red and processed meat with survival among patients with cancers of the upper aerodigestive tract and lung.

    Science.gov (United States)

    Miles, Fayth L; Chang, Shen-Chih; Morgenstern, Hal; Tashkin, Donald; Rao, Jian-Yu; Cozen, Wendy; Mack, Thomas; Lu, Qing-Yi; Zhang, Zuo-Feng

    2016-06-01

    The effect of red and processed meats on cancer survival is unclear. We sought to examine the role of total and processed red meat consumption on all-cause mortality among patients with cancers of the upper aerodigestive tract (UADT) and lung, in order to test our hypothesis that red or processed meat was associated with overall mortality in these patients. Using data from a population-based case-control study conducted in Los Angeles County, we conducted a case-only analysis to examine the association of red or processed meat consumption on mortality after 12 years of follow-up, using a diet history questionnaire. Cox regression was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs), adjusting for potential confounders. Of 601 UADT cancer cases and 611 lung cancer cases, there were 248 and 406 deaths, respectively, yielding crude mortality rates of 0.07 and 0.12 deaths per year. Comparing the highest with lowest quartile of red meat consumption, the adjusted HR was 1.64 (95% CI, 1.04-2.57) among UADT cancer cases; for red or processed meat, the adjusted HR was 1.76 (95% CI, 1.10-2.82). A dose-response trend was observed. A weaker association was observed with red meat consumption and overall mortality among lung cancer cases. In conclusion, this case-only analysis demonstrated that increased consumption of red or processed meats was associated with mortality among UADT cancer cases and WAS weakly associated with mortality among lung cancer cases.

  10. Narrow band imaging and high definition television in the endoscopic evaluation of upper aero-digestive tract cancer.

    Science.gov (United States)

    Piazza, C; Cocco, D; Del Bon, F; Mangili, S; Nicolai, P; Peretti, G

    2011-04-01

    Narrow band imaging and high definition television are recent innovations in upper aero-digestive tract endoscopy. Aim of this prospective, non-randomized, unblinded study was to establish the diagnostic advantage of these procedures in the evaluation of squamous cell cancer arising from various upper aero-digestive tract sites. Between April 2007 and January 2010, 444 patients affected by upper aero-digestive tract squamous cell cancer, or previously treated for it, were evaluated by white light and narrow band imaging ± high definition television endoscopy, both in the pre-/intra-operative setting and during follow-up. Tumour resection was performed taking into account narrow band imaging and high definition television information to obtain histopathologic confirmation of their validity. Endoscopic and pathologic data were subsequently matched to obtain sensitivity, specificity, positive, negative predictive values, and accuracy. Overall, 110 (25%) patients showed adjunctive findings by narrow band imaging ± high definition television when compared to standard white light endoscopy. Of these patients, 98 (89%) received histopatological confirmation. The sensitivity, specificity, positive, negative predictive values, and accuracy for white light-high definition television were 41%, 92%, 87%, 82%, and 67%, for narrow band imaging alone 75%, 87%, 87%, 74%, and 80%, and for narrow band imaging-high definition television 97%, 84%, 88%, 96%, and 92%. The highest diagnostic gain was observed in the oral cavity and oropharynx (25%). Narrow band imaging and high definition television were of value in the definition of superficial tumour extension, and in the detection of synchronous lesions in the pre-/intra-operative settings. These technologies also played an important role during post-treatment surveillance for early detection of persistences, recurrences, and metachronous tumours.

  11. Detection rate of prostate cancer using prostate specific antigen in patients presenting with lower urinary tract symptoms: A retrospective study

    Directory of Open Access Journals (Sweden)

    Chavan P

    2009-01-01

    Full Text Available Background: Need for undertaking prostate biopsies for detection of prostate cancer is often decided on the basis of serum levels of prostate specific antigen (PSA. Aim: To evaluate the case detection rate of prostate cancer among patients presenting with lower urinary tract symptoms (LUTS on the basis of PSA levels and to assess the scope of prostate biopsy in these patients. Setting and Design: A retrospective study from a tertiary care center. Materials and Methods: The clinical and histopathological data of 922 patients presenting with LUTS in the last five years was obtained from the medical record section. They had been screened for prostate cancer using PSA and /or digital rectal examination examination followed by confirmation with prostate biopsy. Statistical Analysis Used: Detection rate and receiver operating characteristic curve were performed using SPSS 16 and Medcalc softwares. Results: The detection rate of prostate cancer according to the PSA levels was 0.6%, 2.3%, 2.5%, 34.1% and 54.9% in the PSA range of 0-4, 4-10, 10-20, 20-50 and> 50 ng/ml, respectively. Maximum prostate cancer cases were detected beyond a PSA value of 20 ng/ml whereas no significant difference in the detection rate was observed in the PSA range of 0-4, 4-10 and 10-20 ng/ml. Conclusion: A low detection rate of prostate cancer observed in the PSA range of 4-20 ng/ml in LUTS patients indicates the need for use of higher cutoff values of PSA in such cases. Therefore we recommend a cutoff of 20 ng/ml of PSA for evaluation of detection rate of prostate cancer among patients presenting with LUTS.

  12. Expected Survival Using Models of Life Table Compared with Survival of Gastrointestinal Tract Cancer Patients in North of Iran

    Directory of Open Access Journals (Sweden)

    H Zeraati

    2011-12-01

    Full Text Available Background: Northern regions of Iran have been encountered to dominate malignancies of gastrointestinal (GI tract. We came to examine the total excess mortality due to the GI cancer in Mazandaran province.Methods: Socio-demographic and clinical data of 484 patients with GI cancer collected during the years 1990-1991were available from Babol Cancer Registry. Patients were followed up for 15 years by the year 2006. Using the West Coale-De­meny life table model, a number of five life tables for men and four for women, corresponding to each birth cohort, were constructed. Observed survival was obtained using the Kaplan-Meier method and compared with the Expected survival cal­culated using the direct adjusted method represented by STEIN et al.Results: The sample of subjects encompassed 66.3% men and 33.7% women with mean age 58.26 ± 10.90, and endoscopy was the general method for cancer detection. Esophagus accounted for 74.2%, and stomach and colorectal accounted for 22.7% and 3.1% of GI cancers, respectively. Survival rate in 15 years following diagnosis was nearly 6%. Comparing pa­tient and expected survival curves showed a significantly reduced survival for patients of each GI cancer over the whole period and especially during the first two years after diagnosis.Conclusion: Patients experienced reduced survival associated with the development of GI cancers. Considering individuals in a population come from different cohorts, adjustment by constructing distinct life tables for different birth cohorts is rec­ommended. The West model is recommended as a first choice to represent mortality in countries whose registration systems are exposed to various errors.

  13. Biliary atresia: pathogenesis and treatment.

    Science.gov (United States)

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

    1998-01-01

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

  14. [Coincidental finding of biliary ascariasis].

    Science.gov (United States)

    Kristensen, Anders Donatsky; Achiam, Michael

    2010-04-19

    We describe a case of biliary ascariasis in a 27-year-old Philippine au-pair with recurrent upper abdominal pain. Hepatobiliary ascariasis is rarely seen in non-endemic areas. The diagnosis is important because severe complications can occur. If migrated into the biliary tree, it is recommended to perform endoscopic extraction combined with antihelmintic therapy. In severe cases, the recommendation is laparoscopic cholecystectomy and peroperative exploration of the common hepatic duct.

  15. Influence of Mesenchymal Stem Cells Conditioned Media on Proliferation of Urinary Tract Cancer Cell Lines and Their Sensitivity to Ciprofloxacin.

    Science.gov (United States)

    Maj, Malgorzata; Bajek, Anna; Nalejska, Ewelina; Porowinska, Dorota; Kloskowski, Tomasz; Gackowska, Lidia; Drewa, Tomasz

    2017-06-01

    Mesenchymal stem cells (MSCs) are known to interact with cancer cells through direct cell-to-cell contact and secretion of paracrine factors, although their exact influence on tumor progression in vivo remains unclear. To better understand how fetal and adult stem cells affect tumors, we analyzed viability of human renal (786-0) and bladder (T24) carcinoma cell lines cultured in conditioned media harvested from amniotic fluid-derived stem cells (AFSCs) and adipose-derived stem cells (ASCs). Both media reduced metabolic activity of 786-0 cells, however, decreased viability of T24 cells was noted only after incubation with conditioned medium from ASCs. To test the hypothesis that MSCs-secreted factors might be involved in chemoresistance acquisition, we further analyzed influence of mesenchymal stem cell conditioned media (MSC-CM) on cancer cells sensitivity to ciprofloxacin, that is considered as potential candidate agent for urinary tract cancers treatment. Significantly increased resistance to tested drug indicates that MSCs may protect cancer cells from chemotherapy. J. Cell. Biochem. 118: 1361-1368, 2017. © 2016 Wiley Periodicals, Inc.

  16. Efficacy of structured triglycerides in parenteral nutrition in elderly patients with acute biliary tract infection%结构脂肪乳的肠外营养支持在高龄老年胆道感染患者急性期治疗中的影响

    Institute of Scientific and Technical Information of China (English)

    李喆; 宋京海; 华彬; 兰勇; 韦军民

    2015-01-01

    Objective To investigate the safety and efficacy of structured triglycerides in parenteral nutrition in elderly patients with acute biliary tract infection.Methods 62 elderly patients with acute biliary tract infection under conservative therapy were randomly divided into structured triglycerides (ST) group and medium-chain triglycerides plus long-chain triglycerides (MCT/LCT) group.Patients underwent parenteral nutrition for 5 days.Levels of hepatic enzymes,blood triglycerides,nitrogen balance,fasting blood insulin and glucose were compared between the two groups after 5 days of parenteral nutrition.Results There were no significant differences in levels of hepatic enzymes,blood triglycerides and fasting blood glucose between ST group and MCT/LCT group.Plasma total bilirubin (T-Bill) levels were increased in the two groups,and T-Bill level dropped faster in the ST group than in the MCT/LCT group after 7 days of parenteral nutrition(P< 0.05).The difference in total cholesterol level dropping was significant between ST group and MCT/ LCT group (P<0.05).The cumulative nitrogen balance for 5 days had significant difference between ST and MCT/LCT groups [(4.7-±-2.2) g vs.(2.8±0.7) g,P<0.05].STG group versus MCT/LCT group had less fluctuation of fasting blood insulin level after 1,4 and 7 days of parenteral nutrition.Conclusions In the acute phase of biliary tract infection in elderly patients,ST-based parenteral nutrition can provide energy and help maintain nitrogen balance,with a little fluctuation of fasting blood insulin level.Short-term nutritional support may have better tolerance in the liver and has little effect on the change of hepatic enzymes.%目的 研究富含结构脂肪乳的肠外营养支持在老年胆道感染患者急性发病期应用的安全性和对机体的影响. 方法 选择我院高龄(≥80岁)胆道感染患者62例,早期均采取保守治疗,其营养支持随机分为结构脂肪乳(STG)组和物理混合的中长链脂肪

  17. Time of Occurrence and Age Distribution of Digestive Tract Cancers in Northern Iran

    Directory of Open Access Journals (Sweden)

    M Mohebbi

    2008-05-01

    Full Text Available Background: Previous studies indicate a high incidence of digestive cancers along southern parts of Caspian Sea including Ma­zandaran Province. The present study was conducted to further investigate time to occurrence, age distribution and pos­sible risks associated with the incidence time of digestive cancers in the above regions. Methods: For this purpose the data of digestive cancer incidence of 3723 cases during a five-year period of 2001 to 2005 col­lected from Babol Cancer Registry Center in Iran. Almost all cancer cases residence of Mazandaran Province is included in this study and so the results could be considered a population-based conclusion. In order to modify the mortality due to other causes before digestive cancers, and to adjust the effect of digestive cancers correlations, a competing risks model was used. The Cox regression model was used for study of risk factors on cancer incidence. Results: Although incidence of colorectal cancer was relatively low, however, unfortunately the age of onset was at the age cate­gory of 15-19, much sooner than occurrence of stomach cancer which was at 20-24 yr (P< 0.0001, and esophageal can­cer at age category of 30-34 yr (P< 0.0001. Conclusion: Life tables of all digestive cancer, esophageal cancer, stomach and colorectal cancers were presented in this pa­per. Risks related to these cancers are significantly higher in men and residences of urban areas than their baseline coun­terparts. (P< 0.0001 More studies needed to identify risk factors and high risk cases for screening and prevention programs.

  18. Role of cytopathology in the diagnosis and management of gastrointestinal tract cancers

    OpenAIRE

    Conrad, Rachel; Cobb, Camilla; Raza, Anwar

    2012-01-01

    Cytology of gastro-intestinal (GI) tract lesions can be used successfully to diagnose neoplastic and non-neoplastic conditions, especially when combined with biopsies. Cytologic evaluation is widely accepted as a cost-effective method that allows rapid interpretation and triaging of material. Technical advances over the years have allowed simultaneous visualization of abnormal tissue and procurement of needle aspirates, brushings and biopsies from mucosal and deeper seated lesions. Successful...

  19. Primary Biliary Cirrhosis Is a Generalized Autoimmune Epithelitis

    Directory of Open Access Journals (Sweden)

    Jun Gao

    2015-03-01

    Full Text Available Primary biliary cirrhosis (PBC is a chronic progressive autoimmune cholestatic liver disease characterized by highly specific antimitochondrial antibodies (AMAs and the specific immune-mediated injury of small intrahepatic bile ducts. Unique apoptotic feature of biliary epithelial cells (BECs may contribute to apotope presentation to the immune system, causing unique tissue damage in PBC. Perpetuation of inflammation may result in senescence of BECs, contributing to irreversible loss of bile duct. In addition to the classic liver manifestations, focal inflammation and tissue damage are also seen in salivary glands and urinary tract in a significant proportion of PBC patients. These findings provide potent support to the idea that molecular mimicry may be involved in the breakdown of autoimmune tolerance and mucosal immunity may lead to a systematic epithelitis in PBC patients. Thus, PBC is considered a generalized epithelitis in clinical practice.

  20. Novel Biliary Reconstruction Techniques During Liver Transplantation

    Science.gov (United States)

    Carmody, Ian C.; Romano, John; Bohorquez, Humberto; Bugeaud, Emily; Bruce, David S.; Cohen, Ari J.; Seal, John; Reichman, Trevor W.; Loss, George E.

    2017-01-01

    Background: Biliary complications remain a significant problem following liver transplantation. Several surgical options can be used to deal with a significant size mismatch between the donor and recipient bile ducts during the biliary anastomosis. We compared biliary transposition to recipient biliary ductoplasty in cadaveric liver transplant. Methods: A total of 33 reconstructions were performed from January 1, 2005 to December 31, 2013. In the biliary transposition group (n=23), 5 reconstructions were performed using an internal stent (5 or 8 French pediatric feeding tube), and 18 were performed without. Of the 10 biliary ductoplasties, 2 were performed with a stent. All patients were managed with standard immunosuppression and ursodiol. Follow-up ranged from 2 months to 5 years. Results: No patients in the biliary transposition group required reoperation; 1 patient had an internal stent removed for recurrent unexplained leukocytosis, and 2 patients required endoscopic retrograde cholangiography and stent placement for evidence of stricture. Three anastomotic leaks occurred in the biliary ductoplasty group, and 2 patients in the biliary ductoplasty group required reoperation for biliary complications. Conclusion: Our results indicate that biliary reconstruction can be performed with either biliary transposition or biliary ductoplasty. These techniques are particularly useful when a significant mismatch in diameter exists between the donor and recipient bile ducts.

  1. Gemcitabine Hydrochloride and Cisplatin With or Without Bevacizumab in Treating Patients With Advanced Urinary Tract Cancer

    Science.gov (United States)

    2017-03-09

    Bladder Urothelial Carcinoma; Distal Urethral Carcinoma; Infiltrating Bladder Urothelial Carcinoma Associated With Urethral Carcinoma; Metastatic Urothelial Carcinoma of the Renal Pelvis and Ureter; Proximal Urethral Carcinoma; Recurrent Bladder Carcinoma; Recurrent Prostate Carcinoma; Recurrent Urethra Carcinoma; Recurrent Urothelial Carcinoma of the Renal Pelvis and Ureter; Regional Urothelial Carcinoma of the Renal Pelvis and Ureter; Stage IV Bladder Cancer; Stage IV Prostate Cancer; Stage IV Urethral Cancer; Ureter Carcinoma

  2. Alcohol dehydrogenase 3 genotype as a risk factor for upper aerodigestive tract cancers

    DEFF Research Database (Denmark)

    Nishimoto, Inês Nobuko; Pinheiro, Nidia A; Rogatto, Silvia R

    2004-01-01

    for ADH3 genotypes using logistic regression models. RESULTS: After adjustment for sex, age, tobacco use, and history of cancer in first-degree family relatives, a significantly higher odds ratio for UADT cancer was observed among individuals with AA genotype and low cumulative alcohol consumption...... (tobacco consumption (... be a risk factor for UADT cancer, especially in individuals with low alcohol or tobacco consumption. However, further epidemiological case-control or cohort studies, preferably prospective, are needed to establish the exact role of ADH3 polymorphism and its association with the development of UADT cancers....

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

    Directory of Open Access Journals (Sweden)

    Pandey Manoj

    2007-08-01

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

  4. 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.

  5. Impact of comorbid anxiety and depression on quality of life and cellular immunity changes in patients with digestive tract cancers

    Institute of Scientific and Technical Information of China (English)

    Fu-Ling Zhou; Wang-Gang Zhang; Yong-Chang Wei; Kang-Ling Xu; Ling-Yun Hui; Xu-Sheng Wang; Ming-Zhong Li

    2005-01-01

    AIM: A study was performed to investigate the impact of comorbid anxiety and depression (CAD) on quality of life (QOL) and cellular immunity changes in patients with digestive tract cancers.METHODS: One hundred and fifty-six cases of both sexes with cancers of the digestive tract admitted between March 2001 and February 2004 in the Department of Medical Oncology, First Affiliated Hospital of Xi'an Jiaotong University were randomly enrolled in the study. Depressive and anxiety disorder diagnoses were assessed by using the Structured Clinical Interview for DSM-Ⅳ. All adult patients were evaluated with the Hamilton depressive scale (HAMD, the 24-item version), the Hamilton anxiety scale (HAMA, a modified 14-item version), quality of life questionnaire-core 30 (QLQ-C30), social support rating scale (SSRS), simple coping style questionnaire (SCSQ), and other questionnaires, respectively. In terms of HAMD ≥ 20 and HAMA ≥ 14, the patients were categorized, including CAD (n = 31) in group A, anxiety disorder (n = 23) in group B,depressive disorder (n = 37) in group C, and non-disorder (n = 65) in group D. Immunological parameters such as T-lymphocyte subsets and natural killer (NK) cell activities in peripheral blood were determined and compared among the four groups.RESULTS: The incidence of CAD was 21.15% in patients with digestive tract cancers. The average scores of social support was 43.67±7.05 for 156 cases, active coping 20.34±7.33, and passive coping 9.55±5.51. Compared with group D, subjective support was enhanced slightly in group A, but social support, objective support, and utilization of support reduced, especially utilization of support with significance (6.16 vs 7.80, P<0.05); total scores of active coping decreased, while passive coping reversed; granulocytes proliferated, monocytes declined,and lymphocytes declined significantly (32.87 vs 34.00,P<0.05); moreover, the percentage of CD3, CD4, CD8and CD56 in T lymphocyte subsets was in lower

  6. Oldest biliary endoprosthesis in situ

    Science.gov (United States)

    Consolo, Pierluigi; Scalisi, Giuseppe; Crinò, Stefano F; Tortora, Andrea; Giacobbe, Giuseppa; Cintolo, Marcello; Familiari, Luigi; Pallio, Socrate

    2013-01-01

    The advantages of endoscopic retrograde cholangiopancreatography over open surgery have made it the predominant method of treating patients with choledocholithiasis. After sphincterotomy, however, 10%-15% of common bile duct stones cannot be removed with a basket or balloon. The methods for managing “irretrievable stones” include surgery, mechanical lithotripsy, intraductal or extracorporeal shock wave lithotripsy and biliary stenting. The case presented was a referred 82-year-old Caucasian woman with a 7-year-old plastic biliary endoprosthesis in situ. To the best of our knowledge the examined endoprosthesis is the oldest endoprosthesis in situ reported in the literature. Endoscopic biliary endoprosthesis placement remains a simple and safe procedure for patients with stones that are difficult to manage by conventional endoscopic methods and for patients who are unfit for surgery or who are high surgical risks. To date no consensus has been reached regarding how long a biliary prosthesis should remain in situ. Long-term biliary stenting may have a role in selected elderly patients if stones extraction has failed because the procedure may prevent stones impaction and cholangitis. PMID:23858381

  7. Novel endoscopic imaging techniques toward in vivo observation of living cancer cells in the gastrointestinal tract.

    Science.gov (United States)

    Inoue, Haruhiro; Kudo, Shin-ei; Shiokawa, Akira

    2005-07-01

    It is now possible to perform microscopic imaging of living cells from both normal mucosa and malignant tissue in the gastrointestinal tract. Endocytoscopy is a catheter-type contact endoscope that has more than 1000-fold magnifying power and can pass through the working channel of the straight-view endoscope. In esophageal cells, the nucleus, cell body, and even the nucleolus were clearly distinguished with high-resolution images comparable with those of conventional cytology. This novel technology has the potential to provide histologic diagnoses during endoscopic examinations, similar to those obtained currently by conventional histology techniques.

  8. Biliary atresia associated with meconium peritonitis.

    Science.gov (United States)

    Chung, Mei-Yung; Ko, Tan-Yung; Huang, Chung-Bin; Lee, Chiang-Hsuan; Hsieh, Chih-Sung

    2006-01-01

    Biliary atresia, malrotation, meconium peritonitis and transient hypothyroidism are occasionally seen in neonatal infants. Biliary atresia associated with malrotation has been reported in some patients with polysplenia syndrome, but biliary atresia associated with meconium peritonitis has only been described by a few investigators. Here we present a case of meconium peritonitis due to malrotation with volvulus, followed by biliary atresia and transient hypothyroidism during early infancy.

  9. Spontaneous rupture of intrahepatic biliary ducts with biliary peritonitis.

    Science.gov (United States)

    Aydin, Unal; Yazici, Pinar; Coker, Ahmet

    2007-01-01

    Spontaneous rupture of intrahepatic biliary ducts is a rare cause of acute abdomen due to biliary peritonitis. We report a 92-year-old woman with 48-h history of upper abdominal pain, nausea and vomiting and peritoneal signs. CT scan showed free fluid in the abdomen and mild dilatation of the common bile duct. Exploratory laparotomy showed bile in the abdominal cavity with leak-age from a ruptured bile duct radicle in segment 3, as confirmed on intraoperative cholangiography. She underwent cholecystectomy, choledochotomy with removal of gallstones, repair of the perforation with primary suture and placement of a T-tube. She had an uneventful recovery.

  10. Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden.

    Science.gov (United States)

    Larsson, L G; Sandström, A; Westling, P

    1975-11-01

    Sideropenic anemia with epithelial lesions (Plummer-Vinson syndrome) was previously very common among women in northern Sweden. The incidence of this condition is decreasing, however, because of better nutrition and improved health care. Plummer-Vinson syndrome as a sequela of previous sideropenic anemia still influences the pattern of hypopharyngeal and oral cancer in northern Sweden where the female/male ratio in these diseases is remarkably high and where cancer in the postcricoid part of the hypopharynx is relatively common. In Sweden as a whole, a decreasing trend in the incidence of hypopharyngeal cancer in women can be demonstrated, which is probably due to diminished prevalence of Plummer-Vinson syndrome.

  11. Identification of immunogenic Salmonella enterica serotype Typhi antigens expressed in chronic biliary carriers of S. Typhi in Kathmandu, Nepal.

    Directory of Open Access Journals (Sweden)

    Richelle C Charles

    Full Text Available BACKGROUND: Salmonella enterica serotype Typhi can colonize and persist in the biliary tract of infected individuals, resulting in a state of asymptomatic chronic carriage. Chronic carriers may act as persistent reservoirs of infection within a community and may introduce infection to susceptible individuals and new communities. Little is known about the interaction between the host and pathogen in the biliary tract of chronic carriers, and there is currently no reliable diagnostic assay to identify asymptomatic S. Typhi carriage. METHODOLOGY/PRINCIPAL FINDINGS: To study host-pathogen interactions in the biliary tract during S. Typhi carriage, we applied an immunoscreening technique called in vivo-induced antigen technology (IVIAT, to identify potential biomarkers unique to carriers. IVIAT identifies humorally immunogenic bacterial antigens expressed uniquely in the in vivo environment, and we hypothesized that S. Typhi surviving in the biliary tract of humans may express a distinct antigenic profile. Thirteen S. Typhi antigens that were immunoreactive in carriers, but not in healthy individuals from a typhoid endemic area, were identified. The identified antigens included a number of putative membrane proteins, lipoproteins, and hemolysin-related proteins. YncE (STY1479, an uncharacterized protein with an ATP-binding motif, gave prominent responses in our screen. The response to YncE in patients whose biliary tract contained S. Typhi was compared to responses in patients whose biliary tract did not contain S. Typhi, patients with acute typhoid fever, and healthy controls residing in a typhoid endemic area. Seven of 10 (70% chronic carriers, 0 of 8 bile culture-negative controls (0%, 0 of 8 healthy Bangladeshis (0%, and 1 of 8 (12.5% Bangladeshis with acute typhoid fever had detectable anti-YncE IgG in blood. IgA responses were also present. CONCLUSIONS/SIGNIFICANCE: Further evaluation of YncE and other antigens identified by IVIAT could lead to

  12. Multidetector CT of emergent biliary pathologic conditions.

    Science.gov (United States)

    Patel, Neel B; Oto, Aytekin; Thomas, Stephen

    2013-01-01

    Various biliary pathologic conditions can lead to acute abdominal pain. Specific diagnosis is not always possible clinically because many biliary diseases have overlapping signs and symptoms. Imaging can help narrow the differential diagnosis and lead to a specific diagnosis. Although ultrasonography (US) is the most useful imaging modality for initial evaluation of the biliary system, multidetector computed tomography (CT) is helpful when US findings are equivocal or when biliary disease is suspected. Diagnostic accuracy can be increased by optimizing the CT protocol and using multiplanar reformations to localize biliary obstruction. CT can be used to diagnose and stage acute cholecystitis, including complications such as emphysematous, gangrenous, and hemorrhagic cholecystitis; gallbladder perforation; gallstone pancreatitis; gallstone ileus; and Mirizzi syndrome. CT also can be used to evaluate acute biliary diseases such as biliary stone disease, benign and malignant biliary obstruction, acute cholangitis, pyogenic hepatic abscess, hemobilia, and biliary necrosis and iatrogenic complications such as biliary leaks and malfunctioning biliary drains and stents. Treatment includes radiologic, endoscopic, or surgical intervention. Familiarity with CT imaging appearances of emergent biliary pathologic conditions is important for prompt diagnosis and appropriate clinical referral and treatment.

  13. 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.

  14. Primary biliary cirrhosis

    Directory of Open Access Journals (Sweden)

    Heathcote E Jenny

    2008-01-01

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

  15. Characterizing variability in in vivo Raman spectra of different anatomical locations in the upper gastrointestinal tract toward cancer detection

    Science.gov (United States)

    Bergholt, Mads Sylvest; Zheng, Wei; Lin, Kan; Ho, Khek Yu; Teh, Ming; Yeoh, Khay Guan; So, Jimmy Bok Yan; Huang, Zhiwei

    2011-03-01

    Raman spectroscopy is an optical vibrational technology capable of probing biomolecular changes of tissue associated with cancer transformation. This study aimed to characterize in vivo Raman spectroscopic properties of tissues belonging to different anatomical regions in the upper gastrointestinal (GI) tract and explore the implications for early detection of neoplastic lesions during clinical gastroscopy. A novel fiber-optic Raman endoscopy technique was utilized for real-time in vivo tissue Raman measurements of normal esophageal (distal, middle, and proximal), gastric (antrum, body, and cardia) as well as cancerous esophagous and gastric tissues from 107 patients who underwent endoscopic examinations. The non-negativity-constrained least squares minimization coupled with a reference database of Raman active biochemicals (i.e., actin, histones, collagen, DNA, and triolein) was employed for semiquantitative biomolecular modeling of tissue constituents in the upper GI. A total of 1189 in vivo Raman spectra were acquired from different locations in the upper GI. The Raman spectra among the distal, middle, and proximal sites of the esophagus showed no significant interanatomical variability. The interanatomical variability of Raman spectra among normal gastric tissue (antrum, body, and cardia) was subtle compared to cancerous tissue transformation, whereas biomolecular modeling revealed significant differences between the two organs, particularly in the gastroesophageal junction associated with proteins, DNA, and lipids. Cancerous tissues can be identified across interanatomical regions with accuracies of 89.3% [sensitivity of 92.6% (162/175) specificity of 88.6% (665/751)], and of 94.7% [sensitivity of 90.9% (30/33) specificity of 93.9% (216/230)] in the gastric and esophagus, respectively, using partial least squares-discriminant analysis together with the leave-one tissue site-out, cross validation. This work demonstrates that Raman endoscopy technique has

  16. [Functional status of the bile excretion system and upper gastrointestinal tract in patients with duodenal ulcer].

    Science.gov (United States)

    Razarenova, T G; Koshel', A P; Klokov, S S; Dibina, T V

    2010-01-01

    The research of functional condition of biliary tract in 35 patients suffered from gastroduodenal ulcers compared with 30 almost healthy patients was conducted. Disorders of motor function were found out in 13.2% patients in control group. The motor-evacuative function of biliary tract conformed to average scores of healthy patients group in only 8.6% cases. The accelerated gallbladder empting (11.4%), the hypermotoric biliary dyskinesia with the absence of latent period of biliary excretion (17.1%), the hypomotoric dysfunction of biliary tract (34.3%) were found out in the rest cases. The separate group of patients were patients with distortion of biliary excretion that was consisted in periodic increase and decrease of gall bladder volume during the contraction. We concluded that motor-evacuative function of biliary tract doesn't depend on the type of pathological process in the stomach or duodenum but correlates with gastric evacuation contents, the rate of cholagogic meal advancement along the duodenum and acid-productive function of the stomach.

  17. Pasteurella multocida urinary tract infection in a patient with cervical cancer.

    Science.gov (United States)

    Singh, Manmeet B; Harrington, Amanda T

    2017-01-01

    Introduction. Infections caused by Pasteurella species are commonly associated with contact with dogs and cats, typically involving bites and scratches, but casual contact with household pets can also be a risk factor. Urinary tract infection (UTI) caused by Pasteurella species is rare and a significant majority of cases have some known risk factor associated with an underlying chronic illness or structural and/or functional urological abnormality. Case presentation. Here, we present a case of a UTI due to Pasteurella multocida in a patient with squamous cell carcinoma of the cervix who also had a household cat. Conclusion. Providers and laboratorians should be aware of risk factors associated with UTIs caused by Pasteurella species.

  18. Pasteurella multocida urinary tract infection in a patient with cervical cancer

    Science.gov (United States)

    Singh, Manmeet B.

    2017-01-01

    Introduction. Infections caused by Pasteurella species are commonly associated with contact with dogs and cats, typically involving bites and scratches, but casual contact with household pets can also be a risk factor. Urinary tract infection (UTI) caused by Pasteurella species is rare and a significant majority of cases have some known risk factor associated with an underlying chronic illness or structural and/or functional urological abnormality. Case presentation. Here, we present a case of a UTI due to Pasteurella multocida in a patient with squamous cell carcinoma of the cervix who also had a household cat. Conclusion. Providers and laboratorians should be aware of risk factors associated with UTIs caused by Pasteurella species.

  19. [Endoscopic management of postoperative biliary fistulas].

    Science.gov (United States)

    Farca, A; Moreno, M; Mundo, F; Rodríguez, G

    1991-01-01

    Biliary fistulas have been managed by surgical correction with no good results. From 1986 to 1990, endoscopic therapy was attempted in 24 patients with postoperative persistent biliary-cutaneous fistulas. Endoscopic retrograde cholangiography demonstrated residual biliary stones in 19 patients (79%). The mean fistula drainage was 540 ml/day, and in 75% the site of the fistula was near the cistic duct stump. Sphincterotomy with or without biliary stent placement resulted in rapid resolution of the fistula in 23 patients (95.8%). In those patients treated with biliary stents the fistula healed spectacularly in 24-72 hrs.

  20. Non-operative residual biliary stone extraction by using steerable catheter and basket

    Energy Technology Data Exchange (ETDEWEB)

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

    1983-06-15

    Nonoperative residual biliary stone removal through the T-tube sinus tract was performed in 9 patients by using steerable catheter and basket under fluoroscopic guidance and the result was satisfactory. There is no significant complication or morbidity. We concluded that this method is 1. easy of performance, highly successful and of no demonstrable risk. 2. can be performed without any medication and in our patient department. 3. the method of choice of treatment in post-op residual biliary stone with T-tube.

  1. 正常胰胆管汇合患者胆汁淀粉酶升高与胆道疾病关系的研究%Correlation between bile amylase elevation and biliary tract disease in patients with normal pancreaticobiliary junction

    Institute of Scientific and Technical Information of China (English)

    任旭; 唐秀芬; 杜明; 朱春兰

    2010-01-01

    目的 探讨正常胰胆管汇合(NPBJ)者胆汁淀粉酶升高与胆道疾病的关系.方法 连续202例患者(胆管胆汁组)在内镜治疗胆道疾病时抽取胆管胆汁检测淀粉酶,其中68例同时检测胆汁脂肪酶,149例做胆汁细菌培养,27例测Oddi括约肌压力(SOM),38例测胆管压力.另外73例(胆囊胆汁组)经皮经肝胆囊镜治疗胆囊结石,取胆囊中胆汁检测淀粉酶,31例进行胆囊黏膜活检.两组病例均除外先天性胰胆管汇合异常、胆肠吻合术和既往内镜乳头切开治疗者.结果 胆管胆汁组95例(47.0%)淀粉酶升高,其中肿瘤(56.9%,29/51)与非肿瘤疾病(43.7%,66/151)差异无统计学意义(P 0. 05 ), although BA was elevated in most patients with hiler cholangiocarcinoma (7/9). The level of BA was correlated with bile lipase (r =0. 561 ), but not with pressure of Oddi's sphincter or bile duct. No significant difference in positive rate of bile bacteria culture was detected between patients with normal BA level and those with elevated level. In GB bile group, BA level was elevated in 25 patients (34. 3% ), in which the frequency of GB epithelium dysplasia is 87.5%, which was significantly higher than that from patients with normal BA level ( P < 0. 001 ). Conclusion The patients with biliary tract disease and NPBJ have high incidence of reflux of pancreatic juice into bile duct. In patients with elevated BA level, there was no significant difference between incidences of neoplastic or non-neoplastic disease, while the frequency of GB epithelium dysplasia and hilar cholangiocarcinoma were higher than those from patients with normal BA level.

  2. [Biliary ileus--a rare complication of cholecystolithiasis].

    Science.gov (United States)

    Lakyová, L; Radonak, J; Vajó, J; Toncr, I; Kudlác, M

    2007-10-01

    The diagnosis of ileus caused by biliary stones occurs very rarely, with the range of 2 % worldwide. This complication of cholecystolithiasis caused by the stone fistulation into gastrointestinal tract and its subsequent obstruction occurs mostly in elderly and has a high mortality rate. During the course of ten years (1996-2006) in the 2nd surgical clinic FNLP in Kosice, 1640 cholecystectomies and 255 operations, due to the obstruction ileus, were performed. Biliary ileus was recorded in four cases. In two cases, the reason being an obstruction caused by a travelled stone into jejunum, one event was caused by a mechanic wedge of a stone in duodenum and in the last event rectosigma was obturated. The diagnostic is relatively difficult because of a nonspecific symptomatology and often negative anamnesis of previous problems with gallstones. According to literature, the most reliable diagnostic method is computer tomography (CT). In our case, abdominal ultrasonography was successful, which pointed out this diagnosis. Gastroscopy localized the place of obstruction, but not its cause and X-ray image showed aerobilia two times. By the use of magnetic resonance cholangiopancreatography (MRCP) the diagnosis was not positively confirmed. Only in one out of four cases, there was a suspicion of the diagnosis of the biliary ileus, which makes its detectability 25%. The aim of this retrospective analysis is the comparison of diagnostic method-options and their range of success in the diagnosis of acute abdomen in our clinic and the entries in the world literature.

  3. 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

  4. 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

  5. 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.

  6. Interobserver agreement in ultrasound examination of the biliary tract

    DEFF Research Database (Denmark)

    Grantcharov, Teodor P; Rasti, Z; Rossen, B;

    2002-01-01

    radiologist's expertise in the primary diagnosis of uncomplicated gallstone disease was as good as the one provided by the experienced colleague. The significant interobserver difference in the measurements of the thickness of the gallbladder wall and the CBD diameter might indicate that assessment...... of these parameters requires extensive practise and the opinion of an experienced colleague must be sought in cases where complications are suspected....

  7. Endoscopic electrosurgical papillotomy and manometry in biliary tract disease.

    Science.gov (United States)

    Geenen, J E; Hogan, W J; Shaffer, R D; Stewart, E T; Dodds, W J; Arndorfer, R C

    1977-05-01

    Endoscopic papillotomy was performed in 13 patients after cholecystectomy for retained or recurrent common bile duct calculi (11 patients) and a clinical picture suggesting papillary stenosis (two patients). Following endoscopic papillotomy, ten of the 11 patients spontaneously passed common bile duct (CBD) stones verified on repeated endoscopic retrograde cholangiopancreatography (ERCP) study. One patient failed to pass a large CBD calculus; one patient experienced cholangitis three months after in inadequate papillotomy and required operative intervention. Endoscopic papillotomy substantially decreased the pressure gradient existing between the CBD and the duodenum in all five patients studied with ERCP manometry. Endoscopic papillotomy is a relatively safe and effective procedure for postcholecystectomy patients with retained or recurrent CBD stones. The majority of CBD stones will pass spontaneously if the papillotomy is adequate.

  8. Empiric antibiotic choices for community-acquired biliary tract infections

    Directory of Open Access Journals (Sweden)

    Kuo-Kuan Chang

    2014-06-01

    Conclusion: The combination of ceftriaxone plus metronidazole appears to be the most appropriate empiric antibiotics for the treatment of CA-BTI at this hospital. Because different hospitals may encounter microorganisms of different antimicrobial susceptibilities, similar approaches may be followed by other hospitals where appropriate empiric therapy has not yet been established for the treatment of CA-BTI.

  9. 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.

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

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

    .9%) vs 5 (10.6%)]. There was no early mortality in either group. Median survival was 44 mo (95% CI: 34.2-53.8) in the PBD group and 41 mo (95% CI: 27.7-54.3; P = 0.86) in the non-PBD group. CONCLUSION: Biliary drainage before surgery for ampullary cancer significantly reduced postoperative wound infection. Overall mortality was not influenced by preoperative drainage.

  11. Risk of upper aerodigestive tract cancer and type of alcoholic beverage: a European multicenter case-control study.

    LENUS (Irish Health Repository)

    Marron, Manuela

    2012-07-01

    The general relationship between cancers of the upper aerodigestive tract (UADT) and alcohol drinking is established. Nevertheless, it is uncertain whether different types of alcoholic beverages (wine, beer and liquor) carry different UADT cancer risks. Our study included 2,001 UADT cancer cases and 2,125 controls from 14 centres in 10 European countries. All cases were histologically or cytologically confirmed squamous cell carcinomas. Controls were frequency matched by sex, age and centre. Logistic regression models were used to estimate odds ratios (OR) and 95 % confidence intervals (95 %CI) adjusted for age, sex, centre, education level, vegetable and fruit intake, tobacco smoking and alcohol drinking, where appropriate. Risk of beverage-specific alcohol consumption were calculated among \\'pure drinker\\' who consumed one beverage type exclusively, among \\'predominant drinkers\\' who consumed one beverage type to more than 66 % and among \\'mixed drinkers\\' who consumed more than one beverage type to similar proportions. Compared to never drinkers and adjusted for cumulative alcohol consumption, the OR and 95 %CI for wine, beer and liquor drinking, respectively, were 1.24 (0.86, 1.78), 1.54 (1.05, 2.27) and 0.94 (0.53, 1.64) among \\'pure drinkers\\' (p value for heterogeneity across beverage types = 0.306), 1.05 (0.76,1.47), 1.25 (0.87,1.79) and 1.43 (0.95, 2.16) among \\'predominant drinkers\\' (p value = 0.456), and 1.09 (0.79, 1.50), 1.20 (0.88, 1.63) and 1.12 (0.82, 1.53) among \\'mixed drinkers\\' (p value = 0.889). Risk of UADT cancer increased with increasing consumption of all three alcohol beverage types. Our findings underscore the strong and comparable carcinogenic effect of ethanol in wine, beer and liquor on organs of the UADT.

  12. Time to surgery and the risk of cancer progression in patients with gynaecologic cancers of the lower genital tract.

    Science.gov (United States)

    Vair, Brett; Altman, Alon D; Nelson, Gregg

    2015-04-01

    Objectif : Nous ne disposons que de peu de données probantes contemporaines pour définir ce qui constitue un délai approprié avant la tenue d’une chirurgie chez des patientes atteintes d’un cancer. Cette étude avait pour but d’examiner si la prolongation du délai avant la tenue d’une chirurgie donne lieu, chez des patientes qui présentent des cancers de stade précoce affectant les voies génitales inférieures, à un risque d’évolution du cancer.  Méthodes : Nous avons mené une étude de cohorte rétrospective en population générale auprès de femmes qui présentaient un carcinome malpighien de stade I affectant le col utérin, la vulve et le vagin, et qui subissaient un traitement chirurgical à Calgary, en Alberta, entre 2000 et 2010. Le stade du cancer et les caractéristiques de la maladie ont été comparées à deux moments distincts : au cours de la consultation initiale auprès du service de gynéco-oncologie et au moment de la chirurgie.  Résultats : Cent cinquante-six patientes ont répondu aux critères d’admissibilité. Une évolution du stade du cancer a été constatée dans 10 cas (6,4 %). Conformément aux cibles actuelles en matière de temps d’attente, le délai avant la tenue d’une chirurgie a été classé comme étant ≤ 28 jours (59 patientes; 38 %) et > 28 jours (97 patientes; 62 %). Une évolution s’est manifestée dans sept des 123 cas de cancer du col utérin (9 %). Dans chacun de ces sept cas, le délai avant la tenue d’une chirurgie avait été > 28 jours (P = 0,095). Aucun des trois cas de cancer du vagin n’a connu une évolution de la maladie. Une évolution s’est manifestée dans trois (10 %) des 30 cas de cancer de la vulve. Dans deux de ces trois cas, le délai avant la tenue d’une chirurgie avait été > 28 jours (P = 0,586). Pour toutes les femmes de la cohorte, le risque relatif d’évolution de la maladie attribuable à la prolongation du délai avant la tenue

  13. The 12p13.33/RAD52 locus and genetic susceptibility to squamous cell cancers of upper aerodigestive tract.

    Directory of Open Access Journals (Sweden)

    Manon Delahaye-Sourdeix

    Full Text Available Genetic variants located within the 12p13.33/RAD52 locus have been associated with lung squamous cell carcinoma (LUSC. Here, within 5,947 UADT cancers and 7,789 controls from 9 different studies, we found rs10849605, a common intronic variant in RAD52, to be also associated with upper aerodigestive tract (UADT squamous cell carcinoma cases (OR = 1.09, 95% CI: 1.04-1.15, p = 6x10(-4. We additionally identified rs10849605 as a RAD52 cis-eQTL inUADT(p = 1x10(-3 and LUSC (p = 9x10(-4 tumours, with the UADT/LUSC risk allele correlated with increased RAD52 expression levels. The 12p13.33 locus, encompassing rs10849605/RAD52, was identified as a significant somatic focal copy number amplification in UADT(n = 374, q-value = 0.075 and LUSC (n = 464, q-value = 0.007 tumors and correlated with higher RAD52 tumor expression levels (p = 6x10(-48 and p = 3x10(-29 in UADT and LUSC, respectively. In combination, these results implicate increased RAD52 expression in both genetic susceptibility and tumorigenesis of UADT and LUSC tumors.

  14. LIVER AND BILIARY SYSTEM

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    2006243 Sequential hemodynamic changes in pre-cancerous lesions of hepatocellular carcinoma:experimental study with MR perfusion. GUAN Sheng (管生),et al. Dept Radiol ,Zhongshan Hosp ,Fudan Univ , Shanghai 200032. Chin J Radiol 2006;40(40(3):231-234. Objective: To determine the hemodynamic changes in precancerous lesions of HCC using MR perfusion(MRP). Methods: During the period of carcinogenesis (12-20

  15. Comparison between endoscopic brush cytology performed before and after biliary stricture dilation for cancer detection Comparação entre citologia por escovado endoscópico realizada antes e depois da dilatação das estenoses biliares para detecção de câncer

    Directory of Open Access Journals (Sweden)

    Laura Cotta Ornellas

    2006-03-01

    Full Text Available BACKGROUND: Confirmation of malignancy within biliary strictures is endoscopically challenging. Dilation of strictures has been reported to enhance cytological diagnosis. AIM: To compare brush cytology results before and after biliary stricture dilation. PATIENTS AND METHODS: Patients with extra-hepatic biliary stricture at endoscopic retrograde cholangiopancreatography were included in the study. Brushing was performed before and immediately after dilation using a 10 Fr dilating catheter. Cytology samples were classified as: negative for malignancy, presence of atypical cells, insufficient material, suspicious for malignancy or positive for malignancy. Final diagnosis was established by surgery, biopsy or follow-up. RESULTS: Biliary brush cytology was performed in 50 patients, with an overall sensitivity of 40% and 27.5%, before and after dilation, respectively. The combination of results increased cancer detection rate to 45%. There were 5/50 (10% minor complications and one death related to the procedure. CONCLUSIONS: Brush cytology performed before biliary stricture dilation has a similar cancer detection rate to that following dilation, although the combination of results enhances sensitivity.RACIONAL: A citologia por escovado apresenta baixa sensibilidade na detecção de câncer em estenoses biliares, mas manipulação endoscópica prévia poderia aumentar a esfoliação de células tumorais. OBJETIVO: Comparar os resultados dos escovados obtidos antes e depois da dilatação de estenoses biliares. PACIENTES E MÉTODOS: Pacientes com estenose biliar extra-hepática diagnosticada durante colangiopancreatografia endoscópica retrógada foram submetidos a citologia por escovado. Em seguida, a estenose foi dilatada com cateter de 10 French e o escovado foi repetido. A citologia foi classificada como: negativa para malignidade, presença de células atípicas, material insuficiente, suspeita para malignidade ou positiva para malignidade. O

  16. Radiological interventions in malignant biliary obstruction

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

    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 pal iative 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.

  17. 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.

  18. Fatigue in primary biliary cirrhosis

    OpenAIRE

    Cauch-Dudek, K; Abbey, S; Stewart, D; Heathcote, E

    1998-01-01

    Background—Fatigue is a frequent and debilitating symptom in patients with primary biliary cirrhosis (PBC). 
Aims—To study fatigue in relation to sleep, depression, and liver disease severity. 
Methods—Patients with PBC completed validated self report questionnaires measuring fatigue, sleep quality, depression, and functional capacity. Verbally reported fatigue and observer rated measure of depression and ursodeoxycholic acid (UDCA) use were recorded. Liver biochemistry and ...

  19. Migration of a biliary stent causing duodenal perforation and biliary peritonitis.

    Science.gov (United States)

    Issa, Hussain; Nahawi, Mamdouh; Bseiso, Bahaa; Al-Salem, Ahmed

    2013-10-16

    Migration of endoscopically placed biliary stents is a well-recognized complication of endoscopic retrograde cholangiopancreatography. Less than 1% of migrated stents however cause intestinal perforation. We present a case of a migrated biliary stent that resulted in duodenal perforation and biliary peritonitis.

  20. Migration of a biliary stent causing duodenal perforation and biliary peritonitis

    OpenAIRE

    Issa, Hussain; Nahawi, Mamdouh; Bseiso, Bahaa; Al-Salem, Ahmed

    2013-01-01

    Migration of endoscopically placed biliary stents is a well-recognized complication of endoscopic retrograde cholangiopancreatography. Less than 1% of migrated stents however cause intestinal perforation. We present a case of a migrated biliary stent that resulted in duodenal perforation and biliary peritonitis.

  1. A case of biliary gastric fistula following percutaneous radiofrequency thermal ablation of hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Angela Falco; Dante Orlando; Roberto Sciarra; Luciano Sergiacomo

    2007-01-01

    Percutaneous radiofrequency thermal ablation (RFA) is an effective and safe therapeutic modality in the management of liver malignancies, performed with ultrasound guidance. Potential complications of RFA include liver abscess, ascites, pleural effusion, skin burn,hypoxemia, pneumothorax, subcapsular hematoma,hemoperitoneum, liver failure, tumour seeding, biliary lesions. Here we describe for the first time a case of biliary gastric fistula occurred in a 66-year old man with a Child's class A alcoholic liver cirrhosis as a complication of RFA of a large hepatocellular carcinoma lesion in the Ⅲ segment. Tn the light of this case, RFA with injection of saline between the liver and adjacent gastrointestinal tract, as well as laparoscopic RFA, ethanol injection (PET),or other techniques such as chemoembolization, appear to be more indicated than percutaneous RFA for large lesions close to the gastrointestinal tract.

  2. [Biliary lithiasis in patients over 75. 100 cases operated upon (author's transl)].

    Science.gov (United States)

    Moreaux, J; Bonnet, J L; Gerum, A

    1982-02-27

    This is a retrospective study of 100 elderly patients (36 men and 64 women aged 75 years or more) operated upon for biliary tract calculi. Thirty-one patients had one or several underlying visceral diseases and 5 had associated carcinoma of the digestive tract. Calculi of the common bile duct were present in 48 cases, and 41 patients had acute infection, including cholecystitis (14) and cholangitis (27). Surgery included cholecystectomy in every case and opening of the common bile duct in 49 cases with either choledocho-duodenal anastomosis (31 cases) or external biliary drainage (18 cases). Only one patient with gastric carcinoma died. The morbidity rate was low (11 post-operative complications) and each group of patients spent about the same time in hospital. Neither mortality nor morbidity were aggravated by the presence of calculi in the common bile duct and/or acute infection. In uncomplicated lithiasis the surgical indications mainly depend upon the severity of underlying visceral diseases. Early intervention seems desirable in most patients with acute cholecystitis or cholangitis. Surgery of the biliary tract is basically the same in elderly and in young patients, but the operation must be simple and, if possible, complete. The quality of medical surveillance and nursing has considerable influence on the results.

  3. Ursodeoxycholic acid for primary biliary cirrhosis

    DEFF Research Database (Denmark)

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

    2012-01-01

    Ursodeoxycholic acid is administered to patients with primary biliary cirrhosis, a chronic progressive inflammatory autoimmune-mediated liver disease with unknown aetiology. Despite its controversial effects, the U.S. Food and Drug Administration has approved its usage for primary biliary cirrhosis....

  4. Biliary ascariasis: radiological clue to diagnosis

    OpenAIRE

    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.

  5. Biliary Dyskinesia in Children: A Systematic Review.

    Science.gov (United States)

    Santucci, Neha R; Hyman, Paul E; Harmon, Carroll M; Schiavo, Julie H; Hussain, Sunny Z

    2017-02-01

    Cholecystectomy rates for biliary dyskinesia in children are rising in the United States, but not in other countries. Biliary dyskinesia is a validated functional gallbladder disorder in adults, requiring biliary colic in the diagnosis. In contrast, most studies in children require upper abdominal pain, absent gallstones on ultrasound, and an abnormal gallbladder ejection fraction (GBEF) on cholecystokinin-stimulated cholescintigraphy for diagnosis. We aimed to systematically review existing literature in biliary dyskinesia in children, determine the validity and reliability of diagnostic criteria, GBEF, and to assess outcomes following cholecystectomy. We performed a systematic review following the PRISMA checklist and searched 7 databases including PubMed, Scopus, Embase, Ovid, MEDLINE, ProQuest, Web of Science, and the Cochrane library. Bibliographies of articles were screened for additional studies. Our search terms yielded 916 articles of which 28 were included. Three articles were manually added from searched references. We reviewed 31 peer-reviewed publications, all retrospective chart reviews. There was heterogeneity in diagnostic criteria and GBEF values. Outcomes after laparoscopic cholecystectomy varied from 34% to 100% success, and there was no consensus concerning factors influencing outcomes. The observational, retrospective study designs that comprised our review limited interpretation of safety and efficacy of the investigations and treatment in biliary dyskinesia in children. Symptoms of biliary dyskinesia overlapped with functional dyspepsia. There is a need for consensus on symptoms defining biliary dyskinesia, validation of testing required for diagnosis of biliary dyskinesia, and randomized controlled trials comparing medical versus surgical management in children with upper abdominal pain.

  6. IMPROVING THE DIAGNOSIS AND TREATMENT OF RETENTION DISORDERS OF THE UPPER URINARY TRACT IN PATIENTS WITH STAGES IIB–III CANCER OF THE CERVIX UTERI

    Directory of Open Access Journals (Sweden)

    A. D. Kaprin

    2014-08-01

    Full Text Available Study investigates the prevalence, diagnosis and treatment in patients with retention disorders upper urinary tract cervical cancer stage IIB III after more than 3 months after combined radiotherapy. In the apartment complex to the diagnosis of renal ultrasound and radioisotope study of renal excretory function added to the study ureteral emissions by color Doppler sonography. Information on ureteral emissions revealed a violation of the early passage of urine in 23.1 % of patients with renal ultrasound revealed no pathology. On the basis of violations ureteral emissions increase in the number of patients, respectively, are assigned to nonoperative treatment (anti-inflammatory, spasmolytic therapy. As a result, decreased by 14.2 % (p = 0.034, female patients, which showed drainage of the upper urinary tract.

  7. IMPROVING THE DIAGNOSIS AND TREATMENT OF RETENTION DISORDERS OF THE UPPER URINARY TRACT IN PATIENTS WITH STAGES IIB–III CANCER OF THE CERVIX UTERI

    Directory of Open Access Journals (Sweden)

    A. D. Kaprin

    2012-01-01

    Full Text Available Study investigates the prevalence, diagnosis and treatment in patients with retention disorders upper urinary tract cervical cancer stage IIB III after more than 3 months after combined radiotherapy. In the apartment complex to the diagnosis of renal ultrasound and radioisotope study of renal excretory function added to the study ureteral emissions by color Doppler sonography. Information on ureteral emissions revealed a violation of the early passage of urine in 23.1 % of patients with renal ultrasound revealed no pathology. On the basis of violations ureteral emissions increase in the number of patients, respectively, are assigned to nonoperative treatment (anti-inflammatory, spasmolytic therapy. As a result, decreased by 14.2 % (p = 0.034, female patients, which showed drainage of the upper urinary tract.

  8. Biliary acute pancreatitis: a review

    Institute of Scientific and Technical Information of China (English)

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

    2000-01-01

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

  9. The association between change in body mass index and upper aerodigestive tract cancers in the ARCAGE project: multicenter case-control study.

    LENUS (Irish Health Repository)

    Park, Sungshim Lani

    2011-03-15

    Previous studies reported an inverse relationship between body mass index (BMI) and upper aerodigestive tract (UADT) cancers. Examining change in BMI over time may clarify these previous observations. We used data from 2,048 cases and 2,173 hospital- and population-based controls from ten European countries (alcohol-related cancers and genetic susceptibility in Europe study) to investigate the relationship with BMI and adult change in BMI on UADT cancer risk. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for associations between BMI at three time intervals and BMI change on UADT cancer development, adjusting for center, age, sex, education, fruit and vegetable intake, smoking and alcohol consumption. We found an inverse relationship between UADT cancers and BMI at time of interview and 2 years before interview. No association was found with BMI at 30 years of age. Regarding BMI change between age 30 and 2 years before interview, BMI decrease (BMI change <-5%) vs. BMI stability (-5% ≤ BMI change <5%) showed no overall association with UADT cancers (OR = 1.15; 95% CI = 0.89, 1.49). An increase in BMI (BMI change ≥+5%) was inversely associated with UADT cancers (OR = 0.74; 95% CI = 0.62, 0.89). BMI gain remained inversely associated across all subsites except for esophageal cancer. When stratified by smoking or by drinking, association with BMI gain was detected only in drinkers and smokers. In conclusion, BMI gain is inversely associated with UADT cancers. These findings may be influenced by smoking and\\/or drinking behaviors and\\/or the development of preclinical UADT cancers and should be corroborated in studies of a prospective nature.

  10. Accomplishments in 2007 in the Management of Hepatobiliary Cancers

    Science.gov (United States)

    Chan, Anthony T.C.; Kishi, Yoji; Chan, Stephen L.

    2008-01-01

    SUMMARY Hepatocellular CarcinomaOverview of the Disease IncidencePrognostic or Predictive FactorsCurrent Therapy Standards SurgeryLocoablative TreatmentSystemic TreatmentAccomplishments and Lack of Accomplishments TherapyMilan Criteria to Select Patients for Liver TransplantBiologic AgentsBiomarkersBasic ScienceWhat Needs To Be DoneFuture Directions Comments on ResearchObstacles to Progress Biliary Tract CancerOverview of the Disease IncidencePrognostic or Predictive FactorsCurrent Therapy StandardsAccomplishments and Lack of Accomplishments TherapyBiomarkersWhat Needs To Be DoneFuture Directions PMID:19352465

  11. [Multi-modarity treatment for colon liver metastases using biliary stent-report of a case].

    Science.gov (United States)

    Hasegawa, Hirofumi; Kudo, Kensuke; Kitagawa, Dai; Nakamura, Toshihiko; Shohji, Fumihiro; Kabashima, Akira; Teramoto, Seiichi; Funahashi, Wataru; Kitamura, Masayuki

    2013-11-01

    We report the case of a 69-year-old male patient with diagnoses of sigmoid colon cancer, ascending colon cancer, and metastatic liver cancer. We performed sigmoidectomy, right hemicolectomy, and central venous port placement. Because the liver metastasis was multifocal, chemotherapy was first initiated and then hepatic resection was performed. However, during chemotherapy, ileus, with a peritoneal dissemination to the small intestine, developed. Small intestine resection and radiation therapy to the pelvic region of the transition were further performed. Thereafter, obstructive jaundice due to obstruction of the bile duct in the hilar area developed, and therefore, we inserted a biliary stent. However, 2 years 9 months after the first medical examination, this patient died of colon cancer. The guidelines above, still chemotherapy developed, treatment policy of recurrent colorectal cancer, have recommended surgical resection with respect to what resectable as local therapy. This case shows that combination therapy with chemotherapy, surgical therapy, radiation therapy, and local therapy such as biliary stenting, is useful.

  12. Imaging findings of biliary hamartomas

    Institute of Scientific and Technical Information of China (English)

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

    2005-01-01

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

  13. Deleted in Malignant Brain Tumors 1 is a versatile mucin-like molecule likely to play a differential role in digestive tract cancer

    DEFF Research Database (Denmark)

    Mollenhauer, J; Herbertz, S; Helmke, B

    2001-01-01

    Deleted in Malignant Brain Tumors 1 (DMBT1) has been proposed as a candidate tumor suppressor gene for brain, lung, and digestive tract cancer. In particular, alterations of the gene and/or a loss of expression have been observed in gastric, colorectal, and esophageal carcinomas. Initial evidence...... a role in mucosal protection. The esophagus is the only tissue displaying an additional smaller transcript of approximately 5 kb. The stratified squamous epithelium of the esophagus is the only epithelium showing a constitutive targeting of DMBT1 to the extracellular matrix (ECM) suggestive of a role...

  14. Treating Biliary System Postoperational Complications by Syndrome Differentiation Using Traditional Chinese Medicine

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ The operation of the biliary system is usually employed for liver,gallbladder or pancreatic diseases.Most benign cases are cholelithiasisinduced cholecystitis and choledochitis,while malignant ones mainly include gallbladder cancers,cholangiocarcinoma or carcinoma of the head of the pancreas.

  15. Real-time ultrasonographic findings of biliary ascariasis

    Energy Technology Data Exchange (ETDEWEB)

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

    1983-06-15

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

  16. 宫颈癌患者术后尿路感染的因素分析%Influencing factors for postoperative urinary tract infections in cervical cancer patients

    Institute of Scientific and Technical Information of China (English)

    闻强; 邵株燕; 王华

    2014-01-01

    OBJECTIVE To explore the influencing factors for urinary tract infections in the cervical cancer patients undergoing radical hysterectomy and pelvic lymphadenectomy so as to provide guidance for the clinical treatment . METHODS A total of 168 cervical cancer patients who underwent the radical hysterectomy and pelvic lymphade‐nectomy in the hospital from Jan 2011 to Jan 2014 were enrolled in the study and divided into the infection group with 35 cases and the non‐infection group with 133 cases ;the clinical data were collected from all the patients and statistically analyzed by using SPSS17 .0 software .RESULTS The urinary tract infections occurred in 35 cervical cancer patients undergoing the radical hysterectomy and pelvic lymphadenectomy , with the infection rate of 20 .8% .The univariate analysis indicated that the influencing factors for the urinary tract infections included the wide resection scope ,history of urinary tract infections or urethral dysfunction ,history of diabetic mellitus ,long‐term catheter indwelling ,no less than 60 years of age ,and long operation duration ,there was statistically signifi‐cant difference (P<0 .05) .CONCLUSION There are a variety of influencing factors for the postoperative urinary tract infections in the cervical cancer patients undergoing the radical hysterectomy and pelvic lymphadenectomy .It is necessary to take corresponding intervention measures in response to the influencing factors so as to reduce the risk of postoperative urinary tract infections in the cervical cancer patients .%目的:探讨影响宫颈癌行广泛性子宫切除及盆腔淋巴结清扫术后发生尿路感染的因素,为临床治疗提供参考依据。方法收集2011年1月-2014年1月在医院因宫颈癌行广泛性子宫切除及盆腔淋巴结清扫术患者168例,分为感染组35例,未感染组133例;收集所有患者的临床资料,采用SPSS17.0软件进行统计分析。结果35例宫颈癌行广泛子宫切

  17. Management of biliary perforation in children

    Directory of Open Access Journals (Sweden)

    Mirza Bilal

    2010-01-01

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

  18. Heterogeneity of the intrahepatic biliary epithelium

    Institute of Scientific and Technical Information of China (English)

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

    2006-01-01

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

  19. Immunological Blood Parameters in Infected and Noninfected Biliary Peritonitis

    OpenAIRE

    Bilookiy, O. V.; Rohovyy, Yu. Ye.; Bilookiy, V. V.

    2015-01-01

    This work deals with the study of immunological blood parameters in infected and noninfected biliary peritonitis. Materials and methods. 55 patients with infected and noninfected biliary peritonitis were examined. There were 21 men and 34 women at the age of 28-74 years. 14 patients suffered from noninfected biliary peritonitis, 41 patients suffered from infected biliary peritonitis. The control group included 12 practically healthy persons. Results. The development of noninfected biliary per...

  20. Endoscopic palliation of malignant biliary stricture

    Institute of Scientific and Technical Information of China (English)

    Sanjay M Salgado; Monica Gaidhane; Michel Kahaleh

    2016-01-01

    Malignant biliary strictures often present late after the window for curative resection has elapsed. In such patients, the goal of therapy is typically focused on palliation. While historically, palliative measures were performed surgically, the advent of endoscopic intervention offers minimally invasive options to provide relief of symptoms, improve quality of life, and in some cases, increase survival of these patients. Some of these therapies, such as endoscopic biliary decompression, have become mainstays of treatment for decades, whereas newer modalities, including radiofrequency ablation, and photodynamic therapy offer additional options for patients with incurable biliary malignancies.

  1. Tumour markers in gastrointestinal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lamerz, R.

    1988-02-01

    For non-endocrine gastrointestinal tumours the following tumour markers are of clinical interest: For esophageal cancer CEA (sensitivity, s: 40-60%) and SCC (squamous cell carcinoma antigen, x: 20-50%); for gastric cancer CEA (s: 30-40%) as well as CA 19-9 (s: 30-40%) because of complementary results (additive s: 50-60); for hepatocellular cancer AFP (first choice, s: 70-90%; second choice CA 19-9, s: 50-70%); for cholangiocellular cancer CA 19-9 (s: 40-70%); for secondary liver cancer in general CEA; for biliary tract cancer CA 19-9 (s: 40-70%) as well as for excretory pancreatic cancer (s: 70-90%); for colorectal cancer CEA (s: 40-70%) as a first choice marker, and CA 19-9 (s: 20-60%) as a second choice marker, and for anal cancer SCC. The frequency of tumour marker determinations depends on follow-up care recommendations for different tumour diseases (e.g. 1-3 monthly during the 1st and 2nd postoperative year, following chemotherapy courses, on change of therapy, on restaging and at unclear alteration of the clinical state). Tumour markers are only valuable adjuncts to the medical care of tumour patients and therefore useless as solitary findings or on missing therapeutic consequence.

  2. Laparoscopic treatment of biliary peritonitis following nonoperative management of blunt liver trauma

    Directory of Open Access Journals (Sweden)

    Bachellier Philippe

    2010-09-01

    Full Text Available Abstract Introduction Nonoperative management (NOM of hemodynamically stable patients with blunt hepatic injuries is considered the current standard of care. However, it is associated with several in-hospital complications. In selected cases laparoscopy could be proposed as diagnostic and therapeutic means. Case report A 28 years-old male was admitted in the Emergency Unit following a motor vehicle crash. CT-scan showed an isolated stade II hepatic injury at the level of the segment IV. Firstly a NOM was decided. Laparoscopic exploration was then performed at day 4 due to a biliary peritonitis. Intraoperative trans-cystic duct cholangiography showed a biliary leaks of left hepatic biliary tract, involving sectioral pedicle to segment III. Cholecystectomy, trans-cystic biliary drainage, application of surgical tissue sealing patch and abdominal drainage were performed. Postoperative outcome was uneventful, with fast patient recovery. Conclusion Laparoscopy has gained a role as diagnostic and therapeutic means in treatment of complications following NOM of blunt liver trauma. This approach seems feasible and safety, with satisfactory postoperative outcome.

  3. 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.

  4. One Health and cancer: A comparative study of human and canine cancers in Nairobi

    Directory of Open Access Journals (Sweden)

    Nyariaro Kelvin Momanyi

    2016-11-01

    Full Text Available Aim: Recent trends in comparative animal and human research inform us that collaborative research plays a key role in deciphering and solving cancer challenges. Globally, cancer is a devastating diagnosis with an increasing burden in both humans and dogs and ranks as the number three killer among humans in Kenya. This study aimed to provide comparative information on cancers affecting humans and dogs in Nairobi, Kenya. Materials and Methods: Dog data collection was by cancer case finding from five veterinary clinics and two diagnostic laboratories, whereas the human dataset was from the Nairobi Cancer Registry covering the period 2002-2012. The analysis was achieved using IBM SPSS Statistics® v.20 (Dog data and CanReg5 (human data. The human population was estimated from the Kenya National Census, whereas the dog population was estimated from the human using a human:dog ratio of 4.1:1. Results: A total of 15,558 human and 367 dog cancer cases were identified. In humans, females had higher cancer cases 8993 (an age-standardized rate of 179.3 per 100,000 compared to 6565 in males (122.1 per 100,000. This order was reversed in dogs where males had higher cases 198 (14.9 per 100,000 compared to 169 (17.5 per 100,000 in females. The incident cancer cases increased over the 11-year study period in both species. Common cancers affecting both humans and dogs were: Prostate (30.4, 0.8, the respiratory tract (8.3, 1.3, lymphoma (5.6, 1.4, and liver and biliary tract (6.3, 0.5, whereas, in females, they were: Breast (44.5, 3.6, lip, oral cavity, and pharynx (8.8, 0.6, liver and biliary tract (6.5, 1.2, and lymphoma (6.0, 0.6, respectively, per 100,000. Conclusion: The commonality of some of the cancers in both humans and dogs fortifies that it may be possible to use dogs as models and sentinels in studying human cancers in Kenya and Africa. We further infer that developing joint animalhuman cancer registries and integrated cancer surveillance systems may

  5. UPDATE ON PRIMARY BILIARY CIRRHOSIS

    Science.gov (United States)

    Invernizzi, Pietro; Selmi, Carlo; Gershwin, M. Eric

    2010-01-01

    Primary biliary cirrhosis (PBC) is an autoimmune chronic liver disease characterized by progressive bile duct destruction eventually leading to cirrhosis, liver failure, and death. The autoimmune pathogenesis is supported by a plethora of experimental and clinical data, such as the presence of autoreactive T cells and serum autoantibodies. The etiology remains unknown, although evidence suggests a role for both genetic susceptibility and environmental factors that remain to be determined. In fact, a number of chemicals and infectious agents have been proposed to induce the disease in predisposed individuals. The recent availability of several murine models will significantly help in understanding pathphysiology mechanisms. In this review, we critically summarize the most recent data on the etiopathogenesis of PBC, discuss the latest theories and developments, and suggest directions for future research. PMID:20359968

  6. Primary Biliary Cirrhosis: Family Stories

    Directory of Open Access Journals (Sweden)

    Daniel Smyk

    2011-01-01

    Full Text Available Primary biliary cirrhosis (PBC is a chronic immune-mediated cholestatic liver disease of unknown aetiology which affects mostly women in middle age. Familial PBC is when PBC affects more than one member of the same family, and data suggest that first-degree relatives of PBC patients have an increased risk of developing the disease. Most often, these familial clusters involve mother-daughter pairs, which is consistent with the female preponderance of the disease. These clusters provide evidence towards a genetic basis underlying PBC. However, clusters of nonrelated individuals have also been reported, giving strength to an environmental component. Twin studies have demonstrated a high concordance for PBC in monozygotic twins and a low concordance among dizygotic twins. In conclusion, studies of PBC in families clearly demonstrate that genetic, epigenetic, and environmental factors play a role in the development of the disease.

  7. Etiopathogenesis of primary biliary cirrhosis

    Institute of Scientific and Technical Information of China (English)

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

    2008-01-01

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

  8. 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...

  9. Computed tomography and obstructive biliary disease.

    Science.gov (United States)

    Havrilla, T R; Haaga, J R; Alfidi, R J; Reich, N E

    1977-05-01

    Forty-four patients with confirmed biliary diseases were studied to determine the value of computed tomography (CT) in the diagnosis of biliary pathology. The results indicate that CT is useful and highly accurate in differentiating between obstructive (surgical) and nonobstructive (medical) disease entities. Of the cases with proved obstruction, 88% were correctly identified. All of the nonobstructive cases had positive CT correlation. In addition, the underlying cause of the occlusion was determined in the majority of cases.

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

    Science.gov (United States)

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

    2001-08-01

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

  11. 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.

  12. Rare presentation of biliary ascariasis.

    Science.gov (United States)

    Rather, Ajaz; Salati, Sajad Ahmad

    2010-09-01

    Ascariasis is the most common helminthic infection in the world. We present a very rare manifestation of ascariasis in which the worms came out through the T-tube tract of a 36 years old patient who had undergone cholecystectomy with choledocholithotomy.

  13. The joint effects of census tract poverty and geographic access on late-stage breast cancer diagnosis in 10 US States.

    Science.gov (United States)

    Henry, Kevin A; Sherman, Recinda; Farber, Steve; Cockburn, Myles; Goldberg, Daniel W; Stroup, Antoinette M

    2013-05-01

    This study evaluated independent and joint effects of census tract (CT) poverty and geographic access to mammography on stage at diagnosis for breast cancer. The study included 161,619 women 40+ years old diagnosed with breast cancer between 2004 -2006 in ten participating US states. Multilevel logistic regression was used to estimate the odds of late-stage breast cancer diagnosis for the entire study population and by state. Poverty was independently associated with late-stage in the overall population (poverty rates >20% OR=1.30, 95% CI=1.26- 1.35) and for 9 of the 10 states. Geographic access was not associated with late-stage diagnosis after adjusting for CT poverty. State-specific analysis provided little evidence that geographic access was associated with breast cancer stage at diagnosis, and after adjusting for poverty, geographic access mattered in only 1 state. Overall, compared to women with private insurance, the adjusted odds ratios for late stage at diagnosis among women with either no insurance, Medicaid, or Medicare were 1.80 (95% CI = 1.65, 1.96), 1.75 (95% CI = 1.68, 1.84), and 1.05 (95% CI 1.01, 1.08), respectively. Although geographic access to mammography was not a significant predictor of late-stage breast cancer diagnosis, women in high poverty areas or uninsured are at greatest risk of being diagnosed with late-stage breast cancer regardless of geographic location and may benefit from targeted interventions.

  14. Carcinoma In Situ Is Significantly Underdetected by Prenephroureterectomy Ureteroscopy in the Management of Upper Tract Urothelial Cancers

    Directory of Open Access Journals (Sweden)

    Angela Gillan

    2015-01-01

    Full Text Available Objective. Diagnostic reliability of prenephroureterectomy ureteroscopy (PNU for the detection of upper tract carcinoma in situ (CIS remains unproven in particular and underreported in general. Methods. Patients who underwent radical nephroureterectomy (RNU in a large multicentre retrospective study for upper tract transitional cell carcinoma (UT-TCC between January 2002 and December 2013 were identified from our hospitals databases. PNU appearances, stage, and grade of ureteroscopic biopsy were compared with final histology results of RNU to assess the diagnostic reliability of PNU for carcinoma in situ (CIS. Results. Three hundred patients underwent RNU for UT-TCC. 106 (106/300; 35.3% of the cohort had PNU using white light with biopsies taken in most (92/106; 86.7%. Postnephroureterectomy histology of the cohort showed CIS in 65 (65/300; 21.6% patients. Thirty nine of patients with CIS (39/65; 60% had prenephroureterectomy ureteroscopy biopsies. Out of ten patients with CIS on ureteroscopic biopsies, six did not show CIS on final histopathology (6/10; 60%. Moreover, grading and staging on PNU biopsies of obvious tumours showed a significant nonconcordance with final histopathology of RNU specimen (P=0.02. Overall survival was also shorter in patients with CIS compared with those without; this showed strong statistical significance (P=0.004. Conclusions. There is a high incidence of CIS in upper tract with significant underdetection and discordance rate between the histopathology of biopsy samples obtained by white light PNU and resected specimen of radical nephroureterectomy. The presence of concomitant CIS and high stage disease in the upper tract TCC carried a poor prognosis following radical nephroureterectomy.

  15. HPV及生殖道其他病原体感染与宫颈癌临床关系的研究进展%Research Progress of the Correlation between HPV and Other Genital Tract Infections and Cervical Cancer

    Institute of Scientific and Technical Information of China (English)

    文彩荷

    2012-01-01

    宫颈癌是妇女中常见的恶性肿瘤,生殖道的病原体感染与宫颈癌的发生、发展密切相关.高危型人乳头状瘤病毒的持续感染成为宫颈癌发生的最危险因素,合并感染的病原体在宫颈癌发病过程中起协同作用.因生殖道感染不断增多,宫颈癌及癌前病变的发生率也在不断升高.需加强对生殖道常见病原菌的检测及生殖道感染的预防,从而减少宫颈癌的发生.%Cervical cancer is a common malignant neoplasm in women. The development of cervical cancer is closely related to genital infections. High-risk human papillomavirus infection is the most dangerous factor for cervical cancer, and the other co-infections play a synergistic role in the pathogenesis of cervical cancer. Due to the continuousy increasing genital tract infections,incidence rates of cervical cancer and pre-cancerous lesion have increased too. The detection of common genital tract pathogens and precaution of genital tract infections are needed to be enhanced to reduce the incidence of cervical cancer.

  16. Timing of cholecystectomy after mild biliary pancreatitis: a systematic review.

    NARCIS (Netherlands)

    Baal, M.C.P.M. van; Besselink, M.G.; Bakker, O.J.; Santvoort, H.C. van; Schaapherder, A.F.; Nieuwenhuijs, V.B.; Gooszen, H.G.; Ramshorst, B. van; Boerma, D.

    2012-01-01

    OBJECTIVES: To determine the risk of recurrent biliary events in the period after mild biliary pancreatitis but before interval cholecystectomy and to determine the safety of cholecystectomy during the index admission. BACKGROUND: Although current guidelines recommend performing cholecystectomy earl

  17. Biliary cholesterol secretion : More than a simple ABC

    NARCIS (Netherlands)

    Dikkers, Arne; Tietge, Uwe J. F.

    2010-01-01

    Biliary cholesterol secretion is a process important for 2 major disease complexes, atherosclerotic cardiovascular disease and cholesterol gallstone disease With respect to cardiovascular disease, biliary cholesterol secretion is regarded as the final step for the elimination of cholesterol originat

  18. Hepatobiliary Tract and Pancreatic Disorders in Celiac Disease

    Directory of Open Access Journals (Sweden)

    Hugh J Freeman

    1997-01-01

    Full Text Available A number of hepatobiliary tract and pancreatic disorders have been documented in patients with celiac disease. Some disorders have shared immunological or genetic factors, including chronic hepatitis, primary biliary cirrhosis and sclerosing cholangitis. Other hepatic or pancreatic pathological changes in celiac disease have been documented with severe malnutrition and malabsorption, including hepatic steatosis and pancreatic insufficiency, sometimes with pancreatic calcification. Finally, celiac disease may be associated with other very rare hepatic complications, such as hepatic T cell lymphoma.

  19. CLINICAL USE OF COMBINED DETECTION WITH TUMOR MARKERS FOR PANCREATIC CANCER

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective To explore the value of clinical use of combined detection with tumor markers for pancreatic cancer. Methods Tumor markers CA242,CA19-9 and CA50 in serum of 32 patinets with pancreatic cancer;26 patients with non-pancreatic digestive tract cancers and 24 patietns with benign pancreatic or biliary tract diseases were measured by immunoradiometric assay (IRMA). Results The levels of three markers in serum and positive rates of patients with pancreatic cancer were higher than those of other patients. The effect of measurement combining CA242 with CA19-9 was the best. The sensitivity ,specificity and accuracy of diagnosis for pancreatic cancer were 92.6%, 73.8% and 81.2% respectively. The levels of CA242 and CA19-9 were positively relative to burden of pancreatic cancer, and serum levels of these two markers of patients with resectable pancreatic cancer were lower than those with unresectable, but on difference was observed for CA50. Conclusion Combined detection of serum CA242 and CA19-9 could prove the effectual indicator for finding the patients with pancreatic cancer in high risk population or for resectable pancreatic cancer. Pre-operative measurement of serum levels of CA242 and CA19-9 is helpful to evaluate the burden of the tumors and possiblity of resect for pancreatic cancers.

  20. Cancer-testis antigen expression in digestive tract carcinomas: frequent expression in esophageal squamous cell carcinoma and its precursor lesions.

    Science.gov (United States)

    Chen, Yao-Tseng; Panarelli, Nicole C; Piotti, Kathryn C; Yantiss, Rhonda K

    2014-05-01

    Cancer-testis (CT) antigens are attractive tumor antigens for cancer immunotherapy. They comprise a group of proteins normally expressed in germ cells and aberrantly activated in a variety of human cancers. The protein expression of eight cancer-testis antigens [MAGEA, NY-ESO-1, GAGE, MAGEC1 (CT7), MAGEC2 (CT10), CT45, SAGE1, and NXF2] was evaluated by immunohistochemistry in 61 esophageal carcinomas (40 adenocarcinoma and 21 squamous cell carcinoma), 50 gastric carcinomas (34 diffuse and 16 intestinal type), and 141 colorectal carcinomas. The highest frequency of expression was found in esophageal squamous cell carcinomas: Positive staining for MAGEA, CT45, CT7, SAGE1, GAGE, NXF2, NY-ESO-1, and CT10 was observed in 57%, 38%, 33%, 33%, 29%, 29%, 19%, and 14% of squamous cell carcinomas, respectively. Similar staining patterns were observed in squamous dysplasias. Expression frequencies of cancer-testis antigens were seen in 2% to 24% of gastroesophageal adenocarcinomas and were not significantly different between adenocarcinomas of the stomach versus the esophagus, or between diffuse and intestinal types of gastric adenocarcinomas. Colorectal cancers did not express NY-ESO-1, CT7, CT10, or GAGE, and only infrequently expressed SAGE1 (0.7%) MAGEA (1.4%), CT45 (3.5%), and NXF2 (8.5%). We conclude that cancer-testis antigens are frequently expressed in esophageal squamous neoplasms. Although cancer-testis antigens are generally considered to be expressed later in tumor progression, they are found in squamous dysplasias, suggesting a potential diagnostic role for cancer-testis antigens in the evaluation of premalignant squamous lesions.

  1. Local involvement of the lower urinary tract in primary colorectal cancer - outcome after en-bloc resection

    DEFF Research Database (Denmark)

    Hartwig, Morten Frederik Schlaikjær; Bulut, Orhan; Thind, Peter;

    2016-01-01

    UNLABELLED: Invasion of urinary organs due to advanced colorectal cancer can comprise a surgical challenge in achieving negative resection margins. The aim of the study was to asses the outcome of patients with colorectal cancer invading the lower urinary organs. MATERIAL AND METHODS: This is a c......-year survival rate in the radical resection group was 74%. CONCLUSIONS: En-bloc resection of colorectal cancer with adjacent urological organs has a high morbidity rate. However it is still possible to achieve negative resection margins in most cases....

  2. Role of cyclooxygenase-2 in the carcinogenesis of gastrointestinal tract cancers: A review and report of personal experience

    Institute of Scientific and Technical Information of China (English)

    Takashi Fujimura; Tetsuo Ohta; Katsunobu Oyama; Tomoharu Miyashita; Koichi Miwa

    2006-01-01

    Selective cyclooxygenase (COX)-2 inhibitors (coxibs)were developed as one of the anti-inflammatory drugs to avoid the various side effects of non-steroidal anti-inflammatory drugs (NSAIDs). However, coxibs also have an ability to inhibit tumor development of various kinds the same way that NSAIDs do. Many experimental studies using cell lines and animal models demonstrated an ability to prevent tumor proliferation of COX-2 inhibitors. After performing a randomized study for polyp chemoprevention study in patients with familial adenomatous polyposis (FAP),which showed that the treatment with celecoxib,one of the coxibs, significantly reduced the number of colorectal polyps in 2000, the U.S. Food and Drug Administration (FDA) immediately approved the clinicai use of celecoxib for FAP patients. However, some coxibs were recently reported to increase the risk of serious cardiovascular events including heart attack and stroke. In this article we review a role of COX-2in carcinogenesis of gastrointestinal tract, such as the esophagus, stomach and colorectum, and also analyze the prospect of coxibs for chemoprevention of gastrointestinal tract tumors.

  3. Contemporary Management of Acute Biliary Pancreatitis

    Directory of Open Access Journals (Sweden)

    Orhan Ozkan

    2014-03-01

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

  4. Current endoscopic approach to indeterminate biliary strictures

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

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

  5. Obstructive jaundice induced by biliary ascariasis.

    Science.gov (United States)

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

    2012-12-13

    Ascaris lumbricoides is one of the most prevalent parasitic infections, especially in developing countries. Its presence can lead to a multitude of presentations, one of the rarer ones being obstructive jaundice due to migration of the worm in to the biliary tree. We describe a case of a man who presented as an emergency to the general surgeons complaining of abdominal pain, fever, jaundice and vomiting. Ultrasound was used and the diagnosis of biliary ascariasis was made. The patient underwent surgery consisting of a cholecystectomy, common bile duct exploration and T-tube choledochostomy. Our report highlights the varied aetiology of obstructive jaundice and the importance of including biliary ascariasis in the differential diagnosis of the jaundiced patient, especially from endemic areas.

  6. Successful surgical management of an extrahepatic biliary cystadenocarcinoma

    Directory of Open Access Journals (Sweden)

    Márcio Lobo Guimarães

    2011-10-01

    Full Text Available Extrahepatic bile duct cancer is an uncommon disease, and few cases are curable by surgery. We report a case of extrahepatic biliary cystadenocarcinoma (BCAC associated with atrophy of the left hepatic lobe. A 54-year old male was admitted with painless obstructive jaundice and a hepatic palpable mass noticed one month before presentation. Liver functions tests were consistent with cholestatic damage and serum carbohydrate antigen 19.9 (CA 19-9 was increased before treatment. Magnetic resonance imaging (MRI disclosed dilatation of the left hepatic bile duct with irregular wall thickening close to the hepatic confluence, and atrophy of left hepatic lobe. The patient was submitted to en bloc extended left hepatectomy with resection of caudate lobe, hilar lymphadenectomy, and suprapancreatic biliary tree resection. All surgical margins were grossly negative, and postoperative course was uneventful, except for a minor bile leak. The patient was discharged on the 15th postoperative day; he is alive without tumor recurrence one year after primary therapy. Although technically challenging, extended en bloc resection is feasible in adults with extrahepatic BCAC and can improve survival with acceptable and manageable morbidity.

  7. Fruit, vegetable, and fiber intake in relation to cancer risk: findings from the European Prospective Investigation into Cancer and Nutrition (EPIC).

    Science.gov (United States)

    Bradbury, Kathryn E; Appleby, Paul N; Key, Timothy J

    2014-07-01

    Fruit, vegetables, and certain components of plant foods, such as fiber, have long been thought to protect against cancer. The European Prospective Investigation into Cancer and Nutrition (EPIC) is a prospective cohort that includes >500,000 participants from 10 European countries and has made a substantial contribution to knowledge in this research area. The purpose of this article is to summarize the findings published thus far from the EPIC study on the associations between fruit, vegetable, or fiber consumption and the risk of cancer at 14 different sites. The risk of cancers of the upper gastrointestinal tract was inversely associated with fruit intake but was not associated with vegetable intake. The risk of colorectal cancer was inversely associated with intakes of total fruit and vegetables and total fiber, and the risk of liver cancer was also inversely associated with the intake of total fiber. The risk of cancer of the lung was inversely associated with fruit intake but was not associated with vegetable intake; this association with fruit intake was restricted to smokers and might be influenced by residual confounding due to smoking. There was a borderline inverse association of fiber intake with breast cancer risk. For the other 9 cancer sites studied (stomach, biliary tract, pancreas, cervix, endometrium, prostate, kidney, bladder, and lymphoma) there were no reported significant associations of risk with intakes of total fruit, vegetables, or fiber.

  8. [Prevalence and risk factors of gastroduodenal and biliary system diseases in infants and preschool children].

    Science.gov (United States)

    Malanicheva, T G; Ziatdinova, N V; Denisova, S N

    2012-01-01

    Gastroduodenal pathology, functional disorders and inflammatory diseases of the biliary tract take leading position among the diseases of the digestive system in children. Precisely these clinical forms are more intensive then other nosology. Continuous screening questionnaire of 786 children aged 1.5 to 7 years was carried out to study the prevalence and risk factors for diseases of the digestive system in children. Based on retrieved data was determined that 47,1 +/- 3,5% of children had symptoms of gastro-intestinal tract and biliary system diseases. They met 2.3 times more often in children aged 4 to 7 years, than in children from 1.5 to 3 years old. Immerced examination revealed that the incidence of dyskinesia of the biliary tract was 33 +/- 3,3%, chronic gastritis (CG) and gastroduodenitis (GDD)--6,2 +/- 1,8%, chronic cholecystitis--4,2 +/- 1,4%, functional disorders of the stomach (FGD)--2,8 +/- 1,2% and duodenal ulcer (DU)--0,3 +/- 0,4% of cases. In the structure of digestive diseases in children from 1.5 to 7 years in the first place were DBT--70%, the second--CGD and CG--14.7%--the third chronic cholecystitis--8.9%, the fourth--FGD--5.9% and in fifth place--DU-0.5% of cases. At the care record in the pediatric clinic with diseases of the digestive system were registered only 7,9 +/- 1,9% of children, which is 5.9 times lower accordinig to data of active diagnostic. The leading medical and social risk factors and their complex influence on the formation of digestive diseases in infants and preschool children.

  9. Update on Primary Biliary Cirrhosis

    Directory of Open Access Journals (Sweden)

    Jenny Heathcote

    2000-01-01

    Full Text Available The diagnosis of primary biliary cirrhosis (PBC is most often made in the asymptomatic phase, sometimes before the development of abnormal liver biochemistry. The antimitochondrial antibody remains the predominant hallmark, although not all patients test positive, even when the most sensitive techniques are used. The etiology of PBC remains elusive; studies suggest that the interlobular bile duct destruction is immune based, and associated autoimmune diseases are common. There are no surrogate markers that predict outcome in asymptomatic patients, whose chance of survival is less than that of age- and sex-matched populations but much better than the median survival of eight years in patients with symptomatic PBC. Symptoms common in this disease are fatigue, pruritus and xanthelasma, as well as complications of portal hypertension and osteoporosis. Treatment includes symptomatic and preventive measures, as well as specific therapeutic measures. Immunosuppressive therapy has yielded disappointing results in the long term management of PBC, and the only therapy shown to improve survival is the hydrophobic dihydroxy bile acid ursodeoxycholic acid. Treatment at a dose of 13 to 15 mg/kg/day is optimal, given in separate doses or as a single dose at least 4 h from giving the oral anion exchange resin cholestyramine, which may be used to control pruritus. However, liver transplantation remains the only cure for this disease, and the best postoperative survival is seen in patients whose serum bilirubin does not exceed 180 µmol/L at the time of liver transplantation. Recurrence takes place but is rarely symptomatic and does not deter from the benefits of transplantation.

  10. Tag single nucleotide polymorphisms of alcohol-metabolizing enzymes modify the risk of upper aerodigestive tract cancers: HapMap database analysis.

    Science.gov (United States)

    Chung, C-S; Lee, Y-C; Liou, J-M; Wang, C-P; Ko, J-Y; Lee, J-M; Wu, M-S; Wang, H-P

    2014-07-01

    Although alcohol is associated with higher upper aerodigestive tract (UADT) cancer risk, only a small fraction of alcoholics develop cancers. There is a lack of evidence proving the association of tag single nucleotide polymorphisms of alcohol-metabolizing enzymes with cancer risk. The aim of this study was to determine the association of these genetic polymorphisms with UADT cancer risk in a Chinese population. It was a hospital-based case-control candidate gene study. The databases of the International HapMap Project were searched for haplotype tag single nucleotide polymorphisms of the genes alcohol dehydrogenase (ADH)1B, ADH1C, and aldehyde dehydrogenase (ALDH)2. The genotyping was performed by the Sequenom MassARRAY system. Totally, 120 head and neck squamous cell carcinoma, 138 esophageal squamous cell carcinoma patients, and 276 age- and gender-matched subjects were enrolled between June 2008 and June 2010.Minor alleles of ADH1B (rs1229984) and ALDH2(rs671) were not only associated with the risk of UADT cancers (odds ratio [OR] [95% confidence interval, CI]: 3.53 [2.14-5.80] and 2.59 [1.79-3.75], respectively) but also potentiated the carcinogenic effects of alcohol (OR [95% CI]: 53.44 [25.21-113.29] and 70.08 [33.65-145.95], respectively). Similar effects were observed for head/neck and esophageal cancer subgroups. Multivariate logistic regression analysis identified four significant risk factors, including habitual use of cigarettes, alcohol, betel quid, and lower body mass index (P < 0.001). The haplotypes GAGC (OR 1.61, 95% CI 1.08-2.40, P = 0.018) and CCAATG (OR 1.69, 95% CI 1.24-2.30, P < 0.001) on chromosomes 4 and 12, respectively, were associated with higher cancer risk. These findings suggested that risk allele or haplotype carriers who consume alcohol and other carcinogens should be advised to undergo endoscopy screening. The information can be used to determine the degree of susceptibility of each subject and can be combined with other

  11. Laproscopic Management of Wandering Biliary Ascariasis

    Directory of Open Access Journals (Sweden)

    Umesh Jethwani

    2012-01-01

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

  12. Kallikrein-related peptidases in cancers of gastrointestinal tract: an inside view of their role and clinical significance.

    Science.gov (United States)

    Linardoutsos, Dimitrios; Gazouli, Maria; Machairas, Anastasios; Bramis, Ioannis; Zografos, Georgios C

    2014-01-01

    Human tissue kallikrein (KLK1) and is related peptidases (KLK2-KLK15) are a family of 15 homologous serine proteases, participating in numerous processes of normal physiology. Considering the irreversible impact of proteases on substrates, the tissue-dependent regulation of KLKs activity becomes crucial for their beneficial role in normal homeostasis. Moreover, KLKs expression is strongly regulated at the transcriptional and post-transcriptional level by steroid hormones and miRNAs, respectively. Deregulation of KLKs expression, secretion and/or activation has been observed in most human malignancies and there is a trend to identify their role in the multi-complex process of cancer development. The identification of extracellular matrix (ECM) proteins, cell-surface receptors, cell-surface adhesion molecules and growth factors among substrates, clearly support the driving role of KLK abnormal expression and function during tumorigenesis and cancer progression. KLKs have also clinical utility in cancer diagnosis and monitoring like KLK 3 (PSA) in prostate cancer. In this review, we tried to summarize the existing literature about the role of KLKs in gastrointestinal cancers as well as to emphasize their clinical significance for patients' prognosis.

  13. Improved Accuracy of Percutaneous Biopsy Using “Cross and Push” Technique for Patients Suspected with Malignant Biliary Strictures

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Prashant, E-mail: p.patel@bham.ac.uk [University of Birmingham, School of Cancer Sciences, Vincent Drive (United Kingdom); Rangarajan, Balaji; Mangat, Kamarjit, E-mail: kamarjit.mangat@uhb.nhs.uk, E-mail: kamarjit.mangat@nhs.net [University Hospital Birmingham NHS Trust, Department of Radiology (United Kingdom)

    2015-08-15

    PurposeVarious methods have been used to sample biliary strictures, including percutaneous fine-needle aspiration biopsy, intraluminal biliary washings, and cytological analysis of drained bile. However, none of these methods has proven to be particularly sensitive in the diagnosis of biliary tract malignancy. We report improved diagnostic accuracy using a modified technique for percutaneous transluminal biopsy in patients with this disease.Materials and MethodsFifty-two patients with obstructive jaundice due to a biliary stricture underwent transluminal forceps biopsy with a modified “cross and push” technique with the use of a flexible biopsy forceps kit commonly used for cardiac biopsies. The modification entailed crossing the stricture with a 0.038-in. wire leading all the way down into the duodenum. A standard or long sheath was subsequently advanced up to the stricture over the wire. A Cook 5.2-Fr biopsy forceps was introduced alongside the wire and the cup was opened upon exiting the sheath. With the biopsy forceps open, within the stricture the sheath was used to push and advance the biopsy cup into the stricture before the cup was closed and the sample obtained. The data were analysed retrospectively.ResultsWe report the outcomes of this modified technique used on 52 consecutive patients with obstructive jaundice secondary to a biliary stricture. The sensitivity and accuracy were 93.3 and 94.2 %, respectively. There was one procedure-related late complication.ConclusionWe propose that the modified “cross and push” technique is a feasible, safe, and more accurate option over the standard technique for sampling strictures of the biliary tree.

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

    LENUS (Irish Health Repository)

    Hennessey, Derek B

    2012-02-01

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

  15. DIGESTIVE TRACT

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    2006217 Effect of RNA silencing of transforming growth factorβ1 on the growth of colon cancer cells by RNA interference. RAN Zhihua (冉志华), et al. Dept Gastroenterol, Renji Hosp, Med Coll. Jiantong Univy, Shanghai 20001, Chin J Dig 2006;26 (3); 167-170. Objectives: To ohserve the effect of inhibition of transforming growth factor (TGF)β1 on the growth and aggression of colon cancer cells by RNA interference. Methods: HCT116 colon cancer cells were transfected with

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

    Science.gov (United States)

    Heineman, Katherine

    2014-02-01

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

  17. Influence of Fasciola hepatica on Serum Biochemical Parameters and Vascular and Biliary System of Sheep Liver

    Science.gov (United States)

    Hodžić, A; Zuko, A; Avdić, R; Alić, A; Omeragić, J; Jažić, A

    2013-01-01

    Background The aim of this study was to evaluate the functional capacity of the liver based on the activity of specific enzymes and bilirubin in serum and also to investigate the influence of mechanical and toxic effects of Fasciola hepatica on the structures of the blood vessels and biliary tract in the sheep liver. Methods Blood samples and liver of 63 indigenous sheep of Pramenka breed, slaughtered in the period from March to December 2009 were used. Based on parasitological findings in the liver, all animals were divided into two groups: control (n = 34) and infected group (n = 29). For investigation and description of pathological changes in sheep liver, naturally infected with F. hepatica, corrosion cast technique was used. Results Biochemical analysis of tested parameters showed a significant elevation (P≤0.05) of serum gamma-glutamyl transferase (GGT), total bilirubin (TBIL) and direct bilirubin (DBIL) in infected sheep group comparing with the control group. No significant differences were observed for activity of aspartate aminotranferase (AST) between groups. Vascular and biliary systems of the liver were found to be affected. Conclusion Results of biochemical analysis are consistent with pathological findings and measuring of tested parameters could be used in early diagnosis of sheep fasciolosis and to test the effectiveness of anthelmintic therapy. Corrosion cast technique is very useful for investigation of pathological changes and neoangiogenesis of vascular and biliary system in sheep liver, caused by mechanical and toxic effects of F. hepatica. PMID:23682266

  18. Influence of Fasciola Hepatica on Serum Biochemical Parameters and Vascular and Biliary System of Sheep Liver

    Directory of Open Access Journals (Sweden)

    A Hodžić

    2013-03-01

    Full Text Available Background: The aim of this study was to evaluate the functional capacity of the liver based on the activity of specific enzymes and bilirubin in serum and also to investigate the influence of mechanical and toxic effects of Fasciola hepatica on the structures of the blood vessels and biliary tract in the sheep liver.Methods: Blood samples and liver of 63 indigenous sheep of Pramenka breed, slaughtered in the period from March to December 2009 were used. Based on parasitological findings in the liver, all animals were divided into two groups: control (n=34 and infected group (n=29. For investigation and description of pathological changes in sheep liver, naturally infected with F. hepatica, corrosion cast technique was used.Results: Biochemical analysis of tested parameters showed a significant elevation (P≤0.05 of serum gamma-glutamyl transferase (GGT, total bilirubin (TBIL and direct bilirubin (DBIL in infected sheep group comparing with the control group. No significant differences were observed for activity of aspartate aminotranferase (AST between groups. Vascular and biliary systems of the liver were found to be affected.Conclusion: Results of biochemical analysis are consistent with pathological findings and measuring of tested parameters could be used in early diagnosis of sheep fasciolosis and to test the effectiveness of anthelmintic therapy. Corrosion cast technique is very useful for investigation of pathological changes and neoangiogenesis of vascular and biliary system in sheep liver, caused by mechanical and toxic effects of F. hepatica.

  19. DIGESTIVE TRACT

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    8.1 Esophagus2007092 Expression of CD80, CD86, TGF-β1 and IL-10 mRNA in the esophageal carcinoma. YANG Wenfeng(杨文锋), et al. Dept Thorac Surg Shandong Cancer Hosp, Jinan 250117. Chin J Oncol 2006;28(10):762-765. Objective To investigate the correlation of CD80 and CD86 mRNA expression with the expression of transforming growth factor-β1 mRNA (TGF-β1 ) and interleukin-10 mRNA (IL-10) in the esophageal cancer. To explore the reason of impaired immunological function of dentritic cell (DC) and the mechanism of cancer cell escaption from body immunity system in the esophageal cancer patient.

  20. 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.

  1. IDUS for Biliary and Pancreatic Duct Lesions

    Institute of Scientific and Technical Information of China (English)

    Takao ltoi

    2008-01-01

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

  2. Biliary ascariasis on magnetic resonance cholangiopancreatography

    Directory of Open Access Journals (Sweden)

    Mohammad A Hashmi

    2009-01-01

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

  3. ETIOLOGY, PATHOGENESIS AND MORPHOLOGY OF BILIARY ATRESIA

    Directory of Open Access Journals (Sweden)

    O. E. Iryshkin

    2012-01-01

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

  4. Management of biliary complications after livertransplantation

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Biliary complications (BC) currently represent a majorsource of morbidity after liver transplantation. Althoughrefinements in surgical technique and medical therapyhave had a positive influence on the reduction of postoperativemorbidity, BC affect 5% to 25% of transplantedpatients. Bile leak and anastomotic stricturesrepresent the most common complications. Nowadays,a multidisciplinary approach is required to managesuch complications in order to prevent liver failure andretransplantation.

  5. Associations of Census-Tract Poverty with Subsite-Specific Colorectal Cancer Incidence Rates and Stage of Disease at Diagnosis in the United States

    Directory of Open Access Journals (Sweden)

    Kevin A. Henry

    2014-01-01

    Full Text Available Background. It remains unclear whether neighborhood poverty contributes to differences in subsite-specific colorectal cancer (CRC incidence. We examined associations between census-tract poverty and CRC incidence and stage by anatomic subsite and race/ethnicity. Methods. CRC cases diagnosed between 2005 and 2009 from 15 states and Los Angeles County (N=278,097 were assigned to 1 of 4 groups based on census-tract poverty. Age-adjusted and stage-specific CRC incidence rates (IRs and incidence rate ratios (IRRs were calculated. Analyses were stratified by subsite (proximal, distal, and rectum, sex, race/ethnicity, and poverty. Results. Compared to the lowest poverty areas, CRC IRs were significantly higher in the most impoverished areas for men (IRR = 1.14 95% CI 1.12–1.17 and women (IRR = 1.06 95% CI 1.05–1.08. Rate differences between high and low poverty were strongest for distal colon (male IRR = 1.24 95% CI 1.20–1.28; female IRR = 1.14 95% CI 1.10–1.18 and weakest for proximal colon. These rate differences were significant for non-Hispanic whites and blacks and for Asian/Pacific Islander men. Inverse associations between poverty and IRs of all CRC and proximal colon were found for Hispanics. Late-to-early stage CRC IRRs increased monotonically with increasing poverty for all race/ethnicity groups. Conclusion. There are differences in subsite-specific CRC incidence by poverty, but associations were moderated by race/ethnicity.

  6. Digestive Tract

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    8.1 Esophagus 2006062 Relationship between the expression of copper - transporting P - type adenosine triphosphatase (ATP7B) in human esophageal cancer tissues and the prognosis of esophageal cancer FENG Changwei(冯常炜 ) et al. Lab Can Res Henan Key Lab for Esophag Can, Zhengzhou Univ, Zhengzhou 450052. Chin J Clin Oncol 2005 ;32(22) :1261 -1263. Objective: To investigate the expression of copper -transporting P - type adenosine triphosphatase ( ATP7B)

  7. 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

  8. Characterization of acute biliary hyperplasia in Fisher 344 Rats administered the Indole-3-Carbinol Analog, NSC-743380

    Energy Technology Data Exchange (ETDEWEB)

    Eldridge, Sandy R.; Covey, Joseph; Morris, Joel [Developmental Therapeutics Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD, 20892 (United States); Fang, Bingliang [The University of Texas MD Anderson Cancer Center, Houston, TX, 77030 (United States); Horn, Thomas L. [IIT Research Institute, Chicago, IL, 60616 (United States); Elsass, Karen E. [Battelle Columbus, Columbus, OH, 43201 (United States); Hamre, John R. [Investigative Toxicology Laboratory, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD 21702 (United States); McCormick, David L. [IIT Research Institute, Chicago, IL, 60616 (United States); Davis, Myrtle A., E-mail: myrtledavis@mail.nih.gov [Developmental Therapeutics Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD, 20892 (United States)

    2014-12-15

    NSC-743380 (1-[(3-chlorophenyl)-methyl]-1H-indole-3-carbinol) is in early stages of development as an anticancer agent. Two metabolites reflect sequential conversion of the carbinol functionality to a carboxaldehyde and the major metabolite, 1-[(3-chlorophenyl)-methyl]-1H-indole-3-carboxylic acid. In an exploratory toxicity study in rats, NSC-743380 induced elevations in liver-associated serum enzymes and biliary hyperplasia. Biliary hyperplasia was observed 2 days after dosing orally for 2 consecutive days at 100 mg/kg/day. Notably, hepatotoxicity and biliary hyperplasia were observed after oral administration of the parent compound, but not when major metabolites were administered. The toxicities of a structurally similar but pharmacologically inactive molecule and a structurally diverse molecule with a similar efficacy profile in killing cancer cells in vitro were compared to NSC-743380 to explore scaffold versus target-mediated toxicity. Following two oral doses of 100 mg/kg/day given once daily on two consecutive days, the structurally unrelated active compound produced hepatic toxicity similar to NSC-743380. The structurally similar inactive compound did not, but, lower exposures were achieved. The weight of evidence implies that the hepatotoxicity associated with NSC-743380 is related to the anticancer activity of the parent molecule. Furthermore, because biliary hyperplasia represents an unmanageable and non-monitorable adverse effect in clinical settings, this model may provide an opportunity for investigators to use a short-duration study design to explore biomarkers of biliary hyperplasia. - Highlights: • NSC-743380 induced biliary hyperplasia in rats. • Toxicity of NSC-743380 appears to be related to its anticancer activity. • The model provides an opportunity to explore biomarkers of biliary hyperplasia.

  9. Interventional Management of Delayed and Massive Hemobilia due to Arterial Erosion by Metallic Biliary Stent

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Hee Seok [Dept. of Radiology, Gyeongsang National University Hospital, Jinju (Korea, Republic of); Shin, Tae Beom [Dept. of Diagnostic Radiology, Kimhae Jung Ang Hospital, Kimhae (Korea, Republic of); Hwang, Jae Cheol [Dept. of Radiology, Ulsan Hospital, Ulsan (Korea, Republic of); Bae, Jae Ik [Dept. of Radiology, Ajou University Hospital, Suwon (Korea, Republic of); Kim, Chang Won [Dept. of Radiology, Busan National University Hospital, Busan (Korea, Republic of)

    2012-01-15

    To evaluate the effectiveness of interventional management for delayed and massive hemobilia secondary to arterial erosion self expandable metallic stent (SES) in with biliary duct malignancy. Over 8-year period, eight patients who suffered from delayed massive hemobilia after SES placement for malignant biliary obstruction as palliative procedure, were included. The mean period between SES placement and presence of massive gastrointestinal hemorrhage was 66.5 days (15-152 days), pancreatic cancer (n = 2), Klatskin tumor (n = 2), common bile duct cancer (n = 2), intrahepatic cholangiocarcinoma (n = 1), and gastric cancer with ductal invasion (n = 1). Angiographic findings were pseudoaneurysm (n = 6), contrast extravasation (n = 1) and arterial spasm at segment (n = 1). Six patients underwent embolization of injured vessels using microcoils and N-butyl cyanoacrylate. Two patients underwent stent graft placement at right hepatic artery to prevent ischemic hepatic damage because of the presence of portal vein occlusion. Massive hemobilia was successfully controlled by the embolization of arteries (n = 6) and stent graft placement (n = 2) without related complications. The delayed massive hemobilia to arterial erosion metallic biliary stent is rare this complication be successfully treated by interventional management.

  10. Patients with brain metastases from gastrointestinal tract cancer treated with whole brain radiation therapy:Prognostic factors and survival

    Institute of Scientific and Technical Information of China (English)

    Susanne Bartelt; Felix Momm; Christian Weissenberger; Johannes Lutterbach

    2004-01-01

    AIM: To identify the prognostic factors with regard to survival for patients with brain metastasis from primary tumors of the gastrointestinal tract.METHODS: Nine hundred and sixteen patients with brain metastases, treated with whole brain radiation therapy (WBRT) between January 1985 and December 2000 at the Department of Radiation Oncology, University Hospital Freiburg, were analyzed retrospectively.RESULTS: Fifty-seven patients presented with a primary tumor of the gastrointestinal tract (esophagus: n = 0, stomach:n = 10, colorectal: n = 47). Twenty-six patients had a solitary brain metastasis, 31 patients presented with multiple brain metastases. Surgical resection was performed in 25 patients.WBRTwas applied with daily fractions of 2 Gray (Gy) or 3 Gy to a total dose of 50 Gy or 30 Gy, respectively. The interval between diagnoses of the primary tumors and brain metastases was 22.6 mo vs8.0 mo for patients with primary tumors of the colon/rectum vs other primary tumors,respectively (P<0.01, log-rank). Median overall survival for all patients with brain metastases (n = 916) was 3.4 mo and 3.2 mo for patients with gastrointestinal neoplasms.Patients with gastrointestinal primary tumors presented significantly more often with a solitary brain metastasis than patients with other primary tumors (P<0.05, log-rank). In patients with gastrointestinal neoplasms (n = 57), the median overall survival was 5.8 mo for patients with solitary brain metastasis vs 2.7 mo for patients with multiple brain metastases (P<0.01, log-rank). The median overall survival for patients with a Karnofsky performance status (KPS) ≥70was 5.5 mo vs2.1 mo for patients with KPS <70 (P<0.01,log-rank). At multivariate analysis (Cox Model) the performance status and the number of brain metastases were identified as independent prognostic factors for overall survival.CONCLUSION: Brain metastases occur late in the course of gastrointestinal tumors. Pretherapeutic variables like KPS and the

  11. Bile acids as endogenous etiologic agents in gastrointestinal cancer

    Institute of Scientific and Technical Information of China (English)

    Harris Bernstein; Carol Bernstein; Claire M Payne; Katerina Dvorak

    2009-01-01

    Bile acids are implicated as etiologic agents in cancer of the gastrointestinal (GI) tract, including cancer of the esophagus, stomach, small intestine, liver, biliary tract, pancreas and colon/rectum. Deleterious effects of bile acid exposure, likely related to carcinogenesis,include: induction of reactive oxygen and reactive nitrogen species; induction of DNA damage; stimulation of mutation; induction of apoptosis in the short term,and selection for apoptosis resistance in the long term.These deleterious effects have, so far, been reported most consistently in relation to esophageal and colorectal cancer, but also to some extent in relation to cancer of other organs. In addition, evidence is reviewed for an association of increased bile acid exposure with cancer risk in human populations, in specific human genetic conditions, and in animal experiments. A model for the role of bile acids in GI carcinogenesis is presented from a Darwinian perspective that offers an explanation for how the observed effects of bile acids on cells contribute to cancer development.

  12. Percutaneous biliary stones removal using balloon sphincteroplasty and hydraulic pressure as primary therapeutic method

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Soo; You, Jin Jong [Gyeongsang National University Hospital, Chinju (Korea, Republic of)

    2005-07-15

    We wanted to report on the efficacy and safety of the percutaneous biliary stone removal technique using hydraulic pressure after balloon sphincteroplasty through the PTBD tract for patients with bile duct stones. The subjects of this study were 85 patients (46 men and 39 women) with bile duct stones who came to hospital over a period of the previous 4 years. All subjects had undergone attempts for with the biliary tree through PTBD. First, an 8-9F sheath was inserted into the biliary tree through the PTBD route by using a balloon catheter prior to sphincteroplasty, and 50cc of hydraulic pressure with contrast-mixed saline solution was then injected via the sheath. Follow-up cholangiogram was performed 1-3 days later to evaluate the results of stone removal. For residual stones, we attempted second, third, and fourth trials to completely remove the stones. The size and number of stones were analyzed. The results were analyzed, together with the complications, after classifying the cases as 'success', 'partial removal' or 'failure' according to the number of remaining stones. Out of 85 patients, 71 (83%) cases had successful results, and 43 (51%) cases resulted in success with the first attempt. The second, third and fourth trials were conducted on 16, 10 and 2 cases, respectively. Out of 14 failure cases, 10 patients had too many intrahepatic duct stones. The complications were abdominal pain (n=21), fever (n=9), and pancreatitis (n=2), and portal vein thrombosis, biloma and sepsis were also found in 1 case each. We report that this percutaneus biliary stone removal technique using hydraulic pressure after balloon sphincteroplasty through the PTBD is safe and effective, and particularly, it achieves good results as the primary therapy for treating only choledocholiths.

  13. Sequential therapy for biliary ascariasis in 19 cases%序贯治疗胆道蛔虫病19例

    Institute of Scientific and Technical Information of China (English)

    刘金生; 袁璐

    2010-01-01

    Objective To improve the curative effect of non-invasive therapy for biliary ascariasis to shorten the course of treatment and minimize the chance of invasive managements such as surgery and endoscopic therapy. Methods The sequential therapy was conducted as: intravenous injection of vitamin C → oral administration of acid drug → expel the worm in the biliary tract. Results For the 19 cases of biliary ascariasis, 15 responded to the conservative treatment after one course of treatment,2 responded to it after two courses, 1 after 3 courses and 1 did not. Conclusion Sequential therapy is effective, convenient and simple for biliary ascariasis and it can reduce the chance of invasive management.%目的 提高非手术治疗胆道蛔虫病的疗效,缩短疗程,避免或减少手术等有创治疗.方法 序贯治疗:静推维生素C→口服酸性物→驱蛔虫.结果 19例胆道蛔虫病人,15例1疗程治愈,2例2疗程,1例3疗程,1例无效.结论 序贯治疗胆道蛔虫起效快,疗效确定,方法简便易行,可避免或减少手术等有创治疗.

  14. E3B1/ABI-1 Isoforms Are Down-Regulated in Cancers of Human Gastrointestinal Tract

    Directory of Open Access Journals (Sweden)

    Rafia A. Baba

    2012-01-01

    Full Text Available The expression of E3B1/ABI-1 protein and its role in cancer progression and prognosis are largely unknown in the majority of solid tumors. In this study, we examined the expression pattern of E3B1/ABI-1 protein in histologically confirmed cases of esophageal (squamous cell carcinoma and adenocarcinoma, gastro-esophageal junction, colorectal cancers and corresponding normal tissues freshly resected from a cohort of 135 patients, by Western Blotting and Immunofluorescence Staining. The protein is present in its phosphorylated form in cells and tissues. Depending on the extent of phosphorylation it is either present in hyper-phosphorylated (M. Wt. 72 kDa form or in hypo-phosphorylated form (M. Wt. 68 kDa and 65 kDa. A thorough analysis revealed that expression of E3B1/ABI-1 protein is significantly decreased in esophageal, gastro-esophageal junction and colorectal carcinomas irrespective of age, gender, dietary and smoking habits of the patients. The decrease in expression of E3B1/ABI-1 was consistently observed for all the three isoforms. However, the decrease in the expression of isoforms varied with different forms of cancers. Down-regulation of E3B1/ABI-1 expression in human carcinomas may play a critical role in tumor progression and in determining disease prognosis.

  15. 肺癌患者下呼吸道感染相关危险因素分析%Analysis of risk factors for patients with lung cancer complicated with lower respiratory tract infections

    Institute of Scientific and Technical Information of China (English)

    赵中海; 韦良心; 刘璐

    2014-01-01

    目的:探讨肺癌患者合并下呼吸道感染时相关危险因素,并进行统计分析,以降低感染率。方法选取2010年12月-2012年12月收治的肺癌患者140例进行研究,观察患者下呼吸道感染情况,对所有患者的临床资料进行分析,探讨呼吸道感染的相关危险因素。结果140例肺癌患者发生呼吸道感染85例,感染率为60.71%;对患者临床资料进行单因素分析发现,年龄、吸烟、基础疾病≥3种、肺癌分期、住院时间、化疗和大剂量使用抗菌药物是发生下呼吸道感染的危险因素(P<0.05);经多因素 logistic回归分析发现,年龄、基础疾病≥3种、住院时间、肺癌分期及大剂量长期使用抗菌药物是导致肺癌患者发生下呼吸道感染的独立危险因素。结论导致肺癌患者发生下呼吸道感染的因素较多,临床需要对高龄糖尿病及肺癌晚期患者进行密切观察,严格控制抗菌药物的滥用,防止下呼吸道感染的发生。%OBJECTIVE To study the risk factors for patients with lung cancer complicated with lower respiratory tract infections ,and conduct statistical analysis to reduce the infection rate .METHODS Totally 140 patients with lung cancer from Dec .2010 to Dec .2012 in our hospital were studied .The situation of lower respiratory tract infection was observed .The clinical data for all patients were analyzed to explore the relevant risk factors of respiratory tract infections . RESULTS Totally 85 out of 140 patients with lung cancer had respiratory tract infections ,the rate was 60 .71% .The univariate analysis of clinical data of patients showed that the patient's age , smoking ,underlying diseases ≥ 3 kinds ,lung cancer staging ,length of stay ,chemotherapy and the use of high-dose antibiotics were risk factors for lower respiratory tract infections in patients with lung cancer (P< 0 .05) . The multivariate logistic regression analysis found that age

  16. Primary biliary cirrhosis-specific autoantibodies in first degree relatives of Greek primary biliary cirrhosis patients

    Institute of Scientific and Technical Information of China (English)

    Theodoros A Zografos; Nikolaos Gatselis; Kalliopi Zachou; Christos Liaskos; Stella Gabeta; George K Koukoulis; George N Dalekos

    2012-01-01

    AIM:To determine the prevalence and significance of primary biliary cirrhosis (PBC)-specific autoantibodies in first-degree relatives (FDRs) of Greek PBC patients.METHODS:The presence of antimitochondrial antibodies (AMA) and PBC-specific antinuclear antibodies (ANA) were determined using indirect immunofluorescence assays,dot-blot assays,and molecularly based enzyme-linked immunosorbent assays in 101 asymptomatic for liver-related symptoms FDRs of 44 PBC patients.In order to specify our results,the same investigation was performed in 40 healthy controls and in a disease control group consisting of 40 asy.mptomatic for liver-related symptoms FDRs of patients with other autoimmune liver diseases namely,autoimmune hepatitis-1 or primary sclerosing cholangitJs (AIH-1/PSC).RESULTS:AMA positivity was observed in 19 (only 4 with abnormal liver function tests) FDRs of PBC patients and none of the healthy controls.The prevalence of AMA was significantly higher in FDRs of PBC patients than in AIH-1/PSC FDRs and healthy controls [18.8%,95% confidence interval (CI):12%-28.1% vs 2.5%,95% CI:0.1%-14.7%,P =0.01; 18.8%,95% CI:12%-28.1% vs 0%,95% CI:0%-10.9%,P =0.003,respectively].PBC-specific ANA positivity was observed in only one FDR from a PSC patient.Multivariate analysis showed that having a proband with PBC independently associated with AMA positivity (odds ratio:11.24,95% CI:1.27-25.34,P =0.03) whereas among the investigated comorbidities and risk factors,a positive past history for urinary tract infections (UTI)was also independently associated with AMA detection in FDRs of PBC patients (odds ratio:3.92,95% CI:1.25-12.35,P =0.02).CONCLUSION:In FDRs of Greek PBC patients,AMA prevalence is significantly increased and independently associated with past UTI.PBC-specific ANA were not detected in anyone of PBC FDRs.

  17. Characterization of acute biliary hyperplasia in Fisher 344 rats administered the indole-3-carbinol analog, NSC-743380.

    Science.gov (United States)

    Eldridge, Sandy R; Covey, Joseph; Morris, Joel; Fang, Bingliang; Horn, Thomas L; Elsass, Karen E; Hamre, John R; McCormick, David L; Davis, Myrtle A

    2014-12-15

    NSC-743380 (1-[(3-chlorophenyl)-methyl]-1H-indole-3-carbinol) is in early stages of development as an anticancer agent. Two metabolites reflect sequential conversion of the carbinol functionality to a carboxaldehyde and the major metabolite, 1-[(3-chlorophenyl)-methyl]-1H-indole-3-carboxylic acid. In an exploratory toxicity study in rats, NSC-743380 induced elevations in liver-associated serum enzymes and biliary hyperplasia. Biliary hyperplasia was observed 2 days after dosing orally for 2 consecutive days at 100mg/kg/day. Notably, hepatotoxicity and biliary hyperplasia were observed after oral administration of the parent compound, but not when major metabolites were administered. The toxicities of a structurally similar but pharmacologically inactive molecule and a structurally diverse molecule with a similar efficacy profile in killing cancer cells in vitro were compared to NSC-743380 to explore scaffold versus target-mediated toxicity. Following two oral doses of 100mg/kg/day given once daily on two consecutive days, the structurally unrelated active compound produced hepatic toxicity similar to NSC-743380. The structurally similar inactive compound did not, but, lower exposures were achieved. The weight of evidence implies that the hepatotoxicity associated with NSC-743380 is related to the anticancer activity of the parent molecule. Furthermore, because biliary hyperplasia represents an unmanageable and non-monitorable adverse effect in clinical settings, this model may provide an opportunity for investigators to use a short-duration study design to explore biomarkers of biliary hyperplasia.

  18. Urinary tract infection - children

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000505.htm Urinary tract infection - children To use the sharing features on this page, please enable JavaScript. A urinary tract infection is an infection of the urinary tract. This ...

  19. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group

    NARCIS (Netherlands)

    J.H.G. Klinkenbijl (Jean); J. Wils; J. Jeekel (Hans); T. Sahmoud; R. van Pel; M.L. Couvreur; C.H. Veenhof; J.P. Arnaud; D. González González (Dionisio); L.Th. de Wit (Laurens); A. Hennipman

    1999-01-01

    textabstractOBJECTIVE: The survival benefit of adjuvant radiotherapy and 5-fluorouracil versus observation alone after surgery was investigated in patients with pancreatic head and periampullary cancers. SUMMARY BACKGROUND DATA: A previous study of adjuvant radiotherapy

  20. DIGESTIVE TRACT

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    8.1 Stomach2003432 Experimental study on mitotic catastrophe induced by pcDNA3-survivin-mutant in gastric cancer cell lines.SUN Jing(孙璟), et al.Dept Gerontol, Ruijin Hosp, Shanghai 2nd Med Univ, Shanghai 200025. Chin J Dig 2003;23(8):487-490.

  1. Improving cellularity and quality of liquid-based cytology slides processed from pancreatobiliary tract brushings.

    Science.gov (United States)

    Campion, Michael B; Kipp, Benjamin R; Humphrey, Sandra K; Zhang, Jun; Clayton, Amy C; Henry, Michael R

    2010-09-01

    Cytology has been reported to have suboptimal sensitivity for detecting pancreatobiliary tract cancer in biliary tract specimens partly as a result of low specimen cellularity and obscuring noncellular components. The goal of this study was to determine if the use of a glacial acetic acid wash prior to processing would increase the cellularity and improve the quality of ThinPrep slides when compared to standard non-gyn ThinPrep processing. Fifty consecutive pancreatobiliary tract specimens containing 20 ml of sample/PreservCyt were divided equally for standard non-gyn ThinPrep (STP) and glacial acetic acid ThinPrep processing (GATP). A manual drop preparation was also performed on residual STP specimen to determine the number of cells left in the vial during STP processing. Twenty-six (52%) specimens had more epithelial cell groupings with the GATP methodology while 19 (38%) had equivalent cellularity with both methods. The STP method produced more epithelial cell groupings in 5 (10%) of the specimens. Of the 26 specimens that had less cells with the STP method, 14 (54%) had > or = 50 cell groupings on the manual drop slide processed from the residual STP specimen suggesting that many cells remain in the vial after STP processing. The GATP method was preferred in 25 (50%) of the specimens, the STP method in 5 (10%), while both methodologies provided similar findings in the remaining 20 (40%) of specimens. The data from this study suggests that the GATP method results in more cells being placed on the slide and was preferred over the STP method in a majority of specimens.

  2. Choledochoduodenal fistula presenting with pneumobilia in a patient with gallbladder cancer: a case report

    Directory of Open Access Journals (Sweden)

    Dadzan Elham

    2012-02-01

    Full Text Available Abstract Introduction Spontaneous biliary tract fistulas are rare entities. Most of them are associated with long-standing gallstones (especially common bile duct stones, or recurrent biliary tract infections, some with more uncommon diseases such as gallbladder cancer. Some authors believe that back flow from fistulas predisposes patients to gallbladder cancer and some believe that cancer causes necrosis and fistula formation. Gallbladder cancer has a dismal prognosis and 85% of patients are dead within a year of diagnosis. A common complication of gallbladder cancer is obstruction of the common bile duct, which may produce multiple intra-hepatic abscesses in or near the tumor-laden gallbladder. Fistula formation may further complicate the clinical picture. Case presentation We present a case of choledochoduodenal fistula in a 60-year-old diabetic African-American woman with gallbladder cancer. The initial clinical presentation was confusing and complex. Our patient was also found to have a gallbladder fossa abscess that was drained percutaneously as another complicating factor relating to her cancer. She developed myocardial infarction, massive upper gastrointestinal bleeding and respiratory arrest during her stay in hospital. Computed tomography was very helpful in assessing our patient and we discuss how, in a patient with pneumobilia, it can be helpful for detecting fistula, air in bile ducts or to show contractions of the gallbladder. Conclusions We believe this case merits reporting as it shows an entity that is not frequently thought of, is hard to diagnose and can be fatal, as in our patient. Careful evaluation, and computed tomography studies and endoscopic retrograde cholangio-pancreatography are helpful in early diagnosis and finding better management options for these patients.

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

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

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

  4. Immunopathogenesis of primary biliary cirrhosis: an old wives' tale

    Directory of Open Access Journals (Sweden)

    Smyk Daniel S

    2011-12-01

    Full Text Available Abstract Primary biliary cirrhosis (PBC is a cholestatic liver disease characterised by the autoimmune destruction of the small intrahepatic bile ducts. The disease has an unpredictable clinical course, but may progress to fibrosis and cirrhosis. Although medical treatment with urseodeoxycholic acid is largely successful, some patients may progress to liver failure requiring liver transplantation. PBC is characterised by the presence of disease specific anti-mitochondrial (AMA antibodies, which are pathognomonic for PBC development. The disease demonstrates an overwhelming female preponderance and virtually all women with PBC present in middle age. The reasons for this are unknown; however several environmental and immunological factors may be involved. As the immune systems ages, it become less self tolerant, and mounts a weaker response to pathogens, possibly leading to cross reactivity or molecular mimicry. Some individuals display immunological changes which encourage the development of autoimmune disease. Risk factors implicated in PBC include recurrent urinary tract infection in females, as well as an increased prevalence of reproductive complications. These risk factors may work in concert with and possibly even accelerate, immune system ageing, contributing to PBC development. This review will examine the changes that occur in the immune system with ageing, paying particular attention to those changes which contribute to the development of autoimmune disease with increasing age. The review also discusses risk factors which may account for the increased female predominance of PBC, such as recurrent UTI and oestrogens.

  5. High Neutrophil-to-lymphocyte Ratio as Prognostic Factor in Patients Affected by Upper Tract Urothelial Cancer: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Marchioni, Michele; Cindolo, Luca; Autorino, Riccardo; Primiceri, Giulia; Arcaniolo, Davide; De Sio, Marco; Schips, Luigi

    2016-12-29

    Given the increasing interest in the possible role of the neutrophil-to-lymphocyte ratio (NLR) as an easily available oncologic marker for upper tract urothelial cancer (UTUC), we sought to quantify the prognostic effect of this biomarker and assess its consistency in UTUC. A systematic review of the published data was performed up to May 2016 using multiple search engines (PubMed, Ovid, and Scopus) to identify eligible comparative studies. A formal meta-analysis was performed for studies comparing patients with a high and those with a low NLR before surgical treatment of UTUC to determine whether the NLR is an independent predictor of survival. Pooled estimates were calculated using a fixed-effects model if no significant heterogeneity was identified. Alternatively, a random-effects model was used when significant heterogeneity was detected. For continuous outcomes, the weighted mean difference was used as a summary measure. For binary variables, the odds ratio or risk ratio was calculated with the 95% confidence intervals (CIs). Statistical analyses were performed using RevMan, version 5. Six studies with 1710 patients were included. A high NLR was associated with poorer oncologic outcomes in patients affected by UTUC, in particular in terms of overall survival (hazard ratio [HR], 1.97; 95% CI, 1.27-3.04; P = .002) and recurrence-free survival (HR, 1.53; 95% CI, 1.19-1.96; P = .0009) but not cancer-specific survival (HR, 1.25; 95% CI, 0.29-5.41; P = .77). Current evidence suggests that the NLR might have an independent role as a prognostic factor in patients affected by UTUC undergoing surgical treatment. The NLR potentially represents an easily available measurement of prognosis; however, it requires validation in larger prospective studies.

  6. 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.

  7. Activation of the aryl hydrocarbon receptor pathway enhances cancer cell invasion by upregulating the MMP expression and is associated with poor prognosis in upper urinary tract urothelial cancer.

    Science.gov (United States)

    Ishida, Masaru; Mikami, Shuji; Kikuchi, Eiji; Kosaka, Takeo; Miyajima, Akira; Nakagawa, Ken; Mukai, Makio; Okada, Yasunori; Oya, Mototsugu

    2010-02-01

    Aryl hydrocarbon receptor (AhR) and the activation of the AhR pathway are involved in xenobiotic-induced toxicity and carcinogenesis. Although xenobiotics, such as cigarette smoke, contribute to the development of urothelial carcinoma (UC), the relationship between AhR and UC is unclear. In the present study, we investigated AhR expression in 209 patients with upper urinary tract UC. The nuclear expression of AhR was significantly associated with histological grade, pathological T stage, lymphovascular invasion and lymph node involvement. A multivariate Cox analysis revealed that nuclear AhR expression was a significant and independent predictor for disease-specific survival (hazard ratio = 2.469, P = 0.013). To determine whether the AhR pathway can be activated in the T24 UC cell line, we examined the expression of cytochrome P450 (CYP) 1A1 and CYP1B1, which are target genes of the AhR pathway, following exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), a ligand of AhR. TCDD treatment upregulated the expression levels of AhR, CYP1A1 and CYP1B1. TCDD enhanced T24 cell invasion associated with the upregulation of matrix metalloproteinase (MMP)-1 and MMP-9. Furthermore, targeting AhR messenger RNA (mRNA) expression in T24 cells with small interfering RNA (siRNA) downregulated the mRNA expression of AhR, CYP1A1, CYP1B1, MMP-1, MMP-2 and MMP-9; furthermore, the cells transfected with siRNA for AhR showed decreased invasion activity in comparison with the cells transfected with a non-targeting siRNA. Our results therefore suggest that AhR plays a role in the invasiveness of UC cells and can serve as a marker for the prognosis of upper urinary tract UC.

  8. Clinicopathologic characteristics of young patients with gallbladder cancer.

    Science.gov (United States)

    Do, Sung-Im; Lee, Hyoun Wook; Sohn, Jin Hee; Kim, Kyungeun

    2017-03-01

    Gallbladder cancer is the most common biliary tract cancer and the fifth most common cancer of the digestive system. However, the clinicopathologic features of gallbladder cancer in young Korean patients have not been studied. This study included 101 consecutive cases of gallbladder cancer that underwent cholecystectomy at Kangbuk Samsung Hospital from December 1990 to March 2011. The patients were divided into two groups by age at initial diagnosis of gallbladder cancer: a young patient group aged less than 45 years and an old patient group aged 45 or older. The young patient group included 10 patients with mean age of 38 (range, 29-44 years). Compared with the old patient group, the young patient group showed polypoid tumor appearance (p=0.014), lower pT stage (p=0.023), more frequent adenoma background (p=0.009), and less frequent dysplasia in remaining mucosa (p=0.001). The disease-related survival rate after 13.5 months was significantly more favorable for the young patients. Gallbladder cancers in young Korean patients have distinct clinicopathologic features of a high frequency of cancer arising in adenoma, rare association with intestinal metaplasia and dysplasia, and a favorable patient's prognosis. These findings suggest that the adenoma-carcinoma pathway could contribute more to gallbladder cancer carcinogenesis in young Korean patients than the metaplasia-dysplasia-carcinoma pathway.

  9. [Biliary ileus--potential complication of cholecystolithiasis].

    Science.gov (United States)

    Okolicány, R; Prochotský, A; Skultéty, J; Sekác, J; Mifkovic, A

    2008-11-01

    Biliary ileus is a rare complication of cholecystolithiasis. The condition occurs predominantly in the elderly with incidence rates of 1-4%, according to the literature data. Most commonly, it develops as a complication of cholelithiasis which remained untreated or was managed conservatively, or as a complication of a gallbladder decubitus necrosis. The condition results in a cholecysto-duodenal fistula. In this case, the cholecystolithiasis is latent or is clinically manifested in a third of the patients. A total of 1560 cholecystectomies (1345 L-CHE and 215 conventional CHE) were performed in our clinic during a five-year period. Biliary ileus was an indication for operation only in two subjects, during the studied period. In the both cases, the diagnosis was established intraoperatively, although upon re-examination of the visualization modalities views (upright native abdominal views, CT scans) the authors concluded that the primary cause of the ileus could have already been identified, based on the above views.

  10. [Biliary peritonitis: retrospective analysis of the disease].

    Science.gov (United States)

    Sirakov, M; Chupetlovski, S; Panov, Ts; Iliev, I

    2001-01-01

    The authors have done a biliary retrospective analysis of 10 deceased patients with a diagnosis of biliary peritonitis (BP). It is reported that the patients who died of BP are 9.5% of all who died of diffuse purulent peritonitis. All deceased patients were advanced and well advanced in years with prolonged complaints--in over 50% of them over 5 years. The complications set in 50% of the cases are recorded in the postoperative period. The perforation of the gallbladder and the biliopancreatitis are in the second place. Intrabiliary fistulas with 4 patients and 1 with a vesicocolon fistula; tumor of the pancreas with 4 patients; empyema of the gallbladder--3; diabetes with 3 of the patients and others are recorded as accompanying troubles which complicate the operation and the outcome of it. The time between the beginning of the complication and the operation with all the deceased patients is over 72 hours.

  11. Endoscopic management of benign biliary strictures.

    Science.gov (United States)

    Rustagi, Tarun; Jamidar, Priya A

    2015-01-01

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

  12. Novel technique for biliary reconstruction using an isolated gastric tube with a vascularized pedicle: a live animal experimental study and the first clinical case

    Directory of Open Access Journals (Sweden)

    Hashem Mostafa

    2011-10-01

    Full Text Available Abstract Background Biliary tract reconstruction continues to be a challenging surgical problem. Multiple experimental attempts have been reported to reconstruct biliary defects with different materials and variable outcome. Our aim was to evaluate a new method for biliary reconstruction using an isolated pedicled gastric tube in a live animal trial and also to present the first clinical case. Methods Seven mongrel dogs underwent biliary reconstruction using gastric tube harvested, completely separated from the greater curvature, and based on a vascularized pedicle with the right gastroepiploic vessels. The tube was interposed between the common bile duct (CBD and the duodenum. Postoperative mortality, morbidity, liver functions, gross and microscopic histological picture were assessed. The first clinical case was also presented where, in a patient with post-cholecystectomy biliary injury, an isolated pedicled gastric tube was interposed between the proximal and distal ends of the CBD. Results One dog did not recover from anesthesia and another one died postoperatively from septic peritonitis. Five dogs survived the procedure and showed uneventful course and no cholestasis. The mean anastomotic circumference was 4.8 mm (range 4-6 for CBD anastomosis and 6.2 mm (range 5-7 for duodenal anastomosis. Histologically, anastomotic sites showed good evidence of healing. In the first clinical case, the patient showed clinical and biochemical improvement. Endoscopic retrograde cholangiography was feasible and assured patent biliary anastomoses. Conclusion In mongrel dogs, biliary reconstruction using pedicled gastric tube interposition between CBD and duodenum is feasible with satisfactory clinical results, anastomotic circumference and histological evidence of healing. The technique is also feasible in human and seems to be promising.

  13. 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

  14. Excretion of biliary compounds during intrauterine life

    Institute of Scientific and Technical Information of China (English)

    Rocio IR Macias; Jose JG Marin; Maria A Serrano

    2009-01-01

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

  15. Excretion of biliary compounds during intrauterine life

    Science.gov (United States)

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

    2009-01-01

    In adults, the hepatobiliary system, together with the kidney, constitute the main routes for the elimination of several endogenous and xenobiotic compounds into bile and urine, respectively. However, during intrauterine life the biliary route of excretion for cholephilic compounds, such as bile acids and biliary pigments, is very poor. Although very early in pregnancy the fetal liver produces bile acids, bilirubin and biliverdin, these compounds cannot be efficiently eliminated by the fetal hepatobiliary system, owing to the immaturity of the excretory machinery in the fetal liver. Therefore, the potentially harmful accumulation of cholephilic compounds in the fetus is prevented by their elimination across the placenta. Owing to the presence of detoxifying enzymes and specific transport systems at different locations of the placental barrier, such as the endothelial cells of chorionic vessels and trophoblast cells, this organ plays an important role in the hepatobiliary-like function during intrauterine life. The relevance of this excretory function in normal fetal physiology is evident in situations where high concentrations of biliary compounds are accumulated in the mother. This may result in oxidative stress and apoptosis, mainly in the placenta and fetal liver, which might affect normal fetal development and challenge the fate of the pregnancy. The present article reviews current knowledge of the mechanisms underlying the hepatobiliary function of the fetal-placental unit and the repercussions of several pathological conditions on this tandem. PMID:19230042

  16. 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.

  17. 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.

  18. Radiotherapy for pancreas and biliary tree cancers. Gross tumor volume (GeV) and clinical target volume (CTV); Radiotherapie des cancers du pancreas et des cancers des voies biliaires extra-hepatiques. Volume tumoral macroscopique (GTV). Volume-cible anatomoclinique (CTV)

    Energy Technology Data Exchange (ETDEWEB)

    Atlan, D. [Hopital Europeen Georges Pompidou, Oncologie-Radiotherapie, 75 - Paris (France); Mornex, F. [Centre Hospitalier Lyon-Sud, 69 - Pierre Benite (France)

    2001-10-01

    Anatomical data of pancreas, biliary tree, regional lymph nodes is required to define GTV and CTV. In case of postoperative irradiation, CTV is designed in collaboration with radiation oncologist and surgeon oncologist. For exclusive radiotherapy, endo-digestive ultrasonography, CT scan and MRI could help radiation oncologist defining GTV. Although, accuracy of all the imaging techniques in past years remains poor. Currently, no available literature is published regarding security margins for the definition of CTV. Therefore, recommendations according to clinical experience are proposed. (authors)

  19. Management of biliary ascariasis in pregnancy.

    Science.gov (United States)

    Shah, Omar Javed; Robanni, Irfan; Khan, Fayaz; Zargar, Showkat Ali; Javid, Gul

    2005-10-01

    Ascariasis is a helminthic infection of humans caused by the nematode Ascaris lumbricoides. Biliary ascariasis is one of the most common and well described entities caused by ascaris. In endemic areas pregnant women are prone to develop biliary ascariasis. Its management poses a great challenge to both the attending surgeon and the endoscopist. Between January 1993 and March 2003, 15 cases of biliary ascariasis were seen in pregnant patients in our institution. Ultrasonography was used as the main investigative tool. Treatment involved management by conservative, endoscopic, and surgical methods, taking due care of both the mother and the fetus. Ten patients (66.6%) were in the third trimester of pregnancy, and 10 (66.6%) patients were in their third pregnancy. Ultrasonography proved to be the best tool for diagnosing and monitoring worms inside the biliary ductal system. Nine (60%) patients responded to the conservative treatment; endoscopic extraction was successful in 4 (66.6%) patients. Surgical treatment was required in 2 (13.3%) patients. One (6.6%) patient had had spontaneous abortion at 12 weeks gestation, and one (6.6%) patient had a premature labor. The remaining patients had normal pregnancies. Management of biliary ascariasis in pregnancy is a challenge for both the attending surgeon and the endoscopist. Safe and effective management requires special attention to the gestational age and accurate recognition of the specific pathology in the patient. The majority of patients respond to conservative treatment, but endoscopic extraction may be needed in nonresponsive cases. Lead shielding of the fetus and limitation of the total fluoroscopic exposure during therapeutic endoscopy can minimize the teratogenic risk of ionizing radiation. Failures of endoscopic extraction may lead to surgical intervention, which carries risks of fetal wastage and premature labor. Routine worming of women in the child-bearing years is recommended in endemic areas of ascariasis

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

    Institute of Scientific and Technical Information of China (English)

    Vasitha Abeysuriya; Kemal I Deen; Navarathne MM Navarathne

    2010-01-01

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

  1. 先天性胆管扩张症胆道癌变机制研究%The Mechanism of Biliary Carcinogenesis in Congenital Biliary Dilatation

    Institute of Scientific and Technical Information of China (English)

    董倩; 木内武美; 国友一史; 金百祥; 古味信彦; 大西克成

    1994-01-01

    制作动物模型,应用改良的Ames试验对胰胆合流异常胆汁产生致突变性的机制进行探讨,认为胰液与胆汁的合流是先天性胆管扩张症患者胆汁产生致突变性的原因,也是胆道癌变的主要诱因.从预防胆道癌变角度看,强调早期旌行扩张胆总管胆囊切除、胰胆分流手术.%To study the high incidence of biliary carcinoma in patients with congenital biliary dilatation,mutagenicity of the bile in dogs with APBD model was assayed by Ames test.The bile from 2 out of 18 APBD dogs was found to be mutagenic,while the bile from 17 normal dogs was not mutagenic.Furthermore,the bile from 5 APBD dogs treated with.1-nitropyrene(1-NP),a typical environ mental mutagen,was more mutagenic than that from 1-NP-treated normal dogs.When the pancreatic juice was added to the bile from 1-NP-treated normal dogs,the mutagenicity of the bile will increase bly 2.0-fold.Mutagens from the environment are usually absorbed together with food.water or air through alimentary or respiratory tract.and are oxidized and conjugated in the liver.The conjugated mutagen loses its mutagenic activity and is discharged with bile through the intestinal tract.However,in case of APBD,the bile contains a lot of pancreatic juice,which will prevent the conjugation of mutagen,So it makes a high mutagenicity of the bile from APBD dogs or CBD patients.

  2. Inflammatory diseases of the gall bladder and biliary system. Part I: Imaging - cholelithasis - inflammation of the gall bladder; Entzuendliche Erkrankungen der Gallenblase und der Gallenwege. Teil I: Bildgebende Verfahren - Cholelithiasis - Entzuendungen der Gallenblase

    Energy Technology Data Exchange (ETDEWEB)

    Helmberger, H. [Krankenhaus Dritter Orden Muenchen-Nymphenburg (Germany). Abteilung fuer Diagnostische und Interventionelle Radiologie/Nuklearmedizin; Kammer, B. [Haunersches Kinderspital der Ludwig-Maximilians-Universitaet Muenchen (Germany). Abteilung Paediatrische Radiologie

    2005-05-01

    Cholelithiasis is the most common affliction of the gallbladder and biliary tract. Including its complications, gallstone disease represents the basis for cholecystitis and cholangitis in the majority of cases. Inflammatory diseases of the biliary system are divided into acute and chronic forms originating from the gallbladder as well as from the biliary tract. Although acute calculous cholecystitis is the most common form, gangrenous, and emphysematous inflammation of the gallbladder as well as gallbladder empyema are included in this group of diseases. In the chronic forms, calculous and acalculous inflammation is also differentiated. Recent developments in cross-sectional imaging in sonography, computed tomography, and magnetic resonance imaging offer numerous tools for depicting the biliary system with high diagnostic accuracy. Invasive imaging modalities of the biliary system are mainly used for therapeutic aspects. (orig.) [German] Die Cholelithiasis ist die haeufigste Erkrankung von Gallenblase und Gallenwegen. Zusammen mit seinen Komplikationen stellt das Gallensteinleiden zugleich in der Mehrzahl der Faelle die Ursache entzuendlicher Erkrankungen des Gallesystems dar. Dabei wird zwischen akuten und chronischen Formen sowohl der Gallenblase als auch der Gallenwege unterschieden. Zu den akuten Cholezystitiden zaehlen neben der begleitenden Entzuendung beim Gallensteinleiden auch die gangraenoese und emphysematoese Cholezystitis sowie das Gallenblasenempyem. Auch bei den chronischen Formen werden Entzuendungen ohne und mit Steinleiden differenziert. Mit den modernen Schnittbildverfahren Sonographie, Computertomographie und Magnetresonanztomographie stehen zahlreiche Moeglichkeiten der Bildgebung des Gallensystems mit hoher diagnostischer Aussagekraft zur Verfuegung. Die Verfahren der direkten Darstellung des Gallesystems kommen hauptsaechlich im Rahmen der Therapie zum Einsatz. (orig.)

  3. 泌尿系肿瘤患者尿路感染危险因素Logistic回归分析%Logistic Regression Analysis of Risk Factors for Urinary Tract Infection in Patients with Urinary Tract Cancer

    Institute of Scientific and Technical Information of China (English)

    彭传真; 宋兆录; 卜秀娟

    2016-01-01

    Objective To investigate the risk factors of urinary tract infection in patients with tumor in De-partment of urology. Methods a retrospective analysis was made on 200 cases of tumor in Department of Urolo-gy,The tumor associated with urinary tract infection as the observation group,According to 1:1 choice compared with no urinary tract infection of urological patients as the control group,on factors that may affect the first single factor V2 and t test;then the single factor analysis,the difference is statistically significant variables of multiva-riate stepwise logistic regression analysis. Results in 200 patients with urinary tract infection in 26 patients,the incidence rate of 13%;univariate analysis of the seven variables is urinary tract infection effects of risk factors (P < 0. 05),using logistic regression analysis,independent risk factors were screened out,or by value size, followed by age,accompanied by a diagnosis and treatment measures,combined with other diseases. Conclu-sions The incidence of urinary tract infection in patients with tumor in Department of Urology is high,and the factors affecting urinary tract infection are more,and the preventive measures should be given according to the factors.%目的:探讨引起泌尿外科肿瘤住院患者尿路感染的危险因素。方法回顾性分析了200例泌尿外科肿瘤住院病历,将肿瘤合并尿路感染者作为观察组,按1∶1选择同期无尿路感染泌尿外科患者作为对照组,对可能的影响因素先进行了单因素V2、t检验;然后将单因素分析差异有统计学意义的变量进行多元逐步Logistic回归分析。结果200例患者中合并尿路感染26例,发生率为13%;单因素分析了7个变量是尿路感染有影响的危险因素(P<0.05),采用了Logistic回归分析,筛选出独立危险因素,按OR值的大小,依次为年龄大、伴有创诊治措施、合并其他的疾病。结论泌尿外科肿瘤住院患者尿路

  4. 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.)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-09-01

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

  6. Biliary ascariasis: MR cholangiography findings in two cases

    Energy Technology Data Exchange (ETDEWEB)

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

    2001-09-01

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

  7. 妇科老年患者卵巢癌术后尿路感染的临床分析%Clinical analysis and nursing care of urinary tract infections in elderly patients of gynecology department after ovarian cancer surgery

    Institute of Scientific and Technical Information of China (English)

    王蕾

    2013-01-01

    OBJECTIVE To investigate the characteristics and predisposing factors of the urinary tract infections (UTI)in the elderly female patients so as to guide the clinical treatment and nursing and reduce the incidence of urinary tract infections. METHODS A total of 136 cases of patients, who underwent the ovarian cancer surgery in the hospital from Jan 2008 to Dec 2011, were enrolled in the study, and the risk factors associated with the urinary tract infections were analyzed. RESULTS Of totally 136 patients investigated, the urinary tract infections occurred in 49 cases of patients with the incidence rate of 36. 03%; the urinary tract irritation was the predominant clinical performance with the positive rate of 57. 14%. Of totally 49 strains of pathogens isolated , there were 25 (51.02%) strains of gram -positive cocci, 23(46.94%) strains of gram-negative bacilli, and 1 (2.04%) strain of fungi. The comparative study of the urinary tract infection patients and the non-urinary tract infection patients concluded that the incidence of urinary tract infections after the ovarian cancer surgery was related to the urinere-main induced by the primary disease, frequency of catheterization, long-term caththeter indwelling, and underlying diseases, the difference was statistically significantc (P<0. 05). CONCLUSION It is an effective way to reduce the incidence of the urinary tract infections after the ovarian cancer surgery to strengthen the nursing of the catheter indwelling, control the time of catheterization, strictly implement the aseptic techniques, advocate the physiological bladder irrigation , and intensify the mental nursing.%目的 了解老年女性尿路感染的特点,分析其易感因素,从而指导临床治疗和护理,降低尿路感染发生率.方法 对医院2008年1月-2011年12月行卵巢癌手术136例患者的尿路感染的发生进行分析.结果 136例患者共发生尿路感染49例,发生率36.03%;临床表现以尿路刺

  8. Cancer

    Science.gov (United States)

    ... cancer Non-Hodgkin lymphoma Ovarian cancer Pancreatic cancer Testicular cancer Thyroid cancer Uterine cancer Symptoms Symptoms of cancer ... tumor Obesity Pancreatic cancer Prostate cancer Stomach cancer Testicular cancer Throat or larynx cancer Thyroid cancer Patient Instructions ...

  9. Tracking the 2015 Gastrointestinal Cancers Symposium: bridging cancer biology to clinical gastrointestinal oncology

    Directory of Open Access Journals (Sweden)

    Aprile G

    2015-05-01

    Full Text Available Giuseppe Aprile,1 Francesco Leone,2,3 Riccardo Giampieri,4 Mariaelena Casagrande,1 Donatella Marino,2,3 Luca Faloppi,4 Stefano Cascinu,4 Gianpiero Fasola,1 Mario Scartozzi5,6 1Department of Oncology, University and General Hospital, Udine, Italy; 2Medical Oncology Department, University of Turin, 3Institute for Cancer Research and Treatment, Candiolo, Turin, Italy; 4Medical Oncology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Universita Politecnica delle Marche, Ancona, Italy; 5Medical Oncology Department, University of Cagliari, 6General Hospital, Cagliari, Italy Abstract: The 2015 Gastrointestinal Cancers Symposium (San Francisco, CA, USA; January 15–17 is the world-class conference co-sponsored by the American Society of Clinical Oncology, the American Society for Radiation Oncology, the American Gastroenterological Association Institute, and the Society of Surgical Oncology, in which the most innovative research results in digestive tract oncology are presented and discussed. In its twelfth edition, the meeting has provided new insights focusing on the underpinning biology and clinical management of gastrointestinal malignancies. More than 3,400 health care professionals gathered from all over the world to share their experiences on how to bridge the recent novelties in cancer biology with everyday medical practice. In this article, the authors report on the most significant advances, didactically moving on three different anatomic tracks: gastroesophageal malignancies, pancreatic and biliary cancers, and colorectal adenocarcinomas. Keywords: colorectal cancer, gastric cancer, ramucirumab, pembrolizumab, target therapy, onartuzumab, AMG 337

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

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

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

  11. Medical image of the week: ascending cholangitis from biliary obstruction

    Directory of Open Access Journals (Sweden)

    Wong C

    2013-04-01

    Full Text Available A 79 year old man with a history of quadriplegia presented to an outside hospital in septic shock. He was found to have an elevated total bilirubin of 10 mg/dL, direct bilirubin of 7 mg/dL, alkaline phosphatase of 405 U/L, and lipase of 370 U/L. Imaging showed cholelithiasis with likely intra- and extrahepatic biliary duct dilatation. The patient underwent placement of a biliary drain with clinical improvement. Additional imaging was requested prior to endoscopic retrograde cholangiopancreatography (ERCP, but magnetic resonance cholangiopancreatography (MRCP was unavailable due to metallic implants. Interventional radiology performed a cholangiogram using the biliary drain which confirmed biliary obstruction. ERCP was then performed, with significant biliary sludge found and two stents placed.

  12. Parasitic disease of the liver and biliary tree

    Directory of Open Access Journals (Sweden)

    Mohamed Abdulrahman

    1997-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

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

  14. 解偶联蛋白-2、PPARγ在梗阻性黄疸及胆道再通大鼠肝脏氧化损伤中的作用%Roles of uncoupling protein-2 and peroxisome proliferators activated receptors γ in liver oxidative injuy of rats with obstructive jaundice and recannalization of biliary tract

    Institute of Scientific and Technical Information of China (English)

    李蔚; 邬善敏; 温暖; 陈辰; 蔡杰

    2013-01-01

    compared with group A, and those in group C were lower significantly than in group B. The expression levels of PPARγ protein in hepatic tissues in group B were lower significantly than in group A, and those in group C were increased significantly as compared with group B. The expression levels of UCP-2 protein in hepatic tissues in group B were increased significantly as compared with group A, and those in group C were lower significantly than in group B. Under an electron microscope, the ultrastructural changes in group B were more significant than in group A, and those in group C were significantly reduced as compared with group B. Conclusion Obstructive jaundice-induced oxidative damage can cause the changes in the liver function and ultrastructures, and relieving obstruction is beneficial to the recovery of the liver function and ultrastructures. PPARγ may be involved in liver oxidation and oxidation reaction induced by obstructive jaundice and biliary recanalization. UCP-2 may be involved in oxygen free radical removal in liver oxidation damage, reducing liver oxidative damage.

  15. Current options for management of biliary atresia.

    Science.gov (United States)

    Gallo, Amy; Esquivel, Carlos O

    2013-03-01

    It is encouraging that we are improving the technical aspects of treatment modalities for biliary atresia. However, it is clear that more needs to be done to best develop new treatment plans while applying the modalities we have (porto-enterostomy or liver transplantation or both) in a way that will afford the best survival and quality-of-life. This review article will discuss a number of points that are vital to improving care and illustrates the need to further scrutinize treatment decisions.

  16. Amylase creatinine clearance ratio after biliary surgery.

    Science.gov (United States)

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

    1977-01-01

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

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    The Cochrane Hepato-Biliary Group (CHBG) is one of the 52 collaborative review groups within The Cochrane Collaboration. The activities of the CHBG focus on collecting hepato-biliary randomized clinical trials (RCT) and controlled clinical trials (CCT), and including them in systematic reviews wi...

  18. Trends in pediatric ostomy surgery: intestinal diversion for necrotizing enterocolitis and biliary diversion for biliary hypoplasia syndromes.

    Science.gov (United States)

    Bastawrous, A A; Torosian, M B; Statter, M B; Arensman, R M

    1995-11-01

    Ostomies are placed in children for different indications than in the older population. Many ostomies of childhood are placed because of congenital or neonatal problems that require temporary or long-term diversion to stabilize the neonatal patient. Necrotizing enterocolitis, the most common reason for placement of neonatal colostomies and ileostomies, is increasing in frequency as more prematurely born infants survive. Recently, there has been an increase in treatment of various biliary hypoplasia syndromes with biliary cutaneous diversion. Children with biliary hypoplasia syndromes are a challenging group of patients who frequently can be helped by ostomies. This article reviews current information on biliary cutaneous diversion for the biliary hypoplasia syndromes and intestinal diversion for necrotizing enterocolitis.

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

    OpenAIRE

    2013-01-01

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

  20. Qualified Census Tracts

    Data.gov (United States)

    Department of Housing and Urban Development — A Qualified Census Tract (QCT) is any census tract (or equivalent geographic area defined by the Census Bureau) in which at least 50% of households have an income...

  1. Urinary tract infection - adults

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000521.htm Urinary tract infection - adults To use the sharing features on this page, please enable JavaScript. A urinary tract infection, or UTI, is an infection of the urinary ...

  2. The Unfinished Business of Primary Biliary Cirrhosis

    Science.gov (United States)

    Selmi, Carlo; Zuin, Massimo; Gershwin, M. Eric

    2008-01-01

    Summary In nearly every multifactorial human disease, there are three periods that characterize our understanding and definition. First, there is a period in which there is rapid accumulation of descriptive data. Second, there is a longer and slower period as information is obtained that redefines and expands basic and clinical knowledge that lacks the final and important area of understanding aetiology and therapeutic intervention. Third, which is much less common for most diseases, is the vigorous definition of pathobiology and treatment. These phases are well illustrated by our current understanding of primary biliary cirrhosis (PBC). The term PBC was first used nearly 60 years ago and for the first 40 or so years, the primary research efforts were directed at clinical definitions and pathology. Subsequently, with the advent of molecular biology, there began a rigorous dissection of the immune response and, in particular, a better understanding of anti-mitochondrial antibodies. These efforts have greatly helped in our understanding of not only the effector mechanisms of disease, but also the uniqueness of the primary target tissue, biliary epithelium. However, this research has still not led to successful translation for specific therapy. PMID:18640737

  3. [Environmental factors and primary biliary cirrhosis].

    Science.gov (United States)

    Chen, L P; Zhao, H; Lyu, B; Cheng, J L

    2016-07-20

    The complex interplay between immune factors and genetic susceptibility plays an essential role in autoimmune diseases. This is especially true for primary biliary cirrhosis (PBC). PBC is an autoimmune cholestatic liver disease characterized by the destruction of the small intrahepatic bile ducts and the presence of high-titer antimitochondrial antibodies (AMA). Among the currently known risk factors, genetic predisposition remains to be the dominant one. However, it is insufficient to explain the different geographic distributions of PBC and the incomplete concordance in identical twins. This suggests an association between specific environmental factors and the development of PBC. Nevertheless, a clear and rational association of environmental factors with primary biliary cirrhosis has not yet been fully elucidated. Our current understanding of the environmental triggers of PBC is limited to numerous suspected factors involved in its development, such as xenobiotics, electrophilic drugs, infection, and other physical, chemical, and even biological factors. Although the factors leading to the breakdown of immune tolerance in PBC are still largely unknown, related geoepidemiological studies may help us better understand the impact of the environment. In addition, a better understanding of the interplay between environmental factors and PBC is the critical step toward improving our management and control of PBC and autoimmunity in general.

  4. Endoscopic treatment of malignant biliary strictures.

    Science.gov (United States)

    Rustagi, Tarun; Jamidar, Priya A

    2015-01-01

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

  5. Non-invasive endoprosthesis in treatment of biliary fistulas and pancreaticfistulas

    Institute of Scientific and Technical Information of China (English)

    Zhi Wei Sun; De Zhuang Fu; Yi Wo Mo; Yah Jin; Xiu Fang Zhu; Xin Jun Zhang; Ou Qiao; Jian Zhong Tang

    2000-01-01

    AIM To search for a simple and safe method to avoid reoperation, reduce complications and mortality,shorten hospital stay and lower the medical cost.METHODS Based on the characteristic of pathology and anatomy of biliary fistula and pancreatic fistula,modified endoscopic nasobiliary drainage or endoscopic nasopancreas drainage with negative pressure wereused to drain the bile and pancreatic juice to the duodenum and in vitro to facilitate fistulous tract close.RESULTS In seven patients with biliary fistulas with conservative treatment who were not yet recoveredafter 6 - 110 days, the leakage was blocked after 6 - 17 days treatment, and in 6 patients with pancreaticfistulas with conservative treatment who were not recovered after 90 - 720 days, the leakage was blockedafter treatment for 12- 28 days.CONCLUSION The advantages of this modefied method are: retain the function of the Oddi sphincter; the anatomy of the pancreatic duct and bile duct and the position of fistulas can be seen clearly withcontrast examination; the drainage effect was defieate, safe and with less complications; the leakageblock can be promoted with the drainage of negative pressure; and hospital stay is shortened and medicalcost is reduced.

  6. State of the art in advanced endoscopic imaging for the detection and evaluation of dysplasia and early cancer of the gastrointestinal tract

    Directory of Open Access Journals (Sweden)

    Coda S

    2014-05-01

    Full Text Available Sergio Coda,1,2 Andrew V Thillainayagam1,2 1Section of Gastroenterology and Hepatology, Department of Medicine and Photonics Group, Department of Physics, Imperial College London, London, UK; 2Endoscopy Unit, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK Abstract: Ideally, endoscopists should be able to detect, characterize, and confirm the nature of a lesion at the bedside, minimizing uncertainties and targeting biopsies and resections only where necessary. However, under conventional white-light inspection – at present, the sole established technique available to most of humanity – premalignant conditions and early cancers can frequently escape detection. In recent years, a range of innovative techniques have entered the endoscopic arena due to their ability to enhance the contrast of diseased tissue regions beyond what is inherently possible with standard white-light endoscopy equipment. The aim of this review is to provide an overview of the state-of-the-art advanced endoscopic imaging techniques available for clinical use that are impacting the way precancerous and neoplastic lesions of the gastrointestinal tract are currently detected and characterized at endoscopy. The basic instrumentation and the physics behind each method, followed by the most influential clinical experience, are described. High-definition endoscopy, with or without optical magnification, has contributed to higher detection rates compared with white-light endoscopy alone and has now replaced ordinary equipment in daily practice. Contrast-enhancement techniques, whether dye-based or computed, have been combined with white-light endoscopy to further improve its accuracy, but histology is still required to clarify the diagnosis. Optical microscopy techniques such as confocal laser endomicroscopy and endocytoscopy enable in vivo histology during endoscopy; however, although of invaluable assistance for tissue characterization, they have not

  7. ‘Latent’ Portal Hypertension in Benign Biliary Obstruction

    Science.gov (United States)

    Ibrarullah, Md.; Sikora, S. S.; Agarwal, D. K.; Kapoor, V. K.; Kaushik, S. P.

    1996-01-01

    A prospective study was undertaken to evaluate the changes in portal venous pressure in patients with benign biliary obstruction (BBO) but without overt clinical, endoscopic or radiological evidence of portal hypertension. Portal venous pressure was measured at laparotomy in 20 patients (10 each with either benign biliary stricture or choledocholithiasis) before and after biliary decompression. Pressure was found to be on the high side in seven patients (>25 cm of saline in three patients and > 30 cm of saline in four). The mean fall of pressure was 3.4 cm of saline after biliary decompression. No correlation could, however, be found between portal venous pressure and duration of biliary obstruction, serum bilirubin or bile duct pressure. Liver histology showed mild to moderate cholestatic changes but maintained portal architecture in all. Benign biliary obstruction may therefore, lead to elevation of portal pressure, even though the patient may not necessarily have any clinical, endoscopic or radiological manifestations of portal hypertension. The pathogenesis of this ‘latent’ portal hypertension is probably multifactorial. If biliary obstruction is left untreated the development of overt portal hypertension may become a possibility in the future. PMID:8725455

  8. Helicobacter pylori cag pathogenicity island (cagPAI involved in bacterial internalization and IL-8 induced responses via NOD1- and MyD88-dependent mechanisms in human biliary epithelial cells.

    Directory of Open Access Journals (Sweden)

    Wongwarut Boonyanugomol

    Full Text Available Helicobacter pylori infection has been proposed to be associated with various diseases of the hepatobiliary tract, including cancer of the bile duct epithelial cells (cholangiocarcinoma, CCA. The ability of H. pylori bacteria to cause pathogenic effects in these cells has, however, yet to be investigated. Given that the cag pathogenicity island (cagPAI is required for H. pylori pathogenesis in gastric epithelial cells, we investigated wild-type and cag mutant strains for their ability to adhere, be internalized and induce pro-inflammatory responses in two bile duct epithelial cell lines derived from cases of CCA. The findings from these experiments were compared to results obtained with the well-characterized AGS gastric cancer cell line. We showed that the cagPAI encodes factors involved in H. pylori internalization in CCA cells, but not for adhesion to these cells. Consistent with previous studies in hepatocytes, actin polymerization and α5β1 integrin may be involved in H. pylori internalization in CCA cells. As for AGS cells, we observed significantly reduced levels of NF-κB activation and IL-8 production in CCA cells stimulated with either cagA, cagL or cagPAI bacteria, when compared with wild-type bacteria. Importantly, these IL-8 responses could be inhibited via either pre-treatment of cells with antibodies to α5β1 integrins, or via siRNA-mediated knockdown of the innate immune signaling molecules, nucleotide oligomerization domain 1 (NOD1 and myeloid differentiation response gene 88 (MyD88. Taken together, the data demonstrate that the cagPAI is critical for H. pylori pathogenesis in bile duct cells, thus providing a potential causal link for H. pylori in biliary tract disease.

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

    Institute of Scientific and Technical Information of China (English)

    施云星; 王广勇; 曾晓虹; 吕礁; 周国中; 刘长云; 覃林花

    2014-01-01

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

  10. Biliary Peritonitis due to Spontaneous Perforation of Choledochus: A Case Report.

    Science.gov (United States)

    Laway, Mushtaq A; Bakshi, Iftikhar H; Shah, Mubbashir; Paray, Showkat A; Malla, Mohd Sadiq

    2013-06-01

    Spontaneous perforation of common bile duct (CBD) in an adult is an exceedingly rare phenomenon. It is mostly seen in infants due to congenital anomalies. The diagnosis of biliary tract perforations is often delayed due to their nonspecific symptoms, which results in high morbidity. Early diagnosis and aggressive therapy are mandatory to alleviate this condition. Delayed diagnoses and treatment may have more serious consequences in terms of morbidity as well as mortality. We herein report spontaneous perforation of CBD in a middle-aged male who presented to our accident and emergency department with acute abdominal pain. Exploratory laparotomy revealed a small perforation with necrosed margins in the supraduodenal part of CBD, which was managed by a T-tube drain. However, no apparent cause for the perforation was found.

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

    Directory of Open Access Journals (Sweden)

    Enrico Ferri

    2016-04-01

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

  12. Recent advances in endoscopic ultrasonography-guided biliary interventions.

    Science.gov (United States)

    Kawakubo, Kazumichi; Kawakami, Hiroshi; Kuwatani, Masaki; Haba, Shin; Kawahata, Shuhei; Abe, Yoko; Kubota, Yoshimasa; Kubo, Kimitoshi; Isayama, Hiroyuki; Sakamoto, Naoya

    2015-08-28

    Interventional endoscopic ultrasonography (EUS) based on EUS-guided fine-needle aspiration has rapidly spread as a minimally invasive procedure. Especially in patients with failed endoscopic retrograde cholangiopancreatography, EUS-guided biliary intervention is reported to be useful as salvage therapy. EUS-guided biliary interventions are carried out using three techniques: EUS-guided bilioenteric anastomosis, EUS-guided rendezvous procedure, and EUS-guided antegrade treatment. Although interventional EUS is not yet a standardized procedure, there have been recent advances in this field that address various biliary diseases. Here, we summarize the indications, techniques, clinical results of previous studies, and future perspectives.

  13. Transjugular Insertion of Bare-Metal Biliary Stent for the Treatment of Distal Malignant Obstructive Jaundice Complicated by Coagulopathy

    Energy Technology Data Exchange (ETDEWEB)

    Tsauo Jiaywei, E-mail: 80732059@qq.com; Li Xiao, E-mail: simonlixiao@gmail.com; Li Hongcui, E-mail: lihongcui520@126.com; Wei Bo, E-mail: allyooking@tom.com; Luo Xuefeng, E-mail: luobo_913@126.com; Zhang Chunle, E-mail: sugar139000@163.com; Tang Chengwei, E-mail: 20378375@qq.com [West China Hospital of Sichuan University, Department of Gastroenterology and Hepatology (China); Wang Weiping, E-mail: irjournalclub@gmail.com [Section of Interventional Radiology, Cleveland Clinic, Imaging Institute (United States)

    2013-04-15

    This study was designed to investigate retrospectively the feasibility of transjugular insertion of biliary stent (TIBS) for the treatment of distal malignant obstructive jaundice complicated by coagulopathy. Between April 2005 and May 2010, six patients with distal malignant obstructive jaundice associated with coagulopathy that was unable to be corrected underwent TIBS at our institution for the palliation of jaundice. Patients' medical record and imaging results were reviewed to obtain information about demographics, procedure details, complications, and clinical outcomes. The intrahepatic biliary tract was successfully accessed in all six patients via transjugular approach. The procedure was technically successfully in five of six patients, with a bare-metal stent implanted after traversing the biliary strictures. One procedure failed, because the guidewire could not traverse the biliary occlusion. One week after TIBS, the mean serum bilirubin in the five successful cases had decreased from 313 {mu}mol/L (range 203.4-369.3) to 146.2 {mu}mol/L (range 95.8-223.3) and had further decreased to 103.6 {mu}mol/L (range 29.5-240.9) at 1 month after the procedure. No bleeding, sepsis, or other major complications were observed after the procedure. The mean survival of these five patients was 4.5 months (range 1.9-5.8). On imaging follow-up, there was no evidence of stent stenosis or migration, with 100 % primary patency. When the risks of hemorrhage from percutaneous transhepatic cholangiodrainage are high, TIBS may be an effective alternative for the treatment of distal malignant obstructive jaundice.

  14. Biliary peritonitis caused by a leaking T-tube fistula disconnected at the point of contact with the anterior abdominal wall: a case report

    Directory of Open Access Journals (Sweden)

    Nikolić Marko

    2008-09-01

    Full Text Available Abstract Introduction Operations on the common bile duct may lead to potentially serious complications such as biliary peritonitis. T-tube insertion is performed to reduce the risk of this occurring postoperatively. Biliary leakage at the point of insertion into the common bile duct, or along the fistula, can sometimes occur after T-tube removal and this has been reported extensively in the literature. We report a case where the site at which the T-tube fistula leaked proved to be the point of contact between the fistula and the anterior abdominal wall, a previously unreported complication. Case presentation A 36-year-old sub-Saharan African woman presented with gallstone-induced pancreatitis and, once her symptoms settled, laparoscopic cholecystectomy was performed, common bile duct stones were removed and a T-tube was inserted. Three weeks later, T-tube removal led to biliary peritonitis due to the disconnection of the T-tube fistula which was recannulated laparoscopically using a Latex drain. Conclusion This case highlights a previously unreported mechanism for bile leak following T-tube removal caused by detachment of a fistula tract at its contact point with the anterior abdominal wall. Hepatobiliary surgeons should be aware of this mechanism of biliary leakage and the use of laparoscopy to recannulate the fistula.

  15. Upregulation of PDZK1 by Calculus Bovis Sativus May Play an Important Role in Restoring Biliary Transport Function in Intrahepatic Cholestasis

    Directory of Open Access Journals (Sweden)

    Dong Xiang

    2017-01-01

    Full Text Available Intrahepatic cholestasis is a main cause of hepatic accumulation of bile acids leading to liver injury, fibrosis, and liver failure. Our previous studies proved that Calculus Bovis Sativus (CBS can restore biliary transport function through upregulating the multidrug resistance-associated protein 2 (MRP2 and breast cancer resistance protein (BCRP in 17α-ethynylestradiol- (EE- induced intrahepatic cholestasis rats. The regulation mechanism of CBS on these transporters, however, remains unclear. This study was designed to evaluate the possible relationship between the effect of CBS on transport activities and the regulation of CBS on the expression of PDZK1, a mainly scaffold protein which can regulate MRP2 and BCRP. Intrahepatic cholestasis model was induced in rats with injection of EE for five consecutive days and then the biliary excretion rates and cumulative biliary excretions were measured. The mRNA and protein expression levels of PDZK1 were detected by reverse transcription-quantitative real-time polymerase chain reaction, western blot, and immunohistochemical analysis. When treated with CBS, cumulative biliary excretions and mRNA and protein expressions of PDZK1 were significantly increased in intrahepatic cholestasis rats. This study demonstrated that CBS exerted a beneficial effect on EE-induced intrahepatic cholestasis rats by restoring biliary transport function, which may result from the upregulation of PDZK1 expression.

  16. Endoscopic management of hilar biliary strictures

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

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

  17. Bile acid signaling and biliary functions

    Directory of Open Access Journals (Sweden)

    Hannah Jones

    2015-03-01

    Full Text Available This review focuses on various components of bile acid signaling in relation to cholangiocytes. Their roles as targets for potential therapies for cholangiopathies are also explored. While many factors are involved in these complex signaling pathways, this review emphasizes the roles of transmembrane G protein coupled receptor (TGR5, farnesoid X receptor (FXR, ursodeoxycholic acid (UDCA and the bicarbonate umbrella. Following a general background on cholangiocytes and bile acids, we will expand the review and include sections that are most recently known (within 5–7 years regarding the field of bile acid signaling and cholangiocyte function. These findings all demonstrate that bile acids influence biliary functions which can, in turn, regulate the cholangiocyte response during pathological events.

  18. Endoscopic therapy of benign biliary strictures

    Institute of Scientific and Technical Information of China (English)

    Joel R Judah; Peter V Draganov

    2007-01-01

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

  19. Primary Biliary Cirrhosis and Hemolytic Anemia Confusing Serum Bilirubin Levels

    Directory of Open Access Journals (Sweden)

    M Brackstone

    2000-01-01

    Full Text Available Hemolysis is observed in more than 50% of patients with cirrhosis. However, there has been little documention of the association of primary biliary cirrhosis with autoimmune hemolytic anemia. Two cases, found within a single practice, of primary biliary cirrhosis coexisting with autoimmune hemolysis and a third case coexisting with hereditary spherocytosis are presented. Anemia in such patients is commonly attributed to chronic disease, and hyperbilirubinemia is attributed to primary biliary cirrhosis. These patients were considered for liver transplantation until the diagnosis of a comorbid hemolytic process was established. This association may be more prevalent than previously recognized. A diagnosis of comorbid hemolysis must always be considered in context with anemia and serum bilirubin levels that rise out of proportion to the severity of the primary biliary cirrhosis.

  20. Congenital biliary atresia: liver injury begins at birth

    DEFF Research Database (Denmark)

    Makin, Erica; Quaglia, Alberto; Kvist, Nina

    2009-01-01

    -note review for infants with definite BA who underwent laparotomy within first week of life. RESULTS: Three infants were identified who had occlusive BA evident on the first day of life. In all cases, their liver was grossly normal, and histologic changes were trivial. CONCLUSION: This suggests......BACKGROUND: The timing of onset of liver injury in biliary atresia (BA) is not known, although in approximately 10% of cases, biliary pathologic condition associated with the biliary atresia splenic malformation syndrome must begin well before birth. METHODS: The study involved retrospective case...... that the detrimental cholestatic liver injury, later characteristic of BA, only begins from the time of birth despite a prenatal occlusive biliary pathology. It may be that tissue injury only occurs with the onset of the perinatal bile surge initiating periductal bile leakage and the triggering of an inflammatory...

  1. Hepatolithiasis with biliary ascariasis – a case report

    Directory of Open Access Journals (Sweden)

    Khithani AS

    2003-12-01

    Full Text Available Abstract Background Biliary ascariasis is regarded as possible etiological factor for hepatolithiasis. Here we report one case of a patient with hepatolithiasis with biliary ascariasis who developed a liver abscess, which was treated with partial hepatectomy. Case presentation A young adult female presented with epigastric pain and vomiting with repeated attacks of cholangitis. ERCP showed evidence of multiple intrahepatic calculi with the development of abscess in the left lobe of liver. The patient underwent partial hepatectomy and was found to have biliary ascariasis on histology. She was treated with antihelmenthic therapy and has had an uneventful postoperative period of 2 years. Conclusion Biliary ascariasis with hepatolithiasis, although rare, should be considered in endemic countries.

  2. 3 T MR cholangiopancreatography appearances of biliary ascariasis

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-03-15

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

  3. Hormone replacement for osteoporosis in women with primary biliary cirrhosis

    DEFF Research Database (Denmark)

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

    2011-01-01

    Women with primary biliary cirrhosis often suffer from postmenopausal osteoporosis due to their age, or osteoporosis secondary to their liver disease, or treatments provided for their liver disease. Hormone replacement increases bone mineral density and reduces fractures in postmenopausal women...

  4. Biochemical and radiological predictors of malignant biliary strictures

    Institute of Scientific and Technical Information of China (English)

    Ibrahim A. Al-Mofleh; Abdulrahman M. Aljebreen; Saleh M. Al-Amri; Rashed S. Al-Rashed; Faleh Z. Al-Faleh; Hussein M. Al-Freihi; Ayman A. Abdo; Arthur C. Isnani

    2004-01-01

    AIM: Differentiation of benign biliary strictures (BBS) from malignant biliary strictures (MBS) remains difficult despite improvement in imaging and endoscopic techniques. The aim of this study was to identify the clinical, biochemical and or radiological predictors of malignant biliary strictures.METHODS: We retrospectively reviewed all charts of patients who had biliary strictures (BS) on endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous cholangiography (PTC) in case of unsuccessful ERCP from March 1998 to August 2002. Patient characteristics, clinical features, biochemical, radiological and biopsy results were all recorded. Stricture etiology was determined based on cytology,biopsy or clinical follow-up. A receiver operator characteristic (ROC) curve was constructed to determine the optimal laboratory diagnostic criterion threshold in predicting MBS.RESULTS: One hundred twenty six patients with biliary strictures were enrolled, of which 72 were malignant. The mean age for BBS was 53 years compared to 62.4 years for MBS (P=0.0006). Distal bile duct stricture was mainly due to a malignant process 48.6% vs 9% (P=0.001). Alkaline phosphates and AST levels were more significantly elevated in MBS (P=0.0002). R OC curve showed that a bilirubin level of 84 pmol/L or more was the most predictive of MBS with a sensitivity of 98.6%, specificity of 59.3% and a positive likelihood ratio of 2.42 (95% CI=0.649-0.8L0). Proximal biliary dilatation was more frequently encountered in MBS compared to BBS, 73.8% vs39.5% (P=0.0001). Majority of BBS (87%) and MBS (78%) were managed endoscopically.CONCLUSION: A serum bilirubin level of 84 μmol/L or greater is the best predictor of MBS. Older age, proximal biliary dilatation, higher levels of bilirubin, alkaline phosphatase, ALT and AST are all associated with MBS. ERCP is necessary to diagnose and treat benign and malignant biliary strictures.

  5. Biliary cholesterol secretion: More than a simple ABC

    Institute of Scientific and Technical Information of China (English)

    Arne; Dikkers; Uwe; JF; Tietge

    2010-01-01

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

  6. Biliary cholesterol secretion: More than a simple ABC

    OpenAIRE

    Dikkers, Arne; Tietge, Uwe JF

    2010-01-01

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

  7. Biliary excretion of iron and ferritin in idiopathic hemochromatosis

    Energy Technology Data Exchange (ETDEWEB)

    Hultcrantz, R.; Angelin, B.; Bjoern-Rasmussen, E.E.; Ewerth, S.; Einarsson, K.

    1989-06-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2000-01-01

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

  9. Clinical significance of serum levels of vascular endothelial growth factor and its receptor in biliary disease and carcinoma

    Institute of Scientific and Technical Information of China (English)

    Munechika Enjoji; Hajime Nawata; Makoto Nakamuta; Koji Yamaguchi; Kazuhiro Kotoh; Marie Fukushima; Masami Kuniyoshi; Masao Tanaka

    2005-01-01

    AIM: To investigate the clinical significance of serum vascular endothelial growth factor (VEGF) and soluble VEGF receptor-1 (VEGFR1/Flt-1) (sVEGFR1) levels in biliary diseases.METHODS: We analyzed the serum levels of these proteins in patients with acute cholangitis (group 1), biliary malignancies (group 2), and primary biliary cirrhosis or primary sclerosing cholangitis (group 3), and in healthy donors (group 4). The influence of inflammation was also analyzed. Serum VEGF levels were expressed as VEGF per platelet (VEGF/PLT, pg/106) in order to exclude the influence of platelet counts.RESULTS: sVEGFR1 levels were significantly higher in groups 1 and 2 than in the control group, but did not correlate with inflammatory markers. VEGF/PLT levels were generally higher in patients with active inflammation than in those with carcinoma. C-reactive protein strongly correlated with the levels of serum VEGF independently of platelet and leukocyte counts, even in cancer patients. In cancer patients, VEGF/PLT and sVEGFR1 levels might be indicators for evaluating the effect of medical treatment or the disease progression.CONCLUSION: Serum VEGF and VEGFR1 might be useful markers for gauging the clinical effect of various treatments on patients.

  10. Cholangiocarcinomas: New Insights from the Discovery of Stem Cell Niches in Peribiliary Glands of the Biliary Tree

    Directory of Open Access Journals (Sweden)

    Vincenzo Cardinale

    2014-01-01

    Full Text Available Peribiliary glands (PBGs are located in the large intrahepatic and extrahepatic bile ducts. Although they were described many years ago, their functions have been elucidated only in the last couple of years when our group demonstrated that PBGs are niches of multipotent stem/progenitor cells of endodermal origin. These cells express genes of multipotency and can be rapidly differentiated in vitro into hepatocytes, cholangiocytes, and endocrine pancreatic cells. PBGs share common features, in terms of stem/progenitor cell niches, with pancreatic duct glands and colon crypts, glandular structures representing in the adult life the endodermal remnants of fetal life. PBG stem/progenitor cells participate in the renewal of surface biliary epithelium and are active players in chronic pathologies of the biliary tree as well as in cholangiocarcinomas (CCA. Specifically, a large amount of recent evidence indicates that the pure mucin-CCA originates from PBGs; this could explain the similarities with pancreatic ductal adenocarcinoma and colorectal cancer, which also originate from transformed gland cells. In this paper, we summarized our recent findings concerning structure and functions of PBGs with the implications for liver pathophysiology and, specifically, for cancers of the biliary tree.

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

    NARCIS (Netherlands)

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

    2012-01-01

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

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

    NARCIS (Netherlands)

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

    2012-01-01

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

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

    NARCIS (Netherlands)

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

    2012-01-01

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

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  15. Development of a prediction model and estimation of cumulative risk for upper aerodigestive tract cancer on the basis of the aldehyde dehydrogenase 2 genotype and alcohol consumption in a Japanese population

    Science.gov (United States)

    Koyanagi, Yuriko N.; Ito, Hidemi; Oze, Isao; Hosono, Satoyo; Tanaka, Hideo; Abe, Tetsuya; Shimizu, Yasuhiro; Hasegawa, Yasuhisa

    2017-01-01

    Alcohol consumption and the aldehyde dehydrogenase 2 (ALDH2) polymorphism are associated with the risk of upper aerodigestive tract cancer, and a significant gene–environment interaction between the two has been confirmed in a Japanese population. To aid the development of a personalized prevention strategy, we developed a risk-prediction model and estimated absolute risks stratified by a combination of the ALDH2 genotype and alcohol consumption. We carried out two age-matched and sex-matched case–control studies: one (630 cases and 1260 controls) for model derivation and the second (654 cases and 654 controls) for external validation. On the basis of data from the derivation study, a prediction model was developed by fitting a conditional logistic regression model using the following predictors: age, sex, smoking, drinking, and the ALDH2 genotype. The risk model, including a combination of the ALDH2 genotype and alcohol consumption, provided high discriminatory accuracy and good calibration in both the derivation and the validation studies: C statistics were 0.82 (95% confidence interval 0.80–0.84) and 0.83 (95% confidence interval 0.81–0.85), respectively, and the calibration plots of both studies remained close to the ideal calibration line. Cumulative risks were obtained by combining odds ratios estimated from the risk model with the age-specific incidence rate and population size. For heavy drinkers with a heterozygous genotype, the cumulative risk at age 80 was above 20%. In contrast, risk in the other groups was less than 5%. In conclusion, modification of alcohol consumption according to the ALDH2 genotype will have a major impact on upper aerodigestive tract cancer prevention. These findings represent a simple and practical model for personalized cancer prevention. PMID:26862830

  16. 小儿胆汁性腹膜炎及其远期随访%The Biliary Peritonitis and Long-term Follow-up in Infants and Children

    Institute of Scientific and Technical Information of China (English)

    李民驹

    1995-01-01

    分析20例小儿胆汁性腹膜炎的临床表现、误诊原因和病因.其中15例随诊6个月至18年,胆道感染症状反复发作是常见的远期并发症.原来无胆总管囊肿者,如胆总管远端梗阻,术后可形成真性或假性胆总管囊肿.%From 1976 to 1993,20 cases with biliary peritonitis were treated and 15 cases were followed up for 6 months to 18 years.The etiology,diagnosis and prognosis of biliary peritonitis were discussed.It is suggested that the determination of bilirubin in ascitic fluid from paracentesis is important in the diagnosis.The author emphasizes the first choice of operation is external drainage of the biliary tract and the abdominal cavity.The repeated infection of biliary tract is the most common complication during follow-up. Subsequent operation should be performed when the choledochal cyst existed of formed later.

  17. Biliary leakage after urgent cholecystectomy: Optimizationof endoscopic treatment

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    AIM To investigate the results of endoscopic treatmentof postoperative biliary leakage occurring after urgentcholecystectomy with a long-term follow-up.METHODS: This is an observational database studyconducted in a tertiary care center. All consecutivepatientswho underwent endoscopic retrograde cholangiography(ERC) for presumed postoperative biliaryleakage after urgent cholecystectomy in the periodbetween April 2008 and April 2013 were consideredfor this study. Patients with bile duct transection andbiliary strictures were excluded. Biliary leakage wassuspected in the case of bile appearance from eitherpercutaneous drainage of abdominal collection orabdominal drain placed at the time of cholecystectomy.Procedural and main clinical characteristics of allconsecutive patients with postoperative biliary leakageafter urgent cholecystectomy, such as indication forcholecystectomy, etiology and type of leakage, ERCfindings and post-ERC complications, were collectedfrom our electronic database. All patients in whomthe leakage was successfully treated endoscopicallywere followed-up after they were discharged from thehospital and the main clinical characteristics, laboratorydata and common bile duct diameter were electronicallyrecorded.RESULTS: During a five-year period, biliary leakagewas recognized in 2.2% of patients who underwenturgent cholecystectomy. The median time fromcholecystectomy to ERC was 6 d (interquartile range,4-11 d). Endoscopic interventions to manage biliaryleakage included biliary stent insertion with or withoutbiliary sphincterotomy. In 23 (77%) patients after firstendoscopic treatment bile flow through existing surgicaldrain ceased within 11 d following biliary therapeuticendoscopy (median, 4 d; interquartile range, 2-8 d).In those patients repeat ERC was not performed and the biliary stent was removed on gastroscopy. In seven(23%) patients repeat ERC was done within one tofourth week after their first ERC, depending on theextent

  18. Efficacy of multiple biliary stenting for refractory benign biliary strictures due to chronic calcifying pancreatitis

    Science.gov (United States)

    Ohyama, Hiroshi; Mikata, Rintaro; Ishihara, Takeshi; Sakai, Yuji; Sugiyama, Harutoshi; Yasui, Shin; Tsuyuguchi, Toshio

    2017-01-01

    AIM To investigate endoscopic therapy efficacy for refractory benign biliary strictures (BBS) with multiple biliary stenting and clarify predictors. METHODS Ten consecutive patients with stones in the pancreatic head and BBS due to chronic pancreatitis who underwent endoscopic therapy were evaluated. Endoscopic insertion of a single stent failed in all patients. We used plastic stents (7F, 8.5F, and 10F) and increased stents at intervals of 2 or 3 mo. Stents were removed approximately 1 year after initial stenting. BBS and common bile duct (CBD) diameter were evaluated using cholangiography. Patients were followed for ≥ 6 mo after therapy, interviewed for cholestasis symptoms, and underwent liver function testing every visit. Patients with complete and incomplete stricture dilations were compared. RESULTS Endoscopic therapy was completed in 8 (80%) patients, whereas 2 (20%) patients could not continue therapy because of severe acute cholangitis and abdominal abscess, respectively. The mean number of stents was 4.1 ± 1.2. In two (20%) patients, BBS did not improve; thus, a biliary stent was inserted. BBS improved in six (60%) patients. CBD diameter improved more significantly in the complete group than in the incomplete group (6.1 ± 1.8 mm vs 13.7 ± 2.2 mm, respectively, P = 0.010). Stricture length was significantly associated with complete stricture dilation (complete group; 20.5 ± 3.0 mm, incomplete group; 29.0 ± 5.1 mm, P = 0.011). Acute cholangitis did not recur during the mean follow-up period of 20.6 ± 7.3 mo. CONCLUSION Sequential endoscopic insertion of multiple stents is effective for refractory BBS caused by chronic calcifying pancreatitis. BBS length calculation can improve patient selection procedure for therapy. PMID:28101303

  19. Review article: anorexia and cachexia in gastrointestinal cancer.

    Science.gov (United States)

    Ockenga, J; Valentini, L

    2005-10-01

    In patients with gastrointestinal malignancies, i.e. cancers of the stomach, colon, liver, biliary tract or pancreas, progressive undernutrition can be regularly observed during the course of illness. Undernutrition significantly affects the patients' quality of life, morbidity and survival. Pathogenetically, two different causes are relevant in the development of undernutrition in patients with gastrointestinal cancer. One cause is reduced nutritional intake. This condition is referred to as anorexia and can be worsened by the side effects of cancer therapy. The other cause is the release of endogenous transmitters and/or other products of the tumour leading to the cachexia syndrome, which is characterized by loss of body weight, negative nitrogen balance and fatigue. Cancer anorexia and cancer cachexia may have synergistic negative effects in affecting the patients' status. In this review, current nutritional support strategies with respect to different clinically relevant situations are described. An algorithm of the treatment strategies, including dietetic counselling, oral supplements, enteral and parenteral nutritional support is given. One focus is the approach of nutrition-focused patient care, which shows promising results. In addition, the possibilities of pharmacological intervention are discussed.

  20. 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

  1. ABO blood type, diabetes and risk of gastrointestinal cancer in northern China

    Institute of Scientific and Technical Information of China (English)

    Yan Gong; Yun-Sheng Yang; Xiao-Mei Zhang; Ming Su; Jean Wang; Jin-Dong Han; Ming-Zhou Guo

    2012-01-01

    AIM: To explore the potential risk factors related to gastrointestinal cancer in northern China.METHODS: A total of 3314 cases of gastrointestinal cancer (esophageal, gastric, pancreatic and biliary) and 2223 controls (including healthy individuals, glioma and thyroid cancer) were analyzed by case-control study. Multivariable logistic regression analysis was applied to evaluate the association between different cancers and hepatitis B surface antigen, sex, age, blood type, diabetes, or family history of cancer.RESULTS: Type 2 diabetes was significantly associated with gastric, biliary and pancreatic cancer with an OR of 2.0-3.0. Blood type B was significantly associated with esophageal cancer [odd ratio (OR) = 1.53, 95% confidence interval (CI) = 1.10-2.14] and biliary cancer (OR = 1.49, 95% CI = 1.09-2.05). The prevalence of type 2 diabetes was significantly higher in gastric, biliary and pancreatic cancers compared with other groups, with ORs ranging between 2.0 and 3.0. Family history of cancer was strongly associated with gastrointestinal compared with other cancers.CONCLUSION: Blood type B individuals are susceptible to esophageal and biliary cancer. Type 2 diabetes is significantly associated with gastric, biliary and especially pancreatic cancer.

  2. Studies of cholecystokinin-stimulated biliary secretions reveal a high molecular weight copper-binding substance in normal subjects that is absent in patients with Wilson's disease.

    Science.gov (United States)

    Iyengar, V; Brewer, G J; Dick, R D; Chung, O Y

    1988-03-01

    Copper is unique among cations in that its balance is regulated by the liver. The liver regulates copper balance by excretion of copper (we call it regulatory copper) in the bile destined for loss in the stool. However, most copper secreted into the gastrointestinal tract, for example, that in saliva and gastric juice, is reabsorbed. The biochemical mechanism by which the normal liver "packages" regulatory copper to prevent its reabsorption is not understood. Whatever the mechanism, it appears to have failed in Wilson's disease, because patients with Wilson's disease do not excrete adequate amounts of regulatory copper in their bile to prevent copper accumulation. In the present work, we have studied cholecystokinin-stimulated biliary secretions obtained by intestinal intubation of five normal subjects and five patients with Wilson's disease. Studies of these secretions reveal: (1) that normal but not Wilson's disease biliary samples had a copper-containing peak in the void volume from Sephadex G-75 columns; (2) that the amount of copper in this peak extrapolated to 24 hours of secretion was appropriate to maintain normal copper balance; (3) that the amount of copper in this peak increased with dietary copper supplementation of normal subjects; (4) that normal but not Wilson's disease biliary samples cross-reacted with each of two ceruloplasmin antibodies; and (5) that the high molecular weight Sephadex G-75 fraction from normal but not from Wilson's disease biliary samples cross-reacted with ceruloplasmin antibody. We postulate that the high molecular weight copper-containing substance observed with Sephadex chromatography in normal biliary samples but absent in Wilson's disease samples is the copper-packaging mechanism for copper balance regulation.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. 心理护理及健康教育对消化道肿瘤化疗患者的影响%Influence of psychological care and health education on patients with digestive tract cancer receiving chemotherapy

    Institute of Scientific and Technical Information of China (English)

    付淑云; 曹安香; 王庆红; 林美雄

    2010-01-01

    目的 研究心理护理及健康教育对消化道肿瘤化疗患者异常情绪的影响.方法 回顾性分析2005年7月至2009年7月收治的消化道恶性肿瘤病例245例,对147例恶性消化道肿瘤化疗患者进行常规治疗的同时实施心理护理及健康教育.列为干预组,并以进行基本护理的98例为对照组,对2组化疗前后焦虑、抑郁指数为指标分析其临床疗效.结果 化疗后干预组的SAS、SDS评分均显著低于基本护理组,而生存时间显著高于基本护理组.结论 心理护理及健康教育干预使肿瘤化疗患者异常情绪程度明显减轻,生存时间也得到显著延长.%Objective To study the impact of psychological care and health education on patients with digestive tract cancer and abnormal emotion receiving chemotherapy. Methods A retrospective analysis was carried out in 245 patients with malignant digestive tract cancer from July 2005 to July 2009 treated in our hospital, 147 cases of these patients received psychological care and health education besides conventional therapy were set as the intervention group, 98 cases given only basic nursing care were set as the control group. The clinical efficacy was analyzed in the two groups before and after chemotherapy using anxiety and depression indexes as indicators. Results After chemotherapy, SAS and SDS scores were significantly lower, while the survival time was significantly higher in the intervention group than those of the control group. Conclusions Psychological care and health education can reduce abnormal emotion in patients with malignant digestive tract cancer receiving chemotherapy and prolonged their survival time.

  4. Cognition of nutrition knowledge in patients with digestive tract cancer: a qualitative study%消化系统肿瘤患者对营养知识认知的质性研究

    Institute of Scientific and Technical Information of China (English)

    李成; 王维利; 章新琼; 张森; 张璟

    2013-01-01

    目的 探讨消化系统肿瘤患者对营养知识的认知现状及教育需求,为开展营养知识健康教育提供参考.方法 采用目的抽样法抽取安徽省某综合性三甲医院的15例消化系统肿瘤患者,运用半结构式深入访谈法收集资料,采用Colaizzi内容分析法分析资料.结果 经分析,提取出4个主题:学习营养知识的态度;营养知识的储备;营养知识的应用;营养知识的获取方式.结论 消化系统肿瘤患者学习营养知识态度良好,但营养知识水平及行为有待提高.医护人员应采取灵活多样的营养知识教育方法,满足患者的需求.%Objective To explore cognition of nutrition knowledge in patients with digestive tract cancer and their education needs,and to provide information for nutrition education.Methods Fifteen patients with digestive tract cancer were chosen in a general tertiary hospital in Anhui province.Data were collected by using semi-structured in-depth interviews and were analyzed with the Colaizzi analysis of phenomenological method.Results Four themes were identified:attitudes toward learning nutrition knowledge,nutrition knowledge reserve,application,and access.Conclusion Patients with digestive tract cancer have positive attitudes toward learning nutrition knowledge,but their nutrition knowledge and behaviors should be improved.Healthcare workers should