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1

Progressive balloon dilatation following hepaticojejunostomy improves outcome of bile duct stricture after iatrogenic biliary injury  

PubMed Central

Background Iatrogenic biliary stricture (IBS) is a disastrous complication of cholecystectomy. Although the endoscopic treatments are well accepted as initial attempts for IBS, surgical hepaticojejunostomy (HJ) is often necessary for a considerable proportion of patients. However, the anastomotic stricture after HJ also occurs. Methods In the present study, a new procedure, progressive balloon dilation following HJ (HJPBD), was designed and utilized in the IBS treatment. We retrospectively compared HJPBD with the traditional HJ in term of the outcomes when used for IBS treatment. Results Between January 1997 and December 2009, 112 patients with IBS attributed to cholecystectomy enrolled in our hospital were treated with surgical reconstruction with either HJ (n=58) or HJPBD (n=54). Of the 58 patients in HJ group, 48 patients (82.8%) had a successful outcome, while 52 out of 54 patients (96.3%) in HJPBD group achieved success. The successful surgical reconstruction rates were significantly different between these two groups, with a further improved outcome in patient undergone progressive balloon dilation following HJ. Additionally, 8 of the 10 failure cases in HJ group were successfully rescued by HJPBD procedure. Conclusions Our findings suggest that the new procedure of HJPBD could be successfully applied to IBS patients, and significantly improve the outcome of IBS reconstruction.

2013-01-01

2

A case of biliary atresia with cystic dilatation of the extrahepatic bile duct and polysplenia syndrome.  

PubMed

A 79-day-old girl presented with jaundice and acholia. Laboratory findings disclosed elevated levels of bilirubin, transaminases, and gamma-glutamyl transferase. A chest X-ray film showed dextrocardia. A computed tomographic scan revealed a cystic mass at the porta hepatis, multiple spleens in the right side of the abdomen, and absence of the inferior vena cava. Under the diagnosis of biliary atresia (BA) (I-cyst) associated with polysplenia syndrome, a hepatic portojejunostomy was performed at 80 days of age. The postoperative course was uneventful, and the jaundice cleared. Although the occurrence of associated anomalies in BA is rare, polysplenia is most commonly seen, and its incidence is reported to be 2% to 10%. Patients with BA and polysplenia usually have a poor prognosis, however, this patient may have a good prognosis due to uneventful recovery from the jaundice. PMID:11149405

Shiono, S; Yamagiwa, I; Obata, K; Okuyama, N; Ouchi, T; Shimazaki, Y

2000-01-01

3

Congenital dilatation of the intrahepatic bile ducts with cholangiocarcinoma  

Microsoft Academic Search

Intrahepatic cholangiocarcinomas were found at necropsy in two previously reported cases of congenital dilatation of the intrahepatic bile ducts. The nature of the developmental abnormality is discussed and compared with other forms of biliary dilatation. Slow-flowing bile for many years probably leads to cholangiocarcinoma.

P. J. Gallagher; R. R. Millis; M. J. Mitchinson

1972-01-01

4

Computed tomography of localized dilatation of the intrahepatic bile ducts  

SciTech Connect

Twenty-nine patients showed localized dilatation of the intrahepatic bile ducts on computed tomography, usually unaccompanied by jaundice. Congenital dilatation was diagnosed when associated with a choledochal cyst, while cholangiographic contrast material was helpful in differentiating such dilatation from a simple cyst by showing its communication with the biliary tract when no choledochal cyst was present. Obstructive dilatation was associated with intrahepatic calculi in 4 cases, hepatoma in 9, cholangioma in 5, metastatic tumor in 5, and polycystic disease in 2. Cholangioma and intrahepatic calculi had a greater tendency to accompany such localized dilatation; in 2 cases, the dilatation was the only clue to the underlying disorder.

Araki, T.; Itai Y.; Tasaka, A.

1981-12-01

5

The effect of time and cholecystectomy on experimental biliary tree dilatation. A multi-imaging evaluation.  

PubMed

The changes of the biliary tree following distal bile duct obstruction and its release were confirmed by biliary scintigraphy and monitored by serial ultrasonography, computed tomography, and values of serum bilirubin and alkaline phosphatase in 14 mongrel dogs. The degree and rate of biliary dilatation were independent of cholecystectomy. The most rapid rate of extrahepatic dilatation occurred within the first 48 hours, while dilated intrahepatic ducts were first recognized three to six days after obstruction. Following release of the obstruction, the degree and rate of resolution of the biliary dilatation were independent of the duration of ligation (one vs. two weeks) and cholecystectomy. The dilatation resolved slowly. Dilated intrahepatic ducts were recognized for as long as eight to 13 days, while extrahepatic biliary dilatation was still present for 13 weeks, at which time the experiment was terminated. It is postulated that the extrahepatic biliary dilatation will approach a plateau approximately one month after total biliary obstruction. It appears that if the obstruction lasts more than one week, it results in irreversible damage to the elasticity of the extrahepatic ducts. Thus, after release of the obstruction, serial biliary imaging is indicated until a new baseline of the biliary tree diameter has been established. PMID:3897118

Raptopoulos, V; Fabian, T M; Silva, W; D'Orsi, C J; Karellas, A; Compton, C C; Krolikowski, F J; Doherty, P; Smith, E H

6

Biliary atresia with aneurysmal dilatation of hepatic artery: A rare anomaly  

PubMed Central

INTRODUCTION The coexistent biliary atresia with aneurysmal dilatation of hepatic artery is a rare association. To know these anomalies will avoid many per operative complications. It is also important to mention that these children require liver transplantation in the long run then these vascular anomalies become more relevant. PRESENTATION OF CASE A four month old male child presented with features of biliary atresia. On exploration a cystic expansile mass was detected beneath thread like common bile duct. Subsequent aspiration and studies proved it to be aneurysmal dilatation of hepatic artery. DISCUSSION With biliary atresia many vascular and cardiac malformations have been described but aneurysmal dilatation of hepatic artery is a rare association. These anomalies may have impact on aetiopathogenesis of biliary atresia and also future liver transplantation. CONCLUSION Awareness of rare association of hepatic artery aneurysm with biliary atresia will help in understanding aetiopathogenesis of biliary atresia and planning liver transplantation in such cases.

Kumar, Bindey; Sinha, Neelam; Kumar, Prem; Hasan, Zaheer; Priyadarshi, Rajiv Nayan; Anand, Utpal; Mandal, Manish

2012-01-01

7

Choledochal cyst with bile duct dilatation: sonography and /sup 99m/Tc IDA cholescintigraphy  

SciTech Connect

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

Han, B.K.; Babcock, D.S.; Gelfand, M.H.

1981-06-01

8

The impact of duct-to-duct interaction on the hex duct dilation  

SciTech Connect

Dilation of the hex duct is an important factor in the operational lifetime of fuel subassemblies in liquid metal fast reactors. It is caused primarily by the irradiation-enhanced creep and void swelling of the hex duct material. Excessive dilation may jeopardize subassembly removal from the core or cause a subassembly storage problem where the grid size of the storage basket is limited. Dilation of the hex duct in Experimental Breeder Reactor II (EBR-II) limits useful lifetime because of these storage basket limitations. It is, therefore, important to understand the hex duct dilation behavior to guide the design and in-core management of fuel subassemblies in a way that excessive duct deformation can be avoided. To investigate the dilation phenomena, finite-element models of the hex duct have been developed. The inelastic analyses were performed using the structural analysis code, ANSYS. Both Type 316 and D9 austenitic stainless steel ducts are considered. The calculated dilations are in good agreement with profilometry measurements made after irradiation. The analysis indicates that subassembly interaction is an important parameter in addition to neutron fluence and temperature in determining hex duct dilation. 5 refs.

Lee, M.J.; Chang, L.K.; Lahm, C.E.; Porter, D.L.

1992-01-01

9

The impact of duct-to-duct interaction on the hex duct dilation  

SciTech Connect

Dilation of the hex duct is an important factor in the operational lifetime of fuel subassemblies in liquid metal fast reactors. It is caused primarily by the irradiation-enhanced creep and void swelling of the hex duct material. Excessive dilation may jeopardize subassembly removal from the core or cause a subassembly storage problem where the grid size of the storage basket is limited. Dilation of the hex duct in Experimental Breeder Reactor II (EBR-II) limits useful lifetime because of these storage basket limitations. It is, therefore, important to understand the hex duct dilation behavior to guide the design and in-core management of fuel subassemblies in a way that excessive duct deformation can be avoided. To investigate the dilation phenomena, finite-element models of the hex duct have been developed. The inelastic analyses were performed using the structural analysis code, ANSYS. Both Type 316 and D9 austenitic stainless steel ducts are considered. The calculated dilations are in good agreement with profilometry measurements made after irradiation. The analysis indicates that subassembly interaction is an important parameter in addition to neutron fluence and temperature in determining hex duct dilation. 5 refs.

Lee, M.J.; Chang, L.K.; Lahm, C.E.; Porter, D.L.

1992-07-01

10

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

PubMed Central

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

2010-01-01

11

Naso-lacrimal duct balloon dilatation.  

PubMed

During a 30 month period (June 1991 to December 1993) 22 stenosed naso-lacrimal ducts in 18 patients were treated by balloon dilatation. A technical success rate of 86% was achieved, and the clinical success rate was 68%, in terms of either completely relieving or greatly improving the patients' symptoms of epiphora. The mean follow-up was 17 months. No complications were encountered. PMID:7955845

McCullough, K M

1994-11-01

12

Choledochal cyst with bile duct dilatation: sonography and /sup 99/mTc IDA cholescintigraphy  

SciTech Connect

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

Han, B.K.; Babcock, D.S.; Gelfand, M.H.

1981-06-01

13

Dilated common duct sign. A potential indicator of a sphincter of Oddi dyskinesia  

SciTech Connect

The cholescintigraphic findings of a Sphincter of Oddi dyskinesia (SOD) in a 45-year-old woman with persistent right upper quadrant pain and biliary colic are reported. After an overnight fast, the patient was injected with 5 mCi of Tc-99 disofenin and .02 micrograms/kg of cholecystokinin (CCK) post maximal gallbladder filling. Pre and postcholescintiscans were obtained and gallbladder ejection fractions determined. The hepatobiliary scan was normal, except for a delay in biliary-bowel transit. The gallbladder responded normally to CCK, however, the Sphincter of Oddi responded abnormally, as there was a paradoxical response to CCK manifested by a marked dilatation of the common bile duct. It was postulate that this dilatation (the dilated common duct sign) was due to an inappropriate response of the smooth muscle of the Sphincter of Oddi (contraction vs relaxation) to CCK and was the cause of this patient's biliary colic. The dilated common duct sign should alert the physician to the possibility of a Sphincter of Oddi dyskinesia.

DeRidder, P.; Fink-Bennett, D.

1984-05-01

14

Intraductal papillary neoplasm of the bile duct accompanying biliary mixed adenoneuroendocrine carcinoma  

PubMed Central

We present the first case of an intraductal papillary neoplasm of the bile duct (IPNB) accompanying a mixed adenoneuroendocrine carcinoma (MANEC). A 74-year-old woman presented with fever of unknown cause. Laboratory data revealed jaundice and liver injury. Contrast-enhanced computed tomography revealed a 20 mm polypoid tumor in the dilated distal bile duct, which exhibited early enhancement and papillary growth. Upper gastrointestinal endoscopy revealed mucus production from the papilla of Vater, characterized by its protruding and dilated orifice. Endoscopic ultrasonography visualized the polypoid tumor in the distal bile duct, but no invasive region was suggested by diagnostic imaging. Therefore, the initial diagnosis was IPNB. After endoscopic nasobiliary drainage, a pylorus-preserving pancreaticoduodenectomy was performed. Pathological examination of the resected bile duct revealed papillary proliferation of biliary-type cells with nuclear atypia, indicating pancreaticobiliary-type IPNB. In addition, solid portions comprised of tumor cells with characteristic salt-and-pepper nuclei were evident. Immunohistochemistry revealed expression of the neuroendocrine marker synaptophysin in this solid component, diagnosing it as a neuroendocrine tumor (NET). Furthermore, the MIB-1 proliferation index of NET was higher than that of IPNB, and microinvasion of the NET component was found, indicating neuroendocrine carcinoma (NET G3). This unique case of MANEC, comprising IPNB and NET, provides insight into the pathogenesis of biliary NET.

Onishi, Ichiro; Kitagawa, Hirohisa; Harada, Kenichi; Maruzen, Syogo; Sakai, Seisyo; Makino, Isamu; Hayashi, Hironori; Nakagawara, Hisatoshi; Tajima, Hidehiro; Takamura, Hiroyuki; Tani, Takashi; Kayahara, Masato; Ikeda, Hiroko; Ohta, Tetsuo; Nakanuma, Yasuni

2013-01-01

15

Biliary scintigraphy with DISIDA. A simpler way of showing bile duct patency in suspected biliary atresia.  

PubMed Central

99mTC-diisopropyl iminodiacetic acid (DISIDA) scintigraphy after oral phenobarbitone treatment accurately indicated bile duct patency or obstruction in 28 of 32 (87%) infants, aged less than 12 weeks, with suspected biliary atresia. This investigation is more rapid than and as accurate as the 131I Rose-Bengal faecal excretion test.

Dick, M C; Mowat, A P

1986-01-01

16

Transhepatic Balloon Dilatation of Early Biliary Strictures in Pediatric Liver Transplantation: Successful Initial and Mid-Term Outcome  

SciTech Connect

Purpose: To evaluate the initial and mid-term outcomes of transhepatic balloon dilatation for the treatment of early biliary strictures in lateral left-segment liver transplants in young children.Methods: Between April 1997 and May 2001, seven children aged 9 months to 6 years with nine benign strictures in left-segment liver grafts were treated percutaneously. Sessions of two or three dilations were performed three or four times at average intervals of 10-20 days. In each session, the biliary stenoses were gradually dilated using balloons of 3-7 mm. Follow-up ranged from 12 to 54 months (mean 27 months, median 12 months). Clinical success was defined as resolution of the stenosis, normalization of liver enzymes and lack of clinical symptoms. Results: Technical success was achieved in all nine strictures. Hemobilia occurred in one patient and was successfully treated. On follow-up, all patients had complete clinical recovery with normalization of liver function and imaging of patent bile ducts. Conclusion: Balloon dilatation is an effective and relatively safe method for the treatment of early biliary strictures in left-segment liver transplantation in young children. We recommend this approach as the initial treatment for early strictures. Metal stents or surgery should be reserved for patients with late appearance of strictures or failure of balloon dilatation.

Belenky, Alexander [Rabin Medical Center, Department of Radiology (Israel); Mor, Eytan [Rabin Medical Center, Department of Transplantation (Israel); Bartal, Gabriel [Hillel-Yaffe Medical Center, Department of Radiology (Israel); Atar, Eli [Rabin Medical Center, Department of Radiology (Israel); Shapiro, Riki [Schneider Children's Medical Center of Israel and Sackler Faculty of Medicine, Tel Aviv University, Institute of Pediatric Gastroenterology (Israel); Bar-Nathan, Nathan [Rabin Medical Center, Department of Transplantation (Israel); Bachar, Gil N. [Rabin Medical Center, Department of Radiology (Israel)], E-mail: drbachar@netvision.net.il

2004-09-15

17

[Bile duct dilatation associated with pancreatic heterotopia: a case report].  

PubMed

Pancreatic heterotopia or aberrant pancreas is a rare congenital anomaly, usually asymptomatic. Its diagnosis is difficult. We report an original observation in an 8-month-old infant, operated in the neonatal period for esophageal atresia type III in the context of VACTERL syndrome, cystic dilatation of the bile duct, and pancreatic heterotopia. PMID:21216134

Atarraf, K; Lachqar, M; Znati, K; Elfatemi, H; Arroud, M; Rami, M; Khattala, K; El Madi, A; Amarti, A; Hida, M; Afifi, A; Bouabdallah, Y

2011-01-07

18

Severity of mastalgia in relation to milk duct dilatation  

Microsoft Academic Search

ObjectiveThe etiology of mastalgia is poorly understood. Histology cannot detect any distinct characteristics. This investigation therefore applied ultrasonography to mastalgia patients to investigate morphological structures and to obtain further insights into the pathophysiology of mastalgia. The aim of the study was to analyze the significance of milk duct dilatation in patients with mastalgia.

Friedolf Peters; Petra Diemer; Olaf Mecks; L. ütje J Behnken

2003-01-01

19

Biliary sphincterotomy is not required for bile duct stent placement.  

PubMed

BACKGROUND: The aim of the present study was to assess the success and outcome of bile duct stent placement without the use of endoscopic biliary sphincterotomy (EBS). PATIENTS AND METHODS: Over a period of 10 years and 9 months, all patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) were prospectively identified. Bile duct stent placement was routinely done without EBS unless additional therapy (stone removal, multiple stenting) was anticipated. RESULTS: Of 5020 patients who underwent ERCP, bile duct stents were placed in 1668 patients. After excluding those requiring additional endoscopic therapy, 1112 patients (89.5%) had ERCP and stent placement without a sphincterotomy and 130 patients (10.5%) had ERCP and stent placement with asphincterotomy. Deployed endoprostheses were self-expandable metallic stents in 15.7% and plastic in 77.5%. Caliber of plastic stents was 10?Fr in 78.9% and <10?Fr in 21.1%. All stents were successfully placed in these 1112 patients without the need for EBS. Comparing patients undergoing bile duct stenting with and without sphincterotomy, no difference was seen in rates of pancreatitis (1.54% vs 2.07%, P?>?0.9999). CONCLUSION: Single bile duct stents, both plastic and metal, can be deployed without EBS. PMID:23517140

Wilcox, C Mel; Kim, Hwasoon; Ramesh, Jayapal; Trevino, Jessica; Varadarajulu, Shyam

2013-03-20

20

Operative ultrasound of the liver and biliary ducts  

SciTech Connect

This book describes the intraoperative use of sonography of the liver and biliary ducts which opens up new perspectives for the surgeon. The diagnosis of tumors becomes much more sensitive and efficient with intraoperative ultrasound than with preoperative transcutaneous sonography of intraoperative palpation. Sonographically aimed puncture and balloon-tipped catheter occlusion of segments or subsegment branches of the portal vein allow on the one hand local blue marking, and on the other hand local bloodlessness during the operation. Surgery of liver tumors thus becomes much more precise.

Bismuth, H.; Castaing, D.

1987-01-01

21

Safety and efficacy of the percutaneous treatment of bile leaks in hepaticojejunostomy or split-liver transplantation without dilatation of the biliary tree.  

PubMed

Biliary leaks complicating hepaticojejunostomy (HJA) or fistulas from cut surface are severe complications after liver transplantation (LT) and split-liver transplantation (SLT). The aim of the study was to describe our experience about the safety and efficacy of radiological percutaneous treatment without dilatation of intrahepatic biliary ducts. From 1990 to 2006, 1595 LTs in 1463 patients were performed in our center. In 1199 LTs (75.2%), a duct-to-duct anastomosis was performed, and in 396 (24.8%), an HJA was performed. One hundred twenty-nine anastomotic or cut-surface bile leakages occurred in 115 patients. Sixty-two biliary leaks occurred in 54 patients with HJA; in 48 cases, an anastomotic fistula was found. Cut-surface fistulas occurred in 14 cases: 5 in right SLTs and 5 in left SLTs. Twenty-two patients were treated with 23 percutaneous approaches for 17 HJA fistulas and 6 cut-surface leaks without intrahepatic bile duct dilatation. Two percutaneous therapeutic approaches were used: percutaneous transhepatic biliary drainage (PTBD) for fistula alone and PTBD with percutaneous drainage of biliary collection in patients with both complications. PTBD was successful in 21 cases (91.3%); the median delay from catheter insertion and leak resolution was 10.3 days (range: 7-41). The median maintenance of drainage was 14.8 days. In 1 patient, fistula recurrence after PTBD needed a surgical approach; after that, an anastomotic fistula was still found, and a new PTBD was successfully performed. In another patient, PTBD was immediately followed by retransplantation for portal vein thrombosis. There were no complications related to the interventional procedure. In conclusion, biliary fistulas after HJA in LT or after SLT can be successfully treated by PTBD. The absence of enlarged intrahepatic biliary ducts should not be a contraindication for percutaneous treatment. PMID:18433033

Righi, Dorico; Franchello, Alessandro; Ricchiuti, Alessandro; Breatta, Andrea Doriguzzi; Versace, Karine; Calvo, Amedeo; Romagnoli, Renato; Fonio, P; Gandini, Giovanni; Salizzoni, Mauro

2008-05-01

22

Biliary complications in adult living donor liver transplantation with duct-to-duct hepaticocholedochostomy or Roux-en-Y hepaticojejunostomy biliary reconstruction  

Microsoft Academic Search

Background. The aim of this study was to compare the incidence of biliary complications after adult living donor liver transplantation (ALDLT) with Roux-en-Y hepaticojejunostomy (R-Y HJ) or duct-to-duct hepaticocholedochostomy (D-D HC). Methods. Biliary complications were reviewed in 20 consecutive ALDLT recipients surviving more than 1 month, including 10 patients who underwent R-Y HJ and 10 patients who underwent D-D HC

Shigeyuki Kawachi; Motohide Shimazu; Go Wakabayashi; Ken Hoshino; Minoru Tanabe; Masashi Yoshida; Yasuhide Morikawa; Masaki Kitajima

2002-01-01

23

Reduction of Biliary Complication Rate Using Continuous Suture and No Biliary Drainage for Duct-to-Duct Anastomosis in Whole-Organ Liver Transplantation  

Microsoft Academic Search

Biliary complications (BC) following orthotopic liver transplantation (OLT) are related to various factors including surgical technique and use of biliary drains for a duct-to-duct (DD) anastomosis. Herein we have reported the influence of changes in surgical technique on BC following OLT in our center. From February 2002 to February 2007, we performed 101 whole-organ OLT with a DD anastomosis in

M. Wojcicki; J. Lubikowski; R. Klek; M. Post; K. Jarosz; A. Bia?ek; M. Wunch; M. Czuprynska

2009-01-01

24

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

PubMed Central

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

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

2009-01-01

25

Regulation of intrahepatic biliary duct morphogenesis by Claudin 15-like b  

PubMed Central

The intrahepatic biliary ducts transport bile produced by the hepatocytes out of the liver. Defects in biliary cell differentiation and biliary duct remodeling cause a variety of congenital diseases including Alagille Syndrome and polycystic liver disease. While the molecular pathways regulating biliary cell differentiation have received increasing attention (Lemaigre, 2010), less is known about the cellular behavior underlying biliary duct remodeling. Here, we have identified a novel gene, claudin 15-like b (cldn15lb), which exhibits a unique and dynamic expression pattern in the hepatocytes and biliary epithelial cells in zebrafish. Claudins are tight junction proteins that have been implicated in maintaining epithelial polarity, regulating paracellular transport, and providing barrier function. In zebrafish cldn15lb mutant livers, tight junctions are observed between hepatocytes, but these cells show polarization defects as well as canalicular malformations. Furthermore, cldn15lb mutants show abnormalities in biliary duct morphogenesis whereby biliary epithelial cells remain clustered together and form a disorganized network. Our data suggest that Cldn15lb plays an important role in the remodeling process during biliary duct morphogenesis. Thus, cldn15lb mutants provide a novel in vivo model to study the role of tight junction proteins in the remodeling of the biliary network and hereditary cholestasis.

Cheung, Isla D.; Bagnat, Michel; Ma, Taylur P.; Datta, Anirban; Evason, Kimberley; Moore, John C.; Lawson, Nathan; Mostov, Keith E.; Moens, Cecilia B.; Stainier, Didier Y.R.

2011-01-01

26

Expression of hepatocytic- and biliary-specific transcription factors in regenerating bile ducts during hepatocyte-to-biliary epithelial cell transdifferentiation  

Microsoft Academic Search

BACKGROUND: Under compromised biliary regeneration, transdifferentiation of hepatocytes into biliary epithelial cells (BEC) has been previously observed in rats, upon exposure to BEC-specific toxicant methylene dianiline (DAPM) followed by bile duct ligation (BDL), and in patients with chronic biliary liver disease. However, mechanisms promoting such transdifferentiation are not fully understood. In the present study, acquisition of biliary specific transcription factors

Pallavi B Limaye; William C Bowen; Anne Orr; Udayan M Apte; George K Michalopoulos

2010-01-01

27

Balloon Dilatation of Salivary Duct Strictures: Report on 36 Treated Glands  

Microsoft Academic Search

Purpose: This paper describes the technique for balloon dilatation of salivary duct strictures and evaluates the clinical and radiographic findings in a consecutive series of 36 affected glands. Methods: Thirty-four patients (36 glands) had balloon dilatation of their salivary duct strictures performed under fluoroscopic control. They were evaluated immediately afterwards and at review by sialography. Results: In 36 cases attempted,

Nicholas A. Drage; Jackie E. Brown; Michael P. Escudier; Ron F. Wilson; Mark McGurk

2002-01-01

28

Antegrade balloon dilatation of nasolacrimal duct obstruction in adults  

PubMed Central

AIMS—To determine the efficacy of antegrade balloon dilatation of postsaccal lacrimal stenosis in adults.?METHODS—Balloon dilatation was performed in a series of 30 patients with complete nasolacrimal duct obstructions and epiphora. Obstruction was diagnosed by canalicular irrigation and transcanalicular endoscopic examination of the lacrimal pathway. Except for four cases in which general anaesthesia was applied, the procedure was performed under local anaesthesia. The Lacricath balloon catheter set was used. Silicone intubation was performed simultaneously. The time at which the tubes were removed depended on the findings at postoperative follow up but was, at the earliest, 3 months postoperatively.?RESULTS—Success was objectified by irrigation and was evaluated subjectively at each follow up examination according to Munk's scale. In all cases the procedure could be performed with subsequent silicone intubation. Three months postoperatively 89.9% of all cases were positive on simple irrigation, and subjective success was also registered (Munk's grade 0 or 1). At 6 months 70% of all cases were positive on irrigation, again with subjective success (Munk's grade 0 or 1). One year postoperatively 73.3% of all procedures showed subjective success (two successful redilatations would raise the success rate to 79.9%).?CONCLUSION—Retrograde as well as antegrade dilatation has been reported to be more or less successful in partial nasolacrimal obstruction. Although the procedure is used as primary treatment in cases of complete obstruction, it can still be performed under local anaesthesia on an outpatient basis. Long term observation will be required to prove the sustained effect of this procedure.??

Kuchar, A; Steinkogler, F

2001-01-01

29

Biliary peritonitis secondary to perforation of common bile duct: an unusual presentation of chronic calcific pancreatitis.  

PubMed Central

Common bile duct perforation causing biliary peritonitis is an unusual entity and a pancreatic calculus causing this perforation is all the more rare, and to our knowledge has not been reported previously. Such an unusual presentation of chronic calcific pancreatitis is herein reported. Images Figure 1

Kumar, A.; Kataria, R.; Chattopadhyay, T. K.; Karak, P. K.; Tandon, R. K.

1992-01-01

30

Biliary peritonitis secondary to perforation of common bile duct: an unusual presentation of chronic calcific pancreatitis.  

PubMed

Common bile duct perforation causing biliary peritonitis is an unusual entity and a pancreatic calculus causing this perforation is all the more rare, and to our knowledge has not been reported previously. Such an unusual presentation of chronic calcific pancreatitis is herein reported. PMID:1461860

Kumar, A; Kataria, R; Chattopadhyay, T K; Karak, P K; Tandon, R K

1992-10-01

31

Morphologic, biophysical, and biochemical consequences of ligation of the common biliary duct in the dog.  

PubMed Central

Common biliary ducts of 32 adult mongrel dogs were ligated for a period of 2 days to 6 weeks. Sham-operated animals served as controls. Bile ducts were removed at sacrifice, and biophysical, morphologic, and biochemical parameters were measured. Our study shows that biliary duct ligation results in an immediate increase of intraductular pressure and is followed quickly by significant increase in the rate of collagen synthesis and the activity of prolyl hydroxylase. Histologic data show subepithelial inflammation followed by marked increases in periductular fibrosis. This fibroproliferative response is paralleled by peak levels of prolyl hydroxylase activity at 2 weeks prostligation. Paradoxically, bile ducts continuously distend throughout the ligation period despite increased fibroplasia. We present here the first topographic (SEM) study of normal and ligated common bile duct epithelium. Following 2 weeks of ligation large crater-like fenestrae are seen ductular epithelial surfaces. This is followed by focal epithelial sloughing. We speculate that the continuous distention and epithelial necrosis seen in the present study may be due to biliary stasis and/or subepithelial infiltration of bile through epithelial fenestrae. This hypothesis is supported by our studies which show that collagen extractibility is markedly increased by the addition of bile to the homogenate. Images Figure 14 Figure 15 Figure 6 Figure 7 Figure 8 Figure 9 Figure 1 Figure 10 Figure 11 Figure 12 Figure 13 Figure 2 Figure 3 Figure 4 Figure 5

Carlson, E.; Zukoski, C. F.; Campbell, J.; Chvapil, M.

1977-01-01

32

Computed tomography of primary intrahepatic biliary malignancy  

SciTech Connect

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

Itai, Y.; Araki, T.; Furui, S.; Yashiro, N.; Ohtomo, K.; Iio, M.

1983-05-01

33

Balloon Dilatation of Salivary Duct Strictures: Report on 36 Treated Glands  

Microsoft Academic Search

  \\u000a Purpose: This paper describes the\\u000a technique for balloon dilatation of salivary duct strictures and\\u000a evaluates the clinical and radiographic findings in a consecutive\\u000a series of 36 affected glands. \\u000a Methods: Thirty-four\\u000a patients (36 glands) had balloon dilatation of their salivary duct\\u000a strictures performed under fluoroscopic control. They were evaluated\\u000a immediately afterwards and at review by sialography. \\u000a Results: In 36 cases

Nicholas A. Drage; Jackie E. Brown; Michael P. Escudier; Ron F. Wilson; Mark McGurk

2002-01-01

34

Evaluation of gallbladder and biliary duct disease using microbubble contrast-enhanced ultrasound  

PubMed Central

Ultrasound examination of the gallbladder is accepted as the primary imaging modality in the assessment of gallbladder disease, with inherent superiority in comparison to other imaging modalities. Contrast-enhanced ultrasound is established as a reliable tool in the detection and characterisation of focal liver lesions. It is less well recognised in gallbladder and biliary disease but can be a valuable complement to baseline ultrasound examination. Contrast-enhanced ultrasound provides the advantages of real-time, repeatable, multiplanar imaging without compromising patient safety or exposing patients to radiation. It can provide specific information as pathology often becomes more conspicuous following the administration of contrast, allowing detailed assessment of benign and malignant conditions arising in the gallbladder and biliary tree. This review illustrates the application of contrast-enhanced ultrasound in the evaluation of a variety of gallbladder and biliary duct diseases. The examination allows clearer delineation of the disease process and more confident diagnosis.

Meacock, L M; Sellars, M E; Sidhu, P S

2010-01-01

35

SPECT/CT unequivocally depicts dilated cystic duct sign on hepatobiliary scintigraphy in acute cholecystitis.  

PubMed

The dilated cystic duct sign (DCDS) on hepatobiliary scintigraphy can lead to a false-negative test in patients with acute cholecystitis. Presented is a case of acute gangrenous cholecystitis with probable DCDS on the planar study that was unequivocally delineated on SPECT/CT imaging. SPECT/CT may be useful when planar findings suggest DCDS. PMID:23334135

Tulchinsky, Mark

2013-02-01

36

Balloon Dilatation of Salivary Duct Strictures: Report on 36 Treated Glands  

SciTech Connect

Purpose: This paper describes the technique for balloon dilatation of salivary duct strictures and evaluates the clinical and radiographic findings in a consecutive series of 36 affected glands. Methods: Thirty-four patients (36 glands) had balloon dilatation of their salivary duct strictures performed under fluoroscopic control. They were evaluated immediately afterwards and at review by sialography. Results: In 36 cases attempted, 33 (92%) strictures were dilated. The immediate post-treatment sialogram was available in 28 cases, of which 23 (82%) demonstrated complete and four (14%) partial elimination of stricture. In one case the appearance was unchanged(4%). Review data (mean 6.8 months) were available on 25 glands: 12 were asymptomatic (48%), 12 (48%) had reduced symptoms and one (4%)failed to improve. Sialographic data were available on 21 glands: in 10(48%) the duct remained patent, in one (5%) the stricture was partially eliminated, in seven (33%) the strictures had returned and in the remaining three (14%) cases there was complete obstruction. Conclusions: Balloon dilatation is an effective treatment of salivary duct stenosis. In half the cases the stricture recurred but symptomatic improvement was achieved and maintained in the majority of cases.

Drage, Nicholas A.; Brown, Jackie E. [Department of Dental Radiology, Guy's Dental Hospital, Guy's and St. Thomas' Hospital Trust, London (United Kingdom); Escudier, Michael P. [Department of Oral Medicine and Pathology, Guy's, King's and St. Thomas' Dental Institute, King's College, London (United Kingdom); Wilson, Ron F. [Dental Clinical Research, Guy's, King's and St. Thomas' Dental Institute, King's College, London (United Kingdom); McGurk, Mark [Department of Oral andMaxillofacial Surgery, Guy's, King's and St. Thomas' Dental Institute, King's College, London (United Kingdom)

2002-10-15

37

Biliary atresia  

MedlinePLUS

Biliary atresia is a blockage in the tubes (ducts) that carry a liquid called bile from the liver ... Biliary atresia occurs when the bile ducts inside or outside the liver do not develop normally. It is ...

38

Pancreatic duct guidewire placement for biliary cannulation in a single-session therapeutic ERCP  

PubMed Central

AIM: To investigate the technical success and clinical complication rate of a cannulated pancreatic duct with guidewire for biliary access. METHODS: During a five-year study period, a total of 2843 patients were included in this retrospective analysis. Initial biliary cannulation method consisted of single-guidewire technique (SGT) for up to 5 attempts, followed by double-guidewire technique (DGT) when repeated unintentional pancreatic duct cannulation had taken place. Pre-cut papillotomy technique was reserved for when DGT had failed or no pancreatic duct cannulation had been previously achieved. Main outcome measurements were defined as biliary cannulation success and post-endoscopic retrograde cholangiopancreatography (ERCP) complication rate. RESULTS: SGT (92.3% success rate) was characterized by statistically significant enhanced patient outcome compared to either the DGT (43.8%, P < 0.001), pre-cut failed DGT (73%, P < 0.001) or pre-cut as first step method (80.6%, P = 0.002). Pre-cut as first step method offered a statistically significantly more favorable outcome compared to the DGT (P < 0.001). The incidence of post-ERCP pancreatitis did not differ in a statistically significant manner between either method (SGT: 5.3%, DGT: 6.1%, Pre-cut failed DGT: 7.9%, Pre-cut as first step: 7.5%) or with patients’ gender. CONCLUSION: Although DGT success rate proved not to be superior to SGT or pre-cut papillotomy, it is considered highly satisfactory in terms of safety in order to avoid the risk of a pre-cut when biliary therapy is necessary in difficult-to-cannulate cases.

Xinopoulos, Dimitrios; Bassioukas, Stefanos P; Kypreos, Dimitrios; Korkolis, Dimitrios; Scorilas, Andreas; Mavridis, Konstantinos; Dimitroulopoulos, Dimitrios; Paraskevas, Emmanouil

2011-01-01

39

Bile-duct dilatation after laparotomy: a potential effect of intestinal hypomotility.  

PubMed

Dilatation of unobstructed extrahepatic bile ducts was observed in patients with conditions associated with intestinal hypomotility. For further investigation of this association, a prospective study was undertaken in which the common hepatic duct was measured in 15 patients before and 1 day after laparotomy, when all patients had postoperative paralytic ileus. A statistically significant (p less than 0.01) increase in the mean diameter of the hepatic duct was observed postoperatively. When compared with the preoperative measurement, the mean diameter of the duct almost doubled, from 3.3 to 5.9 mm. This phenomenon may be due to persistent contraction of the sphincter of Oddi that occurs when intestinal hypomotility eliminates the stimuli for cholecystokinin release. PMID:3489371

Raptopoulos, V; Smith, E H; Cummings, T; Silva, W; Karellas, A

1986-10-01

40

Tc-99m HIDA scintigraphy in segmental biliary obstruction  

SciTech Connect

Segmental biliary obstruction as a result of primary or secondary hepatic malignancy has been reported with increasing frequency. For two representative patients, the clinical and Tc-99m HIDA scintigraphic findings in segmetal biliary obstruction are described. The presence of photon-deficient dilated bile ducts in one segment of the biliary tree is highly suggestive of localized biliary obstruction and should be considered in the patient with suspected or proven hepatic malignancy despite the absence of jaundice.

Zeman, R.K.; Gold, J.A.; Gluck, L.; Caride, V.J.; Burrell, M.; Hoffer, P.B.

1981-05-01

41

Tc-99m HIDA scintigraphy in segmental biliary obstruction  

SciTech Connect

Segmental biliary obstruction as a result of primary or secondary hepatic malignancy has been reported with increasing frequency. For two representative patients, the clinical and Tc-99m HIDA scintigraphic findings in segmental biliary obstruction are described. The presence of photon-deficient dilated bile ducts in one segment of the biliary tree is highly suggestive of localized biliary obstruction and should be considered in the patient with suspected or proven hepatic malignancy despite the absence of jaundice.

Zeman, R.K.; Gold, J.A.; Gluck, L.; Caride, V.J.; Burrell, M.; Hoffer, P.B.

1981-05-01

42

Medical treatment of biliary duct stones: effect of ursodeoxycholic acid administration.  

PubMed Central

Twenty-eight patients with radiolucent biliary duct stones without cholangitis and jaundice were randomly allocated into two treatment groups receiving ursodeoxycholic acid 12 mg/kg (group A) or placebo (group B) in three daily doses for 24 months. In group A stones disappeared completely in seven patients and partially in one; placebo administration had no effect on stone size and three patients of group B (only one of group A) went to surgery for complications. Ursodeoxycholic acid treatment did not adversely affect liver function tests, and alkaline phosphatase decreased. Abdominal and biliary colics also became less frequent in the first six months of therapy in group A, but not in the placebo group. The bile was supersaturated with cholesterol in both groups, but decreased significantly only in patients receiving ursodeoxycholic acid even though the lithogenic index remained high. Cholesterol saturation of bile does not seem to be the only factor determining the dissolution of biliary duct stones which sometimes contain cholesterol as the main component.

Salvioli, G; Salati, R; Lugli, R; Zanni, C

1983-01-01

43

Microcatheter Use for Difficult Percutaneous Biliary Procedures  

SciTech Connect

Percutaneous biliary drainage procedures in patients with nondilated ducts are demanding, resulting in lower success rates than in patients with bile duct dilatation. Pertinent clinical settings include patients with iatrogenic bile leaks, diffuse cholangiocarcinomas, and sclerosing cholangitis. We describe a method to facilitate these procedures with the combined use of a 2.7-Fr microcatheter and a 0.018-in. hydrophilic wire.

Brountzos, Elias N., E-mail: ebrountz@med.uoa.gr; Kelekis, Alexis D.; Ptohis, Nikolaos; Kotsioumba, Ioanna [Athens University Medical School, Attikon University Hospital, Second Department of Radiology (Greece); Misiakos, Evangelos [Athens University, Medical School, Attikon University Hospital, Third Department of Surgery (Greece); Perros, George [Athens University, Medical School, Attikon University Hospital, Fourth Department of Surgery (Greece); Gouliamos, Athanasios D. [Athens University Medical School, Attikon University Hospital, Second Department of Radiology (Greece)

2008-09-15

44

DNA hypomethylation causes bile duct defects in zebrafish and is a distinguishing feature of infantile biliary atresia  

PubMed Central

Summary Infantile cholestatic disorders arise in the context of progressively developing intrahepatic bile ducts. Biliary atresia (BA), a progressive fibroinflammatory disorder of extra- and intrahepatic bile ducts, is the most common identifiable cause of infantile cholestasis and the leading indication for liver transplantation in children. The etiology of BA is unclear, and while there is some evidence for viral, toxic, and complex genetic causes, the exclusive occurrence of BA during a period of biliary growth and remodeling suggests an importance of developmental factors. Interestingly, interferon-? (IFN?) signaling is activated in patients and in the frequently utilized Rhesus rotavirus mouse model of BA, and is thought to play a key mechanistic role. Here we demonstrate intrahepatic biliary defects and upregulated hepatic expression of IFN? pathway genes caused by genetic or pharmacological inhibition of DNA methylation in zebrafish larvae. Biliary defects elicited by inhibition of DNA methylation were reversed by treatment with glucocorticoid, suggesting that the activation of inflammatory pathways was critical. DNA methylation was significantly reduced in bile duct cells from BA patients compared to patients with other infantile cholestatic disorders, thereby establishing a possible etiologic link between decreased DNA methylation, activation of IFN? signaling, and biliary defects in patients. Conclusion: Inhibition of DNA methylation leads to biliary defects and activation of IFN?-responsive genes, thus sharing features with BA, which we determine to be associated with DNA hypomethylation. We propose epigenetic activation of IFN? signaling as a common etiologic mechanism of intrahepatic bile duct defects in BA.

Matthews, Randolph P.; EauClaire, Steven F.; Mugnier, Monica; Lorent, Kristin; Cui, Shuang; Ross, Megan M.; Zhang, Zhe; Russo, Pierre; Pack, Michael

2010-01-01

45

Clues to the etiology of bile duct injury in biliary atresia.  

PubMed

Biliary atresia (BA) is an infantile obstructive cholangiopathy of unknown etiology with suboptimal therapy, which is responsible for 40 to 50% of all pediatric liver transplants. Although the etiology of bile duct injury in BA in unknown, it is postulated that a pre- or perinatal viral infection initiates cholangiocyte apoptosis and release of antigens that trigger a Th1 immune response that leads to further bile duct injury, inflammation, and obstructive fibrosis. Humoral immunity and activation of the innate immune system may also play key roles in this process. Moreover, recent investigations from the murine BA model and human data suggest that regulatory T cells and genetic susceptibility factors may orchestrate autoimmune mechanisms. What controls the coordination of these events, why the disease only occurs in the first few months of life, and why a minority of infants with perinatal viral infections develop BA are remaining questions to be answered. PMID:23397531

Mack, Cara L; Feldman, Amy G; Sokol, Ronald J

2013-02-08

46

The Ballooning Time in Endoscopic Papillary Balloon Dilation for the Treatment of Bile Duct Stones  

PubMed Central

Background/Aims Endoscopic papillary balloon dilation (EPBD) is a safe and effective method for the treatment of choledocholithiasis, but previous studies have rarely reported the appropriate ballooning time (BT). We prospectively evaluated the safety and efficacy of EPBD according to BT in patients undergoing bile duct stone removal. Methods Seventy consecutive patients with bile duct stones were randomly assigned to receive EPBD with either conventional (n = 35, 60 seconds) or short (n = 35, 20 seconds) BT. Results EPBD alone achieved complete bile duct clearance in 67 patients (long BT, n = 33, 94.3%; short BT, n = 34, 97.1%; p = 0.808). We also found no significant difference in the rate of complete duct clearance, including procedures that used mechanical lithotripsy, between the long and short BT groups (97.1% vs. 100%; p = 0.811). Mild pancreatitis was noted in four (11.4%) patients in the long BT group and two (5.7%) patients in the short BT group, but this incidence was not significantly different. Conclusions The study showed that EPBD using both 20-sec and 60-sec BTs is safe and effective for the treatment of bile duct stones. Short and long BTs produced comparable outcomes.

Bang, Byoung Wook; Jeong, Seok; Lee, Jung Il; Lee, Jin-Woo; Kwon, Kye Sook; Kim, Hyung Gil; Shin, Yong Woon; Kim, Young Soo

2010-01-01

47

One-Step Transpapillary Balloon Dilation under Cap-Fitted Endoscopy without a Preceding Sphincterotomy for the Removal of Bile Duct Stones in Billroth II Gastrectomy  

PubMed Central

Background/Aims Endoscopic sphincterotomy may be limited in Billroth II gastrectomy because of difficulty in orientating the duodenoscope and sphincterotome as a result of altered anatomy. This study was planned to investigate the efficacy and safety of endoscopic transpapillary large balloon dilation (EPBD) without preceding sphincterotomy for removal of large CBD stones in Billroth II gastrectomy. Methods Between March 2010 and February 2011, one-step EPBD under cap-fitted forward-viewing endoscopy was performed in patients who had undergone Billroth II gastrectomy at two tertiary referral centers. Main outcome measurements were successful duct clearance and EPBD-related complications. Results Successful access to major duodenal papilla was performed in 13 patients, but successful selective CBD cannulation was achieved in 12 patients (92.3%). Median maximum transverse stone size was 11.5 mm (10 to 14 mm). The mean number of stones was 2 (1-5). The median CBD diameter was 15 mm (12 to 19 mm). Mean procedure time from successful biliary access to complete stone removal was 17.8 min. Complete duct clearance was achieved in all patients. Four patients (33.3%) needed one more session of ERCP for removal of remnant stones. Asymptomatic hyperamylasemia in two patients and minor bleeding in another occurred. Conclusions Without preceding sphincterotomy, one-step EPBD (?10 mm) under cap-fitted forward-viewing endoscopy may be safe and effective for the removal of large stones (?10 mm) with CBD dilatation in Billroth II gastrectomy.

Hwang, Jae Chul; Choi, Hyun Jong; Moon, Jong Ho; Cho, Young Deok; Yoo, Byung Moo; Park, Sang-Heum; Kim, Jin Hong; Kim, Sun-Joo

2012-01-01

48

Rupture of Hepatocellular Carcinoma into the Biliary System with Resulting Bile Duct Thrombi: Report of Two Cases  

Microsoft Academic Search

We report two cases of hepatocellular carcinoma revealed by jaundice and the presence of free-floating tumoural fragments within the biliary system. Two men (one of 64 and one of 73) presented with isolated jaundice. The results from ultrasound, CT and MRI were suggestive of a cholangiocarcinoma. Surgical intervention demonstrated bile duct thrombi from the primary tumour causing obstructive jaundice.

P. Bigot; G. M. Buchanan; A. Hamy; C. Teyssedou; P. Pessaux; J. P. Arnaud

2007-01-01

49

Difficult bile duct stones.  

PubMed

Bile duct stones are routinely removed at time of endoscopic retrograde cholangiopancreatography (ERCP) after biliary sphincterotomy with standard balloon or basket extraction techniques. However, in approximately 10% to 15% of patients, bile duct stones may be difficult to remove due to challenging access to the bile duct (periampullary diverticulum, Billroth II anatomy, Roux-en-Y gastrojejunostomy), large (> 15 mm in diameter) bile duct stones, intrahepatic stones, or impacted stones in the bile duct or cystic duct. The initial approach to the removal of the difficult bile duct stone is to ensure adequate biliary sphincter orifice diameter with extension of biliary sphincterotomy or balloon dilation of the orifice. Mechanical lithotripsy is a readily available adjunct to standard stone extraction techniques and should be available in all ERCP units. If stone extraction fails with these maneuvers, two or more bile duct stents should be inserted, and ursodiol added to aid in duct decompression, stone fragmentation, and stone dissolution. Follow-up ERCP attempts to remove the difficult bile duct stones may be performed locally if expertise is available or alternatively referred to a tertiary center for advanced extracorporeal or intracorporeal fragmentation (mother-baby laser or electrohydraulic lithotripsy) techniques. Nearly all patients with bile duct stones can be treated endoscopically if advanced techniques are utilized. For the rare patient who fails despite these efforts, surgical bile duct exploration, percutaneous approach to the bile duct, or long-term bile duct stenting should be discussed with the patient and family to identify the most appropriate therapeutic option. A thoughtful approach to each patient with difficult bile duct stones and a healthy awareness of the operator/endoscopy unit limitations is necessary to ensure the best patient outcomes. Consultation with a dedicated tertiary ERCP specialty center may be necessary. PMID:16539873

McHenry, Lee; Lehman, Glen

2006-04-01

50

Immune-mediated bile duct injury: The case of primary biliary cirrhosis  

PubMed Central

Autoimmune cholangitis would be the appropriate name to define the immune-mediated bile duct injury following the breakdown of tolerance to mitochondrial proteins and the appearance of serum autoantibodies and autoreactive T cells. Nevertheless, the condition is universally named primary biliary cirrhosis (PBC). The disease etiology and pathogenesis remain largely unknown despite the proposed lines of evidence. One twin study and numerous epidemiology reports suggest that both a susceptible genetic background and environmental factors determine disease onset while a recent genome-wide association study proposed highly significant associations with several common genetic polymorphisms in subgroups of patients. Specific infectious agents and chemicals may contribute to the disease onset and perpetuation in a genetically susceptible host, possibly through molecular mimicry. Importantly, several murine models have been proposed and include strains in which PBC is genetically determined or induced by immunization with chemicals and bacteria. From a pathogenetic standpoint, new exciting data have demonstrated the unique apoptotic features of bile duct cells that allow the mitochondrial autoantigens to be taken up in their intact form within apoptotic blebs. We are convinced that the application of the most recent molecular techniques will soon provide developments in PBC etiology and pathogenesis with likely implications in diagnostics and therapeutics.

Selmi, Carlo; Affronti, Andrea; Ferrari, Laura; Invernizzi, Pietro

2010-01-01

51

Endoscopic papillary balloon intermittent dilatation and endoscopic sphincterotomy for bile duct stones  

PubMed Central

AIM: To compare the effectiveness and safety of endoscopic papillary balloon intermittent dilatation (EPBID) and endoscopic sphincterotomy (EST) in the treatment of common bile duct stones. METHODS: From March 2011 to May 2012, endoscopic retrograde cholangiopancreatography was performed in 560 patients, 262 with common bile duct stones. A total of 206 patients with common bile duct stones were enrolled in the study and randomized to receive either EPBID with a 10-12 mm dilated balloon or EST (103 patients in each group). For both groups a conventional reticular basket or balloon was used to remove the stones. After the procedure, routine endoscopic nasobiliary drainage was performed. RESULTS: First-time stone removal was successfully performed in 94 patients in the EPBID group (91.3%) and 75 patients in the EST group (72.8%). There was no statistically significant difference in terms of operation time between the two groups. The overall incidence of early complications in the EPBID and EST groups was 2.9% and 13.6%, respectively, with no deaths reported during the course of the study and follow-up. Multiple regression analysis showed that the success rate of stone removal was associated with stone removal method [odds ratio (OR): 5.35; 95%CI: 2.24-12.77; P = 0.00], the transverse diameter of the stone (OR: 2.63; 95%CI: 1.19-5.80; P = 0.02) and the presence or absence of diverticulum (OR: 2.35; 95%CI: 1.03-5.37; P = 0.04). Postoperative pancreatitis was associated with the EST method of stone removal (OR: 5.00; 95%CI: 1.23-20.28; P = 0.02) and whether or not pancreatography was performed (OR: 0.10; 95%CI: 0.03-0.35; P = 0.00). CONCLUSION: The EPBID group had a higher success rate of stone removal with a lower incidence of pancreatitis compared with the EST group.

Fu, Bai-Qing; Xu, Ya-Ping; Tao, Li-Sheng; Yao, Jun; Zhou, Chun-Suo

2013-01-01

52

Oxidative stress-induced apoptosis of bile duct cells in primary biliary cirrhosis  

Microsoft Academic Search

There has been a relative paucity of effort at defining effector mechanisms of biliary damage in PBC. We hypothesize that biliary cells are destroyed secondary to the immunologic relationships of inflammation and biliary epithelial apoptosis and, in particular, that biliary damage is a result of reduced levels of glutathione-S-transferase (GST), the production of hypochlorous acid (HOCl) and its association with

Thucydides L. Salunga; Zheng-Guo Cui; Shinji Shimoda; Hua-Chuan Zheng; Kazuhiro Nomoto; Takashi Kondo; Yasuo Takano; Carlo Selmi; Gianfranco Alpini; M. Eric Gershwin; Koichi Tsuneyama

2007-01-01

53

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

PubMed Central

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

2011-01-01

54

Intraoperative assessment of biliary anatomy for prevention of bile duct injury: a review of current and future patient safety interventions  

Microsoft Academic Search

Background  Bile duct injury (BDI) is a dreaded complication of cholecystectomy, often caused by misinterpretation of biliary anatomy.\\u000a To prevent BDI, techniques have been developed for intraoperative assessment of bile duct anatomy. This article reviews the\\u000a evidence for the different techniques and discusses their strengths and weaknesses in terms of efficacy, ease, and cost-effectiveness.\\u000a \\u000a \\u000a \\u000a \\u000a Method  PubMed was searched from January 1980 through

K. Tim Buddingh; Vincent B. Nieuwenhuijs; Lianne van Buuren; Jan B. F. Hulscher; Johannes S. de Jong; Gooitzen M. van Dam

2011-01-01

55

Dissolution of multiple biliary duct stones using methyl tert-butyl ether (MTBE): Experience in two cases  

Microsoft Academic Search

Methyl tert-butyl-ether (MTBE) was sucessfully used for stone dissolution in 2 patients with multiple bile duct cholesterol\\u000a stones. The presence of a biliary-enteric anastomosis precluded the endoccopic approach. Because of leakage of MTBE into the\\u000a bowel, dissolution time ranged from 7.5 to 36 h. No significant complications other than mild nausea were encountered. No\\u000a recurrence of stone formation has been

Ricardo Tobio-Calo; Jose M. Llerena; Isabel Pinto-Pabon; Wilfrido R. Castafieda-Zufiiga

1992-01-01

56

Dissolution of multiple biliary duct stones using methyl tert-butyl ether (MTBE): experience in two cases.  

PubMed

Methyl tert-butyl-ether (MTBE) was successfully used for stone dissolution in 2 patients with multiple bile duct cholesterol stones. The presence of a biliary-enteric anastomosis precluded the endoscopic approach. Because of leakage of MTBE into the bowel, dissolution time ranged from 7.5 to 36 h. No significant complications other than mild nausea were encountered. No recurrence of stone formation has been found at a follow-up varying from 9 to 12 months. PMID:1394363

Tobio-Calo, R; Llerena, J M; Pinto-Pabon, I; Castañeda-Zúñiga, W R

57

[The congenital cystic dilatation of the liver and bile ducts (CDB): our experience].  

PubMed

The congenital cystic dilatation of the liver and bile ducts (CDB) is a very uncommon disease. It often appears in females and most frequently in paediatric patients. Its etiopathogenesis is not yet completely defined. Its evolution includes, together with several complications, the malignant transformation. The Authors present the outcomes of their experience based on a series of 5 patients observed from 1991 till today. Apart from the rarity of this disease, their series is so interesting because 4 out of 5 are adult patients and the fifth one is over 15. In addition, differentiating from the literature trend, the group included only male patients. Are also discussed the most important aspects referring to nosology, epidemiology, etiopathogenesis, clinical pattern and its evolution of CDB, looking over a wide review too. The Authors extensively examine the diagnostic problems; owing to that the patients were observed in the period 1991-1999 it is necessary to clarify that some imaging methods, i.e. CSTscan and the bile duct MNR, were not yet introduced. The surgical treatment has been investigated as well, developed during its historical evolution until nowadays and our solutions for the 5 cases have been presented and discussed. In their series the Authors haven't ever observed during hospitalisation a malignant transformation. PMID:16550874

Zito, Enzo Saverio; Romagnuolo, Giuseppe; La Rocca, Francesco; Castriconi, Maurizio; De Sena, Guido; Chianese, Francesco; Bartone, Giovanni; Giuliano, Maria Elena

58

Biliary ascariasis in a bile duct stones-removed female patient  

PubMed Central

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 sphincterotomy in some regions where ascariasis is epidemic.

Wang, Jun; Pan, Yang-Lin; Xie, Yan; Wu, Kai-Chun; Guo, Xue-Gang

2013-01-01

59

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

SciTech Connect

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

Inal, Mehmet; Aksungur, Erol; Akguel, Erol; Oguz, Mahmut; Seydaoglu, Guelsah [Department of Radiology and Biostatistics, Cukurova University Faculty of Medicine, Balcali, 01330, Adana (Turkey)

2003-02-15

60

Surgical treatment of biliary atresia with patent distal extra hepatic bile ducts: Is hepatic portocholecystostomy the right choice?  

PubMed Central

Purpose: To report the results of surgical treatment of biliary atresia with patent distal extra hepatic bile ducts (BA with PDEBD) with special reference to hepatic portocholecystostomy (HPC) operation. Materials and Methods: The study reviews records of children operated for BA with PDEBD. The type of operation, results of surgery, postoperative course and complications during follow-up are noted. Results: Five children (mean age 83 days) underwent surgery for biliary atresia with patent extra hepatic bile ducts. The diagnosis was confirmed by intraoperative cholangiography in each case. Three children underwent HPC and two had standard hepatic portoenterostomy (HPE) as HPC was not technically feasible. The operation was considered successful in three of five children (60%, two HPC and one HPE), partially successful in one. The mean follow-up was 22 months. None of the children with HPC had cholangitis at follow-up; one child with HPE had recurrent cholangitis. Conclusions: Biliary atresia (BA) with PDEBD may be a variant with a fair chance for surgical success. When feasible, HPC may be a good treatment option in this group with acceptable results and practically no risk of postoperative cholangitis.

Chandrasekharam, V. V. S.

2009-01-01

61

Neonatal NK cells target the mouse duct epithelium via Nkg2d and drive tissue-specific injury in experimental biliary atresia  

PubMed Central

Biliary atresia is a neonatal obstructive cholangiopathy that progresses to end-stage liver disease. Although the etiology is unknown, a neonatal adaptive immune signature has been mechanistically linked to obstruction of the extrahepatic bile ducts. Here, we investigated the role of the innate immune response in the pathogenesis of biliary atresia. Analysis of livers of infants at diagnosis revealed that NK cells populate the vicinity of intrahepatic bile ducts and overexpress several genes involved in cytotoxicity. Using a model of rotavirus-induced biliary atresia in newborn mice, we found that activated NK cells also populated murine livers and were the most abundant cells in extrahepatic bile ducts at the time of obstruction. Rotavirus-primed hepatic NK cells lysed cholangiocytes in a contact- and Nkg2d-dependent fashion. Depletion of NK cells and blockade of Nkg2d each prevented injury of the duct epithelium after rotavirus infection, maintained continuity of duct lumen between the liver and duodenum, and enabled bile flow, despite the presence of virus in the tissue and the overexpression of proinflammatory cytokines. These findings identify NK cells as key initiators of cholangiocyte injury via Nkg2d and demonstrate that injury to the duct epithelium drives the phenotype of experimental biliary atresia.

Shivakumar, Pranavkumar; Sabla, Gregg E.; Whitington, Peter; Chougnet, Claire A.; Bezerra, Jorge A.

2009-01-01

62

A giant retention cyst of the pancreas (cystic dilatation of dorsal pancreatic duct) associated with pancreas divisum  

Microsoft Academic Search

  We describe a rare case of pancreas divisum associated with a giant retention cyst (cystic dilatation of the dorsal pancreatic\\u000a duct), presumably formed following obstruction of the minor papilla. The patient was treated by pancreatico(cysto)jejunostomy.\\u000a A 50-year-old man was admitted with complaints of increasing upper abdominal distension and body weight loss. There was no\\u000a previous history of pancreatitis, gallstones, drinking,

Zenichi Morise; Kazuo Yamafuji; Tadao Tsuji; Atsunori Asami; Kaoru Takeshima; Noritaka Hayashi; Hideo Baba; Fumiko Yoshida; Yuta Abe; Yasuyuki Tokura

2002-01-01

63

Progressive biliary pathology associated with common pancreato-biliary channel.  

PubMed

A female infant who presented with transient obstructive jaundice and who was shown to have mild fusiform dilatation of the common bile duct at the age of 18 months was followed up with hepatobiliary ultrasound scans over a period of 17 years. Enlarging gallbladder polyps were identified during the last 2 years of follow-up, and endoscopic retrograde cholangio-pancreatography (ERCP) showed a common pancreato-biliary channel with minimal bile duct dilatation. A high concentration of pancreatic amylase was detected in the bile. Hepaticojejunostomy and cholecystectomy were performed. Histologically, the resected common bile duct showed fibrous thickening of the wall and loss of surface epithelium. Muscular hypertrophy and polypoid lesions, which were foci of cholesterosis, were identified in the gallbladder. There was a minimal lymphocytic infiltrate in the subepithelial connective tissue. This report documents a progressive change in the ultrasound appearances of the gallbladder and histological changes in the extrahepatic ducts secondary to a common pancreato-biliary channel and pancreato-biliary reflux. PMID:10770409

Pushparani, P; Redkar, R G; Howard, E R

2000-04-01

64

Flowcharts for the management of biliary tract and ampullary carcinomas  

Microsoft Academic Search

No strategies for the diagnosis and treatment of biliary tract carcinoma have been clearly described. We developed flowcharts\\u000a for the diagnosis and treatment of biliary tract carcinoma on the basis of the best clinical evidence. Risk factors for bile\\u000a duct carcinoma are a dilated type of pancreaticobiliary maljunction (PBM) and primary sclerosing cholangitis. A nondilated\\u000a type of PBM is a

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

2008-01-01

65

A mouse model of autosomal recessive polycystic kidney disease with biliary duct and proximal tubule dilatation  

Microsoft Academic Search

Autosomal recessive polycystic kidney disease (ARPKD) is caused by mutations in the polycystic kidney and hepatic disease (PKHD1) gene encoding the protein fibrocystin\\/polyductin. The aim of our study was to produce a mouse model of ARPKD in which there was no functional fibrocystin\\/polyductin to study the pathophysiology of cystic and fibrocystic disease in renal and non-renal tissues. Exon 2 of

J R Woollard; R Punyashtiti; S Richardson; T V Masyuk; S Whelan; B Q Huang; D J Lager; J vanDeursen; V E Torres; V H Gattone; N F LaRusso; P C Harris; C J Ward

2007-01-01

66

[Cystic dilatation of the choledocus].  

PubMed

Choledochal cyst is an uncommon congenital lesion of the pancreatobiliary system. The pathologic features are cystic dilatation of the common bile duct, normal liver parenchyma, a normal intrahepatic biliary system and partial obstruction of the terminal common bile duct. More than 1400 cases have been reported in tre literature, 83 per cent of which have been diagnosed in patients below the age of 30. A triad of abdominal pain, jaundice and a palpable abdominal mass in the right hypocondrium has been classically associated with this condition. Ultrasonography and CT scanning are usually successful in demonstrating the mass. Cholangiography by the endoscopic retrograde approach may demonstrate the cystic dilatation of the common bile duct. The precise relation ship of the cyst to the biliary tree should be demonstrated by cholangiography at operation. The common type I fusiform cyst is currently treated either by excision combined with a biliary intestinal anastomosis of by anastomosis of the cyst to the intestinal tract. Treatment of the rare type II diverticulum consist of simple excision, while the rare type III choledococele is treated by transduodenal excision of the cyst wall. The current mortality rate of choledochal cyst treated by surgical decompression is 5 to 10 per cent. A case of choledochal cyst in a 58 years old woman is described. The anatomopathologic, clinic features and therapeutic lines are pointed out. PMID:3434933

Remonda, G; Piemontese, F; Massaglia, F; Arzani, E; Franchello, A

67

Castration inhibits biliary proliferation induced by bile duct obstruction: novel role for the autocrine trophic effect of testosterone  

PubMed Central

Increased cholangiocyte growth is critical for the maintenance of biliary mass during liver injury by bile duct ligation (BDL). Circulating levels of testosterone decline following castration and during cholestasis. Cholangiocytes secrete sex hormones sustaining cholangiocyte growth by autocrine mechanisms. We tested the hypothesis that testosterone is an autocrine trophic factor stimulating biliary growth. The expression of androgen receptor (AR) was determined in liver sections, male cholangiocytes, and cholangiocyte cultures [normal rat intrahepatic cholangiocyte cultures (NRICC)]. Normal or BDL (immediately after surgery) rats were treated with testosterone or antitestosterone antibody or underwent surgical castration (followed by administration of testosterone) for 1 wk. We evaluated testosterone serum levels; intrahepatic bile duct mass (IBDM) in liver sections of female and male rats following the administration of testosterone; and secretin-stimulated cAMP levels and bile secretion. We evaluated the expression of 17?-hydroxysteroid dehydrogenase 3 (17?-HSD3, the enzyme regulating testosterone synthesis) in cholangiocytes. We evaluated the effect of testosterone on the proliferation of NRICC in the absence/presence of flutamide (AR antagonist) and antitestosterone antibody and the expression of 17?-HSD3. Proliferation of NRICC was evaluated following stable knock down of 17?-HSD3. We found that cholangiocytes and NRICC expressed AR. Testosterone serum levels decreased in castrated rats (prevented by the administration of testosterone) and rats receiving antitestosterone antibody. Castration decreased IBDM and secretin-stimulated cAMP levels and ductal secretion of BDL rats. Testosterone increased 17?-HSD3 expression and proliferation in NRICC that was blocked by flutamide and antitestosterone antibody. Knock down of 17?-HSD3 blocks the proliferation of NRICC. Drug targeting of 17?-HSD3 may be important for managing cholangiopathies.

Yang, Fuquan; Priester, Sally; Onori, Paolo; Venter, Julie; Renzi, Anastasia; Franchitto, Antonio; Munshi, Md Kamruzzaman; Wise, Candace; Dostal, David E.; Marzioni, Marco; Saccomanno, Stefania; Ueno, Yoshiyuki; Gaudio, Eugenio

2011-01-01

68

Histological examination and evaluation of donor bile ducts received during orthotopic liver transplantation--a morphological clue to ischemic-type biliary lesion?  

PubMed

Ischemic-type biliary lesions (ITBL) belong to a group of biliary disorders that are regarded as the major complication in patients with orthotopic liver transplantation (OLT). We performed histological evaluation of donor common bile ducts received during OLT to find morphological clues to the pathomechanisms of ITBL. We investigated 93 grafts of 92 patients (recipients: mean age, 56.5 years; underlying disease: hepatocellular carcinoma (n?=?45), alcoholic cirrhosis (n?=?16), viral hepatitis with cirrhosis (n?=?9), retransplantations (n?=?9), others (n?=?14); donors: mean age, 53.2 years). Donor common bile ducts were received after recirculation of the hepatic artery prior to biliary end-to-end anastomosis and routinely processed. Statistical evaluation was performed by chi-square analysis and multivariate analysis using a logistic regression model. With regard to ITBL (observed in 19.4 %), the following phenomena were found to be statistically relevant: necrosis of the bile duct wall, arteriolonecrosis, vascular lesions (such as subintimal edema), and intramural bleeding (P?duct, we conclude that these phenomena of vascular damage, reflecting microangiopathy, play a major role in the pathogenesis of ITBL. PMID:22588496

Hansen, Torsten; Hollemann, David; Pitton, Michael B; Heise, Michael; Hoppe-Lotichius, Maria; Schuchmann, Marcus; Kirkpatrick, C James; Otto, Gerd

2012-05-17

69

Carcinogenesis and chemoprevention of biliary tract cancer in pancreaticobiliary maljunction  

PubMed Central

Pancreaticobiliary maljunction (PBM) is a high risk factor for biliary tract cancer. In PBM, since the pancreatic duct and bile duct converge outside the duodenal wall beyond the influence of the sphincter of Oddi, pancreatic juice and bile are constantly mixed, producing a variety of harmful substances. Because of this, the biliary mucosa is repeatedly damaged and repaired, which causes an acceleration of cell proliferative activity and multiple gene mutations. Histological changes such as hyperplasia, metaplasia, and dysplasia ultimately result in a high incidence of carcinogenesis. In a nationwide survey by the Japanese Study Group on PBM, coexisting biliary tract cancer was detected in 278 of the 1627 registered cases of PBM (17.1%). Of these cases, in those with dilatation of the extrahepatic bile duct, cancer was often detected not only in the gallbladder but also in the bile ducts. More than 90% of cancer cases without dilatation of the extrahepatic bile duct develop in the gallbladder. Standard treatment for PBM is a cholecystectomy and resection of the extrahepatic bile duct. However, cholecystectomy alone is performed at nearly half of institutions in Japan. Conversely, reports of carcinogenesis in the remnant bile duct or pancreas after diversion surgery are steadily increasing. One of the causes for this is believed to be an accumulation of gene mutations which were present before surgery. Anticancer drugs are ineffective in preventing such carcinogenesis following surgery, thus the postoperative administration of chemopreventive agents may be necessary.

Tsuchida, Akihiko; Itoi, Takao

2010-01-01

70

Mechanisms of major biliary injury during laparoscopic cholecystectomy.  

PubMed Central

Laparoscopic cholecystectomy has become the procedure of choice for surgical removal of the gallbladder. The most significant complication of this new technique is injury to the bile duct. Twelve cases of bile duct injury during laparoscopic cholecystectomy were reviewed. Eight injuries were of a classic type: misidentification of the common duct for the cystic duct, resection of part of the common and hepatic ducts, and associated right hepatic arterial injury. Another injury was similar: clip ligation of the distal common duct with proximal ligation and division of the cystic duct, resulting in biliary obstruction and leakage. Three complications arose from excessive use of cautery or laser in the region of the common duct, resulting in biliary strictures. Evaluation of persistent diffuse abdominal pain led to the recognition of ductal injury in most patients. Ultimately, 10 patients required a Roux-en-Y hepaticojejunostomy to provide adequate biliary drainage. One patient had a successful direct common duct repair, and the remaining patient underwent endoscopic dilatation. Images FIG. 1. FIG. 1. FIG. 2. FIG. 6.

Davidoff, A M; Pappas, T N; Murray, E A; Hilleren, D J; Johnson, R D; Baker, M E; Newman, G E; Cotton, P B; Meyers, W C

1992-01-01

71

Spontaneous Biliary Peritonitis in Children  

PubMed Central

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.

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

2013-01-01

72

Plastic surgery for cutaneous seeding of bile duct cancer following percutaneous biliary drainage  

Microsoft Academic Search

A case of cutaneous seeding of bile duct cancer along a drainage tube is reported. The cutaneous lesion, which caused pain\\u000a and bleeding, was resected and the defect covered by a transposition flap. After the operation, the pain abated. This is the\\u000a third case reported in the English literature and the first case reported in the field of plastic surgery.

A. Shiba; M. Hatoko; T. Okazaki; M. Kuwahara; A. Tanaka; T. Muramatsu

1999-01-01

73

Percutaneous catheter drainage in intraabdominal fluid collections including infected biliary ducts and gallbladders  

SciTech Connect

Sixty-five abscesses, including 6 infected biliary systems and 15 sterile fluid collections, were treated by percutaneous catheter drainage in 77 febrile patients who were evaluated by computerized tomography or ultrasonography of intraabdominal infection. Percutaneous catheter drainage and systemic antibiotic administration without surgery provided satisfactory control of infection in 52 of 65 abscesses (80 percent). Catheter drainage followed by surgical exploration for abscess control was performed in an additional 5 of 65 abscesses (7 percent). Nine death (14 percent) occurred in the abscess group of 64 patients. In 15 patients, aspirations, Gram stain, and culture of the abnormal fluid collection revealed sterile fluid. Drainage with a single catheter allowed complete resolution in 14 of 15 sterile collections. Surgery was performed electively in one patient with a fistula from a pancreatic pseudocyst in the small bowel. No deaths occurred in the noninfected group of 15 patients, 2 of whom underwent drainage of coexisting abscesses.

Miller, M.H.; Frederick, P.R.; Tocino, I.; Bahr, A.L.

1982-12-01

74

Less invasive causal treatment of ejaculatory duct obstruction by balloon dilation: a case report, literature review and suggestion of a CT- or MRI-guided intervention  

PubMed Central

Uni- or bilateral ejaculatory duct obstruction (EDO) is a rare but correctable cause of infertility, chronic pelvic pain and postejaculatory pain. EDO is a congenital or acquired condition, it is the underlying cause of infertility in approximately 5% of infertile men. If acquired, the etiology often remains unresolved, but prostatitis or urethritis with post-inflammatory adhesion of the duct walls seems to be a common underlying pathomechanism. Although a certain constellation of physicochemical semen parameters may lead to correct diagnosis, EDO often resembles a diagnosis by exclusion. Imaging of acquired EDO remains a challenge and the established surgical therapy, transurethral resection of the ejaculatory ducts (TURED), leads to a low rate of natural conception and a high rate of complications such as reflux of urine and epididymitis. We present a case of a male with suspected EDO who underwent a combined approach to both, semi-invasive diagnosis and therapy by transrectal puncture of the seminal vesicles and antegrade balloon-dilation of the ejaculatory ducts. Possibilities and pitfalls of this procedure are described and the literature is reviewed. Furthermore, we suggest a CT- or MRI-guided, percutaneous intervention for treatment of ejaculatory duct obstruction by balloon dilation and demonstrate initial steps of this procedure with a body donor. We call this new procedure PTED (percutaneous transgluteal ejaculatory ductoplasty).

Kayser, Ole; Osmonov, Daniar; Harde, Jonas; Girolami, Guido; Wedel, Thilo; Schafer, Philipp

2012-01-01

75

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  

PubMed Central

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 ?mol/L vs -1.7 ± 9.9 ?mol/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.

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

2008-01-01

76

Endocoil placement after endoscopic ultrasound-guided biliary drainage may prevent a bile leak  

PubMed Central

AIM: To further reduce the risk of bleeding or bile leakage. METHODS: We performed endoscopic ultrasound guided biliary drainage in 6 patients in whom endoscopic retrograde cholangiopancreatography (ERCP) had failed. Biliary access of a dilated segment 2 or 3 duct was achieved from the stomach using a 19G needle. After radiologically confirming access a guide wire was placed, a transhepatic tract created using a 6 Fr cystotome followed by balloon dilation of the stricture and antegrade metallic stent placement across the malignant obstruction. This was followed by placement of an endocoil in the transhepatic tract. RESULTS: Dilated segmental ducts were observed in all patients with the linear endoscopic ultrasound scope from the proximal stomach. Transgastric biliary access was obtained using a 19G needle in all patients. Biliary drainage was achieved in all patients. Placement of an endocoil was possible in 5/6 patients. All patients responded to biliary drainage and no complications occurred. CONCLUSION: We show that placing endocoils at the time of endoscopic ultrasound guided biliary stenting is feasible and may reduce the risk of bleeding or bile leakage.

van der Merwe, Schalk Willem; Omoshoro-Jones, Jones; Sanyika, Charles

2013-01-01

77

Is Biliary Lithogenesis Affected by Length and Implantation of Cystic Duct? (Study of 270 Patients with Endoscopic Retrograde Cholangiopancreatography)  

Microsoft Academic Search

The gallbladder seems to play an important rolein lithogenesis. Moreover, the morphology and theimplantation of the cystic duct may also influence thisprocess. Our purpose was to evaluate if the length and the implantation of the cystic duct mayaffect the formation of gallstones. Between April 1992and March 1994, 270 patients who underwent endoscopicretrograde cholangiopancreatography were included in the study, and the

Francois-Xavier Caroli-Bosc; JEAN-FRANC Ë OIS DEMARQUAY; Massimo Conio; Christiane Deveau; Patrick Hastier; Alan Harris; Remy Dumas; Jean-Pierre Delmont

1997-01-01

78

[Biliary atresia].  

PubMed

Biliary atresia is a rare, neonatal, progressive cholestatic liver disease caused by fibroinflammatory obstruction of the biliary tree. Typical symptoms include prolonged neonatal jaundice, pale stools, and conjugated hyperbilirubinemia. Treatment starts with portoenterostomy, where fibrotic remnants of the extra hepatic bile ducts are replaced with small intestine. Best operative results are achieved among the youngest patients treated in specialized centres. Despite clearance of jaundice after a successful operation, fibrotic change of the liver continues in most. Liver transplantation serves as a salvage procedure if the portoenterostomy fails, or complications of liver cirrhosis develop after an initially successful portoenterostomy. In Finland, biliary atresia treatment was centralized in 2005. Of the patients treated thereafter, 90% are alive and over 80% with their native livers. PMID:23961607

Lampela, Hanna; Pakarinen, Mikko

2013-01-01

79

Silymarin retards collagen accumulation in early and advanced biliary fibrosis secondary to complete bile duct obliteration in rats  

Microsoft Academic Search

Silymarin (SIL), a standardized plant extract containing about 60% polyphenole silibinin, is used as a hepatoprotective agent. Its antifibrotic potential in chronic liver diseases has not been explored. Therefore, we applied SIL to adult Wistar rats that were subjected to complete bile duct occlusion (BDO) by injection of sodium amidotrizoate (Ethibloc). This treatment induces progressive portal fibrosis without significant inflammation.

G Boigk; L Stroedter; H Herbst; J Waldschmidt; EO Riecken; D Schuppan

1997-01-01

80

Nonoperative management of blunt extrahepatic biliary duct transection in the pediatric patient: Case report and review of the literature  

Microsoft Academic Search

An 11-year-old boy sustained a grade IV liver injury and complete disruption of the left hepatic duct (LHD) secondary to a sledding accident. Although he became hemodynamically stable after initial resuscitation in the emergency department and the intensive care unit (ICU), serial paracentesis procedures were necessary to manage abdominal compartment syndrome (ACS). The fluid initially was serosanguinous but subsequently became

Richard P. Sharpe; Michael L. Nance; Perry W. Stafford

2002-01-01

81

Biliary atresia  

PubMed Central

Biliary atresia (BA) is a cholangiodestructive disease affecting biliary tract, which ultimately leads to cirrhosis, liver failure and death if not treated. The incidence is higher in Asian countries than in Europe. Up to 10% of cases have other congenital anomalies, such as polysplenia, asplenia, situs inversus, absence of inferior vena cava and pre-duodenal portal vein, for which we have coined the term Biliary Atresia Splenic Malformation (BASM) syndrome. For these infants the aetiology lies within the first trimester of gestation. For others affected with BA, aetiology is more obscure and perinatal destruction of fully-formed ducts perhaps by the action of hepatotropic viruses has been suggested. Whatever the cause, the lumen of the extrahepatic duct is obliterated at a variable level and this forms the basis for the commonest classification (Types I, II, III). All patients with BA present with varying degree of conjugated jaundice, pale non-pigmented stools and dark urine. Key diagnostic tests include ultrasonography, biochemical liver function tests, viral serology, and (in our centre) a percutaneous liver biopsy. In some centres, duodenal intubation and measurement of intralumenal bile is the norm. Currently BA is being managed in two stages. The first stage involves the Kasai operation, which essentially excises all extrahepatic biliary remnants leaving a transected portal plate, followed by biliary reconstruction using a Roux loop onto that plate as a portoenterostomy. If bile flow is not restored by Kasai procedure or life-threatening complications of cirrhosis ensue then consideration should be given to liver transplantation as a second stage. The outcome following the Kasai operation can be assessed in two ways: clearance of jaundice to normal values and the proportion who survive with their native liver. Clearance of jaundice (<2 mg/dL or <34 µmol/L) after Kasai has been reported to be around 60%, whereas five years survival with native liver ranges from 40% to 65%.

Sinha, C. K.; Davenport, Mark

2008-01-01

82

Biliary atresia  

PubMed Central

Biliary atresia (BA) is a rare disease characterised by a biliary obstruction of unknown origin that presents in the neonatal period. It is the most frequent surgical cause of cholestatic jaundice in this age group. BA occurs in approximately 1/18,000 live births in Western Europe. In the world, the reported incidence varies from 5/100,000 to 32/100,000 live births, and is highest in Asia and the Pacific region. Females are affected slightly more often than males. The common histopathological picture is one of inflammatory damage to the intra- and extrahepatic bile ducts with sclerosis and narrowing or even obliteration of the biliary tree. Untreated, this condition leads to cirrhosis and death within the first years of life. BA is not known to be a hereditary condition. No primary medical treatment is relevant for the management of BA. Once BA suspected, surgical intervention (Kasai portoenterostomy) should be performed as soon as possible as operations performed early in life is more likely to be successful. Liver transplantation may be needed later if the Kasai operation fails to restore the biliary flow or if cirrhotic complications occur. At present, approximately 90% of BA patients survive and the majority have normal quality of life.

Chardot, Christophe

2006-01-01

83

Interval biliary stent placement via percutaneous ultrasound guided cholecystostomy: another approach to palliative treatment in malignant biliary tract obstruction.  

PubMed

Percutaneous cholecystostomy is a minimally invasive procedure for providing gallbladder decompression, often in critically ill patients. It can be used in malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography when the intrahepatic ducts are not dilated or when stent insertion is not possible via the bile ducts. In properly selected patients, percutaneous cholecystostomy in obstructive jaundice is a simple, safe, and rapid option for biliary decompression, thus avoiding the morbidity and mortality involved with percutaneous transhepatic biliary stenting. Subsequent use of a percutaneous cholecystostomy for definitive biliary stent placement is an attractive concept and leaves patients with no external drain. To the best of our knowledge, it has only been described on three previous occasions in the published literature, on each occasion forced by surgical or technical considerations. Traditionally, anatomic/technical considerations and the risk of bile leak have precluded such an approach, but improvements in catheter design and manufacture may now make it more feasible. We report a case of successful interval metal stent placement via percutaneous cholecystostomy which was preplanned and achieved excellent palliation for the patient. The pros and cons of the procedure and approach are discussed. PMID:19688367

Harding, James; Mortimer, Alex; Kelly, Michael; Loveday, Eric

2009-08-18

84

Atypical MRI features of a biliary cystadenoma revealed by jaundice.  

PubMed

We report on the case of a patient admitted for epigastric pain. An abdominal ultrasound revealed a voluminous cystic lesion of the left hepatic lobe. In magnetic resonance imaging, the mass had a liquid-liquid level that was spontaneously hyperintense on T(1)-weighted images and hypointense on T(2)-weighted images. Magnetic resonance cholangiography identified bilateral intrahepatic bile duct dilatation. A left hepatectomy finally revealed a mucinous cystadenoma with pseudo-ovarian stroma that had a pedunculated intraductal extension to the biliary convergence. PMID:17101411

Baudin, Guillaume; Novellas, Sébastien; Buratti, Massimo Senni; Saint-Paul, Marie Christine; Chevallier, Patrick; Gugenheim, Jean; Bruneton, Jean Noël

85

Endoscopic therapy for biliary obstruction  

Microsoft Academic Search

Endoscopic management of biliary obstruction is feasible in most patients and has emerged as standard treatment. Aside from the removal of bile duct stones, placement of a biliary stent is the most commonly employed modality of management. In experienced hands, this is successful in over 90% of patients. Lower procedure-related complications and the relative non-invasive nature of endoscopic treatment has

Nib Soehendra; Kenneth F. Binmoeller; Horst Grimm

1992-01-01

86

Partial biliary obstruction caused by chronic pancreatitis. An appraisal of indications for surgical biliary drainage.  

PubMed Central

This paper presents a retrospective review of 38 patients with intrapancreatic bile duct strictures secondary to chronic alcoholic pancreatitis. The strictures were identified by endoscopic retrograde cholangiopancreatography (ERCP). All patients with pancreatic cancer and gallstone pancreatitis were excluded. The mean alkaline phosphatase and total bilirubin values were 344 +/- 57 IU/dl and 4.4 +/- 0.7 mg/dl, respectively. The mean stricture length was 3.9 +/- 0.5 cm, and the mean common bile duct (CBD) diameter was 1.8 +/- 0.2 cm. The degree of bilirubin and alkaline phosphatase elevation did not correlate with stricture length or the severity of bile duct dilatation. Eighteen of the 38 patients received surgical biliary drainage (BD) as part of their initial therapy, and 20 patients did not. Liver function tests, intrapancreatic stricture length, and the degree of proximal CBD dilation were comparable in these two groups. Patients not undergoing BD did well clinically as only one patient required BD over an average follow-up period of 3.8 years. In conclusion, bypass of these strictures is usually unnecessary, and most patients may be safely treated without operation. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4.

Stahl, T J; Allen, M O; Ansel, H J; Vennes, J A

1988-01-01

87

Cystic Duct Dilatations and Proliferative Epithelial Lesions in Mouse Mammary Glands upon Keratin 5 Promoter-Driven Overexpression of Cyclooxygenase-2  

PubMed Central

Expression and pharmacological studies support a contribution of cyclooxygenase (COX)-2 to mammary gland tumorigenesis. In a recent transgenic study, mouse mammary tumor virus promoter-driven COX-2 expression in mouse mammary glands was shown to result in alveolar hyperplasia, dysplasia, and carcinomas after multiple rounds of pregnancy and lactation. In the study presented here, the effects of constitutive COX-2 overexpression in keratin 5-positive myoepithelial and luminal cells, driven by the keratin 5 promoter in a hormone-independent manner, was investigated. In nulliparous female mice, aberrant COX-2 overexpression correlated with increased prostaglandin (PG) E2 levels and caused cystic duct dilatations, adenosis, and fibrosis whereas carcinomas developed rarely. This phenotype depended on COX-2-mediated PGE2 synthesis and correlated with increased expression of proliferation-associated Ki67 in epithelial cells. No changes in the expression of apoptosis-related Bcl-2, caspase 3, or p53 were observed. Hyperproliferation of the mammary gland epithelial cells was associated with increased aromatase mRNA levels in this tissue. The spontaneous pathologies bear analogies to the human breast with fibrocystic changes. Intriguingly, strong COX-2 expression was observed in fibrocystic changes, as compared to low expression in normal breast epithelium. These results show for the first time that aberrant COX-2 expression contributes to the development of fibrocystic changes (FC), indicating that COX-2 and COX-2-mediated PG synthesis represent potential targets for the therapy of this most frequent benign disorder of the human breast.

Muller-Decker, Karin; Berger, Irina; Ackermann, Karin; Ehemann, Volker; Zoubova, Svetlana; Aulmann, Sebastian; Pyerin, Walter; Furstenberger, Gerhard

2005-01-01

88

Magnetic compression anastomosis for bile duct stenosis after donor left hepatectomy: a case report.  

PubMed

Magnetic compression anastomosis (MCA) provides a minimally invasive treatment creating a nonsurgical, sutureless enteric anastomosis in conjunction with an interventional radiologic technique by using 2 high-power magnets. Recently, the MCA technique has been applied to bile duct strictures after living donor liver transplantation or major hepatectomy. Herein we described use of MCA for bile duct stenosis 5 months after donor left hepatectomy in a 24-year-old man who presented with a stricture at the porta hepatis and intrahepatic bile duct dilatation. Unsuccessful transpapillary biliary drainage and balloon dilatation through a percutaneous transhepatic biliary drainage (PTBD) route led to the MCA. A 4-mm-diameter cylindrical samarium-cobalt (Sm-Co) daughter magnet with a long nylon wire was placed at the superior site of the obstruction through the PTBD route. A 5-mm-diameter Sm-Co parent magnet with an attached nylon handle was endoscopically inserted into the common bile duct and placed at the inferior site of obstruction. The 2 magnets were attracted, sandwiching the stricture and establishing a reanastomosis. In conclusion, the MCA technique was a unique procedure for choledochocholedochostomy in a patient with bile duct stenosis after donor hepatectomy. PMID:22483501

Oya, H; Sato, Y; Yamanouchi, E; Yamamoto, S; Hara, Y; Kokai, H; Sakamoto, T; Miura, K; Shioji, K; Aoyagi, Y; Hatakeyama, K

2012-04-01

89

Fascioliasis: sonographic abnormalities of the biliary tract and evolution after treatment with triclabendazole.  

PubMed

Diagnosis of infection with the liver fluke Fasciola hepatica is usually difficult. Ultrasonography (US) might be a useful diagnostic alternative, and we assessed the value of sequential US in the diagnosis and monitoring of fascioliasis in 76 patients at baseline and for 60 days after treatment with triclabendazole. At baseline, biliary abnormalities were observed in 52 patients. Crescent-shaped parasites were seen in 11 patients; in 2 cases parasites were spontaneously moving and in 4 patients parasites were motionless. Postprandial examination revealed parasites adhering to the gallbladder wall in a further 5 cases. In 3 further cases, gallbladder contents were mobile but did not sediment downwards after patients changed position. Non-specific abnormalities were: impaired gallbladder contractility (n = 23), gallbladder tenderness (n = 19), debris (n = 6), calculi (n = 5), wall thickening (n = 2) and bile duct dilatation (n = 12). During day 1-7, Fasciola-like crescents in the gallbladder or passing through the bile duct were detected in another 15 patients, impaired gallbladder contractility in 16, gallbladder tenderness in 16, and bile duct dilatation in an additional 28 patients. Thirty-two patients with these US abnormalities experienced colic-like abdominal pain accompanied by increased alkaline phosphatase in 25 cases. During day 30-60, abnormalities regressed completely in 45 patients; 2/6 triclabendazole failures were evident by detection of living parasites. Biliary tract abnormalities are frequently observed by US, but the detection-rate of Fasciola hepatica is disappointingly low despite the parasite's relatively large size. US findings must therefore be interpreted together with other clinical measurements. The visualization of parasites being expelled through the dilated common bile duct allowed the causal interpretation of post-therapeutic abdominal pain and increase of liver enzymes. When triclabendazole is given on suspicion, visualization of worm expulsion and bile duct dilatation by US may be used to confirm diagnosis. PMID:10588772

Richter, J; Freise, S; Mull, R; Millán, J C

1999-11-01

90

Management of patients with biliary sphincter of Oddi disorder without sphincter of Oddi manometry  

PubMed Central

Background The paucity of controlled data for the treatment of most biliary sphincter of Oddi disorder (SOD) types and the incomplete response to therapy seen in clinical practice and several trials has generated controversy as to the best course of management of these patients. In this observational study we aimed to assess the outcome of patients with biliary SOD managed without sphincter of Oddi manometry. Methods Fifty-nine patients with biliary SOD (14% type I, 51% type II, 35% type III) were prospectively enrolled. All patients with a dilated common bile duct were offered endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy whereas all others were offered medical treatment alone. Patients were followed up for a median of 15 months and were assessed clinically for response to treatment. Results At follow-up 15.3% of patients reported complete symptom resolution, 59.3% improvement, 22% unchanged symptoms, and 3.4% deterioration. Fifty-one percent experienced symptom resolution/improvement on medical treatment only, 12% after sphincterotomy, and 10% after both medical treatment/sphincterotomy. Twenty percent experienced at least one recurrence of symptoms after initial response to medical and/or endoscopic treatment. Fifty ERCP procedures were performed in 24 patients with an 18% complication rate (16% post-ERCP pancreatitis). The majority of complications occurred in the first ERCP these patients had. Most complications were mild and treated conservatively. Age, gender, comorbidity, SOD type, dilated common bile duct, presence of intact gallbladder, or opiate use were not related to the effect of treatment at the end of follow-up (p > 0.05 for all). Conclusions Patients with biliary SOD may be managed with a combination of endoscopic sphincterotomy (performed in those with dilated common bile duct) and medical therapy without manometry. The results of this approach with regards to symptomatic relief and ERCP complication rate are comparable to those previously published in the literature in cohorts of patients assessed by manometry.

2010-01-01

91

Esophageal dilation \\/ dilators  

Microsoft Academic Search

Opinion statement  Esophageal dilation is the treatment of choice for most patients with esophageal dysphagia (functional and mechanical). Multiple\\u000a forms of esophageal dilators are available. Mechanical dilators (guidewire\\/nonguidewire assisted) are the major forms of dilators\\u000a used. Balloon dilator use has increased but they offer only a marginal advantage over traditional mechanical dilators at a\\u000a greatly increased cost (2° to single use).

Timothy T. Nostrant

2005-01-01

92

Heterogeneity of the intrahepatic biliary epithelium.  

PubMed

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 alpha-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. PMID:16773709

Glaser, Shannon; Francis, Heather; Demorrow, Sharon; Lesage, Gene; Fava, Giammarco; Marzioni, Marco; Venter, Julie; Alpini, Gianfranco

2006-06-14

93

Primary biliary cirrhosis  

Microsoft Academic Search

Primary biliary cirrhosis (PBC) is a chronic, progressive, cholestatic disease of unknown aetiology that affects mainly women. There is a strong association with antimitochondrial antibodies (AMA) and the disease is characterized by granulomatous cholangitis, which leads to progressive destruction of the small and middle-sized intrahepatic bile ducts, leading to fibrosis and cirrhosis. Patients with PBC may present with itching or

James M. Neuberger

2011-01-01

94

Primary biliary cirrhosis  

Microsoft Academic Search

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

Teru Kumagi; E Jenny Heathcote

2008-01-01

95

THE BILIARY FACTOR IN LIVER LESIONS  

PubMed Central

There are excellent reasons for employing the rabbit in an experimental analysis of the biliary factor in liver lesions; and it is possible to obtain in this animal results uncomplicated by infection or by intercurrent cirrhosis. Ligation of the common duct of the rabbit results in a mixed lesion from injury throughout the entire length of the bile channels. By obstructing single ducts and altering the portal stream we have produced cirrhoses of pure monolobular and diffusely intralobular types. The character of the connective tissue changes is determined by the path of escape of bile from the collecting system, which in turn is largely conditional upon the secretory activity, while this again is dependent upon blood flow. The portal flow is largely diverted from regions of local stasis through encroachment on the stream bed by the dilated ducts. There is a large margin of safety in bile elimination by the normal hepatic tissue. Less than a quarter of the liver of the rabbit, and this deprived of its entire portal stream, will suffice to keep the organism free from clinical jaundice and healthy when the remainder of the liver, which receives all of the portal blood, has its ducts ligated. The vicarious elimination thus illustrated is of great importance for regions of local stasis by keeping the blood relatively free from bile, thus preventing resecretion into such regions and facilitating exchange from them into the body fluids. Our experimental monolobular and intralobular cirrhoses are the result of the limitation of biliary lesions to special levels of the duct system. Their resemblance to the different forms of "biliary" cirrhosis associated with Hanot's name is close, and the diverse liver lesions of Hanot's disease are readily explained on the assumption that the stasis, with or without infection, which is indubitably here present, has its situation at different levels in different cases. There are reasons for the view that bile stasis per se may sometimes be a prime cause of the malady. Certainly such stasis must be thought of as acting to complicate many chronic liver lesions. In a later paper experiments on the dog will be described essentially similar in result to those on the rabbit as here set forth.

Rous, Peyton; Larimore, Louise D.

1920-01-01

96

Endoscopic ultrasound guided biliary drainage  

PubMed Central

Endoscopic retrograde cholangio-pancreatography is the most appropriate technique for treating common bile duct and pancreatic duct stenosis secondary to benign and malignant diseases. Even if the procedure is performed by skillful endoscopist, there are patients in whom endoscopic stent placement is not possible. Common causes of failure include complex peri-papillary diverticula, prior surgery procedures, tumor involvement of the papilla, biliary sphincter stenosis, and impacted stones. Percutaneous trans-hepatic biliary drainage (PTBD) and surgical intervention carry morbidity and mortality. Recently endoscopic ultrasonography-guided biliary drainage has been reported as an alternative technique. Endoscopic ultrasonography-guided biliary drainage using either direct access or a rendezvous technique has attracted attention as an alternative procedure to PTBD, with a technical success between 75%-100% and with low complication rate. We have reviewed published data on EUS guided biliary drainage procedures with the aim of summarizing the efficacy and safety of this promising method.

Tarantino, Ilaria; Barresi, Luca; Fabbri, Carlo; Traina, Mario

2012-01-01

97

Detection, localization, and quantitation of degree of common bile duct obstruction by scintigraphy  

SciTech Connect

The detection, localization, and quantitation of the degree of obstruction was successfully accomplished by (/sup 99m/Tc)IDA scintigraphy in 13 of 14 patients with cholangiographically documented common bile duct (CBD) obstruction. Ductal dilation was present on ultrasound examination in only seven patients. The accuracy of biliary scintigraphy was enhanced by several innovations including: (a) selection of a radiopharmaceutical with rapid hepatic uptake and excretion; (b) shorter imaging interval over longer period of time; (c) substitution of image parameter for appearance time; and (d) quantitative measurement of bile emptying parameters following cholecystokinin infusion. Scintigraphically, the partial obstruction was characterized by CBD segmental narrowing or intraluminal filling defects and bile stasis within the area and segmental ducts. It is concluded that quantitative biliary dynamic scintigraphy employing modern techniques can accurately detect and localize CBD obstruction.

Krishnamurthy, G.T.; Lieberman, D.A.; Brar, H.S.

1985-07-01

98

Augmented expression of hepatocytes growth factor activator inhibitor type 1 (HAI1) in intrahepatic small bile ducts in primary biliary cirrhosis  

Microsoft Academic Search

The repair system of damaged biliary mucosa was not fully clarified so far in primary biliary cirrhosis (PBC). Given that\\u000a related factors of the hepatocyte growth factor (HGF) such as HGF activator (HGFA) and HGFA inhibitor type 1 (HAI-1) participate\\u000a in the repair of injured gastrointestinal mucosa, we investigated the involvement of the HGF\\/HGFA\\/HAI-1 system in PBC and\\u000a control livers.

Motoko Sasaki; Hiroko Ikeda; Hiroaki Kataoka; Yasuni Nakanuma

2006-01-01

99

A Multicenter, Prospective Study of a New Fully Covered Expandable Metal Biliary Stent for the Palliative Treatment of Malignant Bile Duct Obstruction  

PubMed Central

Background and Study Aims. Endoscopic placement of self-expanding metal stents (SEMSs) is indicated for palliation of inoperable malignant biliary obstruction. A fully covered biliary SEMS (WallFlex Biliary RX Boston Scientific, Natick, USA) was assessed for palliation of extrahepatic malignant biliary obstruction. Patients and Methods. 58 patients were included in this prospective, multicenter series conducted under an FDA-approved IDE. Main outcome measurements included (1) absence of stent occlusion within six months or until death, whichever occurred first and (2) technical success, need for reintervention, bilirubin levels, stent patency, time to stent occlusion, and adverse events. Results. Technical success was achieved in 98% (57/58), with demonstrated acute removability in two patients. Adequate clinical palliation until completion of followup was achievedin 98% (54/55) of evaluable patients, with 1 reintervention due to stent obstruction after 142 days. Mean total bilirubin decreased from 8.9?mg/dL to 1.2?mg/dL at 1 month. Device-related adverse events were limited and included 2 cases of cholecystitis. One stent migrated following radiation therapy. Conclusions. The WallFlex Biliary fully covered stent yielded technically successful placement with uncomplicated acute removal where required, appropriate reduction in bilirubin levels, and low rates of stent migration and occlusion. This SEMS allows successful palliation of malignant extrahepatic biliary obstruction.

Petersen, Bret T.; Kahaleh, Michel; Kozarek, Richard A.; Loren, David; Gupta, Kapil; Kowalski, Thomas; Freeman, Martin; Chen, Yang K.; Branch, Malcolm S.; Edmundowicz, Steven; Gluck, Michael; Binmoeller, Kenneth; Baron, Todd H.; Shah, Raj J.; Kinney, Timothy; Ross, William; Jowell, Paul; Carr-Locke, David

2013-01-01

100

Surgical significance of extrahepatic biliary tree anomalies.  

PubMed

A patient with an anomalous insertion of the right hepatic duct into the cystic duct was noted during cholecystectomy and confirmed by operative cholangiography. This case and related anomalies of the bile ducts are of sufficient importance that, because of the technical difficulties and dangers incidental to their presence, no surgeon who operates on the gallbladder and bile ducts can afford to be unaware of their existence. Adequate exposure, careful dissection, and accurate knowledge of the regional anatomy plus a realization of the frequency and multiplicity of abnormalities of the extrahepatic biliary tree are requisites for safe biliary tract surgery. In addition, carefully performed operative cholangiography can be an indispensable aid in the clarification of anatomic variations. In case of recognized operative injury to the extrahepatic biliary tree, primary repair or biliary-intestinal anastomosis can usually be carried out with good results. PMID:937657

Prinz, R A; Howell, H S; Pickleman, J R

1976-06-01

101

Surgical treatment of a patient with diaphragmatic invasion by a ruptured hepatocellular carcinoma with biliary and portal venous tumor thrombi.  

PubMed

We describe the surgical treatment of a patient with diaphragmatic invasion by a ruptured hepatocellular carcinoma (HCC) associated with biliary and portal venous tumor thrombi. A 67-year-old man was admitted because of jaundice (total serum bilirubin, 6.6 mg/dL). The serum concentration of alpha-fetoprotein was 236.1 ng/mL. The anti-hepatitis C virus antibodies were present in the serum. Computed tomography showed a large hypervascular mass in the right subphrenic region, surrounded by local effusion. Endoscopic retrograde cholangiography revealed dilatation of the left intrahepatic bile duct caused by biliary tumor thrombi extending from the right hepatic duct to the common bile duct. Endoscopic nasobiliary drainage was performed, and the total serum bilirubin level returned to the normal range. Angiography revealed a hypervascular tumor without extravasation of contrast medium in the right lobe and obstruction of the right anterior branch of the portal vein. Right hepatectomy was attempted 15 days after drainage. Severe invasion of the diaphragm by the ruptured HCC was detected. Bleeding of the ruptured HCC stopped spontaneously. Partial resection of the diaphragm was performed, followed by primary suture, without an artificial patch. Tumor thrombectomy was performed from the common bile duct. Macroscopic examination revealed that the ruptured HCC had invaded the diaphragm. Biliary and portal venous tumor thrombi were present. Histopathological examination showed a moderately differentiated HCC with biliary and portal venous tumor thrombi. The postoperative course was uneventful. The patient was discharged on postoperative day 14. Five months after the operation, local and intrahepatic recurrences of HCC were detected. Six months after operation, the patient died of liver failure. In conclusion, the outcome of a patient with diaphragmatic invasion by a ruptured HCC with biliary tumor thrombi was poor, even after curative hepatic resection. PMID:22687359

Maruyama, Hiroshi; Yoshida, Hiroshi; Hirakata, Atsushi; Matsutani, Takeshi; Yokoyama, Tadashi; Suzuki, Seiji; Matsushita, Akira; Sasajima, Koji; Kikuchi, Yuta; Uchida, Eiji

2012-01-01

102

Functional dyspepsia: how could a biliary dyspepsia sub-group be recognized? A methodological approach.  

PubMed

Functional dyspepsia (FD) includes a heterogeneous group of patients suffering from a variety of different conditions. The Dyspepsia Project has been implemented in 14 GI Units since 1984, in order to epidemiologically test the discriminating power of the Working Teams definitions and of standardized questionnaires. Five per cent of admitted subjects were subclassified as sphincter of Oddi dysfunction or biliary dyspepsia (BD), defined as biliary pain associated or not to bilirubin or alkaline phosphatase elevation, in the abscence of ultrasonographic evidence of gallstone disease or bile duct dilatation. The more useful symptoms in favour of the diagnosis of biliary dyspepsia were found to be pain in the right hypochondrium, radiating to the shoulder, or to the back, initiated by food, and eventually associated with constipation, or epigastric postprandial discomfort. Interestingly, symptoms suggesting biliary dyspepsia are partially shared by dysmotility-like dyspepsia. The placebo response in functional dyspepsia is variable, between 6 and 80% of patients, reflecting variations in the kind and severity of the diseases in different studies. That represents a considerable difficulty in evaluating drug efficacy, even in the case of biliary dyspepsia. A therapeutic double-blind trial in functional dyspepsia using tauro-ursodeoxycholic acid is discussed. PMID:8842844

Koch, M; Capurso, G

1996-06-01

103

Biliary tract manifestations of the Marfan syndrome.  

PubMed

The diagnosis of the Marfan syndrome rests on the four criteria of characteristic musculoskeletal, cardiovascular, ocular, and familial features. Biliary tract manifestations have not been described. A case of Marfan syndrome with recurrent biliary obstruction is presented. Endoscopic retrograde cholangiograms presented a grossly ectatic biliary system which is postulated to be an unrecognized manifestation of this syndrome. In addition, the patient developed choledocholithiasis, which may have resulted from biliary stasis secondary to bile duct ectasia. Biliary obstruction developed in the presence and absence of choledocholithiasis, the latter apparently through kinking of the ectatic common bile duct. Obstruction was clinically relieved by biliary endoprosthesis. The presence of a Zenker's diverticulum in this patient, also unreported in the Marfan syndrome, is of incidental interest. PMID:3605039

Merza, A P; Raiser, M W

1987-08-01

104

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

SciTech Connect

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

Severini, Aldo [Divisione di Radiologia Gastroenterologica, Istituto Nazionale Tumori, Via Venezian 1, I-20133 Milan (Italy); Mantero, Sara [Dipartimento di Bioingegneria, Politecnico di Milano, Piazza Leonardo da Vinci 32, I-20133 Milan (Italy); Tanzi, Maria Cristina; Cigada, Alberto [Dipartimento di Fisica Chimica Applicata, Politecnico di Milano, Piazza Leonardo da Vinci 32, I-20133 Milan (Italy); Addis, Flaminio [Clinica Chirurgica Veterinaria, Universita di Milano, Via Ponzio 7, I-20133 Milan (Italy); Cozzi, Guido; Salvetti, Monica [Divisione di Radiologia Gastroenterologica, Istituto Nazionale Tumori, Via Venezian 1, I-20133 Milan (Italy); Andreola, Salvatore [Divisione di Anatomia Patologica, Istituto Nazionale Tumori, Via Venezian 1, I-20133 Milan (Italy); Motta, Antonella [Stazione Sperimentale per la Seta, Via G. Colombo 81, I-20133 Milan (Italy); Regalia, Enrico; Pulvirenti, Andrea [Divisione di Chirurgia dell'Apparato Digerente, Istituto Nazionale Tumori, Via Venezian 1, I-20133 Milan (Italy); De Pedri, Enrico [Divisione di Radiologia Gastroenterologica, Istituto Nazionale Tumori, Via Venezian 1, I-20133 Milan (Italy); Doci, Roberto [Divisione di Chirurgia dell'Apparato Digerente, Istituto Nazionale Tumori, Via Venezian 1, I-20133 Milan (Italy)

1999-11-15

105

Primary biliary cirrhosis  

Microsoft Academic Search

Primary biliary cirrhosis (PBC) is a chronic progressive disease of the intrahepatic bile ducts that primarily affects middle-aged women. The characteristic features include pruritus and lethargy. Although there is a widespread disturbance of the immune system, with association with other autoimmune diseases such as thyroid disease, sicca syndrome and Raynaud’s syndrome, elevation of immunoglobulins (especially IgM) and auto-antibodies; antibodies to

James M. Neuberger

2007-01-01

106

Pneumoperitoneum Caused by Transhepatic Air Leak After Metallic Biliary Stent Placement  

SciTech Connect

A self-expanding metallic biliary stent was placed for palliation of a common bile duct obstruction in a 68-year-old male with unresectable pancreatic head cancer 3 days after initial percutaneous right transhepatic catheter decompression. The stent crossed the ampulla of Vater. Three days later, the stent was balloon-dilated and the percutaneous access was removed. At removal, a small contrast leak from the transhepatic tract was seen. Three days later, pneumoperitoneum was found with symptoms of peritoneal irritation and fever. A widely open sphincter of Oddi caused by the metallic stent, accompanied by delayed sealing of the transhepatic tract, may have caused the air and bile leakage into the peritoneal space. This case shows that pneumoperitoneum may occur without ductal tear or bowel injury, with a biliary stent crossing the ampulla of Vater.

Lee, Jei Hee; Lee, Deok Hee; Yu, Jeong-Sik [Department of Diagnostic Radiology, Yonsei University College of Medicine, YongDong Severance Hospital, 146-92 Dokok-Dong, Kangnam-Ku, Seoul 135-270 (Korea, Republic of); Lee, Se Joon [Department of Internal Medicine, Yonsei University College of Medicine, YongDong Severance Hospital, 146-92 Dokok-Dong, Kangnam-Ku, Seoul 135-270 (Korea, Republic of); Kwon, Woo-Cheol; Kim, Ki Whang [Department of Diagnostic Radiology, Yonsei University College of Medicine, YongDong Severance Hospital, 146-92 Dokok-Dong, Kangnam-Ku, Seoul 135-270 (Korea, Republic of)

2000-11-15

107

Successful surgical management of an extrahepatic biliary cystadenocarcinoma  

PubMed Central

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.

Pais-Costa, Sergio Renato; Martins, Sandro J.; Araujo, Sergio L. M.; Lima, Olimpia A. T.; Paes, Marcio A.; Guimaraes, Marcio L.

2011-01-01

108

Successful endoscopic treatment of biliary stricture following mesenteric tear caused by blunt abdominal trauma  

Microsoft Academic Search

Biliary duct injuries are frequently iatrogenic, being associated with surgery for gallbladder stones. However, blunt abdominal trauma such as a motor vehicle crash is a rare cause of extrahepatic biliary stricture. A few reports have been published on biliary strictures treated with endoscopic therapy. In the present study, we describe a suprapancreatic biliary stricture associated with mesenteric tear following road

Dong O Kang; Tae Hyo Kim; Seung Suk You; Hyun Ju Min; Hyun Jin Kim; Woon Tae Jung; Ok Jae Lee

109

Do Pancreatic Duct Stents Cause or Prevent Pancreatic Sepsis?  

Microsoft Academic Search

BackgroundPancreatic sepsis can occur after contrast injection into an obstructed or disrupted pancreatic duct. Whether stents cause or prevent pancreatic sepsis is unknown. Accordingly, the pancreatic duct bacteriology in patients with pancreatic duct stents was retrospectively reviewed and contrasted with biliary cultures taken from patients at the time of bile duct stent retrieval and\\/or exchange.

Richard Kozarek; Oistein Hovde; Fouad Attia; Renee France

2003-01-01

110

Anatomical variations of the cystic duct: Two case reports  

Microsoft Academic Search

Anatomical variations of the cystic duct often occur and may be encountered during cholecystectomy. Knowledge of the variable anatomy of the cystic duct and cysticohepatic junction is important to avoid signifi cant ductal injury in biliary surgery. Here, we present two unusual cases with an anomalous cystic duct, namely, low lateral insertion and narrow-winding of the cystic duct. The first

Yun-Hua Wu; Zhi-Su Liu; Quan Sun; Qun Qian; Cong-Qing Jiang

2008-01-01

111

Ball-valve gastric tumor associated with anomalous junction of the pancreatico-biliary ductal system and a right-sided round ligament: report of a case.  

PubMed

We report the case of a ball-valve gastric tumor associated with anomalous junction of the pancreatico-biliary ductal system (AJPBDS) and a right-sided round ligament, misdiagnosed preoperatively as advanced gastric cancer with pancreatic head invasion. A 72-year-old woman presented with chest pain, but laboratory data showed only anemia. Gastroscopy revealed a bleeding polypoid gastric tumor in the anterior wall of the stomach, herniating into the duodenum (ball-valve syndrome), and a Bormann type-2 tumor in the posterior wall. Ultrasonography showed gallbladder stones, dilatation of the intrahepatic bile duct and pancreatic duct, and a left-sided gallbladder (attributed to a right-sided round ligament with anomalous branches of the portal veins). Laparotomy revealed that the gastric tumors were not advanced cancer invading the pancreatic head. Intraoperative cholangiography showed an AJPBDS, causing dilatation of the intrahepatic bile duct and pancreatic duct. We performed distal gastrectomy and cholecystectomy without biliary diversion. Microscopy revealed that the polypoid tumor was a hyperplastic polyp. PMID:18560972

Iso, Yukihiro; Sawada, Tokihiko; Rokkaku, Kyu; Shimoda, Mitsugi; Kubota, Keiichi

2008-04-30

112

Biliary Parasites  

Microsoft Academic Search

Parasitic diseases of the biliary tract occur frequently in tropical and subtropical areas and cause high morbidity and mortality. In general, neither the clinical presentation nor the general laboratory findings are sufficiently unique to raise the possibility of a parasitic biliary infestation in the mind of the surgeon. Once considered, however, the presence of a parasitic biliary infestation is easily

Maher Osman; Susanne Bach Lausten; Talaat El-Sefi; Ibrahim Boghdadi; M-Yousri Rashed; Steen Lindkær Jensen

1998-01-01

113

Unexpected dilatation of the common bile duct after methyl tertiary butyl ether (MTBE) in rabbits. Possible implications to findings in man  

Microsoft Academic Search

Methyl tertiary butyl ether (MTBE) rapidly dissolves cholesterol gall stones in vitro and in vivo. To further characterise tolerability and safety of this aliphatic ether, either MTBE (1 ml\\/kg body wt daily for two days) or an equal amount of saline was infused into the common bile duct (CBD) of eight cholecystectomised rabbits. Transient vomiting, dyspnoea and somnolence developed during

R Tritapepe; C Pozzi; P Caspani; C Di Padova

1989-01-01

114

Treatment of primary biliary cirrhosis  

Microsoft Academic Search

Although primary biliary cirrhosis (PBC) is generally a progressive disease, the rate of progression varies greatly from one patient to another. The terminal phase is characterized by hyperbilirubinaemia (>100?mol\\/l), a major decrease in the number of intrahepatic bile ducts, and extensive fibrosis or cirrhosis. It is now well established that orthotopic liver transplantation is the treatment of choice for patients

Raoul Poupon; Renée Eugénie Poupon

2000-01-01

115

Percutaneous Transhepatic Endoscopic Holmium Laser Lithotripsy for Intrahepatic and Choledochal Biliary Stones  

SciTech Connect

Purpose: To report our approach for treating complicated biliary calculi by percutaneous transhepatic endoscopic biliary holmium laser lithotripsy (PTBL). Patients and Methods: Twenty-two symptomatic patients (11 men and 11 women, age range 51 to 88 years) with intrahepatic or common bile duct calculi underwent PTBL. Nine patients had undergone previous gastrectomy and small-bowel anastomosis, thus precluding endoscopic retrograde cholangiopancreatography. In the other 13 patients, stone removal attempts by ERCP failed due to failed access or very large calculi. We used a 7.5F flexible ureteroscope and a 200-{mu}m holmium laser fiber by way of a percutaneous transhepatic tract, with graded fluoroscopy, to fragment the calculi with direct vision. Balloon dilatation was added when a stricture was seen. The procedure was performed with the patient under general anaesthesia. A biliary drainage tube was left at the end of the procedure. Results: All stones were completely fragmented and flushed into the small bowel under direct vision except for one patient in whom the procedure was aborted. In 18 patients, 1 session sufficed, and in 3 patients, 2 sessions were needed. In 7 patients, balloon dilatation was performed for benign stricture after Whipple operation (n = 3), for choledochalenteric anastomosis (n = 3), and for recurrent cholangitis (n = 1). Adjunctive 'balloon push' (n = 4) and 'rendezvous' (n = 1) procedures were needed to completely clean the biliary tree. None of these patients needed surgery. Conclusion: Complicated or large biliary calculi can be treated successfully using PTBL. We suggest that this approach should become the first choice of treatment before laparoscopic or open surgery is considered.

Rimon, Uri, E-mail: rimonu@sheba.health.gov.il [Tel-Aviv University, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the 'Sackler' School of Medicine (Israel); Kleinmann, Nir [Tel-Aviv University, Department of Urology, Section of Endourology, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the 'Sackler' School of Medicine (Israel); Bensaid, Paul; Golan, Gil; Garniek, Alexander; Khaitovich, Boris [Tel-Aviv University, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the 'Sackler' School of Medicine (Israel); Winkler, Harry [Tel-Aviv University, Department of Urology, Section of Endourology, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the 'Sackler' School of Medicine (Israel)

2011-12-15

116

Filling Defect on ERCP: Biliary Cystadenoma, a Rare Tumor  

PubMed Central

Biliary cystadenomas are rare tumors of the bile ducts most commonly presenting as large right liver lobe lesions. These are usually slow-growing and mostly benign. They commonly present with abdominal pain. On physical exam an abdominal mass can be identified occasionally. Walls of biliary cystadenomas appear thicker than simple cysts, with soft tissue nodules and enhancing septations on CT or MRI. Radiographic images can vary with the amount of protein content in the fluid on CT or MRI. Due to the risk of malignant transformation, complete surgical resection is advised. Hereby, we describe a 37-year-old lady who presented to the outpatient clinic with bloating and abdominal discomfort with intermittent elevated liver enzymes and hyperbilirubinemia. Ultrasound of the liver and bile ducts followed by CT scan and magnetic resonance cholangiopancreatography confirmed the presence of biliary cystadenoma of the intra- and extrahepatic ducts. It was seen as a filling defect of the intra- and extrahepatic ducts (common hepatic duct) on endoscopic retrograde cholangiopancreatography. Involvement of the intra- and extrahepatic bile ducts simultaneously is a rare presentation of this tumor. She later on underwent exploratory laparotomy with extrahepatic bile duct resection, left hepatic lobe resection and reconstruction with hepaticojejunostomy. Pathology confirmed the presence of biliary cystadenoma with ovarian-like stroma. She had recovered uneventfully from the surgery when seen 2 weeks later in the clinic. Biliary cystadenoma is a rare, mostly benign neoplasm of the biliary tract that should be considered in the differential diagnosis of cystic lesions of the biliary tract.

Rayapudi, Krishna; Schmitt, Timothy; Olyaee, Mojtaba

2013-01-01

117

Mutations in vacuolar H+-ATPase subunits lead to biliary developmental defects in zebrafish  

PubMed Central

Summary We identified three zebrafish mutants with defects in biliary development. One of these mutants, pekin (pn), also demonstrated generalized hypopigmentation and other defects, including disruption of retinal cell layers, lack of zymogen granules in the pancreas, and dilated Golgi in intestinal epithelial cells. Bile duct cells in pn demonstrated an accumulation of electron dense bodies. We determined that the causative defect in pn was a splice site mutation in the atp6ap2 gene that leads to an inframe stop codon. atp6ap2 encodes a subunit of the vacuolar H+-ATPase (V-H+-ATPase), which modulates pH in intracellular compartments. The Atp6ap2 subunit has also been shown to function as an intracellular renin receptor that stimulates fibrogenesis. Here we show that mutants and morphants involving other V-H+-ATPase subunits also demonstrated developmental biliary defects, but did not demonstrate the inhibition of fibrogenic genes observed in pn. The defects in pn are reminiscent of those we and others have observed in class C VPS (vacuolar protein sorting) family mutants and morphants, and we report here that knockdown of atp6ap2 and vps33b had an additive negative effect on biliary development. Our findings suggest that pathways important in modulating intracompartmental pH lead to defects in digestive organ development, and support previous studies demonstrating the importance of intracellular sorting pathways in biliary development.

EauClaire, Steven F.; Cui, Shuang; Ma, Liyuan; Matous, James; Marlow, Florence L.; Gupta, Tripti; Burgess, Harold A.; Abrams, Elliott W.; Kapp, Lee D.; Granato, Michael; Mullins, Mary C.; Matthews, Randolph P.

2012-01-01

118

Colloid Carcinoma of the Extrahepatic Biliary Tract with Metastatic Lymphadenopathy Mimicking Cystic Neoplasm: A Case Report  

PubMed Central

The patient is a previously healthy 52-year-old woman who presented with dyspepsia for two months. Multiple imaging modalities including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) showed diffuse bile duct dilatation with an obstructive lesion of the distal extrahepatic biliary duct (EHD) as well as two masses in the peripancreatic area. The peripancreatic masses appeared cystic with posterior acoustic enhancement on ultrasound, low density on CT imaging, and high signal intensity on T2-weighted MRI. The lesion in the distal EHD exhibited similar characteristics on CT and MRI. A Whipple procedure was performed and histological specimens showed malignant cells with large mucin pools that was consistent with a diagnosis of colloid carcinoma of the EHD with metastatic lymphadenopathies. Colloid carcinoma, also called mucinous carcinoma, is classified as a histologic variant of adenocarcinoma. Because the colloid carcinoma of the biliary tree is exceedingly rare, the imaging characteristics and the clinical features of colloid carcinoma remain relatively unknown. We report a case of colloid carcinoma of the common bile duct and its accompanied metastatic lymphadenopathies with characteristic imaging findings reflecting abundant intratumoral mucin pools.

Han, Na Yeon; Park, Beom Jin; Sung, Deuk Jae; Kim, Min Ju; Cho, Sung Bum; Kim, Dong Sik; Lee, Jeong Hyeon

2013-01-01

119

Management of postoperative bile leakage with endoscopic sphincterotomy (EST) and a naso-biliary drain (NBD).  

PubMed

Between July 1987 and December 1990, 13 patients with postoperative bile leakage were treated with endoscopic sphincterotomy and a naso-biliary drain. All the leaks healed in two weeks, except for one (intrahepatic) that needed two months to heal in association with percutaneous management. The non-surgical treatment of bile leakage is the preferred approach on account of the superior safety, efficacy and cost-effectiveness as compared with surgical repair, which is associated with significant morbidity, mortality and costs. The treatment of choice has to be endoscopic, which is much easier and safer than the transhepatic approach, especially in the non-dilated duct, while another advantage over radiology includes the possibility for rapid definitive treatment of distal obstruction (e.g. residual stones). A leak from an extrahepatic duct heals rapidly, while a leak from an intrahepatic duct takes longer to heal and sometimes needs associated percutaneous drainage. Finally, the authors propose treating an extrahepatic bile leak merely with naso-biliary drainage without cutting the papilla, and an intrahepatic bile leak with endoscopic sphincterotomy, nasobiliary drainage and a bilio-duodenal endoprosthesis. PMID:1427570

Foco, A; Garbarini, A; Franchello, A; Orlando, E; Festa, T; Gandini, G; Righi, D; Comotti, F; Massaglia, F; Drago, D

1992-08-01

120

Parotid sialolithiasis in Stensens duct  

Microsoft Academic Search

Salivary duct lithiasis is a condition characterized by the obstruction of a salivary gland or its excretory duct due to the for- mation of calcareous concretions or sialoliths resulting in salivary ectasia and even provoking the subsequent dilation of the salivary gland. Sialolithiasis accounts for 30% of salivary diseases and most commonly involves the submaxillary gland (83 to 94%) and

Daniel Torres Lagares; Sebastián Barranco Piedra; María Ángeles; Serrera Figallo; Pilar Hita Iglesias

121

Complex bile duct injuries: management  

PubMed Central

Background. Laparoscopic cholecystectomy is the present treatment of choice for patients with gallbladder stones, despite its being associated with a higher incidence of biliary injuries compared with the open procedure. Injuries occurring during the laparoscopic approach seem to be more complex. A complex biliary injury is a disease that is difficult to diagnose and treat. We considered complex injuries: 1) injuries that involve the confluence; 2) injuries in which repair attempts have failed; 3) any bile duct injury associated with a vascular injury; 4) or any biliary injury in association with portal hypertension or secondary biliary cirrhosis. The present review is an evaluation of our experience in the treatment of these complex biliary injuries and an analysis of the international literature on the management of patients.

Ardiles, V.; Pekolj, J.

2008-01-01

122

Complicated bile duct stones.  

PubMed

Common bile duct stones (CBDSs) are solid deposits that can either form within the gallbladder or migrate to the common bile duct (CBD), or form de novo in the biliary tree. In the USA around 15% of the population have gallstones and of these, 3% present with symptoms annually. Because of this, there have been major advancements in the management of gallstones and related conditions. Management is based on the patient's risk profile; young and healthy patients are likely to be recommended for surgery and elderly patients with comorbidities are usually recommended for endoscopic procedures. Imaging of gallstones has advanced in the last 30 years with endoscopic retrograde cholangiopancreatography evolving from a diagnostic to a therapeutic procedure in removing CBDSs. We present a complicated case of a patient with a CBDS and periampullary diverticulum and discuss the techniques used to diagnose and remove the stone from the biliary system. PMID:23946532

Roy, Ashwin; Martin, Derrick

2013-08-14

123

Radionuclide imaging of the biliary tract  

SciTech Connect

Cholescintigraphy with technetium-labeled biliary agents has great value in evaluation of the patient with suspected acute cholecystitis. Visualization of the gall bladder virtually excludes acute cholecystitis and obstruction of the cystic duct. Nonvisualization of the gall bladder, however, is not specific for acute cholecystitis and may also occur in some patients with chronic cholecystitis or pancreatitis. Interpretation of gall bladder nonvisualization, therefore, must be correlated with the clinical presentation. Biliary tract imaging is also useful in evaluation of some focal abnormalities within the liver, neonatal jaundice, detection of bile leaks or bile reflux, and biliary-enteric shunts. The role of technetium-labeled biliary agents in the evaluation of patients with jaundice is less clear. Excretion of tracer into the gut excludes complete biliary tract obstruction, but the test may be nonconclusive at higher serum bilirubin levels. If persistent common bile duct activity is observed with delayed excretion into the gut, the diagnosis of partial obstruction may be made, but this procedure will be inconclusive if the common bile duct is not visualized and/or significant hepatocellular disease is present. Ultrasonography and abdominal CT are the preferred tools for the diagnosis of biliary tract obstruction at present, but newer biliary tract agents which achieve better hepatic extraction and greater bile concentration at high serum bilirubin levels may improve the diagnostic efficacy of cholescintigraphy.

Henry, R.E.; Daly, M.J.

1981-01-01

124

Management of Hyperbilirubinemia in Biliary Atresia by Hepatic Progenitor Cell Transplantation Through Hepatic Artery: A Case Report  

Microsoft Academic Search

Cholangiodestruction of bile ducts leads to biliary atresia, a rare disease characterized by intrahepatic and extrahepatic biliary inflammation. If the intrahepatic biliary tree is unaffected, surgical reconstruction by the Kasai procedure of hepatoportoenterostomy of the extra hepatic biliary tract is possible. Untreated, this condition leads to cirrhosis and death within the first year of the life. If the atresia is

A. A. Khan; N. Parveen; V. S. Mahaboob; A. Rajendraprasad; H. R. Ravindraprakash; J. Venkateswarlu; P. Rao; G. Pande; M. Lakshmi Narusu; M. N. Khaja; R. Pramila; A. Habeeb; C. M. Habibullah

2008-01-01

125

Newly Designed Y-configured Single-Catheter Stenting for the Treatment of Hilar-Type Nonanastomotic Biliary Strictures After Orthotopic Liver Transplantation  

SciTech Connect

Purpose: This study was designed to introduce our novel technique of percutaneous single catheter placement into the hilar bile ducts strictures while fulfilling the purpose of bilateral biliary drainage and stenting. We investigated the efficacy and safety of the technique for the treatment of hilar nonanastomotic biliary strictures. Methods: Ten patients who were post-orthotopic liver transplantation between July 2000 and July 2010 were enrolled in this study. Percutaneous Y-configured single-catheter stenting for bilateral bile ducts combined with balloon dilation was designed as the main treatment approach. Technical success rate, clinical indicators, complications, and recurrent rate were analyzed. Results: Technical success rate was 100%. Nine of the ten patients had biochemical normalization, cholangiographic improvement, and clinical symptoms relief. None of them experienced recurrence in a median follow-up of 26 months after completion of therapy and removal of all catheters. Complications were minor and limited to two patients. The one treatment failure underwent a second liver transplantation but died of multiple system organ failure. Conclusions: Percutaneous transhepatic Y-configured single-catheter stenting into the hilar bile ducts is technically feasible. The preliminary trial of this technique combined with traditional PTCD or choledochoscopy for the treatment of hilar biliary strictures after orthotopic liver transplantation appeared to be effective and safe. Yet, further investigation is needed.

Wang Changming; Li Xuan, E-mail: lixuanbysy@163.com [Peking University Third Hospital, Department of Interventional Radiology and Vascular Surgery (China); Song Shibing [Peking University Third Hospital, Department of General Surgery (China); Lv Xianjun; Luan Jingyuan; Dong Guoxiang [Peking University Third Hospital, Department of Interventional Radiology and Vascular Surgery (China)

2012-02-15

126

Primary biliary cirrhosis: therapeutic advances.  

PubMed

Primary biliary cirrhosis (PBC) is a chronic and slowly progressive cholestatic liver disease characterized by destruction of the interlobular bile ducts, which, if untreated, leads to fibrosis, biliary cirrhosis, and liver failure. Because liver transplantation remains the only curative option for PBC, the goals of treatment are to slow the rate of progression, to alleviate related symptoms, and to prevent complications. Ursodeoxycholic acid is the only US Food and Drug Administration-approved medical treatment of PBC. Several agents are undergoing evaluation as monotherapy or as an adjuvant to ursodeoxycholic acid. This review summarizes current therapeutic advances in the care of patients with PBC. PMID:23540499

Czul, Frank; Peyton, Adam; Levy, Cynthia

2013-05-01

127

Onset of apoptosis in the cystic duct during metamorphosis of a Japanese lamprey, Lethenteron reissneri.  

PubMed

A nonparasitic lamprey in Japan, Lethenteron reissneri, stops feeding prior to the commencement of metamorphosis. Resumption of feeding cannot take place due to major alterations in the digestive system, including loss of the gall bladder (GB) and biliary tree in the liver. This degeneration of bile ducts is considered to depend on programmed cell death or apoptosis, but molecular evidence of apoptosis remains lacking. Using terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) staining and immunohistochemistry with an antibody against active caspase-3, we showed that epithelial cells of the cystic duct (CD) and GB became TUNEL-positive by the early metamorphosing stage. Immunohistochemical staining of active caspase-3, a key mediator in the apoptotic cascade, showed that the apoptotic signal was initiated in the region around the CD in the late larval phase. In later stages, active caspase-3-positive epithelial cells were also observed in the large intrahepatic bile duct (IHBD) and peripheral small IHBDs. At the early metamorphosing stage, bile canaliculi between hepatocytes were dilated and displayed features resembling canaliculi in cholestasis. Onset of apoptosis around the CD, which is the pathway for the storage of bile juice, and progression of apoptosis towards the large IHBD, which is the pathway for the secretion of bile juice, may lead to temporary intrahepatic cholestasis. The present study represents the first precise spatial and temporal analysis of apoptosis in epithelial cells of the biliary tract system during metamorphosis of any lamprey species. PMID:20583261

Morii, Mayako; Mezaki, Yoshihiro; Yamaguchi, Noriko; Yoshikawa, Kiwamu; Miura, Mitsutaka; Imai, Katsuyuki; Yoshino, Hiroaki; Hebiguchi, Taku; Hebiguchi, Tatsuzo; Senoo, Haruki

2010-07-01

128

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

PubMed Central

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

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

2012-01-01

129

The immunopathology of human biliary cell epithelium  

Microsoft Academic Search

Bile ducts lined with biliary epithelial cells, or cholangiocytes, are the main components of the biliary system in liver.\\u000a Cholangiocytes participate in the production and transport of bile substances, as well as participate in immune responses.\\u000a Cholangiocytes protect against pathogens by expressing toll-like receptors and anti-microbial peptides; act as antigen-presenting\\u000a cells by expressing human leukocyte antigen molecules and costimulatory molecules;

Ya-Hui Chuang; Ruth Y. Lan; M. Eric Gershwin

2009-01-01

130

Transforming growth factor-beta 2 heterozygous mutant mice exhibit Cowper's gland hyperplasia and cystic dilations of the gland ducts (Cowper's syringoceles)  

PubMed Central

Analyses of mutant mice with a deletion for the transforming growth factor beta 2 (Tgf?2) gene revealed cysts in the perineal/scrotal region of male mice. We present evidence from in situ, light and electron microscopy that the cysts observed in Tgf?2+/? heterozygous mice males derive from Cowper's glandtissue. The Cowper's glands of Tgf?2+/? heterozygous mutant mice display all steps of glandular hyperplasiaand cystic dilation. TGF-? isoforms and TGF-? receptor (T?R-II) were localized immunocytochemicallyin sections of Cowper's glands. TGF-??2 and TGF-?3 were located predominantly inmyoepithelial cells of the Cowper's gland whereas the T?RII was found in the plasma membrane of the acinar cells. TUNEL-assays revealed that apoptotic cell death is significantly reduced in Cowper's glands of Tgf?2+/? heterozygous mutant mice. The fact that Tgf?2+/? heterozygous mutant mice exhibit hyperplasia of Cowper's gland epithelium and Cowper's gland cysts suggests a disturbance of epithelial–stromal interaction mostlikely due to reduced TGF-?2 level, accompanied by a significant decrease in apoptosis.

Dunker, Nicole; Aumuller, Gerhard

2002-01-01

131

Management of Biliary and Duodenal Complications of Chronic Pancreatitis  

Microsoft Academic Search

Biliary stricture and duodenal obstruction have been increasingly recognized as complications of chronic pancreatitis. The anatomical relationship of the distal common bile duct and the duodenum with the head of the pancreas is the main factor for their involvement in chronic pancreatitis. In hospitalized patients with pancreatitis, the incidence of biliary stricture and duodenal obstruction is reported to be about

Joseph D. Vijungco; Richard A. Prinz

2003-01-01

132

Morphological and functional heterogeneity of the mouse intrahepatic biliary epithelium  

Microsoft Academic Search

Rat and human biliary epithelium is morphologically and functionally heterogeneous. As no information exists on the heterogeneity of the murine intrahepatic biliary epithelium, and with increased usage of transgenic mouse models to study liver disease pathogenesis, we sought to evaluate the morphological, secretory, and proliferative phenotypes of small and large bile ducts and purified cholangiocytes in normal and cholestatic mouse

Shannon S Glaser; Eugenio Gaudio; Arundhati Rao; Lisa M Pierce; Paolo Onori; Antonio Franchitto; Heather L Francis; David E Dostal; Julie K Venter; Sharon DeMorrow; Romina Mancinelli; Guido Carpino; Domenico Alvaro; Shelley E Kopriva; Jennifer M Savage; Gianfranco D Alpini

2009-01-01

133

Percutaneous Management of Biliary Strictures After Pediatric Liver Transplantation  

Microsoft Academic Search

We analyze our experience with the management of biliary strictures (BSs) in 27 pediatric patients who underwent liver transplantation with the diagnosis of BS. Mean recipient age was 38 months (range, 2.5-182 months). In all patients percutaneous transhepatic cholangiography, biliary catheter placement, and bilioplasty were performed. In 20 patients the stenoses were judged resolved by percutaneous balloon dilatation and the

Roberto Miraglia; Luigi Maruzzelli; Settimo Caruso; Silvia Riva; Marco Spada; Angelo Luca; Bruno Gridelli

2008-01-01

134

Tumor vessel: A valuable cholangioscopic clue of malignant biliary stricture  

Microsoft Academic Search

Background: An irregularly dilated and tortuous vessel, the so-called tumor vessel, is considered to be one of the cholangioscopic features that suggest biliary malignancy. This is a prospective analysis of the presence of a tumor vessel as a finding that discriminates between benign and malignant biliary strictures. Methods: From August 1997 to August 1998, a total of 63 patients with

Hong-Ja Kim; Myung-Hwan Kim; Sung-Koo Lee; Kyo-Sang Yoo; Dong-Wan Seo; Young-Il Min

2000-01-01

135

Management of Benign Biliary Strictures  

SciTech Connect

Benign biliary strictures are most commonly a consequence of injury at laparoscopic cholecystectomy or fibrosis after biliary-enteric anastomosis. These strictures are notoriously difficult to treat and traditionally are managed by resection and fashioning of acholedocho- or hepato-jejunostomy. Promising results are being achieved with newer minimally invasive techniques using endoscopic or percutaneous dilatation and/or stenting and these are likely to play an increasing role in the management. Even low-grade biliary obstruction carries the risks of stone formation, ascending cholangitis and hepatic cirrhosis and it is important to identify and treat this group of patients. There is currently no consensus on which patient should have what type of procedure, and the full range of techniques may not be available in all hospitals. Careful assessment of the risks and likely benefits have to be made on an individual basis. This article reviews the current literature and discusses the options available. The techniques of endoscopic and percutaneous dilatation and stenting are described with evaluation of the likely success and complication rates and compared to the gold standard of biliary-enteric anastomosis.

Laasch, Hans-Ulrich; Martin, Derrick F. [Department of Radiology, South ManchesterUniversity Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom)

2002-12-15

136

Endoscopic Management of Biliary Complications After Orthotopic Liver Transplantation.  

PubMed

After orthotopic liver transplantation (OLT), biliary duct complications can occur in as many as 10% to 35% of patients. In the early medical and surgical literature, surgical therapy was the primary mode of management of biliary tract complications and was the eventual course of operative intervention in up to 70% of cases. However, with recent advances in therapeutic biliary endoscopy, the current endoscopic and transplantation literature suggests that endoscopic management with techniques such as endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy, biliary stenting, and stone removal techniques can be successfully applied for the majority of post-OLT biliary complications. The most common biliary complications after OLT include biliary strictures (anastomotic and nonanastomotic); bile duct leaks, common bile duct stones, and biliary casts; sphincter of Oddi/ampullary muscle dysfunction/spasm; and disease recurrence (eg, primary sclerosing cholangitis). Predisposing factors for biliary complications after OLT include hepatic artery thrombosis, impaired perfusion of the biliary tree, portal vein thrombosis, and preservation or harvesting injuries, which can increase the incidence of complications as much as 40%. Use of immunosuppressive agents such as cyclosporine can lead to cholesterol/bile stasis and stone formation. Outside of endoscopic therapy, there is little medical or dietary management that can be applied for post-OLT biliary complications. Ursodiol (ursodeoxycholic acid) has often been used as a neoadjuvant to ERCP therapy in the setting of common bile duct stones/casts, and low-fat diets may be recommended in this setting, but no large, randomized trials have advocated medical or conservative management alone. PMID:14585240

Gopal, Deepak V.; Pfau, Patrick R.; Lucey, Michael R.

2003-12-01

137

Management of major biliary complications after laparoscopic cholecystectomy.  

PubMed Central

OBJECTIVE: A total of 50 major bile duct injuries after laparoscopic cholecystectomy were managed by the Duke University Hepatobiliary Service from 1990-1992. The management of these complex cases is reviewed. SUMMARY BACKGROUND DATA: Laparoscopic cholecystectomy is the preferred method for removing the gallbladder. Bile duct injury is the most feared complication of the new procedure. METHODS: Review of videotapes, pathology, and management of the original operations were reviewed retrospectively, and the injuries categorized. Major biliary injury was defined as a recognized disruption of any part of the major extrahepatic biliary system. Biliary leakage was defined as a clinically significant biliary fistula in the absence of major biliary injury, i.e., with an intact extrahepatic biliary system. RESULTS: Thirty-eight injuries were major biliary ductal injuries and 12 patients had simple biliary leakage. Twenty-four patients had the classic type injury or some variant of the classic injury. A standard treatment approach was developed which consisted of ERCP for diagnosis, preoperative PTC with the placement of stents, CT drainage immediately after the PTC for drainage of biliary ascites, and usually Roux-en-Y hepaticojejunostomy with placement of O-rings for future biliary access if necessary. Major ductal injuries were high in the biliary system involving multiple ducts in 31 of the 38 patients. Re-operation was required in 5 of the 38 patients with particularly complex problems. CONCLUSIONS: Successful management of bile duct injury after laparoscopic cholecystectomy requires careful understanding of the mechanisms, considerable preoperative assessment by experts, and a multidisciplinary approach. Images Figure 2. Figure 4. Figure 5. Figure 6. Figure 7. Figure 8.

Branum, G; Schmitt, C; Baillie, J; Suhocki, P; Baker, M; Davidoff, A; Branch, S; Chari, R; Cucchiaro, G; Murray, E

1993-01-01

138

A subcutaneous or subfascial jejunostomy is beneficial in the surgical management of extrahepatic bile duct cancers  

Microsoft Academic Search

Background. Extrahepatic bile duct cancers are rare tumors with a dismal prognosis. Even after a resection, obstructive cholestasis and other biliary complications are the rule. To facilitate retrograde access to the biliary tree for treatment of such biliary complications, a modified Roux-en-Y hepaticojejunostomy is constructed such that the afferent limb is brought up as a subcutaneous or subfascial jejunostomy (SJ).

Oliver F Bathe; Jeff T Pacheco; Paul B Ossi; Dido Franceschi; Danny Sleeman; Duane G Hutson; Edward Russell; Joe U Levi; Alan S Livingstone

2000-01-01

139

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

PubMed Central

Introduction Intra-hepatic cholestasis arising from biliary strictures is a frequent complication in pediatric patients after liver transplantation. Minimally invasive procedures such as percutaneous drainage placement and balloon dilation are the preferred diagnostic and therapeutic modalities. Case presentation We report the case of a 12-month-old Caucasian boy with biliary atresia who was initially treated with hepatoportoenterostomy. In the following months, he developed biliary cirrhosis, accompanied by cystic bile retention, recurrent bile duct infections and malabsorption. Six months after the initial surgical intervention, he underwent living donor liver transplantation. Within two months, the hepatico-jejunostomy became occluded leading to progressive intra-hepatic cholestasis. Under sonographic guidance, external drainage of bile was accomplished by percutaneous trans-hepatic cholangiography and drainage. In total, our patient underwent 12 interventions under general anesthesia until balloon dilatation of the hepatico-jejunostomy was successfully performed. Finally, our patient’s general condition improved and he gained weight. Conclusions Minimally invasive techniques are preferred to surgical revisions and justify even multiple attempts. Interventions under general anesthesia, though not without risks, are still reasonable. Co-operation with parents and multidisciplinary approach to complication management by the involved surgeon, radiologist, pediatrician and anesthesiologist are important.

2013-01-01

140

Biliary duplication cyst with heterotopic gastric mucosa resulting in obstruction of the biliary system: a case report.  

PubMed

Biliary tract duplication cysts with heterotopic gastric mucosa are rare congenital anomalies, with our case representing only the fourth reported case in the literature. An 8-year-old girl with several months of abdominal pain was found to have a complex cystic mass communicating with the biliary system via the common hepatic duct. Intraoperatively, inflammation caused by the cystic mass was found to have resulted in a Mirizzi-like syndrome, with a nearly complete obstruction at the confluence of the left and right hepatic ducts. Histopathologic examination of the biliary mass revealed it to be a duplication cyst lined by heterotopic gastric mucosa with secondary ulceration and fibrosis. Biliary duplication cysts are a rare but important process that should be considered in a child with a mass in the portal triad and biliary obstruction. PMID:22703824

Kim, Jina; Jarboe, Marcus D; Arnold, Meghan A; DiPietro, Michael A; Bloom, David A; Teitelbaum, Daniel H

2012-06-01

141

Per Oral Balloon Sialoplasty: Results in the Treatment of Salivary Duct Stenosis  

SciTech Connect

Purpose: To evaluate the results of balloon dilatation of salivary duct stenosis and to discuss the technique and its limitations. Methods: Balloon dilatation of 30 salivary duct stenoses (24 parotid, 6 submandibular) was carried out in 29 patients over a 5-year period. Duct dilatation was performed with a 3-mm-diameter balloon on a 0.035-inch wire passed into the salivary duct under fluoroscopic guidance. The follow-up period ranged from 1 month to 5 years. Results: In 25 patients balloon dilatation was technically successful in 26 of 30 ducts (87%). Ninety-six percent of parotid duct dilatations and 50% of submandibular duct dilatations were technically successful. Early clinical follow-up after parotid duct dilatation showed that 57% of patients were asymptomatic, 39% showed an improvement in symptoms, and 4% showed no improvement in symptoms. Following technically successful submandibular duct dilatation (3 cases), 1 patient showed complete resolution of symptoms and 1 showed no change in symptoms. No follow-up was available for 1 patient. No significant complications were seen. The longer-term results are presented. Conclusion: Balloon dilatation of salivary duct stenosis is a simple, safe, and clinically effective method of relieving obstructive symptoms of parotid duct stenosis.

Brown, Andrea L. [Department of Radiology, St. George's Hospital, Blackshaw Road, London SW17 0QT (United Kingdom); Shepherd, David [Department of Radiology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, Dorset BH7 7DW (United Kingdom); Buckenham, Timothy M. [Department of Radiology, St. George's Hospital, Blackshaw Road, London SW17 0QT (United Kingdom)

1997-09-15

142

MR Sialographic Evaluation of Sialectasia of Stensen's Duct: Comparison with X-ray Sialography and Ultrasonography  

Microsoft Academic Search

We describe a patient with unilateral sialectasia of Stensen's duct. X-ray sialography, MR sialography, and ultrasonography showed multiple stenoses and rosary dilatation of Stensen's duct during stimulation of the parotid gland. Before stimulation, Stensen's duct showed focal dilatation as indicated by MR sialography and ultrasonography. The patient also had ipsilateral masseter hypertrophy (BMH), which may be a cause of sialectasia.

Hiroko Shojaku; Hideo Shojaku; Masashi Shimizu; Hikaru Seto; Yukio Watanabe

143

MR sialographic evaluation of sialectasia of Stensen's duct: comparison with X-ray sialography and ultrasonography.  

PubMed

We describe a patient with unilateral sialectasia of Stensen's duct. X-ray sialography, MR sialography, and ultrasonography showed multiple stenoses and rosary dilatation of Stensen's duct during stimulation of the parotid gland. Before stimulation, Stensen's duct showed focal dilatation as indicated by MR sialography and ultrasonography. The patient also had ipsilateral masseter hypertrophy (BMH), which may be a cause of sialectasia. PMID:10888049

Shojaku, H; Shojaku, H; Shimizu, M; Seto, H; Watanabe, Y

144

Biliary atresia  

Microsoft Academic Search

Although the prognosis of biliary atresia has been dramatically improved in the era of liver transplantation, the Kasai operation is still the first line of surgical treatment. Successful hepatic portoenterostomy depends on early diagnosis and surgery, adequate surgical technique, prevention of cholangitis, and precise postoperative management. Copyright © 2000 by W.B. Saunders Company

Masaki Nio; Ryoji Ohi

2000-01-01

145

Malignant intraductal oncocytic papillary neoplasm of the common bile duct  

PubMed Central

Recently, several cases of intraductal oncocytic papillary neoplasm (IOPN) of the liver and hepatic bile ducts have been reported. The author herein reports the first case of IOPN of the common bile duct (CBD). A 78-year-old man was admitted to our hospital because of jaundice. Imaging modalities including US, CT, MRI revealed an intraductal tumor of the middle CBD and biliary dilation distal to the tumor. A partial resection of the CBD was performed. Grossly, a papillary tumor measuring 20 × 15 mm was found within the CBD. Mucus is absent. Histologically, the papillary tumor was composed of atypical oncocytes. The atypia was enough to be diagnosed as adenocarcinoma. No invasive features were noted. Immunohistochemically, the tumor cells were positive for pancytokeratins (CK), CK 7, CK 18, CK19, EMA, CA19-9, CEA, mitochondria, p53 protein, C-erbB2, Ki-67 (labeling = 80%), MUC2, MUC5AC and MUC-6,. The tumor cells were negative for CK8, CK20, chromogranin, synaptophysin, neuron-specific enolase, S100 protein, CD56, MUC1, CD10 and CDX2. These immunohistochemical findings were compatible with IOPN. The patient died of other non-tumorous disease 7 year after the operation. In summary, the author presented the first case of IOPN of the CBD.

Terada, Tadashi

2012-01-01

146

Implantation of migrated biliary stents in the digestive tract  

PubMed Central

Background Biliary stents constitute an alternative for the palliative treatment of benign or malignant biliary obstruction, biliary strictures, choledocholithiasis, biliary fistulas from lateral lesions of the biliary duct or cystic duct leaks due to slippage of clip closure. Obstruction resulting in cholangitis is common. Proximal migration to the biliary duct or distal migration to the duodenum with subsequent passage per rectum are relatively frequent, but impaction and perforation of the bowel are rare. Case outlines Two cases are reported. In one patient a migrated stent impacted in the caecal wall, and in the other the impaction produced a perforation of an adherent small bowel loop. Both patients were treated surgically and made an uneventful recovery. Discussion Biliary stents migrate in 8–10% of patients and are generally eliminated by natural means. Occasionally they impact and perforate the digestive tract, usually in the duodenum or other fixed areas or in bowel affected by adhesions due to a previous operation. Although endoscopy is the treatment of choice to retrieve them, operation should be performed whenever there is suspicion of perforation of the intestinal wall.

Cerisoli, C; Gimenez, M; Oria, M; Pardo, R; Pujato, M

2003-01-01

147

Lensing duct  

DOEpatents

A lensing duct to condense (intensify) light using a combination of front surface lensing and reflective waveguiding. The duct tapers down from a wide input side to a narrow output side, with the input side being lens-shaped and coated with an antireflective coating for more efficient transmission into the duct. The four side surfaces are uncoated, preventing light from escaping by total internal reflection as it travels along the duct (reflective waveguiding). The duct has various applications for intensifying light, such as in the coupling of diode array pump light to solid state lasing materials, and can be fabricated from inexpensive glass and plastic.

Beach, Raymond J. (Livermore, CA), Benett

1994-01-01

148

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

PubMed

We encapsulate indocyanine green (ICG) in poly[(D,L-lactide-co-glycolide)-co-PEG] diblock (PLGA-PEG) microballoons for real-time fluorescence and hyperspectral imaging of biliary anatomy. ICG-loaded microballoons show superior fluorescence characteristics and slower degradation in comparison with pure ICG. The use of ICG-loaded microballoons in biliary imaging is demonstrated in both biliary-simulating phantoms and an ex vivo tissue model. The biliary-simulating phantoms are prepared by embedding ICG-loaded microballoons in agar gel and imaged by a fluorescence imaging module in a Da Vinci surgical robot. The ex vivo model consists of liver, gallbladder, common bile duct, and part of the duodenum freshly dissected from a domestic swine. After ICG-loaded microballoons are injected into the gallbladder, the biliary structure is imaged by both hyperspectral and fluorescence imaging modalities. Advanced spectral analysis and image processing algorithms are developed to classify the tissue types and identify the biliary anatomy. While fluorescence imaging provides dynamic information of movement and flow in the surgical region of interest, data from hyperspectral imaging allow for rapid identification of the bile duct and safe exclusion of any contaminant fluorescence from tissue not part of the biliary anatomy. Our experiments demonstrate the technical feasibility of using ICG-loaded microballoons for biliary imaging in cholecystectomy. PMID:23214186

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

2012-11-01

149

Indocyanine-green-loaded microballoons for biliary imaging in cholecystectomy  

NASA Astrophysics Data System (ADS)

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

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

2012-11-01

150

Morphological and Functional Heterogeneity of the Mouse Intrahepatic Biliary Epithelium  

PubMed Central

Rat and human biliary epithelium is morphologically and functionally heterogeneous. Since no information exists on the heterogeneity of the murine intrahepatic biliary epithelium, and with increased usage of transgenic mouse models to study liver disease pathogenesis, we sought to evaluate the morphological, secretory and proliferative phenotypes of small and large bile ducts and purified cholangiocytes in normal and cholestatic mouse models. Methods For morphometry, normal and BDL mouse livers (C57/BL6) were dissected into blocks of 2-4 ?m2, embedded in paraffin, sectioned, and stained with H&E. Sizes of bile ducts and cholangiocytes were evaluated by using SigmaScan to measure the diameters of bile ducts and cholangiocytes. In small and large normal and BDL cholangiocytes, we evaluated the expression of cholangiocyte specific markers, keratin-19 (KRT19), secretin receptor (SR), cystic fibrosis transmembrane conductance regulator (CFTR), and chloride bicarbonate anion exchanger 2 (Cl-/HCO-3 AE2) by immunofluorescence and western blot; and intracellular cAMP levels and chloride efflux in response to secretin (100 nM). To evaluate cholangiocyte proliferative responses after bile duct ligation (BDL), small and large cholangiocytes were isolated from BDL mice. The proliferation status was determined by analysis of the cell cycle by FACS and bile duct mass was determined by the number of KRT19-positive bile ducts in liver sections. Results In situ morphometry established that the biliary epithelium of mice is morphologically heterogeneous, which smaller cholangiocyte lining smaller bile ducts and larger cholangiocytes lining larger ducts. Both small and large cholangiocytes express KRT19 and only large cholangiocytes from normal and BDL mice express SR, CFTR, and Cl-/HCO-3 exchanger and respond to secretin with increased cAMP levels and chloride efflux. Following BDL, only large mouse cholangiocytes proliferate. Conclusion Similar to rats, mouse intrahepatic biliary epithelium is morphologically, and functionally heterogeneous. The mouse is a suitable model for defining the heterogeneity of the biliary tree.

Glaser, Shannon; Gaudio, Eugenio; Rao, Arundhati; Pierce, Lisa; Onori, Paolo; Franchitto, Antonio; Francis, Heather; Dostal, David E; Venter, Julie; DeMorrow, Sharon; Mancinelli, Romina; Carpino, Guido; Alvaro, Domenico; Kopriva, Shelley; Savage, Jennifer; Alpini, Gianfranco

2008-01-01

151

Successful Treatment with a Covered Stent and 6-Year Follow-Up of Biliary Complication After Liver Transplantation  

SciTech Connect

The role of covered stent in the management of biliary complications is not yet defined in liver transplant recipients. This Case Report presents a patient with anastomotic stricture and leakage with biloma treated with a covered stent 32 months following liver transplantation. Signs of in-stent restenosis developed 52 months following covered stent placement, which was resolved by balloon dilation. There were no complications during the interventions. The latest follow-up, at 69 months following primary and 19 months following secondary percutaneous intervention, shows a patent covered stent without any clinical or morphological sign of further restenosis. The clinical success with long-term follow-up data suggests that covered stent implantation can be a rational, minimally invasive option for simultaneous treatment of bile duct stenosis and bile leak following liver transplantation in selected cases.

Doros, Attila, E-mail: dorattila@yahoo.com; Nemeth, Andrea; Deak, Akos Pal; Hartmann, Erika; Gerlei, Zsuzsa; Fazakas, Janos; Kobori, Laszlo [Semmelweis University, Department of Transplantation and Surgery (Hungary)

2010-04-15

152

Biliary dyskinesia.  

PubMed

It has not been firmly established whether dysfunction of the sphincter of Oddi, biliary dyskinesia, exists as a distinct clinical entity. Improved diagnostic methods, such as ERCP and different manometric studies combined with provocation tests, have provided objective evidence that, in some patients with what is termed the postcholecystectomy syndrome, a spastic sphincter of Oddi is a cause of their complaints. Controlled randomised clinical studies are lacking, but previous results have shown that either operative or endoscopic papillotomy might be indicated in some patients with sphincter Oddi dyskinesia. PMID:3860915

Lempinen, M

1985-01-01

153

Extrahepatic Bile Duct Obstruction and Erosive Disruption by Cavitating Porta Hepatis Nodal Metastasis, Treated by Uncovered Wallstent  

SciTech Connect

A 45-year-old woman with advanced gastric carcinoma presented with obstructive jaundice. Percutaneous transhepatic cholangiography (PTC) revealed erosive disruption of the extrahepatic bile ducts by a cavitating metastasis in the porta hepatis, as well as a biliary-duodenal fistula. External-internal biliary drainage via the fistula was plagued by recurrent drain occlusion by necrotic debris. This was ultimately alleviated by successful catheterization of the distal common bile duct (CBD) through the cavity, and linking the common hepatic duct (CHD) and CBD with a Wallstent, across the cavity. This succeeded in improving internal biliary drainage and isolating the exfoliating debris of the cavity from the bile ducts.

Trambert, Jonathan J., E-mail: jtrambert@pol.net; Frost, Andrei [J. D. Weiler Hospital of the Albert Einstein College of Medicine, Department of Radiology (United States); Malasky, Charlotte [J. D. Weiler Hospital of the Albert Einstein College of Medicine, Department of Internal Medicine (United States)

2004-08-15

154

Percutaneous Management of Biliary Strictures After Pediatric Liver Transplantation  

Microsoft Academic Search

We analyze our experience with the management of biliary strictures (BSs) in 27 pediatric patients who underwent liver transplantation\\u000a with the diagnosis of BS. Mean recipient age was 38 months (range, 2.5–182 months). In all patients percutaneous transhepatic\\u000a cholangiography, biliary catheter placement, and bilioplasty were performed. In 20 patients the stenoses were judged resolved\\u000a by percutaneous balloon dilatation and the

Roberto Miraglia; Luigi Maruzzelli; Settimo Caruso; Silvia Riva; Marco Spada; Angelo Luca; Bruno Gridelli

2008-01-01

155

Endoscopic Management of Biliary Complications after Adult Living Donor Liver Transplantation  

Microsoft Academic Search

OBJECTIVES:Biliary complications are one of the important issues to be addressed after liver transplantation. Endoscopic management of biliary complications after deceased donor liver transplantation (DDLT) is widely accepted, but it remains to be established in patients after living donor liver transplantation (LDLT). Endoscopic management in LDLT patients is difficult mainly because of the complexity of duct-to-duct reconstruction.METHODS:A total of 174

Takeshi Tsujino; Hiroyuki Isayama; Yasuhiko Sugawara; Takashi Sasaki; Hirofumi Kogure; Yousuke Nakai; Natsuyo Yamamoto; Naoki Sasahira; Noriyo Yamashiki; Minoru Tada; Haruhiko Yoshida; Norihiro Kokudo; Takao Kawabe; Masatoshi Makuuchi; Masao Omata

2006-01-01

156

Cholangiographic evaluation of bile duct carcinoma  

SciTech Connect

Cholangiograms and clinical histories of 82 patients with biopsy-proved bile duct carcinoma were reviewed. The carcinomas were classified according to morphologic findings and clinical outcome. Ulcerative colitis and antecedent inflammatory disease of the biliary tree, particularly primary sclerosing cholangitis, seem to predispose to the development of bile duct carcinoma. Focal stenotic lesions were the most common morphologic type (62/82). Polypoid carcinomas and diffuse sclerosing carcinomas were less common and of about equal frequency. Prognosis was best for patients with polypoid carcinomas and worst for those with diffuse sclerosing carcinomas. In 69 cases (84%), the tumors involved the intrahepatic or proximal extrahepatic ducts, makin curative resection difficult or impossible. Patients with carcinomas limited to the more distal extrahepatic bile ducts had a longer average survival and a higher probability of surgical cure. Proper management of patients with bile duct carcinoma requires a complete and accurate cholangiographic evaluation of the morphology, location, and extent of the disease.

Nichols, D.A.; MacCarty, R.L.; Gaffey, T.A.

1983-12-01

157

Use of Amplatzer Vascular Plug to Treat a Biliary Cutaneous Fistula  

PubMed Central

Several substances have been used in an attempt to sclerose biliary ducts associated with persistent biliary-cutaneous fistula (BCF). The AMPLATZER Vascular Plug (AVP; AGA Medical, USA) system is a recently developed endovascular occlusion device, introduced as an alternative to permanent embolic materials (metallic coils or acrylic glue), in the occlusion of large and medium-calibre arteries and veins. We report a successful use of the AVP to embolize BCF, developed after the removal of an internal-external biliary drainage.

Ierardi, Anna Maria; Fontana, Federico; Mangini, Monica; Piacentino, Filippo; Cocozza, Eugenio; Frankowska, Emila; Floridi, Chiara

2013-01-01

158

Detection of Helicobacter pylori DNA in Human Biliary Tree and Its Association with Hepatolithiasis  

Microsoft Academic Search

Recently, several authors have reported that Helicobacter pylori DNA has been found in human bile. The aim of this study is to investigate the presence of H. pylori in the biliary tree of Koreans, including the bile, biliary epithelium, and gallstones. This study analyzed intrahepatic bile, bile duct tissue, and gallstones from 43 patients with hepatobiliary disease (PTCS group), gallbladder

Seung-Jae Myung; Myung-Hwan Kim; Ki Nam Shim; Yeon-Suk Kim; Eun Ok Kim; Hong-Ja Kim; Eun-Taek Park; Kyo-Sang Yoo; Byeung-Cheol Lim; Dong Wan Seo; Sung Koo Lee; Young Il Min; Ji Yeon Kim

2000-01-01

159

Congenital duplex gallbladder and biliary mucocele associated with partial hepatic cholestasis and cholelithiasis in a cat  

PubMed Central

A 6-year-old neutered male domestic shorthair cat was presented for acute onset of vomiting. Exploratory laparotomy identified a duplex gallbladder and left cholecystectomy was performed. Histopathology confirmed biliary mucocele and hepatic cholestasis. While rare, biliary mucoceles should be considered as a differential diagnosis for feline extrahepatic bile duct obstruction.

Woods, Katharine S.; Brisson, Brigitte A.; Defarges, Alice M.N.; Oblak, Michelle L.

2012-01-01

160

Late-Onset Autoimmunity: The Paradigm of Primary Biliary Cirrhosis – A Mini-Review  

Microsoft Academic Search

The incidence of autoimmune diseases appears to be increasing in virtually every population. This is well illustrated by primary biliary cirrhosis, a disease characterized by an immune response to small bile ducts and an incidence increasing with age. The etiology of primary biliary cirrhosis remains enigmatic, although there is clearly an interplay of genetics and environment with a possible role

Samuel M. Siegel; Carlo Selmi; Lorenzo Dottorini; Magda Antelmi; Massimo Zuin; Mario Lanfredini; M. Eric Gershwin

2008-01-01

161

Covered metallic stent for ischemic hilar biliary stricture.  

PubMed

Compared with surgery, endoscopic treatment is safe and highly effective for a postoperative hilar benign bile duct stricture (BDS). However, the long-term outcome of conventional placement of a single biliary stent for hilar benign BDS is generally poor. Although the placement of multiple biliary stents is preferred, multiple stenting in a BDS is difficult. Alternatively, single or multiple stent placement above the papilla ('inside stent') or fully-covered self-expandable metallic stents (SEMS) are feasible approaches for benign BDS. Nevertheless, controversy remains regarding whether and how to perform endoscopic biliary drainage for a hilar benign BDS. In patients with hilar benign BDS, endoscopic biliary drainage can be performed by placing conventional plastic stents across the papilla, plastic stents above the papilla or fully-covered SEMS. Individualized treatment should be considered. We report the placement of a fully-covered SEMS for a hilar benign biliary stricture after extended left hepatectomy. PMID:22533752

Kawakami, Hiroshi; Kuwatani, Masaki; Eto, Kazunori; Kudo, Taiki; Asaka, Masahiro

2012-05-01

162

Obstructive jaundice induced by biliary ascariasis.  

PubMed

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. PMID:23239771

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

2012-12-13

163

The pharmacokinetics of the biliary excretion of ciprofloxacin.  

PubMed

The pharmacokinetics of ciprofloxacin excretion have been studied in 54 patients undergoing biliary and pancreatic operations with and without obstruction of the common bile duct. High concentrations were achieved in common duct bile within 20 minutes of intravenous injection and persisted for over 3 hours after 100 mg and for over 8 hours after 200 mg. The concentration of ciprofloxacin in the bile of functioning gall bladders was much greater than that in the common duct bile. Remarkably, it was identified in therapeutic concentrations in the bile of obstructed ducts. This and the rapid fall from initially high venous concentrations probably reflect diffusion from the circulation as a result of the exceptional tissue penetration. A unique feature of this study was the finding of clinically significant concentrations in the bile of obstructed ducts. Two patients developed wound infection and no side effects were observed. The broad spectrum antibiotic ciprofloxacin has potential as a useful agent for prophylaxis in biliary surgery maintaining biliary and venous concentrations in excess of the MIC90 for most biliary pathogens for more than 8 hours. PMID:2487071

Ball, C S; Manson, J M; Reid, F; Tweedle, D E

1989-11-01

164

The Pathogenesis of Biliary Atresia: Evidence for a Virus-Induced Autoimmune Disease  

PubMed Central

Biliary atresia is a mystifying cause of neonatal cholestasis, manifested by progressive inflammation and fibrosis of both the extrahepatic and intrahepatic bile ducts. It is a devastating disease that leads to cirrhosis and the need for liver transplantation in the majority of children. The etiology is unknown, and one theory is that it may involve a primary perinatal hepatobiliary viral infection and a secondary generation of an autoimmune-mediated bile duct injury. This review will outline the evidence from both human and murine studies supporting a potential cholangiotropic viral infection as the initiator of bile duct injury in biliary atresia and the role of the adaptive immune response and autoimmunity in progression of disease. Delineating the pathways of immune and autoimmune-mediated bile duct injury within biliary atresia could stimulate development of new medical interventions aimed at suppressing the specific immune response, decreasing the inflammatory damage to bile ducts, and delaying or negating the need for liver transplantation.

Mack, Cara L.

2013-01-01

165

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

PubMed Central

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

Shanker, Beth-Ann; Eng, Oliver S.; Gendel, Vyacheslav; Nosher, John; Carpizo, Darren R.

2013-01-01

166

Biliary tract obstruction in chronic pancreatitis  

PubMed Central

Bile duct strictures are a common complication in patients with advanced chronic pancreatitis and have a variable clinical presentation ranging from an incidental finding to overt jaundice and cholangitis. The diagnosis is mostly made during investigations for abdominal pain but jaundice may be the initial clinical presentation. The jaundice is typically transient but may be recurrent with a small risk of secondary biliary cirrhosis in longstanding cases. The management of a bile duct stricture is conservative in patients in whom it is an incidental finding as the risk of secondary biliary cirrhosis is negligible. Initial conservative treatment is advised in patients who present with jaundice as most will resolve once the acute on chronic attack has subsided. A surgical biliary drainage is indicated when there is persistent jaundice for more than one month or if complicated by secondary gallstones or cholangitis. The biliary drainage procedure of choice is a choledocho-jejunostomy which may be combined with a pancreaticojejunostomy in patients who have associated pain. Since many patients with chronic pancreatitis have an inflammatory mass in the head of the pancreas, a Frey procedure is indicated but a resection should be performed when there is concern about a malignancy. Temporary endoscopic stenting is reserved for cholangitis while an expandable metal stent may be indicated in patients with severe co-morbid disease.

Abdallah, Abdul A.; Krige, Jake E. J.

2007-01-01

167

Alternatives for the treatment of salivary duct obstruction.  

PubMed

Minimally invasive alternatives for treatment of salivary duct obstruction are discussed. Radiologically- and endoscopically-guided interventions using wire baskets and dilating balloons, including cutting balloons, are covered as are combined endoscopic and open approaches. PMID:19962008

McGurk, Mark; Brown, Jackie

2009-12-01

168

Biliary Cast Syndrome in an Opium Inhaler  

PubMed Central

Biliary cast syndrome (BCS) is an uncommon complication which is mostly described in orthotopic liver transplantation. However, BCS has also been reported rarely in non-liver transplant patients. We describe a male long-term opium inhaler with BCS who underwent successful endoscopic cast removal by balloon enteroscopy-guided endoscopic retrograde cholangiopancreatography. A 52-year-old man, who was a known case of opium addiction, presented with the chief complaint of epigastric pain for 1 week prior to admission. Routine laboratory evaluation revealed cholestatic liver enzyme elevation. A cholestatic pattern was seen in radiographic modalities. Endoscopic retrograde cholangiopancreatography showed a linear filling defect in the intra- and extrahepatic duct. A long biliary cast was successfully removed using an extractor balloon. After removal of the biliary cast the patient is receiving ursodeoxycholic acid and does not report any problem 4 months after treatment. It seems that biliary dyskinesia due to long-term opium use can be a predisposing factor for biliary cast formation.

Dabiri, Reza; Aghdae, Hamid Asadzadeh; Rajabalinia, Hasan; Mohammad Alizadeh, Amir Houshang

2013-01-01

169

Biliary cast syndrome in an opium inhaler.  

PubMed

Biliary cast syndrome (BCS) is an uncommon complication which is mostly described in orthotopic liver transplantation. However, BCS has also been reported rarely in non-liver transplant patients. We describe a male long-term opium inhaler with BCS who underwent successful endoscopic cast removal by balloon enteroscopy-guided endoscopic retrograde cholangiopancreatography. A 52-year-old man, who was a known case of opium addiction, presented with the chief complaint of epigastric pain for 1 week prior to admission. Routine laboratory evaluation revealed cholestatic liver enzyme elevation. A cholestatic pattern was seen in radiographic modalities. Endoscopic retrograde cholangiopancreatography showed a linear filling defect in the intra- and extrahepatic duct. A long biliary cast was successfully removed using an extractor balloon. After removal of the biliary cast the patient is receiving ursodeoxycholic acid and does not report any problem 4 months after treatment. It seems that biliary dyskinesia due to long-term opium use can be a predisposing factor for biliary cast formation. PMID:24163648

Dabiri, Reza; Aghdae, Hamid Asadzadeh; Rajabalinia, Hasan; Mohammad Alizadeh, Amir Houshang

2013-09-05

170

Biliary Origin Septicemia.  

National Technical Information Service (NTIS)

In Chengdu area most cases of septicemia of biliary origin are due to suppurative cholangitis, primary cholangiolithiasis and biliary ascariases. Two autopsies in this series showed thrombi mixed with free billirubin particles in numerous hepatic veins an...

L. Xiao J. Jiang X. Meng R. Chen

1981-01-01

171

Oblique Bile Duct Predisposes to the Recurrence of Bile Duct Stones  

PubMed Central

Background and Study Aims Bile stones represent a highly prevalent condition and abnormalities of the biliary tree predispose to stone recurrence due to development of biliary stasis. In our study, we assessed the importance of an altered bile duct course for stone formation. Patients and Methods 1,307 patients with choledocholithiasis in the absence of any associated hepatobiliary disease who underwent endoscopic retrograde cholangiopancreatography (ERCP) between 2002 and 2009 were analysed. The angle enclosed between the horizontal portion of the common bile duct (CBD) and the horizontal plane was measured (angle ?). Oblique common bile duct (OCBD) was defined as a CBD with angle ?<45°. Results 103 patients (7.9%) were found to harbour OCBD and these were compared to 104 randomly selected control subjects. Compared to controls, OCBD patients were (i) significantly older (72±13 vs. 67±13, p<0.00001); (ii) more frequently underwent a cholecystectomy (p?=?0.02) and biliary surgery (p?=?0.003) prior to the diagnosis and (iii) more often developed chronic pancreatitis (p?=?0.04) as well as biliary fistulae (p?=?0.03). Prior to and after ERCP, OCBD subjects displayed significantly elevated cholestatic parameters and angle ? negatively correlated with common bile duct diameter (r?=?-0.29, p?=?0.003). OCBD subjects more often required multiple back-to-back ERCP sessions to remove bile stones (p?=?0.005) as well as more ERCPs later on due to recurrent stone formation (p<0.05). Conclusion OCBD defines a novel variant of the biliary tree, which is associated with chronic cholestasis, hampers an efficient stone removal and predisposes to recurrence of bile duct stones.

Strnad, Pavel; von Figura, Guido; Gruss, Regina; Jareis, Katja-Marlen; Stiehl, Adolf; Kulaksiz, Hasan

2013-01-01

172

Current Status of Photodynamic Therapy for Bile Duct Cancer  

PubMed Central

The most common form in bile duct cancers is a highly desmoplastic cancer with a growth pattern characterized by periductal extension and infiltration. The prognosis of bile duct cancers, especially hilar cholangiocarcinoma, is limited by tumor spread along the biliary tree leading to refractory obstructive cholestasis, cholangitis, and liver failure. Although biliary endoprosthesis improves occlusion rates and reduces the number of therapeutic interventions, median survival time is not ameliorated. Photodynamic therapy (PDT) is a local photochemical tumor treatment that consists of a photosensitizing agent in combination with laser irradiation of a distinct wavelength. Tumor ablation with PDT combined with biliary stenting reduces cholestasis and significantly improves median survival time in selected patients with bile duct cancers.

Lee, Tae Yoon; Shim, Chan Sup

2013-01-01

173

Cholangiocyte secretion of chemokines in experimental biliary atresia  

PubMed Central

Biliary atresia (BA) is a disease of the newborn which results in obstruction of the biliary tree. The cause of BA remains unknown; however, recent studies using the murine model of biliary atresia have found that rotavirus infection of the biliary epithelial cell (cholangiocyte) triggers an inflammatory response. We hypothesized that rotavirus infection of cholangiocytes results in the release of chemokines, important mediators of the host immune response. Methods In vivo, Balb/c pups were injected with rhesus rotavirus (RRV) or saline, and, their extrahepatic bile ducts were microdissected 2,5, 7, and 14 days after injection. Next, an immortalized cholangiocyte cell line (mCl) was incubated with RRV or serum free media. Qualitative and quantitative chemokine assement was performed using ELISA, PCR, and immunohistchemistry. Results In vivo, increased levels of the chemokines MIP-2, MCP-1, KC and RANTES were found in RRV-infected murine bile ducts. In vitro, infected mCl cells produced increasing amounts of these same chemokines in relation to dose and time. Conclusion These novel results suggest that chemokine expression by RRV-infected cholangiocytes may trigger a host inflammatory process that causes bile duct obstruction. Understanding how viral infection initiates this response may shed light on the pathogenesis of biliary atresia.

Jafri, Mubeen; Donnelly, Bryan; Bondoc, Alex; Allen, Steven; Tiao, Greg

2009-01-01

174

A minimally invasive approach to bile duct injury after blunt liver trauma in pediatric patients  

Microsoft Academic Search

A 12-year-old boy presented with a large liver laceration after blunt abdominal trauma. He was treated nonoperatively and subsequently had bile peritonitis from a bile leak. Endoscopic retrograde cholangiopancreatography (ERCP) visualized the bile duct injury and allowed decompression of the biliary tree with an endoscopically placed biliary stent. A drain also was placed over the laceration through a small subcostal

Neal G. Church; Gary May; David L. Sigalet

2002-01-01

175

Discordance of sonography and cholescintigraphy in acute biliary obstruction  

Microsoft Academic Search

Animal studies have shown that there is a brief interval of several hours after acute biliary obstruction during which sonography will demonstrate only normal-sized bile ducts while \\/sup 99m\\/Tc cholescintigraphy will document total obstruction. Serial studies documented this phenomenon in a patient whose case is reported and reviewed.

J. L. Floyd; T. L. Collins

1983-01-01

176

Discordance of sonography and cholescintigraphy in acute biliary obstruction  

SciTech Connect

Animal studies have shown that there is a brief interval of several hours after acute biliary obstruction during which sonography will demonstrate only normal-sized bile ducts while /sup 99m/Tc cholescintigraphy will document total obstruction. Serial studies documented this phenomenon in a patient whose case is reported and reviewed.

Floyd, J.L.; Collins, T.L.

1983-03-01

177

Genes and (auto)immunity in primary biliary cirrhosis  

Microsoft Academic Search

Primary biliary cirrhosis (PBC) is a chronic autoimmune cholestatic liver disease most commonly encountered in postmenopausal women; it is characterized by high-titer serum autoantibodies to mitochondrial antigens, elevated serum IgM, progressive destruction of intrahepatic bile ducts, and ultimately liver cirrhosis and failure. The cytopathic mechanisms leading to the selective destruction of intrahepatic cholangiocytes are still largely unknown. The current theory

C Selmi; P Invernizzi; M Zuin; M Podda; M F Seldin; M E Gershwin; ME Gershwin

2005-01-01

178

Hepatic portoenterostomy for biliary atresia. A comparative study of histology and prognosis after surgery.  

PubMed Central

Specimens of excised tissue from the porta hepatis in 26 infants with extrahepatic biliary atresia undergoing hepatic portoenterostomy were analysed histologically for the presence and size of biliary ductules. No correlation could be found between the establishment of effective biliary drainage and the number or size of biliary ductules. it is suggested that prognosis after surgery may be related to the intrahepatic lesion and age of the child at operation rather than to the histology of the extrahepatic bile duct remnants. Images Fig. 1a Fig. 1b

Lawrence, D; Howard, E R; Tzannatos, C; Mowat, A P

1981-01-01

179

Role of radiation after operative palliation in cancer of the proximal bile ducts  

SciTech Connect

Cancer of the proximal bile ducts continues to pose a formidable problem to even the most experienced biliary surgeon. From 1977 through 1985, 51 patients with histologically confirmed proximal bile duct cancers underwent surgical treatment. The lesion was confined to the hilar region in 30 patients; there was extensive hepatic infiltration or distant metastatic disease in 21 patients. One patient underwent resection. Biopsy only was performed in six patients. In the remaining 44 patients, transtumoral dilation and intubation were performed. These 44 patients were further analyzed with regard to how survival was affected by the presence of metastatic disease and by the adjunctive use of radiation therapy. Mean survival in those patients with metastatic disease (n = 16) was 6.1 months, and survival was not improved by the use of postoperative radiation. In the absence of metastatic or advanced local disease, however, the addition of external beam radiation did significantly extend the mean survival from 4.5 to 12.2 months and the median survival from 2.2 to 12.2 months. The operative mortality for the series was 14% and postoperative complications occurred in 18 patients. These findings suggest that the addition of external beam radiation improves survival in patients undergoing palliative treatment of hilar tumors. Further confirmation of the value of radiation awaits prospective investigation.

Grove, M.K.; Hermann, R.E.; Vogt, D.P.; Broughan, T.A. (Cleveland Clinic Foundation, OH (USA))

1991-04-01

180

Evaluation of ERCP in the diagnosis of hepatocellular carcinoma invading bile ducts  

Microsoft Academic Search

Endoscopic retrograde cholangiopancreatography (ERCP) was performed preoperatively on 29 patients suffering from hepatocellular\\u000a carcinoma (HCC) invading bile ducts. The outstanding features were: 1. Most of the filling defects were situated within the\\u000a common, right or left hepatic duct associated with proximal bile duct dilatations (17 cases);2. Tumor encasement resulted\\u000a in localised or diffused irregular strictures and dilatations (9 cases); 3.

Cai Jian-ting; Qian Ke-da; Lu Wen-juan; Ying Xin

2001-01-01

181

Cholescintigraphy in extrahepatic biliary obstruction  

SciTech Connect

The effect of etiology on findings in cholescintigraphy in patients with extrahepatic obstruction was retrospectively evaluated in 29 patients. Of 11 patients with obstruction secondary to cancer, seven (78%) of nine had complete obstruction (delayed images were not obtained in two) and nine (82%) of 11 had a moderate to severe decreases in hepatocyte clearance. Of 12 patients with obstruction secondary to cholelithiasis, only four (36%) had complete obstruction (delayed images were not obtained in one) (p less than 0.05) and all 11 had normal or only midly decreased hepatocyte clearance (p less than 0.05). All five patients with obstruction secondary to pancreatitis had mild partial obstruction and normal or mildly decreased hepatocyte clearance. One patient had partial obstruction secondary to an abscess adjacent to the common bile duct; hepatocyte clearance was mildly decreased. Cancerous and noncancerous causes of biliary tract obstruction produce significantly different findings in hepatobiliary imaging.

Klingensmith, W.C.; Kuni, C.C.; Fritzberg, A.R.

1982-07-01

182

Effect of Rotavirus Strain on the Murine Model of Biliary Atresia?  

PubMed Central

Biliary atresia is a devastating disorder of the newborn in which afflicted infants develop inflammation and fibrosis of the extrahepatic biliary tract, resulting in cirrhosis and end-stage liver disease. Infection with a virus is thought to be a contributing factor in the etiology of biliary atresia. In the murine model of biliary atresia, perinatal exposure to rhesus rotavirus (RRV) results in biliary epithelial cell infection causing bile duct obstruction. The purpose of this study was to determine if tropism for the biliary epithelial cell was unique to RRV. Newborn mice underwent intraperitoneal injection with five strains of rotavirus: RRV (simian), SA11-FM (simian/bovine), SA11-SM (simian), EDIM (murine), and Wa (human). RRV and SA11-FM caused clinical manifestations of bile duct obstruction and high mortality. SA11-SM caused clinical signs of hepatobiliary injury but the mortality was markedly reduced. EDIM and Wa caused no sign of hepatobiliary disease. The systemic and temporal distribution of viral protein and live virus varied according to the injected strain. Immunohistochemistry revealed that RRV and SA11-FM targeted the biliary epithelial cells. In contrast, SA11-SM was found in the liver but in not in the biliary epithelium. These results indicate that strain-specific characteristics dictate tropism for cells of hepatobiliary origin which in turn impact the ability to induce the murine model of biliary atresia.

Allen, Steven R.; Jafri, Mubeen; Donnelly, Bryan; McNeal, Monica; Witte, David; Bezerra, Jorge; Ward, Richard; Tiao, Gregory M.

2007-01-01

183

Endoscopic and radiologic management of pancreatic and biliary tract diseases.  

PubMed

Therapeutic biliary and pancreatic endoscopy has evolved over the last 30 years to a level where it represents the primarily mode of therapy for many frequently encountered diseases of the bile ducts liver and pancreas. The complication rates are expected to be low and the expectations of our colleagues are high. The endoscopist is expected to understand the origin and natural history of these diseases and the consequences of the various management options. The training of the endoscopist has taken on a very formal character, as has the emphasis on competency and quality improvement. The appearance of minimally invasive surgery and advanced imaging does not represent a threat to the biliary endoscopist but rather is complimentary and assists us so that unnecessary potentially morbid procedures are not done unnecessarily. The appearance of a new specialty: the minimally invasive biliary interventionalist, who would receive training by gastroenterologists, interventional radiologist and biliary-pancreatic surgeons, is the logical next step! PMID:14719772

Ostroff, James W

2003-10-01

184

Serological and histological diagnosis of primary biliary cirrhosis  

PubMed Central

A simple immunofluorescence test for antibody to a mitochondrial antigen present in many tissues is a reliable method of distinguishing most cases of primary biliary cirrhosis from jaundice due to extrahepatic biliary tract obstruction. Of 30 cases diagnosed as primary biliary cirrhosis, 26 had antimitochondrial antibody whereas none of 77 cases with jaundice due to extrahepatic bile duct obstruction showed this serological abnormality. The antibody was also found in the serum of three of 42 patients who had other forms of cirrhosis and in two of 266 patients with no evidence of liver disease. Clinical, biochemical, and serological findings favour the view that primary biliary cirrhosis is a real entity which, in our present state of knowledge, cannot be defined clearly by any single method of investigation. In particular, the liver may show a variety of histological appearances which, interpreted without regard to the other features of the case, may lead to errors in diagnosis. Images

Goudie, R. B.; Macsween, R. N. M.; Goldberg, D. M.

1966-01-01

185

Biliary tract cancer and occupation in Sweden.  

PubMed Central

Using the Cancer-Environment Registry, which links the incidence of cancer (1961-79) and the 1960 census data on industry and occupation for all employed individuals in Sweden, the occurrence of biliary tract cancer (ICD 7th rev 155.1-.9) was systematically assessed according to occupational and industrial classifications. Data are presented separately for cancer of the gall bladder (ICD 155.1) and other cancers of the biliary tract (ICD 155.2-.9) including cancers of the extrahepatic bile ducts, ampulla of Vater, and unspecified bile passages. Statistically significant increased risks for cancer of the gall bladder were observed for men employed in petroleum refining, papermills, chemical processing, shoemaking, and repairing, and for both men and women employed in textile work. A significant increase in the incidence of other cancers of the biliary tract (mostly cancers of the bile duct) was found for such asbestos related employment as shipbuilding and in the wholesale construction materials industry and among insulation workers. These findings should be considered only as clues to aetiological factors, although several are consistent with earlier observations from other countries.

Malker, H S; McLaughlin, J K; Malker, B K; Stone, B J; Weiner, J A; Ericsson, J L; Blot, W J

1986-01-01

186

Adenocarcinoma of the extrahepatic biliary tree.  

PubMed Central

Increasing survival rates for carcinoma of the biliary tree could reflect the selection of patients for referral to a specialist centre as well as modern improvements in diagnosis and treatment. To determine the true incidence and outcome of biliary cancer, the records of 243 unselected Bristol patients were reviewed retrospectively over a 15-year period. Mean age was 64 years. Gallstones were associated in 38% of cases. Sixty-nine of 87 patients with gallbladder carcinoma were submitted to laparotomy. The operative (30-day) mortality rate was 56% and the one-year survival rate was 7%; one patient with an unexpected carcinoma is alive 7 years after cholecystectomy (1% five-year survival rate). Among 31 patients with carcinoma of the ampulla the operative mortality rate was 27%; one-year and five-year survival rates were 46% and 15%. Bile duct cancers (n = 125) arose proximal to the entry of the cystic duct (n = 63), distal to that point (n = 46) or diffusely (n = 16). For proximal cholangiocarcinoma the operative mortality rate was 38% and 1-year survival rate 17%; no patient lived for 2 years. For distal cholangiocarcinoma the operative mortality rate was 45% and one-year survival rate 26%; no patient lived for 3 years. Only palliative procedures were undertaken for diffuse cholangiocarcinoma; 2 patients survived 1 year (13%). Overall 5 patients with carcinoma of the extrahepatic biliary tree appear to have been cured (2%).

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

1985-01-01

187

Prognosis of extrahepatic biliary atresia.  

PubMed Central

We carried out a retrospective investigation of the 89 patients with extrahepatic biliary atresia born in The Netherlands during a 10 year period. Of these 89 patients 10 had a diagnostic laparotomy only. Eight patients had an anastomosis between the proximal bile duct and the intestine, and the remaining 71 had hepatic portoenterostomies. Bile drainage was re-established in 46 (65%). After successful hepatic portoenterostomy the development of cholangitis was the most important determinant of long term survival; five year survival was 54% in the 19 patients who had cholangitis and 91% in the 27 who did not. In the whole group of 71 patients the five year survival was 47%. Seventeen patients were at least 5 years of age at the time of writing, three of whom had had liver transplantation. Three patients have cirrhosis and hyperbilirubinaemia, and the other 11 have normal bilirubin concentrations and normal or slightly raised transaminase activities. To improve these results early surgical intervention in all children with extrahepatic biliary atresia is necessary, as are better methods of prophylaxis and treatment of cholangitis.

Houwen, R H; Zwierstra, R P; Severijnen, R S; Bouquet, J; Madern, G; Vos, A; Bax, N M; Heymans, H S; Bijleveld, C M

1989-01-01

188

Endoscopic Guided Biliary Drainage: How Can We Achieve Efficient Biliary Drainage?  

PubMed Central

Currently, endoscopic retrograde cholangiopancreatography (ERCP) is the preferred procedure for biliary drainage for various pancreatico-biliary disorders. ERCP is successful in 90% of the cases, but is unsuccessful in cases with altered anatomy or with tumors obstructing access to the duodenum. Due to the morbidity and mortality associated with surgical or percutaneous approaches in unsuccessful ERCP cases, biliary endoscopists have been using endoscopic ultrasound-guided biliary drainage (EUS-BD) more frequently within the last decade in different countries. As with any novel advanced endoscopic procedure that incorporates various approaches, advanced endoscopists all over the world have innovated and adopted diverse EUS-BD techniques. Indications for EUS-BD include failed conventional ERCP, altered anatomy, tumor preventing access into the biliary tree and contraindication to percutaneous access (i.e., ascites, etc.). EUS-BD utilizing EUS-guided rendezvous technique is conducted by creating a tract from either the stomach or the duodenum into the bile duct. Although EUS-BD has rapidly been gaining attraction and popularity in the endoscopic world, the indications and methods have yet to be standardized. There are several access routes and techniques that are employed by advanced endoscopists throughout the world for BD. This article reviews the indications and currently practiced EUS-BD techniques, including indications, technical details (intrahepatic or extrahepatic approach), equipment, patient selection, complications, and overall advantages and limitations.

Kedia, Prashant; Gaidhane, Monica

2013-01-01

189

Interferon-gamma directly mediates developmental biliary defects.  

PubMed

Biliary atresia (BA) is the most common identifiable hepatobiliary disease affecting infants, in which there are defects in intra- and extrahepatic bile ducts and progressive fibrosis. Activation of interferon-gamma (IFN?) appears to be critical in both patients with BA and in rodent models of BA. We have recently reported a zebrafish model of biliary disease that shares features with BA, in which inhibition of DNA methylation leads to intrahepatic biliary defects and activation of IFN? target genes. Here we report that ifng genes are hypomethylated and upregulated in zebrafish larvae treated with azacytidine (azaC), an inhibitor of DNA methylation. Injection of IFN? protein into developing zebrafish larvae leads to biliary defects, suggesting that activation of the IFN? pathway is sufficient to cause developmental biliary defects. These defects are associated with decreased cholangiocyte proliferation and with a decrease in the expression of vhnf1 (hnf1b, tcf2), which encodes a homeodomain protein with previously reported roles in biliary development in multiple models. These results support an importance of IFN? in mediating biliary defects, and also demonstrate the feasibility of direct injection of intact protein into developing zebrafish larvae. PMID:23448251

Cui, Shuang; Eauclaire, Steven F; Matthews, Randolph P

2013-02-28

190

Common bile duct obstruction associated with a dacron H-graft portacaval shunt.  

PubMed

An unusual patient had ascending cholangitis secondary to common bile duct obstruction by stones and a Dacron graft previously utilized in the performance of an H-graft portacaval shunt. Erosion of this foreign body into the common bile duct appeared to be secondary to bacterial contamination of the graft and direct contact of the foreign material with the biliary tree. PMID:147661

Prinz, R A; Pickleman, J

1978-03-01

191

Operative choledochoscopy in common bile duct surgery.  

PubMed Central

Surgical exploration of the common bile duct for gallstones is a common operation but carries a high residual stone rate. Conventional techniques for exploring the bile ducts are blind procedures. The surgeon cannot see what he is doing. Also there has been no reliable method for a postexploratory check of the bile ducts before closure, usually around a T-tube. Operative choledochoscopy allows the surgeon to see stones in the duct, may aid the removal of stones and provides visual postexploratory checks that the common bile duct and the hepatic ducts are clear, that papilla is patent and that no stone is left behind before closure. A personal series of 150 patients had operative choledochoscopy using a flexible fibreoptic choledochoscope. If there was a clear indication on preoperative investigations that the ducts should be explored, an operative cholangiogram was omitted and the choledochoscope used as the exploring instrument. In 127 patients with a diagnosis of gallstone disease, choledochoscopy was used at the primary operation. In 12 patients choledochoscopy was used at a secondary operation for recurrent gallstone disease, and 11 patients had malignant obstruction of the biliary tract. In 70 of the 127 patients, gallstones were found and extracted using the choledochoscope. In 53 patients the ducts were clear, and in 4, other lesions were found: 3 papillomas and one polycystic disease. One hundred and six of the patients had the common bile duct closed primarily with no T-tube drainage. There was no increase in complications and no deaths associated with choledochoscopy or primary closure of the common bile duct.(ABSTRACT TRUNCATED AT 250 WORDS) Images Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 p283-a

Ashby, B. S.

1985-01-01

192

Biliary sludge and acute pancreatitis during pregnancy  

Microsoft Academic Search

Background A 34-year-old Hispanic woman at 34 weeks' gestation presented with upper-abdominal pain, nausea, and vomiting of 1 day's duration. She had no active medical problems and had undergone two prior Caesarean sections. Laboratory tests revealed elevated serum amylase and lipase levels. Ultrasonography demonstrated gallbladder sludge without gallstones, gallbladder wall thickening, or bile-duct dilatation.Investigations Physical examination and laboratory tests of

Cynthia Ko

2006-01-01

193

The spectrum and natural history of common bile duct stenosis in chronic alcohol-induced pancreatitis.  

PubMed Central

Sixty patients with chronic alcohol-induced pancreatitis with endoscopic retrograde cholangiopancreatography evidence of common bile duct stenosis were studied to determine the clinical spectrum and natural history of this complication, as well as the indications for biliary bypass. In 17% of patients, common bile duct stenosis (CBDS) was an incidental finding at ERCP, while in the remaining cases pain and jaundice were the predominant symptoms in 35% and 48%, respectively. Biliary drainage was performed in 38% of patients for persistent or recurrent jaundice, cholangitis, and while undergoing pancreatic duct or cyst drainage procedures for pain. The benign nature of CBDS in chronic alcohol-induced pancreatitis (CAIP) in patients without persistent jaundice is emphasized. In particular, no histologically proved cases of secondary biliary cirrhosis were noted. The majority of patients with CBDS due to CAIP may be safely managed without biliary bypass but require close follow-up. Images Fig. 1. Fig. 2. Fig. 3.

Kalvaria, I; Bornman, P C; Marks, I N; Girdwood, A H; Bank, L; Kottler, R E

1989-01-01

194

Portal fibroblasts: Underappreciated mediators of biliary fibrosis  

PubMed Central

Portal fibroblasts are an important yet often overlooked non-parenchymal cell population in the liver. They are distinct from hepatic stellate cells, yet like stellate cells differentiate in the setting of chronic injury to fibrogenic myofibroblasts, playing an important role in collagen production in the fibrotic liver. Portal fibroblasts are located adjacent to bile duct epithelia and thus play a particularly significant role in biliary fibrosis. New data suggest that they may also have key functions independent of fibrogenesis. This review will address the definition and characteristics of PF as well as their signaling pathways, interactions with the biliary epithelium, and contributions to liver pathobiology. We conclude that portal fibroblasts are an important and multifunctional non-parenchymal cell population in need of further study.

Dranoff, Jonathan A.; Wells, Rebecca G.

2009-01-01

195

Acute Bile Duct Ligation Ameliorates Ischemic Renal Failure  

Microsoft Academic Search

Background: Biliary obstruction affects the renal response to ischemia and also elicits a hepatic cytokine response. Using a murine model, we now test the hypothesis that these hepatic cytokines help determine the outcome of ischemic acute renal failure. Methods: C3H\\/HEN mice were subjected to bile duct ligation 24 h (ABDL) or 7 days (CBDL) prior to induction of acute ischemic

D. Rohan Jeyarajah; Mariusz L. Kielar; Xin J. Zhou; Ying Zhang; Christopher Y. Lu

2003-01-01

196

Intra-operative near-infrared fluorescent cholangiography (NIRFC) in mouse models of bile duct injury  

PubMed Central

Background Accidental injury to the common bile duct is a rare but serious complication of laparoscopic cholecystectomy. Accurate visualization of the biliary ducts may prevent or detect injuries early. Conventional X-Ray cholangiography is often used and can reduce the severity of injury when correctly interpreted. However, it may be useful to have an imaging method that could provide real-time extra-hepatic bile duct visualization without changing the field of view from the laparoscope. The purpose of this study was to use a new NIR fluorescent agent that is rapidly excreted via the biliary route in pre-clinical models to evaluate intra-operative real time near infrared fluorescent cholangiography (NIRFC). Methods To investigate probe function and excretion, a lipophilic near infrared fluorescent agent with hepatobiliary excretion was injected intravenously into one group of C57/BL6 control mice and four groups of C57/BL6 mice with the following experimentally-induced conditions: a) chronic biliary obstruction, b) acute biliary obstruction c) bile duct perforation and e) choledocholithiasis, respectively. The biliary system was imaged intravitally for one hour using near-infrared fluorescence (NIRF) with an intra-operative small animal imaging system (excitation 649 nm, emission 675 nm). Results The extra hepatic ducts and extra-luminal bile were clearly visible due to the robust fluorescence of the excreted fluorochrome. Twenty-five minutes after intravenous injection, the target-to-background ratio peaked at 6.40 ± 0.83 but was clearly visible for ~ sixty minutes. The agent facilitated rapid identification of biliary obstruction and bile duct perforation. Implanted beads simulating choledocholithiasis were promptly identifiable within the common bile duct lumen. Conclusions NIRF agents with hepatobiliary excretion may be used intra-operatively to visualize extra hepatic biliary anatomy and physiology. Used in conjunction with laparoscopic imaging technologies this should enhance hepatobiliary surgery.

Figueiredo, Jose-Luiz; Siegel, Cory; Nahrendorf, Matthias; Weissleder, Ralph

2009-01-01

197

The incidence and management of biliary complications following liver transplantation in children.  

PubMed

Biliary complications following liver transplantation are a cause of significant morbidity and mortality. During the period 1988-1993 ten cases of biliary complications occurred after 98 transplantations in 78 children. The complications were four bile leaks, three intrahepatic biliary strictures (one with recurrent cholangitis), two anastomotic biliary strictures (one with recurrent cholangitis) and one recurrent cholangitis. All leaks occurred within 6 weeks of transplantation whereas all strictures and cholangitic episodes occurred after 3 months. Two biliary complications (20%) - one intrahepatic and one anastomotic stricture - developed secondary to hepatic artery thrombosis. The incidence of biliary complications was 13.2% with whole liver grafts as compared to 6.7% with partial liver grafts and it was 4.3% with duct-to-duct anastomosis as compared to 12.0% with Roux-en-Y hepatico-jejunostomy. Seven children required intervention for management of biliary complications and three were managed conservatively. There were no deaths related to the biliary complications. PMID:7576021

Bhatnagar, V; Dhawan, A; Chaer, H; Muiesan, P; Rela, M; Mowat, A P; Williams, R; Tan, K C; Heaton, N D

1995-01-01

198

Establishment and characterisation of six human biliary tract cancer cell lines  

Microsoft Academic Search

Human cell lines established from biliary tract cancers are rare, and only five have been reported previously. We report the characterisation of six new six biliary tract cancer cell lines (designated SNU-245, SNU-308, SNU-478, SNU-869, SNU-1079 and SNU-1196) established from primary tumour samples of Korean patients. The cell lines were isolated from two extrahepatic bile duct cancers (one adenocarcinoma of

J-L Ku; K-A Yoon; I-J Kim; W-H Kim; J-Y Jang; K-S Suh; S-W Kim; Y-H Park; J-H Hwang; Y-B Yoon; J-G Park

2002-01-01

199

Anomalous pancreaticobiliary union and chronic pancreatitis: rare presentation with biliary peritonitis.  

PubMed

Anomalous pancreaticobiliary union (APBU) has varied presentations. We report the case of a 12-year-old female who presented with biliary peritonitis due to a perforation of the common bile duct due to impaction of a pancreatic calculus at the duodenal papilla. She had a long common-biliary channel and pancreas divisum with chronic calcific pancreatitis involving the pancreatic head and neck. To our knowledge, this is the first such reported case in the literature. PMID:11666058

Shenoy, V G; Jawale, S A; Oak, S N; Kulkarni, B K

2001-09-01

200

The association between biliary tract cancers and cancers of other sites  

Microsoft Academic Search

OBJECTIVE:Cancers of the biliary tract, including cancers of the gallbladder and bile duct, generally carry a very poor prognosis. Little is known about their etiology. The pattern of co-occurrence of two cancers may give clues to shared etiological risk factors. We therefore investigated the association of biliary tract cancer with other cancers, especially with estrogen- and tobacco-related cancers.METHODS:We used data

Yun Su; Habibul Ahsan; Alfred I Neugut

1999-01-01

201

Expression and Clinicopathological Significance of Notch Signaling and Cell-Fate Genes in Biliary Tract Cancer  

Microsoft Academic Search

OBJECTIVES:Biliary tract cancer (BTC) is a fatal cancer originating from epithelial cells of the intra- and extra-hepatic biliary duct system and the gallbladder. Genes and pathways regulating stem and progenitor cells as well as cell-fate decisions are increasingly recognized in tumorigenesis. We evaluated the expression of Notch1, Notch2, and HES1 (hairy and enhancer of split 1), as well as the

Pawel K Mazur; Marc-Oliver Riener; Wolfram Jochum; Glen Kristiansen; Achim Weber; Roland M Schmid; Jens T Siveke

2012-01-01

202

Positive predictive value of cholescintigraphy in common bile duct obstruction  

SciTech Connect

Technetium-99m DISIDA imaging was employed in 400 patients to differentiate obstruction of the common bile duct from medical and other surgical causes of hyperbilirubinemia. Sequential anterior images demonstrated variable degrees of liver uptake, yet there was no evidence of intrabiliary or extrabiliary radioactivity for at least 4 hr after injection in 25 patients. Twenty-three patients were surgically documented to have complete obstruction of the common bile duct. One patient had hepatitis, and another had sickle cell crisis without bile duct obstruction. The remaining patients had either partial or no obstruction of the common bile duct. We conclude that the presence of liver uptake without evident biliary excretion by 4 hr on cholescintigraphy is highly sensitive and predictive of total obstruction of the common bile duct.

Lecklitner, M.L.; Austin, A.R.; Benedetto, A.R.; Growcock, G.W.

1986-09-01

203

Percutaneous Transhepatic Cutting Balloon Papillotomy for Removal of Common Bile Duct Stones  

SciTech Connect

We report the case of a 66-year-old female who presented with jaundice secondary to recurrent adenocarcinoma of the gallbladder and several common bile duct stones. Percutaneous papillary dilatation was planned to remove the common bile duct stones. Papilla was dilated through the percutaneous approach with an 8-mm peripheral cutting balloon instead of a standard balloon. All the stones were pushed successfully into the duodenum with a saline flush. No complications were encountered. Use of a peripheral cutting balloon for dilatation of the papilla seems to be safe and effective because it has the advantage of controlled incision and dilatation of the target at low pressures.

Oguzkurt, Levent, E-mail: loguzkurt@yahoo.com; Ozkan, Ugur; Gumus, Burcak [Baskent University Faculty of Medicine, Department of Radiology (Turkey)

2009-09-15

204

CD40 activation-induced, Fas-dependent apoptosis and NF-kappaB\\/AP1 signaling in human intrahepatic biliary epithelial cells  

Microsoft Academic Search

Fas-mediated mechanisms of apoptosis are thought to be involved in the bile duct loss that characterizes diseases such as primary biliary cirrhosis (PBC). We have previously shown that activation of CD40 on hepatocytes can amplify Fas-mediated apopto- sis; in the present study, we investigated interactions between CD40 and Fas in biliary epithelial cells (BEC). We report that the bile ducts

SIMON C. AFFORD; JALAL AHMED-CHOUDHURY; SATINDER RANDHAWA; CLARE RUSSELL; JANINE YOUSTER; HEATHER A. CROSBY; ARISTIDES ELIOPOULOS; STEFAN G. HUBSCHER; LAWRENCE S. YOUNG; DAVID H. ADAMS

2001-01-01

205

Cholangiocyte cilia are abnormal in syndromic and non-syndromic biliary atresia  

PubMed Central

Biliary atresia is a neonatal disorder characterized by aggressive fibroinflammatory obliteration of the biliary tract. Approximately 20 percent of biliary atresia patients demonstrate left-right laterality defects (syndromic biliary atresia). Cilia participate in important physiologic functions in cholangiocytes, and since some ciliopathies have been associated with both laterality defects and hepatic fibrosis, we hypothesized that patients with syndromic biliary atresia exhibit abnormalities of cholangiocyte cilia that disrupt cholangiocyte homeostasis. Nine biliary atresia specimens were studied, including pre-Kasai diagnostic biopsies (n=7) and liver explants (n=2). Five specimens were from patients with laterality defects. These were compared to normal pediatric livers as well as livers affected by primary sclerosing cholangitis, Wilson’s disease, and cardiac cirrhosis. Biopsy sections were stained with antibodies against keratin 19 (a cholangiocyte marker) and acetylated ?-tubulin (a cilia marker) and were visualized by confocal microscopy. Computer-assisted relative quantification was used to compare staining of cilia within bile ducts among samples. Surprisingly, cilia in biliary atresia specimens were significantly shorter, abnormal in their orientation, and less abundant compared to normal liver and disease controls regardless of the presence of a laterality defect. Conclusion There are significant abnormalities of cholangiocyte cilia in both syndromic and non-syndromic biliary atresia livers compared to normal livers and livers affected by other cholestatic diseases. While this may result from severe cholestasis or inflammation, it may also reflect common mechanistic pathways in different forms of biliary atresia and may have important implications for understanding the progression of the disease.

Chu, Andrew S.; Russo, Pierre A.; Wells, Rebecca G.

2011-01-01

206

Simultaneous duct ectasia of accessory and normally located breast.  

PubMed

Accessory breast and duct ectasia are common clinical problems in their own right. However, their coexistence is a rare entity. Duct ectasia is a dilation in one or more of the larger lactiferous duct filled with a stagnant brown or green secretion, which may or may not discharge through the nipple. This material acts as an irritant and leads to periductal mastitis. Duct ectasia may present with subareolar mass, nipple discharge, nipple retraction, non-cyclical mastalgia or mammary fistula. Surgical options are microdochectomy or cone excision of major ducts. This case report describes the presence of duct ectasia in both accessory breast situated in the axilla and ipsilateral normal breast simultaneously. PMID:19149984

Afridi, Shahida Parveen; Shamim, M Shahid; Rahman, Shafiq Ur; Samo, Khursheed Ahmed; Sabir, Shazia

2009-01-01

207

Utility of Stent-Grafts in Treatment of Porto-Biliary Fistula  

SciTech Connect

A porto-biliary fistula causing hemobilia is a known complication of percutaneous transhepatic biliary drainage (PTBD). We present two patients with hemobilia secondary to porto-biliary fistula, treated successfully by percutaneous placement of stent-grafts. In one case, the stent-graft was placed in the bile duct, and in the other case, it was placed in the intrahepatic portal vein branch. Hemobilia stopped and there were no complications except a small area of hepatic infarction, distal to the stent-graft in the portal vein.

Peynircioglu, Bora; Cwikiel, Wojciech [University of Michigan Hospital, Department of Radiology (United States)], E-mail: cwikiel@med.umich.edu

2006-12-15

208

Differentiation of jaundice in infancy: an application of radionuclide biliary studies  

SciTech Connect

Atresia and hypoplasia of the bile ducts are the most common congenital biliary anomalies of clinical importance. Surgical correction can help about 10% of these infants. However, surgery should be performed within the first month of life to avoid irreversible liver parenchymal changes. It is difficult to separate the surgical condition, biliary atresia, from conditions in which the trauma of laparotomy should be avoided, such as neonatal hepatitis and other clinically indistinguishable causes of obstructive jaundice. Radionuclide imaging with the /sup 99m/Tc-labeled N-substituted iminodiacetic acids (HIDA, PIDIDA, DISIDA, etc) have been helpful in the differential diagnosis of biliary atresia.

Johnston, G.S.; Rosenbaum, R.C.; Hill, J.L.; Diaconis, J.N.

1985-12-01

209

Heterogeneity of Autoreactive T Cell Clones Specific for the E2 Component of the Pyruvate Dehydrogenase Complex in Primary Biliary Cirrhosis  

Microsoft Academic Search

Summary The extraordinary specificity of bile duct destruction in primary biliary cirrhosis (PBC) and the presence of T cell infiltrates in the portal tracts have suggested that biliary epithelial cells are the targets of an autoimmune response. The immunodominant antimitochondrial humoral response in patients with PBC is directed against the E2 component of pyruvate dehydrogenase (PDC-E2). Hitherto, there have only

Judy Van de Water; Aftab Ansari; Thomas Prindiville; Ross L. Coppel; Nancy Ricalton; Brian L. Kotzin; Shengjiang Liu; Thomas E. Roche; Sheri M. Krams; Santiago Munoz; M. Eric Gershwin

210

Etiology of biliary atresia as a developmental anomaly: recent advances.  

PubMed

Biliary atresia (BA) is a progressive fibro-obliterative cholangiopathy affecting the extra- and intrahepatic biliary tree to various degrees and resulting in obstructive bile flow, cholestasis and icterus in neonates. It is the most common cause of pediatric liver transplantation. The etiology of BA is still unclear, although there is some evidence pointing to viral, toxic, and multiple genetic factors. For new therapeutic options other than liver transplantation to be developed, a greater understanding of the pathogenesis of BA is indispensable. The fact that the pathology of BA develops during a period of biliary growth and remodeling suggests an involvement of developmental anomalies. Recent studies indicate an association of the etiology of BA with some genetic factors such as laterality genes, epigenetic regulation and/or microRNA function. In this paper, we present an overview of recent advances in the understanding of the disease focusing on bile duct developmental anomaly. PMID:23567964

Nakamura, Kazuaki; Tanoue, Akito

2013-06-01

211

Extrahepatic biliary atresia in a border collie.  

PubMed

Progressive lameness and leg pain were the predominant clinical signs in a 17-week-old male border collie presented for examination. On clinical investigation, extrahepatic cholestasis in association with rickets due to inadequate vitamin D resorption was diagnosed. The dog was treated parenterally with vitamin D and a cholecystoduodenostomy was performed. At 25 days postsurgery the lameness had resolved and bone structure was radiographically normal. However, at six weeks postsurgery, the dog's condition deteriorated rapidly and euthanasia was finally performed at eight weeks postsurgery. At postmortem examination, Toxocara canis nematodes were found to have invaded the biliary system via the anastomosis between the gallbladder and duodenum, causing biliary and hepatic toxocariasis. The cause of the primary extrahepatic cholestasis was atresia of the common bile duct at the hepatic end. The liver tissue showed microscopic lesions of chronic extrahepatic cholestasis as well as acute inflammation associated with the nematode invasion. There was no postmortem evidence of bone lesions. Extrahepatic biliary atresia is extremely rare in animals and has not been described before in dogs. In contrast, it represents the most common cause of congenital cholestasis in children, occurring in approximately one per 10,000 to 15,000 live births. PMID:10713980

Schulze, C; Rothuizen, J; van Sluijs, F J; Hazewinkel, H A; van den Ingh, T S

2000-01-01

212

Debris-filled biliary system: a difficult diagnosis on MRI and MRCP.  

PubMed

We describe a debris-filled biliary system as a difficult diagnosis using magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRCP). A male patient aged 60 years showed a nonvisualized biliary system due to complete filling with debris. The following imaging features were observed: mild heterogeneity of intermediate signal on T2-weighted, MRCP and T1-weighted images and mild heterogeneous enhancement of periportal tissue on early and late postcontrast images. The absence of simple-appearing bile on T2 or MRCP images made the diagnosis of dilated, debris-filled biliary system challenging. PMID:22370138

Shaikh, Faiq; Elazzazi, Mohamed; Ryan, Andrew; Semelka, Richard C

213

Cutting-Edge Issues in Primary Biliary Cirrhosis  

Microsoft Academic Search

Several crucial issues remain open in our understanding of primary biliary cirrhosis (PBC), an autoimmune liver disease targeting\\u000a the small- and medium-sized intrahepatic bile ducts. These issues include the high tissue specificity of the autoimmune injury\\u000a despite the nontraditional autoantigens found in all mitochondria recognized by PBC-associated autoantibodies, the causes\\u000a of the commonly observed pruritus, and the disease etiology per

Marco Folci; Francesca Meda; M. Eric Gershwin; Carlo Selmi

214

Pancreatic pseudocyst causing extrahepatic biliary obstruction in a dog.  

PubMed

A 3-year-old Rhodesian Ridgeback was examined because of recurrent pancreatitis of 2 months duration. The dog had signs of abdominal pain and jaundice. Blood biochemical findings were consistent with extrahepatic bile duct obstruction, but on abdominal ultrasonography no cause of obstruction was identified. At surgery a pancreatic pseudocyst was found in the body of the pancreas. Cystoduodenostomy, cystic omentalization and biliary diversion resulted in excellent long-term recovery. PMID:10736669

Marchevsky, A M; Yovich, J C; Wyatt, K M

2000-02-01

215

Gallbladder and Biliary Tract  

MedlinePLUS

... Multimedia Table Index In This Topic Digestive Disorders Biology of the Digestive System Gallbladder and Biliary Tract ... Subjects Women's Health Issues Chapters in Digestive Disorders Biology of the Digestive System Symptoms of Digestive Disorders ...

216

Linear echoendoscope-guided ERCP for the diagnosis of occult common bile duct stones  

PubMed Central

Background Less than 67% of patients with intermediate risk for common bile duct (CBD) stones require therapeutic intervention. It is important to have an accurate, safe, and reliable method for the definitive diagnosis of CBD stones before initiating therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Few publications detail the diagnostic efficacy of linear echoendoscopy (EUS) for CBD stones. Methods 30 patients with biliary colic, pancreatitis, unexplained derangement of liver function tests, and/or dilated CBD without an identifiable cause were enrolled in the study. When a CBD stone was disclosed by linear EUS, ERCP with stone extraction was performed. Patients who failed ERCP were referred for surgical intervention. If no stone was found by EUS, ERCP would not be performed and patients were followed-up for possible biliary symptoms for up to three months. Results The major reason for enrollment was acute pancreatitis. The mean predicted risk for CBD stones was 47% (28–61). Of the 12 patients who were positive for CBD stones by EUS, nine had successful ERCP, one failed ERCP (later treated successfully by surgical intervention) and two were false-positive cases. No procedure-related adverse events were noted. For those 18 patients without evidence of CBD stones by EUS, no false-negative case was noted during the three-month follow-up period. Linear EUS had sensitivity, specificity, positive and negative predicted values for the detection of CBD stones of 1, 0.9, 0.8 and 1, respectively. Conclusion Linear EUS is safe and efficacious for the diagnosis of occult CBD stones in patients with intermediate risk for the disease.

2013-01-01

217

Tumor-associated focal chronic pancreatitis from invasion of the pancreatic duct by common bile duct carcinoma: radiologic–pathologic correlation  

Microsoft Academic Search

We report a case of tumor-associated focal chronic pancreatitis of the uncinate process of the pancreas. The chronic pancreatitis\\u000a was secondary to stenosis of the main pancreatic duct from invasion by a common bile duct carcinoma. A feature distinguishing\\u000a the chronic pancreatitis from pancreatic carcinoma was the localized dilatation of pancreatic duct branches evident in the\\u000a focal lesion of the

T. Gabata; J. Sanada; S. Kobayashi; N. Terayama; M. Kadoya; O. Matsui

2003-01-01

218

Primary malt lymphoma of the common bile duct.  

PubMed

Primary mucosa-associated lymphoid tissue (MALT) lymphoma arising in the common bile duct (CBD) is extremely rare. In our case of MALT lymphoma, CT and MRI showed long, segmental, irregular wall thickening of the CBD and minimal dilatation of the upstream bile duct. A preoperative diagnosis of cholangiocarcinoma was made, but histologic evaluation confirmed MALT lymphoma of the CBD. We herein present a rare case of MALT lymphoma of the CBD with CT and MRI findings. PMID:24043969

Cho, Young Hoon; Byun, Jae Ho; Kim, Jin Hee; Lee, Seung Soo; Kim, Hyoung Jung; Lee, Moon-Gyu

2013-08-30

219

Primary Malt Lymphoma of the Common Bile Duct  

PubMed Central

Primary mucosa-associated lymphoid tissue (MALT) lymphoma arising in the common bile duct (CBD) is extremely rare. In our case of MALT lymphoma, CT and MRI showed long, segmental, irregular wall thickening of the CBD and minimal dilatation of the upstream bile duct. A preoperative diagnosis of cholangiocarcinoma was made, but histologic evaluation confirmed MALT lymphoma of the CBD. We herein present a rare case of MALT lymphoma of the CBD with CT and MRI findings.

Cho, Young Hoon; Kim, Jin Hee; Lee, Seung Soo; Kim, Hyoung Jung; Lee, Moon-Gyu

2013-01-01

220

Biliary ascariasis combined with a villous tumor of the papilla. Diagnostic and therapeutic value of endoscopy.  

PubMed

A 64-year-old man admitted for cholangitis presented with an ascaris lumbricoides in the biliary duct and a villous tumor of the ampulla of Vater. ERCP revealed the parasite as a "rail-like" linear defect in the main bile duct, and permitted its extraction. The ampullary tumor was repeatedly ablated with a snare and finally surgically removed because of suspicion of malignancy. This is the first report on such an association. PMID:3691405

Sahel, J; Bastid, C; Choux, R

1987-11-01

221

CORNICE DUCT SYSTEM  

Microsoft Academic Search

SYNERGETICS, INC., is in the process of designing, developing, and testing an air handling duct system that integrates the air duct with the cornice trim of interior spaces. The device has the advantage that the normal thermal losses from ducts into unconditioned attics and crawl spaces can be totally eliminated by bringing the ducts internal to the conditioned space. The

Chuck Ladd; TC Howard

2002-01-01

222

[Some aspects of classification and treatment strategy of iatrogenic bile duct injury].  

PubMed

Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. None of the classification system is universally accepted and worldwide used as each has its own limitation. This article reviews the various classification systems of bile duct injury. Traditionally, biliary injuries have been classified using the Bismuth's classification. This classification does not encompass the whole spectrum of injuries during laparoscopic cholecystectomy. Strasberg's classification made Bismuth's classification much more comprehensive by including various other types of extrahepatic bile duct injuries. Our own classification is simple enough, embraces the majority possible variants of bile duct injuries and convenient in clinical use. PMID:21178207

Agaev, B A; Muslimov, G F; Alieva, G R; Ibragimov, T R; Alizade, V N

2010-11-01

223

Angiographic Findings in Biliary Atresia  

SciTech Connect

We present the angiographic findings of 46 patients with biliary atresia (BA). There were 25 males and 21 females, with a mean age of 22.5 months (range - 1.5 to 141 months). Hepatic and mesenteric angiography were obtained as part of a liver transplantation work-up or as part of the treatment of clinical events. All patients had a histological diagnosis of BA. The portal vein was patent in 43 patients, with a mean size of 4.1 mm, using the arterial catheter as comparison. Portal hepatopetal flow was observed in 20 patient and hepatofugal flow was observed in 21 patients. Presence of gastroesophageal varices was observed in 41 patients. The hepatic artery was enlarged in all patients. In all 46 patients studied, the intrahepatic peripheral hepatic artery branches presented with irregularities in contour, including encasement, strictures, dilatation and angulation, and images suggestive of peripheral occlusion. Angiographic vascular 'tuft-like' blush surrounding the irregular or occluded peripheral arterial segments was observed in 40 patients. The injection of Microfil (registered) in one case showed a marked vascular proliferation within the portal tract, apparently derived from arterial and portal connections, filling the entire portal space. We conclude that the presence of angiographically demonstrable perivascular arterial tufts in the periphery of the hepatic arterial circulation is a common finding in cases of BA, and may be a characteristic diagnostic angiographic finding.

Uflacker, Renan [Medical University of South Carolina, Interventional Radiology (United States)], E-mail: uflacker@musc.edu; Pariente, Daniele M. [Centre Hospitalier Universitaire de Bicetre, Department of Radiology (France)

2004-09-15

224

Squamous metaplasia of lactiferous ducts (SMOLD).  

PubMed

The aim of this review is to illustrate the mammographic and sonographic appearances of squamous metaplasia of the lactiferous ducts (SMOLD) and to discuss the disease processes of this uncommon breast disease, which shows a strong correlation with smoking. The most common mammographic appearance is of a retro-areolar asymmetrical density. Ultrasonography of the symptomatic breast typically shows a retro-areolar, predominately medial, ill-defined, hypoechoic lesion with either abscess or sinus/fistula formation. Duct dilatation and continuity with lactiferous ducts is commonly seen. Increased vascularity is occasionally seen on colour Doppler ultrasound. Pathology tissue confirmation is always required and this can be by histology of a core biopsy or excision specimen, or fine-needle aspiration (FNA) cytology. Occasionally smears of an associated abundant nipple or sinus discharge may be of value. PMID:22964367

Lo, G; Dessauvagie, B; Sterrett, G; Bourke, A G

2012-09-07

225

Biliary strictures complicating liver transplantation. Incidence, pathogenesis, management, and outcome.  

PubMed Central

Six hundred sixty-six patients received 792 liver transplants between February 1, 1984 and September 30, 1991. Biliary reconstruction was by choledochocholedochostomy (CDCD) with T-tube (n = 509) or Roux-en-Y choledochojejunostomy (CDJ) (n = 283). Twenty-five patients (4%) developed biliary strictures. Anastomotic strictures were more common after CDJ (n = 10, 3.5%) than for CDCD (n = 3, 0.6%). Intrahepatic strictures developed in 12 patients. Six patients had occult hepatic artery thrombosis (HAT). The other six patients received grafts in which cold ischemia time exceeded 12 hours. Anastomotic strictures were successfully managed by percutaneous dilation (PD) in five patients (n = 10), operation in three (n = 6), with retransplantation required in two patients. Intrahepatic strictures were managed by PD in seven, retransplantation in one, and expectantly in four patients. Of 25 patients, 19 (76%) are alive with good graft function. In three of six deaths, the biliary stricture was a significant factor to the development of sepsis and allograft failure. The authors conclude that (1) anastomotic strictures are rare after LT; (2) the development of biliary strictures may signify occult HAT; (3) PD is effective for most strictures; and (4) extended cold graft ischemia (less than 12 hours) may be injurious to the biliary epithelium, resulting in intrahepatic stricture formation. Images FIG. 1. FIG. 2. FIG. 3. FIG. 4.

Colonna, J O; Shaked, A; Gomes, A S; Colquhoun, S D; Jurim, O; McDiarmid, S V; Millis, J M; Goldstein, L I; Busuttil, R W

1992-01-01

226

Sox17 haploinsufficiency results in perinatal biliary atresia and hepatitis in C57BL/6 background mice.  

PubMed

Congenital biliary atresia is an incurable disease of newborn infants, of unknown genetic causes, that results in congenital deformation of the gallbladder and biliary duct system. Here, we show that during mouse organogenesis, insufficient SOX17 expression in the gallbladder and bile duct epithelia results in congenital biliary atresia and subsequent acute 'embryonic hepatitis', leading to perinatal death in ~95% of the Sox17 heterozygote neonates in C57BL/6 (B6) background mice. During gallbladder and bile duct development, Sox17 was expressed at the distal edge of the gallbladder primordium. In the Sox17(+/-) B6 embryos, gallbladder epithelia were hypoplastic, and some were detached from the luminal wall, leading to bile duct stenosis or atresia. The shredding of the gallbladder epithelia is probably caused by cell-autonomous defects in proliferation and maintenance of the Sox17(+/-) gallbladder/bile duct epithelia. Our results suggest that Sox17 plays a dosage-dependent function in the morphogenesis and maturation of gallbladder and bile duct epithelia during the late-organogenic stages, highlighting a novel entry point to the understanding of the etiology and pathogenesis of human congenital biliary atresia. PMID:23293295

Uemura, Mami; Ozawa, Aisa; Nagata, Takumi; Kurasawa, Kaoruko; Tsunekawa, Naoki; Nobuhisa, Ikuo; Taga, Tetsuya; Hara, Kenshiro; Kudo, Akihiko; Kawakami, Hayato; Saijoh, Yukio; Kurohmaru, Masamichi; Kanai-Azuma, Masami; Kanai, Yoshiakira

2013-02-01

227

Salivary duct carcinoma: report of a case and review of the literature  

Microsoft Academic Search

Summary Salivary duct carcinoma is a rare primary tumour of the salivary glands arising most frequently in the parotid gland. It has a male preponderance and occurs most often in patients over the age of 50 years. Its distinctive histological features include dilated ducts containing cells arranged in cribriform, papillary or solid patterns often with central necrosis and reminiscent of

D. M. Butterworth; A. W. Jones; B. Kotecha

1992-01-01

228

Scleroderma and Primary Biliary Cirrhosis  

Microsoft Academic Search

Two cases of scleroderma and primary biliary cirrhosis are described. One had systemic sclerosis with primary biliary cirrhosis of six years' duration at the stage of ductular proliferation. The other had the C.R.S.T. syndrome (calcinosis, Raynaud's phenomenon, sclerodactyly, and telangiectases) with primary biliary cirrhosis at the florid stage. Several similar cases were found in a review of other reports, and

I. M. Murray-Lyon; R. P. H. Thompson; I. D. Ansell; Roger Williams

1970-01-01

229

Diagnostic Dilemma in an Unusual Case of Common Bile Duct Obstruction  

PubMed Central

Biliary obstructions are rarely caused by a foreign body and have received sparse attention. We present an unusual case with pruritis and abdominal pain caused by impacted full length surgical gauze within the common bile duct. The patient had previously undergone an open cholecystectomy. Radiological investigations were inconclusive and suggestive of either a calculus or a cholangiocarcinoma. Surgical exploration revealed full length surgical gauze within the common bile duct. Because imaging modalities are often non-determinant, the possibility of biliary tract obstruction from a foreign body should be borne in mind for patients with unusual presentations, especially those who have previously undergone surgery.

Singh, Mohit; Vyas, Hari Gopal; Sharma, Nitin; Chejara, Rajkumar

2011-01-01

230

Duct Joining System  

DOEpatents

A duct joining system for providing an air-tight seal and mechanical connection for ducts and fittings is disclosed. The duct joining system includes a flexible gasket affixed to a male end of a duct or fitting. The flexible gasket is affixed at an angle relative to normal of the male end of the duct. The female end of the other duct includes a raised bead in which the flexible gasket is seated when the ducts are properly joined. The angled flexible gasket seated in the raised bead forms an air-tight seal as well as fastens or locks the male end to the female end. Alternatively, when a flexible duct is used, a band clamp with a raised bead is clamped over the female end of the flexible duct and over the male end of a fitting to provide an air tight seal and fastened connection.

Proctor, John P. (Fairfax, CA)

2001-02-27

231

Experience with common bile duct exploration at Lumbini Medical College.  

PubMed

Common bile duct stones represent a significant danger to patients, because they can lead to biliary colic, obstructive jaundice, cholangitis, or pancreatitis. Common bile duct stones either migrate from the gallbladder or form primarily within the bile ducts themselves. Primary stones are more common in South Asia and are usually sequelae of biliary infection and stasis. In the United States and other Western countries, common bile duct stones are predominantly secondary stones, having formed in the gallbladder. In patients who have gallstones, and in whom a cholecystectomy is considered, common bile duct stones can be found preoperatively, intraoperatively, or postoperatively. Ten percent to 15% of patients undergoing a cholecystectomy will be found to have choledocholithiasis at some point during their treatment. We present our case of 16 patients of common bile duct stones with or without cholelithiasis from April 2011 to March 2012. To review the treatment and outcome of patients with common bile duct (CBD) stones who underwent cholecystecomy with open common bile exploration (CBDE). We analysed the fact that cholecystectomy with commonbile duct exploration still holds as a good modality of treatment where ERCP (Endoscopic Retrograde cholangio pancreaticogram) is not available. All 16 persons in age group of 20-65 years, all females with body weight in the range of 45-60 kgs undergoing inpatient common bile duct exploration during April 2011- March 2012 were included. Common bile duct exploration was successful in all patients. Mean operating time was 120 +/- 40 minutes and length of hospital stay was 13 +/- 3days. 3 complications (18.75%) were recorded, 2 cases of retained stone (12.5%) who underwent choledochoduodenostomy. In 16 patients undergoing common bile duct exploration, CBD stones were discovered with flexible choledochoscope and intraoperative cholangiography. None of the Gallbladder specimen revealed any feature of malignancy in final histopatholgical report. All patients are doing fine till date. Open common bile duct exploration can still be a gold standard technique in set up where ERCP is not available. The results of common bile duct exploration are good with less complications in experienced hands. PMID:23671956

Pokharel, N; Sapkota, P; Kc, B; Rimal, S

2012-06-01

232

The autoimmunity of primary biliary cirrhosis and the clonal selection theory  

Microsoft Academic Search

Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease in which an immune-mediated injury targets the small intrahepatic bile ducts. PBC is further characterized by highly specific serum antimitochondrial autoantibodies (AMAs) and autoreactive T cells, a striking female predominance, a strong genetic susceptibility and a plethora of candidate environmental factors to trigger the disease onset. For these reasons, PBC

Carlo Selmi; Ian R Mackay; M Eric Gershwin

2011-01-01

233

[The treatment of patients with chronic cholecystitis and hypomotor biliary dyskinesia at a sanatorium].  

PubMed

Efficacy of spa treatment with moderately mineralized mineral water from the spring utilized by balneological sanatorium Uva in the Republic of Udmurtia was studied in 524 patients with chronic atrophic gastritis concomitant with chronic cholecystitis and hypokinesia of the biliary ducts. Drinking water proved beneficial for hepatobiliary tract, clinical symptoms regressed, the ability of the gallbladder to concentrate and expel bile improved. PMID:9446306

Gorbunov, Iu V; Korepanov, A M

234

Autoantibodies against subunits of pyruvate dehydrogenase and citrate synthase in a case of paediatric biliary cirrhosis  

Microsoft Academic Search

In a newborn girl with a history of connatal liver damage, histological examination of a liver biopsy sample taken during the seventh week of life revealed incipient destruction of bile ducts. Very high titres of antimitochondrial antibodies were later detected in the plasma. As the hepatic injury tended towards fibrosis, the histological diagnosis became primary biliary cirrhosis. Autoantibodies against E1?,

B Melegh; G Skuta; L Pajor; G Hegedu?s; B Sumegi

1998-01-01

235

Differential leptin responses to acute and chronic biliary obstruction in rats  

Microsoft Academic Search

Background\\/Aims: Recently leptin, a protein released from adipocytes, has been identified as a potent circulating satiety factor. We therefore undertook this series of experiments to examine leptin's role in the anorexia associated with biliary obstruction.Methods: Rats underwent either surgical bile duct resection (BDR) or sham resection (sham). Body weight, and food and water intake were measured during a baseline period

Kevin P Rioux; Paul L Beck; Allison G Hoppin; Ikemefuna Ezedi; Lee Kaplan; Tai Le; Mark G Swain

2000-01-01

236

Variants in Inflammation Genes and the Risk of Biliary Tract Cancers and Stones: A Population-based Study in China  

PubMed Central

To evaluate the role of chronic inflammation in the development of gallstones and biliary tract cancer, we examined the risk associated with 62 single nucleotide polymorphisms (SNPs), including 22 inflammation-related genes, based on a population-based case-control study conducted in Shanghai, China, where the incidence of biliary tract cancer has been increasing in recent decades. The study included 411 cases with biliary tract cancer (237 gallbladder, 127 extrahepatic bile duct, and 47 ampulla of Vater), 895 with biliary stones, and 786 controls randomly selected from the population. Unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association of individual single nucleotide polymorphisms (SNPs) and haplotypes with biliary stones and biliary tract cancer. Of the 62 SNPs examined, 14 were related to the risk of biliary cancer and stones. Specifically, variants in the IL8, IL8RB, RNASEL, and NOS2 genes were associated with biliary stones, while VEGF variants were associated with gallbladder cancer. Of the 10 genes with multiple SNPs from which we inferred haplotypes, only one IL8RB haplotype, consisting of 3 SNPs (rs2230054, rs1126579, rs1126580), was associated with the risk of bile duct cancer (p=0.003) and biliary stones (p=0.02), relative to the most frequent haplotype. In summary, common variants in genes that influence inflammatory responses may predispose to gallstones and biliary tract cancer, suggesting the need for future studies into the immunologic and inflammatory pathways that contribute to biliary diseases, including cancer.

Hsing, Ann W.; Sakoda, Lori C.; Rashid, Asif; Andreotti, Gabriella; Chen, Jinbo; Wang, Bin-Shen; Shen, Ming-Chang; Chen, Bingshu E.; Rosenberg, Philip S.; Zhang, Mingdong; Niwa, Shelley; Chu, Lisa; Welch, Robert; Yeager, Meredith; Fraumeni, Joseph F.; Gao, Yu-Tang; Chanock, Stephen J.

2010-01-01

237

Unilateral versus bilateral endoscopic biliary stenting for malignant hilar biliary strictures.  

PubMed

The present review compared unilateral versus bilateral stenting in order to determine the optimal stenting strategy for malignant hilar biliary strictures based on the previous literature. The role of preoperative biliary drainage prior to liver resection for hilar cholangiocarcinoma remains under discussion. However, in Japan, endoscopic placement of single nasobiliary drainage in the future remnant hepatic lobe is currently considered the most suitable method. In most unresectable cases, unilateral stenting appears to be adequate for ameliorating jaundice. It is technically easier and less expensive than bilateral stenting, with reintervention for stent dysfunction also being considerably easier. However, contrast medium injection into undrained bile ducts is associated with uncontrolled cholangitis and poor prognosis. To prevent this complication, bilateral stenting may be preferred to unilateral stenting. Additionally, previous studies have demonstrated bilateral stenting to be associated with longer stent patency as compared to unilateral stenting. We consider that further large-scale studies are required to clarify whether unilateral or bilateral stenting is a better therapeutic technique for malignant hilar biliary stricture. PMID:23617655

Yasuda, Ichiro; Mukai, Tsuyoshi; Moriwaki, Hisataka

2013-05-01

238

Cardiomyopathy, familial dilated  

Microsoft Academic Search

Dilated cardiomyopathy (DCM) is a heart muscle disease characterized by ventricular dilatation and impaired systolic function. Patients with DCM suffer from heart failure, arrhythmia, and are at risk of premature death. DCM has a prevalence of one case out of 2500 individuals with an incidence of 7\\/100,000\\/year (but may be under diagnosed). In many cases the disease is inherited and

Matthew RG Taylor; Elisa Carniel; Luisa Mestroni

2006-01-01

239

Azimuthal variation of dilatancy  

Microsoft Academic Search

In triaxial laboratory tests, variation of circumferential strain in dilatant granite may reach 100% or more at high stresses. Pseudoelastic compliances s13 and s23 in the plane perpendicular to the maximum stress may differ by a factor of 2-10. Given the magnitude of these differences, in situ azimuthal variation of dilatancy should be the observed rule rather that the exception.

Kate Hadley

1975-01-01

240

Facts and fallacies of common bile duct obstruction by pancreatic pseudocysts.  

PubMed Central

Although it is commonly accepted that pancreatic pseudocysts can cause obstruction of the common bile duct, few documented examples of this phenomenon exist. Most cases of obstructive jaundice associated with pseudocysts appear to be due to fibrotic stricture of the intrapancreatic portion of the common bile duct, rather than to pressure on the duct by the pseudocyst. We report three additional cases, in two of which fibrosis and not the pseudocyst caused the biliary obstruction. This experience illustrates the imperative to perform intraoperative cholangiography after drainage of the pseudocyst and the necessity of a biliary-enteric bypass if bile duct obstruction has not been relieved by simple decompression of the pseudocyst. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7.

Warshaw, A L; Rattner, D W

1980-01-01

241

Evalutaion of the Gender Differences in 4,4'-Methylenedianiline Toxicity, Distribution, and Effects on Biliary Parameters  

Microsoft Academic Search

Exposure to 4,4'-diaminodiphenylmethane (DAPM) has been linked to jaundice, toxic hepatitis, cholangitis, and cholestasis. In rodents, DAPM initially injures biliary epithelial cells, and toxicity is greater in female than male rats. Our goal was to determine if gender differences in DAPM toxicity were due to differences in biliary excretion or covalent binding of DAPM metabolites in the liver. Bile duct-cannulated

Tammy R. Dugas; Vicente Santa Cruz; Hanlin Liu; Mary F. Kanz

2001-01-01

242

B cell deficient mice are protected from biliary obstruction in the rotavirus-induced mouse model of biliary atresia.  

PubMed

A leading theory regarding the pathogenesis of biliary atresia (BA) is that bile duct injury is initiated by a virus infection, followed by an autoimmune response targeting bile ducts. In experimental models of autoimmune diseases, B cells have been shown to play an important role. The aim of this study was to determine the role of B cells in the development of biliary obstruction in the Rhesus rotavirus (RRV)-induced mouse model of BA. Wild-type (WT) and B cell-deficient (Ig-?(-/-)) mice received RRV shortly after birth. Ig-?(-/-) RRV-infected mice had significantly increased disease-free survival rate compared to WT RRV-infected BA mice (76.8% vs. 17.5%). In stark contrast to the RRV-infected BA mice, the RRV-infected Ig-?(-/-) mice did not have hyperbilirubinemia or bile duct obstruction. The RRV-infected Ig-?(-/-) mice had significantly less liver inflammation and Th1 cytokine production compared to RRV-infected WT mice. In addition, Ig-?(-/-) mice had significantly increased numbers of regulatory T cells (Tregs) at baseline and after RRV infection compared to WT mice. However, depletion of Tregs in Ig-?(-/-) mice did not induce biliary obstruction, indicating that the expanded Tregs in the Ig-?(-/-) mice were not the sole reason for protection from disease. Conclusion : B cell deficient Ig-?(-/-) mice are protected from biliary obstruction in the RRV-induced mouse model of BA, indicating a primary role of B cells in mediating disease pathology. The mechanism of protection may involve lack of B cell antigen presentation, which impairs T-cell activation and Th1 inflammation. Immune modulators that inhibit B cell function may be a new strategy for treatment of BA. PMID:23991203

Feldman, Amy G; Tucker, Rebecca M; Fenner, Erika K; Pelanda, Roberta; Mack, Cara L

2013-08-21

243

Long-term efficacy and safety of endotherapy for management of biliary anastamotic strictures following liver transplantation  

Microsoft Academic Search

IntroductionBiliary anastomotic strictures are among the commonest biliary complications following liver transplantation. Endoscopic therapy including balloon dilatation of stricture and maximal stent placement, is widely used as the preferred means of managing these patients.12 However, endoscopic therapy is not standardized and there is very limited prospective data to support the long-term efficacy of this approach. The aim of our study

S Putta; V Sagar; B Gunson; G Haydon; D Freshwater; A Holt; S Pathmakanthan; J Ferguson

2011-01-01

244

Hedgehog Activity, Epithelial-Mesenchymal Transitions, and Biliary Dysmorphogenesis in Biliary Atresia  

PubMed Central

Background Biliary Atresia (BA) is notable for marked ductular reaction and rapid development of fibrosis. Activation of the Hedgehog (Hh) pathway promotes the expansion of populations of immature epithelial cells that co-express mesenchymal markers and may be pro-fibrogenic. We examined the hypothesis that in BA excessive Hh activation impedes ductular morphogenesis and enhances fibrogenesis by promoting accumulation of immature ductular cells with a mesenchymal phenotype. Methods Livers and remnant extrahepatic ducts from BA patients were evaluated by QRT-PCR and immunostaining for Hh ligands, target genes, and markers of mesenchymal cells or ductular progenitors. Findings were compared to children with genetic cholestatic disease, age-matched deceased donor controls, and adult controls. Ductular cells isolated from adult rats with and without bile duct ligation were incubated with Hh ligand-enriched medium ± Hh-neutralizing antibody to determine direct effects of Hh ligands on EMT marker expression. Results Livers from pediatric controls showed greater innate Hh activation than adult controls. In children with BA, both intra- and extra-hepatic ductular cells demonstrated striking up-regulation of Hh ligand production, and increased expression of Hh target genes. Excessive accumulation of Hh-producing cells and Hh-responsive cells also occurred in other infantile cholestatic diseases. Further analysis of the BA samples demonstrated that immature ductular cells with a mesenchymal phenotype were Hh-responsive. Treating immature ductular cells with Hh ligand-enriched medium induced mesenchymal genes; neutralizing Hh ligands inhibited this. Conclusions BA is characterized by excessive Hh pathway activity, which stimulates biliary EMT and may contribute to biliary dysmorphogenesis. Other cholestatic diseases show similar activation, suggesting this is a common response to cholestatic injury in infancy.

Omenetti, Alessia; Bass, Lee M; Anders, Robert A.; Clemente, Maria G; Francis, Heather; Guy, Cinthya D; McCall, Shannon; Choi, Steve S; Alpini, Gianfranco; Schwarz, Kathleen B; Diehl, Anna Mae; Whitington, Peter F

2011-01-01

245

A new xenobiotic-induced mouse model of sclerosing cholangitis and biliary fibrosis.  

PubMed

Xenobiotics and drugs may lead to cholangiopathies and biliary fibrosis, but the underlying mechanisms are largely unknown. Therefore, we aimed to characterize the cause and consequences of hepatobiliary injury and biliary fibrosis in 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC)-fed mice as a novel model of xenobiotic-induced cholangiopathy. Liver morphology, markers of inflammation, cell proliferation, fibrosis, bile formation, biliary porphyrin secretion, and hepatobiliary transporter expression were studied longitudinally in DDC- and control diet-fed Swiss albino mice. DDC feeding led to increased biliary porphyrin secretion and induction of vascular cell adhesion molecule, osteopontin, and tumor necrosis factor-alpha expression in bile duct epithelial cells. This was associated with a pronounced pericholangitis with a significantly increased number of CD11b-positive cells, ductular reaction, and activation of periductal myofibroblasts, leading to large duct disease and a biliary type of liver fibrosis. After 4 weeks, we constantly observed intraductal porphyrin pigment plugs. Glutathione and phospholipid excretion significantly decreased over time. Expression of Ntcp, Oatp4, and Mrp2 was significantly reduced, whereas Bsep expression remained unchanged and adaptive Mrp3 and Mrp4 expression was significantly induced. We demonstrate that DDC feeding in mice leads to i) a reactive phenotype of cholangiocytes and bile duct injury, ii) pericholangitis, periductal fibrosis, ductular reaction, and consequently portal-portal bridging, iii) down-regulation of Mrp2 and impaired glutathione excretion, and iv) segmental bile duct obstruction. This model may be valuable to investigate the mechanisms of xenobiotic-induced chronic cholangiopathies and its sequels including biliary fibrosis. PMID:17600122

Fickert, Peter; Stöger, Ulrike; Fuchsbichler, Andrea; Moustafa, Tarek; Marschall, Hanns-Ulrich; Weiglein, Andreas H; Tsybrovskyy, Oleksiy; Jaeschke, Hartmut; Zatloukal, Kurt; Denk, Helmut; Trauner, Michael

2007-06-28

246

Endoscopy and biliary parasites.  

PubMed

Biliary parasites demand increased awareness among physicians all over the world in view of international travel and migration. Epidemiology, clinical manifestations, diagnosis, and treatment options for a variety of parasites are discussed in this article. Duodenofiberscopes play an important role in the diagnosis and treatment of these parasites. PMID:8903568

Bhargava, D K

1996-01-01

247

Familial dilated cardiomyopathy.  

PubMed

Dilated cardiomyopathy is a disorder affecting heart muscle, characterized by ventricular dilation and reduced systolic function. It represents the most common cause of heart failure. Until recently, dilated cardiomyopathy was considered an exclusively sporadic and idiopathic disease. Now, as defined by the World Health Organization, cardiomyopathy includes not only the idiopathic form, but secondary ones such as ischemic or hypertensive. It is estimated that familial occurrence accounts for 30% of cases of idiopathic dilated cardiomyopathy. The most common mode of inheritance is the autosomal dominant type. The X-linked, autosomal recessive and mitochondrial forms are less common. Different genes or loci are responsible for the cardiac dilatation, and code for sarcomeric, cytoskeleton and nuclear lamina proteins. The molecular interactions of the mutated proteins with factors such as infectious agents or alcohol could explain the variety of presenting signs and symptoms of this type of cardiomyopathy. Recently the European Society of Cardiology published a definition and a protocol for the study of familial dilated cardiomyopathies. Genetic research in the field of dilated cardiomyopathy can increase our understanding of its pathogenesis and lead to new treatment modalities for the disease. PMID:12621922

Martins, Elisabete; Cardoso, José Silva; Abreu-Lima, Cassiano

2002-12-01

248

Cytodiagnosis in the management of extrahepatic biliary stricture.  

PubMed Central

A total of 117 patients presenting with extrahepatic biliary strictures between 1981 and 1989 had 206 cytological examinations of the bile duct or bile (153 non-operative, 53 intraoperative) to establish the presence of malignancy. A final diagnosis of cholangiocarcinoma was made in 88 patients, with 29 patients having benign biliary strictures. The cytological techniques used were fine needle aspiration (n = 102) or brushing (n = 24) of the bile duct, or exfoliative cytology of bile (n = 80). Forty one patients with malignancy had two or more examinations with differing results between samples in 20 cases. The overall sensitivity was 72%. There was only one false positive result, giving a patient predictive value of positive cytology of 98%. Intraoperative cytology was more sensitive than non-operative examination (80% v 42%). Overall, the sensitivity of fine needle aspiration (67%) was greater than that of brush cytology (40%) or exfoliative cytology (30%). No complications were encountered. Cytodiagnosis of extrahepatic biliary strictures is a safe procedure which is not technically demanding, and as it has a high sensitivity and predictive value for positive cytology, cytological confirmation of malignancy should be sought in all clinically and radiologically suspicious cases.

Desa, L A; Akosa, A B; Lazzara, S; Domizio, P; Krausz, T; Benjamin, I S

1991-01-01

249

Laparoscopic cholecystectomy bile duct injuries: more than meets the eye.  

PubMed

Laparoscopic cholecystectomy (LC) has rapidly become standard treatment of symptomatic cholelithiasis. Its advantages are well known, while its risks have not been well defined. The most common major complication of LC is bile duct injury. Over the past year, we have treated six patients for this problem. Injuries included: one partial laceration of the common bile duct; one partial laceration of the common hepatic duct; three complete common hepatic duct transections at the bifurcation, and one clip obstruction of the right hepatic duct. Intraoperative cholangiography was performed in two of six patients. Injury was recognized in these two cases, which were converted to celiotomy for immediate repair. One was repaired primarily; the other required a hepaticojejunostomy. Injuries were not identified at LC in four. Three of the four patients required biliary-enteric reconstruction procedures. With a mean follow-up period of 13 months, four of six patients remain symptomatic. LC does carry a real risk of bile duct injury. Routine intraoperative cholangiography may decrease this risk or at least allow early recognition and repair when it has occurred. Conversion to an open procedure is not a complication of LC but rather a sign of good surgical judgement. Patients not following the routine postoperative course must be evaluated for a possible bile duct injury to prevent the morbidity of delayed diagnosis. PMID:8338285

Rantis, P C; Greenlee, H B; Pickleman, J; Prinz, R A

1993-08-01

250

Absorption of biliary cobalamin in baboons following total gastrectomy  

SciTech Connect

Absorption of radiolabeled cobalamin in baboons was assessed by whole body counting. Retention of biliary cobalamin and an aqueous solution of cyanocobalamin was measured in normal baboons and in baboons after total gastrectomy by using /sup 57/Co-labeled biliary cobalamin and /sup 58/C0-cyanocobalamin, with and without baboon gastric juice containing intrinsic factor. Radiolabeled biliary cobalamin was obtained by intravenous injection of /sup 57/Co-cyanocobalamin in baboons and collection of bile through a cannula placed in the common bile duct. Cobalamin absorption was not completely abolished by gastrectomy and biliary cobalamin was better retained than cyanocobalamin; intrinsic factor enhanced absorption of both forms. After gastrectomy there was steady depletion of liver and serum cobalamin levels, which ceased after a new equilibrium was reached between a progressively diminishing cobalamin loss and the impaired but significant residual level of absorption. These studies in the nonhuman primate provide further information concerning the enterohepatic circulation of cobalamin and suggest that the form of cobalamin in bile may be more readily absorbed than is cyanocobalamin or that bile itself may have an enhancing effect on cobalamin absorption. The data also suggest that physiologically significant amounts of cobalamin may be absorbed in the absence of a gastric source of intrinsic factor.

Green, R.; Jacobsen, D.W.; Van Tonder, S.V.; Kew, M.C.; Metz, J.

1982-11-01

251

Antifibrotic effect of silymarin in rat secondary biliary fibrosis is mediated by downregulation of procollagen ?1(I) and TIMP-1  

Microsoft Academic Search

Background\\/Aims: Silymarin reduces hepatic collagen accumulation by 35% in rats with secondary biliary cirrhosis. The aim of the present study was to explore its antifibrotic mechanism.Methods: Thirty female adult Wistar rats were allocated to (1) bile duct occlusion, (2) bile duct occlusion and oral silymarin at 50 mg\\/kg per day, and (3) sham operation and oral silymarin at 50 mg\\/kg

Ji-Dong Jia; Michael Bauer; Jae Jin Cho; Martin Ruehl; Stefano Milani; Gabriele Boigk; Ernst Otto Riecken; Detlef Schuppan

2001-01-01

252

Transpapillary iridium-192 wire in the treatment of malignant bile duct obstruction  

Microsoft Academic Search

Twenty four patients with malignant bile duct obstruction were treated with intraluminal radiotherapy using iridium-192 wire inserted through an endoscopically placed nasobiliary catheter. Biliary drainage after treatment was maintained by an endoprosthesis. The median dose of intraluminal radiotherapy was 6000 cGy; two patients with cholangiocarcinoma were given a second course because of disease extension; four patients with pancreatic carcinoma received

M D Levitt; B H Laurence; F Cameron; P F Klemp

1988-01-01

253

A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct  

Microsoft Academic Search

Background: Although metallic stents remain patent longer than plastic stents, the optimal palliation of inoperable malignant biliary strictures remains controversial because of the high cost of metallic stents and short patient survival. Methods: A total of 101 patients (mean age 72.5 ± 12.9 years) with malignant strictures of the common bile duct were included in this study, after three exclusions for

Frederic Prat; Olivier Chapat; Beatrice Ducot; Thierry Ponchon; Gilles Pelletier; Jacques Fritsch; Andre Daniel Choury; Catherine Buffet

1998-01-01

254

Blunt Left Extrahepatic Bile Duct Injury: Case Report and Literature Review  

Microsoft Academic Search

Background: Extrahepatic biliary tract injuries following blunt abdominal trauma are very rare and pose a diagnostic and therapeutic challenge. Case Report: We report a case of blunt liver injury with left extrahepatic duct transection following a motor vehicle collision. Technetium 99m dimethyliminodiacetic acid scan confirmed a bile leak and endoscopic retrograde cholangiopancreatography (ERCP) diagnosed the injury of the left extrahepatic

Charles de Mestral; Tarek Razek; Kosar Khwaja; Paola Fata

2008-01-01

255

Primary Biliary Cirrhosis  

Microsoft Academic Search

\\u000a Primary biliary cirrhosis (PBC) is a chronic cholestatic inflammatory iver disease most commonly seen in middle—aged women.\\u000a The cause is unknown but there is much evidence to support an autoimmune process, notably the strong (AMA).The disease has\\u000a an association with the anti-mitochondrial antibodies insidious onset and patients with very early disease are usually only\\u000a recognized,or elevated levels of serum alkaline

D. E. J. Jones; W. L. Gregory; M. F. Bassendine

256

Primary biliary cirrhosis  

Microsoft Academic Search

Primary biliary cirrhosis (PBC) is a chronic, progressive cholestatic liver disease, which is invariably fatal. Circumstantial\\u000a and indirect evidence suggests that autoimmune mechanisms have a role in the pathogenesis of PBC. Antimitochondrial antibodies\\u000a (AMA) are highly sensitive and specific markers that can predict the development of the disease in a healthy individual. Long-term\\u000a administration of ursodeoxycholic acid (UDCA), a naturally

Yaron Bar-Dayan; M. Eric Gershwin; Yair Levi; Howard Amital; Yehuda Shoenfeld

1998-01-01

257

Improved biliary detection and diagnosis through intelligent machine analysis.  

PubMed

This paper reports on work undertaken to improve automated detection of bile ducts in magnetic resonance cholangiopancreatography (MRCP) images, with the objective of conducting preliminary classification of the images for diagnosis. The proposed I-BDeDIMA (Improved Biliary Detection and Diagnosis through Intelligent Machine Analysis) scheme is a multi-stage framework consisting of successive phases of image normalization, denoising, structure identification, object labeling, feature selection and disease classification. A combination of multiresolution wavelet, dynamic intensity thresholding, segment-based region growing, region elimination, statistical analysis and neural networks, is used in this framework to achieve good structure detection and preliminary diagnosis. Tests conducted on over 200 clinical images with known diagnosis have shown promising results of over 90% accuracy. The scheme outperforms related work in the literature, making it a viable framework for computer-aided diagnosis of biliary diseases. PMID:21194781

Logeswaran, Rajasvaran

2010-12-30

258

A novel duct-lobular segmentectomy for breast tumors with nipple discharge using near-infrared indocyanine green fluorescence imaging.  

PubMed

A 44-year-old woman was referred to our hospital with pathological nipple discharge from her left breast. Ultrasonography revealed a solid tumor beneath her left areola that measured 17 mm in diameter with a dilated mammary duct. Contrast-enhanced magnetic resonance imaging showed an early-enhanced cystic tumor and a dilated mammary duct. We performed a duct-lobular segmentectomy using near-infrared indocyanine green (ICG)-fluorescence imaging. Under general anesthesia, a silicone tube was inserted into an orifice of a fluid-discharging mammary duct, and 1 mL dye-fluorescence liquid containing ICG and indigo carmine was injected into the mammary duct. A periareolar incision was made, and the fluorescence image of the demarcated mammary duct segment was obtained. The mammary duct segment was dissected, along with the demarcation line. The cystic lesion and dilated mammary duct were fully resected, and the pathological diagnosis was intraductal papilloma of the breast. We report that near-infrared ICG fluorescence could be applied for imaging of the mammary duct segment, and the fluorescence image allowed for easier duct-lobular segmentectomy for nipple discharge. PMID:24054757

Ohno, Tsuyoshi; Inoue, Keiji; Nagayoshi, Shigeki; Fukuda, Toshio; Irie, Junji

2012-09-27

259

Claudin-1, -2, -3, -4, -7, -8, and -10 Protein Expression in Biliary Tract Cancers  

PubMed Central

Biliary tract cancers are relatively common malignant gastrointestinal tumors in the elderly. Claudins are integral components of tight junctions that play important roles in maintaining epithelial cell polarity, controlling paracellular diffusion, and regulating cell growth and differentiation. The expression profile of claudins has been extensively characterized, but few reports exist on their expression in the normal and neoplastic biliary tract. Our aim was therefore to study claudins by IHC reactions in normal and neoplastic biliary tract samples. We detected that claudin expressions differ in the normal sample groups: the normal gallbladder strongly expressed claudin-2, -3, -4, and -10, but only weak reactions were seen in normal intrahepatic bile ducts. Although each cancer type expressed several claudins with various intensities, only claudin-4 presented especially strong immunoreactions in extrahepatic bile duct cancers and gallbladder carcinomas, whereas claudin-1 and -10 presented in intrahepatic bile duct cancers. Comparing the normal and carcinoma groups, the most significant decrease was detected in the expression of claudin-10. In conclusion, the expression pattern of claudins is different in the various parts of the normal and neoplastic biliary tract; moreover, an unequivocal decrease was detected in the carcinomas compared with their corresponding normal samples. This manuscript contains online supplemental material at http://www.jhc.org. Please visit this article online to view these materials. (J Histochem Cytochem 57:113–121, 2009)

Nemeth, Zsuzsanna; Szasz, Attila Marcell; Tatrai, Peter; Nemeth, Julia; Gyorffy, Hajnalka; Somoracz, Aron; Szijarto, Attila; Kupcsulik, Peter; Kiss, Andras; Schaff, Zsuzsa

2009-01-01

260

Pancreatic and biliary secretion are both altered in cystic fibrosis pigs.  

PubMed

The pancreas, liver, and gallbladder are commonly involved in cystic fibrosis (CF), and acidic, dehydrated, and protein-rich secretions are characteristic findings. Pancreatic function studies in humans have been done by sampling the jejunal fluid. However, it has been difficult to separately study the function of pancreatic and biliary systems in humans with CF, because jejunal fluid contains a mixture of bile and pancreatic fluids. In contrast, pancreatic and biliary ducts open separately into the porcine intestine; therefore, biliary and pancreatic fluid can be individually analyzed in CF pigs. We studied newborn wild-type (WT) and CF pigs and found that CFTR was localized to the pancreatic ducts. We collected bile and pancreatic fluid and analyzed pancreatic enzymes with activity assays and immunoblot. Pancreatic enzyme expression was significantly decreased in CF compared with WT pigs. The volume and pH of pancreatic fluid were significantly lower and protein concentration was >5-fold higher in CF pigs. Secretin stimulation increased pancreatic fluid volume and pH in WT, but not CF, pigs. Baseline bile volume did not differ between WT and CF pigs, but volume did not increase in response to secretin in CF pigs. Bile pH was lower and protein concentration was twofold higher in CF pigs. These results indicate that pancreatic and biliary secretions are altered in CF pigs. Abnormal pancreatic and biliary secretion in CF may have important implications in disease pathogenesis. PMID:22936270

Uc, Aliye; Giriyappa, Radhamma; Meyerholz, David K; Griffin, Michelle; Ostedgaard, Lynda S; Tang, Xiao Xiao; Abu-El-Haija, Marwa; Stoltz, David A; Ludwig, Paula; Pezzulo, Alejandro; Abu-El-Haija, Maisam; Taft, Peter; Welsh, Michael J

2012-08-30

261

Intraoperative placement of transparietohepatic biliary drainage in remedial hepaticojejunostomy: technique and clinical experience.  

PubMed

Remedial biliary surgery most often entails a Roux-en-Y hepaticojejunostomy. Sometimes the duct wall at the porta hepatis has been so damaged by inflammatory changes that the postoperative external drainage of bile away from a biliodigestive suture at risk of dehiscence is advisable. A technique of intraoperative placement of transparietohepatic biliary drainage was devised. The maneuver implies retrograde cannulation of a major intrahepatic duct with a vascular irrigation needle that is pushed to create the transhepatic path. Of 220 remedial hepaticojejunostomies performed in 211 patients (including 151 liver transplant recipients), the technique was applied in 49 (22%) of the most difficult cases in which the preoperative radiologic approach to the biliary tree had failed, was unsafe, or was unfeasible. The only major complication was a parenchymal tear needing perihepatic packing when the maneuver was performed too early after liver transplantation. Postoperative biliary fistula occurred in 2 patients (4%) and access to the biliary tract for percutaneous bilioplasty was provided in the short-term follow-up evaluation of 14 patients (29%). PMID:18361928

Salizzoni, Mauro; Romagnoli, Renato; Mirabella, Stefano; Paraluppi, Gianluca; Franchello, Alessandro; Lupo, Francesco

2008-04-01

262

Pancreatic and biliary secretion are both altered in cystic fibrosis pigs  

PubMed Central

The pancreas, liver, and gallbladder are commonly involved in cystic fibrosis (CF), and acidic, dehydrated, and protein-rich secretions are characteristic findings. Pancreatic function studies in humans have been done by sampling the jejunal fluid. However, it has been difficult to separately study the function of pancreatic and biliary systems in humans with CF, because jejunal fluid contains a mixture of bile and pancreatic fluids. In contrast, pancreatic and biliary ducts open separately into the porcine intestine; therefore, biliary and pancreatic fluid can be individually analyzed in CF pigs. We studied newborn wild-type (WT) and CF pigs and found that CFTR was localized to the pancreatic ducts. We collected bile and pancreatic fluid and analyzed pancreatic enzymes with activity assays and immunoblot. Pancreatic enzyme expression was significantly decreased in CF compared with WT pigs. The volume and pH of pancreatic fluid were significantly lower and protein concentration was >5-fold higher in CF pigs. Secretin stimulation increased pancreatic fluid volume and pH in WT, but not CF, pigs. Baseline bile volume did not differ between WT and CF pigs, but volume did not increase in response to secretin in CF pigs. Bile pH was lower and protein concentration was twofold higher in CF pigs. These results indicate that pancreatic and biliary secretions are altered in CF pigs. Abnormal pancreatic and biliary secretion in CF may have important implications in disease pathogenesis.

Giriyappa, Radhamma; Meyerholz, David K.; Griffin, Michelle; Ostedgaard, Lynda S.; Tang, Xiao Xiao; Abu-El-Haija, Marwa; Stoltz, David A.; Ludwig, Paula; Pezzulo, Alejandro; Abu-El-Haija, Maisam; Taft, Peter; Welsh, Michael J.

2012-01-01

263

Complement and Dilated Cardiomyopathy  

PubMed Central

Dilated cardiomyopathy is a syndrome characterized by cardiac enlargement and impaired systolic function of the heart. Tumor necrosis factor (TNF)-?, a pleiotropic cytokine, seems to play a central role in the progression of dilated cardiomyopathy. Recent data suggest that ongoing inflammation in the myocardium may, in many cases, contribute to the development of disease. Chronic generation of autoantibodies to myocardial antigens or, in some cases, viral infection are pathobiologically involved. Although both antibodies and some viruses activate the complement system, the role of innate immunity in dilated cardiomyopathy has as yet not been investigated systematically. In this study we demonstrate by analysis of myocardial biopsies from 28 patients that C5b-9, the terminal membrane attack complex of complement, accumulates in human myocardium in dilated cardiomyopathy. C5b-9 significantly correlates with immunoglobulin deposition and myocardial expression of TNF-?. In vitro, C5b-9 attack on cardiac myocytes induces nuclear factor (NF)-?B activation as well as transcription, synthesis, and secretion of TNF-?. We conclude that chronic immunoglobulin-mediated complement activation in the myocardium may contribute in part to the progression of dilated cardiomyopathy via C5b-9-induced TNF-? expression in cardiac myocytes.

Zwaka, Thomas P.; Manolov, Dimitar; Ozdemir, Cuneyt; Marx, Nikolaus; Kaya, Ziya; Kochs, Matthias; Hoher, Martin; Hombach, Vinzenz; Torzewski, Jan

2002-01-01

264

Management of major bile duct injury after laparoscopic cholecystectomy: a case report  

PubMed Central

Introduction Bile duct injury is a severe and potentially life-threatening complication of laparoscopic cholecystectomy. Several series have described a 0.5% to 0.6% incidence of bile duct injury during laparoscopic cholecystectomy. The aim of this study was to analyze the presentation, characteristics, related investigation, and treatment results of major bile duct injuries after laparoscopic cholecystectomy. Case presentation A rare case of a 48-year-old Greek woman with a triple bile duct injury (right and left hepatic duct ligation and common bile duct cross-section) is presented. A Roux en Y hepaticojejunostomy was performed after repeated endoscopic retrograde cholangiopancreatographies, percutaneous transhepatic catheterization of the ducts and magnetic resonance cholangiographies to delineate the biliary anatomy and assess the level of injury. Conclusion Early recognition and an adequate multidisciplinary approach are the cornerstones for the optimal final outcome. Suboptimal management of injuries often leads to more extensive damage to the biliary tree and its vasculature. Early referral to a tertiary care center with experienced hepatobiliary surgeons and skilled interventional radiologists would appear to be necessary to assure optimal results.

2009-01-01

265

Interleukin-32 production associated with biliary innate immunity and proinflammatory cytokines contributes to the pathogenesis of cholangitis in biliary atresia.  

PubMed

Biliary atresia (BA) is thought to be associated with infections by viruses such as Reoviridae and is characterized histologically by fibrosclerosing cholangitis with proinflammatory cytokine-mediated inflammation. Interleukin (IL)-32 affects the continuous inflammation by increasing the production of proinflammatory cytokines. In this study, the role of IL-32 in the cholangitis of BA was examined. Immunohistochemistry for IL-32 and caspase 1 was performed using 21 samples of extrahepatic bile ducts resected from BA patients. Moreover, using cultured human biliary epithelial cells (BECs), the expression of IL-32 and its induction on stimulation with a Toll-like receptor [(TLR)-3 ligand (poly(I:C)] and proinflammatory cytokines was examined. BECs composing extrahepatic bile ducts showing cholangitis expressed IL-32 in BA, but not in controls. Caspase 1 was expressed constantly on BECs of both BA and control subjects. Furthermore, poly(I:C) and proinflammatory cytokines [(IL-1?, interferon (IFN)-? and tumour necrosis factor (TNF)-?] induced IL-32 expression strongly in cultured BECs, accompanying the constant expression of TLR-3 and caspase 1. Our results imply that the expression of IL-32 in BECs was found in the damaged bile ducts of BA and induced by biliary innate immunity via TLR-3 and proinflammatory cytokines. These findings suggest that IL-32 is involved initially in the pathogenic mechanisms of cholangitis in BA and also plays an important role in the amplification and continuance of periductal inflammatory reactions. It is therefore tempting to speculate that inhibitors of IL-32 could be useful for attenuating cholangitis in BA. PMID:23607494

Okamura, A; Harada, K; Nio, M; Nakanuma, Y

2013-08-01

266

Biliary cirrhosis caused by Campula spp. in a dolphin and four porpoises.  

PubMed

Biliary cirrhosis produced by Campula spp. is described in 1 striped dolphin Stenella coeruleoalba and 4 harbour porpoises Phocoena phocoena. The hepatic lesions consisted of severe proliferation of fibrous connective tissue with loss of the lobular pattern, nodular regeneration of the hepatic tissue, bile duct hyperplasia and severe inflammatory infiltrate composed of eosinophils, macrophages, lymphocytes and plasma cells. These lesions were associated with severe infestation by Campula spp. Although inflammatory and degenerative hepatic lesions are frequently found in stranded dolphins, biliary cirrhosis has not been previously reported in cetaceans. Massive infestation by these parasites should be included as a cause of hepatic failure resulting in stranding of marine mammals. PMID:24062555

Jaber, J R; Pérez, J; Rotstein, D; Zafra, R; Herráez, P; Carrascosa, C; Fernández, A

2013-09-24

267

Tamoxifen decreases the myofibroblast count in the healing bile duct tissue of pigs  

PubMed Central

OBJECTIVE: The aim of this study was to evaluate the effect of oral tamoxifen treatment on the number of myofibroblasts present during the healing process after experimental bile duct injury. METHODS: The sample consisted of 16 pigs that were divided into two groups (the control and study groups). Incisions and suturing of the bile ducts were performed in the two groups. Tamoxifen (20 mg/day) was administered only to the study group. The animals were sacrificed after 30 days. Quantification of myofibroblasts in the biliary ducts was made through immunohistochemistry analysis using anti-alpha smooth muscle actin of the smooth muscle antibody. Immunohistochemical quantification was performed using a digital image system. RESULTS: In the animals treated with tamoxifen (20 mg/day), there was a significant reduction in immunostaining for alpha smooth muscle actin compared with the control group (0.1155 vs. 0.2021, p?=?0.046). CONCLUSION: Tamoxifen reduced the expression of alpha smooth muscle actin in the healing tissue after bile duct injury, suggesting a decrease in myofibroblasts in the scarred area of the pig biliary tract. These data suggest that tamoxifen could be used in the prevention of biliary tract stenosis after bile duct surgeries.

Siqueira, Orlando Hiroshi Kiono; Filho, Benedito Herani; de Paula, Rafael Erthal; Ascoli, Fabio Otero; da Nobrega, Antonio Claudio Lucas; Carvalho, Angela Cristina Gouvea; Pires, Andrea Rodrigues Cordovil; Gaglionone, Nicolle Cavalcante; Cunha, Karin Soares Goncalves; Granjeiro, Jose Mauro

2013-01-01

268

Notch signaling regulates tubular morphogenesis during repair from biliary damage in mice  

PubMed Central

Background & Aims Repair from biliary damages requires the biliary specification of hepatic progenitor cells and the remodeling of ductular reactive structures into branching biliary tubules. We hypothesized that the morphogenetic role of Notch signaling is maintained during the repair process and have addressed this hypothesis using pharmacologic and genetic models of defective Notch signaling. Methods Treatment with DDC (3,5-diethoxycarbonyl-1,4-dihydrocollidine) or ANIT (alpha-naphthyl-isothiocyanate) was used to induce biliary damage in wild type mice and in mice with a liver specific defect in the Notch-2 receptor (Notch-2-cKO) or in RPB-Jk. Hepatic progenitor cells, ductular reaction, and mature ductules were quantified using K19 and SOX-9. Results In DDC treated wild type mice, pharmacologic Notch inhibition with dibenzazepine decreased the number of both ductular reaction and hepatic progenitor cells. Notch-2-cKO mice treated with DDC or ANIT accumulated hepatic progenitor cells that failed to progress into mature ducts. In RBP-Jk-cKO mice, mature ducts and hepatic progenitor cells were both significantly reduced with respect to similarly treated wild type mice. The mouse progenitor cell line BMOL cultured on matrigel, formed a tubular network allowing the study of tubule formation in vitro; ?-secretase inhibitor treatment and siRNAs silencing of Notch-1, Notch-2 or Jagged-1 significantly reduced both the length and number of tubular branches. Conclusions These data demonstrate that Notch signaling plays an essential role in biliary repair. Lack of Notch-2 prevents biliary tubule formation, both in vivo and in vitro. Lack of RBP-Jk inhibits the generation of biliary-committed precursors and tubule formation.

Fiorotto, Romina; Raizner, Aileen; Morell, Carola M.; Torsello, Barbara; Scirpo, Roberto; Fabris, Luca; Spirli, Carlo; Strazzabosco, Mario

2013-01-01

269

Continuous controllable balloon dilation: a novel approach for cervix dilation  

PubMed Central

Background Cervical dilation using mechanical dilators is associated with various complications, such as uterine perforation, cervical laceration, infections and intraperitoneal hemorrhage. To achieve safe and painless cervical dilation, we constructed a new medical device to achieve confident mechanical cervical dilation: a continuous controllable balloon dilator (CCBD). Methods Controlled pumping of incompressible fluid into the CCBD increases the pressure and outer diameter of the CCBD, continuously dilating the cervical canal. The reliability of the CCBD was confirmed in vitro (testing for consistency and endurance, with no detected risk for breakage) and in vivo. A multi-center clinical study was conducted,with 120 pregnant women randomly assigned to one of three groups: Group I,control group, no dilation;Group II,mechanical dilation, Hegar dilator (HeD); and Group III,CCBD. The tissue material for histological evaluation was obtained from the endocervical mucosa before and after dilation using the HeD or CCBD. Results The CCBD dilations were successful and had no complications in all 40 patients of Group III. The cervical tissue was markedly less damaged after CCBD dilation compared with HeD dilation (epithelium damage: 95% (HeD) vs. 45% (CCBD), P <0.001; basal membrane damage: 82.5% (HeD) vs. 27.5% (CCBD), P <0.001; stromal damage: 62.5% (HeD) vs. 37.5% (CCBD), P <0.01). Cervical hemorrhagia was observed in 90% of the patients after HeD dilation versus in 32.5% of the patients after CCBD dilation. Conclusions The CCBD should be used as a replacement for mechanical dilators to prevent uterine and cervical injury during cervical dilation. Trial registration ISRCTN54007498

2012-01-01

270

[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].  

PubMed

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. PMID:23648538

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

271

Computed-tomographic cholangiography: a new technique for evaluating the head of the pancreas and distal biliary tree  

Microsoft Academic Search

Computed-tomographic cholangiography was used to evaluate the abdomen of 97 patients. The gallbladder and\\/or biliary tree was visualized well in 84 patients (87%); the distal common bile duct (CBD) was visualized well in 68 patients (70%). For 26 patients (30%) from the latter group, visualization of the opacified CBD was essential in order to differentiate the pancreatic head from the

M. Greenberg; B. M. Greenberg; J. M. Rubin; I. M. Greenberg

1982-01-01

272

Human leukocyte antigens in Japanese patients with biliary atresia: Retrospective analysis of patients who underwent living donor liver transplantation  

Microsoft Academic Search

Biliary atresia (BA) is a neonatal obstructive cholangiopathy characterized by a fibrosclerosing obliteration of the extrahepatic bile duct. The aim of this study was to investigate the relationship between human leukocyte antigens (HLA) and susceptibility to BA. We retrospectively analyzed 392 Japanese patients with BA and without extrahepatic anomalies who underwent living donor liver transplantations at our institute. Healthy Japanese

Takeshi Yuasa; Hiroaki Tsuji; Shinya Kimura; Norimi Niwa; Kimiko Yurugi; Hiroto Egawa; Koichi Tanaka; Etsuko Maruya; Hiro-o Saji; Hiroaki Asano; Taira Maekawa

2005-01-01

273

Magnetic Resonance Sialography Findings of Submandibular Ducts Imaging  

PubMed Central

Purpose. We aimed to assess the problem solving capability of magnetic resonance sialography (MR sialography), a noninvasive method for imaging submandibular gland ducts and determining duct-related pathologies, by comparing diseased and healthy cases. Materials and Methods. We conducted radiological assessment on a total of 60 submandibular glands (mean age 44.7) in 20 cases and 10 volunteers. MR sialography examinations were conducted with single-shot fast spin-echo sequence by using a surface coil placed on the submandibular gland. Each gland was evaluated in terms of the length, width and stricture of the main duct, as well as the difference between the intraparenchymal duct width, and the main duct width. Statistical analysis was performed. Results. In the MR sialography the primary duct mean length was determined as 51?mm (40–57?mm) in all submandibular glands. On the MR sialography imaging, the visualization ratio of the ductal system of submandibular gland was evaluated in the cases and volunteers. Conclusion. MR sialography is an effective and a noninvasive method in imaging submandibular gland ducts, demonstrating the presence, location and degree of stricture/dilatation, and elucidating the disease etiology.

Karaca Erdogan, Nezahat; Altay, Canan; Ozenler, Nesibe; Bozkurt, Tugba; Uluc, Engin; Dirim Mete, Berna; Ozdemir, Ismail

2013-01-01

274

Incidence and Consequence of an Hepatic Artery Injury in Patients With Postcholecystectomy Bile Duct Strictures  

PubMed Central

Objective: To compare the clinical presentation and results of treatment of postcholecystectomy bile duct injuries in patients with and without arterial injuries. Summary Background Data: Incidence and impact of arterial injuries in patients with a postcholecystectomy biliary injury are unknown, although they are claimed to increase the risk of septic complications, difficulty of biliary repair and risk of recurrent stricture. Methods: Fifty-five patients referred for postcholecystectomy biliary strictures and who underwent surgical repair were prospectively evaluated by celiac and superior mesenteric angiography. Circumstance and presenting symptoms of the biliary injury in patients with and without vascular injury as well as intra- and postoperative outcome in the 43 patients who underwent a Hepp–Couinaud biliary repair were compared. Results: Incidence of vascular injury was 47%, the most frequent of which was right-sided hepatic artery disruptions (36%). Indication of cholecystectomy (cholecystitis, 42 vs. 45%), technique of resection (laparoscopy, 80 vs. 79%) as well as delay of recognition and presenting symptom of the biliary injury were comparable in patients with and without vascular injury. Among patients undergoing a biliary repair, the level of the biliary injury (Bismuth’s type III or IV 63% vs. 54%), duration of surgery, and incidence of postoperative complications (21 vs. 21%) were also comparable in patients with and without arterial injury. One patient in each group experienced recurrent biliary stricture. Conclusions: The discovery of a disruption of the right branch of the hepatic artery should not affect management of the biliary stricture when if a Hepp–Couinaud repair is performed.

Alves, Arnaud; Farges, Olivier; Nicolet, Jerome; Watrin, Thierry; Sauvanet, Alain; Belghiti, Jacques

2003-01-01

275

S100 protein positive dendritic cells in primary biliary cirrhosis and other chronic inflammatory liver diseases. Relevance to pathogenesis?  

PubMed Central

A study to determine the location of dendritic cells, in chronic inflammatory liver disease was performed. S100 protein positivity and dendritic cytoplasmic morphology were used to identify dendritic cells. S100 protein positive dendritic cells (S100 + DC) were found inside the basement membrane between biliary epithelial cells of septal bile ducts of livers affected by early stage PBC, but were not present at later stages. S100 + DC also were seen in areas of piecemeal necrosis in chronic active hepatitis of various etiologies. In contrast, intra-epithelial S100 + DC were not found with any consistency in sclerosing cholangitis, secondary biliary cirrhosis, extrahepatic biliary atresia, or chronic liver allograft rejection, all of which are characterized by inflammatory bile duct damage. The possible relevance of DC in the pathogenesis of PBC is discussed. Images Figure 1 Figure 2 Figure 3 Figure 4

Demetris, A. J.; Sever, C.; Kakizoe, S.; Oguma, S.; Starzl, T. E.; Jaffe, R.

1989-01-01

276

Reconstruction of the portal vein with 64-slice spiral CT of bile duct obstruction  

PubMed Central

The aim of this study was to evaluate 64-slice spiral CT image reconstruction of the portal vein in biliary obstruction. A total of 34 clinical patients with biliary obstruction were confirmed by 64-slice spiral CT scanning with portal venous phase multi-planar reconstruction (MPR) of the biliary tract, curved planar reconstruction (CPR), thin-slab minimum-intensity projection (TS-MinIP) and maximum intensity projection (MIP). The reconstructed images were reviewed to further assess the position and cause of the biliary obstruction and to judge the accuracy of diagnosis. The 64-slice spiral CT image reconstruction of the biliary obstructions determined the causes with an accuracy of 88.2% (30/34) and identified the location of the obstruction with an accuracy of 100%. A 64-slice spiral CT reconstructed image of the portal bile duct lesions was generated, which indicated the lesion morphology, location and anatomical relationship with surrounding tissues, secondary biliary stricture and the degree of expansion and is of great clinical value in the characterization and preoperative evaluation of biliary disease.

XIA, YUNBAO; PAN, GONGMAO; XUE, FENG; GENG, CHENGJUN

2013-01-01

277

Low loss duct burner  

Microsoft Academic Search

A jet propulsion engine with a fan bypass duct includes a duct burner with a plurality of flame stabilizers therein each mounted to inner case and outer case members through spherical bearings. Each of the stabilizers consists of two blade members having integral arms thereon actuated by fore and aft motion of an external actuating ring to assume an expanded

H. M. Mar; S. B. Reider

1985-01-01

278

Familial inflammatory dilated cardiomyopathy  

Microsoft Academic Search

Background: Systematic family screening has recently identified dilated cardiomyopathy as an inherited disorder in up to 30% of cases. Mutations in genes encoding proteins responsible for myocardial architecture have been identified, but additional pathophysiological mechanisms including inflammatory reactions have been proposed. Aims: Identification and characterization of familial DCM, where at least one affected family member fulfils the criteria for inflammatory

Irene Portig; Andreas Wilke; Matthias Freyland; Markus-Joachim Wolf; Anette Richter; Volker Ruppert; Sabine Pankuweit; Bernhard Maisch

2006-01-01

279

Liver Stem\\/Progenitor Cells in the Canals of Hering: Cellular Origin of Hepatocellular Carcinoma with Bile Duct Tumor Thrombi?  

Microsoft Academic Search

It is generally believed that the invasion of hepatocellular carcinoma (HCC) into the biliary tree ultimately leads to the\\u000a formation of bile duct tumor thrombi (BDTT). However, recent studies revealed that primary tumor might be small, even undetectable,\\u000a and there was no histopathologic evidence of direct tumor invasion into bile duct wall in some patients. During the last decade,\\u000a efforts

Ningfu Peng; Lequn Li; Xiang Cai; Shaozao Tan; Ting Wu

2010-01-01

280

Low loss duct burner  

SciTech Connect

A jet propulsion engine with a fan bypass duct includes a duct burner with a plurality of flame stabilizers therein each mounted to inner case and outer case members through spherical bearings. Each of the stabilizers consists of two blade members having integral arms thereon actuated by fore and aft motion of an external actuating ring to assume an expanded position to increase duct turbulence for mixing air flow therethrough with a fuel supply and into a retracted position against each other to reduce pressure drop under nonafterburning operation. Each of the flame stabilizer blades has a platform that controls communication between a hot air source and a duct for improving fuel vaporization during afterburner operation thereby to increase afterburning limits; the platforms close communication between the hot air source and the duct during nonafterburning operation when flame stabilization is not required.

Mar, H. M.; Reider, S. B.

1985-07-09

281

Dilatation Effect of ''Quantum Clocks''.  

National Technical Information Service (NTIS)

The relativistic dilatation effect of the life-time of unstable microparticles combined with quantum symmetry of their description results in the ''quantum-dilatation'' dilemma. It is due to the classical character of the relativity theory which here reve...

Z. Chylinski

1981-01-01

282

New perspectives on biliary atresia  

PubMed Central

An investigation into the aetiology, diagnosis, and treatment of biliary atresia was carried out because the prognosis remains so poor. In an electron microscopical study no viral particles or viral inclusion bodies were seen, nor were any specific ultrastructural features observed. An animal experiment suggested that obstruction within the biliary tract of newborn rabbits could be produced by maternal intravenous injection of the bile acid lithocholic acid. A simple and atraumatic method of diagnosis was developed using99mTc-labelled compounds which are excreted into bile. Two compounds, 99mTc—pyridoxylidene glutamate (99mTc—PG) and 99mTc—dihydrothioctic acid (99mTc—DHT) were first assessed in normal piglets and piglets with complete biliary obstruction. Intestinal imaging correlated with biliary tract patency, and the same correlation was found in jaundiced human adults, in whom the 99mTc—PG scan correctly determined biliary patency in 21 out of 24 cases. The 99mTc—PG scan compared well with liver biopsy and 131I-Rose Bengal in the diagnosis of 11 infants with prolonged jaundice. A model of extrahepatic biliary atresia was developed in the newborn piglet so that different methods of bile drainage could be assessed. Priorities in biliary atresia lie in a better understanding of the aetiology and early diagnosis rather than in devising new bile drainage procedures. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6

Jenner, R E

1978-01-01

283

Effector role of neonatal hepatic CD8+ lymphocytes in epithelial injury and autoimmunity in experimental biliary atresia  

PubMed Central

Background and Aims Lymphocytes populate the livers of infants with biliary atresia, but it is unknown whether neonatal lymphocytes regulate pathogenesis of disease. Here, we investigate this question by examining the role of T lymphocytes in the destruction of extrahepatic bile ducts of neonatal mice using an experimental model of biliary atresia. Methods Inoculation of neonatal mice with rhesus rotavirus followed by multi-staining flow cytometry to quantify expression of Ifng by hepatic lymphocytes, and real-time PCR for mRNA expression of pro-inflammatory cytokines. This was followed by determining the consequences of antibody-mediated depletion of lymphocyte subtypes on the development of biliary obstruction, and co-culture and cell transfer experiments to investigate the effector role of lymphocyte subtypes on neonatal biliary disease. Results Rotavirus infection results in overexpression of Ifng by neonatal hepatic T cells. Among these cells, depletion of CD4+ cells did not change the course of inflammatory injury and obstruction of neonatal bile ducts. In contrast, loss of CD8+ cells remarkably suppressed duct injury, prevented luminal obstruction, and restored bile flow. Co-culture experiments showed that rotavirus-primed, but not naïve, CD8+ cells were cytotoxic to cholangiocytes. In adoptive transfer experiments, we found that primed CD8+ cells preferentially homed to extrahepatic bile ducts of neonatal mice and invaded their epithelial lining. Conclusion Primed neonatal CD8+ cells can activate a proinflammatory program, target diseased and healthy duct epithelium, and drive the phenotypic expression of biliary atresia, thus constituting a potential therapeutic target to halt disease progression.

Shivakumar, Pranavkumar; Sabla, Gregg; Mohanty, Sujit; McNeal, Monica; Ward, Richard; Stringer, Keith; Caldwell, Charles; Chougnet, Claire; Bezerra, Jorge A.

2007-01-01

284

The prelaparotomy diagnosis of extrahepatic biliary atresia.  

PubMed Central

The diagnostic accuracy of laboratory investigations in the prelaparotomy differentiation between extrahepatic biliary atresia (EHBA) and intrahepatic disease (IHD) was assessed in 86 consecutive infants presenting with conjugated hyperbilirubinaemia. Forty five infants had EHBA and 41 IHD. The mean serum bilirubin concentration, gamma-glutamyltranspeptidase (GGT) activity, and the GGT/aspartate transaminase (AST) ratio were appreciably higher in infants with EHBA than in those with IHD. In infants with IHD, however, serum bilirubin concentrations were in the EHBA range in 19 (47%), as were GGT values in 29 (71%), and GGT/AST ratios in 33 (80%). In individual patients neither increasing nor decreasing GGT values were of diagnostic importance. Failure of biliary excretion of 99Tcm-p-Butyl-ida occurred in 29 of 30 (97%) patients with EHBA but also in 22 of 23 (67%) with IHD. In all 5 patients with IHD associated with alpha 1 antitrypsin deficiency these 4 investigations gave results in the EHBA range. Liver biopsy specimen interpretation, correct in 38 of 42 infants with EHBA, gave an overall accuracy of diagnosis of 86%: the results of 3 further biopsies were equivocal. In 33 of 40 infants with IHD bile duct obstruction was excluded; the remaining 7, including 4 with alpha 1 antitrypsin deficiency, showed equivocal changes. Faecal excretion of 131I rose bengal faecal excretion was less than 10% in 36 of 37 patients with EHBA and in 9 of 26 with IHD, giving an overall accuracy of diagnosis of 84%. In patients in whom genetic disorders, such as alpha 1 antitrypsin deficiency had been excluded, interpretation of liver biopsy specimens together with 131I rose bengal faecal excretion remain the most accurate means of identifying those who need surgery for EHBA and of avoiding unnecessary laparotomy in infants with IHD.

Manolaki, A G; Larcher, V F; Mowat, A P; Barrett, J J; Portmann, B; Howard, E R

1983-01-01

285

[A new case of a rare anomaly of the biliary tract].  

PubMed

We present a 36 year-old female with jaundice, who underwent surgical exploration with the diagnosis of probable biliary fasciolosis vs. Mirizzi´s syndrome. At surgery we found a short common duct leading to the body of gallbladder followed by a long cystic duct draining into the duodenum. Patient underwent hepaticojejunostomy with a Roux Y. The suspicious images of fasciola corresponded to inflammatory nodes in the hepatic hilium. A literature review was conducted and we found very few cases with this rare anomaly, some of them were managed with preservation of a portion of the gallbladder. We discuss the possible implications of this treatment and present an alternative management. PMID:22188967

Orea-Martínez, J G; Bretón-Márquez, J H; Contreras-Vera, R A; Anestesiólogo Práctica Privada, M

286

Role of Kasai procedure in surgery of hilar bile duct strictures  

PubMed Central

AIM: To assess the application of the Kasai procedure in the surgical management of hilar bile duct strictures. METHODS: Ten consecutive patients between 2005 and 2011 with hilar bile duct strictures who underwent the Kasai procedure were retrospectively analyzed. Kasai portoenterostomy with the placement of biliary stents was performed in all patients. Clinical characteristics, postoperative complications, and long-term outcomes were analyzed. All patients were followed up for 2-60 mo postoperatively. RESULTS: Patients were classified according to the Bismuth classification of biliary strictures. There were two Bismuth III and eight Bismuth IV lesions. Six lesions were benign and four were malignant. Of the benign lesions, three were due to post-cholecystectomy injury, one to trauma, one to inflammation, and one to inflammatory pseudotumor. Of the malignant lesions, four were due to hilar cholangiocarcinoma. All patients underwent Kasai portoenterostomy with the placement of biliary stents. There were no perioperative deaths. One patient experienced anastomotic leak and was managed conservatively. No other complications occurred perioperatively. During the follow-up period, all patients reported a good quality of life. CONCLUSION: The Kasai procedure combined with biliary stents may be appropriate for patients with hilar biliary stricture that cannot be managed by standard surgical methods.

Gao, Jin-Bo; Bai, Li-Shan; Hu, Zhi-Jian; Wu, Jun-Wei; Chai, Xin-Qun

2011-01-01

287

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

PubMed Central

Endoscopic retrograde cholangiopancreatography (ERCP) has become the first-line therapy for bile duct drainage. In the hands of experienced endoscopists, conventional ERCP results in a failed cannulation rate of 3% to 5%. This failure can occur more commonly in the setting of altered anatomy or technically difficult cases due to either duodenal or biliary obstruction. In cases of ERCP failure, patients have traditionally been referred for either percutaneous transhepatic biliary drainage (PTBD) or surgery. However, both PTBD and surgery have higher than desirable complication rates. Within the last decade, endoscopic ultrasound-guided biliary drainage (EUS-BD) has become an attractive alternative to PTBD after failed ERCP. Many groups have reported on the feasibility, efficacy and safety of this technique. This article reviews the indications for ERCP and the currently practiced EUS-BD techniques, including EUS-guided rendezvous, EUS-guided choledochoduodenostomy and EUS-guided hepaticogastrostomy.

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

2013-01-01

288

Percutaneous Management of Biliary Strictures After Pediatric Liver Transplantation  

SciTech Connect

We analyze our experience with the management of biliary strictures (BSs) in 27 pediatric patients who underwent liver transplantation with the diagnosis of BS. Mean recipient age was 38 months (range, 2.5-182 months). In all patients percutaneous transhepatic cholangiography, biliary catheter placement, and bilioplasty were performed. In 20 patients the stenoses were judged resolved by percutaneous balloon dilatation and the catheters removed. Mean number of balloon dilatations performed was 4.1 (range, 3-6). No major complications occurred. All 20 patients are symptom-free with respect to BS at a mean follow-up of 13 months (range, 2-46 months). In 15 of 20 patients (75%) one course of percutaneous stenting and bilioplasty was performed, with no evidence of recurrence of BS at a mean follow-up of 15 months (range, 2-46 months). In 4 of 20 patients (20%) two courses of percutaneous stenting and bilioplasty were performed; the mean time to recurrence was 9.8 months (range, 2.4-24 months). There was no evidence of recurrence of BS at a mean follow-up of 12 months (range, 2-16 months). In 1 of 20 patients (5%) three courses of percutaneous stenting and bilioplasty were performed; there was no evidence of recurrence of BS at a mean follow-up of 10 months. In conclusion, BS is a major problem following pediatric liver transplantation. Radiological percutaneous treatment is safe and effective, avoiding, in most cases, surgical revision of the anastomosis.

Miraglia, Roberto, E-mail: rmiraglia@ismett.edu; Maruzzelli, Luigi; Caruso, Settimo [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), Department of Radiology (Italy); Riva, Silvia [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), Department of Pediatric Hepatology (Italy); Spada, Marco [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), Department of Transplantation Surgery (Italy); Luca, Angelo [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), Department of Radiology (Italy); Gridelli, Bruno [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), Department of Transplantation Surgery (Italy)

2008-09-15

289

Persistent mullerian duct syndrome  

PubMed Central

Persistent Mullerian duct syndrome (PMDS) is a rare form of internal male pseudohermaphroditism in which Mullerian duct derivatives are seen in a male patient. This syndrome is characterized by the persistence of Mullerian duct derivatives (i.e. uterus, cervix, fallopian tubes and upper two thirds of vagina) in a phenotypically and karyotypically male patient. In this article we present the USG and MRI features of a case of PMDS with bilateral cryptorchidism and left sided inguinal hernia, containing the uterus and fallopian tubes.

Renu, Divya; Rao, B Ganesh; Ranganath, K; Namitha

2010-01-01

290

The Radiological Management of Biliary Complications Following Liver Transplantation  

SciTech Connect

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

Rieber, Andrea; Brambs, Hans-Juergen [Department of Diagnostic Radiology, University of Ulm, Robert-Koch-Strasse 8, D-89081 Ulm (Germany); Lauchart, Werner [Section of Transplantation Surgery, University of Tuebingen, Hoppe-Seyler-Strasse 3, D-72076 Tuebingen (Germany)

1996-04-15

291

Spontaneous perforation of the common bile duct in children  

SciTech Connect

The authors describe radiologic findings in five patients with spontaneous perforation of the common bile duct (a rare disorder). The patients were 5 weeks, 9 weeks, 3 months, 11 months, and 2 1/2 years old at presentation. The most common presenting complaints were jaundice and abdominal distention (due to ascites). Sonographic findings included ascites in three patients, a loculated fluid collection around the gallbladder in two patients, and both in one patient. The biliary tree was undilated in all patients. Results of hepatobiliary scintigraphy definitely demonstrated that intraperitoneal fluid originated from the biliary tract. Intraoperative cholangiography was used to confirm the diagnosis at surgery. All children were successfully treated with surgery. Recognition of these findings on sonograms and subsequent confirmation with scintigraphy are important to prevent delays in diagnosis of a potentially fatal condition.

Haller, J.O.; Condon, V.R.; Berdon, W.E.; Oh, K.S.; Price, A.P.; Bowen, A.; Cohen, H.L. (State Univ. of New York Downstate Medical Center, Brooklyn (USA))

1989-09-01

292

Dermatological Manifestations in Primary Biliary Cirrhosis Patients: A Case Control Study  

Microsoft Academic Search

OBJECTIVES:Primary biliary cirrhosis (PBC), a disease of probable autoimmune etiology that affects the small intrahepatic bile ducts of mainly middle-aged women is commonly associated with pruritus, xanthomatous lesions, and melanosis. We conducted a prospective study to systematically describe the skin disorders of a group of PBC patients.METHODS:A prospective evaluation and analysis of dermatological manifestations including oral and genital lesions was

Meri Koulentaki; Despina Ioannidou; Maria Stefanidou; Sofia Maraki; I. Drigiannakis; Philippas Dimoulios; Jean Marie Enele Melono; Androniki Tosca; Elias A. Kouroumalis

2006-01-01

293

Primary biliary cirrhosis: lessons learned from an organic-specific disease  

Microsoft Academic Search

Primary biliary cirrhosis is an autoimmune liver disease that predominantly affects women and is characterized by chronic\\u000a progressive destruction of small intrahepatic bile ducts with portal inflammation and subsequent fibrosis. The serological\\u000a hallmark is the presence of antimitochondrial antibodies are directed against the 2-oxo-acid dehydrogenase complexes located\\u000a on the inner membrane of mitochondria. Although the role of antimitochondrial antibodies in

A. Nishio; E. B. Keeffe; M. E. Gershwin

2001-01-01

294

Fracture of Self-Expandable Metal Stent during Endoscopic Removal in Benign Biliary Stricture  

PubMed Central

The endoscopic insertion of the self-expandable metal stent (SEMS) in benign biliary stricture has become an alternative to surgery. Fracture or migration of SEMS can occur rarely as complications. We report a case of fracture of SEMS during endoscopic retrieval in patients with chronic pancreatitis. In this case, broken stent was successfully removed with endoscopic ballooning of bile duct and with a snare device.

Joo, Kyu Re; Chung, Woo Chul; Lee, Kang-Moon; Yang, Jin Mo

2013-01-01

295

Primary Biliary Cirrhosis  

PubMed Central

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

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

2010-01-01

296

Biliary hypoplasia in Williams syndrome.  

PubMed

Neonatal hepatitis and biliary hypoplasia are not recognised features of Williams syndrome. A case of Williams syndrome, presenting with neonatal conjugated hyperbilirubinaemia leading to an initial misdiagnosis is reported. PMID:16632669

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

2006-05-01

297

Biliary hypoplasia in Williams syndrome  

PubMed Central

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

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

2006-01-01

298

Percutaneous Cholangioscopy in the Management of Biliary Disease: Experience in 25 Patients  

SciTech Connect

Purpose: To present our experience performing percutaneous cholangioscopy in the management of 25 patients with biliary disease.Methods: During the last 3 years, 26 percutaneous cholangioscopies were performed in 25 patients with common bile duct disease (n = 16), intrahepatic ducts disease (n = 6), and gallbladder disease (n = 4). Our patient population group included seven with common bile duct stones, three with intrahepatic lithiasis, and eight with benign strictures (six iatrogenic and two postinflammatory). In four patients malignancy was to be excluded, in two the tumor extent was to be evaluated, whereas in one case the correct placement of a metallic stent needed to be controlled. A 9.9 Fr flexible endoscope URF-P (Olympus, 1.2 mm working channel, 70-cm length) was used.Results: In total, percutaneous cholangioscopy answered 30 diagnostic questions, was technically helpful in 19 cases (performing lithotripsy or biopsy or guiding a wire), and of therapeutic help in 12 (performing stone retrieval). In 24 of 26 cases the therapeutic decision and the patient management changed because of the findings or because of the help of the method. In two cases biliary intervention failed to treat the cause of the disease. No major complication due to the use of the endoscopy was noted.Conclusions: Percutaneous cholangioscopy is a very useful tool in the management of patients with biliary disease. The method can help in diagnosis, in performing complex interventional procedures, and in making or changing therapeutic decisions.

Hatzidakis, Adam A.; Alexandrakis, George; Kouroumalis, Helias; Gourtsoyiannis, Nicholas C. [Department of Radiology and Gastroenterology Clinic, University Hospital Heraklion, Medical School of Crete, G-71500 Heraklion-Stavrakia, Crete (Greece)

2000-11-15

299

Reconstructive surgery for ischemic-type lesions at the bile duct bifurcation after liver transplantation.  

PubMed Central

OBJECTIVE: To assess the feasibility, morbidity, mortality, and clinical success rate of surgical reconstruction of the biliary system in patients with ischemic-type biliary lesions in their liver graft. SUMMARY BACKGROUND DATA: After liver transplantation, strictures in the biliary tree with secondary sludge formation can occur in the absence of vascular problems. Jaundice, pruritus, and recurrent cholangitis are predominant clinical features leading to considerable morbidity. Interventional measures are the first-line treatment but are frequently only of transient success. Retransplantation is usually considered when interventional treatment is not effective. METHODS: Surgical exploration and reconstruction was performed in 17 patients with ischemic-type biliary strictures at a median of 2 years after liver transplantation. Findings during surgery, surgical strategies, and postsurgical courses are described. Clinical symptoms and biochemical parameters of cholestasis and liver function were analyzed in the postsurgical course. RESULTS: During surgery, all 17 patients were found to have strictures or sclerotic changes involving the hepatic bifurcation and extrahepatic bile duct. Sludge or stones were present in nine patients. In 14 patients with viable bile ducts proximal to the bifurcation, surgical reconstruction was performed by resection of the bifurcation and hepaticojejunostomy. In three patients with more extensive biliary destruction, portoenterostomy with or without peripheral hepatojejunostomy was performed. The prevalence rate of biliary infection at surgery was 93%; the predominant organisms were Candida and enterococci. The perioperative mortality rate was 0%. Clinical symptoms and biochemical parameters became normal or were considerably improved in 14 of 16 patients (88%). CONCLUSIONS: The hepatic bifurcation seems to be a predominant site for ischemic-type biliary changes after liver transplantation. Surgical treatment by resection of the bifurcation and reconstruction by high hepaticojejunostomy is a safe and highly effective approach leading to cure or persistent major improvement in most patients. Images Figure 1. Figure 2.

Schlitt, H J; Meier, P N; Nashan, B; Oldhafer, K J; Boeker, K; Flemming, P; Raab, R; Manns, M P; Pichlmayr, R

1999-01-01

300

Repair operations on biliary tract.  

PubMed

In a period of 4 years from 1970 through 1974 29 repair operations of bile ducts were performed in 27 patients. In 9 cases choledocholithiasis had been overlooked during the primary operation, in 1 case a foreign body was present in the common bile duct, in 3 cases the long-stump syndrome was diagnosed, in 4 cases injury to the common bile duct occurred during an operation and was immediately dealth with, in 12 cases postoperative stricture of the bile duct was corrected. The authors describe surgical procedures and therapeutic results. The problem of selection of the most suitable operative method is discussed. PMID:825841

Góral, R; Cie?licki, J; Redelbach, J

301

Unusual scintigraphic appearance of perforation of the common bile duct  

SciTech Connect

This report deals with the diagnosis of perforation of the common bile duct into the lesser sac by HIDA cholescintigraphy. The first hour images after injection were suggestive of biliary obstruction. Subsequent images demonstrated unusual accumulations of the activity into the lesser sac and retroperitoneal potential spaces. Careful correlation between scintigraphic and surgical findings were undertaken. The case is reported to demonstrate the scintigraphic findings in choledochal perforation and to stress the importance of carrying out late images when the initial ones are abnormal.

Acevedo, M.O.; Tauxe, W.N.; Scott, J.W.; Aldrete, J.S.

1983-12-01

302

Delayed obstructive jaundice secondary to bullet in common hepatic duct.  

PubMed

A young male presented with obstructive jaundice and recurrent attacks of acute cholangitis. He had sustained gunshot wound in abdomen 9 years back. Laparotomy was done at that time and the bullet was found left within right lobe of liver, as it was inaccessible and possible benefit to take it out was considered less than leaving it in-situ. The patient recovered and did well for 7 years. After 7 years of latency, he developed recurrent attacks of acute cholangitis. The reason of this delayed presentation was probably the migration of the bullet from its original place to the biliary tree i.e. common hepatic duct. PMID:17462186

Hussain, S M Abbas; Zulqurnain, Sikander; Saleem, Omema

2007-04-01

303

Percutaneous Embolization of Transhepatic Tracks for Biliary Intervention  

SciTech Connect

Significant pain can occur after removing transhepatic catheters from biliary access tracks, after percutaneous biliary drainage (PBD) or stenting. We undertook a randomized prospective study to ascertain whether track embolization decreases the amount of pain or analgesic requirement after PBD. Fifty consecutive patients (M:F, 22:28; age range:29-85 years; mean age: 66.3 years) undergoing PBD were randomized to receive track embolization or no track embolization after removal of biliary drainage catheters. A combination of Lipoidol and n-butyl cyanoacrylate were used to embolize transhepatic tracks using an 8F dilator. The patients who did not have track embolization performed had biliary drainage catheters removed over a guide wire. A visual analog scoring (VAS) system was used to grade pain associated with catheter removal, 24 h afterward. A required analgesic score (RAS) was devised to tabulate the analgesia required. No analgesia had a score of 0, oral or rectal nonopiate analgesics had a score of 1, oral opiates had a score of 2, and parenteral opiates had a score of 3. The average VAS and RAS for both groups were calculated and compared.Seven patients were excluded for various reasons, leaving 43 patients in the study group. Twenty-one patients comprised the embolization group and 22 patients comprised the nonembolization group. The mean biliary catheter dwell time was not significantly different (p > 0.05) between the embolization group and nonembolization (mean: 5.4 days vs 6.9 days, respectively). In the nonembolization group, the mean VAS was 3.4. Eight patients required parenteral opiates, three patients required oral opiates, and five patients required oral or rectal analgesics, yielding a mean RAS of 1.6. In the embolization group, the mean VAS was 0.9. No patient required parenteral opiates, six patients required oral opiates, and two patients had oral analgesia. The average RAS was 0.6. Both the VAS and the RAS were significantly lower in the embolization group compared with the nonembolization group (p < 0.0023 and p < 0.002, respectively). No complications were seen related to track embolization. Percutaneous track embolization after removal of biliary drainage catheters decreases patient's perception of pain and decreases the amount of required analgesia. In particular, the amount of opiate analgesia required is considerably less.

Lyon, Stuart M.; Terhaar, Olaf; Given, Mark F.; O'Dwyer, Helena M.; McGrath, Frank P.; Lee, Michael J. [Beaumont Hospital, Department of Academic Radiology (Ireland)], E-mail: mlee@rcsi.ie

2006-12-15

304

Ten minute radiopharmaceutical test in biliary atresia.  

PubMed Central

To provide an objective rapid means of excluding extrahepatic biliary atresia (atresia), a hepatic index was devised from the ratio of the net hepatic to cardiac distribution of 99mTc diisopropyl iminodiacetic acid or methylbrom iminodiacetic acid between 2.5 and 10 minutes after injection. The hepatic index was compared with subjective assessment of abdominal scintigraphy performed repeatedly over 24 hours. In 22 infants with hepatitis the hepatic index ranged from 5.03 to 14.9, one having no excretion on scintiscan. In 26 infants with atresia the index ranged from 0.49 to 4.26 and in two with paucity of intralobular bile ducts it was 1.85 and 3.69. None of these infants had excretion apparent on scintiscans. Similarly, low hepatic indices occurred in four infants with liver dysfunction but pigmented stools, three of whom had no excretion apparent on scintiscans. These preliminary studies suggest that a hepatic index of greater than 5 is much more rapid and as specific in excluding atresia as repeated abdominal scintigraphy. Images Fig. 1

el Tumi, M A; Clarke, M B; Barrett, J J; Mowat, A P

1987-01-01

305

Time Dilation Equation  

NSDL National Science Digital Library

This online article is from the Museum's Seminars on Science, a series of distance-learning courses designed to help educators meet the new national science standards. The article, which offers a simple demonstration of Einstein's Time Dilation Equation, is part of the Frontiers in Physical Science seminar. It uses the example of a light beam bouncing between two mirrors in a rocket to illustrate the theory, and includes a step-by-step look at the math involved in calculating the quantitative solution.

306

Hedgehog signaling regulates epithelial-mesenchymal transition during biliary fibrosis in rodents and humans  

PubMed Central

Epithelial-mesenchymal transitions (EMTs) play an important role in tissue construction during embryogenesis, and evidence suggests that this process may also help to remodel some adult tissues after injury. Activation of the hedgehog (Hh) signaling pathway regulates EMT during development. This pathway is also induced by chronic biliary injury, a condition in which EMT has been suggested to have a role. We evaluated the hypothesis that Hh signaling promotes EMT in adult bile ductular cells (cholangiocytes). In liver sections from patients with chronic biliary injury and in primary cholangiocytes isolated from rats that had undergone bile duct ligation (BDL), an experimental model of biliary fibrosis, EMT was localized to cholangiocytes with Hh pathway activity. Relief of ductal obstruction in BDL rats reduced Hh pathway activity, EMT, and biliary fibrosis. In mouse cholangiocytes, coculture with myofibroblastic hepatic stellate cells, a source of soluble Hh ligands, promoted EMT and cell migration. Addition of Hh-neutralizing antibodies to cocultures blocked these effects. Finally, we found that EMT responses to BDL were enhanced in patched-deficient mice, which display excessive activation of the Hh pathway. Together, these data suggest that activation of Hh signaling promotes EMT and contributes to the evolution of biliary fibrosis during chronic cholestasis.

Omenetti, Alessia; Porrello, Alessandro; Jung, Youngmi; Yang, Liu; Popov, Yury; Choi, Steve S.; Witek, Rafal P.; Alpini, Gianfranco; Venter, Juliet; Vandongen, Hendrika M.; Syn, Wing-Kin; Baroni, Gianluca Svegliati; Benedetti, Antonio; Schuppan, Detlef; Diehl, Anna Mae

2008-01-01

307

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

PubMed Central

A 46-year-old man was admitted with obstructive jaundice and cross-sectional imaging with computed tomography suggested distal biliary obstruction. A distal common bile duct stricture was found at endoscopic retrograde cholangiopancreatography (ERCP) and cytology was benign. A 6 cm fully covered self-expanding metal stent (SEMS) was inserted across the stricture to optimize biliary drainage. However, the SEMS could not be removed at repeat ERCP a few months later. A further fully covered SEMS was inserted within the existing stent to enable extraction and both stents were retrieved successfully a few weeks later. Fully covered biliary (SEMS) are used to treat benign biliary strictures. This is the first reported case of inability to remove a fully-covered biliary SEMS. Possible reasons for this include tissue hyperplasia and consequent overgrowth into the stent proximally, or chemical or mechanical damage to the polymer covering of the stent. Application of the stent-in-stent technique allowed successful retrieval of the initial stent.

Menon, Shyam

2013-01-01

308

Cystic duct patency in malignant obstructive jaundice. An ERCP-based study relevant to the role of laparoscopic cholecystojejunostomy.  

PubMed Central

OBJECTIVE: This endoscopic retrograde cholangiopancreatography-(ERCP)based study estimates the potential role of laparoscopic cholecystojejunostomy for palliation of patients with malignant obstructive jaundice. SUMMARY BACKGROUND DATA: Traditional treatment of malignant obstructive jaundice has used a standard bilioenteric anastomosis. Laparoscopic biliary bypass via a gallbladder conduit currently is an established technique; it provides a low initial morbidity alternative to open procedures, similar to endoscopic stenting. No study has specifically addressed anatomic factors relevant to cholecystojejunostomy, such as prior cholecystectomy, stricture location in reference to the hepatocystic junction, and cystic duct patency in patients with malignant obstructive jaundice. METHODS: Retrograde cholangiograms were reviewed from consecutive patients with malignant obstructive jaundice and a control group without biliary disease who underwent ERCP during a 2-year period. Patients with either prior biliary surgery or hilar tumors were excluded. The presence of gallbladder or cystic duct filling was assessed. In patients with patent cystic ducts, the distance from obstruction to the cystic duct takeoff was classified as either greater or less than 1 cm. RESULTS: Nearly half the patients with malignant obstructive jaundice were ineligible for cholecystojejunostomies because of prior biliary surgery (29%) or hilar tumors (17%). Half (50 of 101) of the remaining potential candidates had patent hepatocystic junctions. Patients with ampullary carcinoma and patent hepatocystic junctions (5 of 9) were all ideal candidates for cholecystojejunostomies, having biliary obstruction more than 1 cm from the cystic duct takeoff. Two thirds of the remaining eligible patients (28 of 45) had obstructions less than 1 cm from patent hepatocystic junctions. CONCLUSIONS: Palliation of malignant obstructive jaundice by laparoscopic cholecystojejunostomy should only be attempted after direct cholangiography demonstrates a patent hepatocystic junction that is well separated from the malignant stricture. The majority of patients with malignant obstructive jaundice are ineligible for cholecystojejunostomies because of prior cholecystectomies, hilar obstructions, or tumor involvement of the hepatocystic junction. Nonoperative treatments will continue to be indicated for the majority of patients with malignant obstructive jaundice. Images Figure 2. Figure 3.

Tarnasky, P R; England, R E; Lail, L M; Pappas, T N; Cotton, P B

1995-01-01

309

Biliary atresia and neonatal hepatobiliary scintigraphy  

SciTech Connect

Hepatobiliary scintigraphy using Tc-99m diethyl IDA was performed on 14 jaundiced neonates. It aided greatly the differential diagnosis between neonatal hepatitis and biliary atresia. Limitations in the interpretation of the results are described, as neonatal hepatitis may be accompanied by biliary excretion ranging from zero to normal. Also both biliary atresia (intra- and extrahepatic) and neonatal hepatitis may show no biliary excretion within 24 hours.

Wynchank, S.; Guillet, J.; Leccia, F.; Soubiran, G.; Blanquet, P.

1984-03-01

310

CORNICE DUCT SYSTEM  

SciTech Connect

SYNERGETICS, INC., is in the process of designing, developing, and testing an air handling duct system that integrates the air duct with the cornice trim of interior spaces. The device has the advantage that the normal thermal losses from ducts into unconditioned attics and crawl spaces can be totally eliminated by bringing the ducts internal to the conditioned space. The following report details work conducted in the second budget period to develop the Cornice Duct System into a viable product for use in a variety of residential or small commercial building settings. A full-scale prototype has been fabricated and tested in a laboratory test building. Based on the results of that testing, the prototype design as been refined, fabricated, installed, and extensively tested in a residential laboratory house. The testing indicates that the device gives substantially superior performance to a standard air distribution system in terms of energy performance and thermal comfort. A patent has been submitted, refined based on feedback from the patent office, and resubmitted. Additional refinements to the design will lead to additional claims being added to the patent in the near future. Designs are being finalized for a refined version that will be fabricated and tested in the same residential laboratory house. Work is expected to be complete on this project in April of 2003.

Wayne Place; Chuck Ladd; TC Howard

2002-12-01

311

Etiology and diagnosis of acute biliary pancreatitis  

Microsoft Academic Search

Establishing a biliary etiology in acute pancreatitis is clinically important because of the potential need for invasive treatment, such as endoscopic retrograde cholangiopancreatography. The etiology of acute biliary pancreatitis (ABP) is multifactorial and complex. Passage of small gallbladder stones or biliary sludge through the ampulla of Vater seems to be important in the pathogenesis of ABP. Other factors, such as

Donald L. van der Peet; Pranav Bhagirath; Chris J. J. Mulder; Marco J. Bruno; Erwin J. M. van Geenen

2010-01-01

312

Hepatic S4a + S5 and bile duct resection for gallbladder carcinoma.  

PubMed

In the surgical treatment of gallbladder cancer, segment 4a + 5 hepatic resection and bile duct resection is usually recommended for T2 and/or T3 gallbladder cancer involving hepatic parenchyma without hepatic biliary confluence. This procedure does not affect liver function excessively, provided there is correct identification of hepatic S4a and S5, the most important aspect of this procedure. In this paper, the technique of hepatic S4a + 5 and bile duct resection is described in detail. This surgical procedure could be a useful option for the surgical treatment of the hepatobiliary pancreatic malignancies. Surgeons should therefore master the surgical techniques for this procedure. PMID:22374509

Miyazaki, Masaru; Shimizu, Hiroaki; Ohtsuka, Masayuki; Yoshidome, Hiroyuki; Kato, Atsushi; Yoshitomi, Hideyuki; Furukawa, Katsunori; Kimura, Fumio

2012-05-01

313

Carcinoid tumor of the common bile duct: a rare complication of von Hippel-Lindau syndrome.  

PubMed

Von Hippel-Lindau syndrome (VHL) is a rare autosomal-dominant, inherited familial cancer syndrome. Hemangioblastomas, pheochromocytomas and renal carcinoma are the frequent reported VHL tumors. Neuroendocrine tumors have also been described, mostly in the pancreas and rarely in the biliary trees. We report the second case of bile duct carcinoid in a 31-year-old VHL woman. She underwent right adrenalectomy for a pheochromocytoma in the past. She also had a positive family history of phenotypic expression of VHL syndrome. The patient presented with biliary colic. Endoscopic retrograde cholangio-pancreatography showed intra-luminal bile duct mass. Surgical exploration identified a beige nodular lesion that was a carcinoid tumor on histology. This new association should be clarified by further genetic investigations. PMID:18300362

Nafidi, Otmane; Nguyen, Bich-N; Roy, André

2008-02-28

314

Carcinoid tumor of the common bile duct: A rare complication of von Hippel-Lindau syndrome  

PubMed Central

Von Hippel-Lindau syndrome (VHL) is a rare autosomal-dominant, inherited familial cancer syndrome. Hemangioblastomas, pheochromocytomas and renal carcinoma are the frequent reported VHL tumors. Neuroendocrine tumors have also been described, mostly in the pancreas and rarely in the biliary trees. We report the second case of bile duct carcinoid in a 31-year-old VHL woman. She underwent right adrenalectomy for a pheochromocytoma in the past. She also had a positive family history of phenotypic expression of VHL syndrome. The patient presented with biliary colic. Endoscopic retrograde cholangio-pancreatography showed intra-luminal bile duct mass. Surgical exploration identified a beige nodular lesion that was a carcinoid tumor on histology. This new association should be clarified by further genetic investigations.

Nafidi, Otmane; Nguyen, Bich N; Roy, Andre

2008-01-01

315

Particle deposition in ventilation ducts  

SciTech Connect

Exposure to airborne particles is detrimental to human health and indoor exposures dominate total exposures for most people. The accidental or intentional release of aerosolized chemical and biological agents within or near a building can lead to exposures of building occupants to hazardous agents and costly building remediation. Particle deposition in heating, ventilation and air-conditioning (HVAC) systems may significantly influence exposures to particles indoors, diminish HVAC performance and lead to secondary pollutant release within buildings. This dissertation advances the understanding of particle behavior in HVAC systems and the fates of indoor particles by means of experiments and modeling. Laboratory experiments were conducted to quantify particle deposition rates in horizontal ventilation ducts using real HVAC materials. Particle deposition experiments were conducted in steel and internally insulated ducts at air speeds typically found in ventilation ducts, 2-9 m/s. Behaviors of monodisperse particles with diameters in the size range 1-16 {micro}m were investigated. Deposition rates were measured in straight ducts with a fully developed turbulent flow profile, straight ducts with a developing turbulent flow profile, in duct bends and at S-connector pieces located at duct junctions. In straight ducts with fully developed turbulence, experiments showed deposition rates to be highest at duct floors, intermediate at duct walls, and lowest at duct ceilings. Deposition rates to a given surface increased with an increase in particle size or air speed. Deposition was much higher in internally insulated ducts than in uninsulated steel ducts. In most cases, deposition in straight ducts with developing turbulence, in duct bends and at S-connectors at duct junctions was higher than in straight ducts with fully developed turbulence. Measured deposition rates were generally higher than predicted by published models. A model incorporating empirical equations based on the experimental measurements was applied to evaluate particle losses in supply and return duct runs. Model results suggest that duct losses are negligible for particle sizes less than 1 {micro}m and complete for particle sizes greater than 50 {micro}m. Deposition to insulated ducts, horizontal duct floors and bends are predicted to control losses in duct systems. When combined with models for HVAC filtration and deposition to indoor surfaces to predict the ultimate fates of particles within buildings, these results suggest that ventilation ducts play only a small role in determining indoor particle concentrations, especially when HVAC filtration is present. However, the measured and modeled particle deposition rates are expected to be important for ventilation system contamination.

Sippola, Mark R.

2002-09-01

316

Isolated right posterior bile duct injury following cholecystectomy: Report of two cases  

PubMed Central

Anatomic variations of the right biliary system are one of the most common risk factors for sectoral bile duct injury (BDI) during cholecystectomy. Isolated right posterior BDI may in particular be a challenge for both diagnosis and management. Herein we describe two cases of isolated right posterior sectoral BDI that took place during laparoscopic cholecystectomy. Despite effective external biliary drainage from the liver hilum in both cases, there was a persistent biliary leak observed which was not visible on endoscopic retrograde cholangiogram. Careful evaluation of images from both endoscopic and magnetic resonance cholangiograms revealed the diagnosis of an isolated right posterior sectoral BDI. These were treated with a delayed bisegmental (segments 6 and 7) liver resection and a Roux-en-Y hepaticojejunostomy respectively with good outcomes at 24 and 4 mo of follow-up. This paper discusses strategies for prevention of such injuries along with the diagnostic and therapeutic challenges it offers.

Wojcicki, Maciej; Patkowski, Waldemar; Chmurowicz, Tomasz; Bialek, Andrzej; Wiechowska-Kozlowska, Anna; Stankiewicz, Rafal; Milkiewicz, Piotr; Krawczyk, Marek

2013-01-01

317

Molecular identification of bacterial 16S ribosomal RNA gene in liver tissue of primary biliary cirrhosis: Is Propionibacterium acnes involved in granuloma formation?  

Microsoft Academic Search

The etiopathogenesis of primary biliary cirrhosis (PBC) remains speculative. Epithelioid granulomas are often found in the vicinity of damaged interlobular bile ducts in PBC, raising the possibility of a reaction to microbial materials. In this study, we tried to detect and identify bacterial DNA within granulomatous lesions in PBC. Using liver sections from 9 patients with PBC and 13 control

Kenichi Harada; Koichi Tsuneyama; Yoshiko Sudo; Shinji Masuda; Yasuni Nakanuma

2001-01-01

318

Intracatheter hyperthermia and iridium-192 radiotherapy in the treatment of bile duct carcinoma  

Microsoft Academic Search

We report a case of a patient with locally advanced bile duct carcinoma treated with 4500 cGy external beam radiotherapy, followed 3 weeks later by intracatheter 915 MHz microwave hyperthermia and radiotherapy delivered through a biliary U-tube placed at the time of surgery. Heating was to 43-45 degrees C for 1 hour followed immediately by intracatheter Iridium-192 seeds to deliver

J. Y. C. Wong; N. L. Vora; C. K. Chou; J. A. McDougall; K. W. Chan; D. O. Findley; B. W. Forell; K. H. Luk; V. J. Philben; J. D. Beatty

1988-01-01

319

Complications following Repair of Extrahepatic Bile Duct Injuries after Blunt Abdominal Trauma  

Microsoft Academic Search

.   Extrahepatic bile duct traumatic injuries are extremely rare and their treatment is difficult and with several controversies.\\u000a The aim of this study was to offer some more clinical information on their surgical repair and outcome. We present seven patients\\u000a with extrahepatic biliary tract lesions after blunt abdominal trauma, (isolated gallbladder lesions were excluded) four males\\u000a and three females from

Jose A. Rodriguez-Montes; Esther Rojo; Luis García-Sancho Martín

2001-01-01

320

Genetics in dilated cardiomyopathy.  

PubMed

Discoveries made during the last 20 years have revealed a genetic origin in many cases of dilated cardiomyopathy (DCM). Currently, over 40 genes have been associated with the disease. Mutations in DCM-causing genes induce the condition through a variety of different pathological pathways with complex and not completely understood mechanisms. Genes that encode for sarcomeric, cytoskeletal, nuclear membrane, dystrophin-associated glycoprotein complex and desmosomal proteins are the principal genes involved. In this review we discuss the most frequent DCM-causing genes. We propose a classification in which DCM genes are considered as being major or minor genes according to their mutation frequency and the available supporting evidence. The main phenotypic characteristics associated with each gene are discussed. PMID:23905888

Garcia-Pavia, Pablo; Cobo-Marcos, Marta; Guzzo-Merello, Gonzalo; Gomez-Bueno, Manuel; Bornstein, Belen; Lara-Pezzi, Enrique; Segovia, Javier; Alonso-Pulpon, Luis

2013-08-01

321

Medical history and the risk of biliary tract cancers in Shanghai, China: implications for a role of inflammation.  

PubMed

Several lines of evidence suggest that inflammation may play a role in the etiology of biliary tract cancers. To examine further the role of inflammation, we evaluated the associations between self-reported inflammatory-related medical conditions and the risk of biliary tract cancers in a population-based case-control study in Shanghai, China. Our analysis included 368 gallbladder cancer cases, 191 bile duct cancer cases, 68 ampulla of Vater cancer cases, and 959 healthy subjects. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for biliary tract cancers in relation to six inflammation-related conditions. Gallbladder cancer was significantly associated with cholecystitis occurring at least 5 years prior to interview (OR = 1.7, 95% CI 1.1-2.9). Even though biliary stones did not significantly modify the associations between cholecystitis and gallbladder cancer, 90% of the gallbladder cancer cases with cholecystitis also had biliary stones, indicating that stones likely play an important role in the link between cholecystitis and gallbladder cancer. Among subjects who smoked and drank alcohol, a history of gastric (OR = 4.3, 95% CI 1.2-15.0) or duodenal ulcers (OR = 3.7, 1.2-12.0) was associated with an excess risk of gallbladder cancer. Although the mechanisms are unclear, our results further support the role for inflammation in the etiology of biliary tract cancers. PMID:21744094

Andreotti, Gabriella; Liu, Enju; Gao, Yu-Tang; Safaeian, Mahboobeh; Rashid, Asif; Shen, Ming-Chang; Wang, Bin-Shen; Deng, Jie; Han, Tian-Quian; Zhang, Bai-He; Hsing, Ann W

2011-07-09

322

Blocked Tear Duct  

MedlinePLUS

... cancer treatment. If you've had radiation or chemotherapy to treat cancer, particularly if the radiation was focused on your face or head, you're at higher risk of developing a blocked tear duct. Complications Because your tears aren't draining the way ...

323

Hepatic parenchymal atrophy induction for intractable segmental bile duct injury after liver resection.  

PubMed

Liver resection can result in various types of bile duct injuries but their treatment is usually difficult and often leads to intractable clinical course. We present an unusual case of hepatic segment III duct (B3) injury, which occurred after left medial sectionectomy for large hepatocellular carcinoma and was incidentally detected 1 week later due to bile leak. Since the pattern of this B3 injury was not adequate for operative biliary reconstruction, atrophy induction of the involved hepatic parenchyma was attempted. This treatment consisted of embolization of the segment III portal branch to inhibit bile production, induction of heavy adhesion at the bile leak site and clamping of the percutaneous transhepatic biliary drainage (PTBD) tube to accelerate segment III atrophy. This entire procedure, from liver resection to PTBD tube removal took 4 months. This patient has shown no other complication or tumor recurrence for 4 years to date. These findings suggest that percutaneous segmental portal vein embolization, followed by intentional clamping of external biliary drainage, can effectively control intractable bile leak from segmental bile duct injury. PMID:22469733

Hwang, Shin; Park, Gil-Chun; Ha, Tae-Yong; Ko, Gi-Young; Gwon, Dong-Il; Choi, Young-Il; Song, Gi-Won; Lee, Sung-Gyu

2012-05-01

324

Emergency percutaneous treatment in surgical bile duct injury.  

PubMed

The aim of this study is to evaluate the efficacy of emergency percutaneous treatment in patients with surgical bile duct injury (SBDI). From May 2004 to May 2007, 11 patients (five men, six women; age range 26-80 years; mean age 58 years) with a critical clinical picture (severe jaundice, bile peritonitis, septic state) due to SBDI secondary to surgical or laparoscopic procedures were treated by percutaneous procedures. We performed four ultrasound-guided percutaneous drainages, four external-internal biliary drainages, one bilioplasty, and two plastic biliary stenting after 2 weeks of external-internal biliary drainage placement. All procedures had 100% technical success with no complications. The clinical emergencies resolved in 3-4 days in 100% of cases. All patients had a benign clinical course, and reoperation was avoided in 100% of cases. Interventional radiological procedures are effective in the emergency management of SBDI since they are minimally invasive and have a high success rate and a low incidence of complications compared to the more complex and dangerous surgical or laparoscopic options. PMID:18463906

Carrafiello, Gianpaolo; Laganà, Domenico; Dizonno, Massimiliano; Ianniello, Andrea; Cotta, Elisa; Dionigi, Gianlorenzo; Dionigi, Renzo; Fugazzola, Carlo

2008-05-08

325

Suppression of proliferative cholangitis in a rat model with direct adenovirus-mediated retinoblastoma gene transfer to the biliary tract.  

PubMed

Proliferative cholangitis (PC) associated with hepatolithiasis develops the stricture of main bile ducts, and is the main cause of residual and/or recurrent stones after repeated treatments for hepatolithiasis. The aim of this study was to inhibit PC using the cytostatic gene therapy with direct adenovirus-mediated retinoblastoma (Rb) gene transfer to the biliary tract. PC was induced by introducing a fine nylon thread into the bile duct in a rat model. The adenovirus vector encoding a nonphosphorylatable, constitutively active form of retinoblastoma gene product (AdRb) was administered directly into the biliary tract. The adenovirus vector encoding beta-galactosidase (AdlacZ) was also given as a control. The bile duct wall thickness and 5'-bromodeoxyuridine (BrdU) labeling index were compared among uninfected, AdlacZ-infected, and AdRb-infected PC rats. The Rb expression in the bile duct was detected using reverse-transcription polymerase chain reaction (RT-PCR) and immunohistochemical study. AdRb-infected bile ducts showed inhibition of the epithelial and fibrous tissue proliferation and the peribiliary gland hyperplasia, resulting in a significant reduction of wall thickness compared with uninfected and AdlacZ-infected ones. The BrdU labeling index was 4.87% +/- 3.06% in the AdRb-infected bile ducts, while those of uninfected and AdlacZ-infected ones were 15.48% +/- 4.61% and 11.72% +/- 1.23%, respectively (P < .05). In conclusion, our cytostatic gene therapy approach using direct Rb gene transfer into the biliary tract suppressed PC in a rat model and may offer an effective therapeutic option for reducing recurrences following treatments against hepatolithiasis. PMID:9731547

Terao, R; Honda, K; Hatano, E; Uehara, T; Yamamoto, M; Yamaoka, Y

1998-09-01

326

Results of a new strategy for reconstruction of biliary injuries having an isolated right-sided component.  

PubMed

Poor results after repair of biliary injuries are most common when injuries are above the bifurcation of the left and right hepatic ducts or involve aberrant ducts. We have developed a novel approach to the right-sided component of such injuries. Preoperatively all isolated sections of the biliary tree are intubated percutaneously. At surgery the left duct is found by the Hepp-Couinaud approach. Dissection is continued to the right, staying within the coronal plane of the left hepatic duct, and continuing across the gallbladder plate into segment 5 between the hepatic parenchyma and the Wallerian sheath of the right portal pedicle. Hepatic parenchyma, anterior to the sheath, is resected. After a length of portal pedicle is exposed, right-sided bile ducts are opened on their anterior surface, using the percutaneous transhepatic stents as a guide, and hepaticojejunostomy is performed. Twenty-three patients were treated from May 1993 to February 1999. Injury types and (number of patients) were as follows: B (n = 2), C (n = 5), E4 (n = 10), and E5 (n = 6). There were no perioperative deaths. Follow-up ranged from 8 months to 7 years (median 3 years). There have been no cases of restricture, reoperation, or jaundice, and no interventional procedures. Serum bilirubin is normal in all patients. Alkaline phosphatase is normal or less than two times the normal value in 21 of 22 living patients. This novel approach brings the benefits of the Hepp-Couinaud approach to the right hepatic ducts. Very satisfactory results were obtained in the most severe types of biliary injury. PMID:11360050

Strasberg, S M; Picus, D D; Drebin, J A

327

[Prognostic factors in the treatment of the bile duct injuries and strictures].  

PubMed

To describe the prognostic factors after surgical reconstruction data. were collected prospectively on 60 patients treated at the Scientific Center of Surgery named after M.Topchubashov and N5 City Hospital with major bile duct injuries and postoperative bile duct strictures between 2000 and 2009. Of the 60 patients 21 had bile duct injuries, other 39 had postoperative strictures. In 15 of 53 patients with iatrogenic injury of bile ducts trauma was recognized and repaired intraoperatively. In 22 patients was early, in 16 patients delayed recognition of bile duct injury. Most of patients had undergone a choledocho (8) or hepaticojejunostomy (33) by Roux. External drainage of bile ducts was performed in 24 patients. Of the 60 patients undergoing surgical reconstruction, 47 hud completed treatment. Of patients who had completed treatment, 82,9% were considered to have a successful outcome (24 patients excellent, 15 patients - good results) without the need for follow-up invasive, diagnostic, or therapeutic interventional procedures. Patients with reconstruction after injury or stricture-without external drainage had a better overall outcome (92,9% successful outcome) than patients with drainage of bile ducts (68,4% successful outcome). Number of stents and length of postoperative stenting also were significant predictors of outcome. Type of operation (laparoscopic or open cholecystectomy) had nd significant influence on outcome. At the same time a successful outcome, without the need for biliary stents, was obtained in 87,5% of patients after laparoscopic cholecystectomy versus 71,8% after open cholecystectomy. PMID:21311472

Agaev, B A; Muslimov, G F; Alieva, G R; Ibragimov, T R

2010-01-01

328

Cornice Duct System  

SciTech Connect

SYNERGETICS, INC., has designed, developed, and tested an air handling duct system that integrates the air duct with the cornice trim of interior spaces. The device has the advantage that the normal thermal losses from ducts into unconditioned attics and crawl spaces can be totally eliminated by bringing the ducts internal to the conditioned space. The following report details work conducted in the second budget period to develop the Cornice Duct System into a viable product for use in a variety of residential or small commercial building settings. A full-scale prototype has been fabricated and tested in a laboratory test building at the Daylighting Facility at North Carolina State University., Based on the results of that testing, the prototype design as been refined, fabricated, installed, and extensively tested in a residential laboratory house. The testing indicates that the device gives substantially superior performance to a standard air distribution system in terms of energy performance and thermal comfort. Patent Number US 6,511,373 B2 has been granted on the version of the device installed and tested in the laboratory house. (A copy of that patent is attached.) Refinements to the device have been carried through two additional design iterations, with a particular focus on reducing installation time and cost and refining the air control system. These new designs have been fabricated and tested and show substantial promise. Based on these design and testing iterations, a final design is proposed as part of this document. That final design is the basis for a continuation in part currently being filed with the U.5, Patent office.

Wayne Place; Chuck Ladd

2004-10-29

329

Fatigue in primary biliary cirrhosis  

Microsoft Academic Search

Primary biliary cirrhosis (PBC) is a chronic, autoimmune, cholestatic liver disease with a slowly progressive course. Without treatment, most patients eventually develop fibrosis of the liver and may need liver transplantation in the late stage of disease. Fatigue and pruritus are the most common symptoms of PBC, but the majority of patients are asymptomatic at first presentation. There is no

Ghulam Abbas; Roberta A. Jorgensen; Keith D. Lindor

2010-01-01

330

Isolated Right Segmental Hepatic Duct Injury Following Laparoscopic Cholecystectomy  

SciTech Connect

Purpose. Laparoscopic cholecystectomy (LC) is the treatment of choice for gallstones. There is an increased incidence of bile duct injuries in LC compared with the open technique. Isolated right segmental hepatic duct injury (IRSHDI) represents a challenge not only for management but also for diagnosis. We present our experience in the management of IRSHDI, with long-term follow-up after treatment by a multidisciplinary approach. Methods. Twelve consecutive patients (9 women, mean age 48 years) were identified as having IRSHDI. Patients' demographics, clinical presentation, management and outcome were collected for analysis. The mean follow-up was 44 months (range 2-90 months). Results. Three patients had the LC immediately converted to open surgery without repair of the biliary injury before referral. Treatments before referral included endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage and surgery, isolated or in combination. The median interval from LC to referral was 32 days. Eleven patients presented with biliary leak and biloma, one with obstruction of an isolated right hepatic segment. Post-referral management of the biliary lesion used a combination of ERCP stenting, percutaneous drainage and stent placement and surgery. In 6 of 12 patients ERCP was the first procedure, and in only one case was IRSHDI identified. In 6 patients, percutaneous transhepatic cholangiography (PTC) was performed first and an isolated right hepatic segment was demonstrated in all. The final treatment modality was endoscopic management and/or percutaneous drainage and stenting in 6 patients, and surgery in 6. The mean follow-up was 44 months. No mortality or significant morbidity was observed. Conclusion. Successful management of IRSHDI after LC requires adequate identification of the lesion, and multidisciplinary treatment is necessary. Half of the patients can be treated successfully by nonsurgical procedures.

Perini, Rafael F. [Medical University of South Carolina, Division of Gastroenterology (United States); Uflacker, Renan [University of South Carolina, Division of Interventional Radiology (United States)], E-mail: uflacker@musc.edu; Cunningham, John T. [Medical University of South Carolina, Division of Gastroenterology (United States); Selby, J. Bayne [University of South Carolina, Division of Interventional Radiology (United States); Adams, David [University of South Carolina, Division of GI Surgery (United States)

2005-04-15

331

Pneumoretroperitoneum, bilateral pneumothorax and emphysema following endoscopic biliary sphincterotomy.  

PubMed

We report a case of pneumothorax, subcutaneous emphysema and pneumoretroperitoneum after an endoscopic sphincterotomy. A 40-yr-old woman presented with dyspnea immediately after she had undergone an endoscopic retrograde cholangiopancreatogram for a residual stone in common bile duct. On arrival to our hospital, she complained about severe dyspnea and on examination subcutaneous emphysema was discovered. A CT scan was conducted and showed a right-sided pneumothorax, a pneumoretroperitoneum in the peritoneal cavity. We recommended to the patient an immediate laparotomic exploration. We discovered a duodenal perforation in which we sutured it with accompanying pyloric exclusion, double truncular vagotomy and gastroenteroanastomosis. Endoscopic retrograde cholangiopancreatogram (ERCP) is a popular procedure for biliary and pancreatic diseases, but it can cause severe complications such as intestinal perforation. Besides perforations, air can spread through the abdominal cavity, retroperitoneum, mediastinum, and the soft tissues of the neck, eventually causing pneumothorax. Early recognition and appropriate management is crucial for optimal results. PMID:23008997

Makni, A; Chebbi, F; Ben Safta, Z

332

Non-surgical approaches to stones in the biliary tree.  

PubMed

Medical treatment of cholesterol gall stones aims to dissolve the stones leaving the biliary tract stone-free and the gall bladder in situ. The introduction of extracorporeal shock wave lithotripsy and contact solvent therapy with methyl tert butyl ether have revolutionised the medical management of both gall bladder stones and bile duct stones which are too large to be treated by sphincterotomy. Both approaches represent a major advance over cheno- and ursodeoxycholic acid which are effective in less than 30% of cases and require prolonged therapy. All medical treatments require a functioning gall bladder and suffer from relapse rates in the order of 10% per annum. Secondary prophylaxis is expensive and the rate of compliance and long term safety have yet to be established. PMID:8339460

Keating, J J; Corrigan, O I; Chua, A; MacDonald, G S; Noonan, N; McNulty, J; Keeling, P W

1993-01-01

333

Modulation of the biliary expression of arylalkylamine N-acetyltransferase alters the autocrine proliferative responses of cholangiocytes in rats.  

PubMed

Secretin stimulates ductal secretion by interacting with secretin receptor (SR) activating cyclic adenosine 3',5'-monophosphate/cystic fibrosis transmembrane conductance regulator/chloride bicarbonate anion exchanger 2 (cAMP?CFTR?Cl(-) /HCO?3- AE2) signaling that is elevated by biliary hyperplasia. Cholangiocytes secrete several neuroendocrine factors regulating biliary functions by autocrine mechanisms. Melatonin inhibits biliary growth and secretin-stimulated choleresis in cholestatic bile-duct-ligated (BDL) rats by interaction with melatonin type 1 (MT1) receptor through down-regulation of cAMP-dependent signaling. No data exist regarding the role of melatonin synthesized locally by cholangiocytes in the autocrine regulation of biliary growth and function. In this study, we evaluated the (1) expression of arylalkylamine N-acetyltransferase (AANAT; the rate-limiting enzyme for melatonin synthesis from serotonin) in cholangiocytes and (2) effect of local modulation of biliary AANAT expression on the autocrine proliferative/secretory responses of cholangiocytes. In the liver, cholangiocytes (and, to a lesser extent, BDL hepatocytes) expressed AANAT. AANAT expression and melatonin secretion (1) increased in BDL, compared to normal rats and BDL rats treated with melatonin, and (2) decreased in normal and BDL rats treated with AANAT Vivo-Morpholino, compared to controls. The decrease in AANAT expression, and subsequent lower melatonin secretion by cholangiocytes, was associated with increased biliary proliferation and increased SR, CFTR, and Cl(-) /HCO?3- AE2 expression. Overexpression of AANAT in cholangiocyte cell lines decreased the basal proliferative rate and expression of SR, CFTR, and Cl(-) /HCO?3- AE2 and ablated secretin-stimulated biliary secretion in these cells. Conclusion: Local modulation of melatonin synthesis may be important for management of the balance between biliary proliferation/damage that is typical of cholangiopathies. (HEPATOLOGY 2013). PMID:23080076

Renzi, Anastasia; DeMorrow, Sharon; Onori, Paolo; Carpino, Guido; Mancinelli, Romina; Meng, Fanyin; Venter, Julie; White, Mellanie; Franchitto, Antonio; Francis, Heather; Han, Yuyan; Ueno, Yoshiyuki; Dusio, Giuseppina; Jensen, Kendal J; Greene, John J; Glaser, Shannon; Gaudio, Eugenio; Alpini, Gianfranco

2013-02-07

334

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

PubMed

Bilhemia or bile mixing with blood is a rare clinical problem. The clinical presentation is usually transient self-resolving hyperbilirubinemia, progressive and rapidly rising conjugated hyperbilirubinemia, or recurrent cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) plays an important role in diagnosis and management. Biliary decompression with endoscopic sphincterotomy is useful in treating these patients. If not recognized and treated in time, the condition can be fatal in a significant proportion of patients. This usually occurs after blunt or penetrating hepatic trauma due to a fistulous connection between the biliary radicle and portal or hepatic venous radical. Cases have been described due to iatrogenic trauma such as liver biopsy and percutaneous biliary drainage. However, the occurrence after trans-jugular intra-hepatic porto-systemic shunt (TIPS) is very rare. We report a case of bilhemia presenting as rapidly rising bilirubin after TIPS. The patient was managed successfully with ERCP and removal of a blood clot from the common bile duct. PMID:19653349

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

2009-08-01

335

[Interstitial lung disease in patients with primary biliary cirrhosis].  

PubMed

Primary biliary cirrhosis (PBC) is a chronic autoimmune disorder of unknown etiology. The disease affects middle-aged women and is characterized by the destruction of the intralobular bile ducts that causes consequent cholestasis. AMA is a hallmark of PBC, composed mostly of IgG and IgM class. The M2 antibody is the most specific one, with sensitivity range of 54-98% depending on type of test used. PBC is often accompanied by other autoimmune diseases, such as Sjögrens syndrome, thyroiditis, rheumatoid arthritis, dermatomyositis, polymyositis. Interstitial lung disease (ILD) has been reported in patients with primary biliary cirrhosis but its frequency and nature are poorly understood. We report pulmonary involvement in the course of PBC in 4 middle-aged women. Histopatological examination of lung specimens was available in three patients: two presented with sarcoid - like granulomas, one with lymphocytic interstitial pneumonia (LIP). In one patient the diagnosis of pulmonary fibrosis was based on clinical and radiological features. Because of abnormal pulmonary function tests (PFT) results all the patients were treated with prednisone, one, additionally with azathioprine. The treatment was successful in all of the patients. PMID:22926910

Bartosiewicz, Ma?gorzata; Siemion-Szcze?niak, Izabela; J?drych, Ma?gorzata; Radwan-Röhrenschef, Piotr; Lewandowska, Katarzyna; Langfort, Renata; Oniszh, Karina; Franczuk, Monika; Ku?, Jan

2012-01-01

336

Role for mycobacterial infection in pathogenesis of primary biliary cirrhosis?  

PubMed Central

Primary biliary cirrhosis (PBC) is a progressive cholestatic liver disease characterized by the immune-mediated destruction of biliary epithelial cells in small intrahepatic bile ducts. The disease is characterized by circulating antimitochondrial antibodies (AMAs) as well as disease-specific antinuclear antibodies, cholestatic liver function tests, and characteristic histological features, including granulomas. A variety of organisms are involved in granuloma formation, of which mycobacteria are the most commonly associated. This has led to the hypothesis that mycobacteria may be involved in the pathogenesis of PBC, along with other infectious agents. Additionally, AMAs are found in a subgroup of patients with mycobacterial infections, such as leprosy and pulmonary tuberculosis. Antibodies against species-specific mycobacterial proteins have been reported in patients with PBC, but it is not clear whether these antibodies are specific for the disease. In addition, data in support of the involvement of the role of molecular mimicry between mycobacterial and human mitochondrial antigens as triggers of cross-reactive immune responses leading to the loss of immunological tolerance, and the induction of pathological features have been published. Thus, antibodies against mycobacterial heat shock protein appear to cross-recognize AMA-specific autoantigens, but it is not clear whether these autoantibodies are mycobacterium-species-specific, and whether they are pathogenic or incidental. The view that mycobacteria are infectious triggers of PBC is intriguing, but the data provided so far are not conclusive.

Smyk, Daniel; Rigopoulou, Eirini I; Zen, Yoh; Abeles, Robin Daniel; Billinis, Charalambos; Pares, Albert; Bogdanos, Dimitrios P

2012-01-01

337

Characteristic differences according to the cirrhotic pattern of advanced primary biliary cirrhosis: Macronodular cirrhosis indicates slow progression  

Microsoft Academic Search

It is important to evaluate advanced primary biliary cirrhosis (PBC) clinicopathologically to clarify its progressive mechanism. According to the cirrhotic pattern, 26 cases of explanted PBC were classified into non-cirrhotic (n=4), macronodular (n=4), mixed nodular (n=6), and micronodular cirrhosis (n=12), to compare their clinical and morphological features. In addition, the degree of preserved intrahepatic bile ducts and other histologic features

Shinichi Aishima; Yousuke Kuroda; Yunosuke Nishihara; Kenichi Taguchi; Tomoharu Yoshizumi; Akinobu Taketomi; Yoshihiko Maehara; Masazumi Tsuneyoshi

2006-01-01

338

Positron emission tomography with [ 18F]fluoro-2-deoxy-D-glucose for diagnosis and staging of bile duct cancer  

Microsoft Academic Search

Malignant tumors with high glucose metabolic rates accumulate [18F]-fluorodeoxyglucose (FDG), a positron emitting tracer. The aim of this study was to evaluate FDG positron emission tomography (PET) for detection and staging of human cholangiocarcinoma (CC). Patients with adenocarcinoma of the biliary tree (n = 26), with benign lesions of the bile ducts (n = 8), and 20 control patients underwent

Regine Kluge; Frank Schmidt; Karel Caca; Henryk Barthel; Swen Hesse; Peter Georgi; Anita Seese; Dominik Huster; Frieder Berr

2001-01-01

339

Multicenter Randomized Trial of 10-French versus 11.5-French Plastic Stents for Malignant Biliary Obstruction  

PubMed Central

Background. There is little prospective data on whether bigger plastic stents are better for patients with malignant biliary obstruction with jaundice. Goals. Multicenter prospective study to compare technical success, clinical response, stent occlusion, and patient survival in patients with malignant biliary obstruction randomized to 10-French or 11.5-French plastic stent. Study. Patients with malignant biliary obstruction were randomized to 10-French or 11.5-French biliary stents. Patients were prospectively assessed for stent occlusion, stent-related interventions, hospital stay, and change in bilirubin. Main outcome measurements included technical success, clinical response, rates of stent occlusion, and survival. Results. 234 patients (47 hilar and 187 common bile duct strictures) were randomized. Outcomes were similar for the 10-French and 11.5-French groups (technical success 99.1% versus 97.4%, P = 0.37). Overall, median stent survival was 213 days, but there was no statistically significant difference in stent survival between 10-French and 11.5-French stents (149 versus 258 days, P = 0.16). Stent survival was significantly longer when placed for common bile duct versus hilar strictures (231 versus 115 days, P = 0.049). Conclusions. The theoretical advantage of improved bile flow for the 11.5-French stent does not translate into more prolonged patency, better clinical response, and longer patient survival than the 10-French stent.

Wagh, Mihir S.; de Bellis, Mario; Fogel, Evan L.; Frakes, James T.; Johanson, John F.; Qaseem, Tahir; Howell, Douglas A.; Lehman, Glen A.; Sherman, Stuart

2013-01-01

340

Accidental insertion of biliary endoprosthesis in the portal vein: A case report.  

PubMed

Accidental insertion of a biliary endoprosthesis in the portal vein is exceptional. We report this rare complication observed in a liver transplant recipient. A sixty-year-old woman underwent liver transplantation for cirrhosis due to primary Budd-Chiari syndrome. Two months after the transplantation, she presented with jaundice. Abdominal ultrasound and biliary MRI identified a short stricture of the common bile duct. A biliary endoprosthesis was inserted leading to partial regression of the jaundice and normalization of liver enzymes. Two months later the patient complained of abdominal pain. Liver tests were perturbed. Abdominal computed tomography showed partial migration of the prosthesis in the duodenum. Endoscopy was performed to remove the prosthesis and replace it with another. The patient rapidly developed right upper quadrant pain with fever. Abdominal ultrasound and computed tomography showed the prosthesis in the portal vein. The biliary endoprosthesis was accidentally inserted in the portal vein. The presence of a postoperative portobiliary fistula was the cause of this complication. Surgical removal was successful and the postoperative outcome was uneventful. PMID:21295538

Miloudi, N; Hefaiedh, R; Mzoughi, Z; Ben Abid, S; Mestiri, H; Ghorbel, A; Khalfallah, T

2011-02-01

341

Dilatational band formation in bone.  

PubMed

Toughening in hierarchically structured materials like bone arises from the arrangement of constituent material elements and their interactions. Unlike microcracking, which entails micrometer-level separation, there is no known evidence of fracture at the level of bone's nanostructure. Here, we show that the initiation of fracture occurs in bone at the nanometer scale by dilatational bands. Through fatigue and indentation tests and laser confocal, scanning electron, and atomic force microscopies on human and bovine bone specimens, we established that dilatational bands of the order of 100 nm form as ellipsoidal voids in between fused mineral aggregates and two adjacent proteins, osteocalcin (OC) and osteopontin (OPN). Laser microdissection and ELISA of bone microdamage support our claim that OC and OPN colocalize with dilatational bands. Fracture tests on bones from OC and/or OPN knockout mice (OC(-/-), OPN(-/-), OC-OPN(-/-;-/-)) confirm that these two proteins regulate dilatational band formation and bone matrix toughness. On the basis of these observations, we propose molecular deformation and fracture mechanics models, illustrating the role of OC and OPN in dilatational band formation, and predict that the nanometer scale of tissue organization, associated with dilatational bands, affects fracture at higher scales and determines fracture toughness of bone. PMID:23129653

Poundarik, Atharva A; Diab, Tamim; Sroga, Grazyna E; Ural, Ani; Boskey, Adele L; Gundberg, Caren M; Vashishth, Deepak

2012-11-05

342

Effect of complete biliary-tract obstruction on serial hepatobiliary imaging in an experimental model: concise communication. [Dogs  

SciTech Connect

In order to determine the effect of biliary obstruction on hepatocyte clearance and bile flow, five dogs were imaged before, and three times a week after, surgical ligation of the common bile duct. THe first postoperative study was performed 3 hr after surgery. Bile flow and duct function were evaluated from analog images; hepatocyte clearance (HC) was estimated in digital images from the ratio of liver to cardiac blood-pool counts at 3 min. Liver function tests were measured serially. 3 hr after surgery the HC index and liver function tests were still normal. Analog images showed no intestinal radioactivity, but accumulation was seen in the distending biliary tract. on the third postoperative day, all liver function tests were abnormal and the HC index was significantly decreased (p less than 0.01). The biliary tract was never seen beyond the first postoperative day. Thus, complete obstruction of the common bile duct does not stop bile flow or cause significant hepatocyte damage in the first few hours. By the third day of obstruction, however, no bile flow is detectible and significant hepatocyte damage has occurred.

Klingensmith, W.C.; Whitney, W.P.; Spitzer, V.M.; Klintmalm, G.B.; Koep, L.M.; Kuni, C.C.

1981-01-01

343

Endoscopic management of biliary fascioliasis: a case report  

PubMed Central

Introduction Fasciola hepatica, an endemic parasite common in Iraq and its neighboring countries, is a very rare cause of cholestasis worldwide. Humans can become definitive hosts of this parasite through their ingestion of a contaminated water plant, for example, contaminated watercress. Symptoms of cholestasis may appear suddenly and, in some cases, are preceded by long periods of fever, eosinophilia, and vague gastrointestinal symptoms. Here we report the case of a woman with a sudden onset of symptoms of cholangitis. Her infection was proved by endoscopic retrograde cholangiography to be due to Fasciola hepatica infestation. Case presentation A 38-year-old Kurdish woman from the northern region of Iraq presented with fever, right upper quadrant abdominal pain, and jaundice. An examination of the patient revealed elevated total serum bilirubin and liver enzymes. An ultrasonography also showed a dilatation of her common bile duct. During endoscopic retrograde cholangiopancreatography, a filling defect was identified in her common bile duct. After sphincterotomy and balloon extraction, one live Fasiola hepatica was extracted and physically removed. Conclusion Fasciola hepatica should be a part of the differential diagnosis of common bile duct obstruction. When endoscopic retrograde cholangiopancreatography is available, the disease can be easily diagnosed and treated.

2010-01-01

344

Lipoic acid prevents development of the hyperdynamic circulation in anesthetized rats with biliary cirrhosis.  

PubMed

Chronic bile duct ligation is associated with the development of oxidant injury, biliary cirrhosis, portal hypertension, and a hyperdynamic circulation. We have previously demonstrated that the hyperdynamic circulation in the partial portal vein-ligated rat can be prevented by the administration of N-acetylcysteine. To extend these findings, we have examined the effect of lipoic acid, a thiol-containing antioxidant, on hemodynamics, oxidative stress, and nitric oxide (NO) production in bile duct-ligated (BDL) cirrhotic rats. Lipoic acid was given continuously in drinking water to normal and BDL rats; control rats received ordinary drinking water, and animals were studied at 24 days following surgery. Lipoic acid prevented the development of the hyperdynamic circulation (cardiac index [CI]: 15.7 +/- 2.0 vs. 29.5 +/- 2.1 mL x min-1 x 100 g-1; P <. 05) and significantly attenuated the rise in portal pressure (PP) (12.7 +/- 0.8 vs. 15.2 +/- 0.5 mm Hg; P <.05). Hepatic nitric oxide synthase (NOS) activity and plasma nitrite/nitrate concentration increased significantly following bile duct ligation, and both of these were prevented by lipoic acid. Lipoic acid had no effect on the biochemical or histological parameters of liver function in the cirrhotic group. We conclude that lipoic acid prevents the development of the hyperdynamic circulation in the rat model of biliary cirrhosis, and that this is associated with decreased synthesis of NO. PMID:10216116

Marley, R; Holt, S; Fernando, B; Harry, D; Anand, R; Goodier, D; Davies, S; Moore, K

1999-05-01

345

Role of liver function enzymes in diagnosis of choledocholithiasis in biliary colic patients.  

PubMed

Liver functional tests due to inflammatory process which induced by cholecystitis might changed and some clinicians suggested that these changes might help us to stone prediction in common bile ducts and decrease hazards of performing ERCP and other invasive procedures. Present study was performed for assessment of role of liver functional test in diagnosis of common bile duct stone in patients with cholecystitis and help in their management. Present prospective study was performed between April 2010 and March 2011 on 350 patients who come to our hospital with cholecystitis or biliary colic diagnosis. Patients with cholesistitis diagnosis were underwent operation for removing gall bladder stone and retrograde cholangiopancreatography (ERCP) was performed for patients with suspicious to biliary colic and common bile duct (CBD) stones. Ultrasonography, aspartate aminotransferases (AST), alanine aminotransferases (ALT), alkaline phosphatase (ALP) and direct and total serum bilirubin were measured for all of participated patients. Mean of AST. ALT, ALP and total and direct bilirubin were had no significant differences between two study groups. In logistic regression analysis, after entering into the model only CBD diameter (OR: 20; P=0.00) and elevated serum level of ALT (OR: 2; P=0.04) were remained into the model and were known as independent predictor of cholelithiasis. Elevated level of liver enzymes had not main role in CBD diagnosis and ERCP had no to perform for suspicious CBD stone only with elevated liver enzyme and even with normal ultrasonography findings. Endosonography as non invasive procedure recommend for patients before ERCP. PMID:22071641

Zare, Mohammad; Kargar, Saeed; Akhondi, Mohsen; Mirshamsi, Mohammad Hussein

2011-01-01

346

Biliary Complications in Living Donor Liver Transplantation: Imaging Findings and the Roles of Interventional Procedures  

SciTech Connect

Purpose. To describe the incidence, types, and findings of biliary complications in living donor liver transplantation (LDLT) and to determine the roles of interventional procedures. Materials and methods. Twenty-four biliary complications among 161 LDLT patients (24/161, 14.9%) were identified. These complications were divided into two groups according to the initial manifestation time, i.e., 'early' (<60 days) or 'late'. The CT and cholangiographic findings were reviewed regarding the presence of a stricture or leak and the location, and length, shape, and degree of the stricture. Both groups were categorized into three subgroups: leak, stricture, and both. The type of interventional procedures used and their roles were determined. Results. Early complications were identified in 14 of the 24 patients (58%) and late complications in 11 (46%). One patient showed both early and late complications. Biliary stricture was detected in 10 patients, leak in 10, and both in 5. By cholangiography, all strictures were irregular and short (mean length 15 {+-} 6 mm) at the anastomotic site and complete obstruction was observed in 2 patients with late stricture. Twenty-three of the 24 patients were treated using percutaneous and/or endoscopic drainage procedures with or without balloon dilatation. Seventeen (74%) showed a good response, but reoperations were inevitable in 6 (26%). All patients except those with complete obstruction showed a favorable outcome after interventional management. Conclusion. Biliary leaks and strictures are predominant complications in LDLT. Most show good responses to interventional treatment. However, complete obstruction needs additional operative management.

Chang, Jung Min; Lee, Jeong Min; Suh, Kyung Suk; Yi, Nam Joon; Kim, Yong Tae; Kim, Se Hyung; Han, Joon Koo, E-mail: hanjk@radcom.snu.ac.kr; Choi, Byung Ihn [Seoul National University College of Medicine, Department of Radiology and Institute of Radiation Medicine (Korea, Republic of)

2005-12-15

347

A mobilized dilation angle model for rocks  

Microsoft Academic Search

Experimental and field observations of rock failure show that the failure process is closely associated with rock dilation, an indicator of volumetric increase during rock deformation. The most common concept used to describe dilation is the dilation angle. The conventional Mohr–Coulomb model considering strain-softening often makes an assumption of constant dilation, but it is observed that the approach is not

X. G. Zhao; M. Cai

2010-01-01

348

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

PubMed

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. PMID:24147198

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

2013-10-16

349

Migration of a biliary stent causing duodenal perforation and biliary peritonitis  

PubMed Central

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.

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

2013-01-01

350

Biliary parasites: Diagnostic and therapeutic strategies  

Microsoft Academic Search

Opinion statement  Parasitic infections of the biliary tract are a common cause of biliary obstruction in endemic areas. This article focuses\\u000a on primary biliary parasites: Ascaris lumbricoides, Clonorchis sinensis, Opisthorchis viverrini, Opisthorchis felineus, Dicrocoelium dendriticum, Fasciola\\u000a hepatica, and Fasciola gigantica. Tropical and subtropical countries have the highest incidence and prevalence of these infections. Diagnosis is made primarily\\u000a through direct microscopic examination

Niraj Khandelwal; Joanna Shaw; Mamta K. Jain

2008-01-01

351

Parasitic infestations of the biliary tract  

Microsoft Academic Search

Parasitic infestations of the biliary tract are a common cause of biliary obstruction in tropical countries and can lead to\\u000a such serious complications as cholangitis and cholangiocarcinoma. Endoscopic therapy has helped in the management of biliary\\u000a complications caused by these parasites. Ascaris lumbricoides organisms, which normally reside in the jejunum, are actively motile and can invade the papilla, thus migrating

Surinder Singh Rana; Deepak Kumar Bhasin; Mohit Nanda; Kartar Singh

2007-01-01

352

Pertussis in Nonimmunized Postsurgical Biliary Atresia  

PubMed Central

A case of pertussis in a patient who had undergone hepatic portocholecystostomy for biliary atresia is described. It has been recommended that infants with postsurgical biliary atresia forgo immunizations because of the high incidence of “ascending cholangitis.” The patient in this study, however, had two characteristics that decreased her susceptibility to ascending cholangitis. This report suggests that patients with postsurgical biliary atresia who undergo hepatic portocholecystostomy rather than hepatic portoenterostomy or do not achieve bile drainage should be immunized according to schedule.

Johnson, Mark S.

1984-01-01

353

A novel use for myocardial perfusion scans: diagnosis of bile duct injury.  

PubMed

A 69-year-old woman was admitted to a tertiary care centre after suffering from an iatrogenic bile duct injury, diagnosed by the unexpected leakage of bile during laparotomy for a colectomy. On initial assessment the patient was clinically stable, although she remained intubated after her surgery. In order to diagnose whether or not she sustained a complete or partial bile duct injury, a finding that would determine if she underwent conservative management or surgical repair, a technetium-99m-hepatobiliary scan was requested. Owing to a shortage in technetium-99m-iminodiacetic acids, the radiopharmaceutical (tracer) for this imaging test, a decision was made to employ technetium-99m-tetrofosmin, the tracer for cardiac scans (traditionally used for diagnosis of myocardial perfusion) as it has been established that this tracer is excreted in the biliary tract. The imaging showed flow of bile into the bowel, thereby establishing bile duct continuity and permitting conservative management. PMID:23925677

Donahoe, Laura; Barnes, David C; Alwayn, Ian

2013-08-07

354

Endoclip Migration into the Common Bile Duct with Stone Formation: A Rare Complication after Laparoscopic Cholecystectomy  

PubMed Central

Introduction: Endoclip migration into the common bile duct after laparoscopic cholecystectomy is a rare complication. Very few cases have been reported in the literature, mostly in the form of case reports. Case Description: We report a case of Endoclip migration into the bile duct with stone formation 6 y after laparoscopic cholecystectomy. The patient presented with recurrent abdominal pain and intermittent jaundice for 6 mo. Diagnosis was suspected when a computed tomography scan of the abdomen showed a metallic density artifact in the lower end of the bile duct. The diagnosis was confirmed by endoscopic retrograde cholangiopancreatography. The patient was successfully managed by endoscopic stone and clip removal. Discussion: Endoclip migration with biliary complications should be considered in the differential diagnosis of postcholecystectomy problems. The clinical manifestations and management are similar to that of noniatrogenic choledocholithiasis.

Bhattacharya, Sankar Prasad

2013-01-01

355

Biliary excretion of antimicrobial drugs.  

PubMed

The development of drugs able to prevent and cure bacterial infections is one of the 20th century's major contributions to human longevity and quality of life. Antibacterial agents are among the most commonly prescribed drugs of any kind worldwide. Used appropriately, these drugs are lifesaving. To eliminate an infection as rapidly as possible, a sufficient concentration of the drug(s) chosen must reach the site of infection. Serum/tissue concentration is a result of various parameters such as absorption, excretion, protein binding and metabolic inactivation. Biliary excretion is an important route for the elimination of some drugs and drug metabolites in humans. Thus, drugs with a high bile concentration are indicated for the treatment of gallbladder infectious diseases. We present a review of a large number of antimicrobial agents most commonly used in daily clinical practice, with regard to their biliary excretion. PMID:12673103

Karachalios, George; Charalabopoulos, Konstantinos

2002-01-01

356

Fatigue in primary biliary cirrhosis  

Microsoft Academic Search

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 tests

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

1998-01-01

357

Whistler leakage from narrow ducts  

NASA Astrophysics Data System (ADS)

Low altitude satellite observations of a variation in the upper cut-off-frequency of whistlers with latitude (at constant altitude) can be convincingly explained in terms of different whistler frequencies leaving a duct at different altitudes. This selective leakage is explained by a downcoming wave escaping from a duct at an altitude where its wavelength becomes approximately equal to the duct width. This altitude is shown to decrease with increasing wave frequency. Leakage according to this mechanism is shown to result in a minimum duct width at a given altitude for ducted guidance of VLF waves. It is found to be consistent with the distribution of duct widths inferred from whistler observations made aboard the low altitude satellite ISIS 1.

Strangeways, H. J.

1986-05-01

358

Liver Transplantation for Biliary Atresia  

PubMed Central

Orthotopic liver transplantation was performed 15 months to 20 years ago in 126 recipients, all of whom were under 18 years of age. Eighty-six of these pediatric recipients were treated before 1980 with azathioprine (or cyclophosphamide) and prednisone, to which antilymphocyte globulin (ALG) usually was added. One-year patient survival was 40%. In the last 40 cases, the new drug cyclosporine has been given with low doses of steroids. The one-year patient survival increased to 65%. Both in the pre-cyclosporine era and more recently, the survival of patients with biliary atresia has been lower than in the next largest category of patients, namely, those with liver-based inborn metabolic errors. The difficulty of operation in patients with biliary atresia has been greater than in recipients with other diagnoses, partly because of previous operations such as portoenterostomy (Kasai procedure). Hepatic portoenterostomy, worthwhile as it is, has posed technical difficulties for eventual liver transplantation, particularly when complicated Roux limb techniques or venting procedures have been applied. In our total experience the longest survival after liver replacement in a child whose original diagnosis was biliary atresia is 13? years.

Iwatsuki, Shunzaburo; Shaw, Byers W.; Starzl, Thomas E.

2010-01-01

359

A modern approach to malignant hilar biliary obstruction.  

PubMed

Management of patients with malignant hilar biliary obstruction is challenging for all specialists involved in their care. Evaluation should focus on potential surgical resection, which offers the principal chance of cure; liver transplantation is offered as an experimental treatment at a few centers. Attempt at curative surgical resection is appropriate for selected tumors and often requires partial hepatectomy. Diagnosis and staging is now facilitated by the use of magnetic resonance cholangiopancreatography (MRCP), spiral computed tomography, and endoscopic ultrasonography, which should largely supplant invasive cholangiography. Use of endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography should be limited primarily to palliation of jaundice in patients with unresectable tumors and to establish tissue diagnoses in ambiguous cases. Palliation of jaundice is optimal with self-expanding metallic stents. Safe and effective drainage can be achieved by using MRCP for targeted endoscopic placement of unilateral metal stents in most cases, with bilateral stents rarely required unless undrained ducts are contaminated. Other palliative modalities for bile duct tumors include surgical bypass, intraluminal and external beam radiation therapy, chemotherapy, and photodynamic therapy. PMID:14668691

Freeman, Martin L; Sielaff, Timothy D

2003-01-01

360

Necessity of a repeat cholangiogram during biliary stent removal after postcholecystectomy bile leak  

PubMed Central

PURPOSE: To assess the need for repeat endoscopic retrograde cholangiography (ERC) in patients undergoing biliary stent removal after management of postcholecystectomy bile leak. METHODS: A retrospective analysis of the Clinical Outcomes Research Initiative endoscopy database at PennState Milton S Hershey Medical Center (Hershey, Pennsylvania, USA) identified all patients referred for ERC with an indication of postcholecystectomy bile leak from January 2001 to June 2010. Baseline demographics, location of bile leak, size of biliary stent placed, duration of stenting, bile leak persistence, and the presence of stone, sludge or strictures on repeat ERC were analyzed. RESULTS: A total of 81 patients underwent ERC for management of bile leaks after cholecystectomy. One patient was excluded due to a complete transection of the common bile duct necessitating immediate surgical intervention. Fourteen (17.5%) patients underwent open cholecystectomy, 46 (57.5%) underwent laparoscopic procedures and 10 (12.5%) procedures were converted from a laparoscopic to an open approach intraoperatively. Of the 80 patients, 47 (58.7 %) had a cystic duct leak, 11 (13.7 %) had a right hepatic duct leak, 11 (13.7%) had a common bile duct leak, five (6.2%) had a gallbladder fossa leak, four (5%) had a common hepatic duct leak and the remaining two (2.5%) had a left hepatic duct leak. All 80 patients underwent biliary stenting as part of management for their bile leak. Fifty-seven of the 80 patients (71.2%) had a 10 Fr stent placed, with the remainder undergoing placement of a 7 Fr stent. Seventy-five (93.7%) patients underwent biliary sphincterotomy during the initial ERC. Sixty-nine patients underwent repeat ERC after a mean duration of 8.2 weeks (range 0.4 to 18.5 weeks). Eleven patients had no reviewable records regarding a repeat procedure performed for stent removal. Three patients required an early repeat ERC due to suspicion of cholangitis and, hence, were excluded from the final analysis. Of the 66 patients included in the final analysis, 61 (92.4%) had resolution of their bile leak on repeat ERC. All patients had resolution of their bile leak by the third ERC. Fifteen patients (22.7%) had an abnormality on repeat cholangiography (persistent leak in four, stones in three, sludge in seven, and a combination of leak and stone in one) that required further endoscopic intervention including balloon sweep or additional stenting. CONCLUSION: Although the majority of postcholecystectomy bile leaks resolve after biliary stent placement, a sizeable percentage (22.7%) of patients had abnormalities on subsequent cholangiograms that required further intervention. These findings suggest the need for a repeat ERC at the time of biliary stent removal in the management of postcholecystectomy bile leaks.

Jain, Vishal; Yeasted, Nathan; Pooran, Nakechand

2012-01-01

361

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

SciTech Connect

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

Culp, William C., E-mail: culpwilliamc@uams.edu; McCowan, Timothy C. [University of Arkansas for Medical Sciences, Department of Radiology (United States); DeValdenebro, Miguel [University of Texas Medical Branch, Department of Anesthesiology (United States); Wright, Lonnie B.; Workman, James L. [University of Arkansas for Medical Sciences, Department of Radiology (United States); Culp, William C. [Scott and White Clinic and Memorial Hospital, The Texas A and M University System Health Science Center College of Medicine, Department of Anesthesiology (United States)

2006-12-15

362

Androgen Receptor CAG Repeat Length and Risk of Biliary Tract Cancer and Stones  

PubMed Central

Biliary tract cancers, encompassing cancers of the gallbladder, extrahepatic bile ducts, and ampulla of Vater, are rare but highly fatal. Gallstones represent the major risk factor for biliary tract cancer, and share with gallbladder cancer a female predominance and an association with reproductive factors and obesity. While estrogens have been implicated in earlier studies of gallbladder cancer, there are no data on the role of androgens. Since intracellular androgen activity is mediated through the androgen receptor (AR), we examined associations between AR CAG repeat length [(CAG)n] and the risk of biliary tract cancers and stones in a population-based study of 331 incident cancer cases, 837 gallstone cases, and 750 controls from Shanghai, China, where the incidence rates for biliary tract cancer are rising sharply. Men with (CAG)n>24 had a significant 2-fold risk of gallbladder cancer (odds ratio [OR]=2.00; 95% confidence interval [CI] 1.07–3.73), relative to those with (CAG)n?22. In contrast, women with (CAG)n>24 had reduced gallbladder cancer risk (OR=0.69, 95% CI 0.43–1.09) relative to those with (CAG)n?22; P-interaction sex=0.01), which was most pronounced for women aged 68–74 (OR=0.48, 95% CI 0.25–0.93; P-interaction age=0.02). No associations were found for bile duct cancer or gallstones. Reasons for the heterogeneity of genetic effects by gender and age are unclear but may reflect an interplay between AR and the levels of androgen as well as estrogen in men and older women. Further studies are needed to confirm these findings and clarify the mechanisms involved.

Meyer, Tamra E.; O'Brien, Thomas G.; Andreotti, Gabriella; Yu, Kai; Li, Qizhai; Gao, Yu-Tang; Rashid, Asif; Shen, Ming-Chang; Wang, Bing-Sheng; Han, Tian-Quan; Zhang, Bai-He; Niwa, Shelley; Fraumeni, Joseph F.; Hsing, Ann W.

2010-01-01

363

Biliary excretion and enterohepatic circulation of 1-nitropyrene metabolites in Fischer-344 rats.  

PubMed

1-Nitropyrene (1-NP), present in diesel engine emissions, is a potent mutagen to bacteria, such as those found in mammalian intestinal tract, which contain nitroreductase enzymes. The purposes of this study were to determine the importance of bile as a route of excretion of 1-NP metabolites and to determine if reabsorption of biliary metabolites required the presence of intestinal bacteria. The bile ducts of male Fischer-344 rats were cannulated, 0.3 or 1.2 mumoles [3H]1-NP was given i.v., and bile, urine, and feces were collected for 24 hr. Biliary excretion accounted for 70 (80%) or 170 (60%) nmoles of [3H]1-NP after the low and high dose, respectively, with half-times for excretion of 1.7 hr +/- 0.3 (+/- S.E.M.) and 3.4 hr +/- 1.6 (+/- S.E.M.). Excretion of [3H]1-NP equivalents in the urine was linearly related to dose, with 6 or 16 nmoles (8%) excreted in 24 hr. At the low dose, more radioactivity appeared in the urine in control rats compared to bile-duct cannulated rats, suggesting that reabsorption of 1-NP metabolites occurred. Pretreatment of rats with orally administered antibiotics prior to i.v. injection of 0.3 mumole [3H]1-NP decreased radioactivity excreted in urine compared to untreated controls, suggesting that intestinal microorganisms may alter the biliary metabolites of 1-NP to facilitate reabsorption. Pretreatment of rats with buthionine sulfoximine, a glutathione depletor, decreased the excretion of certain biliary metabolites, suggesting that they were mercapturic acids of 1-NP metabolites. In summary, the results of these studies indicate that bile was an important route of excretion of nitropyrene metabolites. A portion of the excreted metabolites was reabsorbed from the gut, and this reabsorption required the presence of gut microorganisms. PMID:4015679

Medinsky, M A; Shelton, H; Bond, J A; McClellan, R O

1985-07-01

364

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

SciTech Connect

Purpose: To evaluate the therapeutic effect of percutaneous transhepatic biliary drainage (PTBD) in patients with obstructive jaundice caused by biliary involvement of hepatocellular carcinomas (HCC) and to determine the prognostic factors. Methods: We retrospectively analyzed the data of 22 consecutive patients (M:F = 20:2, mean age 52.8 years).Inclusion criteria were the patient having obstructive jaundice caused by HCC that invaded the bile ducts and having at least 4 weeks of follow-up data after the PTBD. We defined 'good response' and 'poor response' as whether the level of total bilirubin decreased more than 50% in 4 weeks or not. Total bilirubin level (T-bil),Child-Pugh score and the location of biliary obstruction for the two groups were compared. In addition, the interval between clinical onset of jaundice and PTBD, the degree of parenchymal atrophy and the size of the primary tumor were compared. Results: Of the 22 patients, 13 (59.1%) showed good response. T-bil was significantly lower in the good response group than in the poor (14.2 {+-} 6 mg/dlvs 25.9 {+-} 13.8 mg/dl, p = .017). In the five patients with T-bil <10 mg/dl, four (80%) showed good response,while in nine patients with T-bil > 20 mg/dl, only three (33%)showed good response. Although statistically not significant, patients with Child score <10 showed better results [good response rate of 66.7% (12/18)] than patients with Child score ?10 [good response rate of 25% (1/4)]. Involvement of secondary confluence of the bile duct also served as a poor prognostic factor (p =0.235). The interval between clinical onset of jaundice and PTBD, the presence of parenchymal atrophy and the size of the tumor did not show significant effect. Conclusion: Early and effective biliary drainage might be necessary in this group of patients with limited hepatic function.

Lee, Joon Woo; Han, Joon Koo; Kim, Tae Kyoung; Choi, Byung Ihn; Park, Seong Ho; Ko, Young Hwan; Yoon, Chang Jin; Yeon, Kyung-Mo [Department of Radiology and the Institute of Radiation Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744 (Korea, Republic of)

2002-06-15

365

An evaluation of electrosurgical vessel-sealing devices in biliary tract surgery in a porcine model  

PubMed Central

Objectives: The purpose of this study was to evaluate two electrosurgical vessel-sealing devices in biliary surgery. Methods: Porcine common bile ducts (CBDs) were sealed with two electrosurgical devices, an electrothermal bipolar vessel-sealing device (EBVS) and ultrasonic coagulation shears. Acute study animals underwent surgical bile duct sealing followed by immediate burst pressure testing. Chronic study animals were maintained for 1 week postoperatively and then tested. Results: The seal failure rate in the acute study was 50% for both the EBVS device and shears, and 0% for the laparoscopic surgical clip device used as a control. The latter had significantly higher burst pressures (646.2 ± 281.8 mmHg; P = 0.006) than the EBVS device (97.6 ± 86.6 mmHg) and shears (71.7 ± 89.3 mmHg). No significant difference in burst pressures was noted between the EBVS device and shears (97.6 ± 86.6 mmHg vs. 71.7 ± 89.3 mmHg). In the chronic study, obvious bile leaks occurred in one of four pigs (25%) in the EBVS device subgroup and two of four pigs (50%) in the shears subgroup. The average proximal CBD pressure in seven pigs was 16.1 ± 4.1 mmHg. The average chronic burst pressure in the control subgroup was 1088.0 ± 922.6 mmHg. Conclusions: Given the high rates of failure of the EBVS device and the shears in consistently sealing biliary ducts, we do not recommend their routine use in biliary surgery.

Hope, William W; Padma, Srikanth; Newcomb, William L; Schmelzer, Thomas M; Heath, Jessica J; Lincourt, Amy E; Heniford, B Todd; Norton, H James; Martinie, John B; Iannitti, David A

2010-01-01

366

Intrahepatic artery pseudoaneurysm associated with a metallic biliary stent after living donor liver transplantation: report of a case.  

PubMed

An intrahepatic artery pseudoaneurysm (IHAA) is a very rare but potentially lethal complication occurring after liver transplantation. This report presents a case of an IHAA associated with a metallic biliary stent after liver transplantation. A 40-year-old male underwent living donor liver transplantation (LDLT) using a left lobe graft. The bile duct reconstruction was performed with Roux-en-Y hepaticojejunostomy. He developed obstructive jaundice 5 years after LDLT, and had biliary stricture of the anastomosis area, therefore, the two metallic biliary stents were finally positioned at the stricture of the biliary tract. He suddenly developed hematemesis 8 years after LDLT, and computerized tomography scan showed an IHAA. Although seven interlocking detachable coils were placed at the neck of the aneurysm, hematemesis recurred 3 days after the initial embolization. Therefore, retransplantation was successfully performed 25 days after the embolization of IHAA using a right lobe graft from his son. In conclusion, metal stent insertion can lead to the fatal complication of HAA. The placement of a metallic stent could have been avoided in this case. Percutaneous metallic stent insertion for biliary stenosis after liver transplantation should therefore only be performed in carefully selected patients. PMID:22914885

Harada, Noboru; Shirabe, Ken; Soejima, Yuji; Taketomi, Akinobu; Yoshizumi, Tomoharu; Asonuma, Katsuhiro; Inomata, Yukihiro; Maehara, Yoshihiko

2012-08-23

367

Diagnostic utility of CD10 in benign and malignant extrahepatic bile duct lesions.  

PubMed

CD10, a cell surface enzyme with neutral metalloendopeptidase activity, is a marker for intestinal epithelial brush border. It is also present in normal bile ducts and gallbladder epithelia but is absent in cholangiocarcinomas. However, the expression profile of CD10 in benign and malignant extrahepatic biliary lesions has not been studied. In this study, 69 biopsies, 9 resections, and 9 cell blocks prepared from fine-needle aspirations of the extrahepatic bile ducts from 86 patients were studied immunohistochemically for CD10 expression. The majority of cases contained normal biliary epithelium (NL, n=64), along with foci of benign or malignant lesions in various combinations. Benign lesions included reactive atypia (n=35), low-grade dysplasia of unknown significance (n=21), and bile duct adenoma (BDA, n=1). Malignant lesions included high-grade dysplasia (HGD, n=45) and invasive adenocarcinoma (IC, n=30). As expected, the NL showed strong continuous staining at the apical surface in all cases. Benign lesions were also CD10 positive in all but 3 cases; however, the staining pattern was discontinuous, with positive cells varying from 20% to 80%. None of the malignant lesions showed CD10 immunoreactivity, except for 2 HGD cases and 1 IC case, which exhibited focal staining. The Pearson ?2 and Fisher exact tests showed significant statistical difference in CD10 expression among the study groups (P<0.001). Our findings suggest that absence of CD10 expression in strips of atypical biliary epithelial cells may be a phenotype associated with malignant transformation and may serve as a useful marker to aid in the evaluation of bile duct biopsies, in which distinction between benign and malignant lesions on biopsies or cytology specimens can be extremely challenging because of limited sampling, crush artifact, and frequent inflammatory/reactive changes. PMID:21989348

Tretiakova, Maria; Antic, Tatjana; Westerhoff, Maria; Mueller, Jeffrey; Himmelfarb, Eric A; Wang, Hanlin L; Xiao, Shu-Yuan

2012-01-01

368

Endotoxin and CD14 in the progression of biliary atresia  

PubMed Central

Background Biliary atresia (BA) is a typical cholestatic neonatal disease, characterized by obliteration of intra- and/or extra-hepatic bile ducts. However, the mechanisms contributing to the pathogenesis of BA remain uncertain. Because of decreased bile flow, infectious complications and damaging endotoxemia occur frequently in patients with BA. The aim of this study was to investigate endotoxin levels in patients with BA and the relation of these levels with the expression of the endotoxin receptor, CD14. Methods The plasma levels of endotoxin and soluble CD14 were measured with a pyrochrome Limulus amebocyte lysate assay and enzyme-linked immunosorbent assay in patients with early-stage BA when they received the Kasai procedure (KP), in patients who were jaundice-free post-KP and followed-up at the outpatient department, in patients with late-stage BA when they received liver transplantation, and in patients with choledochal cysts. The correlation of CD14 expression with endotoxin levels in rats following common bile duct ligation was investigated. Results The results demonstrated a significantly higher hepatic CD14 mRNA and soluble CD14 plasma levels in patients with early-stage BA relative to those with late-stage BA. However, plasma endotoxin levels were significantly higher in both the early and late stages of BA relative to controls. In rat model, the results demonstrated that both endotoxin and CD14 levels were significantly increased in liver tissues of rats following bile duct ligation. Conclusions The significant increase in plasma endotoxin and soluble CD14 levels during BA implies a possible involvement of endotoxin stimulated CD14 production by hepatocytes in the early stage of BA for removal of endotoxin; whereas, endotoxin signaling likely induced liver injury and impaired soluble CD14 synthesis in the late stages of BA.

2010-01-01

369

Biliary and urinary excretion of inorganic arsenic: monomethylarsonous acid as a major biliary metabolite in rats.  

PubMed

In rats exposed to arsenite (AsIII) or arsenate (AsV), the biliary excretion of arsenic depends completely on availability of hepatic glutathione, suggesting that both AsIII and AsV are transported into bile in thiol-reactive trivalent forms (Gyurasics et al. [1991], Biochem. Pharmacol. 42, 465-468). To test this hypothesis, the bile and urine of bile duct-cannulated rats injected with AsIII or AsV (50 micromol/kg, iv) were collected periodically for 2 h and analyzed for arsenic metabolites by HPLC-hydride generation-atomic fluorescence spectrometry. Arsenic was excreted predominantly into bile in AsIII-injected rats, but the urine was the main route of excretion in AsV-exposed rats. Injected AsIII was excreted in urine practically unchanged, whereas both AsV and AsIII appeared in urine after administration of AsV. Irrespective of the arsenical administered, the bile contained 2 main arsenic species, namely AsIII and a hitherto unidentified metabolite. Formation of this metabolite could be prevented by pretreatment of the rats with the methylation inhibitor periodate-oxidized adenosine, indicating that it is a methylated arsenic compound. This metabolite could be converted in vitro into monomethylarsonic acid (MMAsV) by oxidation, whereas synthetic MMAsV could be converted into the unknown metabolite by reduction. Consequently, this biliary metabolite of both AsIII and AsV is monomethylarsonous acid (MMAsIII), a long-hypothesized, but never identified, intermediate in the biotransformation of AsIII and AsV. Although MMAsIII is thought to be formed from an oxidized precursor, rats injected with MMAsV did not excrete MMAsIII. In summary, the inorganic arsenicals investigated are transported into bile exclusively in trivalent forms, namely as AsIII and MMAsIII, but are excreted in urine in both tri- and pentavalent forms. Identification of MMAsIII is signified by the fact that this metabolite is more toxic than AsIII and AsV and thus formation of MMAsIII represents toxification of inorganic arsenic. PMID:10869450

Gregus, Z; Gyurasics, A; Csanaky, I

2000-07-01

370

Small Arteriovenous Malformation of the Common Bile Duct Causing Hemobilia in a Patient with Hereditary Hemorrhagic Telangiectasia  

SciTech Connect

We report a 54-year-old male patient with arteriovenous malformation located at the common bile duct and hereditary hemorrhagic telangiectasia. The patient was treated as gallstone pancreatitis at first. Three days after endoscopic nasobiliary drainage (ENBD) for biliary drainage to subside gallstone pancreatitis, hemobilia was drained from the ENBD tube and the serum hemoglobin level gradually decreased. Cholangioscopy and angiography revealed that hemobilia was due to a small arteriovenous malformation located at the common bile duct. Subsequently, the patient was successfully treated by endovascular intervention.

Hayashi, Sadao, E-mail: hayashi@m.kufm.kagoshima-u.ac.jp; Baba, Yasutaka; Ueno, Kazuto; Nakajo, Masayuki [Kagoshima University Graduate School of Medical and Dental Sciences, Department of Radiology (Japan)

2008-07-15

371

Canonical Notch2 signaling determines biliary cell fates of embryonic hepatoblasts and adult hepatocytes independent of Hes1.  

PubMed

Notch signaling through the Notch2 receptor is essential for normal biliary tubulogenesis during liver development. However, the signaling events downstream of Notch2 critical for this process are less well defined. Furthermore, whether Notch signaling also underlies adult hepatic cell fate decisions is largely unknown. By implementing different genetic mouse models, we provide a comprehensive analysis that defines the role of Notch in cell fate control in the developing and adult liver. We show that cell-specific activation of Notch2 signaling by a Notch2IC (N2IC) transgene leads to rapid biliary specification of embryonic hepatoblasts, but also-when expressed in up to 6-month-old adult livers-rapidly reprograms adult hepatocytes to biliary cells with formation of tubular-cystic structures. When directed specifically to the adult biliary and facultative liver progenitor cell compartment, Notch2 is capable of inducing a ductular reaction. Furthermore, we characterized the significance of key effectors of canonical Notch signaling during normal development and in N2IC-expressing models. We demonstrate that tubule formation of intrahepatic bile ducts during embryonic development as well as N2IC-induced specification and morphogenesis of embryonic hepatoblasts and biliary conversion of adult hepatocytes all critically rely on canonical Notch signaling via recombination signal binding protein (RBP)-J? but do not require Hes1. Conclusion: Notch2 appears to be the main determinant not only of biliary commitment of embryonic hepatoblasts during development but also of biliary reprogramming of adult hepatocytes. Notch2-dictated cell fates and morphogenesis in both embryonic hepatoblasts and adult hepatocytes rely on canonical Notch signaling but do not require Hes1. Adult liver cells possess a remarkable plasticity to assume new cell fates when embryonic signaling pathways are active. (HEPATOLOGY 2013). PMID:23315998

Jeliazkova, Petia; Jörs, Simone; Lee, Marcel; Zimber-Strobl, Ursula; Ferrer, Jorge; Schmid, Roland M; Siveke, Jens T; Geisler, Fabian

2013-04-17

372

Fluid dynamics of dilatant fluids.  

PubMed

A dense mixture of granules and liquid often shows a severe shear thickening and is called a dilatant fluid. We construct a fluid dynamics model for the dilatant fluid by introducing a phenomenological state variable for a local state of dispersed particles. With simple assumptions for an equation of the state variable, we demonstrate that the model can describe basic features of the dilatant fluid such as the stress-shear rate curve that represents discontinuous severe shear thickening, hysteresis upon changing shear rate, and instantaneous hardening upon external impact. An analysis of the model reveals that the shear thickening fluid shows an instability in a shear flow for some regime and exhibits the shear thickening oscillation (i.e., the oscillatory shear flow alternating between the thickened and the relaxed states). The results of numerical simulations are presented for one- and two-dimensional systems. PMID:22400567

Nakanishi, Hiizu; Nagahiro, Shin-ichiro; Mitarai, Namiko

2012-01-11

373

The Etiology Mystery in Primary Biliary Cirrhosis  

Microsoft Academic Search

The etiology of primary biliary cirrhosis remains largely unknown despite numerous lines of evidence that have been recently proposed or supported. Primary biliary cirrhosis is a chronic cholestatic liver disease for which an autoimmune pathogenesis is widely accepted, mostly based on the presence of autoantibodies and autoreactive T cells. Cumulatively, association and twin studies suggest that both a susceptible genetic

Carlo Selmi; M. Eric Gershwin

2010-01-01

374

Endoscopic management of acute biliary pancreatitis.  

PubMed

Acute pancreatitis represents numerous unique challenges to the practicing digestive disease specialist. Clinical presentations of acute pancreatitis vary from trivial pain to severe acute illness with a significant risk of death. Urgent endoscopic treatment of acute pancreatitis is considered when there is causal evidence of biliary pancreatitis. This article focuses on the diagnosis and endoscopic treatment of acute biliary pancreatitis. PMID:24079788

Kuo, Vincent C; Tarnasky, Paul R

2013-10-01

375

Mining machine duct work arrangement  

SciTech Connect

A mining machine is disclosed which has a vehicle body with a first end thereof having a boom pivoted for up and down rotational movement about an axis extending transversely of the vehicle. A cutter head is carried by the boom and a conveyor is mounted on the vehicular body to carry away material cut by the cutter head. A dust collection system is mounted on the boom and vehicle body to convey dust away from the cutting head area. The dust control system has duct work associated therewith which includes a generally rectangularly intake duct section associated with the boom and a generally rectangularly fixed duct section mounted on the vehicle. A transition section connects the intake and the fixed duct sections. The transition section consists of a two piece arrangement wherein each piece is hinged to the intake duct section and is capable of slidingly engaging the fixed duct section at the end thereof adjacent the boom to sealing couple the intake duct section to the fixed duct section as the boom swings upwardly and downwardly.

Melhuish, J.J.

1985-12-10

376

Regulation of Wolffian Duct Development  

Microsoft Academic Search

Wolffian ducts (WDs) are the embryonic structures that form the male internal genitalia. These ducts develop in both the male and female embryo. However, in the female they subsequently regress, whereas in the male they are stabilised by testosterone. The WDs then develop into separate but contiguous organs, the epididymis, vas deferens and seminal vesicles. Recently, considerable progress has been

Sabine E. Hannema; Ieuan A. Hughes

2007-01-01

377

Intrahepatic transposition of bile ducts.  

PubMed

Objective. To describe the intrahepatic bile duct transposition (anatomical variation occurring in intrahepatic ducts) and to determine the frequency of this variation. Material and Methods. The researches were performed randomly on 100 livers of adults, both sexes. Main research methods were anatomical macrodissection. As a criterion for determination of variations in some parts of bile tree, we used the classification of Segmentatio hepatis according to Couinaud (1957) according to Terminologia Anatomica, Thieme Stuugart: Federative Committee on Anatomical Terminology, 1988. Results. Intrahepatic transposition of bile ducts was found in two cases (2%), out of total examined cases (100): right-left transposition (right segmental bile duct, originating from the segment VIII, joins the left liver duct-ductus hepaticus sinister) and left-right intrahepatic transposition (left segmental bile duct originating from the segment IV ends in right liver duct-ductus hepaticus dexter). Conclusion. Safety and success in liver transplantation to great extent depends on knowledge of anatomy and some common embryological anomalies in bile tree. Variations in bile tree were found in 24-43% of cases, out of which 1-22% are the variations of intrahepatic bile ducts. Therefore, good knowledge on ductal anatomy enables good planning, safe performance of therapeutic and operative procedures, and decreases the risk of intraoperative and postoperative complications. PMID:22550601

Deli?, Jasmin; Savkovi?, Admedina; Isakovi?, Eldar; Markovi?, Sergije; Bajtarevic, Alma; Denjali?, Amir

2012-04-03

378

Air-filled left hepatic duct: the saber sign as an aid to the radiographic diagnosis of pneumobilia  

SciTech Connect

In the supine patient, gas rises to the left hepatic duct. Radiographically, this can be recognized as a saber-shaped lucency to the right of the spine. In a retrospective analysis and review of the radiographs of 40 patients shown to have gas in the biliary tree by ultrasound (US), computed tomography (CT), or radiography, the diagnosis could be made in 37 patients. In 18 of these 37 cases pneumobilia could be identified by the saber-shaped distribution of gas.

Lewandowski, B.J.; Withers, C.; Winsberg, F.

1984-11-01

379

Silencing of the Rotavirus NSP4 Protein Decreases the Incidence of Biliary Atresia in Murine Model  

PubMed Central

Biliary atresia is a common disease in neonates which causes obstructive jaundice and progressive hepatic fibrosis. Our previous studies indicate that rotavirus infection is an initiator in the pathogenesis of experimental biliary atresia (BA) through the induction of increased nuclear factor-kappaB and abnormal activation of the osteopontin inflammation pathway. In the setting of rotavirus infection, rotavirus nonstructural protein 4 (NSP4) serves as an important immunogen, viral protein 7 (VP7) is necessary in rotavirus maturity and viral protein 4 (VP4) is a virulence determiner. The purpose of the current study is to clarify the roles of NSP4, VP7 and VP4 in the pathogenesis of experimental BA. Primary cultured extrahepatic biliary epithelia were infected with Rotavirus (mmu18006). Small interfering RNA targeting NSP4, VP7 or VP4 was transfected before rotavirus infection both in vitro and in vivo. We analyzed the incidence of BA, morphological change, morphogenesis of viral particles and viral mRNA and protein expression. The in vitro experiments showed NSP4 silencing decreased the levels of VP7 and VP4, reduced viral particles and decreased cytopathic effect. NSP4-positive cells had strongly positive expression of integrin subunit ?2. Silencing of VP7 or VP4 partially decreased epithelial injury. Animal experiments indicated after NSP4 silencing, mouse pups had lower incidence of BA than after VP7 or VP4 silencing. However, 33.3% of VP4-silenced pups (N?=?6) suffered BA and 50% of pups (N?=?6) suffered biliary injury after VP7 silencing. Hepatic injury was decreased after NSP4 or VP4 silencing. Neither VP4 nor VP7 were detected in the biliary ducts after NSP4. All together, NSP4 silencing down-regulates VP7 and VP4, resulting in decreased incidence of BA.

Feng, Jiexiong; Yang, Jixin; Zheng, Shuaiyu; Qiu, Yinrong; Chai, Chengwei

2011-01-01

380

Isolated extrahepatic bile duct rupture: a rare consequence of blunt abdominal trauma. Case report and review of the literature  

PubMed Central

A 16-year-old girl suffered blunt abdominal trauma. Clinically, a severe motor impairment with paraesthesia of the legs was found. Posterior osteosynthesis in T10-L1 with laminectomy in T10-T12 and posterolateral arthrodesis in T11-T12 was performed because of a dorsal traumatic vertebral fracture. On hospital day 7, because of an acute abdomen, surgical laparoscopic exploration showed sterile bloody fluid without any evident hemorrhagic injury. On hospital day 11, the patient was reoperated on by the laparoscopic approach for increasing abdominal pain and fever: a peritoneal biliary fluid was aspirated. After conversion to open surgery, cholecystectomy was performed. Intraoperative cholangiography was considered as normal. On arrival at our institution 13?days after injury, the patient was operated on for a biliary peritonitis. Intraoperatively, a trans-cystic cholangiography showed a biliary leakage of the common bile duct; a T-tube was placed into the common bile duct; a subhepatic drainage was placed too. On postoperative day 30, a T-tube cholangiography showed a normal biliary tree, without any leakage, and the T-tube was subsequently removed. The patient had a complete recovery.

2012-01-01

381

Immunolocalization of VEGF A and its receptors, VEGFR1 and VEGFR2, in the liver from patients with biliary atresia.  

PubMed

In biliary atresia (BA), a cholangiopathy of elusive etiology invariably leads to cirrhosis, and a disturbed angiogenesis may be involved. We evaluated the hepatobiliary immunolocalization of vascular endothelial growth factor (VEGF) A, VEGF receptor 1 (R1), and R2 in BA. We analyzed biopsies obtained at portoenterostomy from infants with BA (n=52), including embryonic (n=14) and perinatal (n=38) types. Controls were infants with intrahepatic cholestasis (IC; n=7). In BA, VEGF A immunolocalization was also evaluated in explants (n=33) and at the porta hepatis (n=16). We morphometrically assessed the percentage of CK7 (PCK7) positivity in BA and the ratio medial layer thickness/luminal diameter in hepatic artery branches in BA and IC. We found that arteries were more frequently positive for VEGF A in BA at portoenterostomy (P=0.006) than in other groups. In explants, VEGF A immunolocalization was mainly lobular (P<0.001). VEGFR2 was less frequently positive in BA than IC in bile ducts (P=0.023) and hepatocytes (P=0.011). A higher PCK7 positivity was associated with arterial (P<0.001) and biliary (P=0.040) VEGF A positivity. PCK7 was correlated with biliary (P=0.031), arterial (P=0.031), and hepatocytic (P=0.032) VEGF A positivity in BA at portoenterostomy. VEGF A was positive in arteries and bile ducts at the porta hepatis mainly in the perinatal BA type (P=0.013). Biliary (P=0.016) and arterial (P=0.044) VEGF A positivity were associated with higher ratio medial layer thickness/luminal diameter values. Our findings suggest that hypoxia/ischemia affects the portal structures in BA at portoenterostomy, beginning at the porta hepatis, and it is associated both with the extent of biliary proliferation and medial layer thickening. PMID:21285868

Edom, Patrícia Turnes; Meurer, Luise; da Silveira, Themis Reverbel; Matte, Ursula; dos Santos, Jorge Luiz

2011-07-01

382

Primary duct closure versus T-tube drainage following exploration of the common bile duct.  

PubMed

T-tube drainage of the common bile duct (CBD) following duct exploration has become standard surgical practice. This randomized prospective study has compared primary closure versus T-tube drainage of the CBD following exploration for calculous disease. Thirty-seven patients underwent primary closure and 26 underwent closure over T-tube. Both groups were comparable in terms of age, indications for surgery, associated illnesses, pre-operative bilirubin, amylase and white cell count. Forty-three per cent of operations were performed by a consultant in the primary closure group and 65% in the T-tube group. There was no significant difference in the duration of operation, incidence of wound infection, surgical or other complications following operation between the two groups. However, the postoperative stay was significantly prolonged in the T-tube group, to a median of 11 days, compared to 8 days in the primary closure group (P = 0.0001). This prolongation in stay was unrelated to whether admission was as an emergency or elective. T-tube drainage of the bile continued for a median of 7 days postoperative, whereas the bile drained via a wound drain in only 13 (35%) of the primary closure group, for a median of 5 days in these 13 patients. Long-term follow up was achieved in 48 patients, by a questionnaire sent at a median of 2.8 years following operation. Abdominal pains following recovery from the operation were experienced by 18% of the primary closure group and 20% of the T-tube group. No patient developed jaundice or pancreatitis, nor needed further biliary surgery following operation.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7980254

Williams, J A; Treacy, P J; Sidey, P; Worthley, C S; Townsend, N C; Russell, E A

1994-12-01

383

Management of posthaemorrhagic ventricular dilatation.  

PubMed

Intraventricular haemorrhage and posthaemorrhagic ventricular dilatation remain an important challenge in the management of prematurity and are associated with significant permanent morbidity. Progressive ventricular dilatation causes white matter injury by pressure, distortion, free radical injury and inflammation. Therapeutic interventions include serial lumbar punctures, only useful when the ventricles remain in communication with the lumbar subarachnoid space, and repeated aspiration through a ventricular access device. Reduction of cerebrospinal fluid production by acetazolamide and frusemide in a large multicentre randomised trial showed a worse outcome in the treated arm. A trial of drainage, irrigation and fibrinolytic therapy did not demonstrate a reduced need for permanent cerebrospinal fluid diversion, but did show a significant reduction in severe cognitive disability at two years. Ventriculoperitoneal shunting is indicated when the ventricles continue to enlarge at a body weight of around 2.5 kg and cerebrospinal fluid protein levels are below 1.5 g /L. This review summarises current concepts on the pathophysiology and management of posthaemorrhagic ventricular dilatation, underlining clinical challenges and ongoing research. Although the percentage of small preterm infants developing intraventricular haemorrhage (IVH) has been greatly reduced in the last three decades, increased survival of very immature infants has meant that large IVH with subsequent posthaemorrhagic ventricular dilatation is still a serious unsolved problem. PMID:21289015

Whitelaw, Andrew; Aquilina, Kristian

2011-02-02

384

Post-stenotic aortic dilatation  

PubMed Central

Aortic stenosis is the most common valvular heart disease affecting up to 4% of the elderly population. It can be associated with dilatation of the ascending aorta and subsequent dissection. Post-stenotic dilatation is seen in patients with AS and/or aortic regurgitation, patients with a haemodynamically normal bicuspid aortic valve and following aortic valve replacement. Controversy exists as to whether to replace the aortic root and ascending aorta at the time of aortic valve replacement, an operation that potentially carries a higher morbidity and mortality. The aetiology of post-stenotic aortic dilatation remains controversial. It may be due to haemodynamic factors caused by a stenotic valve, involving high velocity and turbulent flow downstream of the stenosis, or due to intrinsic pathology of the aortic wall. This may involve an abnormality in the process of extracellular matrix remodelling in the aortic wall including inadequate synthesis, degradation and transport of extracellular matrix proteins. This article reviews the aetiology, pathology and management of patients with post-stenotic aortic dilatation.

Wilton, Emma; Jahangiri, Marjan

2006-01-01

385

21 CFR 876.5470 - Ureteral dilator.  

Code of Federal Regulations, 2013 CFR

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5470 Ureteral dilator. (a) Identification. A ureteral dilator is a...

2013-04-01

386

21 CFR 876.5450 - Rectal dilator.  

Code of Federal Regulations, 2013 CFR

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5450 Rectal dilator. (a) Identification. A rectal dilator is a...

2013-04-01

387

Improved Model of Rock Mass Dilatation.  

National Technical Information Service (NTIS)

This report documents the results of an investigation aimed at developing analytical models for calculating closure and failure resistance of deep tunnels, based on an improved dilatation model for the rock. The phenomenon of rock dilatancy is first revie...

E. Detournay C. St. John

1985-01-01

388

Fluctuating Dilatation Rate as an Acoustic Source.  

National Technical Information Service (NTIS)

Ribner's (1962) dilatational acoustic theory is revisited. A rigorous connection between the fluctuating dilatation rate and the acoustic source field is established; this vindicates Ribner's heuristic contention while indicating additional acoustic sourc...

J. R. Ristorcelli

1997-01-01

389

Induction of MIC-1/growth differentiation factor-15 following bile duct injury.  

PubMed

Macrophage inflammatory peptide-1 (MIC-1)/growth/differentiation factor-15 (GDF-15) is a divergent member of the transforming growth factor-beta superfamily cloned by others and us. MIC-1/GDF-15 is expressed in the liver, breast, and colon. Studies have demonstrated a growth-inhibiting effect of MIC-1/GDF-15 on colon and breast cancer cell lines in vitro and on tumor growth in vivo. We previously reported that MIC-1 expression is rapidly induced after a wide variety of murine acute and chronic liver injuries including aniline dye administration. I hypothesized, therefore, that MIC-1/GDF-15 may be a mediator of biliary tract injury and could play a role in regulation of bile duct proliferation. C57BL/6 mice underwent surgical ligation of the common bile duct. Northern blot analysis revealed a time-dependent induction of MIC-1/GDF-15 mRNA in the liver. In situ hybridization of liver sections for MIC-1/GDF-15 expression after bile duct ligation demonstrated a zone 1 or periportal expression pattern, consistent with expression of MIC-1 in periductular hepatocytes. Northern blot analysis of liver mRNA from patients with sclerosing cholangitis or cirrhosis also demonstrated enhanced expression of MIC-1/GDF-15. MIC-1/GDF-15 is expressed after bile duct injury in mice and humans. Taken together with the previously demonstrated growth inhibitory effects of MIC-1/GDF-15 on normal and transformed cells, MIC-1/GDF-15 may play a role in regulation of bile duct proliferation and biliary tumor formation. PMID:14592665

Koniaris, Leonidas G

2003-11-01

390

Current management of biliary atresia  

PubMed Central

Extra?hepatic biliary atresia occurs in approximately 1:15?000 live births leading to about 50 new cases/year in the UK. Presentation is with prolonged jaundice, usually in a term baby who develops signs of obstructive jaundice. Management has been improved by public and professional education to encourage early referral and diagnosis to facilitate initial surgery before 8?weeks of age. Surgical management is complementary and includes an attempt to restore biliary flow (the Kasai portoenterostomy) and liver transplantation if necessary. Medical management consists of antibiotics, ursodeoxycholic acid to encourage bile flow, fat soluble vitamin supplementation and nutritional support. Centralising surgery to specialised centres has improved survival of this potentially fatal disease to over 90% in the UK. Over half of infants undergoing portoenterostomy will clear the jaundice and have a greater than 80% chance of a good quality of life, reaching adolescence without transplantation. For those children developing intractable complications of cirrhosis and portal hypertension, liver transplantation provides a 90% chance of achieving normal life.

Kelly, Deirdre A; Davenport, Mark

2007-01-01

391

Redo surgery for biliary atresia.  

PubMed

The Kasai redo surgery is important for treating biliary atresia. In the era of liver transplantation (LTx), pediatric surgeons must accurately select patients for redo surgery and ensure that potential LTx can be performed later. Although optimal timing for redo varies among cases, appropriate timing is essential. We reviewed the significance, optimal timing, operative procedures, and indications of Kasai redo surgery. Between 1989 and 2011, 2,630 patients were registered in the Japanese Biliary Atresia Registry (JBAR), and the data collected from JBAR regarding Kasai redo surgery were analyzed. Patients were divided into two groups, Group 1 (1989-1999, n = 1,423) and Group 2 (2000-2011, n = 1,207). The redo incidence significantly reduced in Group 2. Although no significant difference was found in the native liver jaundice-free survival rates between the two groups, the overall survival rate at initial registry was significantly higher in Group 2. This may be because of the limited number of patients selected for redo and increased availability of early LTx. Patients who achieved sufficient bile drainage following the initial Kasai surgery but developed sudden bile flow cessation were the best candidates for Kasai redo surgery; it should be performed only once for this subset. PMID:23982391

Nio, Masaki; Sasaki, Hideyuki; Tanaka, Hiromu; Okamura, Atsushi

2013-10-01

392

[Reconstruction of the common bile duct with a free venous autograft (experimental work - preliminary communication)].  

PubMed

In seven dogs, the authors performed a resection of the supraduodenal part of the main bile duct, 15-2 cm. in length. The arising defect was bridged over with a free autovenous graft taken from the exterior jugular vein (T-T anastomosis), without using a temporary or permanent prosthesis. The animals were followed-up 60 days and the sacrificed. Three dogs perished: the first one on the third day due to intoxication, the second dog on the thirteenth day because of anastomosis' disruption and consequent biliary peritonitis, and the third one on the eighteenth day of unknown causes. In the immediate postoperative course the values of the bilirubin and alkaline phosphatase were increased while those of transaminase were not significantly altered. These values began to normalize during the third week. An intravenous biliography was made on the sixtieth day showing a normal filling of the gallbladder, with an orderly visualization of hepato-choledochus and its correct transit, but with stenosis at the distal anastomosis. Macroscopically, the graft appeared slightly enlarged in length and diameter due to the mentioned stenosis. Histologically, the graft took on an appearance similar to the main bile duct, while its endothelium was completely replaced by biliary epithelium. An answer about the viability of this autovenous graft to serve as a substituent of a normal common bile duct is to be expected with further experimental work. PMID:6880537

Sisi?, F; Nakas, A; Vujovi?, B; Vukoti?, L; Stojanovi?, B; Hamadzi?, M; Krni?, J; Stevanci?, M; Duzi?, E

1983-01-01

393

Hepatectomy for bile duct injuries: When is it necessary?  

PubMed Central

Iatrogenic bile duct injuries (IBDI) are still a challenge for surgeons. The most frequently, they are caused by laparoscopic cholecystectomy which is one of the commonest surgical procedure in the world. Endoscopic techniques are recommended as initial treatment of IBDI. When endoscopic treatment is not effective, surgery is considered. Different surgical biliary reconstructions are performed in most patients in IBDI. Roux-Y hepaticojejunostomy is the commonest biliary reconstruction for IBDI. In some patients with complex IBDI, hepatectomy is required. Recently, Li et al analyzed the factors that had led to hepatectomy for patients with IBDI after laparoscopic cholecystectomy (LC). Authors concluded that hepatectomy might be necessary to manage early or late complications after LC. The study showed that proximal IBDI (involving hepatic confluence) and IBDI associated with vascular injuries were the two independent risk factors of hepatectomy in this series. Authors distinguished two main groups of patients that require liver resection in IBDI: those with an injury-induced liver necrosis necessitating early intervention, and those in whom liver resection is indicated for treatment of liver atrophy following long-term cholangitis. In this commentary, indications for hepatectomy in patients with IBDI are discussed. Complex biliovascular injuries as indications for hepatectomy are presented. Short- and long-term results in patients following liver resection for IBDI are also discussed. Hepatectomy is not a standard procedure in surgical treatment of IBDI, but in some complex injuries it should be considered.

Jablonska, Beata

2013-01-01

394

Effect of modern analgesic drugs (tramadol, pentazocine, and buprenorphine) on the bile duct sphincter in man.  

PubMed Central

Modern narcotic analgesic drugs, such as tramadol, pentazocine, and buprenorphine share similarities of molecular structure with morphine which is widely believed to cause spasm of the bile duct sphincter and so impede bile flow. This study assessed the effects of intravenously administered analgesics on bile duct sphincter motor activity measured by ERCP manometry. Ten minutes after pentazocine injection the duration of contractions and baseline pressure of the bile duct sphincter rose from 6.2 +/- 0.2 to 8.2 +/- 0.27 s and from 5.1 +/- 0.6 to 8.8 +/- 0.4 mmHg respectively. Tramadol, buprenorphine and saline showed no such effect. These data indicated that the effects of such drugs on bile duct sphincter function can be safely assessed by ERCP manometry and that pentazocine adversely affects the bile duct sphincter, whilst tramadol and buprenorphine do not. We consider therefore that pentazocine is not the premedication of first choice for endoscopic procedures involving the sphincter of Oddi and should also be avoided in patients with pancreatic and biliary disorders.

Staritz, M; Poralla, T; Manns, M; Meyer Zum Buschenfelde, K H

1986-01-01

395

Gallbladder carcinosarcoma accompanied with bile duct tumor thrombi: A case report  

PubMed Central

Gallbladder carcinosarcoma is one of the rarest subsets of gallbladder malignancies. The first case of carcinosarcoma of the gallbladder was reported in 1907. To date, <100 cases have been reported in the English literature. The present study reports a case of gallbladder carcinosarcoma accompanied with tumor thrombi, presenting as a soft tissue mass in the common bile duct and resulting in the obstruction and inflammation of the biliary tract. Initially, the patient was diagnosed with a gallbladder tumor and choledocholithiasis. No cases of carcinosarcoma of the gallbladder accompanied with bile duct tumor thrombus formation have been reported to date. A cholecystectomy with liver segmentectomy (S4a+S5) and a lymph node dissection were performed. The presence of a tumor thrombus in the common bile duct was confirmed by analysis of a frozen section during surgery. Resection of the extrahepatic bile duct and Roux-en-Y type hepatic cholangiojejunostomy were also performed. In addition, the gallbladder carcinosarcoma was observed to produce ?-fetoprotein. The patient underwent an uneventful post-operative recovery and, to date, no clinical or radiological evidence of disease recurrence or metastasis has been identified. Carcinosarcoma of the gallbladder accompanied with tumor thrombi is extremely rare. Tumor thrombi in the common bile duct may easily be misdiagnosed as choledocholithiasis. The treatment and prognosis of gallbladder carcinosarcoma is similar to that of gallbladder carcinoma.

WANG, YAN; GU, XIAODONG; LI, ZHENYANG; XIANG, JIANBIN; CHEN, ZONGYOU

2013-01-01

396

Primary biliary tract melanoma: Report of a case and review of the literature  

PubMed Central

INTRODUCTION Primary melanoma of the bile duct is extremely rare with only nine cases of primary melanoma of the bile duct reported in the literature. PRESENTATION OF CASE A 55-year-old previously healthy gentleman developed increasing jaundice over several months and subsequently underwent an ERCP with stone extraction. Cytology brushings in an area of a distal stricture in the bile duct were concerning for cholangiocarcinoma. The patient was referred to our institution and underwent a pancreaticoduodenectomy. The surgical specimen showed a single 4.5 cm polypoid lesion located in the bile duct. A diagnosis of melanoma was rendered after immunohistochemical studies on the tumor demonstrated positivity for melanoma markers. Follow-up of the patient with skin, ocular, and lymph node exams showed no evidence of melanoma. A PET scan 4 and 10 months post-surgery failed to reveal either a primary skin lesion or other sites of metastases. DISCUSSION The vast majority of melanomas of the bile duct represent metastases from a cutaneous source and tend to present as multiple flat pigmented lesions. Conversely, cases of primary bile duct melanoma are characterized by a distinct gross morphology consisting of a solitary intraluminal polypoid lesion attached by a pedicle with no other identifiable primary lesion. Other supporting criteria include absence of other involved sites and presence of an in situ junctional component. CONCLUSION Given the clinical history, gross findings, and lack of a primary cutaneous site or other demonstrable metastases, this patient likely represents the tenth reported case of primary biliary tract melanoma.

Smith, Nathaniel E.; Taube, Janis M.; Warczynski, Tam M.; Collier, Kevin D.; Pawlik, Timothy M.

2012-01-01

397

Basic tips for duct design  

SciTech Connect

During the last few years, ASHRAE Journal and other trade publications have presented lucid descriptions of the basic physics of airflow in ductwork, pressure drop and methods of sizing and optimization (Brooks 1995, Tsal et al. 1988a, Williams 1995). What is missing is a practical means for numerically modeling HVAC duct systems. This article is centered on the performance, economics and modeling of duct systems. Specific subjects examined include duct shape, fitting performance, leakage and appropriate oversizing. Computer modeling is discussed to provide a better grasp as to how it can be used as a practical design tool.

Evans, R.A. [Evans Associates, Richland, WA (United States); Tsal, R.J. [Netsal and Associates, Fountain Valley, CA (United States)

1996-07-01

398

Various Techniques for the Surgical Treatment of Common Bile Duct Stones: A Meta Review  

PubMed Central

Common bile duct stones (CBDSs) may occur in up to 3%–14.7% of all patients for whom cholecystectomy is preformed. Patients presenting with CBDS have symptoms including: biliary colic, jaundice, cholangitis, pancreatitis or may be asymptomatic. It is important to distinguish between primary and secondary stones, because the treatment approach varies. Stones found before, during, and after cholecystectomy had also differing treatments. Different methods have been used for the treatment of CBDS but the suitable therapy depends on conditions such as patient' satisfaction, number and size of stones, and the surgeons experience in laparoscopy. Endoscopic retrograde cholangiopancreatography with or without endoscopic biliary sphincterotomy, laparoscopic CBD exploration (transcystic or transcholedochal), or laparotomy with CBD exploration (by T-tube, C-tube insertion, or primary closure) are the most commonly used methods managing CBDS. We will review the pathophysiology of CBDS, diagnosis, and different techniques of treatment with especial focus on the various surgical modalities.

Shojaiefard, Abolfazl; Esmaeilzadeh, Majid; Ghafouri, Ali; Mehrabi, Arianeb

2009-01-01

399

HLA IN PRIMARY BILIARY CIRRHOSIS: AN OLD STORY NOW REVIVING  

PubMed Central

Primary biliary cirrhosis (PBC) is an autoimmune biliary disease characterized by injury of small and medium size bile ducts eventually leading to liver cirrhosis and death. While the causes remain enigmatic, recent evidence has strengthened the importance of genetic factors in determining the susceptibility to the disease. Besides the strong heritability suggested by familial occurrence and monozygotic twins concordance, for decades there has not been a clear association with specific genes, with the only exception of a low risk conferred by a class II human leukocyte antigen (HLA) variant, the DRB1*08 allele, at least in some populations. Only recently the story began to change when a strong protective associations between PBC and the HLA DRB1*11 and DRB1*13 alleles were found in Italian and UK series. But HLA genes fully returned to attract interest thanks to recent genome-wide association studies (GWAS) which clearly demonstrated that the major component of the genetic architecture of PBC are within the HLA region. As expected in a genetically complex disease, GWAS also identified several novel non-HLA variants, but it is to note that all of them are in immuno-related genes. In this review, the paradigmatic tale of what, and how, we learned about HLA genes in PBC will be retraced with particular focus on how GWAS are enabling us to rewrite the story of PBC pathogenesis. These recent discoveries will not only driving functional studies but will also held the promise of developing novel disease-specific treatments.

Invernizzi, Pietro

2011-01-01

400

Elevated Bile Acids in Newborns with Biliary Atresia (BA)  

PubMed Central

Biliary Atresia (BA), a result from inflammatory destruction of the intrahepatic and extrahepatic bile ducts, is a severe hepatobiliary disorder unique to infancy. Early diagnosis and Kasai operation greatly improve the outcome of BA patients, which encourages the development of early screening methods. Using HPLC coupled tandem mass spectrometry, we detected primary bile acids content in dried blood spots obtained from 8 BA infants, 17 neonatal jaundice and 292 comparison infants at 3–4 days of life. Taurocholate (TC) was significantly elevated in biliary atresia infants (0.98±0.62 µmol/L) compared to neonatal jaundice (0.47±0.30 µmol/L) and comparison infants (0.43±0.40 µmol/L), with p?=?0.0231 and p?=?0.0016 respectively. The area under receiver operating characteristic (ROC) curve for TC to discriminate BA and comparison infants was 0.82 (95% confidence interval: 0.72–0.92). A cutoff of 0.63 µmol/L produced a sensitivity of 79.1% and specificity of 62.5%. The concentrations of total bile acids were also raised significantly in BA compared to comparison infants (6.62±3.89 µmol/L vs 3.81±3.06 µmol/L, p?=?0.0162), with the area under ROC curve of 0.75 (95% confidence interval: 0.61–0.89). No significant difference was found between the bile acids of neonatal jaundice and that of comparison infants. The early increase of bile acids indicates the presentation of BA in the immediate newborn period and the possibility of TC as newborn screening marker.

Xiao, Yongtao; Wang, Yang; Wen, Jie; Zou, Gang-Ming; Gu, XueFan; Cai, Wei

2012-01-01

401

Management of an occluded biliary metallic stent  

PubMed Central

In patients with a malignant biliary obstruction who require biliary drainage, a self-expandable metallic stent (SEMS) provides longer patency duration than a plastic stent (PS). Nevertheless, a stent occlusion by tumor ingrowth, tumor overgrowth and biliary sludge may develop. There are several methods to manage occluded SEMS. Endoscopic management is the preferred treatment, whereas percutaneous intervention is an alternative approach. Endoscopic treatment involves mechanical cleaning with a balloon and a second stent insertion as stent-in-stent with either PS or SEMS. Technical feasibility, patient survival and cost-effectiveness are important factors that determine the method of re-drainage and stent selection.

Ridtitid, Wiriyaporn; Rerknimitr, Rungsun

2012-01-01

402

Biliary pseudolithiasis in childhood: a case report.  

PubMed

Cholelithiasis is uncommon in childhood and usually associated with any predisposing factors such as congenital abnormalities of biliary tract, hemolytic diseases, TPN administration and diseases of terminal ileum. Recent studies demonstrated ceftriaxone inducing reversible precipitations in gallbladder that mimic cholelithiasis. This complication is termed "biliary pseudolithiasis" or "reversible cholelithiasis". In this paper we describe a patient who developed biliary pseudolithiasis after six days of ceftriaxone therapy which completely resolved eleven days after the end of the treatment, and discuss the indication for cholecystectomy. PMID:10584197

Herek, O; Sario?lu, A; Koçer, N; Tiryaki, A; Akkemik, B

1999-10-01

403

Association of oesophageal atresia and cholecystohepatic duct.  

PubMed

A rare hepatobiliary malformation in which the common hepatic duct drains directly into the gallbladder or the cystic duct (cholecystohepatic duct) is described in two children born with oesophageal atresia. Attention is drawn to the rarity of this combination. A brief review of the literature of cholecystohepatic and accessory hepatic ducts is also presented. PMID:9914348

Redkar, R G; Davenport, M; Myers, N; Howard, E R

1999-01-01

404

New insights on the pathogenesis of biliary cirrhosis provided by studies in FXR knockout mice.  

PubMed

The nuclear bile acid receptor, farnesoid X receptor (FXR), may play a pivotal role in liver fibrosis. We tested the impact of genetic FXR ablation in four different mouse models. Hepatic fibrosis was induced in wild-type and FXR knock-out mice (FXR((-/-))) by CCl(4) intoxication, 3,5-diethoxycarbonyl-1,4-dihydrocollidine feeding, common bile duct ligation, or Schistosoma mansoni (S.m.)-infection. In addition, we determined nuclear receptor expression levels (FXR, pregnane X receptor (PXR), vitamin D receptor, constitutive androstane receptor (CAR), small heterodimer partner (SHP)) in mouse hepatic stellate cells (HSCs), portal myofibroblasts (MFBs), and human HSCs. Cell type-specific FXR protein expression was determined by immunohistochemistry in five mouse models and prototypic human fibrotic liver diseases. Expression of nuclear receptors was much lower in mouse and human HSCs/MFBs compared with total liver expression with the exception of vitamin D receptor. FXR protein was undetectable in mouse and human HSCs and MFBs. FXR loss had no effect in CCl(4)-intoxicated and S.m.-infected mice, but significantly decreased liver fibrosis of the biliary type (common bile duct ligation, 3,5-diethoxycarbonyl-1,4-dihydrocollidine). These data suggest that FXR loss significantly reduces fibrosis of the biliary type, but has no impact on non-cholestatic liver fibrosis. Since there is no FXR expression in HSCs and MFBs in liver fibrosis, our data indicate that these cells may not represent direct therapeutic targets for FXR ligands. PMID:21672564

Fausther, Michel; Dranoff, Jonathan A

2011-05-11

405

Stenoses of the salivary ducts-sialendoscopy based diagnosis and treatment.  

PubMed

Our aim was to analyse the nature of a sialendoscopy-based classification and present its use in the treatment of stenoses of Wharton's and Stensen's ducts. The classification of stenoses of Wharton's duct has not been published before. We did 133 sialendoscopies in 114 patients who presented with possible obstruction of the ducts to the tertiary centre for ENT at the University Department in Pozna?. Twenty-seven patients had their parotid ducts treated, and 24 their submandibular ducts. Suspicion of stenotic changes of the ductal system was suggested during ultrasound examination. They were examined with semirigid endoscopes that enabled direct visualisation of the stenotic areas. A total of 69 stenoses were diagnosed in 51 patients. Stenoses were divided into three groups according to their site. Patients with stenosis of the salivary ducts were treated by dilatation of the stenotic area, intraductal steroid injections, and insertion of a stent for 14-21 days. Forty of the 51 reported considerable improvement, and 7 partial improvement. Four patients had no improvement. Sialendoscopy is a safe way to treat obstruction of the salivary glands. Short and medium term follow up show that it is extremely successful. PMID:22938753

Kope?, Tomasz; Szyfter, Witold; Wierzbicka, Ma?gorzata; Nealis, Justin

2012-08-29

406

What Is Bile Duct Cancer?  

MedlinePLUS

... tiny tubes (ductules) where bile collects from the liver cells. The ductules come together to form small ducts , ... be confused with cancers that start in the liver cells, which are called hepatocellular carcinomas , and are often ...

407

The pathophysiology of cholestasis with special reference to primary biliary cirrhosis.  

PubMed

Cholestasis in primary biliary cirrhosis results from impairment of bile flow either by reduced transport at the level of the canaliculi or by disturbed bile flow through damaged intrahepatic bile ductules. Whatever its cause, the expression of hepatic transport proteins will be affected. In cholestatic rats: the expression of the multispecific organic anion transporter mrp2 is decreased; the bile salt export pump bsep and the phospholipid transporter mdr2 are less affected; the carrier protein for hepatic uptake of bile salts ntcp is sharply down-regulated; Mrp3, a basolateral ATP-dependent transporter for glucuronides and bile salts, is upregulated. Thus, bile salts that cannot exit the hepatocyte because of the cholestasis are effectively removed across the basolateral membrane. These may be adaptive responses in defence against overloading of hepatocytes with cytotoxic bile salts. These responses show that the expression of hepatic transporter proteins is highly regulated. This occurs by transcriptional and post-transcriptional mechanisms. Primary biliary cirrhosis starts as a disease of the small intrahepatic bile ducts and therefore the experimental evidence for 'cross-talk' between hepatocytes and cholangiocytes is of great interest for this disease and needs to be further investigated. New insights in bile physiology may enable the development of new therapies for cholestatic liver diseases as primary biliary cirrhosis. PMID:10976015

Jansen, P L

2000-08-01

408

Management of hyperbilirubinemia in biliary atresia by hepatic progenitor cell transplantation through hepatic artery: a case report.  

PubMed

Cholangiodestruction of bile ducts leads to biliary atresia, a rare disease characterized by intrahepatic and extrahepatic biliary inflammation. If the intrahepatic biliary tree is unaffected, surgical reconstruction by the Kasai procedure of hepatoportoenterostomy of the extra hepatic biliary tract is possible. Untreated, this condition leads to cirrhosis and death within the first year of the life. If the atresia is complete, liver transplantation is the only option. As a result of the shortage of donor livers, hepatocytes have been infused over the past two decades, providing proof of the concept that cell therapy can be effective for the treatment of liver diseas