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1

Dilated Common Bile Duct in Opium Addicts with and without Biliary Symptoms - Implication for Research in AIDS  

Microsoft Academic Search

Background: Opium addicts (OA) with no biliary symptoms have been shown to have dilated common bile duct (CBD). Endoscopic retrograde cholangio-pancreatography (ERCP) without biliary drainage in such asymptomatic OA is hazardous. Hence it is not indicated unless there are clear clinical and laboratory evidences of biliary stasis. Aims: To show that even when matched with controls with the same clinical

Cholangiopathy S Y Chuah; C K Leong; C W Pang

2

Percutaneous Transhepatic Balloon Dilation of Biliary-Enteric Anastomotic Strictures after Surgical Repair of Iatrogenic Bile Duct Injuries  

PubMed Central

Purpose To evaluate the efficacy of percutaneous balloon dilation of biliary-enteric anastomotic strictures resulting from surgical repair of laparoscopic cholecystectomy-related bile duct injuries. Material and Methods A total of 61 patients were referred to our institution from 1995 to 2010 for treatment of obstruction at the biliary-enteric anastomosis following surgical repair of laparoscopic cholecystectomy-related bile duct injuries. Of these 61 patients, 27 underwent surgical revision upon stricture diagnosis, and 34 patients were managed using balloon dilation. Of these 34 patients, 2 were lost to follow up, leaving 32 patients for analysis. The primary study objective was to determine the clinical success rate of balloon dilation of biliary-enteric anastomotic strictures. Secondary study objectives included determining anastomosis patency, rates of stricture recurrence following treatment, and morbidity. Results Balloon dilation of biliary-enteric anastomotic strictures was clinically successful in 21 of 32 patients (66%). Anastomotic stricture recurred in one of 21 patients (5%) after an average of 13.1 years of follow-up. Patients who were unsuccessfully managed with balloon dilation required significantly more invasive procedures (6.8 v. 3.4; p?=?0.02) and were left with an indwelling biliary catheter for a significantly longer period of time (8.8 v. 2.0 months; p?=?0.02) than patients whose strictures could be resolved by balloon dilation. No significant differences in the number of balloon dilations performed (p?=?0.17) or in the maximum balloon diameter used (p?=?0.99) were demonstrated for patients with successful or unsuccessful balloon dilation outcomes. Conclusion Percutaneous balloon dilation of anastomotic biliary strictures following surgical repair of laparoscopic cholecystectomy-related injuries may result in lasting patency of the biliary-enteric anastomosis. PMID:23110053

Lee, Andrew Y.; Gregorius, John; Kerlan, Robert K.; Gordon, Roy L.; Fidelman, Nicholas

2012-01-01

3

Combined percutaneous balloon dilation and extracorporeal shock wave lithotripsy for treatment of biliary stricture and common bile duct stones.  

PubMed

We report a case of cholangitis, liver abscess, and common bile duct stones in a patient with a benign stricture at a choledochojejunal anastomosis, 3 yr after a complicated duodenohemipancreatectomy. Because surgical reintervention seemed inappropriate, a percutaneous transhepatic balloon dilation was performed after temporary internal-external biliary drainage. Extracorporeal shockwave lithotripsy (ESWL) was successfully applied to fragment all common bile duct stones, with subsequent spontaneous evacuation of all stone fragments through the dilated bilioenteric anastomosis. Only one similar case report has been published before (1), though with a different sequence of therapeutic modalities. Moreover, according to our literature review, this is the first report of ESWL of common bile duct stones by means of the Dornier Compact Lithotriptor (Dornier, Germany) with electromagnetic shockwave source. PMID:8079943

Schoonjans, R; De Man, M; Aerts, P; Van der Spek, P; Van Steenberge, R; Lepoutre, L

1994-09-01

4

[Isolated or multifocal segmental intrahepatic bile duct dilatation: management].  

PubMed

Segmentary dilatation of intrahepatic bile ducts are well depicted with ultrasound. Two groups of diseases could be differentiated by searching a liver mass: biliary diseases without any tumor or dilatation of biliary duct due to an adjacent liver mass. Inside these two groups, some diseases are frequent and other not. We will emphasize autoimmune cholangitis and (Low Phospholipid Associated Cholelithiasis) LPAC with MDR3 deficiency. Decisional trees are proposed. PMID:16691179

Vullierme, M P; Vilgrain, V

2006-04-01

5

Diagnostics of Biliary Dilatation by Means of Magnetic Resonance Cholangiopancreatography  

PubMed Central

Summary Background Magnetic resonance cholangiopancreatography is a relatively noninvasive technique of biliary and pancreatic duct imaging. MRCP technique utilizes T2-weighted sequences, in which bile is characterized by high signal intensity, whilst signal intensity of surrounding tissues is reduced. The purpose of this publication was to assess the diagnostic value of magnetic resonance cholangiopancreatography in the diagnostics of biliary dilatation. Material/Methods MRCP examinations of 148 patients (48 men and 100 women; the average age was 56) performed on a 1.5T Achieva Philips device in the Provincial Hospital in Rzeszow between November 2011 and April 2013 were included in retrospective analysis. Examined group was divided into three subgroups: patients after cholecystectomy, patients with cholecystolithiasis and patients without gallbladder concretions. The definitive cause of biliary dilatation was determined mainly on the basis of MRCP and ECPW examinations, and, in individual cases, during intraoperative cholangiography and laparatomy. Results Signal loss corresponding to probable concretions was identified in 34 cases. In the group of patients with cholecystolithiasis the cause of biliary dilatation was usually (45%) cholelithiasis. MRCP image was typical in 4 out of 9 malignant cases. The cause of biliary dilatation was usually (20%) a neoplasm in the group of patients without gallstones. Benign causes of biliary dilatation, apart from cholelithiasis, were identified in 16 individuals, including 4 cases in which the diagnosis was identified using MRCP, whereas in the remaining 12 cases ECPW examination proved conclusive to the final diagnosis. Conclusions Magnetic resonance cholangiopancreatography enables reliable diagnosis of causes of biliary dilatation as long as they involve presence of gallbladder deposits and tumors. In benign causes of biliary dilatation, apart from cholelithiasis, MRCP picture is often atypical and therefore, the final identification of the cause of biliary dilatation is possible when this imagining method is combined with ERCP and additional tests. PMID:25243036

Szalacha-Tara?a, Ewa; Ramotowski, Rados?aw; Guz, Wies?aw; Samojedny, Antoni; Dziurzy?ska-Bia?ek, Ewa; Jadczak, Przemys?aw

2014-01-01

6

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

PubMed

Endoscopic retrograde cholangiography is the most commonly used technique for removal of common bile duct stones. Biliary sphincterotomy during the procedure facilitates stone retrieval from the common bile duct. However, sphincterotomy ablates the normal biliary sphincter mechanism. This facilitates duodeno-biliary reflex and can result in inward migration of luminal parasite into the biliary system. In areas where ascariasis is endemic there is an increased risk of biliary ascariasis in postbiliary sphincterotomy patients. We report an unusual case where a patient presented with recurrent biliary colic after cholecystectomy and common bile duct stone extraction and was diagnosed to have biliary ascariasis with the help of endoscopic ultrasound examination of the biliary system. PMID:24407145

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

2014-04-01

7

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

PubMed

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. PMID:23716999

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

2013-05-28

8

[Reflux into the pancreatic duct during peroperative biliary radiomanometry. Report of 200 cases (author's transl)].  

PubMed

The authors have observed 200 cases of reflux into the pancreatic duct out of 2,500 biliary operations with radiomanometry. Out of the 200 cases, 109 were functional, i.e. due to a common duct with or without an ampoule of Vater, or due to duodenal stockage whether there was a common duct or not. They had no therapeutic consequence. 38 were organic due to an obstruction (impacted gall stone, or odditis which favours reflux) and needed sphincterotomy especially when the pancreatic duct was dilated. In 53 cases, no organic or anatomical explanation was found. Reflux occurring at physiological pressures is more likely to be functional. The degree of reflux does not always depend on the increase in perfusion pressure. The time of the reflux depends partly on its nature. Early reflux is found mainly in cases of obstruction. Reflux secondary to passage into the duodenum is mainly found in functional reflux with stockage. Wirsung's duct is dilated in more than 75% of cases with obstruction and in only 3 cases out of 20 with functional reflux. Reflux into Santorini's duct is 3 times more common when there is papillary obstruction. PMID:849964

Lataste, J; Albou, J C

1977-01-01

9

Internal pancreatic stent causing irreversible dilatation of pancreatic duct.  

PubMed

A 28-year-old woman underwent a pylorus preserving Whipple procedure for pancreatic serous cystadenoma located on the head of the pancreas. During the operation, an internal stent (7F silastic catheter, 9 cm in length) was placed within the pancreatic duct in the area of pancreaticojejunal end-to-end Dunking type anastomosis to prevent development of fistula. The stent was positioned so that one third of its length would lie into the pancreatic duct, and it was anchored to the periductal pancreatic tissue with only one rapidly absorbable chromic suture. Leakage from the anastomosis was not observed, and she was discharged without any complaint. Early postoperative abdominal CT examination revealed that the stent was retained within the normal caliber pancreatic duct (Fig. 1a). Six months after the operation, she began to complain to epigastric pain triggered by the meals. The laboratory analysis was normal, particularly liver biochemical tests and serum amylase. The internal pancreatic stent within the dilated pancreatic duct was detected by an additional CT examination (Fig. 1b). The stent was removed endoscopically at the third attempt. The pain was resolved after its removal. Control CT examination which was taken at the 18th month after removal of the stent showed dilatation of the pancreatic duct (Fig. 2a). The patient remained free of any complaint, although regressed pancreatic duct dilatation has persisted over 4 years of follow-up (Fig. 2b). PMID:24799775

Hasbahceci, Mustafa; Erol, Cengiz

2014-02-01

10

Paclitaxel-eluting balloon dilation of biliary anastomotic stricture after liver transplantation  

PubMed Central

AIM: To investigate the safety and effectiveness of endoscopic therapy with a paclitaxel-eluting balloon (PEB) for biliary anastomotic stricture (AS) after liver transplantation (LT). METHODS: This prospective pilot study enrolled 13 consecutive eligible patients treated for symptomatic AS after LT at the University Hospital of Münster between January 2011 and March 2014. The patients were treated by endoscopic therapy with a PEB and followed up every 8 wk by endoscopic retrograde cholangiopancreatography (ERCP). In cases of re-stenosis, further balloon dilation with a PEB was performed. Follow-up was continued until 24 mo after the last intervention. RESULTS: Initial technical feasibility, defined as successful balloon dilation with a PEB during the initial ERCP procedure, was achieved in 100% of cases. Long-term clinical success (LTCS), defined as no need for further endoscopic intervention for at least 24 mo, was achieved in 12 of the 13 patients (92.3%). The mean number of endoscopic interventions required to achieve LTCS was only 1.7 ± 1.1. Treatment failure, defined as the need for definitive alternative treatment, occurred in only one patient, who developed recurrent stenosis with increasing bile duct dilatation that required stent placement. CONCLUSION: Endoscopic therapy with a PEB is very effective for the treatment of AS after LT, and seems to significantly shorten the overall duration of endoscopic treatment by reducing the number of interventions needed to achieve LTCS.

Hüsing, Anna; Reinecke, Holger; Cicinnati, Vito R; Beckebaum, Susanne; Wilms, Christian; Schmidt, Hartmut H; Kabar, Iyad

2015-01-01

11

Paucity of biliary ducts: A rare etiology of neonatal cholestasis  

PubMed Central

We report a case of a newborn with cholestasis that was diagnosed as nonsyndromic Alagille syndrome. The main feature of the disease is a paucity of biliary ducts. There are two known types of the disease: the syndromic type which is associated with other congenital defects and the nonsyndromic type without other anomalies detected at birth. We describe the case and discuss its clinical and radiologic findings. We also discuss the various etiologies of cholestasis that are included in the differential diagnosis. PMID:22690284

Figiel, Steven Cornell; Franco, Arie; Pucar, Darko; Lewis, Kristopher Neal; Lee, Jeffrey Roberts

2012-01-01

12

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

PubMed

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

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

2014-12-01

13

Computed tomographic features of biliary obstruction  

SciTech Connect

A retrospective review of CT scans in 69 consecutive patients with proven biliary obstruction due to both malignant and benign causes was performed to define and differentiate CT changes. Abrupt termination of a dilated extrahepatic biliary duct was characteristic of a malignant process in the absence of a mass. Gradual tapering of a dilated duct was specific for benign disease. Other findings, such as degree of intra- or extrahepatic duct dilation and presence or absence of a dilated pancreatic duct were not reliable in distinguishing benign from malignant causes. The authors also found CT to be accurate in detecting common duct stones with a sensitivity exceeding 80%.

Baron, R.L.; Stanley, R.J.; Lee, J.K.T.; Koehler, R.E.; Levitt, R.G.

1983-06-01

14

Congenital dilatation of the common bile duct and pancreaticobiliary maljunction—clinical implications  

Microsoft Academic Search

Clinical conditions and diagnosis  Congenital dilatation of the common bile duct is a disease in which the extrahepatic bile duct, or both the extra and intrahepatic\\u000a bile ducts, is dilated in various ways. Pancreaticobiliary maljunction is a disease in which the pancreatic duct meets the\\u000a bile duct outside of the duodenal wall beyond the sphincter Oddi. Recently, these diseases have been

Wataru Kimura

2009-01-01

15

Endoscopic therapy for type B surgical biliary injury in a patient with short cystic duct.  

PubMed

Anatomical variations of the cystic duct are well-defined. The presence of short or absent cystic duct is unusual and represents a co-factor of biliary injury especially during laparoscopic cholecystectomy. Thus, its knowledge is important to avoid ductal injury in hepato-biliary surgery. We experienced the case of a 40-year-old woman with symptomatic cholelitiasis, who underwent to laparoscopic cholecystectomy. At surgery, an accidental bile duct lesion was carried, during Calot's triangle dissection, due the particular difficulties in dissecting an extremely short cystic duct found at the junction of the common hepatic duct and common bile duct. No vascular anomalies were present. The biliary leakage from the common bile duct was intraoperative identified and subsequentially treated by the endoscopic method. Laparoscopic cholecystectomy with sequential biliary endoprosthesis insertion was completed without conversion to open surgery. The endoscopic stenting was the definitive treatment for the leakage. No evidence of biliary stent complication was observed during the follow-up. This report documents a case of short cystic duct with particular emphasis to the biliary injury risk during the laparoscopic dissection of "unusual" Calot's triangle, and examines our mini-invasive therapeutic strategies in the management of bile leakage after laparoscopic cholecystectomy. PMID:20615365

Selvaggi, F; Cappello, G; Astolfi, A; Di Sebastiano, P; Del Ciotto, N; Di Bartolomeo, N; Innocenti, P

2010-05-01

16

Biliary parasitic diseases including clonorchiasis, opisthorchiasis and fascioliasis  

Microsoft Academic Search

Parasitic infection of the biliary tree is caused by liver flukes, namely Clonorchis sinensis and Opisthorchis viverrini. These flukes reside in the peripheral small bile ducts of the liver and produce chronic inflammation of the bile duct, bile\\u000a duct dilatation, mechanical obstruction, and bile duct wall thickening. On imaging,\\u000a peripheral small intrahepatic bile ducts are dilated, but the large bile

Jae Hoon Lim; Eimorn Mairiang; Geung Hwan Ahn

2008-01-01

17

Biliary parasitic diseases including clonorchiasis, opisthorchiasis and fascioliasis  

Microsoft Academic Search

Parasitic infection of the biliary tree is caused by liver flukes, namely Clonorchis sinensis and Opisthorchis viverrini. These flukes reside in the peripheral small bile ducts of the liver and produce chronic inflammation of the bile duct, bile\\u000a duct dilatation, mechanical obstruction, and bile duct wall thickening. On imaging, peripheral small intrahepatic bile ducts\\u000a are dilated, but the large bile

Jae Hoon Lim; Eimorn Mairiang; Geung Hwan Ahn

18

Which Is the Better Treatment for the Removal of Large Biliary Stones? Endoscopic Papillary Large Balloon Dilation versus Endoscopic Sphincterotomy  

PubMed Central

Background/Aims We evaluated the efficacy and cost-effectiveness of endoscopic papillary large balloon dilation (EPLBD) for large common bile duct (CBD) stone removal compared with endoscopic sphincterotomy (EST). Methods A total of 1,580 patients who underwent endoscopic CBD stone extraction between January 2001 and July 2010 were reviewed. The following inclusion criteria were applied: choledocholithiasis treated by EPLBD with minor EST or EST with mechanical lithotripsy; and follow-up >9 months after treatment. Results Forty-nine patients with EPLBD and 41 with EST were compared. There was no significant difference in the complication rates and stone recurrence rates between the two groups. However, significantly more endoscopic retrograde cholangiopancreatography (ERCP) sessions were required in the EST group to achieve the complete removal of stones (1.7 times vs 1.3 times; p=0.03). The mean cost required for complete stone removal per patient was significantly higher in the EST group compared to the EPLBD group (USD $1,644 vs $1,225, respectively; p=0.04). Dilated CBD was the only significant factor associated with recurrent biliary stones (relative risk, 1.09; 95% confidence interval, 1.02 to 1.17; p=0.02). Conclusions EPLBD is the better treatment (compared to EST) for removing large CBD stones because EPLBD requires fewer ERCP sessions and is less expensive. PMID:25071911

Paik, Woo Hyun; Ryu, Ji Kon; Park, Jin Myung; Song, Byeong Jun; Kim, Jaihwan; Park, Joo Kyung; Kim, Yong-Tae

2014-01-01

19

Expression of collagens type I and IV, osteonectin and transforming growth factor beta-1 (TGF?1) in biliary atresia and paucity of intrahepatic bile ducts during infancy  

Microsoft Academic Search

Background\\/Aims: Biliary atresia and paucity of intrahepatic bile ducts are the main causes of neonatal cholestasis leading to hepatic fibrosis. Fibrotic evolution is slow in paucity of bile ducts as compared to the rapid progression to biliary cirrhosis in biliary atresia when cholestasis persists despite hepatoportoenterostomy. Our aim was to compare the expression of collagens type I and IV,?-smooth muscle

Thierry Lamireau; Brigitte Le Bail; Liliane Boussarie; Monique Fabre; Pierre Vergnes; Olivier Bernard; Frédéric Gautier; Paulette Bioulac-Sage; Jean Rosenbaum

1999-01-01

20

Endoscopic papillary large balloon dilation for removal of bile duct stones  

PubMed Central

AIM: To investigate the efficacy and outcomes of endoscopic papillary large balloon dilation (EPLBD) for bile duct stones in a multicenter prospective study. METHODS: Lithotomy by EPLBD was conducted in 124 patients with bile duct stones ? 13 mm in size or with three or more bile duct stones ? 10 mm. After endoscopic sphincterotomy, the papilla was dilated using balloons 12-20 mm in diameter fitting the bile duct diameter. RESULTS: The success rate of first-time lithotomy was 86.3% (107/124) and the final lithotomy success rate was 100% (124/124). Lithotripsy was needed in 10 of the 124 (13.6%) patients. Adverse events due to the treatment procedure occurred in 6 (4.8%) patients, all of which were mild. Performing large balloon dilation after endoscopic sphincterotomy in patients with large stones or multiple stones in the bile duct is considered to ensure the safety of treatment and to reduce the need for lithotripsy. CONCLUSION: It is suggested that treatment by EPLBD for large bile duct stones may be safe and useful. PMID:25493029

Sakai, Yuji; Tsuyuguchi, Toshio; Kawaguchi, Yoshiaki; Hirata, Nobuto; Nakaji, So; Kitamura, Katsuya; Mikami, Shigeru; Fujimoto, Tatsuya; Ijima, Masashi; Kurihara, Eishin; Oana, Shuhei; Nishino, Takayoshi; Tamura, Ryo; Sakamoto, Dai; Nakamura, Masato; Nishikawa, Takao; Sugiyama, Harutoshi; Yoshida, Hitoshi; Mine, Tetsuya; Yokosuka, Osamu

2014-01-01

21

Surgical Technique for Right Lobe Adult Living Donor Liver Transplantation Without Venovenous Bypass or Portocaval Shunting and With Duct-to-Duct Biliary Reconstruction  

PubMed Central

Objective To report the authors’ experience with adult living donor liver transplantation (ALDLT) without venovenous bypass and to describe modifications that will allow for a direct duct-to-duct biliary reconstruction. Summary Background Data Adult living donor liver transplantation is being evaluated as a method to alleviate the organ shortage. Descriptions of the procedure have emphasized the use of venovenous bypass, portocaval decompression, and the mandatory use of a Roux-en-Y biliary enteric anastomosis. The authors describe a technique for ALDLT without venovenous bypass, portocaval decompression, or caval clamping in 11 recipients and describe the modifications to the procedure that may allow a duct-to-duct biliary reconstruction in certain cases. Methods Between March 1999 and March 2000, 11 ALDLTs were performed at the authors’ institution. All procedures were performed without venovenous bypass, portocaval decompression, or caval clamping. After a modification to the procedure, five of the last six recipients underwent biliary reconstruction with a direct duct-to-duct anastomosis. Data regarding donor, recipient, and graft survival, complications, and graft function were collected. Results Recipients comprised five women and six men, mean age 48 years. Donors comprised five women and six men, mean age 36.5 years. Donor to recipient relationships included sibling, spouse, son, and daughter. Indications for transplantation were hepatitis C, hepatitis C with hepatocellular carcinoma, primary biliary cirrhosis, primary sclerosing cholangitis, ethanol, and cryptogenic. No case required venovenous bypass or portocaval shunting. The right hepatic vein of the donor graft was anastomosed to the confluence of the left and middle hepatic veins in all cases. All donors are alive and well, with no adverse complications reported. Recipient and graft survival rates were 91% and 82%, respectively, for ALDLT versus 92% and 92% for recipients of cadaveric organs during the same time period. One recipient died of multiple organ failure and sepsis. Biliary reconstruction was performed by Roux-en-Y hepaticojejunostomy in the six cases. In five of the last six recipients, direct duct-to-duct biliary reconstruction with a T tube was used. No anastomotic leaks or strictures occurred in the patients undergoing duct-to-duct reconstruction. Conclusions Adult living donor liver transplantation can be performed safely and may help alleviate the organ shortage. Neither venovenous bypass nor portocaval shunting is necessary to perform the procedure, and modifications to both the donor and recipient hepatectomy procedures may allow biliary reconstruction to be performed by a direct duct-to-duct anastomosis in selected cases. PMID:11303131

Grewal, Hani P.; Shokouh-Amiri, M. Hosein; Vera, Santiago; Stratta, Robert; Bagous, Wagdi; Gaber, A. Osama

2001-01-01

22

The effect of biliary stenting on difficult common bile duct stones  

PubMed Central

Introduction If common bile duct (CBD) stones (choledocholithiasis) are left untreated, they may cause increases in morbidity and mortality due to several conditions. Aim In this study, using transient biliary stenting following the failure of an initial endoscopic retrograde cholangiopancreatography (ERCP) session, we aimed to show the effects of making the CBD stones smaller and easier to remove in the following session. Material and methods In 156 of 1300 (12%) patients with CBD stones, who underwent balloon screening and/or basket lithotripsy following ERCP and CBD cannulation, it was not possible to remove the stones in the first session. Of these 156 patients, 64 (4.9%) were further followed and tested following transient biliary stenting. Results In the last ERCP following biliary stenting, the maximum stone sizes and stone indices were decreased in 54 (83%) patients and stone fragmentation was observed in 46 (72%) patients. Complete and incomplete removal was obtained in 40 (62.5%) and 24 (37.5%) patients, respectively. Conclusions Biliary stenting, fragmentation and the reduction in the size of difficult common bile duct stones caused by the first session of ERCP may increase the chance of success in the next session of ERCP. PMID:25061492

Arabul, Mahmut; Celik, Mustafa; Alper, Emrah; Unsal, Belk?s

2014-01-01

23

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

24

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. PMID:21528077

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

2011-01-01

25

Reappraisal of endoscopic papillary balloon dilation for the management of common bile duct stones  

PubMed Central

Although endoscopic sphincterotomy (EST) is still considered as a gold standard treatment for common bile duct (CBD) stones in western guideline, endoscopic papillary balloon dilation (EPBD) is commonly used by the endoscopists in Asia as the first-line treatment for CBD stones. Besides the advantages of a technical easy procedure, endoscopic papillary large balloon dilation (EPLBD) can facilitate the removal of large CBD stones. The indication of EPBD is now extended from removal of the small stones by using traditional balloon, to removal of large stones and avoidance of lithotripsy by using large balloon alone or after EST. According to the reports of antegrade papillary balloon dilatation, balloon dilation itself is not the cause of pancreatitis. On the contrary, adequate dilation of papillary orifice can reduce the trauma to the papilla and pancreas by the basket or lithotripter during the procedure of stone extraction. EPLBD alone is as effective as EPLBD with limited EST. Longer ballooning time may be beneficial in EPLBD alone to achieve adequate loosening of papillary orifice. The longer ballooning time does not increase the risk of pancreatitis but may reduce the bleeding episodes in patients with coagulopathy. Slowly inflation of the balloon, but not exceed the diameter of bile duct and tolerance of the patients are important to prevent the complication of perforation. EPBLD alone or with EST are not the sphincter preserved procedures, regular follow up is necessary for early detection and management of CBD stones recurrence.

Lai, Kwok-Hung; Chan, Hoi-Hung; Tsai, Tzung-Jiun; Cheng, Jin-Shiung; Hsu, Ping-I

2015-01-01

26

Reappraisal of endoscopic papillary balloon dilation for the management of common bile duct stones.  

PubMed

Although endoscopic sphincterotomy (EST) is still considered as a gold standard treatment for common bile duct (CBD) stones in western guideline, endoscopic papillary balloon dilation (EPBD) is commonly used by the endoscopists in Asia as the first-line treatment for CBD stones. Besides the advantages of a technical easy procedure, endoscopic papillary large balloon dilation (EPLBD) can facilitate the removal of large CBD stones. The indication of EPBD is now extended from removal of the small stones by using traditional balloon, to removal of large stones and avoidance of lithotripsy by using large balloon alone or after EST. According to the reports of antegrade papillary balloon dilatation, balloon dilation itself is not the cause of pancreatitis. On the contrary, adequate dilation of papillary orifice can reduce the trauma to the papilla and pancreas by the basket or lithotripter during the procedure of stone extraction. EPLBD alone is as effective as EPLBD with limited EST. Longer ballooning time may be beneficial in EPLBD alone to achieve adequate loosening of papillary orifice. The longer ballooning time does not increase the risk of pancreatitis but may reduce the bleeding episodes in patients with coagulopathy. Slowly inflation of the balloon, but not exceed the diameter of bile duct and tolerance of the patients are important to prevent the complication of perforation. EPBLD alone or with EST are not the sphincter preserved procedures, regular follow up is necessary for early detection and management of CBD stones recurrence. PMID:25685263

Lai, Kwok-Hung; Chan, Hoi-Hung; Tsai, Tzung-Jiun; Cheng, Jin-Shiung; Hsu, Ping-I

2015-02-16

27

Endoscopic ultrasound-guided biliary drainage for right hepatic bile duct obstruction: novel technical tips.  

PubMed

Endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) is not normally indicated for an obstructed right intrahepatic bile duct (IHBD). The technical feasibility and clinical efficacy of a novel technique of EUS-BD for right IHBD obstruction were evaluated. A total of 11 patients underwent drainage using either a left or a right biliary access route. The causes of obstructive jaundice were cholangiocarcinoma (n?=?6), pancreatic cancer (n?=?3), gastric cancer (n?=?1), and colon cancer (n?=?1). After placement of an uncovered metal stent to bridge the obstruction, a hepaticogastrostomy was completed using a covered stent. Mean procedure time was 33.9?±?10.0 minutes. Technical and functional success were achieved in all patients, and no adverse events occurred. This novel method appears to be safe and effective for right IHBD obstruction. PMID:25264761

Ogura, Takeshi; Sano, Tatsushi; Onda, Saori; Imoto, Akira; Masuda, Daisuke; Yamamoto, Kazuhiro; Kitano, Masayuki; Takeuchi, Toshihisa; Inoue, Takuya; Higuchi, Kazuhide

2015-01-01

28

[Ultrasound of gallbladder and bile duct.  

PubMed

The cystic nature of the gallbladder and bile duct when dilated, and the advantages of ultrasound as a quick, reproducible, convenient, cheap and low risk technique, with a high sensitivity and specificity, make it the most eligible technique in biliary pathology studies. Ultrasound has become a valuable tool for doctors studying biliary pathology and its complications, from abnormal liver function results, right upper quadrant pain, or jaundice, to cholelithiasis, cholecystitis, or suspicion of biliary tumors. PMID:25450432

Segura Grau, A; Joleini, S; Díaz Rodríguez, N; Segura Cabral, J M

2014-11-11

29

Improving patient and user safety during endoscopic investigation of the pancreatic and biliary ducts  

NASA Astrophysics Data System (ADS)

Endoscopic investigation of the main pancreatic duct and biliary ducts is called endoscopic retrograde cholangiopancreatography (ERCP), and carries a risk of pancreatitis for the patient. During ERCP, a metal guidewire is inserted into the pancreatobiliary duct from a side-viewing large endoscope within the duodenum. To verify correct placement of the ERCP guidewire, an injection of radiopaque dye is required for fluoroscopic imaging, which exposes the patient and clinical team to x-ray radiation. A safer and more effective means to access the pancreatobiliary system can use direct optical imaging, although the endoscope diameter and stiffness will be significantly larger than a guidewire's. To quantify this invasiveness before human testing, a synthetic force-sensing pancreas was fabricated and attached to an ERCP training model. The invasiveness of a new, 1.7-mm diameter, steerable scanning fiber endoscope (SFE) was compared to the standard ERCP guidewire of 0.89-mm (0.035") diameter that is not steerable. Although twice as large and significantly stiffer than the ERCP guidewire, the SFE generated lower or significantly less average force during insertion at all 4 sensor locations (P<0.05) within the main pancreatic duct. Therefore, the addition of steering and forward visualization at the tip of the endoscope reduced the invasiveness of the in vitro ERCP procedure. Since fluoroscopy is not required, risks associated with dye injection and x-ray exposure can be eliminated when using direct optical visualization. Finally, the SFE provides wide-field high resolution imaging for image-guided interventions, laser-based fluorescence biomarker imaging, and spot spectral analysis for future optical biopsy.

Chandler, John E.; Melville, C. David; Lee, Cameron M.; Saunders, Michael D.; Burkhardt, Matthew R.; Seibel, Eric J.

2011-03-01

30

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. PMID:21607152

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

2010-01-01

31

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

32

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

33

Gray scale ultrasound diagnosis of obstructive biliary disease.  

PubMed

B-mode ultrasound examinations have been useful in demonstrating cholelithiasis and obstructive dilatation of the gallbladder. It is now possible with gray scale ultrasound technique to demonstrate dilatation of the common bile duct, as differentiated from the gallbladder, and also to show fluid containing spaces within the liver. Discrimination between solid and fluid filled intrahepatic structures is readily made, and dilated biliary radicles are frequently discernible. PMID:1200220

Stone, L B; Ferrucci, J T; Warshaw, A L; Wittenberg, J; Slutsky, M

1975-09-01

34

Mutations of K-ras but not p53 genes in biliary duct and pancreatic duct carcinomas induced in hamsters by cholecystoduodenostomy with dissection of the common duct followed by N-nitrosobis(2-oxopropyl)amine.  

PubMed

An experimental model for the induction of extrahepatic biliary duct carcinomas in hamsters given cholecystoduodenostomy with dissection of the extrahepatic duct at the distal end of the common duct (CDDB) followed by N-nitrosobis(2-oxopropyl)amine (BOP) has been reported [Tajima et al. (1994) Jpn. J. Cancer Res., 85, 780-788]. The CDDB procedure greatly accelerates cell turnover in the biliary epithelium. In the present experiment, mutations of K-ras and p53 genes in the induced lesions were investigated by the reverse transcriptase-polymerase chain reaction-single strand conformation polymorphism (RT-PCR-SSCP) method followed by direct sequencing. Mutations of K-ras, involving a G to A transition in second position of codon 12 of K-ras exon 1, were detected in six out of eight (75%) extrahepatic bile duct carcinomas and six out of eleven (54.5%) pancreatic duct carcinomas. However, no mutations of p53 were observed in either tumor type. The results indicate an association between anomalous pancreaticobiliary junction and development of biliary carcinomas that may be pertinent to the human situation, and indicate that conditions of the model predispose to mutations occurring in K-ras but not p53. PMID:9310259

Majima, T; Tsujiuchi, T; Tsutsumi, M; Tsunoda, T; Konishi, Y

1997-09-16

35

Initial experience with endoscopic retrograde cholangiography and endoscopic retrograde biliary stenting for treatment of extrahepatic bile duct obstruction in dogs.  

PubMed

Objective-To describe techniques for endoscopic retrograde cholangiography (ERC) and endoscopic retrograde biliary stenting of the common bile duct (CBD) for minimally invasive treatment of extrahepatic bile duct obstruction (EHBDO) in dogs. Design-Experimental study and clinical report. Animals-7 healthy research dogs and 2 canine patients. Procedures-ERC and endoscopic retrograde biliary stenting were performed in healthy purpose-bred research dogs and client-owned dogs with a diagnosis of EHBDO that underwent an attempted biliary stent procedure. Research dogs were euthanized after completion of the procedure and underwent necropsy. With dogs under general anesthesia, the pylorus was cannulated with a side-view duodenoscope, and the duodenum was entered. The major duodenal papilla (MDP) and minor duodenal papilla were then identified, and the MDP was cannulated. Endoscopic retrograde cholangiography and endoscopic retrograde biliary stenting were attempted with the aid of endoscopy and fluoroscopy in all dogs. Procedure time, outcome for duodenal and MDP cannulation, and success of stent placement were recorded. Results-Endoscopic retrograde cholangiography was successfully performed in 5 of 7 research dogs and in 1 of 2 patients. Biliary stenting was achieved in 4 of 7 research dogs and 1 of 2 patients, with a polyurethane (n = 4) or self-expanding metallic stent (1). One patient had a mass such that visualization of the MDP was impossible and no attempt at biliary cannulation could be made. After placement, stent patency was documented by means of contrast cholangiography and visualization of biliary drainage into the duodenum intra-operatively. No major complications occurred during or after the procedure in any patient. Follow-up information 685 days after stent placement in 1 patient provided evidence of biliary patency on serial repeated ultrasonography and no evidence of complications. Conclusions and Clinical Relevance-ERC and endoscopic retrograde biliary stenting were successfully performed in a small group of healthy dogs and 1 patient with EHBDO, but were technically challenging procedures. Further investigation of this minimally invasive technique for the treatment of EHBDO in dogs is necessary before this may be considered a viable alternative to current treatment methods. PMID:25632818

Berent, Allyson; Weisse, Chick; Schattner, Mark; Gerdes, Hans; Chapman, Peter; Kochman, Michael

2015-02-15

36

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

PubMed

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. PMID:24106417

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

2013-09-28

37

Percutaneous video choledochoscopic treatment of retained biliary stones via dilated T-tube tract  

Microsoft Academic Search

Background  Retained biliary stones is a common clinical problem in patients after surgery for complicated gallstone disease. When postoperative\\u000a endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy are unsuccessful, several percutaneous\\u000a procedures for stone removal can be applied as alternatives to relaparotomy. These procedures are performed either under fluoroscopic\\u000a control or with the use of choledochoscopy, but it is also possible to

E. M. Gamal; A. Szabó; E. Szüle; A. Vörös; P. Metzger; G. Kovács; J. Rózsahegyi; A. Oláh; I. Rózsa; J. Kiss

2001-01-01

38

Polyarteritis nodosa presented as a dilatation of the intrahepatic bile duct.  

PubMed

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis of small- and medium-sized arteries in multiorgan systems. PAN may affect the gastrointestinal tract in 14%-65% of patients, but rarely involves the biliary tract and liver. We describe a patient without underlying disease who was diagnosed with PAN during resection of the gallbladder and liver. PMID:25368854

Choi, Han Lim; Sung, Ro Hyun; Kang, Min Ho; Jeon, Hyun Jeong; Yun, Hyo Yung; Jang, Lee Chan; Choi, Jae Woon; Song, Young Jin; Ryu, Dong Hee

2014-11-01

39

Large balloon dilation post endoscopic sphincterotomy in removal of difficult common bile duct stones: A literature review  

PubMed Central

Endoscopic sphincterotomy (ES) is the standard therapy in common bile duct (CBD) stones extraction. Large stones (? 12 mm) or multiple stones extraction may be challenging after ES alone. Endoscopic sphincterotomy followed by large balloon dilation (ESLBD) has been described as an alternative to ES in these indications. Efficacy, safety, cost-effectiveness and technical aspects of the procedure have been here reviewed. PubMed and Google Scholar search resulted in forty-one articles dealing with CBD stone extraction with 12 mm or more dilation balloons after ES. ESLBD is at least as effective as ES, and reduces the need for additional mechanical lithotripsy. Adverse events rates are not statistically different after ESLBD compared to ES for pancreatitis, bleeding and perforation. However, particular attention should be paid in patients with CBD strictures, which is identified as a risk factor of perforation. ESLBD is slightly cost-effective compared to ES. A small sphincterotomy is usually performed, and may reduce bleeding rates compared to full sphincterotomy. Dilation is performed with 12-20 mm enteral balloons. Optimal inflation time is yet to be determined. The procedure can be performed safely even in patients with peri-ampullary diverticula and surgically altered anatomy. ESLBD is effective and safe in the removal of large CBD stones, however, small sphincterotomy might be preferred and CBD strictures should be considered as a relative contraindication. PMID:24976713

Rouquette, Olivier; Bommelaer, Gilles; Abergel, Armando; Poincloux, Laurent

2014-01-01

40

Choleperitoneum due to intrahepatic bile duct rupture - case report.  

PubMed

Non-traumatic perforations of the bile ducts are unfrequently encountered entities, all the more when they affect the intrahepatic bile ducts, exteriorizing their biliary content in the great peritoneal cavity. Reporting such a case has determined the authors to perform a careful overview of the cases present in the literature. An observation that can be made based on these is that the obstruction of the main bile duct due to lithiasis determines, by pressure increase, the dilation of the bile system branches, all on the background of an unknown malformation of the intrahepatic bile ducts. PMID:25149621

Simion, L; Straja, Dn; Prunoiu, Vm; Alecu, M; Br?tucu, E

2014-01-01

41

CT and MR cholangiography: advantages and pitfalls in perioperative evaluation of biliary tree  

PubMed Central

Recent developments in imaging technology have enabled CT and MR cholangiopancreatography (MRCP) to provide minimally invasive alternatives to endoscopic retrograde cholangiopancreatography for the pre- and post-operative assessment of biliary disease. This article describes anatomical variants of the biliary tree with surgical significance, followed by comparison of CT and MR cholangiographies. Drip infusion cholangiography with CT (DIC-CT) enables high-resolution three-dimensional anatomical representation of very small bile ducts (e.g. aberrant branches, the caudate branch and the cystic duct), which are potential causes of surgical complications. The disadvantages of DIC-CT include the possibility of adverse reactions to biliary contrast media and insufficient depiction of bile ducts caused by liver dysfunction or obstructive jaundice. Conventional MRCP is a standard, non-invasive method for evaluating the biliary tree. MRCP provides useful information, especially regarding the extrahepatic bile ducts and dilated intrahepatic bile ducts. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRCP may facilitate the evaluation of biliary structure and excretory function. Understanding the characteristics of each type of cholangiography is important to ensure sufficient perioperative evaluation of the biliary system. PMID:22422383

Hyodo, T; Kumano, S; Kushihata, F; Okada, M; Hirata, M; Tsuda, T; Takada, Y; Mochizuki, T; Murakami, T

2012-01-01

42

Advances in the endoscopic management of common bile duct stones.  

PubMed

Extraction of common bile duct stones by endoscopic retrograde cholangiopancreatography generally involves biliary sphincterotomy, endoscopic papillary balloon dilation or a combination of both. Endoscopic papillary large-balloon dilation after sphincterotomy has increased the safety of large stone extraction. Cholangioscopically directed electrohydraulic and laser lithotripsy using single-operator mother-daughter systems or direct peroral cholangioscopy using ultraslim endoscopes are increasingly utilized for the management of refractory stones. In this Review, we focus on advances in endoscopic approaches and techniques, with a special emphasis on management strategies for 'difficult' common bile duct stones. PMID:24860928

Trikudanathan, Guru; Arain, Mustafa A; Attam, Rajeev; Freeman, Martin L

2014-09-01

43

Ultrasound of the extrahepatic bile duct: issues of size.  

PubMed

Ultrasound is a pivotal study for evaluation of the biliary tree. In particular, the size of the extrahepatic bile duct is a critical measurement and has been a contentious issue since the early days of diagnostic ultrasound. This article reviews the history and ongoing issues regarding sonography of the normal-size duct and a variety of factors that may affect its size, including age, prior surgery, congenital abnormalities, anatomical variations, and medications. Other related sonographic issues are discussed including abnormal nondilated ducts and abnormal intraluminal contents such as sludge or air that make evaluation of the duct more difficult, particularly in patients with primary sclerosing cholangitis and prior liver transplantation. Ultimately, the luminal size of the extrahepatic duct should be considered as a single part of the entire assessment of the biliary tree that must also include the intrahepatic and pancreatic ducts, the pattern of dilatation (variable vs progressively dilated to a single point of obstruction), any wall thickening, intraluminal sludge, calculi or mass, and extraluminal compression. Clinical symptoms and abnormal laboratory values should prompt further evaluation despite a normal appearance of the bile duct, whereas pursuit of an isolated finding of an enlarged duct without supporting clinical data may not be warranted. PMID:20498562

Horrow, Mindy M

2010-06-01

44

Atypical presentation of an advanced obstructive biliary cancer without jaundice  

PubMed Central

Patient: Female, 60 Final Diagnosis: Cholangiocarcinoma Symptoms: Abdominal pain • abdominal discomfort Medication: — Clinical Procedure: — Specialty: Oncology Objective: Unusual natural history/clinical course Background: Cholangiocarcinoma remains to be a challenging case to diagnose and manage as it usually presents in advanced stage and survival rate remains dismal despite the medical breakthroughs. It is usually classified as intrahepatic, perihilar or distal tumor which can lead to bile duct obstruction causing sluggish flow of bile through the biliary tract and promoting increased absorption of bilirubin, bile acids and bile salts into systemic circulation accounting for the occurrence of jaundice, dark-colored urine and generalized pruritus. It usually becomes symptomatic when the tumor has significantly obstructed the biliary drainage causing painless jaundice and deranged liver function with cholestatic pattern. Jaundice occurs in 90% of the cases when the tumor has obstructed the biliary drainage system. A markedly dilated gallbladder as initial presenting feature in the absence of other typical obstructive clinical manifestations of an advanced stage of the cholangiocarcinoma is rare. Case Report: This case report presents an atypical case of an elderly woman who presented with advanced metastatic ductal cholangiocarcinoma with markedly dilated gallbladder and liver mass without other clinical manifestations and laboratory evidence of cholestatic jaundice. Conclusions: The mere presence of Courvoisier’s sign, even in the absence of other signs of biliary obstruction, could be suggestive of advanced neoplastic process along the biliary tract. Laboratory evidence of cholestasis might lag behind the clinical severity of the biliary obstruction in cholangiocarcinoma. PMID:24223234

Salvador, Vincent Bryan; Samrao, Pushkinder; Leytin, Anatoly; Basith, Mohammed

2013-01-01

45

Biliary cast - complication of cholangitis and pancreatitis in a pancreas divisum patient.  

PubMed

We report a rare cause of biliary cast secondary to cholangitis and pancreatitis, in a 60 year old female patient with pancreas divisum. She was admitted in our hospital with an acute pancreatitis (alcoholic etiology was excluded) complicated with pancreatic abscess and obstructive jaundice. The patient had undergone a complex surgical intervention: cholecystectomy,choledocotomy with extraction of the biliary thrombus,external biliary drainage through a T tube, evacuation of the pancreatic abscess, sequestrectomy, peritoneal lavage and multipledrainages. In spite of the surgical and intensive care support,the biliary drainage through the T tube had ceased and the obstructive jaundice had reappeared in a more accentuated fashion. Endoscopic retrograde cholangiography showed complete pancreas divisum and diffuse multiple stenosis alternating with dilatation of the intrahepatic biliary tree (a pattern of sclerosing cholangitis). An endoscopic prosthesis was placed inside the right hepatic bile duct. Despite the use of the combined endoscopic plus UDCA (ursodeoxycholic acid) treatment for the management of the biliary cast syndrome, the evolution was unfavorable with hepatic coma,septic shock and finally death. The necropsy revealed an extensive biliary cast in the entire biliary tree and pyogeniccholangitis. The patient had a fatal outcome despite all the surgical, endoscopic and conservative efforts, with development of intraductal biliary obstruction and secondary pyogenic cholangitis. Biliary cast syndrome is a rare but very aggressive entity and its management is often difficult despite the advances in surgery and endoscopy treatments. PMID:25375059

Graur, F; Neagos, H; Cavasi, A; Al Hajjar, N

2014-01-01

46

Small sphincterotomy combined with endoscopic papillary large balloon dilation vs sphincterotomy alone for removal of common bile duct stones  

PubMed Central

AIM: To evaluate the efficacy and safety of endoscopic papillary large diameter balloon dilation (EPLBD) following limited endoscopic sphincterotomy (EST) and EST alone for removal of large common bile duct (CBD) stones. METHODS: We retrospectively compared EST + EPLBD (group A, n = 64) with EST alone (group B, n = 89) for the treatment of large or multiple bile duct stones. The success rate of stone clearance, procedure-related complications and incidents, frequency of mechanical lithotripsy use, and recurrent stones were recorded. RESULTS: There was no statistically significant difference between the two groups regarding periampullary diverticula (35.9% vs 34.8%, P > 0.05), pre-cut sphincterotomy (6.3% vs 6.7%, P > 0.05), size (12.1 ± 2.0 mm vs 12.9 ± 2.6 mm, P > 0.05) and number (2.2 ± 1.9 vs 2.4 ± 2.1, P > 0.05) of stones or the diameters of CBD (15.1 ± 3.3 mm vs 15.4 ± 3.6 mm, P > 0.05). The rates of overall stone removal and stone removal in the first session were not significantly different between the two groups [62/64 (96.9%) vs 84/89 (94.4%), P > 0.05; and 58/64 (90.6%) vs 79/89 (88.8%), P > 0.05, respectively]. The rates of post-endoscopic retrograde cholangiopancreatography pancreatitis and hyperamylasemia were not significantly different between the two groups [3/64 (4.7%) vs 4/89 (4.5%), P > 0.05; 7/64 (10.9%) vs 9/89 (10.1%), P > 0.05, respectively]. There were no cases of perforation, acute cholangitis, or cholecystitis in the two groups. The rate of bleeding and the recurrence of CBD stones were significantly lower in group A than in group B [1/64 (1.6%) vs 5/89 (5.6%), P < 0.05; 1/64 (1.6%) vs 6/89 (6.7%), P < 0.05, respectively]. CONCLUSION: EST + EPLBD is an effective and safe endoscopic approach for removing large or multiple CBD stones. PMID:25548495

Guo, Shi-Bin; Meng, Hua; Duan, Zhi-Jun; Li, Chun-Yan

2014-01-01

47

[A case of fascioliasis in the intrahepatic duct with concurrent clonochiasis].  

PubMed

The main causes of biliary obstruction are stones and cancers. Fascioliasis is a very rare case which causes biliary obstruction. Fascioliasis is a zoonosis caused by Fasciola hepatica which infects herbivores like sheep and cattle. F. hepatica lives in the biliary system or the liver parenchyma of a host. In Korea, the occurrence of this infection in human is very rare and only few cases have been reported. A 32-year-old male presented with upper abdominal pain and jaundice. His laboratory finding revealed elevated liver transaminases. Abdomen CT scan showed mild left intrahepatic bile duct dilatation. On ERCP, adult F. hepatica worms were found and were thus removed. Concurrently, clonorchiasis was diagnosed by stool exam and serologic enzyme-linked immunosorbent assay test. Clonorchiasis was treated with praziquantel. Herein, we report a case of intrahepatic bile duct dilatation due to F. hepatica infection with concurrent Clonorchis sinensis infestation. PMID:25420741

Kim, Seung-Hyun; Jung, Chang-Kil; Her, Jin; Hur, Ki-Hwan; Choi, Jae-Hyuc; Kang, Kee-Hoon; Hwang, Chan-Hee

2014-11-01

48

[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

49

21 CFR 876.5010 - Biliary catheter and accessories.  

Code of Federal Regulations, 2010 CFR

... A biliary catheter and accessories is a tubular flexible device used for temporary or prolonged drainage of the biliary tract, for splinting of the bile duct during healing, or for preventing stricture of the bile duct. This generic...

2010-04-01

50

Differentiation of pancreatobiliary cancer from benign biliary strictures using neutrophil gelatinase-associated lipocalin.  

PubMed

Aim of the study was to investigate the value of serum and bile neutrophil gelatinase-associated lipocalin (NGAL) for distinguishing malignant strictures caused by cholangiocarcinoma (CCA) or pancreatic cancer from benign biliary strictures. The study was performed prospectively on patients admitted for endoscopic or radiologic biliary decompression. Forty patients with dilated biliary ducts, including 16 cases of CCA, 6 cases of pancreatic cancer, and 18 cases of benign biliary stricture were enrolled. Their sera and bile were collected to measure NGAL. Routine biochemistry including measurement of serum levels of carbohydrate antigens (CA) 19-9 and carcinoembryonic antigen (CEA) was also performed. The serum CA19-9, serum CEA, and bile NGAL levels were significantly increased in patients with malignant strictures as compared with patients with benign biliary diseases. Serum NGAL had no significant value for discriminating between malignant and benign biliary strictures. Bile NGAL levels had a receiver characteristic area under the curve of 0.74, sensitivity 77.3, and specificity 72.2% for discriminating between pancreatobiliary cancer and benign biliary diseases. Bile NGAL and serum CA19-9 were independent parameters and their combined use improved diagnostic accuracy (sensitivity 91%, negative predictive value 85.7%). We conclude that measurement of biliary, but not serum NGAL, may differentiate malignant pancreatobiliary from benign biliary strictures, serving as a complementary biomarker for serum CA19-9. PMID:23568978

Budzynska, A; Nowakowska-Dulawa, E; Marek, T; Boldys, H; Nowak, A; Hartleb, M

2013-02-01

51

Endoscopic management of difficult common bile duct stones  

PubMed Central

Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients. Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed. Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities. PMID:23345939

Trikudanathan, Guru; Navaneethan, Udayakumar; Parsi, Mansour A

2013-01-01

52

Rare event of biliary papillomatosis arising in a choledochal cyst.  

PubMed

A 31-year-old man presented with features of recurrent cholangitis for 7?months. Examination revealed icterus and a palpable 10×8?cm lump in the right hypochondrium extending into the epigastrium. Total and direct bilirubin was raised (8.4, 6.7?mg/dL). Alkaline phosphatase (468?U/L) was raised but other liver enzymes were normal. Ultrasound of the abdomen showed dilated intrahepatic biliary radicals (IHBRs) and common hepatic duct (CHD) with a significant intrahepatic portion. Contrast-enhanced CT scan of the abdomen showed similar findings. MR cholangiopancreatography demonstrated diffusely dilated IHBRs and choledochal cyst involving the CHD. The common bile duct was mildly dilated without any filling defect. Tumour markers (carcinoembryonic antigen and cancer antigen 19-9) were normal. The patient underwent complete excision of the extrahepatic biliary system including choledochal cyst and Roux-en-Y hepaticojejunostomy. Opening up the bile duct showed very thick gelatinous material and multiple pedunculated papillary type structures arising from the wall of the choledochal cyst. PMID:24990847

Nishant, Kumar; Singh, Varun Kumar; Sharma, Barun Kumar

2014-01-01

53

Twenty-Second versus Sixty-Second Dilation Duration in Endoscopic Papillary Balloon Dilation for the Treatment of Small Common Bile Duct Stones: A Prospective Randomized Controlled Multicenter Trial  

PubMed Central

Background/Aims Endoscopic papillary balloon dilation (EPBD) has been advocated as an alternative therapy to endoscopic sphincterotomy for the treatment of common bile duct (CBD) stones. However, there is no established consensus on the optimal balloon dilation duration (BDD). We prospectively evaluated the efficacy and post-endoscopic retrograde cholangiopancreatography (ERCP) complications between the 20- and 60-second EPBD groups. Methods A total of 228 patients with small CBD stones (?12 mm) were randomly assigned to undergo EPBD with a 20- or 60-second duration at six institutions. We evaluated baseline patient characteristics, endoscopic data, clinical outcomes, and procedure-related complications. In addition, we analyzed risk factors for postprocedural pancreatitis. Results CBD stones were removed successfully in 107 of 109 patients (98.1%) in the 20-second group and in 112 of 119 patients (94.1%) in the 60-second group (p=0.146). Post-ERCP pancreatitis developed in seven patients (6.4%) in the 20-second group and nine patients (7.5%) in the 60-second group (p=0.408). In multivariate analysis, contrast dye injection into the pancreatic duct is a significant risk factor for post-EPBD pancreatitis. Conclusions Based on the data showing that there were no significant differences in safety and efficacy between the two BDD groups, 20 seconds of BDD may be adequate for treatment of small CBD stones with EPBD.

Bang, Byoung Wook; Lee, Tae Hoon; Song, Tae Jun; Han, Joung-Ho; Choi, Hyun Jong; Moon, Jong Ho; Kwon, Chang-Il

2015-01-01

54

Endoscopic papillary balloon dilation: Revival of the old technique  

PubMed Central

Radiologists first described the removal of bile duct stones using balloon dilation in the early 1980s. Recently, there has been renewed interest in endoscopic balloon dilation with a small balloon to avoid the complications of endoscopic sphincterotomy (EST) in young patients undergoing laparoscopic cholecystectomy. However, there is a disparity in using endoscopic balloon papillary dilation (EPBD) between the East and the West, depending on the origin of the studies. In the early 2000s, EST followed by endoscopic balloon dilation with a large balloon was introduced to treat large or difficult biliary stones. Endoscopic balloon dilation with a large balloon has generally been recognized as an effective and safe method, unlike EPBD. However, fatal complications have occurred in patients with endoscopic papillary large balloon dilation (EPLBD). The safety of endoscopic balloon dilation is still a debatable issue. Moreover, guidelines of indications and techniques have not been established in performing endoscopic balloon dilation with a small balloon or a large balloon. In this article, we discuss the issue of conventional and large balloon endoscopic dilation. We also suggest the indications and optimal techniques of EPBD and EPLBD. PMID:24363517

Jeong, Seung Uk; Moon, Sung-Hoon; Kim, Myung-Hwan

2013-01-01

55

Gallbladder and Bile Duct Disorders  

MedlinePLUS

... by-products of drugs from the body. The biliary tract consists of small tubes (ducts) that carry bile ... the liver. It stores bile (see Gallbladder and Biliary Tract ). When bile is needed, as when people eat, ...

56

Eosinophilic cholangiopathy: the diagnostic dilemma of a recurrent biliary stricture. Should surgery be offered for all?  

PubMed

A 63-year-old man presented with the initial diagnosis of autoimmune pancreatitis with obstructive jaundice. CT of the abdomen revealed an oedematous pancreas and dilated common bile duct (CBD), without gallstones. After failure of initial retrograde cholangiopancreatography, a percutaneous biliary catheter was inserted with good drainage. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) revealed a 2 cm distal CBD stricture. A biliary stent was inserted past the stricture. Biopsy of the stricture, brush cytology of the bile duct and fine needle aspiration of pancreatic head under endoscopic ultrasound guidance were negative for malignancy. Autoimmune screen was negative as well. However, the patient represented with cholangitis requiring repeat ERCP and insertion of a second biliary stent. He finally underwent cholecystectomy with excision of the distal CBD and Roux-En-Y hepaticojejunostomy. Histology revealed diffuse eosinophilic cholecystitis and cholangitis. A retrospective review of the blood results showed persistent eosinophilia in full blood count measurements from presentation and persisting throughout the treatment period. PMID:24390967

Seow-En, Isaac; Chiow, Adrian Kah Heng; Tan, Siong San; Poh, Wee Teng

2014-01-01

57

Pneumoperitoneum Caused by Transhepatic Air Leak After Metallic Biliary Stent Placement  

Microsoft Academic Search

A self-expanding metallic biliary stent was placed for palliation of a common bile duct obstruction in a 68-year-old male\\u000a with unresectable pancreatic head cancer 3 days after initial percutaneous right transhepatic catheter decompression. The\\u000a stent crossed the ampulla of Vater. Three days later, the stent was balloon-dilated and the percutaneous access was removed.\\u000a At removal, a small contrast leak from

Jei Hee Lee; Deok Hee Lee; Jeong-Sik Yu; Se Joon Lee; Woo-Cheol Kwon; Ki Whang Kim

2000-01-01

58

Pneumoperitoneum Caused by Transhepatic Air Leak After Metallic Biliary Stent Placement  

Microsoft Academic Search

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

Jei Hee Lee; Deok Hee Lee; Jeong-Sik Yu; Se Joon Lee; Woo-Cheol Kwon; Ki Whang Kim

2000-01-01

59

Intraductal papillary neoplasm of the bile duct developing in a patient with primary sclerosing cholangitis: A case report  

PubMed Central

We report a case of intraductal papillary neoplasm of the bile duct (IPNB) that developed in a patient with primary sclerosing cholangitis. A 46-year-old woman was admitted to our hospital with obstructive jaundice. The liver function tests demonstrated increased serum liver enzyme levels. Computed tomography showed dilatation of the intrahepatic bile ducts. Abdominal ultrasonography revealed a highly echoic protruding lesion in the posterior bile duct near the right lobe of the liver. The lesion was suspected to be IPNB, but we were unable to confirm whether it was a carcinoma. A right hepatectomy was performed, and this showed that the dilated bile duct was filled with mucin and contained several yellowish papillary tumors. Histologically, the neoplastic biliary epithelium showed papillary growth in the dilated lumen. The tumor was diagnosed as IPNB, high-grade intraepithelial neoplasia secreting abundant mucin. No recurrence has been detected 3 years after surgery. PMID:25400480

Hachiya, Hiroyuki; Kita, Junji; Shiraki, Takayuki; Iso, Yukihiro; Shimoda, Mitsugi; Kubota, Keiichi

2014-01-01

60

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%. PMID:20011467

Sinha, C. K.; Davenport, Mark

2008-01-01

61

Video-laparoscopic treatment of a sizeable cyst of the cystic duct: a case report.  

PubMed

A case of cystic dilation isolated from the cystic duct is described. The patient showed symptoms of chronic calculous cholecystitis; the ultrasonographic examination confirmed the clinical hypothesis and showed a 1.3-cm calculus impacted in the infundibulum of the gallbladder. The hepatic and biliary functions were normal. During surgery, the routine cholangiographic study showed a sizable cyst in the cystic canal, as well as an anomalous duct uniting the cyst to the right hepatic duct. As for the rest of the extrahepatic biliary canal, as well as the intrahepatic canal, nothing abnormal was noticed. The videolaparoscopic treatment consisted of a ligature with a clip of the cystic duct and the anomalous duct plus en bloc resection of the cyst and the gallbladder. Histopathologic study showed it to be a benign cyst and chronic calculous cholecystitis. It is important to establish the site of the cyst precisely before surgery, as the procedure should include its resection, since it could be the source of infection or development of lithiasis and even malignant degeneration. There are two hypotheses for the appearance of cysts in the biliary tract: congenital, due to a flaw in the multiplication of the cells that will form the biliary tract during the fetal life, and by aggression by pancreatic juice flowing back to the main biliary canal. The congenital origin seems to be the hypothesis that better explains the appearance of the cyst in the case described here, considering that the backflow of the pancreatic juice could hardly have occurred because of the anatomy as observed: the nonexistence of the common biliary-pancreatic canal and the valvular mechanism, present in the cystic canal, between the cyst itself and the confluence of the cystic canal into the main biliary canal, in addition to the anomalous biliary canal communicating the cyst to the right intrahepatic canal. PMID:9799149

Bresciani, C; Gama-Rodrigues, J; Santos, V R

1998-10-01

62

Biliary papillomatosis. Case report.  

PubMed

Biliary papillomatosis is a disease characterized by multiple papillary tumours of variable distribution and extent in the intrahepatic and/or extrahepatic biliary tree. Papillary carcinoma can develop within these lesions. Because biliary papillomatosis is a rare biliary pathological entity, its clinical features and outcome are not well known. The course of this disease is very prolonged. This diagnostic difficulty is due above all to the problematic distinction between biliary papillomatosis and cholelithiasis. Therapeutic strategy should be decided pre-operatively among resection, transplantation or stent. In many cases surgical strategy is decided during surgery, considering the mass extension, the local infiltration and the patient's age, and, when possible, with the aid of extemporaneous histological examination. Recently we experienced a case of biliary papillomatosis of the common hepatic duct in a 82-year-old man, presented with obstructive jaundice and pain in the right upper quadrant and epigastrium radiated to the ipsilateral scapula. First we made cholecystectomy and we positioned the T-tube. The follow-ups performed with laboratory tests and T-tube cholangiogram showed no jaundice but the filling defect in the common bile duct was still present. So we performed a resection of the common bile duct and an hepatico-jejunostomy at the hepatic pedicle. The histological examination showed a villous adenoma of the common bile duct with high-grade dysplasia. PMID:21988050

Forlano, Immacolata; Fersini, Alberto; Tartaglia, Nicola; Ambrosi, Antonio; Neri, Vincenzo

2011-01-01

63

Interval Biliary Stent Placement Via Percutaneous Ultrasound Guided Cholecystostomy: Another Approach to Palliative Treatment in Malignant Biliary Tract Obstruction  

SciTech Connect

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.

Harding, James, E-mail: drjames.harding@btinternet.com; Mortimer, Alex [North Bristol NHS Trust, Frenchay Hospital, Department of Radiology (United Kingdom); Kelly, Michael [North Bristol NHS Trust, Frenchay Hospital, Department of General Surgery (United Kingdom); Loveday, Eric [North Bristol NHS Trust, Frenchay Hospital, Department of Radiology (United Kingdom)

2010-12-15

64

[Biliary lithiasis].  

PubMed

No treatment is recommended for silent gallstones. The diagnosis of acute cholecystitis is based on clinical and biological signs and on abdominal sonography. Early laparoscopic cholecystectomy is the treatment of choice, except in case of severe (grade III) cholecystitis where a percutaneous cholecystostomy associated with antibiotic therapy is recommended. The diagnostic accuracy of abdominal sonography for the diagnosis of common bile duct stones is poor. A second-line MR cholangiopancreatography or an endoscopic sonography is often needed to confirm the diagnosis. The treatment of acute cholangitis is based on both antibiotic therapy and biliary drainage. Results of the treatment of common bile duct stone with either laparoscopic surgery or with the combined endoscopic sphincterotomy plus laparoscopic cholecystectomy are comparable when performed by well-trained practitionners. The choice of the method should be based on the locally available treatment. PMID:21397448

Payen, Jean-Louis; Muscari, Fabrice; Vibert, Eric; Ernst, Olivier; Pelletier, Gilles

2011-06-01

65

Management of bile duct injuries combined with accessory hepatic duct during laparoscopic cholecystectomy  

PubMed Central

Bile duct injuries (BDIs) are difficult to avoid absolutely when the biliary tract has a malformation, such as accessory hepatic duct. Here, we investigated the management strategies for BDI combined with accessory hepatic duct during laparoscopic cholecystectomy. PMID:25232275

Ren, Pei-Tu; Lu, Bao-Chun; Yu, Jian-Hua; Zhu, Xin

2014-01-01

66

Iatrogenic Biliary Injuries: Multidisciplinary Management in a Major Tertiary Referral Center  

PubMed Central

Background. Iatrogenic biliary injuries are considered as the most serious complications during cholecystectomy. Better outcomes of such injuries have been shown in cases managed in a specialized center. Objective. To evaluate biliary injuries management in major referral hepatobiliary center. Patients & Methods. Four hundred seventy-two consecutive patients with postcholecystectomy biliary injuries were managed with multidisciplinary team (hepatobiliary surgeon, gastroenterologist, and radiologist) at major Hepatobiliary Center in Egypt over 10-year period using endoscopy in 232 patients, percutaneous techniques in 42 patients, and surgery in 198 patients. Results. Endoscopy was very successful initial treatment of 232 patients (49%) with mild/moderate biliary leakage (68%) and biliary stricture (47%) with increased success by addition of percutaneous (Rendezvous technique) in 18 patients (3.8%). However, surgery was needed in 198 patients (42%) for major duct transection, ligation, major leakage, and massive stricture. Surgery was urgent in 62 patients and elective in 136 patients. Hepaticojejunostomy was done in most of cases with transanastomotic stents. There was one mortality after surgery due to biliary sepsis and postoperative stricture in 3 cases (1.5%) treated with percutaneous dilation and stenting. Conclusion. Management of biliary injuries was much better with multidisciplinary care team with initial minimal invasive technique to major surgery in major complex injury encouraging early referral to highly specialized hepatobiliary center. PMID:25435672

Salama, Ibrahim Abdelkader; Shoreem, Hany Abdelmeged; Saleh, Sherif Mohamed; Hegazy, Osama; Housseni, Mohamed; Abbasy, Mohamed; Badra, Gamal; Ibrahim, Tarek

2014-01-01

67

Knockout of histidine decarboxylase decreases bile duct ligation-induced biliary hyperplasia via downregulation of the histidine decarboxylase/VEGF axis through PKA-ERK1/2 signaling.  

PubMed

Histidine is converted to histamine by histidine decarboxylase (HDC). We have shown that cholangiocytes 1) express HDC, 2) secrete histamine, and 3) proliferate after histamine treatment via ERK1/2 signaling. In bile duct-ligated (BDL) rodents, there is enhanced biliary hyperplasia, HDC expression, and histamine secretion. This studied aimed to demonstrate that knockdown of HDC inhibits biliary proliferation via downregulation of PKA/ERK1/2 signaling. HDC(-/-) mice and matching wild-type (WT) were subjected to sham or BDL. After 1 wk, serum, liver blocks, and cholangiocytes were collected. Immunohistochemistry was performed for 1) hematoxylin and eosin, 2) intrahepatic bile duct mass (IBDM) by cytokeratin-19, and 3) HDC biliary expression. We measured serum and cholangiocyte histamine levels by enzyme immunoassay. In total liver or cholangiocytes, we studied: 1) HDC and VEGF/HIF-1? expression and 2) PCNA and PKA/ERK1/2 protein expression. In vitro, cholangiocytes were stably transfected with shRNA-HDC plasmids (or control). After transfection we evaluated pPKA, pERK1/2, and cholangiocyte proliferation by immunoblots and MTT assay. In BDL HDC(-/-) mice, there was decreased IBDM, PCNA, VEGF, and HDC expression compared with BDL WT mice. Histamine levels were decreased in BDL HDC(-/-). BDL HDC(-/-) livers were void of necrosis and inflammation compared with BDL WT. PKA/ERK1/2 protein expression (increased in WT BDL) was lower in BDL HDC(-/-) cholangiocytes. In vitro, knockdown of HDC decreased proliferation and protein expression of PKA/ERK1/2 compared with control. In conclusion, loss of HDC decreases BDL-induced biliary mass and VEGF/HIF-1? expression via PKA/ERK1/2 signaling. Our data suggest that HDC is a key regulator of biliary proliferation. PMID:25169977

Graf, Allyson; Meng, Fanyin; Hargrove, Laura; Kennedy, Lindsey; Han, Yuyan; Francis, Taylor; Hodges, Kyle; Ueno, Yoshiyuki; Nguyen, Quy; Greene, John F; Francis, Heather

2014-10-15

68

Biliary cystic disease.  

PubMed

Biliary cystic disease, though uncommon, can present at a wide range of ages with a wide range of symptoms. Choledochal cysts are associated with the development of both cholangiocarcinoma and gallbladder cancer. Thus, most biliary cystic disease is best managed operatively. Many factors should be considered when performing surgery on patients with choledochal cysts, including age, presenting symptoms, cyst type, associated biliary stones, prior biliary surgery, intrahepatic strictures, hepatic atrophy/hypertrophy, biliary cirrhosis, portal hypertension, and associated biliary malignancy. When feasible, surgical treatment should consist of cholecystectomy and complete surgical excision of extrahepatic cysts with Roux-en-Y reconstruction. Because the risk of recurrent cholangitis is significant and additional symptoms and problems are common, the use of long-term soft Silastic biliary stents (Dow Corning Corp., Midland, MI) should be considered when complex intrahepatic and extrahepatic cystic disease is present. Alternatively, the Roux-en-Y jejunal limb can be marked at the fascia for future percutaneous access. Reconstruction via hepaticoduodenostomy and jejunal interposition has been associated with increased postoperative pain due to bile reflux gastritis. Thus, hepaticojejunostomy reconstruction is recommended. For choledochal cysts involving the distal bile duct, the bile duct should be excised at the intrapancreatic portion. Resection of the pancreatic head should be reserved for patients with established malignancies. Surgical excision of the intrahepatic portion of the bile duct should be individualized to include preservation of hepatic parenchyma when the liver is not cirrhotic. If cirrhosis is advanced, hepatic transplantation may be indicated, but this is rare. Oncologic principles should be followed in the presence of a malignancy. Lifelong follow-up is required because of the possibility of a "field" defect increasing susceptibility to cancer throughout the biliary tract epithelium. PMID:16539871

Lipsett, Pamela A; Locke, Jayme E

2006-04-01

69

Biliary Cast Formation with Sclerosing Cholangitis in Critically Ill Patient: Case Report and Literature Review  

PubMed Central

Sclerosing cholangitis in critically ill patients (SC-CIP) is a rare condition that is not familiar to many radiologists. In addition, the associated imaging findings have not been described in the radiological literature. We report a case of biliary cast formation with SC-CIP and describe the radiological findings of CT, magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiography (ERC). A diagnosis of SC-CIP should be considered in intensive care unit (ICU) patients with persistent cholestasis during or after a primary illness. The typical CT, MRCP and ERC findings include new biliary casts in the intrahepatic duct with multiple irregular strictures, dilatations, and relative sparing of the common bile duct. PMID:22563276

Kwon, O-nyoung; Park, Chang Keun; Mun, Sung Hee

2012-01-01

70

Endoscopic management of biliary strictures after liver transplantation  

PubMed Central

Bile duct strictures remain a major source of morbidity after orthotopic liver transplantation (OLT). Biliary strictures are classified as anastomotic or non-anastomotic strictures according to location and are defined by distinct clinical behaviors. Anastomotic strictures are localized and short. The outcome of endoscopic treatment for anastomotic strictures is excellent. Non-anastomotic strictures often result from ischemic and immunological events, occur earlier and are usually multiple and longer. They are characterized by a far less favorable response to endoscopic management, higher recurrence rates, graft loss and need for retransplantation. Living donor OLT patients present a unique set of challenges arising from technical factors, and stricture risk for both recipients and donors. Endoscopic treatment of living donor OLT patients is less promising. Current endoscopic strategies for biliary strictures after OLT include repeated balloon dilations and placement of multiple side-by-side plastic stents. Lifelong surveillance is required in all types of strictures. Despite improvements in incidence and long term outcomes with endoscopic management, and a reduced need for surgical treatment, the impact of strictures on patients after OLT is significant. Future considerations include new endoscopic technologies and improved stents, which could potentially allow for a decreased number of interventions, increased intervals before retreatment, and decreased reliance on percutaneous and surgical modalities. This review focuses on the role of endoscopy in biliary strictures, one of the most common biliary complications after OLT. PMID:19673012

Williams, Emmanuelle D; Draganov, Peter V

2009-01-01

71

Anomalous connection of the right hepatic duct into the cystic duct: utility of magnetic resonance cholangiopancreatography.  

PubMed

A 41-year-old female was admitted to our hospital for treatment of uterus carcinoma. Abdominal ultrasound showed gallbladder stones. Although magnetic resonance cholangiopancreatography revealed the right intrahepatic bile ducts, left hepatic duct and the common bile duct, the confluence of the right and left hepatic ducts was not visualized. At surgery, intra-operative cholangiography showed a biliary anomaly of the right hepatic duct entering the cystic duct. Subsequently cholecystectomy was accomplished without any injury to the bile duct. Our case may be the eighth such case of this rare biliary anomaly. When magnetic resonance cholangiopancreatography does not show the confluence of the right and left hepatic ducts, biliary anomaly of the right hepatic duct should be suspected and careful dissection should be performed from the Hartman's pouch, followed by intraoperative cholangiography, in order to avoid unnecessary injury to the bile duct. PMID:12828051

Yamamoto, Satoshi; Sakuma, Atsushi; Rokkaku, Kyu; Nemoto, Takehiko; Kubota, Keiichi

2003-01-01

72

Management of Benign Biliary Strictures  

Microsoft Academic Search

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 a choledocho- 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

Hans-Ulrich Laasch; Derrick F. Martin

2002-01-01

73

The value of biliary endoscopy.  

PubMed

The value of biliary endoscopy was determined in 100 consecutive patients undergoing choledochotomy. Using a compact, rigid, right-angled choledochoscope with a rod-lens optical system the biliary tract was inspected for residual stomes following conventional exploration. Completion operative cholangiography and postoperative T-tube cholangiography were performed in all patients. Of 52 patients undergoing primary choledocholithotomy, the duct was cleared of all calculi in 51. A small residual stone was found by postoperative cholangiography in one patient. Exploration revealed no calculi in the ducts of the remaining 30 patients. Biliary endoscopy was of benefit to the surgeon in the majority of patients. In 17 patients, calculi missed by standard exploration were detected; in five of these, the calculi could be retrieved only under endoscopic control. In 11 patients, interpretation of operative cholangiograms was aided, while in three the endoscopic findings clarified operative strategy. The use of biliary endoscopy did not increase the postoperative morbidity or mortality rates beyond those oridinarily encountered in choledocholithotomy. Current experience indicates that the new choledhchoscope overcomes limitations of previous endoscopes and should serve as the definitive diagnostic tool for operative biliary endoscopy. The addition of this technique to the armamentarium of the biliary surgeon will play a significant role in overcoming the age-old problem of the retained common duct stone. PMID:1129668

Shore, J M; Berci, G; Morgenstern, L

1975-04-01

74

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

75

Pneumoperitoneum caused by transhepatic air leak after metallic biliary stent placement.  

PubMed

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. PMID:11232901

Lee, J H; Lee, D H; Yu, J S; Lee, S J; Kwon, W C; Kim, K W

2000-01-01

76

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

77

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. PMID:24046786

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

2013-01-01

78

Biliary stricture  

MedlinePLUS

... Endoscopic retrograde cholangiopancreatography (ERCP) Percutaneous transhepatic cholangiogram (PTC) Magnetic resonance cholangiopancreatography (MRCP) The following blood tests can help reveal a problem with the biliary ...

79

New Diagnosis and Therapy Model for Ischemic-Type Biliary Lesions following Liver Transplantation—A Retrospective Cohort Study  

PubMed Central

Ischemic-type biliary lesions (ITBLs) are a major cause of graft loss and mortality after orthotopic liver transplantation (OLT). Impaired blood supply to the bile ducts may cause focal or extensive damage, resulting in intra- or extrahepatic bile duct strictures or dilatations that can be detected by ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, and cholangiography. However, the radiographic changes occur at an advanced stage, after the optimal period for therapeutic intervention. Endoscopic retrograde cholangio-pancreatography (ERCP) and percutaneous transhepatic cholangiodrainage (PTCD) are the gold standard methods of detecting ITBLs, but these procedures cannot be used for continuous monitoring. Traditional methods of follow-up and diagnosis result in delayed diagnosis and treatment of ITBLs. Our center has used the early diagnosis and intervention model (EDIM) for the diagnosis and treatment of ITBLs since February 2008. This model mainly involves preventive medication to protect the epithelial cellular membrane of the bile ducts, regular testing of liver function, and weekly monitor of contrast-enhanced ultrasonography (CEUS) to detect ischemic changes to the bile ducts. If the liver enzyme levels become abnormal or CEUS shows low or no enhancement of the wall of the hilar bile duct during the arterial phase, early ERCP and PTCD are performed to confirm the diagnosis and to maintain biliary drainage. Compared with patients treated by the traditional model used prior to February 2008, patients in the EDIM group had a lower incidence of biliary tract infection (28.6% vs. 48.6%, P?=?0.04), longer survival time of liver grafts (24±9.6 months vs. 17±12.3 months, P?=?0.02), and better outcomes after treatment of ITBLs. PMID:25192214

Zhang, Ying-cai; Qu, En-ze; Ren, Jie; Zhang, Qi; Zheng, Rong-qin; Yang, Yang; Chen, Gui-hua

2014-01-01

80

A new variant of cholecystohepatic duct: MR cholangiography demonstration.  

PubMed

Magnetic resonance cholangiography used before laparoscopic cholecystectomy may reduce the incidence of post-operative complications related to the high anatomic variability of the biliary system. A number of anatomic variants of the biliary tree have been reported. We present a rare case in which magnetic resonance cholangiography demonstrated a new variant of the cholecystohepatic bile duct acting as a communication between the gallbladder fundus and an intrahepatic biliary duct. PMID:25086964

Minutoli, Fabio; Naso, Serena; Visalli, Carmela; Iannelli, Dario; Silipigni, Salvatore; Pitrone, Alessia; Bottari, Antonio

2014-08-01

81

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

82

Melatonin regulation of biliary functions  

PubMed Central

The intrahepatic biliary epithelium is a three-dimensional tubular system lined by cholangiocytes, epithelial cells that in addition to modify ductal bile are also the targets of vanishing bile duct syndromes (i.e., cholangiopathies) such as primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) that are characterized by the damage/proliferation of cholangiocytes. Cholangiocyte proliferation is critical for the maintenance of the biliary mass and secretory function during the pathogenesis of cholangiopathies. Proliferating cholangiocytes serve as a neuroendocrine compartment during the progression of cholangiopathies, and as such secrete and respond to hormones, neurotransmitters and neuropeptides contributing to the autocrine and paracrine pathways that regulate biliary homeostasis. The focus of this review is to summarize the recent findings related to the role of melatonin in the modulation of biliary functions and liver damage in response to a number of insults. We first provide a general background on the general function of cholangiocytes including their anatomic characteristics, their innervation and vascularization as well the role of these cells on secretory and proliferation events. After a background on the synthesis and regulation of melatonin and its role on the maintenance of circadian rhythm, we will describe the specific effects of melatonin on biliary functions and liver damage. After a summary of the topics discussed, we provide a paragraph on the future perspectives related to melatonin and liver functions. PMID:24696836

Glaser, Shannon; Han, Yuyan; Francis, Heather

2014-01-01

83

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

84

Biliary tract neoplasms: diagnosis and staging  

PubMed Central

Abstract Most biliary tract neoplasms are malignant and have been traditionally divided into cancers of the gallbladder, the extrahepatic bile ducts, and ampulla of Vater. Although infrequent, bile duct carcinomas and cancer of the gallbladder are not rare. In the United States, an estimated 6000–7000 new cases of carcinoma of the gallbladder and 3000–4000 new cases of carcinoma of the bile ducts are diagnosed annually. Familiarity with the imaging characteristics of gallbladder and bile duct neoplasms is important to expedite the diagnosis and appropriate treatment of patients who often present with non-specific symptoms of right upper quadrant pain, jaundice, and weight loss. PMID:17921093

Shelhamer, Ryan P.

2007-01-01

85

Biliary Colic  

MedlinePLUS

... ache in the upper abdomen that happens when gallstones interfere with the normal flow of bile from ... intestine, where it mixes with partially digested food. Gallstones are the most common reason for biliary colic. ...

86

[Biliary atresia: a severe illness].  

PubMed

Biliary atresia is a serious disease of unknown cause, affecting newborns. An inflammation and progressive destruction of the bile ducts lead to jaundice, dark urines, and acholia, between the second and sixth weeks of life. Neonatal cholestasis could be due to several different diseases, thus a diagnosis of biliary atresia and early derivation for surgical treatment are necessary to allow a restoration of the bile flow. Eighty percent of the children normalize serum bilirubin after the portoenterostomy (Kasai operation), if they are operated before their 45 days of life. When Kasai operation fails, a liver transplantation is the only possibility. Biliary atresia must be diagnosed before the first month of life and must be considered as a surgical emergency. PMID:25362914

Ramonet, Margarita; Ciocca, Mirta; Alvarez, Fernando

2014-12-01

87

An infant with biliary ascites.  

PubMed

Biliary ascites in children due to perforation of bile duct is a rare entity. The exact pathogenesis is not known but there are proposed mechanisms including congenital weakness of ductal wall, pancreaticobiliary malunion, tuberculosis, necrotizing enterocolitis and rupture of choledochal cyst. Presentation may be acute or sub-acute. Progressive insidious course is the common presentation in children with jaundice, clay colored stool, abdominal distension with slightly elevated liver enzymes but well documented cholestasis. Clinical suspicion with ultrasound, CT, MRCP and ascitic tap provides clue to the diagnosis. Both conservative and surgical interventions are in practice for managing these children. We report a 7 months old infant with biliary ascites due to perforation of bile duct. PMID:25518792

Saeed, Anjum; Mouzan, Mohammed El; Assiri, Asaad; Alsarkhy, Ahmed; Majeed, Kashif

2014-11-01

88

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

89

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

ClinicalTrials.gov

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

2014-06-11

90

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

91

Hepatobiliary/Pancreas Pathology: SY11-2 RECENT PROGRESS IN BILIARY TRACT PATHOLOGY AND CHOLANGIOCARCINOMA.  

PubMed

The biliary tract and pancreas develop from the foregut at almost same time, and the morphology of the biliary tract and pancreatic ducts share several features. In addition, there are peribiliary glands around the biliary tract, which occasionally contain pancreatic acini and enzymes. Some pancreatic and biliary tract diseases share similar pathological features. For example, IgG4-related disease affects the pancreas (autoimmune pancreatitis) and the biliary tract (IgG4-related sclerosing cholangitis), and peribiliary cysts and pancreatic damages in chronic alcoholics show similar histologies. Interestingly, perihilar cholangiocarcinoma and pancreatic duct adenocarcinoma, and their precursor lesions such as biliary intraepithelial neoplasm (BilIN) and pancreatic intraepithelial neoplasm (PanIN), show similar histologies and phenotypes, suggesting that these carcinoma and precursor lesions share similar developmental processes. Based on the similarities between the pancreas and biliary tract, we would like to propose that several biliary diseases have their counterparts in the pancreas (pancreatic diseases with pancreatic counterparts). PMID:25188108

Nakanuma, Yasuni

2014-10-01

92

EUS diagnosis of ectopic opening of the common bile duct in the duodenal bulb: A case report  

PubMed Central

Among the various congenital anomalies of the biliary system, an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male was admitted to hospital for severe right upper quadrant abdominal pain, followed by fever, chills, elevated body temperature and mild icterus. The diagnosis of ectopic opening of CBD in the duodenal bulb was established on endoscopic ultraso-nography (EUS), which clearly demonstrated dilated CBD, with multiple stones and air in the lumen, draining into the bulb. A normal pancreatic duct, which did not drain into the bulb, was also observed. This finding was confirmed on ERCP and surgery. As far as we know, this is the first case of this anomaly diagnosed by EUS. Ectopic opening of the CBD in the duodenal bulb is not an incidental finding, but a pathologic condition which can be associated with clinical entities such as recurrent or intractable duodenal ulcer, recurrent biliary pain, choledocholithiasis or acute cholangitis. Endoscopic ultrasonography features allow preoperative diagnosis of this anomaly and can replace ERCP as a first diagnostic tool in such clinical circumstances. Embryology of the anomalies of the extrahepatic biliary tree has been also reviewed. PMID:16124069

Krstic, Miodrag; Stimec, Bojan; Krstic, Radmilo; Ugljesic, Milenko; Knezevic, Srbislav; Jovanovic, Ivan

2005-01-01

93

[Non-surgical treatment of biliary lithiasis].  

PubMed

The usefulness of the treatment of the biliary lithiasis with chenodeoxycholic and ursodeoxycholic acids is discussed, including the selection of patients, optimal doses, adverse effects and recurrence of stones. New treatment with methyl tertiary butyl ether and extracorporeal shock wave lithotripsy (ESWL) is evaluated. Endoscopic procedures, eventually combined with ESWL, represent the preferred treatment for patients with bile duct stones. PMID:2700107

Conte, V P

1989-01-01

94

Biliary Atresia  

MedlinePLUS

... released into bile. Blockage of the bile ducts forces bilirubin to build up in the blood. Other ... causes of jaundice. Liver scans. Liver scans are special x rays that use chemicals to create an ...

95

Morphologic factors of biliary trees are associated with gallstone-related biliary events  

PubMed Central

AIM: To determine the risk factors for gallstone-related biliary events. METHODS: This retrospective cohort study evaluated magnetic resonance cholangiopancreatography images from 141 symptomatic and 39 asymptomatic gallstone patients who presented at a single tertiary hospital between January 2005 and December 2012. RESULTS: Logistic regression analysis showed significant differences between symptomatic and asymptomatic patients with gallstones in relation to the number of gallstones, the angle between the long axis of the gallbladder and the cystic duct, and the cystic duct diameter. Multivariate analysis showed that the number of gallstones (OR = 1.27, 95%CI: 1.03-1.57; P = 0.026), the angle between the long axis of the gallbladder and the cystic duct (OR = 1.02, 95%CI: 1.00-1.03; P = 0.015), and the diameter of the cystic duct (OR = 0.819, 95%CI: 0.69-0.97; P = 0.018) were significantly associated with biliary events. The incidence of biliary events was significantly elevated in patients who had the presence of more than two gallstones, an angle of > 92° between the gallbladder and the cystic duct, and a cystic duct diameter < 6 mm. CONCLUSION: These findings will help guide the treatment of patients with asymptomatic gallstones. Clinicians should closely monitor patients with asymptomatic gallstones who exhibit these characteristics. PMID:25574102

Park, Jin-Seok; Lee, Don Haeng; Lim, Jun Hyeok; Jeong, Seok; Jeon, Young Sun

2015-01-01

96

Long-Term Placement of Subcutaneous Ruesch-Type Stents for Double Biliary Stenosis in a Living-Donor Liver Transplant Recipient  

SciTech Connect

Biliary reconstruction continues to be a major source of morbidity following liver transplantation. The spectrum of biliary complications is evolving due to the increasing number of split-liver and living-donor liver transplantation, which are even associated with a higher incidence of biliary complications. Bile duct strictures are the most common cause of late biliary complications and account for up to 40% of all biliary complications. Optimal therapy for posttransplantation anastomotic biliary strictures remains uncertain and requires a multidisciplinary approach. We report the case of a 54-year-old Caucasian male affected by hepatocarcinoma and hepatitis C-related cirrhosis who underwent right-lobe living-donor liver transplantation from his son complicated by double anastomotic stenosis of the main right hepatic duct and of an accessory biliary duct draining segments 6 and 7 of the graft that was successfully treated by percutaneous transhepatic cholangiography with long-term subcutaneous placement of two internal Ruesch-type biliary stents.

Adani, Gian Luigi, E-mail: adanigl@hotmail.com; Baccarani, Umberto; Lorenzin, Dario; Risaliti, Andrea [Udine University School of Medicine, Department of Surgery and Transplantation (Italy); Como, Giuseppe [Udine University School of Medicine, Department of Radiology (Italy); Gasparini, Daniele; Sponza, Massimo [AOSMM-Hospital, Department of Interventional Radiology (Italy); Bresadola, Vittorio; Bresadola, Fabrizio [Udine University School of Medicine, Department of Surgery and Transplantation (Italy)

2007-04-15

97

Magnetic resonance evaluations of biliary malignancy and condition at high-risk for biliary malignancy: Current status  

PubMed Central

Tumors of the biliary tree are relatively rare; but their incidence is rising worldwide. There are several known risk factors for bile duct cancers, and these are seem to be associated with chronic inflammation of the biliary epithelium. Herein, 2 risk factors have been discussed, primary sclerosing cholangitis and reflux of pancreatic juice into the bile duct, as seen in such as an abnormal union of the pancreatic-biliary junction because magnetic resonance imaging (MRI) is used widely and effectively in the diagnosis of these diseases. When biliary disease is suspected, MRI can often help differentiate between benignity and malignancy, stage tumors, select surgical candidates and guide surgical planning. MRI has many advantages over other modalities. Therefore, MRI is a reliable noninvasive imaging tool for diagnosis and pre-surgical evaluation of bile duct tumors. Nowadays remarkable technical advances in magnetic resonance technology have expanded the clinical applications of MRI in case of biliary diseases. In this article, it is also discussed how recent developments in MRI contributes to the diagnosis of the bile duct cancer and the evaluation of patients with risk factors affecting bile duct cancer. PMID:24432183

Sugita, Reiji

2013-01-01

98

Indocyanine-green-loaded microballoons for biliary imaging in cholecystectomy  

PubMed Central

Abstract. 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.

2012-01-01

99

[Primary biliary cirrhosis: therapeutic options].  

PubMed

Primary biliary cirrhosis (PBC) is a chronic and slowly progressive cholestatic liver disease of autoimmune etiology, characterized by injury of the intra-hepatic bile ducts that may eventually lead to liver failure. Many drugs have been performed for treatment, including agents with choleretic and immunosuppressive properties. Patients, particularly those who start ursodeoxycholic acid treatment at early-stage disease and who respond with improvement of liver biochemistry, have a good prognosis. Liver transplantation is usually an option for PBC patients with severe liver failure. PMID:19886235

Abenavoli, Ludovico

2009-09-01

100

Acute biliary pancreatitis: diagnosis and treatment.  

PubMed

Gallstones are the commonest cause of acute pancreatitis (AP), a potentially life-threatening condition, worldwide. The pathogenesis of acute pancreatitis has not been fully understood. Laboratory and radiological investigations are critical for diagnosis as well prognosis prediction. Scoring systems based on radiological findings and serologic inflammatory markers have been proposed as better predictors of disease severity. Early endoscopic retrograde cholangiopancreatography (ERCP) is beneficial in a group of patients with gallstone pancreatitis. Laparoscopic cholecystectomy with preoperative endoscopic common bile duct clearance is recommended as a treatment of choice for acute biliary pancreatitis. The timing of cholecystectomy, following ERCP, for biliary pancreatitis can vary markedly depending on the severity of pancreatitis. PMID:19636174

Hazem, Zakaria M

2009-01-01

101

Biliary cysts: Etiology, diagnosis and management  

PubMed Central

Biliary cysts (BC) are rare dilatations of different parts of a biliary tract. They account for approximately 1% of all benign biliary diseases. BC occur the most frequently in Asian and female populations. They are an important problem for pediatricians, gastroenterologists, radiologists and surgeons. Clinical presentation and management depend on the BC type. Cholangiocarcinoma is the most serious and dangerous BC complication. The other complications associated with BC involve cholelithiasis and hepatolithiasis, cholangitis, acute and chronic pancreatitis, portal hypertension, liver fibrosis and secondary liver cirrhosis and spontaneous cyst perforation. Different BC classifications have been described in the literature. Todani classification dividing BC into five types is the most useful in clinical practice. The early diagnosis and proper treatment are very important, because BC are associated with a risk of carcinogenesis. A malignancy risk increases with the age. Radiological investigations (ultrasonography, computed tomography, endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography) play an important role in BC diagnostics. Currently, prenatal diagnosis using ultrasonography is possible. It allows to differentiate biliary disorders in fetals and to perform the early surgical treatment that improves results. In most patients, total cyst excision with Roux-Y hepaticojejunostomy is the treatment of choice. Surgical treatment of BC is associated with high success rate and low morbidity and mortality. The early treatment is associated with a lower number of complications. Patients following BC surgery require permanent and careful postoperative observation using laboratory and imaging investigations because of possibility of biliary anastomosis stricture and biliary cancer in tissue remnant. PMID:23002354

Jab?o?ska, Beata

2012-01-01

102

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. PMID:19204666

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

103

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

104

Ampullary intervention for bile duct stones in patients with surgically altered anatomy.  

PubMed

Transpapillary endoscopic treatment is a standard technique for the treatment of bile duct stones. This technique includes biliary cannulation, ampullary interventions such as endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD), and stone removal. In patients with Roux-en-Y anastomosis, the transpapillary approach using an ordinary scope has been challenging. A recently developed single-/double-balloon enteroscope enables therapeutic endoscopic retrograde cholangiopancreatography to be carried out in such cases. EST using a balloon enteroscope is often difficult to carry out as a result of restriction of scope maneuverability or inadequate direction of the accessory. Although EPBD is easy to carry out for any anatomy, large or multiple stones are difficult to remove by EPBD only because of insufficient opening of Vater's papilla. Endoscopic papillary large-balloon dilation following EST is reported to be useful for the treatment of large and/or multiple stones. This technique is also useful for the treatment of bile duct stones in patients with Roux-en-Y anastomosis. PMID:24750160

Ito, Kei; Masu, Kaori; Kanno, Yoshihide; Ohira, Tetsuya; Noda, Yutaka

2014-04-01

105

Preoperative biliary drainage in hilar cholangiocarcinoma: When and how?  

PubMed Central

Hilar cholangiocarcinoma is a tumor of the extrahepatic bile duct involving the left main hepatic duct, the right main hepatic duct, or their confluence. Biliary drainage in hilar cholangiocarcinoma is sometimes clinically challenging because of complexities associated with the level of biliary obstruction. This may result in some adverse events, especially acute cholangitis. Hence the decision on the indication and methods of biliary drainage in patients with hilar cholangiocarcinoma should be carefully evaluated. This review focuses on the optimal method and duration of preoperative biliary drainage (PBD) in resectable hilar cholangiocarcinoma. Under certain special indications such as right lobectomy for Bismuth type IIIA or IV hilar cholangiocarcinoma, or preoperative portal vein embolization with chemoradiation therapy, PBD should be strongly recommended. Generally, selective biliary drainage is enough before surgery, however, in the cases of development of cholangitis after unilateral drainage or slow resolving hyperbilirubinemia, total biliary drainage may be considered. Although the optimal preoperative bilirubin level is still a matter of debate, the shortest possible duration of PBD is recommended. Endoscopic nasobiliary drainage seems to be the most appropriate method of PBD in terms of minimizing the risks of tract seeding and inflammatory reactions. PMID:24634710

Paik, Woo Hyun; Loganathan, Nerenthran; Hwang, Jin-Hyeok

2014-01-01

106

Burdick's Technique for Biliary Access Revisited  

PubMed Central

The precut sphincterotomy is used to facilitate selective biliary access in cases of difficult biliary cannulation. Needle-knife precut papillotomy is the standard of care but is associated with a high rate of complications such as pancreatitis, duodenal perforation, bleeding, etc. Sometimes during bowing of the sphincterotome/cannula and the use of guide wire to facilitate biliary cannulation, inadvertent formation of a false passage occurs in the 10 to 11 o'clock direction. Use of this step to access the bile duct by the intramucosal incision technique was first described by Burdick et al., and since then two more studies have also substantiated the safety and efficacy of this non-needle type of precut sphincterotomy. In this review, we discuss this non-needle technique of precut sphincterotomy and also share our experience using this "Burdick's technique."

Goenka, Mahesh Kumar

2015-01-01

107

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

108

Bile duct cyst type V (Caroli's disease): surgical strategy and results  

PubMed Central

Background. Caroli's disease (CD) is a benign congenital disorder characterized by segmental cystic dilatation of the intrahepatic biliary ducts. Therapeutic strategy includes medical treatment, percutaneous, endoscopic or surgical drainage of the affected bile ducts, liver resection or transplantation. The aim of this study was to analyse the results and long-term follow-up of a consecutive series of patients who underwent surgical treatment for CD. Patients and methods. Between 1995 and 2005, 10 patients were surgically treated for CD. Variables evaluated were: age, gender, clinical presentation, diagnostic procedures, percutaneous and surgical treatments, histopathological analysis and outcome. Results. The average age of the patients was 45.8 years. Recurrent cholangitis was the main clinical manifestation (70%). In unilateral CD a liver resection was performed in nine patients (left lateral sectionectomy in seven, left hepatectomy in one and right hepatectomy in one). In bilateral disease a cholecystectomy, duct exploration, hepaticojejunostomy and liver biopsy of both lobes were performed. Average follow-up was 60 months. All the patients are alive and free of symptoms without recurrence in the remnant liver. Discussion. Liver resection is the preferred therapeutic option for unilateral CD, demonstrating good results in long-term follow-up. In bilateral disease, hepaticojejunostomy could be considered as an alternative or a previous step to liver transplantation, which still remains the ultimate option. PMID:18345305

Schelotto, Pablo Barros; Rodríguez, Juan Alvarez; Duek, Fernando; Quarin, Carlos; Garay, Verónica; Amante, Marcelo; Cassini, Eduardo; Imventarza, Oscar

2007-01-01

109

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

PubMed Central

A 62-year-old male was referred to our hospital because of liver dysfunction, diffuse pancreatic swelling, and trachelophyma. At admission, the patient was free of pain. Physical examination showed enlarged and palpable bilateral submandibular masses, but no palpable mass or organomegaly in the abdomen. Laboratory findings were as follows: total protein 90 g/L with ?-globulin of 37.3% (33 g/L), total bilirubin 4 mg/L, aspartate aminotransferase 39 IU/L, alanine aminotransferase 67 IU/L, ?-glutamyl transpeptidase 1 647 IU/L, and amylase 135 IU/L. Autoanti-bodies were negative, and tumor markers were within the normal range. Serum IgG4 level was markedly elevated (18 900 mg/L). Computed tomography (CT) showed diffuse swelling of the pancreas and dilatation of both common and intra-hepatic bile ducts. Endoscopic retrograde pancreatography (ERP) revealed diffuse irregular and narrow main pancreatic duct and stenosis of the lower common bile duct. Biopsy specimens from the pancreas, salivary gland and liver showed marked periductal IgG4-positive plasma cell infiltration with fibrosis. We considered this patient to be autoimmune pancreatitis (AIP) with fibrosclerosis of the salivary gland and biliary tract, prescribed prednisolone at an initial dose of 40 mg/d. Three months later, the laboratory data improved almost to normal. Abdominal CT reflected prominent improvement in the pancreatic lesion. Swelling of the salivary gland also improved. At present, the patient is on 10 mg/d of prednisolone without recurrence of the pancreatitis. We present here a case of AIP with fibrosclerosis of salivary gland and biliary tract. PMID:16222761

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

2005-01-01

110

Raised pressure in the bile ducts after orthotopic liver transplantation  

Microsoft Academic Search

Biliary complications are common after orthotopic liver transplantation. Bile leakage in the immediate postoperative period and on removal of the T-tube could possibly be caused by a raised bile duct pressure. In order to test this hypothesis, bile duct pressure was studied in seven consecutive liver transplant patients. During the operation, the common bile duct was anastomosed end-to-end over a

A. Thune; S. Friman; H. Persson; B. Berglund; B. Nilsson; J. Svanvik

1994-01-01

111

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. PMID:24163648

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

2013-01-01

112

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

2013-01-01

113

Lensing duct  

DOEpatents

A lensing duct to condense (intensify) light using a combination of front surface lensing and reflective waveguiding is described. 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. 3 figures.

Beach, R.J.; Benett, W.J.

1994-04-26

114

Late biliary complications in human alveolar echinococcosis are associated with high mortality  

PubMed Central

AIM: To evaluate the incidence of late biliary complications in non-resectable alveolar echinococcosis (AE) under long-term chemotherapy with benzimidazoles. METHODS: Retrospective analysis of AE patients with biliary complications occurring more than three years after the diagnosis of AE. We compared characteristics of patients with and without biliary complications, analyzed potential risk factor for biliary complications and performed survival analyses. RESULTS: Ninety four of 148 patients with AE in Zurich had non-resectable AE requiring long-term benzimidazole chemotherapy, of which 26 (28%) patients developed late biliary complications. These patients had a median age of 55.5 (35.5-65) years at diagnosis of AE and developed biliary complications after 15 (8.25-19) years of chemotherapy. The most common biliary complications during long-term chemotherapy were late-onset cholangitis (n = 14), sclerosing cholangitis-like lesions (n = 8), hepatolithiasis (n = 5), affection of the common bile duct (n = 7) and secondary biliary cirrhosis (n = 7). Thirteen of the 26 patients had undergone surgery (including 12 resections) before chemotherapy. Previous surgery was a risk factor for late biliary complications in linear regression analysis (P = 0.012). CONCLUSION: Late biliary complications can be observed in nearly one third of patients with non-resectable AE, with previous surgery being a potential risk factor. After the occurrence of late biliary complications, the median survival is only 3 years, suggesting that late biliary complications indicate a poor prognostic outcome. PMID:24914349

Frei, Pascal; Misselwitz, Benjamin; Prakash, Meher K; Schoepfer, Alain M; Prinz Vavricka, Bettina M; Müllhaupt, Beat; Fried, Michael; Lehmann, Kuno; Ammann, Rudolf W; Vavricka, Stephan R

2014-01-01

115

Error traps and vasculo-biliary injury in laparoscopic and open cholecystectomy.  

PubMed

Many biliary misidentification injuries occur due to error traps-methods that work well in most circumstances but which are apt to under certain conditions. We have identified four such traps from an extensive experience in repair of biliary injuries. The most common cause of misidentification results from the "infundibular technique" error trap. This problem is usually associated with severe inflammation which hides the cystic duct and obliterates the triangle of Calot making the common hepatic duct appear to be part to the gallbladder wall. Another error trap -- the "fundus-down" cholecystectomy has been associated with injuries in which the vascular component of the injury has been even more serious than the biliary one ie, "vasculo-biliary injuries" These vasulo-biliary injuries result in hepatic infarction requiring liver resection, possibly including transplantation. As opposed to the infundibular technique error trap the fundus down error trap usually occurs at open cholecystectomy after conversion. The two other error traps are due to failure to perceive the presence of an aberrant right hepatic duct on cholangiography and injury to the common bile duct in the case of a "parallel union" cystic duct. Knowledge of these error traps and their avoidance can help to reduce the incidence of biliary injuries. PMID:18535766

Strasberg, Steven M

2008-01-01

116

Hepatobiliary scintigraphy for detecting biliary strictures after living donor liver transplantation  

PubMed Central

AIM: To investigate the diagnostic accuracy of hepatobiliary scintigraphy (HBS) in detecting biliary strictures in living donor liver transplantation (LDLT) patients. METHODS: We retrospectively reviewed 104 adult LDLT recipients of the right hepatic lobe with duct-to-duct anastomosis, who underwent HBS and cholangiography. The HBS results were categorized as normal, parenchymal dysfunction, biliary obstruction, or bile leakage without re-interpretation. The presence of biliary strictures was determined by percutaneous cholangiography or endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: In 89 patients with biliary strictures, HBS showed biliary obstruction in 50 and no obstruction in 39, for a sensitivity of 56.2%. Of 15 patients with no biliary strictures, HBS showed no obstruction in 11, for a specificity of 73.3%. The positive predictive value (PPV) was 92.6% (50/54) and the negative predictive value (NPV) was 22% (11/50). We also analyzed the diagnostic accuracy of the change in bile duct size. The sensitivity, NPV, specificity, and PPV were 65.2%, 27.9%, 80% and 95%, respectively. CONCLUSION: The absence of biliary obstruction on HBS is not reliable. Thus, when post-LDLT biliary strictures are suspected, early ERCP may be considered. PMID:21677831

Kim, Yu Jin; Lee, Kyu Taek; Jo, Young Cheol; Lee, Kwang Hyuck; Lee, Jong Kyun; Joh, Jae-Won; Kwon, Choon Hyuck David

2011-01-01

117

Transjugular Insertion of Biliary Stents (TIBS) in Two Patients with Malignant Obstruction, Ascites, and Coagulopathy  

SciTech Connect

Two patients with pancreatic malignancies presented with biliary obstruction which could not be treated from an endoscopic approach. Standard transhepatic biliary drainage was relatively contraindicated because of moderate ascites and coagulopathy related to underlying liver disease. In one patient, a transjugular, transvenous approach was used to deliver a Wallstent endoprosthesis across the distal common bile duct obstruction in a single step procedure. In the second case, a previously placed biliary Wallstent was revised with an additional stent from a similar approach. Transjugular biliary catheterization offers a valuable alternative approach for primary stent placement or revision in patients with contraindication to standard transhepatic drainage.

Amygdalos, Michael A.; Haskal, Ziv J.; Cope, Constantin [Department of Interventional Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (United States); Kadish, Steven L.; Long, William B. [Department of Interventional Endoscopy, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (United States)

1996-03-15

118

MR imaging of benign and malignant biliary conditions.  

PubMed

MR imaging is a noninvasive, radiation-free imaging method for evaluation of the biliary system. Continued advancements in MR imaging system hardware and sequence design, coupled with novel gadolinium chelate agents, allow for a detailed evaluation of the bile ducts and surrounding soft tissues. New hepatocyte-specific contrast agents may hold utility in the anatomic and functional evaluation of bile duct injury. MR imaging is also the imaging method of choice for bile duct tumor diagnosis, staging, and presurgical planning. Familiarity with the proper methodology of MR image acquisition and interpretation is critical for optimized diagnostic assessment. PMID:25086940

Costello, James R; Kalb, Bobby; Chundru, Surya; Arif, Hina; Petkovska, Iva; Martin, Diego R

2014-08-01

119

THC:YAG nasolacrimal duct recanalization.  

PubMed

In an early exploration of a new technique for creating a patent nasolacrimal duct system, a chromium-sensitized and thulium- and holmium-doped YAG laser was used to canalize the nasolacrimal duct of a fresh-frozen bisected human cadaver head. The laser--long-pulsed (300 milliseconds), compact, self-contained, and solid-state--operates in the near infrared range (2.1 microns). The technique involved passing a 550-micrometer quartz fiberoptic through the dilated superior punctum and canalicular system, down through the nasolacrimal duct. The quartz fiberoptic was then withdrawn into the area of the lacrimal sac. Pulse energies of 500 mJ were used at a repetition rate of five pulses per second to ablate the duct lining. The nasolacrimal duct was then unroofed and the epithelial lining of the duct histopathologically evaluated. PMID:8290219

Silkiss, R Z

1993-11-01

120

Imaging findings of biliary hamartomas  

PubMed Central

AIM: To evaluate the imaging findings of biliary hamartomas (von Meyenburg complexes, VMCs) and discuss the differential diagnosis with other related diseases. METHODS: Imaging findings of biliary hamartomas on ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), MR cholangiopancreatography (MRCP)and hepatobiliary scintigraphy were retrospectively analyzed in six patients. RESULTS: On ultrasound images, five of the six cases showed multiple small hyper- and hypo-echoic lesions with comet-tail echoes, especially when magnified by US with the usage of zoom function. In all the six cases, multiple tiny hypodense lesions less than 10 mm in diameter were revealed as scattered throughout the liver with no enhancement on CT. These tiny lesions were demonstrated to be hyper- and hypo-intensity on T2- and TI-weighed images, respectively, in three patients who underwent MRI examinations. MRCP was performed in two patients, and clearly showed multiple tiny irregular- and round-shaped hyper-intensity lesions. MRCP and hepatobiliary scintigraphy showed normal appearances of intra- and extra-hepatic bile ducts in two and one patients, respectively. CONCLUSION: Imaging modalities are useful in the diagnosis and differential diagnosis of VMCs. A correct diagnosis might be obtained when typical imaging findings are present even without a histological confirmation. PMID:16419165

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

2005-01-01

121

Primary biliary cirrhosis in adults.  

PubMed

Primary biliary cirrhosis (PBC) is a chronic, autoimmune, cholestatic liver disease. It is characterized by slow destruction of small intrahepatic bile ducts, impaired biliary secretion and stasis of toxic endogenous bile acids within the liver with progression to liver fibrosis and cirrhosis. It has an increasing prevalence worldwide. It occurs more commonly in women than men at a ratio of 10:1. In most cases, diagnosis relies on a positive antimitochondrial antibody in the context of chronic cholestasis, without the need for a liver biopsy. Ursodeoxycholic acid improves survival even in patients with advanced liver disease. Certain findings such as fatigue, anti-nuclear antibodies, anti-centromere antibodies and the GP210 antinuclear antibody predict a poor outcome. Up to 40% of patients do not respond satisfactorily to ursodeoxycholic acid therapy and should be considered for adjunctive therapies. Several adjunctive and newer therapies are being tested and some appear promising. We provide a review of PBC with a focus on advances in therapies that may impact the management of PBC in the near future. PMID:24580040

Momah, Njideka; Lindor, Keith D

2014-05-01

122

Primary biliary cirrhosis  

PubMed Central

Primary biliary cirrhosis (PBC) is a chronic and slowly progressive cholestatic liver disease of autoimmune etiology characterized by injury of the intrahepatic bile ducts that may eventually lead to liver failure. Affected individuals are usually in their fifth to seventh decades of life at time of diagnosis, and 90% are women. Annual incidence is estimated between 0.7 and 49 cases per million-population and prevalence between 6.7 and 940 cases per million-population (depending on age and sex). The majority of patients are asymptomatic at diagnosis, however, some patients present with symptoms of fatigue and/or pruritus. Patients may even present with ascites, hepatic encephalopathy and/or esophageal variceal hemorrhage. PBC is associated with other autoimmune diseases such as Sjogren's syndrome, scleroderma, Raynaud's phenomenon and CREST syndrome and is regarded as an organ specific autoimmune disease. Genetic susceptibility as a predisposing factor for PBC has been suggested. Environmental factors may have potential causative role (infection, chemicals, smoking). Diagnosis is based on a combination of clinical features, abnormal liver biochemical pattern in a cholestatic picture persisting for more than six months and presence of detectable antimitochondrial antibodies (AMA) in serum. All AMA negative patients with cholestatic liver disease should be carefully evaluated with cholangiography and liver biopsy. Ursodeoxycholic acid (UDCA) is the only currently known medication that can slow the disease progression. Patients, particularly those who start UDCA treatment at early-stage disease and who respond in terms of improvement of the liver biochemistry, have a good prognosis. Liver transplantation is usually an option for patients with liver failure and the outcome is 70% survival at 7 years. Recently, animal models have been discovered that may provide a new insight into the pathogenesis of this disease and facilitate appreciation for novel treatment in PBC. PMID:18215315

Kumagi, Teru; Heathcote, E Jenny

2008-01-01

123

Histological assessment of bile lake formation after hepatic portoenterostomy for biliary atresia  

Microsoft Academic Search

Bile lakes develop after hepatic portoenterostomy in some patients with biliary atresia, and have been regarded as an indication\\u000a of poor prognosis. We reported that bile lakes have no epithelium of the bile duct on their wall, and are surrounded by bile\\u000a ducts; however, the mechanism of bile lake formation is little known. We investigated histologically how bile ducts are

Takahisa Tainaka; Kenitiro Kaneko; Shigeo Nakamura; Yasuyuki Ono; Wataru Sumida; Hisami Ando

2008-01-01

124

Extrahepatic biliary cancer: New staging classification  

PubMed Central

Tumor staging defines the point in the natural history of the malignancy when the diagnosis is made. The most common staging system for cancer is the tumor, node, metastases classification. Staging of cancers provides useful parameters in the determination of the extent of disease and prognosis. Cholangiocarcinoma are rare and refers to cancers that arise from the biliary epithelium. These tumors can occur anywhere along the biliary tree. These tumors have been previously divided into extrahepatic and intrahepatic lesions. Until recently the extrahepatic bile duct tumors have been considered as a single entity per American Joint Commission on Cancer (AJCC) staging classification. The most recent changes to the AJCC classification of bile duct cancers divide the tumors into two major categories: proximal and distal tumors. This practical classification is based on anatomy and surgical management. High quality cross-sectional computed tomography (CT) and/or magnetic resonance (MR) imaging of the abdomen are essential information to accurately stage this tumors. Imaging plays an important role in diagnosis, localization, staging and optimal management of cholangiocarcinoma. For example, it helps to localize the tumor to either perihilar or distal bile duct, both of which have different management. Further, it helps to accurately stage the disease and identify the presence of significant nodal and distant metastasis, which may preclude surgery. Also, it helps to identify the extent of local invasion, which has a major impact on the management. For example, extensive involvement of hepatic duct reaching up to second-order biliary radicals or major vascular encasement of portal vein or hepatic arteries precludes curative surgery and patient may be managed by palliative therapy. Further, imaging helps to identify any anatomical variations in the hepatic arterial or venous circulation and biliary ductal system, which is vital information for surgical planning. This review presents relevant clinical presentation and imaging acquisition and presentation for the accurate staging classification of bile duct tumors based on the new AJCC criteria. This will be performed with the assistance of anatomical diagrams and representative CT and MR images. The image interpretation must include all relevant imaging information for optimum staging. Detailed recommendations on the items required on the radiology report will be presented. PMID:22937214

Ganeshan, Dhakshinamoorthy; Moron, Fanny E; Szklaruk, Janio

2012-01-01

125

Simultaneous Non-Traumatic Perforation of the Right Hepatic Duct and Gallbladder: An Atypical Occurrence  

PubMed Central

Simultaneous non-traumatic perforation of the extrahepatic bile duct and the gallbladder is an uncommon occurrence that has been infrequently reported. We describe a patient with a spontaneous perforation of both the extrahepatic bile duct and the gallbladder. A contrast-enhanced computed tomography (CECT) scan of the abdomen and endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a perforation of the gallbladder and a free leak from the right hepatic duct, respectively. Endoscopic biliary drainage following a sphincterotomy and biliary stent placement led to a dramatic improvement in the patient’s general condition. He was subsequently scheduled to undergo an elective cholecystectomy. Repeat ERCP performed at 4 weeks after the initial stenting showed a normal cholangiogram and a distally migrated stent, which was there after removed. However, early stent removal led to re-perforation of hepatic duct and gallbladder. A repeat endoscopic biliary drainage did not help, and the patient developed biliary peritonitis. Surgical exploration revealed a perforation at the fundus of the gallbladder, 400 ml of biliopurulent collection and a frozen Calot’s triangle. A subtotal cholecystectomy, gall stone removal, and a thorough peritoneal lavage were undertaken. The patient improved postoperatively. The second biliary stent was removed after 4 months. This case report highlights the role of endoscopic biliary drainage in the management of an extrahepatic bile duct perforation and warns against the early removal of a biliary stent. PMID:23610553

Garg, Pankaj Kumar; Jain, Bhupendra Kumar; Pandey, Satya Deo; Rathi, Vinita; Puri, Amarendra Singh

2012-01-01

126

Ultrasonographic study of the Wirsung duct caliber after meal.  

PubMed

The pancreatic duct or at least parts of this structure can be demonstrated today by sonography in 50-82% according to various authors. We have measured the caliber of the sonographically visualized pancreatic duct in 20 normal subjects after physiological stimulation with meal. The mean caliber of the duct markedly increased after meal. During dilatation a longer segment of duct is more clearly visualized. It is possible to document an increase of caliber of Wirsung duct "in vivo" as an evident sign of pancreatic secretion. PMID:1751816

Brogna, A; Bucceri, A M; Catalano, F; Ferrara, R; Mangiameli, A; Monello, S; Blasi, A

1991-05-01

127

Duct closure  

DOEpatents

A closure for an inclined duct having an open upper end and defining downwardly extending passageway. The closure includes a cap for sealing engagement with the open upper end of the duct. Associated with the cap are an array of vertically aligned plug members, each of which has a cross-sectional area substantially conforming to the cross-sectional area of the passageway at least adjacent the upper end of the passageway. The plug members are interconnected in a manner to provide for free movement only in the plane in which the duct is inclined. The uppermost plug member is attached to the cap means and the cap means is in turn connected to a hoist means which is located directly over the open end of the duct.

Vowell, Kennison L. (Canoga Park, CA)

1987-01-01

128

Prolonged exposure of cholestatic rats to complete dark inhibits biliary hyperplasia and liver fibrosis.  

PubMed

Biliary hyperplasia and liver fibrosis are common features in cholestatic liver disease. Melatonin is synthesized by the pineal gland as well as the liver. Melatonin inhibits biliary hyperplasia of bile duct-ligated (BDL) rats. Since melatonin synthesis (by the enzyme serotonin N-acetyltransferase, AANAT) from the pineal gland increases after dark exposure, we hypothesized that biliary hyperplasia and liver fibrosis are diminished by continuous darkness via increased melatonin synthesis from the pineal gland. Normal or BDL rats (immediately after surgery) were housed with light-dark cycles or complete dark for 1 wk before evaluation of 1) the expression of AANAT in the pineal gland and melatonin levels in pineal gland tissue supernatants and serum; 2) biliary proliferation and intrahepatic bile duct mass, liver histology, and serum chemistry; 3) secretin-stimulated ductal secretion (functional index of biliary growth); 4) collagen deposition, liver fibrosis markers in liver sections, total liver, and cholangiocytes; and 5) expression of clock genes in cholangiocytes. In BDL rats exposed to dark there was 1) enhanced AANAT expression/melatonin secretion in pineal gland and melatonin serum levels; 2) improved liver morphology, serum chemistry and decreased biliary proliferation and secretin-stimulated choleresis; and 4) decreased fibrosis and expression of fibrosis markers in liver sections, total liver and cholangiocytes and reduced biliary expression of the clock genes PER1, BMAL1, CLOCK, and Cry1. Thus prolonged dark exposure may be a beneficial noninvasive therapeutic approach for the management of biliary disorders. PMID:25214401

Han, Yuyan; Onori, Paolo; Meng, Fanyin; DeMorrow, Sharon; Venter, Julie; Francis, Heather; Franchitto, Antonio; Ray, Debolina; Kennedy, Lindsey; Greene, John; Renzi, Anastasia; Mancinelli, Romina; Gaudio, Eugenio; Glaser, Shannon; Alpini, Gianfranco

2014-11-01

129

Percutaneous transhepatic biliary stenting in patients with intradiverticular papillae and biliary strictures caused by ampullary carcinoma: A case report  

PubMed Central

Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy is a well-established procedure for the treatment of bile duct strictures. However, the procedure is difficult to perform in patients with intradiverticular papillae or tumor infiltration of the major papilla. Percutaneous transhepatic biliary stenting (PTBS) is commonly used in the management of malignant biliary stricture. The current study reports two cases of PTBS performed to treat malignant obstructive jaundice caused by ampullary carcinoma complicated with intradiverticular papillae. PTBS is potentially a safe technique for this relatively rare condition. PMID:24944703

NIU, HONG-TAO; HUANG, QIANG; ZHAI, REN-YOU

2014-01-01

130

Percutaneous transhepatic biliary stenting in patients with intradiverticular papillae and biliary strictures caused by ampullary carcinoma: A case report.  

PubMed

Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy is a well-established procedure for the treatment of bile duct strictures. However, the procedure is difficult to perform in patients with intradiverticular papillae or tumor infiltration of the major papilla. Percutaneous transhepatic biliary stenting (PTBS) is commonly used in the management of malignant biliary stricture. The current study reports two cases of PTBS performed to treat malignant obstructive jaundice caused by ampullary carcinoma complicated with intradiverticular papillae. PTBS is potentially a safe technique for this relatively rare condition. PMID:24944703

Niu, Hong-Tao; Huang, Qiang; Zhai, Ren-You

2014-04-01

131

On the mechanical behavior of the human biliary system  

PubMed Central

This paper reviews the progress made in understanding the mechanical behaviour of the biliary system. Gallstones and diseases of the biliary tract affect more than 10% of the adult population. The complications of gallstones, i.e. acute pancreatitis and obstructive jandice, can be lethal, and patients with acalculous gallbladder pain often pose diagnostic difficulties and undergo repeated ultrasound scans and oral cholecystograms. Moreover, surgery to remove the gallbladder in these patients, in an attempt to relieve the symptoms, gives variable results. Extensive research has been carried out to understand the physiological and pathological functions of the biliary system, but the mechanism of the pathogenesis of gallstones and pain production still remain poorly understood. It is believed that the mechanical factors play an essential role in the mechanisms of the gallstone formation and biliary diseases. However, despite the extensive literature in clinical studies, only limited work has been carried out to study the biliary system from the mechanical point of view. In this paper, we discuss the state of art knowledge of the fluid dynamics of bile flow in the biliary tract, the solid mechanics of the gallbladder and bile ducts, recent mathematical and numerical modelling of the system, and finally the future challenges in the area. PMID:17457970

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

2007-01-01

132

Double cystic duct in a child with VACTERL association: a case report.  

PubMed

Double cystic duct is an extremely rare anomaly of the biliary tract not described in the pediatric literature. We report the first pediatric case born with VACTERL association found to have double cystic ducts during gallbladder surgery for symptomatic cholelithiasis. Description of the anatomic variability, cholangiography images, and pathologic findings along with review of the literature is included. PMID:19954104

Lugo-Vicente, Humberto; Correa, Maria; Brunet, Hector

2009-01-01

133

Biliary obstruction - series (image)  

MedlinePLUS

... indicate a high level of bilirubin, a waste product of the liver, or diagnosis may come from an endoscopic examination. Untreated biliary obstruction may cause life-threatening infection or chronic liver disease.

134

Primary Biliary Cirrhosis  

MedlinePLUS

... the test or may develop bacterial cholangitis or pancreatitis—inflammation of the pancreas. Liver biopsy. A liver ... are unknown. Most research suggests it is an autoimmune disease. Primary biliary cirrhosis is more common in ...

135

Tolerance of bile duct to intraoperative irradiation  

SciTech Connect

In order to determine the effects of intraoperative radiation therapy of the bile duct and surrounding tissues, seven adult dogs were subjected to laparotomy and intraoperative irradiation with 11 MeV electrons. Two animals were treated at each dose level of 2000, 3000, and 4500 rads. A single dog which received a laparotomy and sham irradiation served as a control. The irradiation field consisted of a 5 cm diameter circle encompassing the extrahepatic bile duct, portal vein, hepatic artery, and lateral duodenal wall. The animals were followed clinically for mor than 18 months after treatment, and autopsies were performed on dogs that died to assess radiation-induced complications or tissue damage. All dogs developed fibrosis and mural thickening of the common duct, which appeared by 6 weeks following irradiation and which was dose-related, being mild at low doses and more severe at high doses. Hepatic changes were seen as early as 6 weeks after irradiation, consisting of periportal inflammation and fibrosis. The hepatic changes appeared earliest at the highest doses. Frank biliary cirrhosis eventually developed at all dose levels. Duodenal fibrosis appeared in the irradiation portal, being most severe at the highest doses and in some animals resulting in duodenal obstruction. No changes were observed in irradiated portions of portal vein and hepatic artery at any dose level. It was concluded that intraoperative radiation therapy delivered to the region of the common duct leads to ductal fibrosis, partial biliary obstruction with secondary hepatic changes, and duodenal fibrosis if bowel wall is included in the field. Clinical use of intraoperative radiation therapy to the bile duct in humans may require routine use of biliary and duodenal bypass to prevent obstructive complications.

Sindelar, W.F.; Tepper, J.; Travis, E.L.

1982-09-01

136

Bile duct reconstruction by a young surgeon in living donor liver transplantation using right liver graft.  

PubMed

Biliary strictures and bile leaks account for the majority of biliary complications after living donor liver transplantation (LDLT). The aim of this study was to examine differences in biliary complications after adult LDLTs were performed by an experienced senior surgeon and an inexperienced junior surgeon. Surgeries included bile duct reconstruction after adult LDLT using a right liver graft, and risk factors for biliary stricture were identified. We retrospectively reviewed the medical records of 136 patients who underwent LDLT in order to identify patients who developed biliary complications. The senior surgeon performed 102 surgeries and the junior surgeon performed 34 surgeries. The proportion of patients with biliary stricture was similar between the senior and the junior surgeons (27.5% vs 26.5%; P?=?0.911). However, the incidence of biliary leakage was higher in patients of the junior surgeon than in those of the senior surgeon (23.5% vs 2.9%; P?=?0.001). The frequency of percutaneous drainage was also higher for the junior surgeon than the senior surgeon because of the junior surgeon's high leakage rate of the drainage. When the junior surgeon performed bile duct anastomosis, biliary leakage occurred in 7 patients between the 11th and 20th cases. However, biliary leakage occurred in only 1 case thereafter. Bile duct reconstruction performed by beginner surgeons in LDLT using right lobe grafts should be cautiously monitored and observed by a senior surgeon until an inexperienced junior surgeon has performed at least 20 cases, because of the high incidence of biliary leakage related to surgeon's inexperience in bile duct reconstructions in LDLT. PMID:25255023

Kim, Jong Man; Cho, Wontae; Kwon, Choon Hyuck David; Joh, Jae-Won; Park, Jae Berm; Ko, Justin Sangwook; Gwak, Mi Sook; Kim, Gaab Soo; Kim, Sung Joo; Lee, Suk-Koo

2014-09-01

137

Role of Cholangiocytes in Primary Biliary Cirrhosis  

PubMed Central

Primary biliary cirrhosis (PBC) is an autoimmune liver disease characterized by selective destruction of intrahepatic cholangiocytes. Mechanisms underlying the development and progression of the disease are still controversial and largely undefined. Evidence suggests that PBC results from an articulated immunologic response against an immunodominant mitochondrial autoantigen, the E2 component of the pyruvate dehydrogenase complex (PDC-E2); characteristics of the disease are also the presence of disease-specific antimitochondrial autoantibodies (AMAs) and autoreactive CD4 and CD8 T cells. Recent evidence suggests that cholangiocytes show specific immunobiological features that are responsible for the selective targeting of those cells by the immune system. The immune reaction in PBC selectively targets small sized, intrahepatic bile ducts; although a specific reason for that has not been defined yet, it has been established that the biliary epithelium displays a unique heterogeneity, for which the physiological and pathophysiological features of small and large cholangiocytes significantly differ. In this review article, the authors provide a critical overview of the current evidence on the role of cholangiocytes in the immune-mediated destruction of the biliary tree that characterizes PBC. PMID:25057951

Lleo, Ana; Maroni, Luca; Glaser, Shannon; Alpini, Gianfranco; Marzioni, Marco

2014-01-01

138

[Malignant biliary obstruction, general review and clinical practice].  

PubMed

This review recalls the clinical, anatomic, physiopathological and etiological features necessary in the management of patients with neoplastic bile duct obstruction and exposes the current practice concerning endoscopic and radiologic palliative drainage. Clinical practice according to the clinical situations is explained. This review exposes complications management for patients having undergone an endoscopic or percutaneous drainage of the biliary ducts, the particular case of periportal stenosis, the respective indications of endoscopic and transhepatic percutaneous drainage, usual immediate evolution according to the type of the stenosis and the technique used as well as the management in case of stent obstruction. PMID:23644517

Bonnel, Didier; André, Thierry; Mader, Benoît; Lefebvre, Jean-François; Bensoussan, Emmanuel; Liguory, Claude

2013-05-01

139

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 PMID:4051422

Ashby, B. S.

1985-01-01

140

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. PMID:20033407

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

2009-01-01

141

Anatomical variations of the cystic duct: two case reports.  

PubMed

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 significant 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 case was a 64-year-old man with cholelithiasis and chronic cholecystitis. During surgery, the entrance of the cystic duct was misidentified as being short and leading into the right hepatic duct. Further exploration showed multiple calculi in the right and common hepatic ducts. Cholecystectomy was completed, followed by T-tube drainage of the common and right hepatic ducts. Postoperative T-tube cholangiography demonstrated that the two T tubes were respectively located in the cystic and common hepatic duct. Six weeks later, the retained stones in the distal choledochus were extracted by cholangioscopy through the sinus tract of the T-tube. The second case was a 41-year-old woman, in which, preoperative endoscopic retrograde cholangiopancreatography (ERCP) revealed a long cystic duct, with a narrow and curved-in lumen. The patient underwent open cholecystectomy. Both patients were cured. The authors propose that preoperative ERCP or magnetic resonance cholangiopancreatography (MRCP), and intraoperative cholangiography or cholangioscopy constitute a useful and safe procedure for determining anatomical variations of the cystic duct. PMID:18176982

Wu, Yun-Hua; Liu, Zhi-Su; Mrikhi, Rekia; Ai, Zhong-Li; Sun, Quan; Bangoura, Gassimou; Qian, Qun; Jiang, Cong-Qing

2008-01-01

142

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. PMID:24043976

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

2013-01-01

143

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

144

The flow of bile in the human cystic duct  

Microsoft Academic Search

Clinical studies suggest that the flow of bile in the biliary system may be a contributing factor in the pathogenesis of cholelithiasis, but little is known about its transport mechanism. This paper reports a numerical study of steady flow in human cystic duct models. In order to obtain parametric data on the effects of various anatomical features in the cystic

R. C. Ooi; X. Y. Luo; S. B. China; A. G. Johnson; N. C. Bird

2004-01-01

145

Prospective observational multicenter study to define a diagnostic algorithm for biliary candidiasis  

PubMed Central

AIM: To develop an algorithm to improve the diagnosis and treatment of patients with biliary candidiasis. METHODS: We performed a prospective study of 127 patients who underwent endoscopic retrograde cholangiopancreatography, for various biliary disorders, at 3 tertiary referral centers in Germany from July 2011 through July 2012 (ClinicalTrials.gov: NCT01109550). Bile, buccal, and stool samples were collected. When indicated, endoscopic transpapillary bile duct biopsies were performed to clarify the etiology of bile duct strictures and to prove invasive fungal infections. RESULTS: Candida species were detected in 38 of the 127 bile samples (29.9%). By multivariate analysis patients’ age and previous endoscopic sphincterotomy were independent risk factors for biliary candidiasis (P < 0.05). Patients with immunosuppression (P = 0.058) and recent long-term antibiotic therapy (> 7 d) (P = 0.089) tend to be at risk for biliary candidiasis. One patient was negative in mycological culture of bile fluid but invasive biliary candidiasis was diagnosed histologically. Of Candida subspecies detected, 36.7% were azole-resistant, such as C glabrata. Eight patients received anti-mycotic therapy, based on our algorithm. Of these, 3 had cancer with biliary tract involvement, 2 had secondary sclerosing cholangitis, 1 had retroperitoneal fibrosis, and 5 had septicemia. In all patients contamination was ruled out by smears of the endoscope channel. CONCLUSION: Gastroenterologists should be aware of frequent candida colonization in patients with cholangitis and biliary disorders. Our suggested algorithm facilitates the further clinical management. PMID:25232260

Lenz, Philipp; Eckelskemper, Franziska; Erichsen, Thomas; Lankisch, Tim; Dechêne, Alexander; Lubritz, Gabriele; Lenze, Frank; Beyna, Torsten; Ullerich, Hansjörg; Schmedt, Andre; Domagk, Dirk

2014-01-01

146

Endoscopic sphincterotomy plus large-balloon dilation vs endoscopic sphincterotomy for choledocholithiasis: A meta-analysis  

PubMed Central

AIM: To perform a meta-analysis of large-balloon dilation (LBD) plus endoscopic sphincterotomy (EST) vs EST alone for removal of bile duct stones. METHODS: Databases including PubMed, EMBASE, the Cochrane Library, the Science Citation Index, and important meeting abstracts were searched and evaluated by two reviewers independently. The main outcome measures included: complete stone removal, stone removal in the first session, use of mechanical lithotripsy, procedure time, and procedure-related complications. A fixed-effects model weighted by the Mantel-Haenszel method was used for pooling the odds ratio (OR) when heterogeneity was not significant among the studies. When a Q test or I2 statistic indicated substantial heterogeneity, a random-effects model weighted by the DerSimonian-Laird method was used. RESULTS: Six randomized controlled trials involving 835 patients were analyzed. There was no significant heterogeneity for most results; we analyzed these using a fixed-effects model. Meta-analysis showed EST plus LBD caused fewer overall complications than EST alone (OR = 0.53, 95%CI: 0.33-0.85, P = 0.008); subcategory analysis indicated a significantly lower risk of perforation in the EST plus LBD group (Peto OR = 0.14, 95%CI: 0.20-0.98, P = 0.05). Use of mechanical lithotripsy in the EST plus LBD group decreased significantly (OR = 0.26, 95%CI: 0.08-0.82, P = 0.02), especially in patients with a stone size larger than 15 mm (OR = 0.15, 95%CI: 0.03-0.68, P = 0.01). There were no significant differences between the two groups regarding complete stone removal, stone removal in the first session, post-endoscopic retrograde cholangiopancreatography pancreatitis, bleeding, infection of biliary tract, and procedure time. CONCLUSION: EST plus LBD is an effective approach for the removal of large bile duct stones, causing fewer complications than EST alone. PMID:24409076

Yang, Xiao-Ming; Hu, Bing

2013-01-01

147

Ultrasonographic findings of type IIIa biliary atresia  

PubMed Central

Purpose: To describe the ultrasonographic (US) findings of type IIIa biliary atresia. Methods: We retrospectively reviewed a medical database of patients pathologically confirmed to have biliary atresia, Kasai type IIIa, between January 2002 and May 2013 (n=18). We evaluated US findings including the visible common bile duct (CBD), triangular cord thickness, gallbladder size and shape, and subcapsular flow on color Doppler US; laboratory data; and pathological hepatic fibrosis grades. We divided them into two groups-those with visible (group A) and invisible (group B) CBD on US-and compared all parameters between the two groups. Results: CBD was visible on US in five cases (27.8%; group A) and invisible in 13 cases (72.2%; group B). US was performed at an earlier age in group A than in group B (median, 27 days vs. 60 days; P=0.027) with the maximal age of 51 days. A comparison of the US findings revealed that the triangular cord thickness was smaller (4.1 mm vs. 4.9 mm; P=0.004) and the gallbladder length was larger (20.0 mm vs. 11.7 mm; P=0.021) in group A. The gallbladder shape did not differ between the two groups, and the subcapsular flow was positive in all cases of both groups. There was no significant difference in the laboratory data between the two groups. Upon pathological analysis, group A showed low-grade and group B showed low- to high-grade hepatic fibrosis. Conclusion: When CBD is visible on US in patients diagnosed with type IIIa biliary atresia, other US features could have a false negative status. A subcapsular flow on the color Doppler US would be noted in the type IIIa biliary atresia patients. PMID:25036753

2014-01-01

148

[Primary biliary cirrhosis and pregnancy].  

PubMed

Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease, asymptomatic during a protracted time, characterized by changes in the small-sized bile ducts near portal spaces. The etiology of PBC is undefined, but immunologic and environmental disturbances may contribute to the disease. Infertility is often associated with PBC and cirrhosis, but pregnancy may well occur in women with PBC and without cirrhosis or in some others with compensated cirrhosis. A pluridisciplinary approach including gastroenterologists and obstetricians is recommended. The patient must be closely monitored throughout her pregnancy with maternal and routine antenatal care. Medical treatment requires ursodeoxycholic acid (UDCA). In non-cirrhotic UDCA-treated women with PBC, pregnancy often follows a normal course with vaginal delivery. In cirrhotic patients, UDCA must be continued during pregnancy, esophageal and gastric varices must be evaluated before pregnancy, and endoscopic ligature is recommended for treating large varices. Additionally, beta-blocker therapy may be associated, especially when variceal rupture occurred previously. Elective cesarean section is recommended in patients with large esophageal or gastric varices because of the potentially increased risk of variceal bleeding during maternal expulsive efforts in case of vaginal delivery. PMID:23628147

Ducarme, G; Bernuau, J; Luton, D

2014-05-01

149

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

150

Mechanical nasal alar dilators.  

PubMed

Most studies on nasal dilators have used Breathe Right or Nozovent. Both devices dilate the nasal valves, reduce nasal resistance, and improve nasal airflow. The use of dilators improves airflow most on inspiration, as the valve is stabilised and prevented from collapse. The response varies greatly between individuals, and can be impressive. The effect of nasal dilators may be lower in non-Caucasians. During exercise, nasal dilators delay the onset of oronasal breathing, and can have only small effects on performance thereafter. Nozovent and Breathe Right can reduce snoring, and improve otherwise obstructed breathing during sleep in selected patients. It is a challenge to find those patients, and one way could be to perform polysomnography with and without nasal dilator. PMID:17216739

Ellegård, Eva

2006-12-01

151

[Study of biliary tract atresia with HIDA Tc 99].  

PubMed

This report has been motivated to assess the permeability of portoenterostomy with isotopic methods (HIDA Tc 99) in two cases of biliary tract atresia. Both cases have followed a good evolution during 1 1/2 and 8 years respectively, with vanishing of the icterus and achieving an acceptable biliary flow. We used the hepatic gammagraphy with HIDA Tc 99 to evaluate biliary drainage and functional status of biliary tract. Also we used other classical biochemical parameters. This isotope is useful to evaluate the effectiveness of portoenterostomy by the amount and quality of biliary flow, and specially drainage ducts. Actually this method is the safest as compared to all the others, specially transparietohepatic cholangiography. The special characteristics os this isotope and the quality of the records allow the study of both function and structure of hepatic parenchyma through the curves activity/time. This curve measures between the periphery of hepatogram and porta hepatis follows a parallel course to bilirubin clearance. By all that we think that this method, with serial determinations, can be a precise parameter of surgical intervention, and it is useful as a early indicator of bad course, allowing an evaluation of cholangitis and the indication to reintervention. PMID:6881750

Morales, L; Rovira, J; Sancho, N A; Uroz, J A; Juliá, V

1983-04-01

152

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

153

Neuroendocrine tumors of extrahepatic biliary tract.  

PubMed

Neuroendocrine tumors of the extrahepatic bile ducts (EBNETs) are very rare. The aim of the present review is to elucidate the characteristics of EBNETs, their treatment and prognosis. An exhaustive systematic review of the literature was performed from 1959 up-to-date. One hundred articles, describing 150 cases were collected. Each article was carefully analyzed and a database was created. The most common symptoms were jaundice (60.3 %) and pruritus (19.2 %). Cholelithiasis co-existed in 15 cases (19.2 %). Hormone- and vasoactive peptide- related symptoms were present in only 7 cases (9 %). The most frequent sites were found to be the common hepatic duct and the proximal common bile duct (19.2 %). Surgical management was considered the main treatment for EBNETs, while excision of extrahepatic biliary tree (62.82 %) with portal vein lymphadenectomy (43.6 %) was the most popular procedure. EBNETs are extremely rare. Their rarity makes their characterization particularly difficult. Up to date the final diagnosis is made after surgery by pathology and immunohistochemistry findings. The present analysis of the existing published cases elucidates many aspects of these tumours, giving complete clinicopathological documentation. PMID:24917351

Michalopoulos, Nickos; Papavramidis, Theodossis S; Karayannopoulou, Georgia; Pliakos, Ioannis; Papavramidis, Spiros T; Kanellos, Ioannis

2014-10-01

154

Contrast-enhanced ultrasound in the biliary system: Potential uses and indications  

PubMed Central

Conventional ultrasound (US) is the first-line imaging investigation for biliary diseases. However, it is lack of the ability to depict the microcirculation of some lesions which may lead to failure in diagnosis for some biliary diseases. The use of contrast-enhanced US (CEUS) has reached the field of bile duct disease in recent years and promising results have been achieved. In this review, the methodology, image interpretation, enhancement pattern, clinical usefulness, and indications for CEUS in the biliary system are summarized. CEUS may be indicated in the biliary system under the following circumstances: (1) Where there is a need to make a characterization of intrahepatic cholangiocarcinoma (ICC); (2) For differentiation diagnosis between ICC and other tumors (i.e. hepatocellular carcinoma or liver metastasis) or infectious diseases; (3) For differentiation diagnosis between biliary cystadenoma and biliary cystadenocarcinoma; (4) To detect malignant change in Caroli’s disease; (5) To depict the extent of Klatskin’s tumor with greater clarity; (6) To make a distinction between gallbladder cholesterol polyp, adenoma and polypoid cancer; (7) To make a distinction between chronic cholecystitis with thickened wall and gallbladder cancer; (8) For differentiation diagnosis between motionless sludge and gallbladder cancer; (9) For differentiation diagnosis between common bile duct cancer and sludge or stone without acoustic shadowing; and (10) In patients who are suspected of having a drop of their percutaneous transhepatic cholangiodrainage tube, US contrast agent can be administered to through the tube detect the site of the tube. PMID:21160719

Xu, Hui-Xiong

2009-01-01

155

Abnormal /sup 99//sup m/Tc-PIPIDA scans mistaken for common duct obstruction  

SciTech Connect

/sup 99//sup m/Tc-PIPIDA scans were obtained in three patients with acute abdominal pain. The appearance of the scans suggested partial common duct obstruction. Two patients underwent surgery. One had acute appendicitis and the second had infarction of the distal ileum. In both cases, the gallbladder and biliary tract were normal. The third patient had been treated with morphine, which is known to increase biliary tract pressure and may cause contraction of the sphincter of Oddi. An ultrasound study of the gallbladder was normal and all symptoms resolved within 24 hours. Subsequently, three additional patients without biliary disease have been seen who had similar hepatobiliary scans. All three had received meperidine prior to the study. It is concluded that acute abdominal disease or the administration of morphine sulfate or meperidine can result in a scan pattern suggesting partial distal common duct obstruction in the absence of gallbladder or biliary tract disease.

Taylor, A. Jr. (Univ. of California Medical Center, San Diego); Kipper, M.S.; Witztum, K.; Greenspan, G.; Kan, M.

1982-07-01

156

Abnormal /sup 99m/Tc-PIPIDA scans mistaken for common duct obstruction  

SciTech Connect

/sup 99m/Tc-PIPIDA scans were obtained in three patients with acute abdominal pain. The appearance of the scans suggested partial common duct obstruction. Two patients underwent surgery. One had acute appendicitis and the second had infarction of the distal ileum. In both cases, the gallbladder and biliary tract were normal. The third patient had been treated with morphine, which is known to increase biliary tract pressure and may cause contraction of the sphincter of Oddi. An ultrasound study of the gallbladder was normal and all symptoms resolved within 24 hours. Subsequently, three additional patients without biliary disease have been seen who had similar hepatobiliary scans. All three had received meperidine prior to the study. It is concluded that acute abdominal disease or the administration of morphine sulfate or meperidine can result in a scan pattern suggesting partial distal common duct obstruction in the absence of gallbladder or biliary tract disease.

Taylor, A. Jr.; Kipper, M.S.; Witztum, K.; Greenspan, G.; Kan, M.

1982-07-01

157

Role of magnetic resonance cholangiopancreatography in the evaluation of biliary disease.  

PubMed

Magnetic resonace cholangiopancreatography (MRCP) was introduced in 1991, as a non-invasive method of imaging the biliary tree. Although endoscopic cholongiopancreatography (ERCP) has been the mainstay for diagnosing and treating pancreatico-biliary disease, complications such as pancreatitis, cholangitis, haemorrhage and duodenal perforation have limited its use as a routine diagnostic test. Although ERCP is still the standard of reference for imaging the pancreatico-biliary system, MRCP is the examination of choice in a setting where ERCP is difficult or impossible. It is useful in cases with severe biliary obstruction to evaluate the ducts proximal to the obstruction. MRCP has specific advantages over ERCP as it is non-invasive, cheaper, uses no radiation, requires no anaesthesia and is less operator dependent. When combined with conventional T1- and T2-weighted sequences, it allows detection of extraductal disease. The technology is still evolving to make the MRCP examination faster, sharper and with higher spatial resolution. PMID:21509322

Al-Dhuhli, Humoud

2009-12-01

158

Dilating Eye Drops  

MedlinePLUS

... the eye allows for a more accurate measurementof refractive error (need for glasses) in children. Finally, dilating eye ... lasting drops than do adults to accurately measure refractive error. Weaker drops are used for premature babies and ...

159

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

160

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

2012-09-01

161

Vitamin D Nuclear Receptor Deficiency Promotes Cholestatic Liver Injury by Disruption of Biliary Epithelial Cell Junctions in Mice  

PubMed Central

Alterations in apical junctional complexes (AJCs) have been reported in genetic or acquired biliary diseases. The vitamin D nuclear receptor (VDR), predominantly expressed in biliary epithelial cells in the liver, has been shown to regulate AJCs. The aim of our study was thus to investigate the role of VDR in the maintenance of bile duct integrity in mice challenged with biliary-type liver injury. Vdr?/? mice subjected to bile duct ligation (BDL) displayed increased liver damage compared to wildtype BDL mice. Adaptation to cholestasis, ascertained by expression of genes involved in bile acid metabolism and tissue repair, was limited in Vdr?/? BDL mice. Furthermore, evaluation of Vdr?/? BDL mouse liver tissue sections indicated altered E-cadherin staining associated with increased bile duct rupture. Total liver protein analysis revealed that a truncated form of E-cadherin was present in higher amounts in Vdr?/? mice subjected to BDL compared to wildtype BDL mice. Truncated E-cadherin was also associated with loss of cell adhesion in biliary epithelial cells silenced for VDR. In these cells, E-cadherin cleavage occurred together with calpain 1 activation and was prevented by the silencing of calpain 1. Furthermore, VDR deficiency led to the activation of the epidermal growth factor receptor (EGFR) pathway, while EGFR activation by EGF induced both calpain 1 activation and E-cadherin cleavage in these cells. Finally, truncation of E-cadherin was blunted when EGFR signaling was inhibited in VDR-silenced cells. Conclusion: Biliary-type liver injury is exacerbated in Vdr?/? mice by limited adaptive response and increased bile duct rupture. These results indicate that loss of VDR restricts the adaptation to cholestasis and diminishes bile duct integrity in the setting of biliary-type liver injury. (Hepatology 2013;58:1401–1412) PMID:23696511

Firrincieli, Delphine; Zúñiga, Silvia; Rey, Colette; Wendum, Dominique; Lasnier, Elisabeth; Rainteau, Dominique; Braescu, Thomas; Falguières, Thomas; Boissan, Mathieu; Cadoret, Axelle; Housset, Chantal; Chignard, Nicolas

2013-01-01

162

Intraoperative Near-Infrared Fluorescent Cholangiography (NIRFC) in Mouse Models of Bile Duct Injury  

Microsoft Academic Search

Background  Accidental injury to the common bile duct is a rare but serious complication of laparoscopic cholecystectomy. Accurate visualization\\u000a of the biliary ducts may prevent injury or allow its early detection. Conventional X-ray cholangiography is often used and\\u000a can mitigate the severity of injury when correctly interpreted. However, it may be useful to have an imaging method that could\\u000a provide real-time

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

2010-01-01

163

Bile duct confluence: anatomic variations and its classification.  

PubMed

Accurate knowledge of the anatomy of the bile ducts is critical for successfully hepato-biliary surgery. We describe the anatomical variations of the confluence of the bile ducts, their branches patterns, frequency and classification. From 1996 to 2011, we have collected data of the bile duct confluence. 2,032 and 1,014 anatomical variations of right and left bile ducts, respectively, were reviewed and classified according to the branching pattern. The frequencies of each type of the right hepatic duct (RHD) were as follows: Type A1-1,247 (61.3%); Type A2-296 (14.5%); Type A3-272 (13.3%); Type A4-124 (6.1%); Type A5-21 (1%) and others-72 (3.5%) and, for the left hepatic duct (LHD) was as follows: Type B1-773 (76.2%); Type B2-153 (15%); Type B3-38 (3.7%); Type B4-9 (0.8%); Type B5-29 (2.8%) and others-12 (1.1%). Atypical branching patterns of both the right and left hepatic ducts were found in 14 and 8%, respectively. The two most common variations of the RHD were right anterior and posterior hepatic ducts join together to form the RHD and trifurcation where the RHD is absent and right anterior and posterior hepatic ducts join directly to the confluence with the LHD to form the common hepatic duct. The two most common variations in the LHD were segment IV drainage to the left and right hepatic ducts. PMID:23817807

Chaib, Eleazar; Kanas, Alexandre Fligelman; Galvão, Flavio Henrique Ferreira; D'Albuquerque, Luiz Augusto Carneiro

2014-03-01

164

Imaging tests for accurate diagnosis of acute biliary pancreatitis.  

PubMed

Gallstones represent the most frequent aetiology of acute pancreatitis in many statistics all over the world, estimated between 40%-60%. Accurate diagnosis of acute biliary pancreatitis (ABP) is of outmost importance because clearance of lithiasis [gallbladder and common bile duct (CBD)] rules out recurrences. Confirmation of biliary lithiasis is done by imaging. The sensitivity of the ultrasonography (US) in the detection of gallstones is over 95% in uncomplicated cases, but in ABP, sensitivity for gallstone detection is lower, being less than 80% due to the ileus and bowel distension. Sensitivity of transabdominal ultrasonography (TUS) for choledocolithiasis varies between 50%-80%, but the specificity is high, reaching 95%. Diameter of the bile duct may be orientative for diagnosis. Endoscopic ultrasonography (EUS) seems to be a more effective tool to diagnose ABP rather than endoscopic retrograde cholangiopancreatography (ERCP), which should be performed only for therapeutic purposes. As the sensitivity and specificity of computerized tomography are lower as compared to state-of-the-art magnetic resonance cholangiopancreatography (MRCP) or EUS, especially for small stones and small diameter of CBD, the later techniques are nowadays preferred for the evaluation of ABP patients. ERCP has the highest accuracy for the diagnosis of choledocholithiasis and is used as a reference standard in many studies, especially after sphincterotomy and balloon extraction of CBD stones. Laparoscopic ultrasonography is a useful tool for the intraoperative diagnosis of choledocholithiasis. Routine exploration of the CBD in cases of patients scheduled for cholecystectomy after an attack of ABP was not proven useful. A significant rate of the so-called idiopathic pancreatitis is actually caused by microlithiasis and/or biliary sludge. In conclusion, the general algorithm for CBD stone detection starts with anamnesis, serum biochemistry and then TUS, followed by EUS or MRCP. In the end, bile duct microscopic analysis may be performed by bile harvested during ERCP in case of recurrent attacks of ABP and these should be followed by laparoscopic cholecystectomy. PMID:25469022

?urlin, Valeriu; S?ftoiu, Adrian; Dumitrescu, Daniela

2014-11-28

165

S100A9 is a Biliary Protein Marker of Disease Activity in Primary Sclerosing Cholangitis  

PubMed Central

Background and Aims Bile analysis has the potential to serve as a surrogate marker for inflammatory and neoplastic disorders of the biliary epithelium and may provide insight into biliary pathophysiology and possible diagnostic markers. We aimed to identify biliary protein markers of patients with primary sclerosing cholangitis (PSC) by a proteomic approach. Methods Bile duct-derived bile samples were collected from PSC patients (n?=?45) or patients with choledocholithiasis (n?=?24, the control group). Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was performed to analyse the proteins, 2-D-gel patterns were compared by densitometry, and brush cytology specimens were analysed by RT-PCR. Results A reference bile-duct bile proteome was established in the control group without signs of inflammation or maligancy comprising a total of 379 non-redundant biliary proteins; 21% were of unknown function and 24% had been previously described in serum. In PSC patients, the biliary S100A9 expression was elevated 95-fold (p<0.005), serum protein expression was decreased, and pancreatic enzyme expression was unchanged compared to controls. The S100A9 expression was 2-fold higher in PSC patients with high disease activity than in those with low activity (p<0.05). The brush cytology specimens from the PSC patients with high disease activity showed marked inflammatory activity and leukocyte infiltration compared to the patients with low activity, which correlated with S100A9 mRNA expression (p<0.05). Conclusions The bile-duct bile proteome is complex and its analysis might enhance the understanding of cholestatic liver disease. Biliary S100A9 levels may be a useful marker for PSC activity, and its implication in inflammation and carcinogenesis warrants further investigation. PMID:22253789

Ruppert, Thomas; Giese, Thomas; Flechtenmacher, Christa; Weiss, Karl Heinz; Kloeters-Plachky, Petra; Stremmel, Wolfgang; Schirmacher, Peter; Sauer, Peter; Gotthardt, Daniel Nils

2012-01-01

166

Ducted turbine theory with right angled ducts  

NASA Astrophysics Data System (ADS)

This paper describes the use of an inviscid approach to model a ducted turbine - also known as a diffuser augmented turbine - and a comparison of results with a particular one-dimensional theory. The aim of the investigation was to gain a better understanding of the relationship between a real duct and the ideal diffuser, which is a concept that is developed in the theory. A range of right angled ducts, which have a rim for a 90° exit angle, were modelled. As a result, the performance of right angled ducts has been characterised in inviscid flow. It was concluded that right angled ducts cannot match the performance of their associated ideal diffuser and that the optimum rotor loading for these turbines varies with the duct dimensions.

McLaren-Gow, S.; Jamieson, P.; Graham, J. M. R.

2014-06-01

167

Review article: Spectrum of biliary infections in the West and in the East.  

PubMed

Biliary infections are an important cause of morbidity in the Western world. With regard to epidemiology, etiology, microbiological spectrum, prevalence, location and composition of gallstones, pathogenesis, clinical sign and therapy, there are large differences between the spectrum of biliary infections in the East and in the West (Table 1). In Western countries, gallstones are found in 10 to 40%. In Eastern countries, the incidence of gallstones is only 2 to 6%. Some eighty-five percent of the gallstones in the West are cholesterol stones, in contrast to the East, where 97% are bile pigment stones. The most important difference is characterized by the origin of common bile duct stones. In the West, common bile duct stones generally originate in the gallbladder, in contrast to the East, where primary common bile duct stones are often found--especially in the intrahepatic segments--with no evidence of gallbladder stones. The sex distribution male to female in the West is 1:2, in the East 1:1. In the West, biliary infections occur mainly in an elderly population, 50% being older than 70 years. In the East, biliary infections appear also in younger people, 50% being younger than 40 years. Parasites play an aetiological role in the East, but not in the West. The typical therapy of gallstones in the West is cholecystectomy, and of common bile duct stones endoscopic sphincterotomy. Due to the frequency of intrahepatic stones in Eastern Countries, the therapeutic spectrum there includes even large hepatic resections and biliary enteric anastomoses. PMID:18612470

Beger, H G; Schwarz, A

1995-01-01

168

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. (44 Glen Dr., Fairfax, CA 94930); deKieffer, Robert C. (Boulder, CO)

2001-01-01

169

Biliary dyskinesia in pediatrics.  

PubMed

Biliary dyskinesia (BD) is a diagnosis that is being made increasingly in children. It is defined by abdominal pain thought to be biliary in nature based on location and character; a completely normal gallbladder on imaging tests, typically ultrasound; and decreased gallbladder contraction in response to a pharmacological stimulus. Unlike other functional gastrointestinal disorders (FGIDs) that are treated with medications, behavioral therapy, and/or dietary modification, current clinical practice has accepted cholecystectomy as the treatment of choice for BD, which now accounts for up to 50% of cholecystectomies in children. Although well-designed trials are missing, accumulating evidence argues against such an approach. First, BD is by definition a benign disorder without risk of truly relevant complications. Second, despite reportedly high rates of satisfaction with postoperative outcomes, most children continue to experience symptoms. Lastly, limited long-term studies have demonstrated comparable benefit of operative and conservative therapy. To summarize, BD should be seen as a more localized manifestation of functional abdominal pain, which may improve over time independent of the type of therapy chosen. Despite the widespread adoption of minimally invasive surgery in pediatrics, a different risk-benefit ratio favors conservative treatment for this benign disorder. PMID:24716563

Srinath, Arvind; Saps, Miguel; Bielefeldt, Klaus

2014-04-01

170

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 PMID:100043

Jenner, R E

1978-01-01

171

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

SciTech Connect

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

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

2013-06-15

172

Foreign Body Wharton's Duct.  

PubMed

A case of fingernail sliver lodged in the Wharton's duct is reported as the incidence of foreign body in duct is scarcely reported due to small puncta. Foreign body was removed under local anesthesia by opening the Wharton's duct as a day care procedure. PMID:22754817

Taneja, Mansi; Taneja, M K

2011-07-01

173

Biliary and Non-Biliary Contributions to Reverse Cholesterol Transport  

PubMed Central

Purpose of Review The process of reverse cholesterol transport (RCT) is critical for disposal of excess cholesterol from the body. Although it is generally accepted that RCT requires biliary secretion, recent studies show that RCT persists in genetic or surgical models of biliary insufficiency. Discovery of this non-biliary pathway has opened new possibilities of targeting the intestine as an inducible cholesterol excretory organ. In this review we highlight the relative contribution and therapeutic potential for both biliary and non-biliary components of reverse cholesterol transport (RCT). Recent Findings Recently, the proximal small intestine has gained attention for its underappreciated ability to secrete cholesterol in a process called transintestinal cholesterol efflux (TICE). Although this intestinal pathway for RCT is quantitatively smaller than the biliary route under normal physiological conditions, the TICE pathway is highly inducible, providing a novel therapeutic opportunity for treatment of atherosclerotic cardiovascular disease (ASCVD). In fact, recent studies show that intestine-specific activation of RCT protects against ASCVD in mice. Summary It is well known that the small intestine plays a gatekeeper role in the maintenance of cholesterol balance. Through integrated regulation of cholesterol absorption and TICE, the small intestine is a key target for new therapies against ASCVD. PMID:22262055

Temel, Ryan E.; Brown, J. Mark

2013-01-01

174

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

175

Is Roux-en-Y choledochojejunostomy an independent risk factor for nonanastomotic biliary strictures after liver transplantation?  

PubMed

Biliary reconstruction using Roux-en-Y choledochojejunostomy has been suggested as a risk factor for the development of nonanastomotic biliary strictures (NAS) after liver transplantation. Roux-en-Y reconstruction, however, is preferentially used in patients transplanted for primary sclerosing cholangitis (PSC), and the disease itself is also associated with a higher incidence of NAS. The aim of this study was to determine whether Roux-en-Y reconstruction is really an independent risk factor for NAS. A series of 486 consecutive adult liver transplants were studied. Biliary reconstruction in patients transplanted for PSC was either by Roux-en-Y choledochojejunostomy or by duct-to-duct anastomosis, depending on the quality of the recipient's extrahepatic bile duct. Univariate and multivariate statistical analyses were used to identify risk factors for the development of NAS. The overall incidence of NAS was 16.5% (80/486). In univariate analyses, the following variables were significantly associated with NAS: PSC as the indication for transplantation, type of biliary reconstruction (Roux-en-Y versus duct-to-duct), and postoperative cytomegalovirus infection. After multivariate logistic regression analysis, PSC as the indication for transplantation (odds ratio, 2.813; 95% confidence interval, 1.624-4.875; P < 0.001) and postoperative cytomegalovirus infection (odds ratio, 2.098; 95% confidence interval, 1.266-3.477; P = 0.004) remained as independent risk factors for NAS. Biliary reconstruction using Roux-en-Y choledochojejunostomy was not identified as an independent risk factor for NAS. In conclusion, the association between Roux-en-Y choledochojejunostomy and NAS observed in previous studies can be explained by the more frequent use of Roux-en-Y reconstruction in patients with PSC. Roux-en-Y reconstruction itself is not an independent risk factor for NAS. Liver Transpl 15:924-930, 2009. (c) 2009 AASLD. PMID:19642122

Hoekstra, Harm; Buis, Carlijn I; Verdonk, Robert C; van der Hilst, Christian S; van der Jagt, Eric J; Haagsma, Elizabeth B; Porte, Robert J

2009-08-01

176

Evaluation of the biliary excretion of pencillin G.  

PubMed

Biliary excretion of penicillin G was studied experimentally by perfusion of isolated rabbit liver. Under these conditions, bile recovery accounted for 5% of the amount of penicillin G added to the perfusing blood (10 mg). In man, after intravenous administration of a 599-mg dose of penicillin G (1,000,000 U) to patients provided with T-tube drainage (n = 10), the maximum biliary level averaged 18.0 +/- 8.0 microgram/ml at 2 h; biliary recovery of penicillin G accounted for 0.12% of the administered dose. The excretion of penicillin G in the juice collected through duodenal tubing in normal subjects averaged 0.07% of the administered dose. Peroperative assays showed that the concentrations determined 1 h after intravenous administration 599 mg of the drug attained 45.7 +/- 16.7 microgram/ml in the gallbladder bile and 93.5 +/- 16.3 microgram/ml in the common-duct bile. PMID:456074

Brogard, J M; Pinget, M; Doffoel, M; Adloff, M; Lavillaureix, J

1979-01-01

177

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. PMID:23420165

Siqueira, Orlando Hiroshi Kiono; Filho, Benedito Herani; de Paula, Rafael Erthal; Áscoli, Fábio Otero; da Nóbrega, Antonio Cláudio Lucas; Carvalho, Angela Cristina Gouvêa; Pires, Andréa Rodrigues Cordovil; Gaglionone, Nicolle Cavalcante; Cunha, Karin Soares Gonçalves; Granjeiro, José Mauro

2013-01-01

178

Polyurethane-covered metal stent for management of distal malignant biliary obstruction  

Microsoft Academic Search

Background: The efficacy of polyurethane-covered metal expandable stents for treatment of neoplastic distal biliary obstruction was analyzed. Methods: Twenty-one patients with unresectable malignant tumors involving the mid to distal bile duct who were seen with obstructive jaundice were consecutively enrolled. Eighteen patients underwent endoscopic implantation of a polyurethane-covered metal stent and 3 patients underwent transhepatic insertion because of duodenal obstruction.

Hiroyuki Isayama; Yutaka Komatsu; Takeshi Tsujino; Haruhiko Yoshida; Minoru Tada; Yasushi Shiratori; Takao Kawabe; Masao Omata

2002-01-01

179

Review of experimental animal models of biliary acute pancreatitis and recent advances in basic research  

PubMed Central

Acute pancreatitis (AP) is a formidable disease, which, in severe forms, causes significant mortality. Biliary AP, or gallstone obstruction-associated AP, accounts for 30–50% of all clinical cases of AP. In biliary AP, pancreatic acinar cell (PAC) death (the initiating event in the disease) is believed to occur as acinar cells make contact with bile salts when bile refluxes into the pancreatic duct. Recent advances have unveiled an important receptor responsible for the major function of bile acids on acinar cells, namely, the cell surface G-protein-coupled bile acid receptor-1 (Gpbar1), located in the apical pole of the PAC. High concentrations of bile acids induce cytosolic Ca2+ overload and inhibit mitochondrial adenosine triphosphate (ATP) production, resulting in cell injury to both PACs and pancreatic ductal epithelial cells. Various bile salts are employed to induce experimental AP, most commonly sodium taurocholate. Recent characterization of taurolithocholic acid 3-sulphate on PACs has led researchers to focus on this bile salt because of its potency in causing acinar cell injury at relatively low, sub-detergent concentrations, which strongly implicates action via the receptor Gpbar1. Improved surgical techniques have enabled the infusion of bile salts into the pancreatic duct to induce experimental biliary AP in mice, which allows the use of these transgenic animals as powerful tools. This review summarizes recent findings using transgenic mice in experimental biliary AP. PMID:22221567

Wan, Mei H; Huang, Wei; Latawiec, Diane; Jiang, Kun; Booth, David M; Elliott, Victoria; Mukherjee, Rajarshi; Xia, Qing

2012-01-01

180

Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression.  

PubMed

Nonanastomotic biliary strictures (NAS) after orthotopic liver transplantation (OLT) are associated with high retransplant rates. The aim of the present study was to describe the treatment of and identify risk factors for radiological progression of bile duct abnormalities, recurrent cholangitis, biliary cirrhosis, and retransplantation in patients with NAS. We retrospectively studied 81 cases of NAS. Strictures were classified according to severity and location. Management of strictures was recorded. Possible prognostic factors for bacterial cholangitis, radiological progression of strictures, development of severe fibrosis/cirrhosis, graft survival, and patient survival were evaluated. Median follow-up after OLT was 7.9 years. NAS were most prevalent in the extrahepatic bile duct. Twenty-eight patients (35%) underwent some kind of interventional treatment, leading to a marked improvement in biochemistry. Progression of disease was noted in 68% of cases with radiological follow-up. Radiological progression was more prevalent in patients with early NAS and one or more episodes of bacterial cholangitis. Recurrent bacterial cholangitis (>3 episodes) was more prevalent in patients with a hepaticojejunostomy. Severe fibrosis or cirrhosis developed in 23 cases, especially in cases with biliary abnormalities in the periphery of the liver. Graft survival, but not patient survival, was influenced by the presence of NAS. Thirteen patients (16%) were retransplanted for NAS. In conclusion, especially patients with a hepaticojejunostomy, those with an early diagnosis of NAS, and those with NAS presenting at the level of the peripheral branches of the biliary tree, are at risk for progressive disease with severe outcome. PMID:17457935

Verdonk, Robert C; Buis, Carlijn I; van der Jagt, Eric J; Gouw, Annette S H; Limburg, Abraham J; Slooff, Maarten J H; Kleibeuker, Jan H; Porte, Robert J; Haagsma, Elizabeth B

2007-05-01

181

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

182

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

183

Biliary Stent Migration with Duodenal Perforation  

PubMed Central

Intestinal perforation from a migrated biliary stent is a known complication of endoscopic biliary stent placement. We present a case of stent migration and resultant duodenal perforation after stent placement for a malignant biliary stricture in a 52-year-old woman. We review the current literature on the diagnosis and management of stent migration and intestinal perforation after endoscopic stent placement for biliary strictures. A plain abdominal radiograph is necessary for early diagnosis of biliary stent migration. If a stent becomes lodged in the gastrointestinal tract, endoscopic or operative extraction of the stent is necessary to prevent subsequent intestinal perforation and peritonitis. Intestinal perforation secondary to biliary stent dislocation should be considered in all patients presenting with fever and abdominal pain after biliary stent insertion. Any abnormality that prevents stent migration through the intestinal tract such as gastroenterostomy, abdominal wall hernia, extensive adhesions or colonic divertucula may be a contraindication for insertion of a plastic biliary stent because of increased perforation risk.

Yaprak, Muhittin; Mesci, Ayhan; Colak, Taner; Yildirim, Bulent

2008-01-01

184

Brushing cytology in biliary tract obstruction.  

PubMed

During a period of eight years (1980 to 1987), cytologic samples were obtained by brushing and reverse screw devices from 54 patients undergoing transhepatic cholangiography for evaluation of obstructive jaundice. Eight patients were excluded from this study, seven for inadequate follow-up and one because of unsatisfactory cytologic material. Of the remaining cases, 32 were cytologically diagnosed as adenocarcinomas; all but one patient proved to have malignant disease by histologic examination and/or through clinical follow-up. These included 21 pancreatic carcinomas, 6 bile duct carcinomas, 1 ampullary carcinoma, 1 gallbladder carcinoma and 2 metastatic carcinomas. In one case, the diagnosis of malignancy was found to be in error upon review of the cytologic smears. Of 14 patients with negative cytologic diagnoses, 7 were found to have malignant neoplasms and 7 had benign diseases. These findings indicate that, while a positive cytologic diagnosis is a reliable indicator of a malignant biliary obstruction, a negative result does not exclude malignancy. PMID:2321454

Rupp, M; Hawthorne, C M; Ehya, H

1990-01-01

185

Hepatic and Biliary Ascariasis  

PubMed Central

Ascariasis mainly contributes to the global helminthic burden by infesting a large number of children in the tropical countries. Hepato-biliary ascariasis (HBA) is becoming a common entity now than in the past owing to the frequent usage of ultrasonograms and endoscopic diagnostic procedures in the clinical practice. There are a variety of manifestations in HBA and diagnosis depends on a high index of suspicion in endemic areas coupled with subsequent confirmation by sonographic or endoscopic demonstration of the worm. Most of them present with acute abdomen and jaundice. Oriental or recurrent pyogenic cholangiopathy is possibly the result of HBA, commonly encountered in South-East Asian countries. Conservative treatment with anthelminthic agents is used in the majority. Failure to respond to medical therapy usually indicates the need for endoscopic or surgical interventions. Overall, mortality is low and prognosis is good, but many epidemiological and immunological aspects of Ascaris infection are unclear, meaning our understanding the disease and infection still remains incomplete. Therefore, it is difficult to definitely put down a fixed modality of treatment for HBA. This underscores the need for further studies as ascariasis has the potential to adversely affect the national socio-economy by compromising the health of children and adults alike with its sheer number. PMID:24926166

Das, Anup K

2014-01-01

186

Hepatic and biliary ascariasis.  

PubMed

Ascariasis mainly contributes to the global helminthic burden by infesting a large number of children in the tropical countries. Hepato-biliary ascariasis (HBA) is becoming a common entity now than in the past owing to the frequent usage of ultrasonograms and endoscopic diagnostic procedures in the clinical practice. There are a variety of manifestations in HBA and diagnosis depends on a high index of suspicion in endemic areas coupled with subsequent confirmation by sonographic or endoscopic demonstration of the worm. Most of them present with acute abdomen and jaundice. Oriental or recurrent pyogenic cholangiopathy is possibly the result of HBA, commonly encountered in South-East Asian countries. Conservative treatment with anthelminthic agents is used in the majority. Failure to respond to medical therapy usually indicates the need for endoscopic or surgical interventions. Overall, mortality is low and prognosis is good, but many epidemiological and immunological aspects of Ascaris infection are unclear, meaning our understanding the disease and infection still remains incomplete. Therefore, it is difficult to definitely put down a fixed modality of treatment for HBA. This underscores the need for further studies as ascariasis has the potential to adversely affect the national socio-economy by compromising the health of children and adults alike with its sheer number. PMID:24926166

Das, Anup K

2014-04-01

187

Lightweight Valve Closes Duct Quickly  

NASA Technical Reports Server (NTRS)

Expanding balloon serves as lightweight emergency valve to close wide duct. Uninflated balloon stored in housing of duct. Pad resting on burst diaphragm protects balloon from hot gases in duct. Once control system triggers valve, balloon inflates rapidly to block duct. Weighs much less than does conventional butterfly, hot-gas, or poppet valve capable of closing duct of equal diameter.

Fournier, Walter L.; Burgy, N. Frank

1991-01-01

188

Duct Tape Durability Testing  

SciTech Connect

Duct leakage is a major source of energy loss in residential buildings. Most duct leakage occurs at the connections to registers, plenums, or branches in the duct system. At each of these connections, a method of sealing the duct system is required. Typical sealing methods include tapes or mastics applied around the joints in the system. Field examinations of duct systems have shown that taped seals tend to fail over extended periods of time. The Lawrence Berkeley National Laboratory (LBNL) has been testing sealant durability for several years using accelerated test methods and found that typical duct tape (i.e., cloth-backed tapes with natural rubber adhesives) fails more rapidly than other duct sealants. This report summarizes the results of duct sealant durability testing over two years for four UL 181B-FX listed duct tapes (two cloth tapes, a foil tape and an Oriented Polypropylene (OPP) tape). One of the cloth tapes was specifically developed in collaboration with a tape manufacturer to perform better in our durability testing. The tests involved the aging of common ''core-to-collar joints'' of flexible duct to sheet metal collars. Periodic air leakage tests and visual inspection were used to document changes in sealant performance. After two years of testing, the flex-to-collar connections showed little change in air leakage, but substantial visual degradation from some products. A surprising experimental result was failure of most of the clamps used to mechanically fasten the connections. This indicates that the durability of clamps also need to be addressed ensure longevity of the duct connection. An accelerated test method developed during this study has been used as the basis for an ASTM standard (E2342-03).

Sherman, Max H.; Walker, Iain S.

2004-04-01

189

Aircraft Inlet Ducts  

NASA Technical Reports Server (NTRS)

After studying three Tech Briefs reports on NASA submerged duct technology developed for high performance aircraft, Wilhelm Cashen was able to adapt the technology to the induction intercooler system of turbocharged lightplanes. In lightplane installations, the submerged ducts introduce cool "ram" air to the propulsion system for greater operating efficiency.

1984-01-01

190

Brush cytology in the assessment of pancreatico–biliary strictures: a review of 406 cases  

PubMed Central

Aims—To assess the accuracy of brush cytology in patients investigated for pancreatico–biliary strictures. Methods—All pancreatico–biliary brush cytology specimens submitted from two major teaching hospitals over a 6.5 year period were reviewed. Four hundred and forty eight satisfactory specimens from 406 patients with adequate clinical and/or pathological follow up data were examined in the study period. Results—Two hundred and forty six patients (60.6%) were shown to have neoplastic strictures. One hundred and forty seven tumours were identified cytologically, including 87 of 146 pancreatic carcinomas, 29 of 47 cholangiocarcinomas, one of one bile duct adenoma, four of seven carcinomas of the gallbladder, eight of 13 ampullary carcinomas, two of three ampullary adenomas, 10 of 16 malignancies of undetermined origin, none of two islet cell tumours, one of three hepatocellular carcinomas, and five of eight metastatic tumours. The three adenomas identified on brush cytology could not be distinguished from adenocarcinoma morphologically. One hundred and sixty patients (39.4%) had benign strictures, most often as a result of chronic pancreatitis and bile duct stones. There were three false positive cytological diagnoses mainly as a result of the misinterpretation of cases with relatively scant and/or degenerative atypical epithelial cells. Forty one cases were reported as atypical or suspicious of malignancy on brush cytology, of which 29 were ultimately shown to have carcinoma. The overall diagnostic sensitivity and specificity were 59.8% and 98.1%, respectively. The sensitivity increased from 44.3% in the initial third of cases to 70.7% in the final third of cases examined in the series. Conclusions—Brush cytology, in conjunction with other clinical and radiological investigations, is a useful technique in the assessment of patients with suspected pancreatico–biliary neoplasia. Key Words: brush cytology • pancreatico-biliary strictures • pancreatico-biliary neoplasia PMID:11376018

Stewart, C; Mills, P; Carter, R; O'Donohue, J; Fullarton, G; Imrie, C; Murray, W

2001-01-01

191

Treatment and long-term follow-up of extrahepatic biliary obstruction with bilirubin cholelithiasis in a Somali cat with pyruvate kinase deficiency  

Microsoft Academic Search

A 2-year-old female neutered Somali cat was presented with vomiting and acute onset jaundice 1 year after diagnosis of pyruvate kinase (PK) deficiency. Diagnostic investigations revealed a moderate regenerative haemolytic anaemia, severe hyperbilirubinaemia and elevated liver enzymes. Ultrasonography revealed marked distension of the gall bladder and common bile duct (CBD), consistent with extrahepatic biliary obstruction (EHBO). At cholecystotomy, the gall

Andrea M. Harvey; Peter E. Holt; Frances J. Barr; Francesca Rizzo; Séverine Tasker

2007-01-01

192

21 CFR 874.3900 - Nasal dilator.  

Code of Federal Regulations, 2010 CFR

...2010-04-01 2010-04-01 false Nasal dilator. 874.3900 Section 874.3900 Food...DEVICES Prosthetic Devices § 874.3900 Nasal dilator. (a) Identification. A nasal dilator is a device intended to provide...

2010-04-01

193

21 CFR 876.5450 - Rectal dilator.  

Code of Federal Regulations, 2010 CFR

... Rectal dilator. (a) Identification. A rectal dilator is a device designed to dilate the anal sphincter and canal when the size of the anal opening may interfere with its function or the passage of an examining instrument. (b)...

2010-04-01

194

21 CFR 876.5450 - Rectal dilator.  

Code of Federal Regulations, 2012 CFR

... Rectal dilator. (a) Identification. A rectal dilator is a device designed to dilate the anal sphincter and canal when the size of the anal opening may interfere with its function or the passage of an examining instrument. (b)...

2012-04-01

195

21 CFR 876.5450 - Rectal dilator.  

Code of Federal Regulations, 2011 CFR

... Rectal dilator. (a) Identification. A rectal dilator is a device designed to dilate the anal sphincter and canal when the size of the anal opening may interfere with its function or the passage of an examining instrument. (b)...

2011-04-01

196

21 CFR 876.5450 - Rectal dilator.  

Code of Federal Regulations, 2014 CFR

... Rectal dilator. (a) Identification. A rectal dilator is a device designed to dilate the anal sphincter and canal when the size of the anal opening may interfere with its function or the passage of an examining instrument. (b)...

2014-04-01

197

21 CFR 876.5450 - Rectal dilator.  

Code of Federal Regulations, 2013 CFR

... Rectal dilator. (a) Identification. A rectal dilator is a device designed to dilate the anal sphincter and canal when the size of the anal opening may interfere with its function or the passage of an examining instrument. (b)...

2013-04-01

198

Management of primary biliary cirrhosis  

Microsoft Academic Search

Primary biliary cirrhosis (PBC) is a presumed autoim- mune disease of the liver, which predominantly affects women once over the age of 20 years. Most cases are diagnosed when asymptomatic (60%). The antimitochon- drial antibody is present in serum in most, but not in all, patients with PBC. The disease generally progresses slowly but survival is less than an age-

E. Jenny Heathcote

2000-01-01

199

STATE OF CALIFORNIA DUCT LEAKAGE TEST EXISTING DUCT SYSTEM  

E-print Network

of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessibleSTATE OF CALIFORNIA DUCT LEAKAGE TEST ­ EXISTING DUCT SYSTEM CEC-CF-4R-MECH-21 (Revised 03 Leakage Test ­ Existing Duct System (Page 1 of 3) Site Address: Enforcement Agency: Permit Number

200

Unusual scintigraphic appearance of perforation of the common bile duct.  

PubMed

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. PMID:6686097

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

1983-12-01

201

Ultrasound Findings of Intraductal Papillary Neoplasm in Bile Duct and the Added Value of Contrast-Enhanced Ultrasound.  

PubMed

Purpose: To investigate the imaging features of intraductal papillary neoplasm in bile duct (IPNB) on baseline ultrasound and contrast-enhanced ultrasound (CEUS). Materials and Methods: The imaging features on baseline ultrasound and CEUS in 16 pathologically proven IPNB lesions in 15 patients were retrospectively analyzed. Real-time contrast specific modes and contrast agent of SonoVue were used for CEUS. Results: Bile duct dilation was present in all patients. The mean lengths for the intraductal papillary adenomas and adenocarcinomas were 2.5?± 1.1 (range, 1.2?-?4.2?cm) and 5.6?±?2.0?cm (range, 3.3?-?9.8?cm) (P?=?0.004). Three imaging types of IPNB on ultrasound were depicted: bile duct dilation with intraductal mass (n?=?8), bile duct dilation without intraductal mass (n?=?3), and cystic-solid mixed type (n?=?5). On CEUS, solid components of 13 lesions appeared hyper- (n?=?12) or iso-enhancement (n?=?1) in the arterial phase whereas all showed hypo-enhancement in the portal and late phases. For 3 lesions of bile duct dilation without intraductal mass, CEUS showed non-enhancement during all phases. Pre-surgical CEUS and conventional ultrasound made correct diagnoses in 12 (75.0?%) and 5(31.3?%) of 16 IPNBs respectively (P?=?0.04). For CECT, correct diagnosis was also achieved in 12 (75.0?%) of 16 lesions (P?=?1.00, in comparison with CEUS). Conclusions: IPNB should be taken into consideration when intraductal mass or cystic-solid mass with bile duct dilation, or remarkable bile duct dilation without intraductal mass, are found on US.?Intraductal mass length >?3.0?cm is more commonly found in malignant IPNB. CEUS might facilitate the diagnosis of IPNB by easily excluding the possibility of commonly found sludge, nonshadowing stones, or blood clots. PMID:25188491

Liu, L N; Xu, H X; Zheng, S G; Sun, L P; Guo, L H; Zhang, Y F; Xu, J M; Liu, C; Xu, X H

2014-09-01

202

How to access photodynamic therapy for bile duct carcinoma  

PubMed Central

Background Photodynamic therapy (PDT) is a promising treatment option for local control of remnant cancer after surgical resection or biliary stenosis by the unresectable tumor in patients with bile duct carcinomas (BDC). To achieve effective tumor necrosis, an appropriate approach to laser irradiation is necessary. Methods The efficacy of endoscopy-guided PDT using porfimer (n=12) or talaporfin sodium (n=13) was investigated by evaluating the transhepatic biliary routes and endoscopic retrograde biliary (ERB) routes in 25 patients with BDC. Results Diseases included perihilar intrahepatic cholangiocarcinoma (ICC) in four patients, extrahepatic BDCs in 19 and ampular carcinoma (AC) in two patients. Adjuvant PDT after surgical resection was performed in 18 patients, and PDT for tumor biliary stenosis was performed in seven. In patients undergoing surgical resections, the mean period between the operation and PDT was 87±42 days. In patients who underwent prior surgical resections, the transhepatic route was used in five (28%), the jejunal loop was used in 11 (61%), the T-tube route was used in one, and the endoscopic retrograde cholangiography (ERC) route via papilla Vater was used in one. In unresectable BDC, the ERC route was used in four patients (57%), and the transhepatic biliary route was used in three (43%). Endoscopic-guided PDT could not be performed in one patient because of a technical failure. Except for the complication of photosensitivity, endoscopy-related complications were not observed in any patients. Patients undergoing PDT with porfimer sodium had a significantly longer admission period compared to patients undergoing PDT with talaporfin sodium (36 vs. 5 days, respectively) (P<0.01). Conclusions PDT was safely and definitively performed using the endoscopy-guided approach via the transhepatic or ERC route. By considering the disadvantages of both routes, PDT must be adequately achieved for local control of BDC. PMID:25332999

Isomoto, Hajime; Abo, Takafumi; Nonaka, Takashi; Morisaki, Tomohito; Arai, Junichi; Takagi, Katsunori; Ohnita, Ken; Shoji, Hiroyuki; Urabe, Shigetoshi; Senoo, Takemasa; Murakami, Goshi; Nagayasu, Takeshi

2014-01-01

203

[The diagnosis of lithiasis of the extrahepatic biliary tract].  

PubMed

The diagnostic approach to 227 patients presenting lithiasis of the extrahepatic biliary ducts is discussed. All patients are diagnosed in the second surgical department of the University Aleksandrovska Hospital over an eleven-year period on the ground of complex examinations, including: clinical, laboratory and instrumental (echography, endoscopic retrograde cholangiopancreatography, cholangiography, computerized tomography) study. As shown by the clinical data analysis, the basic symptoms are pain--in 221 cases (97.35%), jaundice--128 (56.38%), accompanied in most of them by dyspeptic complaints, and in a minor part--by cholangitis manifestations. Of the laboratory data, the most commonly met with are the abnormally increased values of serum bilirubin, alkaline phosphatase, liver tests etc. Of the instrumental methods echography is first and foremost used in the preoperative period, supplemented in certain cases with other methods. Intraoperatively, cholangiography is routinely used for concrement detection. PMID:9854935

Maruf, M; Baev, S

1998-01-01

204

[Combined cholestatic jaundice due to cholelithiasis and primary biliary cirrhosis].  

PubMed

An 82-year-old man was admitted because of painless jaundice and pruritus. Multiple small gallstones were seen on ultrasonography. Hepatic needle biopsy revealed bile stasis, intrahepatic bile ducts proliferation and inflammatory infiltration of the portal spaces. As the jaundice deepened, cholecystectomy was performed and a gallbladder full of small calculi was removed. Wedge biopsy of the liver led to the diagnosis of primary biliary cirrhosis (PBC). Colchicine was started and since then his condition has improved and become stable. PBC in an old man is very uncommon. The combination with gallbladder stones imposed special diagnostic and therapeutic problems. Although gallbladder stones are more common in PBC than in the general population, the combination of the 2 clinical entities is not sufficiently emphasized in the literature. PMID:1464385

Heinrich, I; Nashitz, J; Yeshurun, D

1992-11-15

205

Endoscopic ultrasonography can diagnose distal biliary strictures without a mass on computed tomography  

PubMed Central

AIM: To assess the diagnostic ability of endoscopic ultrasonography (EUS) for evaluating causes of distal biliary strictures shown on endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP), even without identifiable mass on computed tomography (CT). METHODS: The diagnostic ability of EUS was retrospectively analyzed and compared with that of routine cytology (RC) and tumor markers in 34 patients with distal biliary strictures detected by ERCP or MRCP at Dokkyo Medical School Hospital from December 2005 to December 2008, without any adjacent mass or eccentric thickening of the bile duct on CT that could cause biliary strictures. Findings considered as benign strictures on EUS included preservation of the normal sonographic layers of the bile duct wall, irrespective of the presence of a mass lesion. Other strictures were considered malignant. Final diagnosis of underlying diseases was made by pathological examination in 18 cases after surgical removal of the samples, and by clinical follow-up for > 10 mo in 16 cases. RESULTS: Seventeen patients (50%) were finally diagnosed with benign conditions, including 6 “normal” subjects, while 17 patients (50%) were diagnosed with malignant disease. In terms of diagnostic ability, EUS showed 94.1% sensitivity, 82.3% specificity, 84.2% positive predictive value, 93.3% negative predictive value (NPV) and 88.2% accuracy for identifying malignant and benign strictures. EUS was more sensitive than RC (94.1% vs 62.5%, P = 0.039). NPV was also better for EUS than for RC (93.3% vs 57.5%, P = 0.035). In addition, EUS provided significantly higher sensitivity than tumor markers using 100 U/mL as the cutoff level of carbohydrate antigen 19-9 (94.1% vs 53%, P = 0.017). On EUS, biliary stricture that was finally diagnosed as malignant showed as a hypoechoic, irregular mass, with obstruction of the biliary duct and invasion to surrounding tissues. CONCLUSION: EUS can diagnose biliary strictures caused by malignant tumors that are undetectable on CT. Earlier detection by EUS would provide more therapeutic options for patients with early-stage pancreaticobiliary cancer. PMID:20066744

Saifuku, Yasuyuki; Yamagata, Michiko; Koike, Takero; Hitomi, Genyo; Kanke, Kazunari; Watanabe, Hidetaka; Murohisa, Toshimitsu; Tamano, Masaya; Iijima, Makoto; Kubota, Keiichi; Hiraishi, Hideyuki

2010-01-01

206

Histological Changes in the Bile Duct after Long-Term Placement of a Fully Covered Self-Expandable Metal Stent within a Common Bile Duct: A Canine Study  

PubMed Central

Background/Aims To date, it has been difficult to determine the optimal stenting duration of a fully covered self-expandable metal stent (FCSEMS) in a benign biliary stricture. The purpose of this study was to identify the histopathological changes in a bile duct resulting from long-term placement of a FCSEMS. Methods An FCSEMS was inserted into the common bile duct of 12 canines, and the animals were divided into four groups. Posteuthanasia, necropsy was performed to examine the histopathological changes in the bile ducts after 1, 3, 6, and 9 months. Results The results of necropsy showed that the covered membranes of the FCSEMSs were intact and easily removed from the bile ducts in 11 of the canines. Severe epithelial hyperplasia of the stented bile duct and epithelial ingrowth into the stent occurred in one animal (from the 3-month group). On histopathological examination, mild inflammatory changes were observed in the stented bile ducts, and there was no significant difference between the four groups. Among the 12 animals, five had de novo stricture. Conclusions An FCSEMS can be inserted into the bile duct without severe histopathological changes up until 9 months. However, a de novo stricture and severe epithelial hyperplasia relating to the stent insertion might occur. PMID:24570888

Song, Tae Jun; Joo, Mee; Park, Do Hyun; Seo, Dong Wan; Lee, Sung Koo; Kim, Myung-Hwan

2014-01-01

207

Pharmacotherapy of dilated cardiomyopathy.  

PubMed

The pharmacological treatment of dilated cardiomyopathy overlaps with the treatment of heart failure. The primary objective of this treatment is to slow the progression of disease and improve quality and length of life. All patients, including those with asymptomatic dysfunction of the left ventricle, ought to receive angiotensin converting enzyme inhibitors, (in the case of intolerance, angiotensin receptor blockers), and beta blockers. The results of studies involving aliskiren have been, so far, disappointing. In symptomatic heart failure NYHA II-IV diuretics and mineralcorticoid receptor antagonists should be added to treatment. Digoxin is recommended in the event of atrial fibrillation, and otherwise only in the event of NYHA III and IV. Ivabradine is recommended for patients with sinus rhythm and pulse rate of > 70/min. In decompensation of heart failure, dobutamine, phosphodiesterase inhibitors or levosimendan are administered over the short-term. Of the recent treatment options, the vasopressin blocker and adenosine A1 receptor antagonist (rolofylline) were disappointing. One treatment with potential for the future is omecamtiv mecarbil, a heart myosin activator. PMID:25483945

Spinarova, Lenka; Spinar, Jindrich

2014-01-01

208

Bile duct obstruction  

MedlinePLUS

... examine you and feel your belly. The following blood test results could be due to a possible blockage: Increased ... A blocked bile duct may also alter the results of the following ... Gallbladder radionuclide scan Lipase blood test Prothrombin ...

209

Autocrine regulation of biliary pathology by activated cholangiocytes  

PubMed Central

The bile duct system of the liver is lined by epithelial cells (i.e., cholangiocytes) that respond to a large number of neuroendocrine factors through alterations in their proliferative activities and the subsequent modification of the microenvironment. As such, activation of biliary proliferation compensates for the loss of cholangiocytes due to apoptosis and slows the progression of toxic injury and cholestasis. Over the course of the last three decades, much progress has been made in identifying the factors that trigger the biliary epithelium to remodel and grow. Because a large number of autocrine factors have recently been identified as relevant clinical targets, a compiled review of their contributions and function in cholestatic liver diseases would be beneficial. In this context, it is important to define the specific processes triggered by autocrine factors that promote cholangiocytes to proliferate, activate neighboring cells, and ultimately lead to extracellular matrix deposition. In this review, we discuss the role of each of the known autocrine factors with particular emphasis on proliferation and fibrogenesis. Because many of these molecules interact with one another throughout the progression of liver fibrosis, a model speculating their involvement in the progression of cholestatic liver disease is also presented. PMID:22194419

Jensen, Kendal; Marzioni, Marco; Munshi, Kamruzzaman; Afroze, Syeda

2012-01-01

210

Intraoperative ultrasound as an educational guide for laparoscopic biliary surgery  

PubMed Central

AIM: To analyze the efficacy of routine intraoperative ultrasound (IOUS) as a guide for understanding biliary tract anatomy, to avoid bile duct injury (BDI) after laparoscopic cholecystectomy (LC), as well as any burden during the learning period. METHODS: A retrospective analysis was performed using 644 consecutive patients who underwent LC from 1991 to 2006. An educational program with the use of IOUS as an operative guide has been used in 276 cases since 1998. RESULTS: IOUS was highly feasible even in patients with high-grade cholecystitis. No BDI was observed after the introduction of the educational program, despite 72% of operations being performed by inexperienced surgeons. Incidences of other morbidity, mortality, and late complications were comparable before and after the introduction of routine IOUS. However, the operation time was significantly extended after the educational program began (P < 0.001), and the grade of laparoscopic cholecystitis (P = 0.002), use of IOUS (P = 0.01), and the experience of the surgeons (P = 0.05) were significant factors for extending the length of operation. CONCLUSION: IOUS during LC was found to be a highly feasible modality, which provided accurate, real-time information about the biliary structures. The educational program using IOUS is expected to minimize the incidence of BDI following LC, especially when performed by less-skilled surgeons. PMID:18416464

Hakamada, Kenichi; Narumi, Shunji; Toyoki, Yoshikazu; Nara, Masaki; Oohashi, Motonari; Miura, Takuya; Jin, Hiroyuki; Yoshihara, Syuichi; Sugai, Michihiro; Sasaki, Mutsuo

2008-01-01

211

Ultrasonography, laboratory, and cholangiography correlation of biliary complications in pediatric liver transplantation.  

PubMed

The aim of this study is to correlate the US, laboratory, and cholangiography findings in pediatric liver transplant patients with biliary complications, trying to identify reliable decision-making tools for the management of these complications. Retrospective review was carried out of US results in 39 consecutive patients, from 2011 to 2013, with biliary complications after LT, documented by PTC. According to US biliary dilation, patients were classified as: mild, moderate, and severe, and according to laboratory findings as: normal or abnormal serum bilirubin and level of serum GGT. Data were correlated with PTC findings, divided in three groups: mild, moderate, and severe/occlusive BDS. There was no statistically significant correlation between the US findings and the laboratory findings and between US findings with PTC. There was a statistically significant correlation between GGT and cholangiography. In our series, abnormal US could not predict the severity of BDS on PTC. Bilirubin results were not able to predict the US findings either. GGT results demonstrated a statistically significant correlation with the severity of BDS found on PTC. These findings emphasize the role of GGT in the evaluation and decision of biliary interventions in pediatric liver transplant recipients. PMID:25529070

Teplisky, Darío; Urueña Tincani, Eliana; Halac, Esteban; Garriga, Matías; Cervio, Guillermo; Imventarza, Oscar; Sierre, Sergio

2015-03-01

212

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

PubMed

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. PMID:24106416

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

2013-09-28

213

Distal bile duct cancers complicated with cholangiobronchopleural fistula after ERCP: A case report  

PubMed Central

Distal (lower) bile duct cancers arise in the lower half of the biliary tree closer to the small intestine. Biliary disease complicated with cholangiobronchopleural fistula, which may occur in cases of multiple hepatobiliary stones or biliary ascariasis-associated severe infection, has rarely been reported in the literature, particularly following endoscopic retrograde cholangiopancreatography (ERCP). The present study describes the case of a 60-year-old female with distal cholangiocarcinoma complicated with cholangiobronchopleural fistula after ERCP for this rare disease. This complication was likely due to the inability to control retrograde infection following ERCP and, thus, the infection was disseminated. This resulted in mixed infection involving the diaphragm and pleura, and further penetrating the bronchus. The patient was managed with pancreatoduodenectomy and has since remained in good health. PMID:25202419

ZHANG, CHANGSONG; YANG, GUANGSHUN; LING, YANG; CHEN, GUIHUA; ZHOU, TIANBAO

2014-01-01

214

Distal bile duct cancers complicated with cholangiobronchopleural fistula after ERCP: A case report.  

PubMed

Distal (lower) bile duct cancers arise in the lower half of the biliary tree closer to the small intestine. Biliary disease complicated with cholangiobronchopleural fistula, which may occur in cases of multiple hepatobiliary stones or biliary ascariasis-associated severe infection, has rarely been reported in the literature, particularly following endoscopic retrograde cholangiopancreatography (ERCP). The present study describes the case of a 60-year-old female with distal cholangiocarcinoma complicated with cholangiobronchopleural fistula after ERCP for this rare disease. This complication was likely due to the inability to control retrograde infection following ERCP and, thus, the infection was disseminated. This resulted in mixed infection involving the diaphragm and pleura, and further penetrating the bronchus. The patient was managed with pancreatoduodenectomy and has since remained in good health. PMID:25202419

Zhang, Changsong; Yang, Guangshun; Ling, Yang; Chen, Guihua; Zhou, Tianbao

2014-10-01

215

An unusual case of trisomy 18 associated with paucity of bile ducts.  

PubMed

A case of neonatal cholestasis associated with Trisomy 18 (Edward's syndrome) is presented. A 3-day-old boy was referred to our clinic due to respiratory distress, elevated serum direct bilirubin levels, a systolic heart murmur, growth restriction and micrognathia. Liver biopsy and chromosomal analysis revealed paucity of intrahepatic bile ducts and Trisomy 18. Extrahepatic biliary atresia was reported in only a few patients with Trisomy 18. To our knowledge, we described for the first time a patient with Trisomy 18 and neonatal cholestasis associated with paucity of interlobular bile ducts. PMID:23421547

Kahramaner, Zelal; Erdemir, Aydin; Cosar, Hese; Turkoglu, Ebru; Sutcuoglu, Sumer; Turelik, Ozlem; Cumurcu, Suheyla; Bayol, Umit; Ozer, Esra

2013-10-01

216

Hepatic copper in primary biliary cirrhosis: biliary excretion and response to penicillamine treatment.  

PubMed Central

Excessive hepatic copper accumulation occurs in long-lasting cholestatic liver disorders especially in primary biliary cirrhosis. As in Wilson's disease, penicillamine has recently been introduced for the treatment of primary biliary cirrhosis. In Wilson's disease there is decreased biliary excretion of copper. The present study shows that as compared with controls the biliary excretion of copper is not decreased in primary biliary cirrhosis; instead it may be increased in some patients. However, when compared with high hepatic copper concentration biliary copper excretion was low. In contrast with copper, biliary secretion of bile acids was decreased in eight of the 17 patients. Treatment with oral penicillamine (600 mg/day) for one year resulted in a significant decrease of hepatic copper concentration, but had no consistent effect on the biliary excretion of copper or on the amount of histologically stainable orcein-positive copper-binding protein. The results suggest that excessive hepatic copper accumulation in primary biliary cirrhosis may not be primarily caused by a decreased biliary excretion, or that a new equilibrium is achieved in advanced primary biliary cirrhosis. D-penicillamine appears to improve significantly the biliary excretion of bile acids. PMID:7308845

Salaspuro, M P; Pikkarainen, P; Sipponen, P; Vuori, E; Miettinen, T A

1981-01-01

217

Primary biliary cirrhosis in brothers  

PubMed Central

This is the first report of two brothers who demonstrated the classical clinical course, histology, biochemistry and auto-antibodies of primary biliary cirrhosis. Both also exhibited an associated keratoconjunctivitis sicca and, in one, renal tubular acidosis resulted in severe systemic acidosis after lactulose therapy and with a subsequent intraperitoneal variceal rupture. Screening of the relatives recalled a high incidence of ‘auto-immune’ disease and auto-antibodies. PMID:1089970

Bown, R.; Clark, M. L.; Doniach, D.

1975-01-01

218

MR imaging of the biliary system.  

PubMed

Although ultrasound, computed tomography, and cholescintigraphy play essential roles in the evaluation of suspected biliary abnormalities, magnetic resonance (MR) imaging and MR cholangiopancreatography can be used to evaluate inconclusive findings and provide a comprehensive noninvasive assessment of the biliary tract and gallbladder. This article reviews standard MR and MR cholangiopancreatography techniques, clinical applications, and pitfalls. Normal biliary anatomy and variants are discussed, particularly as they pertain to preoperative planning. A spectrum of benign and malignant biliary processes is reviewed, emphasizing MR findings that aid in characterization. PMID:24889169

Yam, Benjamin L; Siegelman, Evan S

2014-07-01

219

The NF-?B inhibitors attenuate hepatic injury in bile duct ligated rats  

Microsoft Academic Search

Cholestasis-induced liver injury during bile duct obstruction causes an inflammatory response and this inflammatory process may be an important source of tissue injury. We hypothesized that NF-?B inhibition would decrease liver injury in a rat model of extrahepatic biliary obstruction. A total of 40 female rats of Sprague-Dawley strain were allocated to four groups. First group was sham operated control.

Sava? Demirbilek; Melih Ak?n; Kubilay Gürünlüo?lu; Nasuhi E. Ayd?n; Memet H. Emre; Erkan Ta?; Rauf T. Aksoy; Selma Ay

2006-01-01

220

The effect of plasma low density lipoprotein apheresis on the hepatic secretion of biliary lipids in humans  

PubMed Central

Background—The liver is a key organ in the metabolism of cholesterol in humans. It is the only organ by which substantial amounts of cholesterol are excreted from the body, either directly as free cholesterol into the bile or after conversion to bile acids. The major part of cholesterol synthesis in the body occurs in the liver. Cholesterol is also taken up by the liver from plasma lipoproteins. The relative contributions of newly synthesised cholesterol and plasma lipoprotein cholesterol to bile acid synthesis and biliary cholesterol secretion, respectively, are not known in detail. ?Aims—To determine how a rapid lowering of plasma low density lipoprotein (LDL) and very low density lipoprotein (VLDL) cholesterol influences the biliary secretion rates of cholesterol and bile acids in patients with cholesterol gallstones and complete biliary drainage. In this model with a completely interrupted enterohepatic circulation, the secretion of bile acids equals the new synthesis of bile acids in the liver. ?Patients—Eight patients with common bile duct stones of cholesterol type undergoing conventional cholecystectomy and choledocholithotomy. ?Methods—At operation a balloon occludable Foley catheter attached to a T tube was inserted into the bile duct with the balloon placed just past the distal limb of the T tube. The T tube was allowed to drain the bile externally. One week after the operation the Foley catheter balloon was inflated, creating complete biliary drainage. Twelve hours following the inflation plasma LDL apheresis was carried out for two hours. Bile was collected for 15 minute periods starting one hour before the apheresis and ending two hours after its termination. During the collection of bile, plasma lipids were analysed on several occasions. ?Results—The plasma level of LDL cholesterol decreased by 26% from (mean (SEM)) 2.19 (0.29) to 1.63 (0.17) mmol/l during the LDL apheresis while high density lipoprotein (HDL) cholesterol in plasma was unaffected. During LDL apheresis apolipoprotein B containing lipoproteins bind to the column, causing a significant decrease of not only plasma LDL but also of VLDL cholesterol. The secretion rate of bile acids decreased significantly by 31% from 131 (38) to 90 (16) µmol/15 minutes (p=0.045). The output of phospholipids also decreased by 19%. The biliary secretion rate of cholesterol was not, however, affected by the plasma LDL apheresis. ?Conclusions—The results suggest that, in patients with cholesterol gallstones and complete biliary drainage, lowering of plasma LDL and VLDL cholesterol reduces the biliary secretion rate—synthesis—of bile acids without affecting the biliary secretion rate of cholesterol. ?? Keywords: bile acids; biliary lipids; cholesterol; lipoproteins; plasma apheresis PMID:9414982

Hillebrant, C; Nyberg, B; Einarsson, K; Eriksson, M

1997-01-01

221

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

NASA Astrophysics Data System (ADS)

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

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

2014-03-01

222

Bilirubin and alkaline phosphatase values before and after surgery for biliary obstruction.  

PubMed

From a study of 178 patients who underwent operation for biliary obstruction, we found that preoperative bilirubin values above 14 mg/dl and alkaline phosphatase values over 5 times normal meant that common duct stones were an unlikely cause of the obstruction. Jaundice for more than 4 weeks before operation, bilirubin values greater than 10 mg/dl and the presence of significant fibrosis in the portal spaces indicated a lower than average chance of postoperative resolution of jaundice. After successful biliary surgery, the rate of decrease in serum alkaline phosphatase was haphazard and of little diagnostic value. The postoperative rate of decrease in the bilirubin values followed first-order kinetics and averaged 8 percent/day. This rate was not significantly influenced by the disease process, the length of preoperative clinical jaundice or the absolute height of the preoperative serum bilirubin level. PMID:7053658

Pellegrini, C A; Thomas, M J; Way, L W

1982-01-01

223

Iatrogenic bile duct injuries: Etiology, diagnosis and management  

PubMed Central

Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Roux-en-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is end-to-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life. PMID:19725140

Jab?o?ska, Beata; Lampe, Pawe?

2009-01-01

224

A classification of ductal plate malformations based on distinct pathogenic mechanisms of biliary dysmorphogenesis  

PubMed Central

Ductal plate malformations (DPM) are developmental anomalies considered to result from lack of ductal plate remodeling during bile duct morphogenesis. In mice, bile duct development is initiated by the formation of primitive ductal structures lined by two cell types, namely ductal plate cells and hepatoblasts. During ductal plate remodeling the primitive ductal structures mature to ducts as a result from differentiation of the ductal plate cells and hepatoblasts to cholangiocytes. We here report that this process is conserved in human fetal liver. These findings prompted us to evaluate how DPM develop in three mouse models, namely mice with livers deficient in Hepatocyte Nuclear Factor (HNF)6, HNF1? or cystin-1 (cpk mice). Human liver from a patient with a HNF1B/TCF2 mutation, and from fetuses affected with Autosomal Recessive Polycystic Kidney Disease (ARPKD) were also analysed. Despite the epistatic relationship between HNF6, HNF1? and cystin-1, the three mouse models displayed distinct morphogenic mechanisms of DPM. They all developed biliary cysts lined by cells with abnormal apico-basal polarity. However, the absence of HNF6 led to an early defect in ductal plate cell differentiation. In HNF1?-deficient liver, maturation of the primitive ductal structures was impaired. Cpk mouse livers and human fetal ARPKD showed normal differentiation and maturation but abnormal duct expansion. Conclusion DPM is the common end-point of distinct defects initiated at distinct stages of bile duct morphogenesis. Our observations provide a new pathogenic classification of DPM. PMID:21391226

Raynaud, Peggy; Tate, Joshua; Callens, Céline; Cordi, Sabine; Vandersmissen, Patrick; Carpentier, Rodolphe; Sempoux, Christine; Devuyst, Olivier; Pierreux, Christophe E.; Courtoy, Pierre; Dahan, Karin; Delbecque, Katty; Lepreux, Sébastien; Pontoglio, Marco; Guay-Woodford, Lisa M.; Lemaigre, Frédéric P.

2012-01-01

225

Evaluation of fully covered self-expanding metal stents in benign biliary strictures and bile leaks  

PubMed Central

AIM: To investigate the use of fully covered metal stents in benign biliary strictures (BBS) and bile leaks. METHODS: We studied 17 patients, at Harbor-UCLA Medical center (Los Angeles), with BBS (n = 12) and bile leaks (n = 5) from July 2007 to February 2012 that had received placement of fully covered self-expanding metal stents (FCSEMs). Fourteen patients had endoscopic placement of VIABIL® (Conmed, Utica, New York, United States) stents and three had Wallflex® (Boston Scientific, Mass) stents. FCSEMS were 8 mm or 10 mm in diameter and 4 cm to 10 cm in length. Patients were followed at regular intervals to evaluate for symptoms and liver function tests. FCSEMS were removed after 4 or more weeks. Resolution of BBS and leak was documented cholangiographically following stent removal. Stent patency can be defined as adequate bile and contrast flow from the stent and into the ampulla during endoscopic retrograde cholangiopancreatography (ERCP) without clinical signs and/or symptoms of biliary obstruction. Criterion for bile leak resolution at ERCP is defined as absence of contrast extravasation from the common bile duct, cystic duct remanent, or gall bladder fossa. Rate of complications such as migration, and in-stent occlusion were recorded. Failure of endoscopic therapy was defined as persistent biliary stenosis or continuous biliary leakage after 12 mo of stent placement. RESULTS: All 17 patients underwent successful FCSEMS placement and removal. Etiologies of BBS included: cholecystectomies (n = 8), cholelithiasis (n = 2), hepatic artery compression (n = 1), pancreatitis (n = 2), and Whipple procedure (n = 1). All bile leaks occurred following cholecystectomy. The anatomic location of BBS varied: distal common bile duct (n = 7), common hepatic duct (n = 1), hepaticojejunal anastomosis (n = 2), right intrahepatic duct (n = 1), and choledochoduodenal anastomatic junction (n = 1). All bile leaks were found to be at the cystic duct. Twelve of 17 patients had failed prior stent placement or exchange. Resolution of the biliary strictures and bile leaks was achieved in 16 of 17 patients (94%). The overall median stent time was 63 d (range 27-251 d). The median stent time for the BBS group and bile leak group was 62 ± 58 d (range 27-199 d) and 92 ± 81 d (range 48-251 d), respectively. All 17 patients underwent successful FCSEMS removal. Long term follow-up was obtained for a median of 575 d (range 28-1435 d). Complications occurred in 5 of 17 patients (29%) and included: migration (n = 2), stent clogging (n = 1), cholangitis (n = 1), and sepsis with hepatic abscess (n = 1). CONCLUSION: Placement of fully covered self-expanding metal stents may be used in the management of benign biliary strictures and bile leaks with a low rate of complications. PMID:23858377

Lalezari, David; Singh, Inder; Reicher, Sofiya; Eysselein, Viktor Ernst

2013-01-01

226

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

227

Effect of UDCA on intracellular and biliary pH in isolated rat hepatocyte couplets and perfused livers.  

PubMed

To study how ursodeoxycholic acid (UDCA) increases biliary HCO3- concentration and alkalinizes bile, intracellular pH (pHi) and canalicular pH (pHc) were measured microfluorimetrically in isolated rat hepatocyte couplets (IRHC). Isolated perfused rat livers (IPRL) were also used to assess the roles of Cl-, HCO3-, and zone III hepatocytes. In IRHC, UDCA diminished pHi only when HCO3- was omitted. pHi recovery was inhibited by amiloride. UDCA did not affect pHi recovery from an acid load (NH4Cl) nor modify pHc (+HCO3-). In IPRL, biliary HCO3- concentration increased following UDCA despite removal of Cl- (to inhibit Cl(-)-HCO3- exchanger) or destruction of zone III hepatocytes with digitonin. Moreover, when HCO3- was omitted from the perfusate, biliary pH rose following UDCA even though the hypercholeresis was abolished. Thus 1) hepatic UDCA uptake represents an acid load that is counteracted by Na(+)-H+ exchange when HCO3- is absent; 2) UDCA does not alkalinize pHc; and 3) alkalinization of biliary pH in IPRL is not HCO3- dependent, does not involve Cl(-)-HCO3- exchange, or zonal differences in UDCA metabolism or excretion. UDCA appears to alkalinize bile by protonation within the bile duct lumen. UDCAH may then cross the biliary epithelium. PMID:1987808

Strazzabosco, M; Sakisaka, S; Hayakawa, T; Boyer, J L

1991-01-01

228

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

229

Ulcerative Colitis Associated with Primary Biliary Cirrhosis  

Microsoft Academic Search

Primary biliary cirrhosis and ulcerative colitisare two diseases with many features of autoimmunity.Thirteen cases of coexistence of the two diseases havebeen reported in the literature so far. Patients are usually younger and more often males thanthe ordinary primary biliary cirrhosis patient, whilethe colitis is mild and easily controllable. In ahomogeneous population of 550,000 inhabitants of the island of Crete, 412

M. Koulentaki; I. E. Koutroubakis; E. Petinaki; M. Tzardi; H. Oekonomaki; I. Mouzas; E. A. Kouroumalis

1999-01-01

230

Dynamic instability of ducts conveying fluid  

NASA Technical Reports Server (NTRS)

A finite element analysis was used to study dynamic instability in ducts conveying high speed fluids. Ducts examined include cantilevered curved, flexibly supported, arbitrarily shaped, and composite duct systems. Partial differential equations were used to study the duct systems.

Yu, Y. Y.

1975-01-01

231

Immunoadsorption therapy in dilated cardiomyopathy.  

PubMed

Dilated cardiomyopathy is a common myocardial disease characterized by ventricular chamber enlargement and systolic dysfunction that result in heart failure. In addition to genetic predisposition, viral infection and myocardial inflammation play a causal role in the disease process of dilated cardiomyopathy. Experimental and clinical studies suggest that activation of the humoral immune system, with production of circulating cardiac autoantibodies, plays an important functional role in the development and progression of cardiac dysfunction in patients with dilated cardiomyopathy. Small open-controlled studies showed that removal of circulating antibodies by immunoadsorption results in improvement of cardiac function and decrease in myocardial inflammation. At present, immunoadsorption is an experimental treatment option for improvement of cardiac function - therapy that calls for confirmation by a placebo-controlled multicenter study. PMID:25494978

Felix, Stephan B; Beug, Daniel; Dörr, Marcus

2015-02-01

232

Salivary duct stones  

MedlinePLUS

... remove the stone are: Massaging the gland with heat. The doctor or dentist may be able to push the stone out of the duct. In some cases, you may need surgery to cut out the stone. A newer treatment that uses shock waves to break the stone into small pieces ...

233

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

ClinicalTrials.gov

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

2014-05-19

234

Intraductal papillary mucinous neoplasm of the bile duct with gastric and duodenal fistulas  

PubMed Central

Intraductal papillary mucinous neoplasm (IPMN) of the bile duct is still rare and not yet understood despite of its increased incidence and similar clinicopathologic characteristics compared with IPMN of the pancreas. The fistula formation into other organs can occur in IPMN, especially the pancreatic type. To our knowledge, only two cases of IPMN of the bile duct with a choledochoduodenal fistula were reported and we have recently experienced a case of IPMN of the bile duct penetrating into two neighboring organs of the stomach and duodenum presenting with abdominal pain and jaundice. Endoscopy showed thick mucin extruding from two openings of the fistulas. Endoscopic suction of thick mucin using direct peroral cholangioscopy with ultra-slim endoscope through choledochoduodenal fistula was very difficult and ineffective because of very thick mucin and next endoscopic suction through the stent after prior insertion of biliary metal stent into choledochogastric fistula also failed. Pathologic specimen obtained from the proximal portion of the choledochogastric fistula near left intrahepatic bile duct through the metal stent showed a low grade adenoma. The patient declined the surgical treatment due to her old age and her abdominal pain with jaundice was improved after percutaneous transhepatic biliary drainage with the irrigation of N-acetylcysteine three times daily for 10 d. PMID:25031793

Hong, Man Yong; Yu, Dong Wook; Hong, Seung Goun

2014-01-01

235

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

236

Vasodilator therapy of dilated cardiomyopathy.  

PubMed Central

Vasoconstriction increases impedance to ventricular ejection and impairs the performance of the dilated myopathic heart. Vasodilator drug therapy by reducing vascular resistance, increasing vascular compliance and increasing vascular capacitance improves cardiac function and relieves the signs and symptoms of congestive heart failure. Earlier intervention in an attempt to alter the natural history of cardiomyopathy should be studied. PMID:3774700

Cohn, J. N.

1986-01-01

237

Variants in motilin, somatostatin and their receptor genes and risk of biliary tract cancers and stones in Shanghai, China.  

PubMed

Altered motility of the gallbladder can result in gallstone and cholecystitis, which are important risk factor for biliary tract cancer. Motilin (MLN) and somatostatin (SST) are known important modulators of gallbladder motility. To determine whether genetic variants in motilin, somatostatin, and their receptor genes are associated with the risk of biliary tract cancers and stones, nine tag-SNPs were determined in 439 biliary tract cancer cases (253 gallbladder, 133 extrahepatic bile duct and 53 ampulla of Vater cancer cases), 429 biliary stone cases, and 447 population controls in a population-based case-control study in Shanghai, China. We found that subjects with the MLNR rs9568169 AA genotype and SSTR5 rs169068 CC genotype were significantly associated with risk of extrahepatic bile duct cancer (OR =0.49, 95% CI: 0.27-0.89; OR =2.40, 95% CI: 1.13-5.13) compared to the major genotypes. MLN rs2281820 CT and rs3793079 AT genotypes had significantly increased risks of gallstones (OR =1.52, 95% CI: 1.06-2.18; OR =1.64, 95% CI: 1.20-2.25) compared to TT genotypes. Besides, Haplotype analysis showed that MLN T-T-T haplotype (rs2281820-rs3793079-rs2281819) had a non-significantly elevated risk of gallstone (OR =1.30, 95% CI: 0.91-1.86) compared with C-A-A haplotype. To the best of our knowledge, this is the first study to report an association between genetic polymorphisms in MLN, MLNR and their receptor genes and risk of biliary tract cancers and stones. PMID:24999450

Xu, Hong-Li; Hsing, Ann W; Koshiol, Jill; Chu, Lisa W; Cheng, Jia-Rong; Gao, Jing; Tan, Yu-Ting; Wang, Bing-Sheng; Shen, Ming-Chang; Gao, Yu-Tang

2014-12-01

238

Jaundice in non-cirrhotic primary biliary cirrhosis: the premature ductopenic variant  

PubMed Central

The clinical and pathological findings of four females with primary biliary cirrhosis (PBC) with an unusual and hitherto not well recognised course are reported. Patients suffered severe pruritus and weight loss with progressive icteric cholestasis which did not respond to such treatments as ursodeoxycholic acid and immunosuppressives. In all cases liver histology revealed marked bile duct loss without however significant fibrosis or cirrhosis. Further diagnostic studies and repeat biopsies confirmed the absence of liver cirrhosis as well as other potential causes of hyperbilirubinaemia. Comparison of the fibrosis-ductopenia relationship for our cases with that for a group of 101 non-cirrhotic PBC patients indicated that in the former the severity of bile duct loss relative to the amount of fibrosis was significantly higher. The proportion of portal triads containing an interlobular bile duct was 3%, 4%, 6%, and 10% compared with 45% (median; range 8.3-100%) for controls (p<0.001). Three patients received a liver transplant 6-7 years after the first manifestation of PBC because of progressive cholestasis, refractory pruritus, and weight loss, while the fourth patient is considering this option. In one case cirrhosis had developed at the time of transplantation while the others still had non-cirrhotic disease. These cases suggest that cholestatic jaundice in non-cirrhotic PBC may be secondary to extensive "premature" or accelerated intrahepatic bile duct loss. Although the extent of fibrosis may be limited initially, progression to cirrhosis appears to be inevitable in the long run. Despite intact protein synthesis and absence of cirrhotic complications, liver transplantation in the pre-cirrhotic stage for preventing malnutrition and to improve quality of life should be considered for these patients.???Keywords: primary biliary cirrhosis; jaundice; ductopenia; portal tract; cholestasis; liver biopsy PMID:11454806

Vleggaar, F; van Buuren, H R; Zondervan, P; ten, K; Hop, W; the, D

2001-01-01

239

Magnetic compression anastomosis for benign obstruction of the common bile duct.  

PubMed

Advances in interventional radiology have made possible magnetic compression anastomosis between the bile duct and the small intestine as a novel treatment. A 70-year-old man who had undergone subtotal gastrectomy for gastric cancer 2 years previously experienced recurring cholangitis with high fever and jaundice. Diagnostic evaluation subsequently demonstrated complete obstruction of the common bile duct which was attributed to recurrent cholangitis. A parent magnet was placed endoscopically into the afferent loop of the duodenum through the gastrojejunostomy with Billroth II reconstruction. The daughter magnet attached to a guide wire was placed in the obstructed common bile duct through a percutaneous transhepatic cholangiographic drainage tube. Two magnets were immediately attracted towards each other transmurally, and anastomosis was established on day 32 after the procedure. This novel method of magnetic compression anastomosis has the advantages of noninvasiveness and simplicity, as well as being a well-tolerated procedure for indications such as biliary obstruction. PMID:11668410

Takao, S; Matsuo, Y; Shinchi, H; Nakajima, S; Aikou, T; Iseji, T; Yamanouchi, E

2001-11-01

240

Burkholderia contaminans: unusual cause of biliary sepsis.  

PubMed

We report a case of biliary tract infection caused by a strain of Burkholderia contaminans, a member of the Burkholderia cepacia complex. The patient developed sepsis after endoscopic retrograde cholangiopancreatography (ERCP). Gram-negative bacilli were isolated from blood and bile cultures. Automated bacterial identification systems identified the organism as Burkholderia cepacia, whereas DNA sequence analysis revealed that the recA gene isolate was identical to that of B. contaminans. The patient responded to therapy with the antibiotics trimethoprim/sulfamethoxazole and biliary tract decompression. This case suggests that B. contaminans can be a causative agent of healthcare-associated biliary tract infections such as ERCP-related cholangitis. PMID:23292160

Ohji, Goh; Ohkusu, Kiyofumi; Toguchi, Akihiro; Otsuka, Yoshihito; Hosokawa, Naoto; Iwata, Kentaro

2013-10-01

241

Clinicopathological characterization of so-called “cholangiocarcinoma with intraductal papillary growth” with respect to “intraductal papillary neoplasm of bile duct (IPNB)”  

PubMed Central

Cholangiocarcinoma (CC) of the biliary tract occasionally presents a predominant intraductal papillary growth in the bile ducts, called as biliary tract carcinoma (BTC) of papillary growth (PG) and intrahepatic CC (ICC) of intraductal growth (IG) type. Recently, intraductal papillary neoplasm of bile duct (IPNB) has been proposed as a pre-invasive biliary neoplasm. This study was performed to characterize pathologically BTC of PG type and ICC of IG type with respect to IPNB. It was found that 126 of such 154 CCs (81.8%) fulfilled the criteria of IPNB, while the remaining 28 cases showed different histologies, such as tubular adenocarcinoma and carcinosarcoma. These IPNBs occurred in old aged patients with a male predominance, and the left lobe was rather frequently affected in the liver. A majority of these cases were high grade IPNB (43 cases) and invasive IPNB (77 cases), while low grade IPNB was rare (6 cases). Pancreatobiliary type was predominant (48 cases) followed by gastric (30 cases), intestinal (29 cases) and oncocytic (19 cases) types. Mucus hypersecretion was found in 45 cases, and this was frequent in IPNB at the intrahepatic large bile duct and hilar bile ducts but rare at the extrahepatic bile ducts. Interestingly, 36 cases of high grade and invasive IPNBs contained foci of moderately differentiated adenocacinoma within the intraductal papillary tumor. In conclusion, a majority of ICC of IG type and BTC of PG type could be regarded as a IPNB lineage, and clinically detectable IPNBs were already a malignant papillary lesion. PMID:25031730

Nakanuma, Yasuni; Sato, Yasunori; Ojima, Hidenori; Kanai, Yae; Aishima, Shinichi; Yamamoto, Masakazu; Ariizumi, Shun-ichi; Furukawa, Toru; Hayashi, Hiroki; Unno, Michiaki; Ohta, Tetsuo

2014-01-01

242

Safety and efficacy of endoscopic retrograde cholangiopancreatography for common bile duct stones in liver cirrhotic patients.  

PubMed

In order to investigate the safety and efficacy of endoscopic retrograde cholangiopancreatograpy (ERCP) in liver cirrhosis patients with common bile duct stones, we retrospectively analyzed data of 46 common bile duct stones patients with liver cirrhosis who underwent ERCP between 2000 and 2008. There were 12 cases of Child-Pugh A, 26 cases of Child-Pugh B, and 8 cases of Child-Pugh C. 100 common bile duct stones patients without liver cirrhosis were randomly selected. All the patients were subjected to ERCP for biliary stones extraction. The rates of bile duct clearance and complications were compared between cirrhotic and non-cirrhotic patients. The success rate of selective biliary cannulation was 95.6% in liver cirrhotic patients versus 97% in non-cirrhotic patients (P>0.05). The bile duct clearance rate was 87% in cirrhotic patients versus 96% in non-cirrhotic patients, but the difference was not statistically significant. Two liver cirrhotic patients (4.35%, 2/46) who were scored Child-Pugh C had hematemesis and melena 24 h after ERCP. The hemorrhage rate after ERCP in non-cirrhotic patients was 3%. The hemorrhage rate associated with ERCP in Child-Pugh C patients was significantly higher (25%, 2/8) than that (3%, 3/100) in non-cirrhotic patients (P<0.01%). There was no significant difference between these two groups in the rate of post-ERCP pancreatitis (PEP) and cholangitis. ERCP is safe and effective for Child-Pugh A and B cirrhotic patients with common bile duct stones. Hemorrhage risk in ERCP is higher in Child-Pugh C patients. PMID:25135737

Li, De-min; Zhao, Jie; Zhao, Qiu; Qin, Hua; Wang, Bo; Li, Rong-xiang; Zhang, Min; Hu, Ji-fen; Yang, Min

2014-08-01

243

Transcatheter thoracic duct embolization in the dog. An experimental study.  

PubMed

Thoracic duct embolization was created by injecting an isobutyl 2-cyanoacrylate/iophendylate (IBCA) mixture through a cannulated mesenteric lymphatic vessel in eight normal dogs. Aqueous contrast lymphangiography was repeated at minute 10 and week 6. Six dogs were euthanatized at week 6 and two dogs at month 6. Embolization with 1.5 to 3.9 ml of the mixture resulted in complete obstruction of the thoracic duct in all eight dogs. Results of lymphangiography in six dogs at week 6 showed a persistent, complete obstruction of the thoracic duct in six dogs and alternate lymphaticovenous anastomoses in four dogs. Histologically, there were a sclerosing granulomatous response surrounding the lymphatic embolus, mild congestive changes in the mesenteric lymph nodes, and mild lacteal dilatation in the jejunum. The procedure was well tolerated with only a few complications. One dog suffered partial thrombosis of the cranial vena cava by the injected material with later dislodgement and embolization of a pulmonary artery branch. Modifications have been made in the injection procedure to avoid this complication. This technique for occlusion of the thoracic duct shows potential for clinical use in the management of canine chylothorax. The obstruction appears to be complete and permanent, and surgical/anesthetic time is decreased greatly from previously described procedures. PMID:2773291

Pardo, A D; Bright, R M; Walker, M A; Patton, C S

1989-01-01

244

[Lithiasis of the extrahepatic bile ducts].  

PubMed

This is a literature survey on issues relating to average incidence rate of choledocholithiasis for the last few years, basic mechanisms and factors underlying the formation of biliary calculi, as well as form and location of the concrements, with a special reference to the impact of the latter on the course run by the disease. Choledocholithiasis is divided in two forms--primary and secondary: in the former the underlying causes and criteria for the occurrence of calculi are described, and in the latter--the factors and conditions promoting migration of the concrements towards the bile ducts, with emphasis on the importance of the division suggested in choledocholithiasis treatment. The clinical picture with its characteristic symptoms, and the pathogenesis of the latter are also discussed. Evolution of the disease left without adequate intervention has unfavourable prognosis. A description is submitted of the various complications and their characteristic manifestations observed. Differential diagnosis is made both often and rarely met with diseases presenting similar symptomatology. PMID:9739844

Maruf, M; Baev, S

1997-01-01

245

Poorly differentiated adenocarcinoma with signet-ring cell carcinoma of the extrahepatic bile duct in a 42-year-old Japanese female: a case report.  

PubMed

Poorly differentiated adenocarcinoma without papilla or tubule formation of the extrahepatic bile duct is rare. Here we present a case (a 42-year-old Japanese woman) without either pancreatobiliary maljunction or liver disease. The patient had obstructive jaundice. Imaging studies revealed a bile duct tumor obstructing the common bile duct and invading the surrounding tissues. Pathologic examination revealed a dense periductal growth of poorly differentiated adenocarcinoma containing signet-ring cells, but without papilla or tubule formation in the extrahepatic bile duct. The tumor cells directly invaded the pancreatic parenchyma and the portal vein. In the extrahepatic bile duct, poorly differentiated adenocarcinoma may be established as a distinct clinicopathologic entity if the tumors are characterized by: 1) the absence of papilla or tubule formation, 2) Asian preponderance, 3) occurrence at a younger age than is usual for patients with biliary cancers, and 4) an aggressive mural invasiveness. PMID:20200586

Ogata, Sho; Kimura, Akifumi; Hatsuse, Kazuo; Yamamoto, Junji; Shimazaki, Hideyuki; Nakanishi, Kuniaki; Kawai, Toshiaki

2010-02-01

246

Biliary elimination of cyclophosphamide in man  

Microsoft Academic Search

A 72-year-old male with a lymphoma and obstructive jaundice received 900 mg cyclophosphamide IV as a part of a chemotherapeutic regimen whilst external biliary drainage was in progress. Plasma, urinary, and biliary pharmacokinetics of cyclophosphamide and nitrobenzylpyridine (NBP)-alkylating metabolites were studied. In 32 h 891 ml bile was collected, and this contained unchanged cyclophosphamide and NBP-alkylating material. Despite fluctuations in

J. S. Dooley; C. A. James; H. J. Rogers; R. Stuart-Harris

1982-01-01

247

The Role of Perioperative Endoscopic Retrograde Cholangiopancreatography and Biliary Drainage in Large Liver Hydatid Cysts  

PubMed Central

Background. The best surgical technique for large liver hydatid cysts (LHCs) has not yet been agreed on. Objectives. The objective of this study was to examine the role of perioperative endoscopic retrograde cholangiopancreatography (ERCP) and biliary drainage in patients with large LHCs. Methods. A 20-year retrospective study of patients with LHCs treated surgically at the University Clinical Center of Kosovo (UCCK). We divided patients into 2 groups based on treatment period: 1981–1990 (Group I) and 2001–2010 (Group II). Demographic characteristics (sex, age), the surgical procedure performed, complications rate, and outcomes were compared. Results. Of the 340 patients in our study, 218 (64.1%) were female with median age of 37 years (range, 17 to 81 years). 71% of patients underwent endocystectomy with partial pericystectomy and omentoplication, 8% total pericystectomy, 18% endocystectomy with capitonnage, and 3% external drainage. In Group I, 10 patients underwent bile duct exploration and T-tube placement; in Group II, 39 patients underwent bile duct exploration and T-tube placement. In addition, 9 patients in Group II underwent perioperative ERCP with papillotomy. The complication rate was 14.32% versus 6.37%, respectively (P = 0.001). Conclusion. Perioperative ERCP and biliary drainage significantly decreased the complication rate and improved outcomes in patients with large LHCs. PMID:25431783

Bicaj, B.; Limani, D.; Maxhuni, M.; Rrusta, A.; Hoxha, F.; Sada, F.; Hashani, S.; Musa, R.; Latifi, R.

2014-01-01

248

Biliary strictures: diagnostic considerations and approach.  

PubMed

Biliary strictures present a diagnostic challenge, especially when no etiology can be ascertained after laboratory evaluation, abdominal imaging and endoscopic retrograde cholangiopancreatography (ERCP) sampling. These strictures were traditionally classified as indeterminate strictures, although with advances in endoscopic techniques and better understanding of hepato-biliary pathology, more are being correctly diagnosed. The implications of missing a malignancy in patients with biliary strictures-and hence delaying surgery-are grave but a significant number of patients (up to 20%) undergoing surgery for suspected biliary malignancy can have benign pathology. The diagnostic approach to these patients involves detailed history and physical examination and depends on the presence or absence of jaundice, level of obstruction, and presence or absence of a mass lesion. While abdominal imaging helps to find the level of obstruction and provides a 'road map' for further endoscopic investigations, tissue diagnosis is usually needed to make decisions on management. Initially ERCP was the only modality to investigate these strictures but now, with the development of endoscopic ultrasound with fine needle aspiration and the availability of newer techniques such as intraductal ultrasound, single-operator cholangioscopy and confocal laser endomicroscopy, the diagnostic approach to biliary strictures has changed significantly. In this review, we will focus on the decision-making process for patients with biliary strictures and discuss the key decision points that should dictate further diagnostic investigations at each step. PMID:25355800

Singh, Ajaypal; Gelrud, Andres; Agarwal, Banke

2015-02-01

249

A case of methicillin-resistant Staphylococcus aureus infection following bile duct stenting  

PubMed Central

AIM: To present a case of methicillin-resistant Staphylococcus aureus (MRSA) infection following bile duct stenting in a patient with malignant biliary obstruction. METHODS: A 78-year-old male patient was admitted to a community hospital with progredient painless jaundice lasting over two weeks, weight loss and sweating at night. Whether a stent should be implanted pre-operatively in jaundiced patients or whether these patients should directly undergo surgical resection, was discussed. RESULTS: ERC and a biopsy from the papilla of Vater revealed an adenocarcinoma. In addition, a 7-Ch plastic stent was placed into the common bile duct. Persistent abdominal pain, increasing jaundice, weakness and indigestion led to the transfer of the patient to our hospital. A pylorus-preserving pancreatoduodenectomy was performed. Intraoperatively, bile leaked out of the transected choledochus and the stent was found to be dislocated in the duodenum. A smear of the bile revealed an infection with MRSA, leading to post-operative isolation of the patient. CONCLUSION: As biliary stents can cause severe infection of the bile, the need for pre-operative placement of biliary stents should be carefully evaluated in each individual case. PMID:15761984

Diener, Markus K; Ulrich, Alexis; Weber, Theresia; Wente, Moritz N; Büchler, Markus W; Friess, Helmut

2005-01-01

250

Endoscopic diagnosis of extrahepatic bile duct carcinoma: Advances and current limitations.  

PubMed

The accurate diagnosis of extrahepatic bile duct carcinoma is difficult, even now. When ultrasonography (US) shows dilatation of the bile duct, magnetic resonance cholangiopancreatography followed by endoscopic US (EUS) is the next step. When US or EUS shows localized bile duct wall thickening, endoscopic retrograde cholangiopancreatography should be conducted with intraductal US (IDUS) and forceps biopsy. Fluorescence in situ hybridization increases the sensitivity of brush cytology with similar specificity. In patients with papillary type bile duct carcinoma, three biopsies are sufficient. In patients with nodular or infiltrating-type bile duct carcinoma, multiple biopsies are warranted, and IDUS can compensate for the limitations of biopsies. In preoperative staging, the combination of dynamic multi-detector low computed tomography (MDCT) and IDUS is useful for evaluating vascular invasion and cancer depth infiltration. However, assessment of lymph nodes metastases is difficult. In resectable cases, assessment of longitudinal cancer spread is important. The combination of IDUS and MDCT is useful for revealing submucosal cancer extension, which is common in hilar cholangiocarcinoma. To estimate the mucosal extension, which is common in extrahepatic bile duct carcinoma, the combination of IDUS and cholangioscopy is required. The utility of current peroral cholangioscopy is limited by the maneuverability of the "baby scope". A new baby scope (10 Fr), called "SpyGlass" has potential, if the image quality can be improved. Since extrahepatic bile duct carcinoma is common in the Far East, many researchers in Japan and Korea contributed these studies, especially, in the evaluation of longitudinal cancer extension. PMID:21611097

Tamada, Kiichi; Ushio, Jun; Sugano, Kentaro

2011-05-10

251

Ascaris lumbricoides and its invasion of the accessory cystic duct: An unusual presentation.  

PubMed

Around the world, Ascaris lumbricoides is the most common helminthic infection. We describe the case of a 25-year-old woman, known to have had Ascaris infestation, presenting with abdominal pain, constipation and jaundice together with fever and tachycardia. There was tenderness in the right hypochondrium and liver function tests confirmed cholestatic jaundice. An abdominal ultrasound showed multiple linear echogenic foci in the distal small intestine along with cholelithiasis and a thick-walled gall bladder with a single stone compressing the common bile duct (Mirizzi syndrome). The patient underwent exploratory laparotomy; more than 100 worms were found inside the small intestine and they were removed by enterotomy and manual decompression. No worm could be palpated within the common bile duct (CBD). Cholecystectomy was performed, during which an accessory cystic duct was noted opening into the common bile duct superiorly to the main cystic duct. A 10?cm live worm was found coming out of it and was removed via forceps. Later on an endoscopic retrograde cholangio-pancreatogram (ERCP) showed a widened ampulla, a mildly dilated common bile duct, but without any filling defects. The patient made an uneventful postoperative recovery being discharged on the ninth day. Worms in an accessory cystic duct have not been report in the medical literature so far. PMID:25430551

Majid, Zain; Masood, Irfan; Pirzada, Muhammad Taqi

2014-11-27

252

Retrospective evaluation of endoscopic stenting of combined malignant common bile duct and gastric outlet-duodenum obstructions  

PubMed Central

Malignant dual obstruction in the common bile duct and gastric outlet-duodenum can cause difficulties in palliative treatment. The purpose of this study was to summarize our successful experience with the endoscopic stenting procedure for the palliative treatment of malignant biliary and gastric outlet-duodenum obstruction. Seventeen patients who underwent dual stenting procedures for the common bile duct and duodenum were retrospectively reviewed. The success rate of placement, palliative effect for biliary and duodenal obstruction, incidence of complication and restricture and stent patency were analyzed. Stent placement achieved a 100% success rate. Total bilirubin decreased from 263.4±62.5 to 157.6±25.1 ?mol/l, direct bilirubin decreased from 233.2±66.5 to 130.9±27.7 ?mol/l and alkaline phosphatase from 534.2±78.7 to 216.3±23.3 IU/l. The differences between the preoperative and postoperative results were statistically significant (P<0.01). The gastric outlet obstruction score increased significantly from 0.9±1.1 to 2.1±0.7 points (P<0.01). The general nutritional status of the patients was improved. No serious complications occurred in any of the patients, and the survival time of patients following stenting ranged between 70 and 332 days with a mean survival time of 192 days. In conclusion, our methodology for combined biliary and enteral stenting is highly effective for the palliation of malignant biliary and gastric outlet-duodenal obstruction. PMID:25187819

YU, JIANFENG; HAO, JIANYU; WU, DONGFANG; LANG, HAIBO

2014-01-01

253

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. PMID:22624830

2012-01-01

254

Transjejunal biliary interventions: going back to a road less traveled.  

PubMed

Percutaneous transhepatic biliary interventions are not without risk and potential complications. In patients with bilioenteric anastomosis in whom repeat biliary interventions are expected, percutaneous transjejunal access is a very useful approach that is not frequently used nowadays. We provide a brief review of the history, indications, and current status of transjejunal biliary interventions. Transjejunal biliary access provides a relatively atraumatic pathway to the biliary system in patients that need repeat interventions. Multiple studies have provided convincing data that in appropriately chosen patients receiving a bilioenteric anastomosis, an antecolic limb of jejunum should be placed for subsequent access in biliary intervention. PMID:24316661

Lopera, Jorge E; Ramsey, Gregory R

2014-12-01

255

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

SciTech Connect

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

Nyman, Rickard, E-mail: rickard.nyman@akademiska.se; Ekloef, Hampus; Eriksson, Lars-Gunnar [University Hospital, Department of Diagnostic Radiology (Sweden); Karlsson, Britt-Marie; Rasmussen, Ib [University Hospital, Department of Surgery (Sweden); Lundgren, Dan; Thomsen, Peter [Goeteborg University, Biomaterials/Cell Biology (Sweden)

2005-01-15

256

Remains of the day: Biliary complications related to single-port laparoscopic cholecystectomy  

PubMed Central

AIM: To assesse the rate of bile duct injuries (BDI) and overall biliary complications during single-port laparoscopic cholecystectomy (SPLC) compared to conventional laparoscopic cholecystectomy (CLC). METHODS: SPLC has recently been proposed as an innovative surgical approach for gallbladder surgery. So far, its safety with respect to bile duct injuries has not been specifically evaluated. A systematic review of the literature published between January 1990 and November 2012 was performed. Randomized controlled trials (RCT) comparing SPLC versus CLC reporting BDI rate and overall biliary complications were included. The quality of RCT was assessed using the Jadad score. Analysis was made by performing a meta-analysis, using Review Manager 5.2. This study was based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. A retrospective study including all retrospective reports on SPLC was also performed alongside. RESULTS: From 496 publications, 11 RCT including 898 patients were selected for meta-analysis. No studies were rated as high quality (Jadad score ? 4). Operative indications included benign gallbladder disease operated in an elective setting in all studies, excluding all emergency cases and acute cholecystitis. The median follow-up was 1 mo (range 0.03-18 mo). The incidence of BDI was 0.4% for SPLC and 0% for CLC; the difference was not statistically different (P = 0.36). The incidence of overall biliary complication was 1.6% for SPLC and 0.5% for CLC, the difference did not reached statistically significance (P = 0.21, 95%CI: 0.66-15). Sixty non-randomized trials including 3599 patients were also analysed. The incidence of BDI reported then was 0.7%. CONCLUSION: The safety of SPLC cannot be assumed, based on the current evidence. Hence, this new technology cannot be recommended as standard technique for laparoscopic cholecystectomy. PMID:24574757

Allemann, Pierre; Demartines, Nicolas; Schäfer, Markus

2014-01-01

257

What Is Bile Duct Cancer?  

MedlinePLUS

... liver – much more common than intrahepatic bile duct cancer – is hepatocellular carcinoma, which develops from liver cells. Hepatocellular carcinoma is discussed in more detail in our document ...

258

The management of treatment-resistant biliary calculi using percutaneous endourologic techniques  

PubMed Central

Background Complicated choledocholithiasis cannot always be managed by standard surgical, radiologic or endoscopic methods. One additional approach is to use percutaneous techniques developed by endourologists to treat renal calculi. In this report, we present our experience over the past 10 years with this novel approach. Methods We conducted a retrospective review of all patients who underwent percutaneous, endoscopic treatment of biliary calculi at our institution between January 1997 and August 2007. Primary outcomes of interest were symptom- and stone-free rates, length of stay in hospital and complications. Results Nineteen patients underwent 21 percutaneous treatments for biliary calculi. All were dependent on external drainage for symptom control. The primary indications for treatment were cholangitis, retained stone, biliary colic and jaundice. Seventeen patients (89.5%) had failed prior endoscopic retrograde cholangiopancreatography (ERCP) or open attempts at treatment. The 2 remaining patients (10.5%) were deemed unfit for a general anesthetic. Patients had experienced a mean of 1.8 (standard deviation [SD] 1.0) prior failed attempts at stone removal. We used several treatment modalities, including holmium:yttrium-aluminum-garnet laser (61.9%), electrohydraulic lithotripter (19.0%), ultrasound (9.5%), basket extraction (9.5%) and balloon dilatation of the ampulla (19.0%). Overall, treatment led to successful removal of the biliary drainage tube in 94.7% of patients and 76.2% were stone-free. We performed cholangiograms an average of 21.8 (SD 13.7) days after treatment. The average length of stay in hospital was 1.9 (SD 1.1) days. One patient experienced a perioperative acute coronary syndrome and another experienced prolonged biliary drainage. Both had successful endoscopic treatment of their calculi. There were no cases of treatment-related sepsis, and we observed no other complications. Conclusion Biliary calculi may be successfully treated using standard endourologic methods with high stone-free rates. This technique is generally well-tolerated even among high-risk patients. PMID:19865576

Ray, A. Andrew; Davies, Edward T.; Duvdevani, Mordechai; Razvi, Hassan; Denstedt, John D.

2009-01-01

259

Contributions of hepatocytes and bile ductular cells in ductular reactions and remodeling of the biliary system after chronic liver injury.  

PubMed

Mature hepatocytes are suggested to possess a capacity for bile ductular transdifferentiation, but whether and how hepatocytes contribute to ductular reaction in chronic liver diseases has not been elucidated. We examined whether mouse hepatocytes can transdifferentiate into bile ductular cells in vitro, using a three-dimensional collagen gel culture method, and in vivo, using a liver repopulation model in which ?-galactosidase-positive hepatocytes from Alb-Cre × ROSA26R mice were transplanted into the liver of wild-type mice. We further examined the relative contribution of intrinsic hepatocytes in ductular reaction in a hepatocyte lineage-tracing model using Mx1-Cre × ROSA26R mice treated with polyinosinic-polycytidylic acid. Within collagen gels, hepatocytes exhibited branching morphogenesis associated with the emergence of bile duct-like phenotype. In the liver repopulation model, many ?-galactosidase-positive, hepatocyte-derived bile ductular structures were identified; these markedly increased after liver injury. In Mx1-Cre × ROSA26R mice, relatively minor but significant contributions of hepatocyte-derived bile ductules were observed in both periportal and centrilobular ductular reaction. As the centrilobular ductular reaction progressed, the portal ducts or ductules migrated toward the injured area and joined with hepatocyte-derived ductules, leaving the portal tract without biliary structures. We conclude that hepatocytes and bile ducts or ductules are important sources of ductular reaction and that the intrahepatic biliary system undergoes remarkable remodeling in response to chronic liver injury. PMID:25193593

Nagahama, Yasuharu; Sone, Masayuki; Chen, Xi; Okada, Yoko; Yamamoto, Masahiro; Xin, Bing; Matsuo, Yasuhiro; Komatsu, Mikiko; Suzuki, Akira; Enomoto, Katsuhiko; Nishikawa, Yuji

2014-11-01

260

[The surgical treatment of extrahepatic bile duct lithiasis].  

PubMed

Data concerning operative treatment of 227 patients with lithiasis of the extrahepatic biliary ducts, covering an eleven-year period (1985 to 1995 inclusive), are presented. In all cases diagnosis and operation are done in the Second Surgical Clinic at the Medical University--State University Hospital "Alexandrovska"--Sofia. By type the surgical interventions are distributed as follows: external drainage of hepaticocholedochus--122 cases (53.74 per cent), choledochoduodenostomy 69 (30.39 per cent) and transduodenal papillosphincterotomy 36 (15.85 per cent). Fifteen patients develop postoperative complications (6.60 per cent), and in five patients the outcome is fatal with postoperative lethality amounting to 2.20 per cent. The basic indications for the various types of surgical interventions are established. PMID:9974032

Maruf, M; Baev, S

1998-01-01

261

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

PubMed Central

AIM: To explore a method to establish an animal model of ischemic type intrahepatic biliary lesion in rabbits. METHODS: Forty Japanese white rabbits of clean grade were divided randomly into four groups (10 rabbits per group) including sham operation (SO) group, and artery-bile obstruction (ABO)-1 h group, ABO-2 h group and ABO-3 h group. All the rabbits in this study underwent the same initial surgical procedure in which the liver was prepared as for graft removal during liver transplantation. Subsequently in the SO group, no additional vascular intervention was performed, while in groups ABO-1 h, ABO-2 h and ABO-3 h, the animals underwent combined clamping of the hepatic artery and common bile duct with microvascular clips for 1, 2 and 3 h, respectively. After the scheduled occlusion time, the clip was removed to recover blood supply. The animals were killed 4 wk after operation. The survival rate, liver function, cholangiography and histopathological manifestation of the rabbits in each group were observed. RESULTS: The survival rate was 100% in groups SO, ABO-1 h and ABO-2 h, while it was 60% in group ABO-3 h. At each observation time, the change degree of the indexes of liver function was proportional to the clamping time (ABO-3 h > ABO-2 h > ABO-1 h > SO, P < 0.05). Cholangiographical and histopathologic manifestations both showed that intrahepatic biliary lesion aggravated proportionally with the increase of the clamping time. CONCLUSION: An animal model of ischemic type intrahepatic biliary lesion in rabbits is successfully established, which may provide a reliable technique for basic and clinical research into the etiology, development and prophylaxis of ischemic type intrahepatic biliary lesion after liver transplantation. PMID:19222099

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

2009-01-01

262

Percutaneous Endoscopic Holmium Laser Lithotripsy for Management of Complicated Biliary Calculi  

PubMed Central

Background and Objectives: Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to evaluate the role of such urological interventions for the treatment of complex biliary calculi. Methods: We conducted a retrospective review of all patients (n=9) undergoing percutaneous holmium laser lithotripsy for complicated biliary calculi over a 4-year period (12/2003 to 12/2007). All previously failed standard techniques include ERCP with sphincterotomy (n=6), PTHC (n=7), or both of these. Access to the biliary system was obtained via an existing percutaneous transhepatic catheter or T-tube tracts. Endoscopic holmium laser lithotripsy was performed via a flexible cystoscope or ureteroscope. Stone clearance was confirmed intra- and postoperatively. A percutaneous transhepatic drain was left indwelling for follow-up imaging. Results: Mean patient age was 65.6 years (range, 38 to 92). Total stone burden ranged from 1.7 cm to 5 cm. All 9 patients had stones located in the CBD, with 2 patients also having additional stones within the hepatic ducts. All 9 patients (100%) were visually stone-free after one endoscopic procedure. No major perioperative complications occurred. Mean length of stay was 2.4 days. At a mean radiological follow-up of 5.4 months (range, 0.5 to 21), no stone recurrence was noted. Conclusions: Percutaneous endoscopic holmium laser lithotripsy is a minimally invasive alternative to open salvage surgery for complex biliary calculi refractory to standard approaches. This treatment is both safe and efficacious. Success depends on a multidisciplinary approach. PMID:19660213

Healy, Kelly; Chamsuddin, Abbas; Spivey, James; Martin, Louis; Nieh, Peter

2009-01-01

263

Bile Duct (Cholangiocarcinoma) Cancer: Radiation Therapy  

MedlinePLUS

... cancer Next Topic Chemotherapy for bile duct cancer Radiation therapy for bile duct cancer Radiation therapy uses ... of radiation for bile duct cancer. External beam radiation therapy (EBRT) This type of radiation therapy uses ...

264

Black Hole Entropy and Dilatations  

E-print Network

Dilatations by means of a constant factor can be seen in a double way: as a simple change of units length or as a conformal mapping of the starting spacetime into a ``stretched'' one with the same units length. The numerical value of the black hole entropy depends on the interpretations made for the stretched manifold. Further, we study the possibility to choose an unusual ``mass dependent'' normalization for the timelike Killing vector for a Kerr black hole with and without a cosmic string.

Stefano Viaggiu

2004-06-14

265

Natural history and management of primary biliary cirrhosis  

PubMed Central

Primary biliary cirrhosis (PBC) is a chronic inflammatory autoimmune disease that mainly targets the cholangiocytes of the interlobular bile ducts in the liver. It is a rare disease with prevalence of less than one in 2000. Its prevalence in developing countries is increasing presumably because of growth in recognition and knowledge of the disease. PBC is thought to result from a combination of multiple genetic factors and superimposed environmental triggers. The contribution of the genetic predisposition is evidenced by familial clustering. Several risk factors, including exposure to infectious agents and chemical xenobiotics, have been suggested. Common symptoms of the disease are fatigue and pruritus, but most patients are asymptomatic at first presentation. The prognosis of PBC has improved because of early diagnosis and use of ursodeoxycholic acid, the only established medical treatment for this disorder. When administered at adequate doses of 13–15 mg/kg/day, up to two out of three patients with PBC may have a normal life expectancy without additional therapeutic measures. However, some patients do not respond adequately to ursodeoxycholic acid and might need alternative therapeutic approaches. PMID:24367233

Al-Harthy, Nadya; Kumagi, Teru

2012-01-01

266

The pupil dilation response to visual detection  

NASA Astrophysics Data System (ADS)

The pupil dilation reflex is mediated by inhibition of the parasympathetic Edinger-Westphal oculomotor complex and sympathetic activity. It has long been documented that emotional and sensory events elicit a pupillary reflex dilation. Is the pupil response a reliable marker of a visual detection event? In two experiments where viewers were asked to report the presence of a visual target during rapid serial visual presentation (RSVP), pupil dilation was significantly associated with target detection. The amplitude of the dilation depended on the frequency of targets and the time of the detection. Larger dilations were associated with trials having fewer targets and with targets viewed earlier during the trial. We also found that dilation was strongly influenced by the visual task.

Privitera, Claudio M.; Renninger, Laura W.; Carney, Thom; Klein, Stanley; Aguilar, Mario

2008-02-01

267

Does hepatic vagus nerve modulate the progression of biliary fibrosis in rats?  

PubMed

Recent studies have shown that vagus nerve activation inhibits cytokine production in a variety of non-neural cells though activation of ?7 nicotinic acetylcholine receptor (?7nAChR). Since chronic inflammation plays a pivotal role in liver fibrosis, this study was designed to investigate the role of hepatic vagus nerve in the progression of hepatic fibrosis in rats. Cirrhosis was induced by chronic ligation of the bile duct. Hepatic hydroxyproline level, portal pressure, serum transaminase level, hepatic TIMP-1 (tissue inhibitor of metalloproteinase-1) and MCP-1 (monocyte chemoattractant peptide-1) expression were measured in order to assess the progression of liver cirrhosis. ?7nAChR expression was assessed using RT-PCR as well as immunostaining. RT-PCR analysis of the liver showed that ?7nAChR mRNA is expressed in rat liver. Immunostaining study demonstrated that hepatic ?7nAChR is mainly expressed in the hepatocytes of cirrhotic liver with minimum ?7nAChR expression in biliary epithelium or myofibroblasts. Bile duct ligation was associated with portal hypertension, increased hepatic hydroxyproline level as well as TIMP-1 and MCP-1 expression in the liver. However neither selective hepatic vagotomy nor methyllycaconitine (an ?7nAChR antagonist) could significantly affect development of portal hypertension or hepatic fibrosis in rats. Selective hepatic vagotomy could only attenuate serum aspartate aminotransferase level in bile duct ligated rats but did not have a significant effect on hepatic inflammation as assessed by MCP-1 mRNA expression. Our study provides evidence against a crucial role for the hepatic vagus nerve as an intrinsic protective mechanism in modulation of hepatic fibrosis in a rat model of biliary cirrhosis. PMID:25088816

Hajiasgharzadeh, Khalil; Tavangar, Seyed Mohammad; Javan, Mohammad; Dehpour, Ahmad R; Mani, Ali R

2014-10-01

268

Primary common bile duct stones  

Microsoft Academic Search

Primary or stasis stones in the common duct are a distinct clinical, anatomical, and pathological entity. In the older patient with chills, fever, and jaundice, it is axiomatic that a primary or stasis stone will be found in a common duct that measures 20 mm or more in diameter. Furthermore, about 20% of such patients will not have stones in

John L. Madden

1978-01-01

269

Dilated cardiomyopathy due to a phospholamban duplication.  

PubMed

Dilated cardiomyopathy is characterised by dilation and impaired systolic function. We present the case of a child with dilated cardiomyopathy caused by a 624 kb duplication of 6q22.31, which includes the phospholamban gene. The patient also has failure to thrive and developmental delay due to complex cytogenetic abnormalities including a 5p15 deletion associated with Cri du Chat and an 11p15 duplication associated with Russell-Silver syndrome. PMID:24451198

Lee, Teresa M; Addonizio, Linda J; Chung, Wendy K

2014-10-01

270

Brain abscess after esophageal dilatation: case report.  

PubMed

Brain abscess formation is a serious disease often seen as a complication to other diseases and to procedures. A rare predisposing condition is dilatation therapy of esophageal strictures. A case of brain abscess formation after esophageal dilatations is presented. A 59-year-old woman was admitted with malaise, progressive lethargy, fever, aphasia and hemiparesis. Six days before she had been treated with esophageal dilatation for a stricture caused by accidental ingestion of caustic soda. The brain abscess was treated with surgery and antibiotics. She recovered completely. This clinical case illustrates the possible association between therapeutic esophageal dilatation and the risk of brain abscess formation. PMID:17710371

Gaïni, S; Grand, M; Michelsen, J

2008-02-01

271

Treatment of Common Bile Duct Obstruction by Pancreatic Cancer Using Various Stents: Single-Center Experience  

SciTech Connect

Purpose: To compare the effectiveness of various means of stenting in patients with biliary obstruction caused by pancreatic cancer in a retrospective analysis. Methods: Sixty-two patients with biliary obstruction due to unresectable pancreatic cancer underwent biliary stenting. On the basis of the findings obtained by percutaneous transhepatic cholangiography(10 patients) and endoscopic retrograde cholangiography (52 patients),the site of obstruction was distal to the hilar confluence,predominantly especially in the middle to lower third of the common bile duct. Polyurethane-covered Wallstents (9 mm in diameter) we reinserted in 13 patients, while uncovered Wallstents (10 mm in diameter)were used in 10 patients and plastic stents (10 Fr and 12 Fr) were used in 39 patients. Results: Stenting was successful in 34 patients (87.2%) treated with plastic stents and in 22 patients(95.7%) treated with Wallstents. Effective biliary drainage was achieved in 32 out of 34 patients (94.1%) treated with plastic stents and in 21 out of 22 patients (95.5%) treated with Wallstents. The cumulative patency rate was significantly higher for the uncovered and covered Wallstents compared to plastic stents, but was not significantly higher for covered than for uncovered Wallstents. Stentocclusion occurred in 23 patients (70%; all by clogging) from the plastic stent group, in two patients (22%; by tumor ingrowth) from the uncovered Wallstent group, and in one patient (9%; by clogging) from the covered Wallstent group. The survival rate showed no significant difference among the three stent groups. Conclusion: The Wallstent is effective for long-term palliation in patients with obstruction caused by pancreatic cancer invading the middle to lower part of the common bile duct. The covered Wallstent can prevent tumor ingrowth, a problem with the uncovered Wallstent. However, it may be necessary to take measures to prevent the migration or clogging of covered Wallstents.

Nakamura, Toshifumi; Hirai, Ritsuko; Kitagawa, Mutsuo; Takehira, Yasunori; Yamada, Masami [Department of Gastroenterology, Hamamatsu Medical Center, 328 Tomitsuka-cho, Hamamatsu, Shizuoka (Japan); Tamakoshi, Katsutoshi; Kobayashi, Yoshimasa; Nakamura, Hirotoshi [SecondDepartment of Internal Medicine, Hamamatsu University School ofMedicine, Shizuoka (Japan); Kanamori, Masao [Department of Public Health, HamamatsuUniversity School of Medicine, Shizuoka (Japan)

2002-10-15

272

Pancreatic duct strictures  

Microsoft Academic Search

Opinion statement  \\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a The treatment of pancreatic duct strictures is based on an accurate assessment of the etiology of the disease, and then the\\u000a degree of symptomatology. Our outline for therapy is as follows:\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Exclude a diagnosis of malignancy by using radiologic, endoscopic, histologic, and molecular biologic modalities.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Once a benign stricture has been demonstrated, we favor a

Jawad Ahmad; John Martin

2000-01-01

273

[Porta-biliary area modifications during the graft-versus-host reaction in chick embryo and rat fetus].  

PubMed

Our results (light and electron microscopic study) show that both in chick embryos engrafted with fowl homologous spleen cells and in rat fetuses receiving blood cells from their own mother (homologous system) histologic changes occur in porta-biliary areas consisting in paravascular infiltrates (P.V.I.), bile ducts disorganization and periportal hepatocyte alterations. These modifications are closely similar to those described in other post-natal Graft Versus Host Reaction models. Yet, in both cases, the cells of the P.V.I. are chiefly of the granulocytic serie instead of the classical lymphoïd P.V.I. PMID:43189

Gérard, H; Kohler, F

1979-01-01

274

PMR Graphite Engine Duct Development  

NASA Technical Reports Server (NTRS)

The objective was to demonstrate the cost and weight advantages that could be obtained by utilizing the graphite/PMR15 material system to replace titanium in selected turbofan engine applications. The first component to be selected as a basis for evaluation was the outer bypass duct of the General Electric F404 engine. The operating environment of this duct was defined and then an extensive mechanical and physical property test program was conducted using material made by processing techniques which were also established by this program. Based on these properties, design concepts to fabricate a composite version of the duct were established and two complete ducts fabricated. One of these ducts was proof pressure tested and then run successfully on a factory test engine for over 1900 hours. The second duct was static tested to 210 percent design limit load without failure. An improved design was then developed which utilized integral composite end flanges. A complete duct was fabricated and successfully proof pressure tested. The net results of this effort showed that a composite version of the outer duct would be 14 percent lighter and 30 percent less expensive that the titanium duct. The other type of structure chosen for investigation was the F404 fan stator assembly, including the fan stator vanes. It was concluded that it was feasible to utilize composite materials for this type structure but that the requirements imposed by replacing an existing metal design resulted in an inefficient composite design. It was concluded that if composites were to be effectively used in this type structure, the design must be tailored for composite application from the outset.

Stotler, C. L.; Yokel, S. A.

1989-01-01

275

[Significance of biliary dysfunction in the pathogenesis of gallstone disease].  

PubMed

The paper shows the role of biliary dysfunction in the formation of biliary sludge. Found that among all motor dysfunction themost common is reduction of contractile function of the gallbladder (in 63.3% of cases), which is combined with 73.2% Oddi's sphincter hypertonus. T The combination of ursodeoxycholic acid (UDCA) with mebeverine has a better effect than monotherapy with UDCA, as increases the frequency of relief of biliary dyspepsia symptoms, normalizes the biliary tract functional status and 95% of cases leads to the elimination of biliary sludge. PMID:22364003

Il'chenko, I A; Deliukina, O V

2011-01-01

276

Common bile duct wall thickening due to intramural varices diagnosed by colour Doppler ultrasound.  

PubMed

Cases of common bile duct (CBD) wall thickening due to varicose dilation of intramural veins consequential to portal vein thrombosis (PVT) are rare and present a considerable differential diagnostic problem, as they can mimic cholangiocarcinoma. In such cases, colour Doppler ultrasound (CD US) is a very valuable diagnostic method. There are only a few reports in literature on CD US findings of collateral circulation in a thickened CBD wall following PVT. A patient with obstructive jaundice, a tumour of the pancreatic head, CBD wall thickening, and pre-existing PVT is presented. CD US demonstrated collateral circulation of the thrombosed portal vein in the thickened wall of the common bile duct, thus ruling out a mass in the CBD. Obstructive jaundice seldom occurs with choledocal varices. In this patient, the bile duct obstruction was due to the carcinoma of the pancreatic head. PMID:16596516

Grgurevi?, I; Buljevac, M; Kujundzi?, M; Vukeli?-Markovi?, M; Kardum, D; Brkljaci?, B

2006-10-01

277

Mechanical Properties of Dilated Human Ascending Aorta  

Microsoft Academic Search

Dilation of the ascending aorta, associated with Marfan Syndrome, bicuspid aortic valve, or advanced age, may lead to aortic dissection and rupture. Mathematical models can be used to assess the relative importance of increased wall stresses and decreased strength in these mechanical failures. To obtain needed inputs for such models, mechanical properties of dilated human ascending aorta were measured in

Ruth J. Okamoto; Jessica E. Wagenseil; William R. DeLong; Sara J. Peterson; Nicholas T. Kouchoukos; Thoralf M. Sundt; III

2002-01-01

278

The role of dilatation in bilharzial ureters.  

PubMed

Endoscopic dilatation of bilharzial ureteric strictures was carried out in 35 men and four women. The procedure had to be repeated in 10 patients after 2 months and three patients have required regular dilatation every 4 months for the last 2 years. The selection of patients is important since they should have neither an active lesion nor a stenotic calcific one. PMID:3109536

Wishahi, M M

1987-05-01

279

Recent advances in endoscopic management of difficult bile duct stones.  

PubMed

Endoscopic treatment is now recognized worldwide as the first-line treatment for bile duct stones. Endoscopic sphincterotomy combined with basket and/or balloon catheter is generally carried out for stone extraction. However, some stones are refractory to treatment under certain circumstances, necessitating additional/other therapeutic modalities. Large bile duct stones are typically treated by mechanical lithotripsy. However, if this fails, laser or electrohydraulic lithotripsy (EHL) is carried out under the guidance of conventional mother-baby cholangioscopy. More recently, direct cholangioscopy using an ultrathin gastroscope and the newly developed single-use cholangioscope system - the SpyGlass direct visualization system - are also used. In addition, extracorporeal shock wave lithotripsy has also been used for stone fragmentation. Such fragmentation techniques are effective in cases with impacted stones, including Mirizzi syndrome. Most recently, endoscopic papillary large balloon dilationhas been introduced as an easy and effective technique for treating large and multiple stones. In cases of altered anatomy, it is often difficult to reach the papilla; in such cases, a percutaneous transhepatic approach, such as EHL or laser lithotripsy under percutaneous transhepatic cholangioscopy, can be a treatment option. Moreover, enteroscopy has recently been used to reach the papilla. Furthermore, an endoscopic ultrasound-guided procedure has been attempted most recently. In elderly patients and those with very poor general condition, biliary stenting only is sometimes carried out with or without giving subsequent dissolution agents. PMID:23650878

Yasuda, Ichiro; Itoi, Takao

2013-07-01

280

A prospective study of radionuclide biliary scanning in acute pancreatitis.  

PubMed Central

Early surgery for biliary pancreatitis has resulted in a need for an accurate method of gallstone detection in acute pancreatitis. Fifty patients with acute pancreatitis were studied prospectively to assess the diagnostic value of Radionuclide Biliary Scanning (RBS) performed within 72 hours of an attack. To assess the general accuracy of RBS a further 154 patients with suspected acute cholecystitis or biliary colic were similarly studied. There were 34 patients with biliary pancreatitis and 18 (53%) had a positive scan (no gallbladder seen). There were 16 patients with non-biliary pancreatitis and 5 (31%) had a positive scan. All 51 patients with acute cholecystitis had a positive scan, as did 82% of the 51 patients with biliary colic. There were 52 patients with no biliary or pancreatic disease and none of these had a positive scan. RBS is highly accurate in confirming a diagnosis of acute cholecystitis or biliary colic. However, it cannot be relied on to differentiate between biliary and non-biliary pancreatitis and should certainly not be used as the basis for biliary surgery in these patients. PMID:6859781

Neoptolemos, J. P.; Fossard, D. P.; Berry, J. M.

1983-01-01

281

Measurements of Smoke Characteristics in HVAC Ducts  

Microsoft Academic Search

The characteristics of smoke traveling in an HVAC duct have been observed along with the response of selected duct smoke detectors. The simulated HVAC system consists of a 9 m long duct, 0.45 m in diameter. An exhaust fan is placed at one end of the duct and is capable of inducing airflow rates that range from 0 to 1.5

Steven D. Wolin; Noah L. Ryder; Frederic Leprince; James A. Milke; Frederick W. Mowrer; Jose L. Torero

2001-01-01

282

Isaptent--a new cervical dilator.  

PubMed

A new cervical dilator, Isaptent, was prepared from granulated Plantago ovata (Isapgol) seed husk. It was evaluated in a multicentric clinical trial for dilatation of the cervix in subjects opting for medical termination of pregnancy. The trial covered 804 women in over 21 centres in different parts of the country. The cases were between 15 to 45 years of age, 0 to 10 parity with a gestation period of 8 to 24 weeks. A single tent was used in 750 subjects and satisfactory dilatation was achieved in 94% of the cases. The cervical dilatation bore no relationship to age, parity and gestation period of the subjects. The tent provided self-lubrication, caused no apparent damage to the cervix and the vaginal flora remained unchanged in the randomly selected subjects in whom bacteriologic studies were performed. The outcome of the clinical trial and advantages of Isaptent over the other procedures used for cervical dilatation are discussed. PMID:6987038

Khanna, N M; Sarin, J P; Nandi, R C; Singh, S; Setty, B S; Kamboj, V P; Dhawan, B N; Singh, L; Kutty, D; Engineer, A D

1980-01-01

283

Mirizzi syndrome type Va: A rare coexistence of double cholecysto-biliary and cholecysto-enteric fistulae  

PubMed Central

Mirizzi syndrome is a rare cause of intermittent obstructive jaundice, where an impacted stone in the cystic duct or Hartmann’s pouch mechanically obstructs the common bile duct (CBD). We report a rare case of double cholecysto-biliary and cholecysto-enteric fistulae, in a 75-year-old female patient, presenting with a right upper quadrant abdominal pain and intermittent obstructive jaundice. Endoscopic retrograde cholangiopancreatography suggested Mirizzi syndrome. Operative findings included erosions of the lateral wall of the CBD and the second portion of the duodenum due to impacted gallstones. The defects were reconstructed primarily and a Kehr tube was inserted. The patient had an uneventful postoperative course and was discharged on the 14th postoperative day. PMID:21161027

Lampropoulos, Pavlos; Paschalidis, Nikolaos; Marinis, Athanasios; Rizos, Spiros

2010-01-01

284

Pharmacological manipulation of biliary water and lipids: potential consequences for prevention of acute biliary pancreatitis.  

PubMed

Acute biliary pancreatitis, caused by macroscopic cholesterol gallstones or microlithiasis, is often a severe disease with considerable morbidity and mortality. Formation of cholesterol gallstones and microlithiasis is caused by cholesterol crystallization from cholesterol supersaturated gallbladder bile. Particularly patients with fast and extensive crystallization, due to highly concentrated bile, low biliary phospholipid contents and gallbladder mucin hypersecretion seem at risk for pancreatitis. Patients who suffered from acute biliary pancreatitis should undergo cholecystectomy as secondary prevention strategy. For patients at high surgical risk, endoscopic sphincterotomy may be an appropriate alternative. Pharmacological manipulation of biliary lipids by the hydrophilic bile salt ursodeoxycholic acid is reserved for patients with recurrent pancreatitis despite previous cholecystectomy or sphincterotomy, or with contraindications to surgical and endoscopic treatment. Maintenance therapy with ursodeoxycholic acid is however a very effective secondary prevention strategy. Potentially, secondary prevention of acute biliary pancreatitis could also be achieved through decreasing biliary mucin contents by UDCA, NSAIDs or N-acetylcystein, or through achieving bile dilution (currently not feasible). PMID:16089352

Venneman, Niels G; vanBerge-Henegouwen, Gerard P; van Erpecum, Karel J

2005-06-01

285

Urosodeoxycholic Acid Therapy in a Child with Trimethoprim-Sulfamethoxazole-induced Vanishing Bile Duct Syndrome  

PubMed Central

We present a case of a 7-year-old boy who had cholestasis after trimethoprim-sulfamethoxazole combination therapy. Liver biopsy was performed 36 days after the onset of jaundice because of no evidence of improving cholestasis. Liver histology revealed portal inflammation, bile plug, and biliary stasis around the central vein with the loss of the interlobular bile ducts. Immunohistochemical stains for cytokeratin 7 and 19 were negative. These findings were consistent with those of vanishing bile duct syndrome (VBDS). Chlestasis was progressively improved with dose increment of urosodeoxycholic acid from conventional to high dose. This is the first case report of trimethoprime-sulfamethoxazole associated VBDS in Korean children. The case suggests that differential diagnosis of VBDS should be considered in case of progressive cholestatic hepatitis with elevation of alkaline phosphatase and gamma-glutamyl transpeptidase after or during taking medicine to treat nonhepatobiliary diseases illness. PMID:24511525

Cho, Hyun Jeong; Jwa, Hye Jeong; Kim, Kyu Seon; Gang, Dae Yong

2013-01-01

286

Sound propagation in choked ducts  

NASA Technical Reports Server (NTRS)

The linearized equations describing the propagation of sound in variable area ducts containing flow are shown to be singular when the duct mean flow is sonic. The singularity is removed when previously ignored nonlinear terms are retained. The results of a numerical study, for the case of plane waves propagating in a one-dimensional converging-diverging duct, show that the sound field is adequately described by the linearized equations only when the axial mean flow Mach number at the duct throat M sub th 0.6. For M sub th 0.6, the numerical results showed that acoustic energy flux was not conserved. An attempt was made to extend the study to include the nonlinear behavior of the sound field. Meaningful results were not obtained due, primarily, to numerical difficulties.

Hersh, A. S.; Liu, C. Y.

1976-01-01

287

Articulated transition duct in turbomachine  

DOEpatents

Turbine systems are provided. A turbine system includes a transition duct comprising an inlet, an outlet, and a duct passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of the transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The duct passage includes an upstream portion and a downstream portion. The upstream portion extends from the inlet between an inlet end and an aft end. The downstream portion extends from the outlet between an outlet end and a head end. The turbine system further includes a joint coupling the aft end of the upstream portion and the head end of the downstream portion together. The joint is configured to allow movement of the upstream portion and the downstream portion relative to each other about or along at least one axis.

Flanagan, James Scott; McMahan, Kevin Weston; LeBegue, Jeffrey Scott; Pentecost, Ronnie Ray

2014-04-29

288

Analysis of residential duct losses  

NASA Astrophysics Data System (ADS)

To assess the impact of measured duct losses on energy consumption, it is necessary to consider the duct system as but one element in the residential environmental control system that includes both the building frame and the furnace. Based on data collected in this effort, it was concluded that duct systems should include return registers in each room and balancing dampers in all supply branches. This will increase occupant comfort and decrease heating costs. It may also improve the performance of a central air conditioning system. It was also found that taping and insulating duct-work can produce meaningful energy savings, while the use of outside air for combustion was of minor consequence.

Orlando, J. A.; Gamze, M. G.; Malik, N.; Crews, R.; Michaels, G.; Christie, J.

1980-08-01

289

Increased biliary protein precedes gallstone formation  

Microsoft Academic Search

Although nucleation is critical to the pathogenesis of cholesterol gallstones, the factors responsible for this process are poorly defined. Numerous potential nucleating agents have been identified in the bile of humans and animals with cholelithiasis, including mucus, calcium, and bilirubin. Recent studies have shown that patients with cholesterol crystals and gallstones have increased biliary total protein, suggesting that protein may

A. James Moser; Mohammad Z. Abedin; Joel J. Roslyn

1994-01-01

290

Primary cancers of extrahepatic biliary passages  

Microsoft Academic Search

The records of 22 patients with cancers of extrahepatic biliary passages (EHBP) were analyzed to understand their natural histories and patterns of failure and to evaluate the effectiveness of various treatments. None of the preoperative investigations consistently defined the entire extent of tumor. Percutaneous transhepatic cholangiography (PTHC) was the most helpful (100%) in accurately defining the site of ductal obstruction.

B. Mittal; M. Deutsch; S. Iwatsuki

1985-01-01

291

TWO NEW DUCT LEAKAGE TESTS  

SciTech Connect

Two variations on the tests for duct leakage currently embodied in ASHRAE Standard 152P (Method of Test for Determining the Design and Seasonal Efficiencies of Residential Thermal Distribution Systems) are presented. Procedures are derived for calculating supply and return duct leakage to/from outside using these new variations. Results of these tests are compared with the original ones in Standard 152P on the basis of data collected in three New York State homes.

ANDREWS,J.W.

1998-12-01

292

External stenting of pancreaticojejunostomy anastomosis and pancreatic duct after pancreaticoduodenectomy.  

PubMed

Pancreatic fistula is a major cause of morbidity and mortality after pancreaticoduodenectomy. External drainage of pancreaticojejunostomy anastomosis with a stent is used to reduce the rate of pancreatic fistula. This study compares the rates of pancreatic fistula between external stent drainage versus no-stent drainage for pancreaticojejunal anastomosis following pancreaticoduodenectomy. A total of 53 patients undergoing pancreaticoduodenectomy for various benign and malignant pathologies were included in the study. An external stent was inserted across the anastomosis to drain the pancreatic duct in 26 patients and 27 patients received no stent. The primary end point was pancreatic fistula. All surgeries were done by a single surgeon with expertise in hepatobiliary pancreatic surgery at a single institute. The two groups were comparable in demographic data, underlying pathologies, presenting complaints, presence of comorbid illnesses and proportion of patients with preoperative biliary drainage, pancreatic consistency and duct diameter. The pancreatic fistula rates were similar in both the groups (11.5 vs. 14.8 %, P = 0.725). The morbidity and surgical re-exploration rate were statistically not significant between the two groups (65.4 vs. 51.9 %, P = 0.318 and 11.5 vs. 7.4 %, P = 0.60). Postoperative stay was also similar with a mean of 14 days in both the groups (P = 0.66). The mortality rate was statistically not significant in the two groups (3.8 vs. 7.4 %, P = 0.575). External drainage of pancreaticojejunostomy anastomosis and the pancreatic duct with a stent does not decrease the rate of postoperative pancreatic fistula after pancreaticoduodenectomy. PMID:22987013

Kaman, Lileswar; Nusrath, Syed; Dahiya, Divya; Duseja, Ajay; Vyas, Sameer; Saini, Vikas

2012-12-01

293

Alteration of methotrexate biliary and renal elimination during extrahepatic and intrahepatic cholestasis in rats.  

PubMed

Methotrexate (MTX), an important anticancer and immunosuppressive agent, has been suggested for the treatment of primary biliary cirrhosis. However, the drug's pharmacodynamics and toxicity is dependent on its concentrations in plasma which in turn are directly related to MTX's elimination in the liver and kidney. Therefore, the aim of this study was to evaluate changes in MTX biliary and renal excretion during either intrahepatic or obstructive cholestasis in rats. The steady state pharmacokinetic parameters of MTX were evaluated in rats one (BDO1) or seven (BDO7) days after bile duct obstruction (BDO) or 18 h after administration of lipopolysaccharide (LPS). In comparison to the respective control groups, biliary and total clearances of MTX were decreased to 12% and 49% in the BDO1 group, to 5% and 56% in the BDO7 animals, and to 42% and 43% in the LPS group, respectively. Renal clearance of MTX was unchanged in BDO groups, but decreased to 23% of controls in the LPS animals. The serum biochemistry and expression of main hepatic MTX transporters (Mrp2, Mrp3, Mrp4, Bcrp, Oatp1a1, Oatp1a4 and Oatp1b2) confirmed the pathological cholestatic changes in the liver and partly elucidated the cause of changes in MTX pharmacokinetic parameters. In conclusion, this study is the first describing marked alteration of MTX hepatic and renal elimination induced by cholestasis in rats. Moreover, the reported changes in MTX pharmacokinetics and respective transporter expression suggest important mechanistic differences between the two widely used cholestatic models. PMID:19952415

Brcakova, Eva; Fuksa, Leos; Cermanova, Jolana; Kolouchova, Gabriela; Hroch, Milos; Hirsova, Petra; Martinkova, Jirina; Staud, Frantisek; Micuda, Stanislav

2009-12-01

294

Longterm outcome of photodynamic therapy compared with biliary stenting alone in patients with advanced hilar cholangiocarcinoma  

PubMed Central

Objectives This study aimed to determine longterm outcomes and factors associated with increased survival after photodynamic therapy (PDT) compared with endoscopic biliary drainage alone in patients presenting with advanced hilar cholangiocarcinoma (CC). Methods A retrospective analysis of the institutional database identifying all patients who presented with a diagnosis of hilar CC between December 1999 and January 2011 was conducted. Results Of the 232 patients identified, 72 (31%) were treated with PDT (Group A) and 71 (31%) were treated with endoscopic biliary drainage alone (Group B). Median survival was 9.8 months [95% confidence interval (CI) 7.42–12.25] in Group A and 7.3 months (95% CI 4.79–9.88) in Group B (P= 0.029). On multivariate analysis, biliary drainage without PDT (P= 0.025) and higher T-stage (P= 0.002) were significant predictors of shorter survival in all patients. In a subgroup analysis of patients in the PDT group, lower pre-PDT bilirubin level (P= 0.005), multiple PDT treatments (P= 0.044) and shortened time to treatment after diagnosis (P= 0.013) were significant predictors of improved survival. Median metal stent patency was longer in Group A than in Group B (215 days vs. 181 days; P= 0.018). Conclusions Photodynamic therapy with stenting resulted in longer survival than stenting alone. Early PDT after diagnosis and multiple PDT treatments were shown to have survival benefits. Metal stent patency was longer in patients receiving PDT. Higher T-stage appears to be a predictor of early mortality in advanced bile duct cancer treated with PDT. PMID:22321037

Cheon, Young Koog; Lee, Tae Yoon; Lee, Seung Min; Yoon, Jung Yoon; Shim, Chan Sup

2012-01-01

295

Safety and efficacy of a novel plastic stent coated with stone-dissolving agents for the treatment of biliary stones in a porcine model.  

PubMed

Background and study aim: We previously reported on a plastic stent that was coated with ethylenediaminetetraacetic acid (EDTA) and sodium cholate, which dissolved common bile duct (CBD) stones ex vivo. The aim of this study was to investigate the safety and efficacy of such stents on biliary stones in a live porcine model. Methods: Stents without coating or with degradable membranes containing 0?% or 50?% EDTA and sodium cholate were inserted together with human CBD stones into the porcine CBD. Serum laboratory variables, histological examinations of the bile duct, and the weight change in stones were compared during and after stent placement for 6 months. Results: A total of 16 pigs were included (5 no coating, 5 0?% coating, 6 50?% coating). Biliary stones showed decreased weight in all groups; however, stones in the group with 50?% coated stents showed a greater reduction in weight compared with the no coating and the 0?% coating groups (269?±?66?mg vs. 179?±?51?mg [P?=?0.09]; 269?±?66?mg vs. 156?±?26?mg [P?=?0.01], respectively). Conclusions: The plastic stent coated with 50?% agent enhanced CBD stone dissolution in vivo and may be a promising tool for patients with difficult biliary stones. PMID:25479561

Cai, Xiao Bo; Zhang, Wei Xing; Zhang, Ru Ling; Dong Yuan, Xiao; Yang, Qin; Qi, Xiao Shen; Li, Bai Wen; Qin Qian, Yue; Wang, Xing Peng; Lu, Lun Gen; Xu, Zheng Jie; Wan, Xin Jian

2014-12-01

296

IgG4 Levels in Bile for Distinguishing IgG4-Associated Cholangiopathy from Other Biliary Disorders: A Single Blinded Pilot Study  

PubMed Central

Background/Aims Immunoglobulin G4 (IgG4)-associated cholangiopathy (IAC) is an inflammatory disease and may mimic primary sclerosing cholangitis (PSC), cholangiocarcinoma (CCA), or pancreatic cancer on cholangiography. We investigated whether IgG4 levels in bile aspirated during endoscopic retrograde cholangiopancreatography (ERCP) can distinguish IAC from PSC, CCA, and pancreatic cancer. Methods Bile was aspirated directly from the common bile duct during ERCP in patients with IAC prior to steroid therapy. For control purposes, bile was obtained from patients with PSC, CCA, pancreatic cancer, and benign biliary conditions (sphincter of oddi dysfunction/choledocholithiasis). Results Biliary IgG4 levels were measured in 54 patients. The median bile IgG4 levels were markedly elevated in patients with IAC (5.5 mg/dL; interquartile range [IQR], 5.1 to 15.6) as compared to patients with benign biliary conditions (0 mg/dL; IQR, 0 to 0.1; p=0.003). The median biliary IgG4 levels in PSC, CCA, and pancreatic cancer were 1.2 (IQR, 0.2 to 3.8), 0.9 (IQR, 0.2 to 3.4), and 0.2 mg/dL (IQR, 0.1 to 0.8), respectively. A cutoff value of 3.8 mg/dL distinguished IAC from PSC and CCA patients with 100% and 76.9% sensitivity and specificity, respectively. Conclusions The results of this pilot study suggest that measurement of biliary IgG4 levels may have clinical value in distinguishing patients with IAC from biliary disorders that can mimic IAC. PMID:25505722

Navaneethan, Udayakumar; Gutierrez, Norma G.; Jegadeesan, Ramprasad; Venkatesh, Preethi GK; Poptic, Earl; Sanaka, Madhusudhan R.; Vargo, John J.

2014-01-01

297

Experimental Study of Poly-l-Lactic Acid Biodegradable Stents in Normal Canine Bile Ducts  

SciTech Connect

Purpose: This study was designed to clarify the advantages of biodegradable stents in terms of mucosal reaction and biodegradation after placement. We designed a biodegradable stent and assessed stent degradation and changes in the normal bile ducts of dogs. Methods: The biodegradable stent is a balloon-expandable Z stent consisting of poly-l-lactic acid (PLLA) with a diameter of 6 mm and a length of 15 mm. We assessed four groups of three beagle dogs each at 1, 3, 6, and 9 months of follow-up. After evaluating stent migration by radiography and stent and bile duct patency by cholangiography, the dogs were sacrificed to remove the bile duct together with the stent. The bile duct lumen was examined macroscopically and histologically, and the stent degradation was examined macroscopically and by scanning electron microscopy (SEM). Results: Bile duct obstruction was absent and none of the stents migrated. Macroscopic evaluation showed moderate endothelial proliferation in the bile ducts at the implant sites at 3 and 6 months and a slight change at 9 months. Slight mononuclear cell infiltration was histologically identified at all time points and epithelial hyperplasia that was moderate at 3 months was reduced to slight at 6 and 9 months. Stent degradation was macroscopically evident in all animals at 9 months and was proven by SEM in two dogs at 6 months and in all of them at 9 months. Conclusions: Our results suggest that PLLA bioabsorbable stents seems to be useful for implantation in the biliary system with further investigation.

Yamamoto, Kiyosei, E-mail: yamakiyo@zg7.so-net.ne.jp; Yoshioka, Tetsuya; Furuichi, Kinya; Sakaguchi, Hiroshi; Anai, Hiroshi; Tanaka, Toshihiro; Morimoto, Kengo [Nara Medical University, Department of Radiology (Japan); Uchida, Hideo [Daiyukai General Hospital, Department of Radiology (Japan); Kichikawa, Kimihiko [Nara Medical University, Department of Radiology (Japan)

2011-06-15

298

Nervous and Neuroendocrine regulation of the pathophysiology of cholestasis and of biliary carcinogenesis  

PubMed Central

Cholangiocytes, the epithelial cells lining the biliary ducts, are the target cells in several liver diseases. Cholangiopathies and cholangiocarcinoma generate interest in many scientists since the genesis. The developing mechanisms, and the therapeutic tools of these diseases are still undefined. Several studies demonstrate that many hormones, neuropeptides and neurotransmitters regulate malignant and non-malignant cholangiocyte pathophysiology in the course of chronic biliary diseases. The aim of this review is to present the findings of several studies published in the recent years that contributed to clarifying the role of nervous and neuroendocrine regulation of the pathophysiologic events associated with cholestasis and cholangiocarcinoma development. This manuscript is organized into two parts. The first part offers an overview of the innervation of the liver and the origin of neuroendocrine hormones, neurotransmitters and neuropeptides affecting cholangiocyte function and metabolism. The first section also reviews the effects played by several neuroendocrine hormones and nervous system on cholangiocyte growth, survival and functional activity in the course of cholestasis. In the second section, we summarize the results of some studies describing the role of nervous system and neuroendocrine hormones in the regulation of malignant cholangiocyte growth. PMID:16773704

Marzioni, Marco; Fava, Giammarco; Benedetti, Antonio

2006-01-01

299

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

PubMed

Biliary atresia (BA) is a neonatal disorder characterized by aggressive fibroinflammatory obliteration of the biliary tract. Approximately 20 percent of BA patients demonstrate left-right laterality defects (syndromic BA). Cilia participate in important physiological functions in cholangiocytes, and as some ciliopathies have been associated with both laterality defects and hepatic fibrosis, we hypothesized that patients with syndromic BA exhibit abnormalities of cholangiocyte cilia that disrupt cholangiocyte homeostasis. Nine BA 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 with 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 BA specimens were significantly shorter, abnormal in their orientation, and less abundant compared with normal liver and disease controls regardless of the presence of a laterality defect. There are significant abnormalities of cholangiocyte cilia in both syndromic and non-syndromic BA livers compared with normal livers and livers affected by other cholestatic diseases. Although this may result from severe cholestasis or inflammation, it may also reflect common mechanistic pathways in different forms of BA and may have important implications for understanding the progression of the disease. PMID:22301700

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

2012-05-01

300

Resolution of hydatid liver cyst by spontaneous rupture into the biliary tract.  

PubMed

Among the complications of hydatid liver disease, spontaneous cyst rupture into the biliary tract is unusual, occurring in 3.2-17% of cases. Its endoscopic management has been reported rarely, and corresponding complete photodocumentation is unique. Such a case is described and comprehensively illustrated in a 48-year-old immunocompromised man, presenting with upper abdominal pain, obstructive jaundice, and fever. Impaction of hydatid material into the common bile duct and the papilla of Vater was relieved endoscopically, and the patient was consecutively treated with two courses of mebendazole. This management resulted in complete clinical resolution of hepatic hydatosis after 8 months of follow-up. Complications of overt cyst perforation may be allergic, obstructive, secondary infectious, or metastatic. Ultrasound and computed tomography are complementary tools for diagnosis of hepatic echinococcosis, with endoscopic retrograde cholangiography being the "gold standard" in confirming rupture into the biliary system. Laboratory results are usually non-specific. While surgical excision is the treatment of choice, selected patients may primarily be managed endoscopically, followed by anthelminthic therapy. PMID:9210631

Becker, K; Frieling, T; Saleh, A; Häussinger, D

1997-06-01

301

Autoantibodies in primary biliary cirrhosis: Recent progress in research on the pathogenetic and clinical significance  

PubMed Central

Primary biliary cirrhosis (PBC) is a chronic progressive cholestatic liver disease characterized by immune-mediated destruction of the small- and medium-sized intrahepatic bile ducts and the presence of antimitochondrial antibodies (AMA) in the serum. AMA are detected in over 90% of patients with PBC, whereas their prevalence in the general population is extremely low, varying from 0.16% to 1%. Previous studies have shown that the unique characteristics of biliary epithelial cells undergoing apoptosis may result in a highly direct and very specific immune response to mitochondrial autoantigens. Moreover, recent studies have demonstrated that serum from AMA-positive PBC patients is reactive with a number of xenobiotic modified E2 subunits of the pyruvate dehydrogenase complex, which is not observed in the serum of normal individuals. These findings indicate that chemicals originating from the environment may be associated with a breakdown in the tolerance to mitochondrial autoantigens. While it is currently generally accepted that AMA are the most specific serological markers of PBC, more than 60 autoantibodies have been investigated in patients with PBC, and some have previously been considered specific to other autoimmune diseases. This review covers the recent progress in research on the pathogenetic and clinical significance of important autoantibodies in PBC. Determining the pathogenic role of those autoantibodies in PBC remains a priority of basic and clinical research. PMID:24627596

Yamagiwa, Satoshi; Kamimura, Hiroteru; Takamura, Masaaki; Aoyagi, Yutaka

2014-01-01

302

Radiation Exposure in Biliary Procedures Performed to Manage Anastomotic Strictures in Pediatric Liver Transplant Recipients: Comparison Between Radiation Exposure Levels Using an Image Intensifier and a Flat-Panel Detector-Based System  

SciTech Connect

Purpose: The aim of this study was to estimate radiation exposure in pediatric liver transplants recipients who underwent biliary interventional procedures and to compare radiation exposure levels between biliary interventional procedures performed using an image intensifier-based angiographic system (IIDS) and a flat panel detector-based interventional system (FPDS). Materials and Methods: We enrolled 34 consecutive pediatric liver transplant recipients with biliary strictures between January 2008 and March 2013 with a total of 170 image-guided procedures. The dose-area product (DAP) and fluoroscopy time was recorded for each procedure. The mean age was 61 months (range 4-192), and mean weight was 17 kg (range 4-41). The procedures were classified into three categories: percutaneous transhepatic cholangiography and biliary catheter placement (n = 40); cholangiography and balloon dilatation (n = 55); and cholangiography and biliary catheter change or removal (n = 75). Ninety-two procedures were performed using an IIDS. Seventy-eight procedures performed after July 2010 were performed using an FPDS. The difference in DAP between the two angiographic systems was compared using Wilcoxon rank-sum test and a multiple linear regression model. Results: Mean DAP in the three categories was significantly greater in the group of procedures performed using the IIDS compared with those performed using the FPDS. Statistical analysis showed a p value = 0.001 for the PTBD group, p = 0.0002 for the cholangiogram and balloon dilatation group, and p = 0.00001 for the group with cholangiogram and biliary catheter change or removal. Conclusion: In our selected cohort of patients, the use of an FPDS decreases radiation exposure.

Miraglia, Roberto, E-mail: rmiraglia@ismett.edu; Maruzzelli, Luigi [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Department of Diagnostic and Interventional Radiology (Italy)] [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Department of Diagnostic and Interventional Radiology (Italy); Tuzzolino, Fabio [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Department of Information Technology (Italy)] [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Department of Information Technology (Italy); Indovina, Pietro Luigi [Medical Physic ISMETT Consultant, Fismeco (Italy)] [Medical Physic ISMETT Consultant, Fismeco (Italy); Luca, Angelo [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Department of Diagnostic and Interventional Radiology (Italy)] [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Department of Diagnostic and Interventional Radiology (Italy)

2013-12-15

303

Acute gastric dilatation with infarction and perforation  

PubMed Central

This is a report of a 22-year-old woman with treated anorexia nervosa who died of complications of acute gastric dilatation—that is, infarction and perforation with severe and irreversible shock. Binge eating and drinking, precipitated by emotional crises, contributed to her acute gastric dilatation. This complication of anorexia nervosa has been previously reported, but, unlike the others, this case ended fatally. The literature is reviewed. ImagesFigure PMID:7308853

Saul, S H; Dekker, A; Watson, C G

1981-01-01

304

Gall bladder and extrahepatic bile duct changes in Opisthorchis viverrini-infected hamsters.  

PubMed

Opisthorchis viverrini infection is associated with several hepatobiliary diseases, but few reports have described extrahepatic lesions in opisthorchiasis. We therefore sequentially investigated histological changes of the gall bladder and extrahepatic bile duct in hamsters infected with 25 (group 1), 50 (group 2) and 100 (group 3) metacercariae for up to 180 days. Acute inflammatory reactions, including congestion, neutrophil and eosinophil infiltration, occurred in the gall bladder as early as day 7 of groups 2 and 3 and on day 14 in group 1; the extrahepatic bile ducts exhibited the changes on day 3 post-infection (p.i.). Mononuclear cell infiltration, mucus hypersecretion and fibrosis were gradually observed thereafter. Active inflammation reached a plateau at approximately 60 days in all infected groups. The well-established chronic histological changes of the gall bladder and extrahepatic bile duct were fibrosis and mononuclear cell infiltration with lymphoid aggregation and, additionally, ductal dilatation for the latter. Overall, the pathological changes in the extrahepatic bile duct were more severe than those in the gall bladder for the same dose and period of infection. The results demonstrate that pathological changes in the gall bladder and extrahepatic bile duct do occur in O. viverrini infection and may be extrapolated to human infection. PMID:12062790

Sripa, Banchob; Kaewkes, Sasithorn

2002-07-01

305

Nonanastomotic biliary strictures after liver transplantation, part 1: Radiological features and risk factors for early vs. late presentation.  

PubMed

Nonanastomotic biliary strictures (NAS) are a serious complication after orthotopic liver transplantation (OLT). The exact pathogenesis is unclear. Purpose of this study was to identify risk factors for the development of NAS after OLT. A total of 487 adult liver transplants with a median follow-up of 7.9 years were studied. All imaging studies of the biliary tree were reviewed. Cholangiography was routinely performed between postoperative days 10-14 and later on demand. Localization of NAS at first presentation was categorized into 4 anatomical zones of the biliary tree. Severity of NAS was semiquantified as mild, moderate, or severe. Donor, recipient, and surgical characteristics and variables were analyzed to identify risk factors for NAS. NAS developed in 81 livers (16.6%). Thirty-seven (7.3%) were graded as moderate to severe. In 85% of the cases, anatomical localization of NAS was around or below the bifurcation of the common bile duct. A large variation was observed in the time interval between OLT and first presentation of NAS (median 4.1 months; range 0.3-155 months). NAS presenting early (< or =1 year) after OLT were associated with preservation-related risk factors. Cold and warm ischemia times were significantly longer in patients with early NAS compared with NAS presenting late (>1 year) after OLT (694 minutes vs. 490 minutes, P = 0.01, and 57 minutes vs. 53 minutes, P < 0.05, respectively), and early NAS were more frequently located in the central bile ducts. NAS presenting late (>1 year) after OLT were found more frequently in the periphery of the liver and were more frequently associated with immunological factors, such as primary sclerosing cholangitis, as the indication for OLT (24% vs. 45%, P < 0.05). By separating cases of NAS on the basis of the time of presentation after transplantation, we were able to identify differences in risk factors, indicating different pathogenic mechanisms depending on the time of initial presentation. PMID:17457932

Buis, Carlijn I; Verdonk, Robert C; Van der Jagt, Eric J; van der Hilst, Christian S; Slooff, Maarten J H; Haagsma, Elizabeth B; Porte, Robert J

2007-05-01

306

Biliary Cystadenoma in a Rabbit ( Oryctolagus cuniculus)  

Microsoft Academic Search

Biliary tumors are rarely diagnosed in rabbits, and there are very few published case reports of this disease within this group of animals. This case involves an approximately 6-year-old spayed female pet rabbit that was referred for an abdominal mass noted on survey full-body radiographs obtained during an examination after presenting for acute onset anorexia. Otherwise, the patient had an

Julie DeCubellis; Astrid M. Kruse; Robert J. McCarthy; Laurie A. Zacher; Dominique Penninck; Adam T. Watson; Nicola Parry; Thomas M. Donnelly; Jörg Mayer

2010-01-01

307

Control Analysis of Biliary Lipid Secretion  

Microsoft Academic Search

Biliary lipid secretion is a complex process involving a multitude of metabolic pathways. It has always been assumed that bile salt secretion (BSec) fully controls this process. Recently we have demonstrated, that mdr2 P-glycoprotein (P-gp) is an important controlling step as well. In this study we have analysed the control structure of this pathway with Metabolic Control Analysis.Methods: FVB mice

Albert K. Groen; Ronald P. J. Oude Elferink; Joseph M. Tager

1996-01-01

308

The natural history of primary biliary cirrhosis.  

PubMed

Our understanding of the natural history of primary biliary cirrhosis (PBC) has been evolving especially following the introduction of ursodeoxycholic acid (UDCA). A clearer understanding of disease pathophysiology and earlier diagnosis with increased prevalence of the disease worldwide has led to increased interest and improved outcomes in patients with PBC. In this article, the authors touch briefly on features of the disease and describe the natural history of PBC prior to and after the introduction of UDCA. PMID:25057955

Imam, Mohamad H; Lindor, Keith D

2014-08-01

309

Photodynamic therapy for occluded biliary metal stents  

NASA Astrophysics Data System (ADS)

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

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

1999-02-01

310

Endoscopic extraction of large common bile duct stones: A review article.  

PubMed

Since therapeutic endoscopic retrograde cholangiopancreatography replaced surgery as the first approach in cases of choledocolithiasis, a plethora of endoscopic techniques and devices appeared in order to facilitate rapid, safe and effective bile duct stones extraction. Nowadays, endoscopic sphincterotomy combined with balloon catheters and/or baskets is the routine endoscopic technique for stone extraction in the great majority of patients. Large common bile duct stones are treated conventionally with mechanical lithotripsy, while the most serious complication of the procedure is "basket and stone impaction" that is predominately resolved surgically. In cases of difficult, impacted, multiple or intrahepatic stones, more sophisticated procedures have been used. Electrohydraulic lithotripsy and laser lithotripsy are performed using conventional mother-baby scope systems, ultra-thin cholangioscopes, thin endoscopes and ultimately using the novel single use, single operator SpyGlass Direct Visualization System, in order to deliver intracorporeal shock wave energy to fragment the targeted stone, with very good outcomes. Recently, large balloon dilation after endoscopic sphincterotomy confirmed its effectiveness in the extraction of large stones in a plethora of trials. When compared with mechanical lithotripsy or with balloon dilation alone, it proved to be superior. Moreover, dilation is an ideal alternative in cases of altered anatomy where access to the papilla is problematic. Endoscopic sphincterotomy followed by large balloon dilation represents the onset of a new era in large bile duct stone extraction and the management of "impaction" because it seems that is an effective, inexpensive, less traumatic, safe and easy method that does not require sophisticated apparatus and can be performed widely by skillful endoscopists. When complete extraction of large stones is unsuccessful, the drainage of the common bile duct is mandatory either for bridging to the final therapy or as a curative therapy for very elderly patients with short life expectancy. Placing of more than one plastic endoprostheses is better while the administration of Ursodiol is ineffective. The great majority of patients with large stones can be treated endoscopically. In cases of unsuccessful stone extraction using balloons, baskets, mechanical lithotripsy, electrohydraulic or laser lithotripsy and large balloon dilation, the patient should be referred for extracorporeal shock wave lithotripsy or a percutaneous approach and finally surgery. PMID:22624068

Stefanidis, Gerasimos; Christodoulou, Christos; Manolakopoulos, Spilios; Chuttani, Ram

2012-05-16

311

Endoscopic extraction of large common bile duct stones: A review article  

PubMed Central

Since therapeutic endoscopic retrograde cholangiopancreatography replaced surgery as the first approach in cases of choledocolithiasis, a plethora of endoscopic techniques and devices appeared in order to facilitate rapid, safe and effective bile duct stones extraction. Nowadays, endoscopic sphincterotomy combined with balloon catheters and/or baskets is the routine endoscopic technique for stone extraction in the great majority of patients. Large common bile duct stones are treated conventionally with mechanical lithotripsy, while the most serious complication of the procedure is “basket and stone impaction” that is predominately resolved surgically. In cases of difficult, impacted, multiple or intrahepatic stones, more sophisticated procedures have been used. Electrohydraulic lithotripsy and laser lithotripsy are performed using conventional mother-baby scope systems, ultra-thin cholangioscopes, thin endoscopes and ultimately using the novel single use, single operator SpyGlass Direct Visualization System, in order to deliver intracorporeal shock wave energy to fragment the targeted stone, with very good outcomes. Recently, large balloon dilation after endoscopic sphincterotomy confirmed its effectiveness in the extraction of large stones in a plethora of trials. When compared with mechanical lithotripsy or with balloon dilation alone, it proved to be superior. Moreover, dilation is an ideal alternative in cases of altered anatomy where access to the papilla is problematic. Endoscopic sphincterotomy followed by large balloon dilation represents the onset of a new era in large bile duct stone extraction and the management of “impaction” because it seems that is an effective, inexpensive, less traumatic, safe and easy method that does not require sophisticated apparatus and can be performed widely by skillful endoscopists. When complete extraction of large stones is unsuccessful, the drainage of the common bile duct is mandatory either for bridging to the final therapy or as a curative therapy for very elderly patients with short life expectancy. Placing of more than one plastic endoprostheses is better while the administration of Ursodiol is ineffective. The great majority of patients with large stones can be treated endoscopically. In cases of unsuccessful stone extraction using balloons, baskets, mechanical lithotripsy, electrohydraulic or laser lithotripsy and large balloon dilation, the patient should be referred for extracorporeal shock wave lithotripsy or a percutaneous approach and finally surgery. PMID:22624068

Stefanidis, Gerasimos; Christodoulou, Christos; Manolakopoulos, Spilios; Chuttani, Ram

2012-01-01

312

Biliary Atresia: 50 Years after the First Kasai  

PubMed Central

Biliary atresia is a rare neonatal disease of unknown etiology, where obstruction of the biliary tree causes severe cholestasis, leading to biliary cirrhosis and death in the first years of life, if the condition is left untreated. Biliary atresia is the most frequent surgical cause of cholestatic jaundice in neonates and should be evoked whenever this clinical sign is associated with pale stools and hepatomegaly. The treatment of biliary atresia is surgical and currently recommended as a sequence of, eventually, two interventions. During the first months of life a hepatoportoenterostomy (a “Kasai,” modifications of which are discussed in this paper) should be performed, in order to restore the biliary flow to the intestine and lessen further damage to the liver. If this fails and/or the disease progresses towards biliary cirrhosis and life-threatening complications, then liver transplantation is indicated, for which biliary atresia represents the most frequent pediatric indication. Of importance, the earlier the Kasai is performed, the later a liver transplantation is usually needed. This warrants a great degree of awareness of biliary atresia, and the implementation of systematic screening for this life-threatening pathology. PMID:23304557

Wildhaber, Barbara E.

2012-01-01

313

Functional Self-Expandable Metal Stents in Biliary Obstruction  

PubMed Central

Biliary stents are widely used not only for palliative treatment of malignant biliary obstruction but also for benign biliary diseases. Each plastic stent or self-expandable metal stent (SEMS) has its own advantages, and a proper stent should be selected carefully for individual condition. To compensate and overcome several drawbacks of SEMS, functional self-expandable metal stent (FSEMS) has been developed with much progress so far. This article looks into the outcomes and defects of each stent type for benign biliary stricture and describes newly introduced FSEMSs according to their functional categories. PMID:24143314

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

2013-01-01

314

Evaporation Duct Estimation from Clutter Using Meteorological Statistics  

E-print Network

Evaporation Duct Estimation from Clutter Using Meteorological Statistics Caglar Yardim*, Peter addresses how to incorporate meteo- rological statistics into evaporative duct estimation within a Bayesian framework. 1 Regional Statistics and Evaporation Duct Inversion Algorithm Evaporation duct refractivity

Gerstoft, Peter

315

What Are the Key Statistics about Bile Duct Cancer?  

MedlinePLUS

... for bile duct cancer? What are the key statistics about bile duct cancer? Bile duct cancer is ... it is when it is found. For survival statistics, see the section “ Survival statistics for bile duct ...

316

Performance Study of a Ducted Fan System  

NASA Technical Reports Server (NTRS)

An experimental investigation was completed in the NASA Ames 7- by 10-Foot Wind Tunnel with the objective of determining the performance characteristics of a ducted fan. The model was an annular duct with a 38-in diameter, 10-in chord, and a 5-bladed fixed-pitch fan. Model variations included duct angle of attack, exit vane flap length, flap deflection angle, and duct chord length. Duct performance data were obtained for axial and forward flight test conditions. Axial flow test data showed figure of merit decreases with increasing advance ratio. Forward flight data showed an increasing propulsive force with decreasing duct angle of attack. Exit vane flap deflection angle and flap chord length were shown to be an effective way of providing side force. Extending the duct chord did not effect the duct performance.

Abrego, Anita I.; Bulaga, Robert W.; Rutkowski, Michael (Technical Monitor)

2002-01-01

317

46 CFR 116.610 - Ventilation ducts.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Ventilation ducts. 116.610 Section 116.610 Shipping COAST GUARD, DEPARTMENT OF HOMELAND...PASSENGERS CONSTRUCTION AND ARRANGEMENT Ventilation § 116.610 Ventilation ducts. (a) For the...

2010-10-01

318

Acute Suppuration of the Pancreatic Duct in a Patient with Tropical Pancreatitis  

PubMed Central

Background/Aim Pancreatic sepsis secondary to infected necrosis, pseudocyst, or pancreatic abscess is a well-known clinical entity. Acute suppuration of the pancreatic duct (ASPD) in the setting of chronic calcific pancreatitis and pancreatic ductal obstruction with septicemia is a rare complication that is seldom reported. It is our aim to report a case of ASPD with Klebsiella ornithinolytica, in the absence of pancreatic abscess or infected necrosis. Case Report A 46-year-old Asian-Indian man with chronic tropical pancreatitis who was admitted with recurrent epigastric pain that rapidly evolved into septic shock. A CT scan of abdomen revealed a dilated pancreatic duct with a large calculus. Broad-spectrum antibiotics, vasopressors and activated recombinant protein C were initiated. Emergency ERCP showed the papilla of Vater spontaneously expelling pus. Probing and stenting was instantly performed until pus drainage ceased. Repeat CT scan confirmed the absence of pancreatic necrosis or fluid collection, and decreasing ductal dilatation. Dramatic clinical improvement was observed within 36 hours after intervention. Blood cultures grew Klebsiella ornithinolytica. The patient completed his antibiotic course and was discharged. Conclusion ASPD without pancreatic abscess or infected necrosis is an exceptional clinical entity that should be included in the differential diagnosis of pancreatic sepsis. A chronically diseased pancreas and diabetes may have predisposed to the uncommon pathogen. The presence of intraductal pancreatic stones obstructing outflow played a major role in promoting bacterial growth, suppuration and septicemia. Immediate drainage of the pancreatic duct with endoscopic intervention is critical and mandatory. PMID:21490834

Deeb, Liliane S.; Bajaj, Jasmeet; Bhargava, Sandeep; Alcid, David; Pitchumoni, C.S.

2008-01-01

319

LBNL -53547 Advanced Duct Sealant Testing  

E-print Network

LBNL - 53547 Advanced Duct Sealant Testing Max H. Sherman and Iain S. Walker Energy Performance-76SF00098. #12;Advanced Duct Sealant Testing Max Sherman and Iain Walker Energy Performance What follows is the final report for the Advanced Duct Sealant Testing, 500-010-002, conducted

320

Atypical Sweat Duct Hyperplasia Accompanying Keratoacanthoma  

Microsoft Academic Search

25 cases of atypical sweat duct proliferation in association with cutaneous tumors are described. 20 of these were keratoacanthomas. The compression of the duct either in its dermal or intraepidermal portion is considered to be the etiology. Similar changes are seen with decubitus ulcer and stasis dermatitis. Atypical sweat duct hyperplasia may be useful as an extra aid in the

Daniel J. Santa Cruz; Kathryn Clausen

1977-01-01

321

Mixed convection flow in narrow vertical ducts  

Microsoft Academic Search

The mixed convection flow in a vertical duct is analysed under the assumption that e, the ratio of the duct width to the length over which the wall is heated, is small. It is assumed that a fully developed Poiseuille flow has already been set up in the duct before heat from the wall causes this to be changed by

T. Mahmood; J. H. Merkin

1989-01-01

322

Design and performance of duct acoustic treatment  

NASA Technical Reports Server (NTRS)

The procedure for designing acoustic treatment panels used to line the walls of aircraft engine ducts and for estimating the resulting suppression of turbofan engine duct noise is discussed. This procedure is intended to be used for estimating noise suppression of existing designs or for designing new acoustic treatment panels and duct configurations to achieve desired suppression levels.

Motsinger, R. E.; Kraft, R. E.

1991-01-01

323

Association of Preoperative Biliary Drainage With Postoperative Outcome Following Pancreaticoduodenectomy  

PubMed Central

Objective To determine whether preoperative biliary instrumentation and preoperative biliary drainage are associated with increased morbidity and mortality rates after pancreaticoduodenectomy. Summary Background Data Pancreaticoduodenectomy is accompanied by a considerable rate of postoperative complications and potential death. Controversy exists regarding the impact of preoperative biliary instrumentation and preoperative biliary drainage on morbidity and mortality rates after pancreaticoduodenectomy. Methods Two hundred forty consecutive cases of pancreaticoduodenectomy performed between January 1994 and January 1997 were analyzed. Multiple preoperative, intraoperative, and postoperative variables were examined. Pearson chi square analysis or Fisher’s exact test, when appropriate, was used for univariate comparison of all variables. Logistic regression was used for multivariate analysis. Results One hundred seventy-five patients (73%) underwent preoperative biliary instrumentation (endoscopic, percutaneous, or surgical instrumentation). One hundred twenty-six patients (53%) underwent preoperative biliary drainage (endoscopic stents, percutaneous drains/stents, or surgical drainage). The overall postoperative morbidity rate after pancreaticoduodenectomy was 48% (114/240). Infectious complications occurred in 34% (81/240) of patients. Intraabdominal abscess occurred in 14% (33/240) of patients. The postoperative mortality rate was 5% (12/240). Preoperative biliary drainage was determined to be the only statistically significant variable associated with complications (p = 0.025), infectious complications (p = 0.014), intraabdominal abscess (p = 0.022), and postoperative death (p = 0.037). Preoperative biliary instrumentation alone was not associated with complications, infectious complications, intraabdominal abscess, or postoperative death. Conclusions Preoperative biliary drainage, but not preoperative biliary instrumentation alone, is associated with increased morbidity and mortality rates in patients undergoing pancreaticoduodenectomy. This suggests that preoperative biliary drainage should be avoided whenever possible in patients with potentially resectable pancreatic and peripancreatic lesions. Such a change in current preoperative management may improve patient outcome after pancreaticoduodenectomy. PMID:10450725

Povoski, Stephen P.; Karpeh, Martin S.; Conlon, Kevin C.; Blumgart, Leslie H.; Brennan, Murray F.

1999-01-01

324

Wind Turbine With Concentric Ducts  

NASA Technical Reports Server (NTRS)

Wind Turbine device is relatively compact and efficient. Converging inner and outer ducts increase pressure difference across blades of wind turbine. Turbine shaft drives alternator housed inside exit cone. Suitable for installation on such existing structures as water towers, barns, houses, and commercial buildings.

Muhonen, A. J.

1983-01-01

325

Formation of artificial ionospheric ducts  

Microsoft Academic Search

It is well known that strong electron heating by a powerful HF-facility can lead to the formation of electron and ion density perturbations that stretch along the magnetic field line. Those density perturbations can serve as ducts for ELF waves, both of natural and artificial origin. This paper presents the first experimental evidence of plasma modifications associated with ion outflows

G. M. Milikh; K. Papadopoulos; H. Shroff; C. L. Chang; T. Wallace; E. V. Mishin; M. Parrot; J. J. Berthelier

2008-01-01

326

The Neural Substrates of Subjective Time Dilation  

PubMed Central

An object moving towards an observer is subjectively perceived as longer in duration than the same object that is static or moving away. This ”time dilation effect” has been shown for a number of stimuli that differ from standard events along different feature dimensions (e.g. color, size, and dynamics). We performed an event-related functional magnetic resonance imaging (fMRI) study, while subjects viewed a stream of five visual events, all of which were static and of identical duration except the fourth one, which was a deviant target consisting of either a looming or a receding disc. The duration of the target was systematically varied and participants judged whether the target was shorter or longer than all other events. A time dilation effect was observed only for looming targets. Relative to the static standards, the looming as well as the receding targets induced increased activation of the anterior insula and anterior cingulate cortices (the ”core control network”). The decisive contrast between looming and receding targets representing the time dilation effect showed strong asymmetric activation and, specifically, activation of cortical midline structures (the ”default network”). These results provide the first evidence that the illusion of temporal dilation is due to activation of areas that are important for cognitive control and subjective awareness. The involvement of midline structures in the temporal dilation illusion is interpreted as evidence that time perception is related to self-referential processing. PMID:20161994

Wittmann, Marc; van Wassenhove, Virginie; Craig, A. D. (Bud); Paulus, Martin P.

2009-01-01

327

Dilated cardiomyopathy and progressive familial intrahepatic cholestasis.  

PubMed

This case is of a 29-year-old man with progressive familial intrahepatic cholestasis type 1 also known as Byler's disease. At the age of 21, our patient developed non-ischaemic dilated cardiomyopathy. Cardiac MRI demonstrated global wall thinning, with significant areas of myocardial fibrosis in the mid and epicardial walls from base to apex on postgadolinium late contrast enhanced images. No shared genetic loci between dilated cardiomyopathy and Byler's or cholestatic liver disease have yet been found. This presents the first documented case of non-ischaemic dilated cardiomyopathy, with evidence of mid wall fibrosis, in association with an established diagnosis of progressive familial intrahepatic cholestasis type 1 since childhood. PMID:24654243

James, Stephanie; Waterhouse, Deirdre; McDonald, Kenneth; O'Hanlon, Rory

2014-01-01

328

Autophagy may occur at an early stage of cholangiocarcinogenesis via biliary intraepithelial neoplasia.  

PubMed

Similar to the pancreatic carcinoma sequence model, cholangiocarcinoma reportedly follows a stepwise carcinogenesis process via the precursor lesion biliary intraepithelial neoplasia (BilIN). Given that autophagy plays an important role in the occurrence and development of carcinomas, we examined the involvement of autophagy in multistep cholangiocarcinogenesis. Thirty-six patients with hepatolithiasis associated with BilIN and/or cholangiocarcinoma, 7 with intrahepatic cholangiocarcinoma, 8 with intraductal papillary neoplasm of the bile duct (IPNB), and 6 with control livers were surveyed. Their lesions were categorized as follows: invasive carcinoma (n = 16), IPNB (n = 8), BIlN-3 (n = 16), BilIN-1/2 (n = 40), nonneoplastic large bile duct (n = 55), and peribiliary gland (n = 55). We examined the immunohistochemical expression of autophagy-related proteins, microtubule-associated proteins light chain 3? (LC3), beclin-1, and p62/sequestosome-1 (p62), as well as tumor suppressor gene product p53. The extent of expression was semiquantitatively assessed. The status of KRAS mutations at codons 12 and 13 was examined in selected cases of BilIN-1/2. The expression of LC3 (cytoplasmic), beclin-1 (cytoplasmic), and p62 (cytoplasmic and nuclear) was significantly higher in BilIN-1/2, BilIN-3, IPNB, and invasive carcinoma than in large bile duct and peribiliary gland (P < .01). KRAS mutation was detected in 6 (40%) of 15 BilIN-1/2 lesions, and there was no correlation between the status of KRAS mutation and the expression of autophagy-related proteins. In conclusion, this study is the first to disclose that the expression of autophagy-related proteins, LC3, beclin-1, and p62, was increased at an early stage of multistep cholangiocarcinogenesis in hepatolithiasis. Autophagy, probably deregulated autophagy, may be related to the occurrence and development of cholangiocarcinoma. PMID:25466963

Sasaki, Motoko; Nitta, Takeo; Sato, Yasunori; Nakanuma, Yasuni

2015-02-01

329

Giant biliary mucinous cystadenoma of the liver.  

PubMed

Biliary mucinous cystadenomas (BMC) of the liver are rare benign cystic tumors, however an estimated 20% undergo malignant transformation. They have recently been redefined as mucinous cystic neoplasms in the 2010 WHO classification. The preferred treatment is through radical resection, as there are high recurrence rates with other treatment modalities; however this is often not possible in patients with bilobar or giant cysts, and liver transplantation may be indicated. We present a patient with a giant biliary mucinous cystadenoma of the liver and discuss the management with reference to the literature. A 47 year-old woman presented with a 6-week history of moderate epigastric discomfort on a background of 12 months of symptom-free abdominal distension. A giant cystic bilobar tumor of the liver measuring 22 x 23 x 17 cm was diagnosed and characterised by ultrasound scan and magnetic resonance imaging. Serum bilirubin, alkaline phosphatase and gamma-glutamyl transpeptidase were elevated, though other laboratory data including tumor markers (CEA, aFP, CA19-9) were within normal limits. Total excision of the cyst was not possible due to its size and position, and the patient underwent cyst drainage, a sub-total cyst excision and omentoplasty. Histology confirmed a benign biliary mucinous cystadenoma with an ovarian stroma. Though the patient remained clinically well, routine post-operative computed tomography (CT) surveillance showed an 11 cm recurrent cyst at 6 months. A partial cyst resection with close follow-up, regular CA19-9 serology and ultrasound/CT imaging, may be a reasonable alternative for bilobar or giant cysts. However should any features pathognomonic of malignancy develop, then a liver transplantation is indicated. PMID:24114831

Grubor, Nikica Mirko; Colovic, Radoje B; Atkinson, Henry Dushan; Micev, Marjan T

2013-01-01

330

General Information about Extrahepatic Bile Duct Cancer  

MedlinePLUS

... blocking the small intestine and causing bile to build up in the gallbladder, a biliary bypass may be ... procedure helps to relieve jaundice caused by the build-up of bile. Stent placement: If the tumor is ...

331

Role of epimorphin in bile duct formation of rat liver epithelial stem-like cells: involvement of small G protein RhoA and C/EBP?.  

PubMed

Epimorphin/syntaxin 2 is a high conserved and very abundant protein involved in epithelial morphogenesis in various organs. We have shown recently that epimorphin (EPM), a protein exclusively expressed on the surface of hepatic stellate cells and myofibroblasts of the liver, induces bile duct formation of hepatic stem-like cells (WB-F344 cells) in a putative biophysical way. Therefore, the aim of this study was to present some of the molecular mechanisms by which EPM mediates bile duct formation. We established a biliary differentiation model by co-culture of EPM-overexpressed mesenchymal cells (PT67(EPM)) with WB-F344 cells. Here, we showed that EPM could promote WB-F344 cells differentiation into bile duct-like structures. Biliary differentiation markers were also elevated by EPM including Yp, Cx43, aquaporin-1, CK19, and gamma glutamyl transpeptidase (GGT). Moreover, the signaling pathway of EPM was analyzed by focal adhesion kinase (FAK), extracellular regulated kinase 1/2 (ERK1/2), and RhoA Western blot. Also, a dominant negative (DN) RhoA-WB-F344 cell line (WB(RhoA-DN)) was constructed. We found that the levels of phosphorylation (p) of FAK and ERK1/2 were up-regulated by EPM. Most importantly, we also showed that RhoA is necessary for EPM-induced activation of FAK and ERK1/2 and bile duct formation. In addition, a dual luciferase-reporter assay and CHIP assay was performed to reveal that EPM regulates GGT IV and GGT V expression differentially, possibly mediated by C/EBP?. Taken together, these data demonstrated that EPM regulates bile duct formation of WB-F344 cells through effects on RhoA and C/EBP?, implicating a dual aspect of this morphoregulator in bile duct epithelial morphogenesis. PMID:21935930

Jia, Yali; Yao, Hailei; Zhou, Junnian; Chen, Lin; Zeng, Quan; Yuan, Hongfeng; Shi, Lei; Nan, Xue; Wang, Yunfang; Yue, Wen; Pei, Xuetao

2011-11-01

332

Simultaneous intraductal papillary neoplasms of the bile duct and pancreas treated with chemoradiotherapy.  

PubMed

Some authors have suggested that intraductal papillary mucinous neoplasms of the bile duct (IPMN-B) could be the the biliary counterpart of IPMN of the pancreas (IPMN-P) since they share several clinical-pathological features. These include prominent intraductal papillary proliferation pattern, a gastrointestinal phenotype, frequent mucin hyper-secretion and progression to mucinous carcinoma. To date there are just four reported cases of patients with synchronous IPMN-B and IPMN-P all of which were treated surgically. We hereby report the case of a 76-year-old woman who was incidentally diagnosed with both an asymptomatic 3 cm bulky fluid lesion obstructing the bile duct lumen, diagnosed as a malignant IPMN-B, and synchronous multiple pancreatic cystic lesions (10-13 mm) communicating with an irregular Wirsung, diagnosed as branch duct IPMN-P. Since surgery was ruled-out because of the patient's age and preferences, she underwent a conservative management regimen comprising both chemotherapy and radiotherapy. This was effective in decreasing the mass size and in resolving subsequent jaundice. This is also the first reported case of IPMN-B successfully treated with chemoradiotherapy. Clinicians should consider medical treatment as an option in this clinical scenario, in patients who may be unfit for surgery. PMID:22403738

Valente, Roberto; Capurso, Gabriele; Pierantognetti, Paola; Iannicelli, Elsa; Piciucchi, Matteo; Romiti, Adriana; Mercantini, Paolo; Larghi, Alberto; Federici, Giulia Francesca; Barucca, Viola; Osti, Maria Falchetto; Di Giulio, Emilio; Ziparo, Vincenzo; Delle Fave, Gianfranco

2012-02-15

333

Simultaneous intraductal papillary neoplasms of the bile duct and pancreas treated with chemoradiotherapy  

PubMed Central

Some authors have suggested that intraductal papillary mucinous neoplasms of the bile duct (IPMN-B) could be the the biliary counterpart of IPMN of the pancreas (IPMN-P) since they share several clinical-pathological features. These include prominent intraductal papillary proliferation pattern, a gastrointestinal phenotype, frequent mucin hyper-secretion and progression to mucinous carcinoma. To date there are just four reported cases of patients with synchronous IPMN-B and IPMN-P all of which were treated surgically. We hereby report the case of a 76-year-old woman who was incidentally diagnosed with both an asymptomatic 3 cm bulky fluid lesion obstructing the bile duct lumen, diagnosed as a malignant IPMN-B, and synchronous multiple pancreatic cystic lesions (10-13 mm) communicating with an irregular Wirsung, diagnosed as branch duct IPMN-P. Since surgery was ruled-out because of the patient’s age and preferences, she underwent a conservative management regimen comprising both chemotherapy and radiotherapy. This was effective in decreasing the mass size and in resolving subsequent jaundice. This is also the first reported case of IPMN-B successfully treated with chemoradiotherapy. Clinicians should consider medical treatment as an option in this clinical scenario, in patients who may be unfit for surgery. PMID:22403738

Valente, Roberto; Capurso, Gabriele; Pierantognetti, Paola; Iannicelli, Elsa; Piciucchi, Matteo; Romiti, Adriana; Mercantini, Paolo; Larghi, Alberto; Federici, Giulia Francesca; Barucca, Viola; Osti, Maria Falchetto; Di Giulio, Emilio; Ziparo, Vincenzo; Delle Fave, Gianfranco

2012-01-01

334

HAARP-Induced Ionospheric Ducts  

SciTech Connect

It is well known that strong electron heating by a powerful HF-facility can lead to the formation of electron and ion density perturbations that stretch along the magnetic field line. Those density perturbations can serve as ducts for ELF waves, both of natural and artificial origin. This paper presents observations of the plasma density perturbations caused by the HF-heating of the ionosphere by the HAARP facility. The low orbit satellite DEMETER was used as a diagnostic tool to measure the electron and ion temperature and density along the satellite orbit overflying close to the magnetic zenith of the HF-heater. Those observations will be then checked against the theoretical model of duct formation due to HF-heating of the ionosphere. The model is based on the modified SAMI2 code, and is validated by comparison with well documented experiments.

Milikh, Gennady; Vartanyan, Aram [University of Maryland, College Park, MD, 20742 (United States)

2011-01-04

335

Percutaneous Transhepatic Removal of Bile Duct Stones: Results of 261 Patients  

SciTech Connect

Purpose: To determine the effectiveness of percutaneous transhepatic removal of bile duct stones when the procedure of endoscopic therapy fails for reasons of anatomical anomalies or is rejected by the patient. Methods: Between April 2001 and May 2010, 261 patients (138 male patients and 123 female patients; age range, 14-92 years; mean age, 64.6 years) with bile duct stones (common bile duct [CBD] stones = 248 patients and hepatolithiasis = 13 patients) were included in the study. First, percutaneous transhepatic cholangiography was performed and stones were identified. Percutaneous transhepatic balloon dilation of the papilla of Vater was performed. Then stones were pushed out into the duodenum with a Fogarty balloon catheter. If the stone diameter was larger than 15 mm, then basket lithotripsy was performed before balloon dilation. Results: Overall success rate was 95.7%. The procedure was successful in 97.5% of patients with CBD stones and in 61.5% of patients with hepatolithiasis. A total of 18 (6.8%) major complications, including cholangitis (n = 7), subcapsular biloma (n = 4), subcapsular hematoma (n = 1), subcapsular abscess (n = 1), bile peritonitis (n = 1), duodenal perforation (n = 1), CBD perforation (n = 1), gastroduodenal artery pseudoaneurysm (n = 1), and right hepatic artery transection (n = 1), were seen after the procedure. There was no mortality. Conclusion: Our experience suggests that percutaneous transhepatic stone expulsion into the duodenum through the papilla is an effective and safe approach in the nonoperative management of the bile duct stones. It is a feasible alternative to surgery when endoscopic extraction fails or is rejected by the patient.

Ozcan, Nevzat, E-mail: nevzatcan@yahoo.com; Kahriman, Guven, E-mail: guvenkahriman@hotmail.com; Mavili, Ertugrul, E-mail: ertmavili@yahoo.com [Erciyes University, Department of Radiology, Medical Faculty, Gevher Nesibe Hospital (Turkey)

2012-06-15

336

Scale (or Grid) Drawings and Dilations  

NSDL National Science Digital Library

This "simple activity to reinforce the concept of dilation is that of the scale (or grid) drawing" has students produce scale drawings of a given picture using grid paper to a scale of 2 and a scale of 1/2. The directions for the activity are given here as well as clear instructions for students.

2010-08-03

337

What Happens At The Dilatancy Boundary?  

NASA Astrophysics Data System (ADS)

The dilatancy concept offers a reliable basis for the assessment of underground build- ings in rock salt, e.g. a repository for radioactive waste [1]. Stress conditions are pre- dictable where creep failure and increasing permeability will inevitably develop [2]. However, recent investigations focusing on the damage induced volume increase as well on the crack sensitive P- and S-velocities suggest that the determination of the so-called dilatancy boundary may depend on the addressed physical process. To solve remaining uncertainties the microcrack sensitivity of various independently measured physical parameters has been investigated during the evolution of dilatancy in rock salt, e.g. volumetric strain resp. porosity, P- and S-wave velocities, permeability, hu- midity induced creep and pore fluid pressure effects. In summary, this leads to a new and comprehensive synoptic view of the stress and deformation induced changes of rock properties in salt, which impressively confirms the general concept of dilatancy. [1] Christescu and Hunsche (1998), Time effects in Rock Mechanics. Wiley &Sons, Chichester. [2] Popp, T., Kern, H. und O. Schulze, 2001. J. Geophys. Res. 106, 4061- 4078

Popp, T.; Hunsche, U.; Schulze, O.

338

Full-Face Undermining Using Progressive Dilators  

Microsoft Academic Search

The application of a new and simple method of facial cutaneous detachment using specially designed bifaceted rigid steel wands called Dilson Luz Vascular Dilation Wands is described. These wands considerably reduce the bleeding during face-lift surgery, reducing both postoperative hematomas and the risk of facial nerve injury. This technique involves stretching the blood vessels to the point of rupture by

Dilson Ferreira da Luz; Moises Wolfenson; Joaquim Figueiredo; Jose Carlos Didier

2005-01-01

339

Modeling particle loss in ventilation ducts  

SciTech Connect

Empirical equations were developed and applied to predict losses of 0.01-100 {micro}m airborne particles making a single pass through 120 different ventilation duct runs typical of those found in mid-sized office buildings. For all duct runs, losses were negligible for submicron particles and nearly complete for particles larger than 50 {micro}m. The 50th percentile cut-point diameters were 15 {micro}m in supply runs and 25 {micro}m in return runs. Losses in supply duct runs were higher than in return duct runs, mostly because internal insulation was present in portions of supply duct runs, but absent from return duct runs. Single-pass equations for particle loss in duct runs were combined with models for predicting ventilation system filtration efficiency and particle deposition to indoor surfaces to evaluate the fates of particles of indoor and outdoor origin in an archetypal mechanically ventilated building. Results suggest that duct losses are a minor influence for determining indoor concentrations for most particle sizes. Losses in ducts were of a comparable magnitude to indoor surface losses for most particle sizes. For outdoor air drawn into an unfiltered ventilation system, most particles smaller than 1 {micro}m are exhausted from the building. Large particles deposit within the building, mostly in supply ducts or on indoor surfaces. When filters are present, most particles are either filtered or exhausted. The fates of particles generated indoors follow similar trends as outdoor particles drawn into the building.

Sippola, Mark R.; Nazaroff, William W.

2003-04-01

340

Dilatation of the collecting system during pregnancy: physiologic vs obstructive dilatation  

Microsoft Academic Search

.   Dilatation of the collecting system is a classical phenomenon during pregnancy, due to hormonal and extrinsic compressive\\u000a factors. Imaging has to differentiate a physiological dilatation and a pathological obstruction due to urolithiasis. Presently,\\u000a sonography, using both, B-mode and color Doppler, has the potential to demonstrate the physiological compression of ureters\\u000a at the level of the pelvic brim. A pathological

N. Grenier; J. L. Pariente; H. Trillaud; C. Soussotte; C. Douws

2000-01-01

341

Hydrocephalus due to extreme dilation of Virchow-Robin spaces.  

PubMed

Virchow-Robin spaces (VRS) are extensions of the subarachnoid space surrounding perforating blood vessels entering the brain parenchyma. VRS are fluid filled, but almost virtual and only visible on MRI of the brain when dilated. Such dilations are commonly asymptomatic. In rare cases, extreme dilations can be observed; the clinical repercussions of which remain unclear. We report the case of a patient presenting symptoms of normal pressure hydrocephalus due to extreme VRS mesencephalon dilations. PMID:25564639

Revel, Frederic; Cotton, Francois; Haine, Max; Gilbert, Thomas

2015-01-01

342

Endoscopic dilation of benign esophageal strictures: report on 1043 procedures  

Microsoft Academic Search

ObjectiveEndoscopic dilation is considered the best treatment for most cases of benign esophageal stricture, although the best dilation technique and the kind of stricture is the most amenable to treatment is still controversial. We report on our experience on a large series of patients treated by dilation without the aid of fluoroscopy and compare the results of this therapy among

J. C. Pereira-Lima; R. P. Ramires; I. Zamin; A. P. Cassal; C. A. Marroni; A. A. Mattos

1999-01-01

343

Symptomatic cholelithiasis and functional disorders of the biliary tract.  

PubMed

Symptomatic cholelithiasis and functional disorders of the biliary tract present with similar signs and symptoms. The functional disorders of the biliary tract include functional gallbladder disorder, dyskinesia, and the sphincter of Oddi disorders. Although the diagnosis and treatment of symptomatic cholelithiasis are relatively straightforward, the diagnosis and treatment of functional disorders can be much more challenging. Many aspects of the diagnosis and treatment of functional disorders are in need of further study. This article discusses uncomplicated gallstone disease and the functional disorders of the biliary tract to emphasize and update the essential components of diagnosis and management. PMID:24679419

Cafasso, Danielle E; Smith, Richard R

2014-04-01

344

Particle deposition in ventilation ducts: Connectors, bends anddeveloping flow  

Microsoft Academic Search

In ventilation duct flow the turbulent flow profile is commonly disturbed or not fully developed and these conditions are likely to influence particle deposition to duct surfaces. Particle deposition rates at eight S-connectors, in two 90{sup o} duct bends and in two ducts where the turbulent flow profile was not fully developed were measured in a laboratory duct system with

Mark R. Sippola; William W. Nazaroff

2004-01-01

345

Ramjet bypass duct and preburner configuration  

NASA Technical Reports Server (NTRS)

A combined turbofan and ramjet aircraft engine includes a forward bypass duct which allows the engine to operate more efficiently during the turbofan mode of operation. By mounting a ramjet preburner in the forward duct and isolating this duct from the turbofan bypass air, a transition from turbofan operation to ramjet operation can take place at lower flight Mach numbers without incurring pressure losses or blockage in the turbofan bypass air.

Orlando, Robert J. (Inventor)

1994-01-01

346

Sound propagation in acoustically lined elliptical ducts  

NASA Astrophysics Data System (ADS)

Sound propagation in ducts with elliptical cross-sections can be described in terms of modes characterized by Mathieu functions of orders specified by the boundary conditions. For ducts with locally reacting liners there is coupling between modes because the admissible solutions are linear combinations of Mathieu functions of different orders and the eigenvalues are roots of an infinite determinant. The amount of mode coupling depends on the eccentricity of the duct. For the case of small eccentricity of the duct, approximate general solutions are derived and an example is discussed, where solutions are found.

Oliveira, J. M. G. S.; Gil, P. J. S.

2014-08-01

347

Liver cyst with inflammatory hepatic duct polyp.  

PubMed

This is a case report of a 50-year-old woman, who presented with upper abdominal pain, vomiting and two episodes of jaundice in five months. Computerised tomographic scan revealed a cyst in the 4th segment of the liver. Peroperatively it was found to be a simple liver cyst arising from the left hepatic duct. The cyst was excised. Peroperative cholangiogram revealed obstruction in the common hepatic duct. A polyp in the common hepatic duct, causing obstruction, was excised. The presence of liver cyst with hepatic duct polyp is a rare association. PMID:12887848

Hussain, Dildar; Ahmed, Mushtaq

2003-07-01

348

Generator stator core vent duct spacer posts  

DOEpatents

Generator stator cores are constructed by stacking many layers of magnetic laminations. Ventilation ducts may be inserted between these layers by inserting spacers into the core stack. The ventilation ducts allow for the passage of cooling gas through the core during operation. The spacers or spacer posts are positioned between groups of the magnetic laminations to define the ventilation ducts. The spacer posts are secured with longitudinal axes thereof substantially parallel to the core axis. With this structure, core tightness can be assured while maximizing ventilation duct cross section for gas flow and minimizing magnetic loss in the spacers.

Griffith, John Wesley (Schenectady, NY); Tong, Wei (Clifton Park, NY)

2003-06-24

349

Surgical Resection of Thoracic Duct Lymphangioma  

PubMed Central

A 67-year-old male patient came to the hospital due to lung cancer and mediastinal cystic mass which was suspected to be esophageal duplication cyst. Video-assisted thoracoscopic surgery (VATS) was performed and intra-operative finding suggested it as a cystic mass along the thoracic duct. Thoracic duct was ligated and the cyst was completely resected. A 48-year-old female patient visited the hospital for dysphagia. Mediastinal cystic mass was suspected to be an esophageal duplication cyst. Intraoperative finding suggest a thoracic duct lymphangioma. After thoracic duct ligation, the mass was completely resected with VATS. Postoperative chylothorax did not develop in both cases. PMID:25207258

Bok, Jin San; Jun, Jae Hyun; Lee, Hyun Joo; Park, In Kyu; Kang, Chang Hyun; Kim, Young Tae

2014-01-01

350

Surgical resection of thoracic duct lymphangioma.  

PubMed

A 67-year-old male patient came to the hospital due to lung cancer and mediastinal cystic mass which was suspected to be esophageal duplication cyst. Video-assisted thoracoscopic surgery (VATS) was performed and intra-operative finding suggested it as a cystic mass along the thoracic duct. Thoracic duct was ligated and the cyst was completely resected. A 48-year-old female patient visited the hospital for dysphagia. Mediastinal cystic mass was suspected to be an esophageal duplication cyst. Intraoperative finding suggest a thoracic duct lymphangioma. After thoracic duct ligation, the mass was completely resected with VATS. Postoperative chylothorax did not develop in both cases. PMID:25207258

Bok, Jin San; Jun, Jae Hyun; Lee, Hyun Joo; Park, In Kyu; Kang, Chang Hyun; Kim, Young Tae

2014-08-01

351

Experimental investigations on freely exposed ducted radiators  

NASA Technical Reports Server (NTRS)

This report deals with the relation between the open areas, the drag, and the air flow as observed on freely exposed, ducted radiators - the air conductivity being modified from zero to one unit. In conjunction with theoretical results, the individual components of the drag of ducted radiators are discussed and general rules established for low-loss ducts. The influence of the wall thickness of the ducts, of the length ratio of the exit, and the effects of sonic velocity on diffusers are dealt with by special measurement.

Linke, W

1941-01-01

352

Neuropeptide Y inhibits biliary hyperplasia of cholestatic rats by paracrine and autocrine mechanisms.  

PubMed

Neuropeptide Y (NPY) exerts its functions through six subtypes of receptors (Y?-Y?). Biliary homeostasis is regulated by several factors through autocrine/paracrine signaling. NPY inhibits cholangiocarcinoma growth; however, no information exists regarding the autocrine/paracrine role of NPY on biliary hyperplasia during cholestasis. The aims of this study were to determine: 1) the expression of NPY and Y?-Y? in cholangiocytes and 2) the paracrine/autocrine effects of NPY on cholangiocyte proliferation. Normal or bile duct ligation (BDL) rats were treated with NPY, neutralizing anti-NPY antibody, or vehicle for 7 days. NPY and NPY receptor (NPYR) expression was assessed in liver sections and isolated cholangiocytes. NPY secretion was assessed in serum and bile from normal and BDL rats, as well as supernatants from normal and BDL cholangiocytes and normal rat cholangiocyte cell line [intrahepatic normal cholangiocyte culture (NRICC)]. We evaluated intrahepatic bile ductal mass (IBDM) in liver sections and proliferation in cholangiocytes. With the use of NRICC, the effects of NPY or anti-NPY antibody on cholangiocyte proliferation were determined. The expression of NPY and all NPYR were increased after BDL. NPY levels were lower in serum and cholangiocyte supernatant from BDL compared with normal rats. NPY secretion from NRICC was detected at both the basolateral and apical domains. Chronic NPY treatment decreased proliferating cellular nuclear antigen (PCNA) expression and IBDM in BDL rats. Administration of anti-NPY antibody to BDL rats increased cholangiocyte proliferation and IBDM. NPY treatment of NRICC decreased PCNA expression and increased the cell cycle arrest, whereas treatment with anti-NPY antibody increased proliferation. Therapies targeting NPY-mediated signaling may prove beneficial for the treatment of cholangiopathies. PMID:23703654

DeMorrow, Sharon; Meng, Fanyin; Venter, Julie; Leyva-Illades, Dinorah; Francis, Heather; Frampton, Gabriel; Pae, Hae Yong; Quinn, Matthew; Onori, Paolo; Glaser, Shannon; McDaniel, Kelly; Mancinelli, Romina; Gaudio, Eugenio; Alpini, Gianfranco; Franchitto, Antonio

2013-08-01

353

Adult sea lamprey tolerates biliary atresia by altering bile salt composition and renal excretion  

PubMed Central

The sea lamprey (Petromyzon marinus) is a genetically programmed animal model for biliary atresia as it loses its bile ducts and gallbladder during metamorphosis. However, in contrast to patients with biliary atresia or other forms of cholestasis who develop progressive disease, the post-metamorphosis lampreys grow normally to adult size. To understand how the adult lamprey thrives without the ability to secrete bile, we examined bile salt homeostasis in larval and adult lampreys. Adult livers were severely cholestatic with levels of bile salts >1 mM, but no evidence of necrosis, fibrosis, or inflammation. Interestingly, both larvae and adults had normal plasma levels (~10 ?M) of bile salts. In larvae, petromyzonol sulfate (PZS) was the predominant bile salt, whereas the major bile salts in adult liver were sulfated C27 bile alcohols. Cytotoxicity assays revealed that PZS was highly toxic. Pharmacokinetic studies in free-swimming adults revealed that ~35% of intravenously injected bromosulfophthalein (BSP) was eliminated over a 72 hr period. Collection of urine and feces demonstrated that both endogenous and exogenous organic anions, including biliverdin, bile salts and BSP, were predominantly excreted via the kidney with minor amounts also detected in feces. Gene expression analysis detected marked up-regulation of orthologs of known organic anion and bile salt transporters in the kidney with lesser effects in the intestine and gills in adults compared to larvae. These findings indicate that adult lampreys tolerate cholestasis by altering hepatic bile salt composition, while maintaining normal plasma bile salt levels predominantly through renal excretion of bile products. Therefore, we conclude that strategies to accelerate renal excretion of bile salt and other toxins should be beneficial for patients with cholestasis. PMID:23175353

Cai, Shi-Ying; Lionarons, Daniël A.; Hagey, Lee; Soroka, Carol J.; Mennone, Albert; Boyer, James L.

2012-01-01

354

Macrophage-mediated phagocytosis of apoptotic cholangiocytes contributes to reversal of experimental biliary fibrosis  

PubMed Central

Studies have suggested the reversibility of liver fibrosis, but the mechanisms of fibrosis reversal are poorly understood. We investigated the possible functional link between apoptosis, macrophages, and matrix turnover in rat liver during reversal of fibrosis secondary to bile duct ligation (BDL). Biliary fibrosis was induced by BDL for 4 wk. After Roux-en-Y (RY)-bilio-jejunal-anastomosis, resolution of fibrosis was monitored for up to 12 wk by hepatic collagen content, matrix metalloproteinase (MMP) expression and activities, and fibrosis-related gene expression. MMP expression and activities were studied in macrophages after engulfment of apoptotic cholangiocytes in vitro. Hepatic collagen decreased to near normal at 12 wk after RY-anastomosis. During reversal, profibrogenic mRNA declined, whereas expression of several profibrolytic MMPs increased. Fibrotic septa showed fragmentation at week 4 and disappeared at week 12. Peak histological remodeling at week 4 was characterized by massive apoptosis of cytokeratin 19+ cholangiocytes, >90% in colocalization with CD68+ macrophages, and a 2- to 7.5-fold increase in matrix-degrading activities. In vitro, phagocytosis of apoptotic cholangiocytes induced matrix-degrading activities and MMP-3, -8, and -9 in rat peritoneal macrophages. We concluded that reconstruction of bile flow after BDL leads to an orchestrated fibrolytic program that results in near complete reversal of advanced fibrosis. The peak of connective tissue remodeling and fibrolytic activity is associated with massive apoptosis of cholangiocytes and their phagocytic clearance by macrophages in vivo. Macrophages upregulate MMPs and become fibrolytic effector cells upon apoptotic cholangiocyte engulfment in vitro, suggesting that phagocytosis-associated MMP induction in macrophages significantly contributes to biliary fibrosis reversal. PMID:20056896

Popov, Yury; Sverdlov, Deanna Y.; Bhaskar, K. Ramakrishnan; Sharma, Anisha K.; Millonig, Gunda; Patsenker, Eleonora; Krahenbuhl, Stephan; Krahenbuhl, Lukas

2010-01-01

355

Adult sea lamprey tolerates biliary atresia by altering bile salt composition and renal excretion.  

PubMed

The sea lamprey (Petromyzon marinus) is a genetically programmed animal model for biliary atresia, as it loses its bile ducts and gallbladder during metamorphosis. However, in contrast to patients with biliary atresia or other forms of cholestasis who develop progressive disease, the postmetamorphosis lampreys grow normally to adult size. To understand how the adult lamprey thrives without the ability to secrete bile, we examined bile salt homeostasis in larval and adult lampreys. Adult livers were severely cholestatic, with levels of bile salts >1 mM, but no evidence of necrosis, fibrosis, or inflammation. Interestingly, both larvae and adults had normal plasma levels (?10 ?M) of bile salts. In larvae, petromyzonol sulfate (PZS) was the predominant bile salt, whereas the major bile salts in adult liver were sulfated C27 bile alcohols. Cytotoxicity assays revealed that PZS was highly toxic. Pharmacokinetic studies in free-swimming adults revealed that ?35% of intravenously injected bromosulfophthalein (BSP) was eliminated over a 72-hour period. Collection of urine and feces demonstrated that both endogenous and exogenous organic anions, including biliverdin, bile salts, and BSP, were predominantly excreted by way of the kidney, with minor amounts also detected in feces. Gene expression analysis detected marked up-regulation of orthologs of known organic anion and bile salt transporters in the kidney, with lesser effects in the intestine and gills in adults compared to larvae. These findings indicate that adult lampreys tolerate cholestasis by altering hepatic bile salt composition, while maintaining normal plasma bile salt levels predominantly through renal excretion of bile products. Therefore, we conclude that strategies to accelerate renal excretion of bile salt and other toxins should be beneficial for patients with cholestasis. (HEPATOLOGY 2013;57:2418-2426). PMID:23175353

Cai, Shi-Ying; Lionarons, Daniël A; Hagey, Lee; Soroka, Carol J; Mennone, Albert; Boyer, James L

2013-06-01

356

Double Ducted Fan (DDF) as a Novel Ducted Fan Inlet Lip Separation Control Device  

E-print Network

or minimal inlet flow distortion. The DDF concept is proven to be an effective way of dealing with inlet flowDouble Ducted Fan (DDF) as a Novel Ducted Fan Inlet Lip Separation Control Device Ali Akturk computational study of a novel ducted fan inlet flow conditioning concept that will significantly improve

Camci, Cengiz

357

Environmental Factors in Primary Biliary Cirrhosis  

PubMed Central

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

Juran, Brian D.; Lazaridis, Konstantinos N.

2014-01-01

358

Mitochondrial antibodies in primary biliary cirrhosis  

PubMed Central

The effect on the mitochondrial antigen of different agents known to influence the integrity and structure of membranes has been studied using quantitative complement fixation with autoantibodies from the serum of a patient with primary biliary cirrhosis. The susceptibility to proteolytic enzymes suggests that the antigen is a protein. Activity depends upon an association with phospholipids. Addition of phospholipids prevents loss of antigen during artificial ageing of mitochondria at 37°. Activity is lost after treatment with phospholipases or solvents which extract phospholipids. Antigen is also destroyed by surface active agents which dissociate the link with phospholipid but those which weaken bonds between phospholipids and hydrophobic molecules yield fragments of antigen-containing membrane structures which, nonetheless, still react with the mitochondrial autoantibody. ImagesFIG. 2FIG. 4 PMID:5804537

Berg, P. A.; Roitt, I. M.; Doniach, D.; Cooper, H. M.

1969-01-01

359

MITOCHONDRIAL ANTIBODIES IN PRIMARY BILIARY CIRRHOSIS  

PubMed Central

The antigen reacting with complement-fixing antibodies in the sera of patients with primary biliary cirrhosis was localized predominantly in the mitochondrial fraction of tissue homogenates obtained by differential centrifugation. Purified mitochondrial preparations had a high content of the antigen whereas purified lysosomes failed to fix complement with PBC sera. Analysis of a number of fractionation experiments showed a high correlation between antigen content and the mitochondrial enzyme succinic dehydrogenase in all fractions. There was much poorer correlation with lysosomal and micrososomal enzyme markers. The patterns of staining obtained with a fluorescein conjugate of IgG from a PBC patient closely paralleled those obtained with a histochemical method for the demonstration of succinic dehydrogenase, further confirming the mitochondrial localization of the antigen. Staining was brightest in cells containing mitochondria with well-developed cristae. Studies on mitochondria fragmented by osmotic lysis, hexane, lysolecithin, and ultrasound suggest that the antigen is associated with the mitochondrial inner membranes. PMID:4165742

Berg, Peter A.; Doniach, Deborah; Roitt, Ivan M.

1967-01-01

360

Genetics and epigenetics of primary biliary cirrhosis.  

PubMed

Primary biliary cirrhosis (PBC) has been considered a multifactorial autoimmune disease presumably arising from a combination of environmental and genetic factors, with genetic inheritance mostly suggested by familial occurrence and high concordance rate among monozygotic twins. In the last decade, genome-wide association studies, new data on sex chromosome defects and instabilities, and initial evidence on the role of epigenetic abnormalities have strengthened the crucial importance of genetic and epigenetic factors in determining the susceptibility of PBC. High-throughput genetic studies in particular have revolutionized the search for genetic influences on PBC and have the potential to be translated into clinical and therapeutic applications, although more biological knowledge on candidate genes is now needed. In this review, these recent discoveries will be critically summarized with particular focus on the possible steps that may transfer genetic and epigenetic knowledge to direct health benefits in patients with PBC. PMID:25057949

Bianchi, Ilaria; Carbone, Marco; Lleo, Ana; Invernizzi, Pietro

2014-08-01

361

Management of Injury to the Common Bile Duct in a Patient with Roux-en-Y Gastric Bypass  

PubMed Central

Introduction. Most surgeons prefer Roux-en-Y hepaticojejunostomy (RYHJ) for biliary reconstruction following a common bile duct (CBD) injury. However, in patients with a Roux-en-Y gastric bypass (RYGB) a RYHJ may be technically challenging and can interfere with bowel physiology induced by RYGB. The use of a hepaticoduodenostomy (HD) resolves both these issues. Presentation of Case. We present a case of CBD injury during laparoscopic cholecystectomy one year after laparoscopic RYGB for morbid obesity. Due to adhesions and previous surgery with RYGB, we did not want to interfere with the RYGB physiology by anastomosing the CBD to the jejunum or ileum. Succeeding a full Kocher's maneuver we performed biliary reconstruction by a tension-free end-to-side HD. The postoperative recovery was uneventful and the patient was discharged after eight days. At four-month follow-up, the patient had stable weight and normal laboratory test results. MRCP demonstrated normal intra- and extrahepatic bile ducts with status after HD. Discussion. We propose that HD should be considered in treatment of CBD injury in post-RYGB patients as it may reduce the risk of interfering with the post-RYGB physiology. PMID:25161795

Mala, Tom; Berntzen, Dag Tallak Kjærsdalen

2014-01-01

362

Cell lineage tracing reveals a biliary origin of intrahepatic cholangiocarcinoma  

PubMed Central

Intrahepatic cholangiocarcinoma (ICC) is a treatment refractory malignancy with a high mortality and an increasing incidence worldwide. Recent studies have observed that activation of Notch and AKT signalling within mature hepatocytes is able to induce the formation of tumours displaying biliary lineage markers, thereby raising the suggestion that it is hepatocytes, rather than cholangiocytes or hepatic progenitor cells that represent the cell of origin of this tumour. Here we utilise a cholangiocyte-lineage tracing system to target p53 loss to biliary epithelia and observe the appearance of labelled biliary lineage tumours in response to chronic injury. Consequent to this, up-regulation of native functional Notch signalling is observed to occur spontaneously within cholangiocytes and hepatocytes in this model as well as in human ICC. These data prove that in the context of chronic inflammation and p53 loss, frequent occurrences in human disease, biliary epithelia are a target of transformation and an origin of ICC. PMID:24310400

Guest, Rachel V; Boulter, Luke; Kendall, Timothy J; Minnis-Lyons, Sarah E; Walker, Robert; Wigmore, Stephen J; Sansom, Owen J; Forbes, Stuart J

2014-01-01

363

Role of stents and laser therapy in biliary strictures  

NASA Astrophysics Data System (ADS)

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

Chennupati, Raja S.; Trowers, Eugene A.

2001-05-01

364

Surgical treatment in proximal bile duct cancer. A single-center experience.  

PubMed Central

OBJECTIVES: The authors evaluated the experience and results of a single center in surgical treatment of proximal bile duct carcinoma. SUMMARY BACKGROUND DATA: Whenever feasible, surgery is the appropriate treatment in proximal bile duct carcinoma. To improve survival rates and with special regard to liver transplantation, the extent of surgical radicalness remains an open issue. PATIENTS AND METHODS: Retrospective analysis of 249 patients who underwent surgery for proximal bile duct carcinoma via the following procedures: resection (n = 125), liver transplantation (n = 25), and exploratory laparotomy (n = 99). Survival rates were calculated according to the Kaplan-Meier method, uni- and multivariate analysis of prognostic factors, and log rank test (p < 0.05). RESULTS: Survival rates after resection and liver transplantation are correlated with international Union Against Cancer (UICC) tumor stage (resection: overall 5-year, 27.1%; stage I and II, 41.9%; stage IV, 20.7%; liver transplantation: overall 5-year, 17.1%; stage I and II, 37.8%; stage IV, 5.8%). Significant univariate prognostic factors for survival after liver resection were lymph node involvement (N category), tumor stage, tumor-free margins, and vascular invasion; for transplantation, they were local tumor extent, N category, tumor stage, and infiltration of liver parenchyma. For resection and transplantation, a multivariate analysis showed prognostic significance of tumor stage and tumor-free margins. CONCLUSION: Resection remains the treatment of choice in proximal bile duct carcinoma. Whenever possible, decisions about resectability should be made during laparotomy. With regard to the observation of long-term survivors, liver transplantation still can be justified in selected patients with stage II carcinoma. It is unknown whether more radical procedures, such as liver transplantation combined with multivisceral resections, will lead to better outcome in advanced stages. With regard to palliation, surgical drainage of the biliary system performed as hepatojejunostomy can be recommended. PMID:8916878

Pichlmayr, R; Weimann, A; Klempnauer, J; Oldhafer, K J; Maschek, H; Tusch, G; Ringe, B

1996-01-01

365

Systemic inflammation in nonischemic dilated cardiomyopathy  

Microsoft Academic Search

We investigated links between inflammatory systemic activation and clinical presentation of nonischemic dilated cardiomyopathy\\u000a (NIDC). Thirty-one consecutive patients with NIDC (age 57 ± 10 years, left ventricular ejection fraction 32% ± 7%) were enrolled\\u000a in the study: subjects with ischemic heart disease, valvular heart disease, congenital malformations, pulmonary, renal, inflammatory,\\u000a or metabolic diseases were excluded. All patients underwent physical examination,

Luisa De Gennaro; Natale Daniele Brunetti; Andrea Cuculo; Pier Luigi Pellegrino; Matteo Di Biase

2008-01-01

366

Primary large cell neuroendocrine carcinoma in the common bile duct: First Asian case report  

PubMed Central

Large cell neuroendocrine carcinoma (LCNEC) in the biliary system is a poorly differentiated, high-grade neuroendocrine tumor. These tumors exhibit aggressive behavior and an increased tendency for early nodal and distant metastases. Herein, we report an unusual case of a pure primary LCNEC of the common bile duct (CBD). A 75-year-old female presented with nausea and jaundice. The patient underwent a CBD excision with lymph node dissection. Upon histological and immunohistochemical examination, the tumor exhibited pure large cell-type neuroendocrine features. Metastases were noted in two of the eight lymph nodes. The patient was administered adjuvant chemotherapy. The patient’s cancer recurred 7 mo after surgery, and the patient died from liver failure 5 mo after recurrence. The prognosis of LCNEC of CBD remains poor despite curative resection and adjuvant chemotherapy. The role of additional therapies, such as multimodal treatment including radiation therapy, must be further studied to improve the prognoses of patients. PMID:25548506

Park, Sung Bae; Moon, Suk Bae; Ryu, Young Joon; Hong, Jeana; Kim, Yang Hee; Chae, Gi Bong; Hong, Seong Kweon

2014-01-01

367

Stones in the common bile duct: experience with medical dissolution therapy.  

PubMed Central

Thirty-one patients with radiolucent common bile duct stones received medical treatment. Nineteen had Rowachol, a terpene preparation, eight (42%) achieving complete stone disappearance within 3 to 48 months. Fifteen (including 3 of the above) took Rowachol with bile acid (chenodeoxycholic in 11, ursodeoxycholic in 4) for 3 to 60 months: 11 (73%) achieved complete dissolution within 18 months. Persistent symptoms and complications settled on conservative management: 8 (25%) patients required admission (2 biliary colic, 1 obstructive jaundice, 4 cholangitis, 1 pancreatitis). One patient died of a myocardial infarction during recovery from pancreatitis; the other continued treatment, 2 achieving complete dissolution/disappearance. Oral dissolution therapy with Rowachol and bile acids should be considered when endoscopic sphincterotomy or surgery is not feasible, but careful attention to potential complications is required while stones persist. PMID:4022860

Somerville, K. W.; Ellis, W. R.; Whitten, B. H.; Balfour, T. W.; Bell, G. D.

1985-01-01

368

Stones in the common bile duct: experience with medical dissolution therapy.  

PubMed

Thirty-one patients with radiolucent common bile duct stones received medical treatment. Nineteen had Rowachol, a terpene preparation, eight (42%) achieving complete stone disappearance within 3 to 48 months. Fifteen (including 3 of the above) took Rowachol with bile acid (chenodeoxycholic in 11, ursodeoxycholic in 4) for 3 to 60 months: 11 (73%) achieved complete dissolution within 18 months. Persistent symptoms and complications settled on conservative management: 8 (25%) patients required admission (2 biliary colic, 1 obstructive jaundice, 4 cholangitis, 1 pancreatitis). One patient died of a myocardial infarction during recovery from pancreatitis; the other continued treatment, 2 achieving complete dissolution/disappearance. Oral dissolution therapy with Rowachol and bile acids should be considered when endoscopic sphincterotomy or surgery is not feasible, but careful attention to potential complications is required while stones persist. PMID:4022860

Somerville, K W; Ellis, W R; Whitten, B H; Balfour, T W; Bell, G D

1985-04-01

369

Primary large cell neuroendocrine carcinoma in the common bile duct: First Asian case report.  

PubMed

Large cell neuroendocrine carcinoma (LCNEC) in the biliary system is a poorly differentiated, high-grade neuroendocrine tumor. These tumors exhibit aggressive behavior and an increased tendency for early nodal and distant metastases. Herein, we report an unusual case of a pure primary LCNEC of the common bile duct (CBD). A 75-year-old female presented with nausea and jaundice. The patient underwent a CBD excision with lymph node dissection. Upon histological and immunohistochemical examination, the tumor exhibited pure large cell-type neuroendocrine features. Metastases were noted in two of the eight lymph nodes. The patient was administered adjuvant chemotherapy. The patient's cancer recurred 7 mo after surgery, and the patient died from liver failure 5 mo after recurrence. The prognosis of LCNEC of CBD remains poor despite curative resection and adjuvant chemotherapy. The role of additional therapies, such as multimodal treatment including radiation therapy, must be further studied to improve the prognoses of patients. PMID:25548506

Park, Sung Bae; Moon, Suk Bae; Ryu, Young Joon; Hong, Jeana; Kim, Yang Hee; Chae, Gi Bong; Hong, Seong Kweon

2014-12-21

370

Formation and interpretation of dilatant echelon cracks.  

USGS Publications Warehouse

The relative displacements of the walls of many veins, joints, and dikes demonstrate that these structures are dilatant cracks. We infer that dilatant cracks propagate in a principal stress plane, normal to the maximum tensile or least compressive stress. Arrays of echelon crack segments appear to emerge from the peripheries of some dilatant cracks. Breakdown of a parent crack into an echelon array may be initiated by a spatial or temporal rotation of the remote principal stresses about an axis parallel to the crack propagation direction. Near the parent-crack tip, a rotation of the local principal stresses is induced in the same sense, but not necessarily through the same angle. Incipient echelon cracks form at the parent-crack tip normal to the local maximum tensile stress. Further longitudinal growth along surfaces that twist about axes parallel to the propagation direction realigns each echelon crack into a remote principal stress plane. The walls of these twisted cracks may be idealized as helicoidal surfaces. An array of helicoidal cracks sweeps out less surface area than one parent crack twisting through the same angle. Thus, many echelon cracks grow from a single parent because the work done in creating the array, as measured by its surface area decreases as the number of cracks increases. -from Authors

Pollard, D.D.; Segall, P.; Delaney, P.T.

1982-01-01

371

Bougie urethral dilators: revival or survival?  

PubMed Central

Objectives To present our center's experience in managing bladder outlet obstruction (BOO) conditions using bougie dilators. We described the dilation technique methodically for teaching purpose. Patients and method Retrospectively, a total of 196 medical records over the last four years denoting BOO conditions in men, women, and children were retrieved for analysis. Data reviewed for common complications was namely: perforation, recurrence, urinary tract obstruction (UTI) and inability to overcome the obstruction. Results Among the 196 analyzed cases, 24 (12.2%) cases were cured, whereas 172 (87.8%) cases reported complications. Within the complicated cases analyzed, 134 (68.4%) cases had recurrent obstructions, 13 (6.6%) cases had perforations, 6 (3.0%) cases developed UTI, while in 19 (9.7%) cases, we failed to pass the obstruction. Conclusions In our center where urethral dilation technique has revived four years ago, it turned back to be the standard choice in managing BOO cases. We propose the technique to Urology training program directors, all over the world, to teach it as a compulsory skill for junior urologists to master. PMID:24757552

Al–Adawi, Mohammad Ahmad

2013-01-01

372

Pancreatic and Biliary Excretion of Camostat in Dogs  

Microsoft Academic Search

It has been reported that camostat (Foy-305), a synthetic proteinase inhibitor, is excreted into the biliary-pancreatic juice in rats. To confirm whether camostat is excreted into bile or pancreatic juice, camostat (5 mg\\/kg\\/h) was given intravenously to dogs with pancreatic or biliary fistulae. Camostat and its active metabolite (Foy-251) in bile and pancreatic juice were measured by high-performance liquid chromatography

Motoji Kitagawa; Tetsuo Hayakawa; Takaharu Kondo; Tokimune Shibata; Yoshiyuki Sugimoto

1988-01-01

373

In Vivo and In Situ Evaluation of a Wireless Magnetoelastic Sensor Array for Plastic Biliary Stent Monitoring  

PubMed Central

This paper presents the in vivo and in situ evaluation of a system that wirelessly monitors the accumulation of biliary sludge in a plastic biliary stent. The sensing element, located within the stent, is a passive array of magnetoelastic resonators that is queried by a wireless electromagnetic signal. The in vivo and in situ testing uses commercially-available plastic biliary stents, each enhanced with an array of ribbon sensors (formed from Metglas™ 2826MB). The sensor array is approximately 70 mm long and contains individual resonators that are 1 mm in width and have lengths of 10 mm, 14 mm, and 20 mm. The array is anchored into the 2.8 mm inner-diameter stent using a thermal staking technique. For the in situ testing, an instrumented stent is placed in various locations within the abdominal cavity of a female domestic swine carcass to evaluate the wireless range of the system; these results show that a wireless signal can be obtained from a range of at least 7.5 cm from a sensor array covered in bile. The in vivo testing includes the endoscopic implantation of an instrumented stent into the bile duct of a swine. After implantation, the swine was housed for a period of 4 weeks, during which the animal showed no ill effects and followed the expected growth curve from 29 kg to 42 kg. At the conclusion of the in vivo test, the animal was euthanized, and the instrumented stent explanted and examined. The results presented in this paper indicate that the monitoring system does not adversely affect the health of the animal and can feasibly provide sufficient wireless range after implantation. PMID:23460136

Green, Scott R.; Kwon, Richard S.; Elta, Grace H.; Gianchandani, Yogesh B.

2013-01-01

374

In vivo and in situ evaluation of a wireless magnetoelastic sensor array for plastic biliary stent monitoring.  

PubMed

This paper presents the in vivo and in situ evaluation of a system that wirelessly monitors the accumulation of biliary sludge in a plastic biliary stent. The sensing element, located within the stent, is a passive array of magnetoelastic resonators that is queried by a wireless electromagnetic signal. The in vivo and in situ testing uses commercially-available plastic biliary stents, each enhanced with an array of ribbon sensors (formed from Metglas™ 2826 MB). The sensor array is approximately 70 mm long and contains individual resonators that are 1 mm in width and have lengths of 10 mm, 14 mm, and 20 mm. The array is anchored into the 2.8 mm inner-diameter stent using a thermal staking technique. For the in situ testing, an instrumented stent is placed in various locations within the abdominal cavity of a female domestic swine carcass to evaluate the wireless range of the system; these results show that a wireless signal can be obtained from a range of at least 7.5 cm from a sensor array covered in bile. The in vivo testing includes the endoscopic implantation of an instrumented stent into the bile duct of a swine. After implantation, the swine was housed for a period of 4 weeks, during which the animal showed no ill effects and followed the expected growth curve from 29 kg to 42 kg. At the conclusion of the in vivo test, the animal was euthanized, and the instrumented stent explanted and examined. The results presented in this paper indicate that the monitoring system does not adversely affect the health of the animal and can feasibly provide sufficient wireless range after implantation. PMID:23460136

Green, Scott R; Kwon, Richard S; Elta, Grace H; Gianchandani, Yogesh B

2013-06-01

375

Measure Guideline: Sealing and Insulating of Ducts in Existing Homes  

SciTech Connect

This document begins with a discussion on potential cost and performance benefits of duct sealing and insulating. It continues with a review of typical duct materials and components and the overall procedures for assessing and improving the duct system.

Aldrich, R.; Puttagunta, S.

2011-12-01

376

Regulatory T cells control the CD8 adaptive immune response at the time of ductal obstruction in experimental biliary atresia  

PubMed Central

CD8 T-lymphocytes are effector cells of cholangiocyte injury in human and in rhesus rotavirus (RRV) induced experimental biliary atresia (BA). Here, we hypothesize that neonatal deficiency in CD25+CD4+ regulatory T cells (Tregs) leads to aberrant activation of hepatic T-lymphocytes in BA. We found that adoptive transfer of total CD4 cells, but not of CD25-depleted CD4 cells, prior to RRV inoculation reduced expansion of CD8 cells, plasma bilirubin levels, ductal inflammation and bile duct epithelial injury at 7 days postinfection (dpi) compared with age-matched infected controls without adoptive transfer. Searching for mechanisms, we found that in vitro production of IFN? by naïve CD8 cells upon polyclonal stimulation was enhanced in co-culture with hepatic dendritic cells (DC)s from RRV infected, but not with DCs from non-infected mice which was correlated with an increased proportion of CD11b+ myeloid (m)DCs and up-regulation of the costimulatory molecule CD86 on RRV-primed DCs. Furthermore, DC-dependent T-lymphocyte activation was blocked by anti-CD86 antibody in dose dependent fashion. Importantly, expression of CD86 on mDCs was down-regulated by Tregs in vitro, and adoptive transfer of Treg-containing CD4 cells decreased expression of CD86 on hepatic mDCs at 7dpi. On the contrary, in mice resistant to experimental BA, CD25+ cell depletion aggravated bile duct injury at 12dpi after RRV inoculation, as plasma bilirubin levels were elevated by >20fold compared with non-depleted infected controls. Increased susceptibility to hepatobiliary injury in Treg-depleted mice was linked to hepatic CD8 expansion and enhanced stimulatory capacity of hepatic DCs. Conclusion Activation of hepatic T-lymphocytes driving biliary obstruction in BA is regulated by mDCs via CD86-dependent costimulation and is susceptible to inhibition by Tregs. PMID:22334397

Lages, Celine S.; Simmons, Julia; Chougnet, Claire A.; Miethke, Alexander G.

2012-01-01

377

Portal tract eosinophils and hepatocyte cytokeratin 7 immunoreactivity helps distinguish early-stage, mildly active primary biliary cirrhosis and autoimmune hepatitis.  

PubMed

We studied nondiagnostic liver biopsy specimens from 20 patients with definite primary biliary cirrhosis (PBC) and 18 with definite autoimmune hepatitis (AIH) to identify distinguishing features. All patients had early-stage disease; biopsy specimens were devoid of granulomas or diagnostic features of PBC or AIH. Diagnoses were based on serologic and clinical variables. Sixteen specimens from each group were immunostained with cytokeratin 7. The density of portal tract eosinophils and number with cytokeratin 7-reactive periportal hepatocytes were quantified. Sixteen of 18 patients with AIH and 13 of 20 with PBC had no or minimal bile duct injury. Histologic activity index scores were 5.8 in AIH and 5.7 in PBC. The mean portal eosinophil score was greater in PBC than in AIH. Cytokeratin 7 identified many central bile ducts that were obscured by portal inflammation. The mean periportal cytokeratin 7-reactive hepatocyte score was greater in PBC than in AIH. Portal eosinophils and cytokeratin 7 reactivity in periportal hepatocytes are supportive of PBC rather than AIH. No morphologic features were supportive of AIH. Cytokeratin 7 reactivity in periportal hepatocytes may be an early response to PBC-induced biliary obstruction in other regions of the liver. PMID:11764073

Goldstein, N S; Soman, A; Gordon, S C

2001-12-01

378

Relationship between Anomalous Pancreaticobiliary Ductal Union and Pathologic Inflammation of Bile Duct in Choledochal Cyst  

PubMed Central

Purpose Choledochal cyst is a cystic dilatation of common bile duct. Although the etiology is presently uncertain, anomalous pancreaticobiliary ductal union (APBDU) is thought to be a major etiology of choledochal cyst. In this study, we analyzed the clinical and anatomical characteristics and pathologies of patients diagnosed with choledochal cyst in a single institute for 25 years. Methods A total of 113 patients, diagnosed with choledochal cyst and who received an operation in Severance Children's Hospital from January 1988 to May 2013, were included. Medical records were reviewed, including clinical and demographic data, surgical procedures. Abdominal ultrasonography, magnetic resonance cholangiopancreatography, and intraoperative cholangiography were used as diagnostic tools for evaluation and classification of choledochal cyst and the presence of anomalous pancreaticobiliary ductal union. Todani's classification, and relationship between APBDU and surgical pathology. Results Among 113 patients, 77 patients (68.1%) presented symptoms such as hepatitis, pancreatitis and/or cholecystitis. Eighty three patients (73.5%) had APBDU, and 94 patients (83.2%) showed inflammatory pathologic changes. APBDU, pathologic inflammation, and serological abnormalities such as hepatitis or pancreatitis showed a statistically significant correlation to one another. Conclusion APBDU is thought to be one of the etiologic factors of choledochal cyst. It is related to the inflammatory changes in bile duct that can lead to the cystic dilatation. PMID:25349833

Park, So Won; Koh, Hong; Oh, Jung-Tak; Han, Seok Joo

2014-01-01

379

An unusual case of biliary bezoar causing small bowel obstruction in a patient with ampullary diverticulum and stapled gastroplasty.  

PubMed

Primary small bowel bezoars constitute 0.44% of small bowel obstructions (SBO). We report a case of a man with a history of gastroplasty who presented with lower abdominal pain. Initial examination revealed leucocytosis and serum lipase. CT of the abdomen/pelvis was consistent with pancreatitis, cholelithiasis and a stable, 3.8?cm, ampullary diverticulum, without obstruction of the pancreatic/common bile duct. Considering this was the patient's first episode of pancreatitis with evidence of cholelithiasis, it seemed prudent that he would benefit from cholecystectomy but not diverticulectomy. Post-cholecystectomy he represented to the hospital with biliary emesis. CT of the abdomen/pelvis revealed postsurgical changes. Owing to non-resolution of the symptoms, 48?h later a small bowel follow-through was obtained that suggested partial SBO. Ultimately, the patient was taken for exploratory laparoscopy and small bowel resection, after a large intramural mass was encountered in the small bowel. Final pathology revealed a 3?cm biliary bezoar causing obstruction and stercoral ulceration. PMID:25498113

Ashfaq, Awais; Madura, James A; Chapital, Alyssa B

2014-01-01

380

Biliary excretion of iron and ferritin in idiopathic hemochromatosis  

SciTech Connect

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

Hultcrantz, R.; Angelin, B.; Bjoern-Rasmussen, E.E.; Ewerth, S.; Einarsson, K.

1989-06-01

381

Minimally Invasive Management of Biliary Tract Injury Following Percutaneous Nephrolithotomy  

PubMed Central

Introduction: Percutaneous nephrolithotomy is generally considered a safe option for the management of large complex or infectious upper urinary tract calculi. Biliary tract injury is a rare and potentially serious complication of percutaneous nephrolithotomy that can even lead to mortality, especially in cases where biliary peritonitis develops. All reported cases of biliary tract injury have been managed by either open or laparoscopic cholecystectomy. Case Presentation: Herein for the first time, we report a 39-year old woman with biliary tract injury following percutaneous nephrolithotomy who was managed less invasively by insertion of a percutaneous cholecystostomy tube. The patient was discharged home shortly thereafter, and the tube was later removed at a follow up visit after a normal cholangiogram. Conclusions: Biliary tract injury is a rare and potentially serious complication of percutaneous nephrolithotomy that can even lead to mortality. If a biliary tract injury is suspected during percutaneous renal procedures, diverting the bile away from the leak may resolve the problem without the need for a cholecystectomy. Ideally this can be done with ERCP and a stent, but in cases where this is not technically feasible; a percutaneous cholecystostomy can be successful at accomplishing the same result.

Rahnemai-Azar, Ata A; Rahnemaiazar, Amir A; Naghshizadian, Rozhin; Cohen, Jacob H; Naghshizadian, Iman; Gilchrist, Brian F; Farkas, Daniel T

2014-01-01

382

Imaging of malignancies of the biliary tract- an update  

PubMed Central

Malignancies of the biliary tract include cholangiocarcinoma, gallbladder cancers and carcinoma of the ampulla of Vater. Biliary tract adenocarcinomas are the second most common primary hepatobiliary cancer. Due to their slow growing nature, non-specific and late symptomatology, these malignancies are often diagnosed in advanced stages with poor prognosis. Apart from incidental discovery of gall bladder carcinoma upon cholecystectomy, early stage biliary tract cancers are now detected with computed tomography (CT) and magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP). Accurate characterization and staging of these indolent cancers will determine outcome as majority of the patients’ are inoperable at the time of presentation. Ultrasound is useful for initial evaluation of the biliary tract and gallbladder masses and in determining the next suitable modality for further evaluation. Multimodality imaging plays an integral role in the management of the biliary tract malignancies. The imaging techniques most useful are MRI with MRCP, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS) and positron emission tomography (PET). In this review we will discuss epidemiology and the role of imaging in detection, characterization and management of the biliary tract malignancies under the three broad categories of cholangiocarcinomas (intra- and extrahepatic), gallbladder cancers and ampullary carcinomas. PMID:25608662

2014-01-01

383

Recent advances and problems in the management of pancreaticobiliary maljunction: feedback from the guidelines committee.  

PubMed

Clinical practice guidelines on how to deal with pancreaticobiliary maljunction (PBM) were made in Japan in 2012, representing a world first. Using a narrow definition, congenital biliary dilatation involves only Todani type I (except type Ib) and type IV-A, both of which are accompanied by PBM in almost all cases. Prospective ultrasonographic study revealed that the maximum diameter of the common bile duct increased with age. Pathophysiological conditions due to pancreatobiliary reflux occur in patients with high confluence of the pancreaticobiliary ducts, a common channel ? 6?mm long and occlusion of communication during contraction of the sphincter of Oddi. Since PBM can be diagnosed by magnetic resonance cholangiopancreatography, multi-planar reconstruction multi-detector row computed tomography and endoscopic ultrasonography, the current diagnostic criteria should be revised to take these diagnostic imaging modalities into consideration. According to a nationwide survey, biliary cancer occurred in 21.6% of adult patients with PBM with biliary dilatation and 42.2% of patients with PBM without biliary dilatation. In biliary cancer associated with PBM without biliary dilatation, 88.1% were gallbladder cancer. Treatment for PBM with biliary dilatation is prophylactic flow-diversion surgery, but further investigations and surveillance studies are needed to clarify the appropriate surgical strategy for PBM without biliary dilatation. PMID:23798483

Kamisawa, Terumi; Ando, Hisami; Shimada, Mitsuo; Hamada, Yoshinori; Itoi, Takao; Takayashiki, Tsukasa; Miyazaki, Masaru

2014-02-01

384

Evaporation duct effects on sea clutter  

Microsoft Academic Search

Existing sea clutter models are in general agreement on the trends and magnitudes of sea reflectivity at low (1°-10°) grazing angles. However, at extremely low grazing angles (<1°), models, theory, and measurements show considerable differences. The effects of the oceanic evaporation duct on grazing angle are investigated. Significant changes in grazing angle due to the evaporation duct are found and

RICHARD A. PAULUS

1990-01-01

385

Particle Deposition in Industrial Duct Bends  

Microsoft Academic Search

A study of particle deposition in industrial duct bends is presented. Particle deposition by size was measured by comparing particle size distributions upstream and downstream of bends that had geometries and flow conditions similar to those used in industrial ventilation. As the interior surface of the duct bend was greased to prevent particle bounce, the results are applic- able to

THOMAS M. PETERS; DAVID LEITH

2004-01-01

386

Double-duct liquid metal magnetohydrodynamic engine  

DOEpatents

An internal combustion, liquid metal (LM) magnetohydrodynamic (MHD) engine and an alternating current (AC) magnetohydrodynamic generator, are used in combination to provide useful AC electric energy output. The engine design has four pistons and a double duct configuration, with each duct containing sodium potassium liquid metal confined between free pistons located at either end of the duct. The liquid metal is forced to flow back and forth in the duct by the movement of the pistons, which are alternatively driven by an internal combustion process. In the MHD generator, the two LM-MHD ducts pass in close proximity through a Hartmann duct with output transformer. AC power is produced by operating the engine with the liquid metal in the two generator ducts always flowing in counter directions. The amount of liquid metal maintained in the ducts may be varied. This provides a variable stroke length for the pistons. The engine/generator provides variable AC power at variable frequencies that correspond to the power demands of the vehicular propulsion. Also the engine should maintain nearly constant efficiency throughout the range of power usage. Automobiles and trucks could be powered by the invention, with no transmission or power converter devices being required.

Haaland, Carsten M. (Oak Ridge, TN)

1997-01-01

387

Double-duct liquid metal magnetohydrodynamic engine  

DOEpatents

An internal combustion, liquid metal (LM) magnetohydrodynamic (MHD) engine and an alternating current (AC) magnetohydrodynamic generator, are used in combination to provide useful AC electric energy output. The engine design has-four pistons and a double duct configuration, with each duct containing sodium potassium liquid metal confined between free pistons located at either end of the duct. The liquid metal is forced to flow back and forth in the duct by the movement of the pistons, which are alternatively driven by an internal combustion process. In the MHD generator, the two LM-MHD ducts pass in close proximity through a Hartmann duct with output transformer. AC power is produced by operating the engine with the liquid metal in the two generator ducts always flowing in counter directions. The amount of liquid metal maintained in the ducts may be varied. This provides a variable stroke length for the pistons. The engine/generator provides variable AC power at variable frequencies that correspond to the power demands of the vehicular propulsion. Also the engine should maintain nearly constant efficiency throughout the range of power usage. Automobiles and trucks could be powered by the invention, with no transmission or power converter devices being required.

Haaland, Carsten M. (Oak Ridge, TN)

1995-01-01

388

Rocket-in-a-Duct Performance Analysis  

NASA Technical Reports Server (NTRS)

An axisymmetric, 110 N class, rocket configured with a free expansion between the rocket nozzle and a surrounding duct was tested in an altitude simulation facility. The propellants were gaseous hydrogen and gaseous oxygen and the hardware consisted of a heat sink type copper rocket firing through copper ducts of various diameters and lengths. A secondary flow of nitrogen was introduced at the blind end of the duct to mix with the primary rocket mass flow in the duct. This flow was in the range of 0 to 10% of the primary massflow and its effect on nozzle performance was measured. The random measurement errors on thrust and massflow were within +/-1%. One dimensional equilibrium calculations were used to establish the possible theoretical performance of these rocket-in-a-duct nozzles. Although the scale of these tests was small, they simulated the relevant flow expansion physics at a modest experimental cost. Test results indicated that lower performance was obtained at higher free expansion area ratios and longer ducts, while, higher performance was obtained with the addition of secondary flow. There was a discernable peak in specific impulse efficiency at 4% secondary flow. The small scale of these tests resulted in low performance efficiencies, but prior numerical modeling of larger rocket-in-a-duct engines predicted performance that was comparable to that of optimized rocket nozzles. This remains to be proven in large-scale, rocket-in-a-duct tests.

Schneider, Steven J.; Reed, Brian D.

1999-01-01

389

Postoperative Chemoradiotherapy for Extrahepatic Bile Duct Cancer  

Microsoft Academic Search

Purpose: To evaluate the effect of postoperative concurrent chemoradiotherapy using three-dimensional conformal radiotherapy and to identify the prognostic factors that influence survival in patients with extrahepatic bile duct cancer. Methods and Materials: We retrospectively analyzed the data from 101 patients with extrahepatic bile duct cancer who had undergone postoperative concurrent chemoradiotherapy using three-dimensional conformal radiotherapy. Of the 101 patients, 52

Jin-hong Park; Eun Kyung Choi; Seung Do Ahn; Sang-wook Lee; Si Yeol Song; Sang Min Yoon; Young Seok Kim; Yu Sun Lee; Sung-Gyu Lee; Shin Hwang; Young-Joo Lee; Kwang-Min Park; Tae Won Kim; Heung Moon Chang; Jae-Lyun Lee; Jong Hoon Kim

2011-01-01

390

VHF and Microwave Propagation Characteristics of Ducts  

Microsoft Academic Search

Observations from many years of amateur radio operations together with commercial microwave propagation studies and are used to illustrate the nature of the VHF propagation in ducts. Recently developed formula for characterizing VHF and microwave propagation in ducts are used and modified to reconcile the observations with theory. Measurements from a high resolution SODAR are used to show the complex

Andrew L. Martin

2007-01-01

391

Electromagnetic propagation in PEC and absorbing curved S-ducts  

NASA Technical Reports Server (NTRS)

A finite-element Galerkin formulation has been developed to study transverse magnetic (TM) wave propagation in 2-D S-curved ducts with both perfectly conducting and absorbing walls. The reflection and transmission at the entrances and the exits of the curved ducts are determined by coupling the finite-element solutions in the curved ducts to the eigenfunctions of an infinite, uniform, perfectly conducting duct. Example solutions are presented for a double mitred and S-ducts of various lengths. The length of the S-duct is found to significantly effect the reflective characteristics of the duct. Also, the effect of curvature on an absorbing duct is illustrated.

Baumeister, Kenneth J.

1988-01-01

392

Muscles Involved in Naris Dilation and Nose Motion in Rat.  

PubMed

In a number of mammals muscle dilator nasi (naris) has been described as a muscle that reduces nasal airflow resistance by dilating the nostrils. Here we show that in rats the tendon of this muscle inserts into the aponeurosis above the nasal cartilage. Electrical stimulation of this muscle raises the nose and deflects it laterally towards the side of stimulation, but does not change the size of the nares. In alert head-restrained rats, electromyographic recordings of muscle dilator nasi reveal that it is active during nose motion rather than nares dilation. Together these results suggest an alternative role for the muscle dilator nasi in directing the nares for active odor sampling rather than dilating the nares. We suggest that dilation of the nares results from contraction of muscles of the maxillary division of muscle nasolabialis profundus. This muscle group attaches to the outer wall of the nasal cartilage and to the plate of the mystacial pad. Contraction of these muscles exerts a dual action: it pulls the lateral nasal cartilage outward, thus dilating the naris, and drags the plate of the mystacial pad rostrally to produce a slight retraction of the vibrissae. On the basis of these results, we propose that muscle dilator nasi of the rat should be re-named muscle deflector nasi, and that the maxillary parts of muscle nasolabialis profundus should be referred to as muscle dilator nasi. Anat Rec, 2014. © 2014 Wiley Periodicals, Inc. PMID:25257748

Deschênes, Martin; Haidarliu, Sebastian; Demers, Maxime; Moore, Jeffrey; Kleinfeld, David; Ahissar, Ehud

2014-09-25

393

Changes in intraocular pressure after pharmacologic pupil dilation  

PubMed Central

Background Intraocular pressure (IOP) may vary according to the change of ocular conditions. In this study, we want to assess the effect and mechanism of pupil dilation on IOP in normal subjects. Methods We prospectively evaluated 32 eyes of 32 patients (age; 61.7?±?8.2?years) with normal open angles under diurnal IOP. IOP was measured every two hours from 9?AM to 11?PM for one day to establish baseline values and was measured again for one day to assess the differences after dilation. To induce dilation, we administered 2.5% phenylephrine and 1% tropicamide every 5?minutes from 8:30?AM to 8:45?AM and for every two hours from 11?AM to 9?PM to keep the pupil dilated. Diurnal IOP, biometry, Visante OCT, and laser flare photometry were measured before and after dilation. Results We observed a significant increase in IOP after dilation, 1.85?±?2.01?mmHg (p?=?0.002). IOP elevation remained significant until about four hours after dilation. Thereafter, IOP decreased slowly and eventually reached pre-dilation level (p?>?0.05). Flare values decreased, and the anterior chamber angle became wider after mydriasis. Conclusions Dilation of the pupil significantly and incidentally elevated IOP in normal subjects. Further related studies are warranted to characterize the mechanism of the increased IOP after dilation. PMID:23017184

2012-01-01

394

Analysis of patients with biliary atresia coming to liver transplantation.  

PubMed

Seventy-two patients with end-stage liver disease underwent liver transplantation between March 1981 and March 1984; 35 (49%) with biliary atresia, the remainder with other disorders. This provided us with a unique opportunity to analyze factors leading to liver failure in patients who had undergone biliary drainage procedures for "uncorrectable" biliary atresia. Four patients in the biliary atresia group were excluded (no corrective procedure done, 3; "correctable" biliary atresia, 1), leaving 31 patients for study. Transplantation survival was 84% for the study group and 73% in children with other primary liver disorders. Most patients were less than 3 months old at the time of initial surgery, had minimal liver disease, and had accepted corrective operations by experienced surgeons. Despite these "favorable" factors, bile drainage was rarely achieved. All patients with continued bile drainage at the time of transplantation had repeated episodes of cholangitis, and cholangitis was associated with cessation of bile drainage in half of those with transient function. Findings at hepatectomy suggested that in four cases where bile drainage was never achieved, reexploration may have been successful. Complications included those associated with hepatic failure and portal hypertension. Of note were a high incidence of bone disease and a 43% incidence of stomal hemorrhage in patients with stomas. The short-term survival after transplantation was comparable in the biliary atresia group and the children with other disorders. This suggests that while the presence of a previous biliary drainage procedure may increase the technical difficulty of transplantation, it does not decrease survival. PMID:6440971

Pettitt, B J; Zitelli, B J; Rowe, M I

1984-12-01

395

Advanced Turbofan Duct Liner Concepts  

NASA Technical Reports Server (NTRS)

The Advanced Subsonic Technology Noise Reduction Program goal is to reduce aircraft noise by 10 EPNdB by the year 2000 relative, to 1992 technology. The improvement goal for nacelle attenuation is 25% relative to 1992 technology by 1997 and 50% by 2000. The Advanced Turbofan Duct Liner Concepts Task work by Boeing presented in this document was in support of these goals. The basis for the technical approach was a Boeing study conducted in 1993-94 under NASA/FAA contract NAS1-19349, Task 6, investigating broadband acoustic liner concepts. As a result of this work, it was recommended that linear double layer, linear and perforate triple layer, parallel element, and bulk absorber liners be further investigated to improve nacelle attenuations. NASA LaRC also suggested that "adaptive" liner concepts that would allow "in-situ" acoustic impedance control also be considered. As a result, bias flow and high-temperature liner concepts were also added to the investigation. The major conclusion from the above studies is that improvements in nacelle liner average acoustic impedance characteristics alone will not result in 25% increased nacelle noise reduction relative to 1992 technology. Nacelle design advancements currently being developed by Boeing are expected to add 20-40% more acoustic lining to hardwall regions in current inlets, which is predicted to result in and additional 40-80% attenuation improvement. Similar advancements are expected to allow 10-30% more acoustic lining in current fan ducts with 10-30% more attenuation expected. In addition, Boeing is currently developing a scarf inlet concept which is expected to give an additional 40-80% attenuation improvement for equivalent lining areas.

Bielak, Gerald W.; Premo, John W.; Hersh, Alan S.

1999-01-01

396

Common Bile Duct Stones Detected After Cholecystectomy:Advancement into the Duodenum via the Percutaneous Route  

SciTech Connect

Purpose: To report our experience in the use of percutaneous extraction of common bile duct stones detected in the post-cholecystectomy period. Methods: Forty-two patients in whom endoscopic cannulation and/or sphincterotomy had failed or could not be done due to several reasons underwent balloon dilatation of the ampulla of Vater and subsequent advancement of the stones via the percutaneous transhepatic route or T-tube tract. Results: The procedure was successful in 42 cases. In three patients, stones were crushed in the common bile duct and pushed as fragments into the duodenum. In all cases transient adverse effects were observed. There were no major complications. All cases were checked with ultrasonography for 6 months after the procedure. Conclusion: Percutaneous extraction of common bile duct stones is an effective method of treatment with a high success rate,low complication rate and shorter hospital stay. It may serve as an alternative method in cases where endoscopic removal of stones fails.

Ozcan, Nevzat, E-mail: nevzatcan@yahoo.com; Erdogan, Nuri [ErciyesUniversity Faculty of Medicine, 38039-Kayseri, Department of Radiology (Turkey); Baskol, Mevlut [Erciyes University Faculty of Medicine, 38039-Kayseri, Department ofGastroenterology (Turkey)

2003-04-15

397

Bile Duct Adenoma with Oncocytic Features  

PubMed Central

Bile duct adenomas are benign bile duct proliferations usually encountered as an incidental finding. Oncocytic bile duct neoplasms are rare and the majority are malignant. A 61-year-old male with a diagnosis of colorectal adenocarcinoma was undergoing surgery when a small white nodule was discovered on the surface of the right lobe of his liver. This lesion was composed of cytologically bland cells arranged in tightly packed glands. These cells were immunopositive for cytokeratin 7, negative for Hep Par 1, contained mucin, and had a Ki67 proliferation index of 8%. The morphology, immunophenotype, presence of mucin, and normal appearing bile ducts, as well as the increased Ki67 proliferation rate, were consistent with a bile duct adenoma with oxyphilic (oncocytic) change. Oncocytic tumors in the liver are rare; the first described in 1992. Only two bile duct adenomas with oncocytic change have been reported and neither of them had reported mucin production or the presence of normal appearing bile ducts within the lesion. PMID:24592348

Johannesen, E. J.; Wu, Zihao; Holly, Jason-Scott

2014-01-01

398

Bile duct adenoma with oncocytic features.  

PubMed

Bile duct adenomas are benign bile duct proliferations usually encountered as an incidental finding. Oncocytic bile duct neoplasms are rare and the majority are malignant. A 61-year-old male with a diagnosis of colorectal adenocarcinoma was undergoing surgery when a small white nodule was discovered on the surface of the right lobe of his liver. This lesion was composed of cytologically bland cells arranged in tightly packed glands. These cells were immunopositive for cytokeratin 7, negative for Hep Par 1, contained mucin, and had a Ki67 proliferation index of 8%. The morphology, immunophenotype, presence of mucin, and normal appearing bile ducts, as well as the increased Ki67 proliferation rate, were consistent with a bile duct adenoma with oxyphilic (oncocytic) change. Oncocytic tumors in the liver are rare; the first described in 1992. Only two bile duct adenomas with oncocytic change have been reported and neither of them had reported mucin production or the presence of normal appearing bile ducts within the lesion. PMID:24592348

Johannesen, E J; Wu, Zihao; Holly, Jason-Scott

2014-01-01

399

Hepatitis C and bile duct loss.  

PubMed Central

AIM: To assess whether bile duct loss is associated with the bile duct damage induced by chronic hepatitis C. METHODS: Sections were examined from 171 liver biopsy specimens from patients with chronic hepatitis C, 98 biopsy specimens from patients with chronic hepatitis B, 25 postmortem specimens from patients with no evidence of liver disease, and 23 patients who underwent protocol liver biopsy at the time of cholecystectomy. RESULTS: The bile duct:portal tract ratio for the hepatitis C group was 0.89, for the hepatitis B group was 0.93 and for the two control groups was 0.96 and 0.90, respectively. The ratio was lower in the hepatitis C group than in the other three. In no case of chronic hepatitis C was the ratio less than 0.60. In the hepatitis C group greater bile duct loss was seen in cirrhotic patients. CONCLUSIONS: Hepatitis C is associated with bile duct loss and this was related to the stage of the disease. However, in the cases studied this did not reach what is generally considered to be significant (that is, greater than 50% of portal tracts lacking bile ducts). This does not preclude a contributory effect of hepatitis C to bile duct loss in the presence of other risk factors, especially in liver transplant recipients. PMID:8943752

Goldin, R D; Patel, N K; Thomas, H C

1996-01-01

400

Gastric Necrosis due to Acute Massive Gastric Dilatation  

PubMed Central

Gastric necrosis due to acute massive gastric dilatation is relatively rare. Vascular reasons, herniation, volvulus, acute gastric dilatation, anorexia, and bulimia nervosa play a role in the etiology of the disease. Early diagnosis and treatment are highly important as the associated morbidity and mortality rates are high. In this case report, we present a case of gastric necrosis due to acute gastric dilatation accompanied with the relevant literature. PMID:23983714

Pergel, Ahmet; Yucel, Ahmet Fikret; Sahin, Dursun Ali; Ozer, Ender

2013-01-01

401

Evaluation and screening ultrasonic signs in the diagnosis of fetal biliary cystic malformation.  

PubMed

Abstract Objective: To evaluate and screen for fetal biliary cystic malformation (BCM) associated-ultrasonic key signs or sign-combinations. Methods: Thirty cases of fetal abdominal cysts were investigated, followed up and divided into BCM and non-BCM groups. Expression rates of seven fetal BCM-associated ultrasonic signs in the two groups (A: the cyst was located in the right upper quadrant of the abdomen, B: located beneath the porta hepatis, C: having no septum, D: not the gallbladder, E: connected to the gallbladder, F: connected to the hepatic ducts, G: its inferior portion ended in the epigastric region, anterior to the spinal column) were compared. The diagnostic efficacy of single signs and sign-combinations was evaluated by diagnostic test. Results: The expressions of Sign A and Sign D had no statistically significant differences between the two groups. Single sign of B, F and G had diagnostic efficacy. The diagnostic index of B reached 1.8571. The diagnostic index of the sign-combinations B and D, F or G, and E or F or G reached 2.0000. Conclusion: When the fetal cyst was located beneath the porta hepatis and was not the gallbladder, BCM could be diagnosed. Sign G might be another significant ultrasonic sign in BCM prenatal diagnosis. PMID:25330845

Cong, Xiang; Sun, Xiubin; Liu, Shaoping

2014-11-14

402

Celiac disease, primary biliary cirrhosis and helicobacter pylori infection: one link for three diseases.  

PubMed

The association between celiac disease (CD) and primary biliary cirrhosis (PBC) has been reported in literature. Recent epidemiological studies showed an increased prevalence of CD in patients with PBC and vice versa. The cause of PBC is unknown. However, considerable evidence points to an autoimmune basis. The role of infectious agents, such as Helicobacter pylori (H. pylori), has been proposed to stimulate antibody cross-reaction with mitochondria of the bile duct cells. We report a case of a 36-year-old woman with diagnosis of CD, PBC and H. pylori infection. Strict adherence to gluten-free diet, associated to ursodeoxycholic acid (UDCA) administration and eradication treatment for H. pylori infection, led to a marked improvement of clinical status. Our experience supports the pathogenetic role of increased intestinal permeability in the course of CD and H. pylori infection to induce PBC. Future studies are needed to clarify this link to, and in particular the role played by abnormal intestinal permeability and infectious agents in the pathogenesis of PBC. PMID:21244776

Abenavoli, L; Arena, V; Giancotti, F; Vecchio, F M; Abenavoli, S

2010-01-01

403

Utilization of Ancillary Studies in the Cytologic Diagnosis of Biliary and Pancreatic Lesions  

PubMed Central

The Papanicolaou Society of Cytopathology has developed a set of guidelines for pancreatobiliary cytology including indications for endoscopic ultrasound-guided fine-needle aspiration, terminology and nomenclature of pancreatobiliary disease, ancillary testing, and post-biopsy management. All documents are based on the expertise of the authors, a review of the literature, discussions of the draft document at several national and international meetings, and synthesis of selected online comments of the draft document. This document presents the results of these discussions regarding the use of ancillary testing in the cytologic diagnosis of biliary and pancreatic lesions. Currently, fluorescence in situ hybridization (FISH) appears to be the most clinically relevant ancillary technique for cytology of bile duct strictures. The addition of FISH analysis to routine cytologic evaluation appears to yield the highest sensitivity without loss in specificity. Loss of immunohistochemical staining for the protein product of the SMAD4 gene and positive staining for mesothelin support a diagnosis of ductal adenocarcinoma. Immunohistochemical markers for endocrine and exocrine differentiation are sufficient for a diagnosis of endocrine and acinar tumors. Nuclear staining for beta-catenin supports a diagnosis of solid-pseudopapilary neoplasm. Cyst fluid analysis for amylase and carcinoembryonic antigen aids in the preoperative classification of pancreatic cysts. Many gene mutations (KRAS, GNAS, VHL, RNF43, and CTNNB1) may be of aid in the diagnosis of cystic neoplasms. Other ancillary techniques do not appear to improve diagnostic sensitivity sufficiently to justify their increased costs. PMID:24639398

Layfield, Lester J.; Ehya, Hormoz; Filie, Armando C.; Hruban, Ralph H.; Jhala, Nirag; Joseph, Loren; Vielh, Philippe; Pitman, Martha B.

2015-01-01

404

Primary Biliary Cirrhosis and Primary Sjögren's Syndrome: Insights for the Stomatologist  

PubMed Central

Primary biliary cirrhosis (PBC) is a chronic progressive autoimmune disease characterized by portal inflammation and immune-mediated destruction of the intrahepatic bile ducts. Primary Sjögren's syndrome is an autoimmune disease characterized by lymphocytic infiltration of exocrine glands, mainly the lachrymal and salivary glands, in the absence of other definitively diagnosed rheumatologic disease. We report a diagnosed case of primary Sjögren's syndrome associated with PBC. A 59-year-old Caucasian woman went to oral evaluation reporting dry mouth, difficulty in eating associated with burning mouth syndrome, dysgeusia and dysphagia. Intraoral examination revealed extensive cervical caries, gingivitis, gingival retraction, angular cheilitis and atrophic tongue. Hyposalivation was detected by salivary flow and Schirmer's test was positive. Antinuclear and antimitochondrial antibodies were both positive. Anti-Ro/SSA and anti-La/SSB antibodies were negative. A minor salivary gland biopsy of the lower lip was performed. Histopathologic analysis revealed lymphocytic infiltrate with destruction of salivary gland architecture in some areas and replacement of glandular tissues by mononuclear cells. Optimal management of PBC associated with Sjögren's syndrome requires a multidisciplinary approach as the key to optimal patient care. Dental practitioners should be able to recognize the clinical features of this associated condition. Appropriate dental care may prevent tooth decay, periodontal disease and oral infections as well as improve the patient's quality of life. PMID:25298762

Lins, Liliane; Paraná, Raymundo; Almeida Reis, Silvia Regina; Pereira Falcão, Antônio Fernando

2014-01-01

405

Primary biliary tract malignancies: MRI spectrum and mimics with histopathological correlation.  

PubMed

Contrast-enhanced magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRCP), due to their excellent soft tissue contrasts, have become first-line noninvasive tests in the characterization and detection of both hepatic and pancreaticobiliary pathologies. MRCP is also helpful in detecting the level and cause of obstruction in patients presenting with jaundice. Cholangiocarcinoma (CCA) is the most common primary malignant tumor arising from the bile duct epithelium, with extrahepatic tumors presenting more often than with intrahepatic ones. However, the diagnosis and management of CCA is made more complex by a variety of malignant and benign conditions that resemble CCA, including hepatocellular carcinoma variants such as the fibrolamellar variant of hepatocellular carcinoma, cholangiocellular carcinoma, biliary metastases, hepatic inflammatory pseudotumor, lymphoepithelioma-like carcinoma, confluent fibrosis, primary sclerosis cholangitis, and the secondary sclerosing cholangitis complex. Consequently, knowledge of the underlying risk factors and imaging characteristics of these conditions is important in differentiating between neoplastic and non-neoplastic conditions in order to reach a definite diagnosis. Endoscopic retrograde cholangiopancreatography should be reserved for those patients who require intervention or biopsy for histopathological diagnosis. PMID:25416002

Mittal, Pardeep K; Moreno, Courtney Coursey; Kalb, Bobby; Mittal, Ankush; Camacho, Juan C; Maddu, Kiran; Kitajima, Hiroumi D; Quigley, Brian C; Kokabi, Nima; Small, William C

2014-11-22

406

Oral Tolerance and Pyruvate Dehydrogenase in Patients with Primary Biliary Cirrhosis  

PubMed Central

Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease characterized by the immunological destruction of intralobular bile ducts and serum anti-mitochondrial antibodies (AMA). Based upon previous work of oral tolerance and autoimmunity, we hypothesized that feeding the mitochondrial autoantigens of PBC would alter the clinical course and the level of antimitochondrial antibodies. The bovine pyruvate dehydrogenase complex (PDC) was purified and 5 mg fed in gelatin capsules to 6 patients with early stage PBC for 6 months. Antimitochondrial antibodies and liver biochemistries were measured at every 3 months for 12 months. The clinical trial was completed for all patients except for 1 who showed deterioration of pre-existing skin rash during treatment, which disappeared within 2 weeks after treatment was discontinued. However, after 1 year, neither the titers of AMAs nor liver biochemistries were significantly changed by this treatment. This is the first trial to test the efficacy of oral tolerance induction in PBC. However, the data, which limited in scope, did not demonstrate efficacy and further highlights the difficulties in showing continuing evidence of tolerance induction in autoimmunity. PMID:12739782

Suzuki, Ayako; van de Water, Judy; Gershwin, M. Eric; Jorgensen, Roberta; Angulo, Paul; Lindor, Keith

2002-01-01

407

E. coli Induced Experimental Model of Primary Biliary Cirrhosis: At Last  

PubMed Central

Recurrent urinary tract infections (UTI) have been considered potential triggers of primary biliary cirrhosis (PBC), an autoimmune cholestatic liver disease characterised by progressive destruction of intrahepatic bile ducts. Additional support for the link made between PBC and UTI was based on early observations of recurrent episodes of bacteriuria in female patients with PBC. A series of large epidemiological studies demonstrated a strong correlation between recurrent UTI and PBC, initiating a series of studies investigating the role of Escherichia coli (E. coli, the most prevalent organism isolated in women with UTI) as a trigger of PBC. Immunological evidence of B- and T-cell cross-reactive responses implicating PBC-specific autoantigens and E. coli mimics have been clearly demonstrated, adding support to the notion that E. coli is a potential infectious inducer of PBC in susceptible individuals. One of the major limitations in proving the E. coli/PBC association was the lack of reliable E. coli-infected animal models of PBC. This review provides an overview of the evidence linking this infectious agent with PBC and discusses the pros and cons of a recently developed E. coli-infected animal model of PBC. PMID:25580301

Koutsoumpas, Andreas L.; Smyk, Daniel S.; Bogdanos, Dimitrios P.

2014-01-01

408

New Therapies for Primary Biliary Cirrhosis.  

PubMed

Primary biliary cirrhosis (PBC) is a rare inflammatory liver disease for which ursodeoxycholic acid (UDCA) is the only therapy approved by the U.S. Food and Drug Administration. Patients with a biochemical response to UDCA therapy have a similar survival rate compared to the general population. However, up to 40 % of PBC patients do not achieve a complete response to UDCA, have an increased risk of liver-related death and liver transplantation, and represent a persistent medical need for new therapies. Several novel drugs have recently been studied and show potential efficacy in PBC. Obeticholic acid, a farnesoid X receptor agonist, has been tested in phase II trials and initial results after 1 year in a phase III international trial suggest that it may be effective in achieving a biochemical response in approximately 40 % of patients who do not completely respond to UDCA. Several small studies on fibrates have suggested that they may have efficacy, but larger studies are needed. Surprisingly, results of immunomodulators and biologics have not yet been able to demonstrate efficacy, but new approaches have shown promise in animal models and their translation to human clinical trials are awaited. PMID:25331740

Floreani, Annarosa; Franceschet, Irene; Perini, Lisa; Cazzagon, Nora; Gershwin, M Eric; Bowlus, Christopher L

2014-10-21

409

Predicting outcome in primary biliary cirrhosis.  

PubMed

Primary biliary cirrhosis (PBC) is a slowly progressive autoimmune liver disease that may ultimately result in liver failure and premature death. Predicting outcome is of key importance in clinical management and an essential requirement for patients counselling and timing of diagnostic and therapeutic interventions. The following factors are associated with progressive disease and worse outcome: young age at diagnosis, male gender, histological presence of cirrhosis, accelerated marked uctopenia in relation to the amount of fibrosis, high serum bilirubin, low serum albumin levels, high serum alkaline phosphatase levels, esophageal varices, hepatocellular carcinoma (HCC) and lack of biochemical response to ursodeoxycholic acid (UDCA). The prognostic significance of symptoms at diagnosis is uncertain. UDCA therapy and liver transplantation have a significant beneficial effect on the outcome of the disease. The Mayo risk score in PBC can be used for estimating individual prognosis. The Newcastle Varices in PBC Score may be a useful clinical tool to predict the risk for development of esophageal varices. Male gender, cirrhosis and non-response to UDCA therapy in particular, are risk factors for development of HCC. PMID:24927602

Lammers, Willem J; Kowdley, Kris V; van Buuren, Henk R

2014-01-01