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PubMed1975

Susceptibility of the liver and biliary tract to anaerobic infection in extrahepatic biliary tract obstruction. Bacteriological investigations - an experimental study in rabbits.

The influence of common duct occlusion on susceptibility to infection with anaerobic gram-negative rods was investigated in rabbits. Intravenous inoculation was performed with three B. fragilis strains isolated from human infections and with a stock culture of Fusobacterium mortiferum. Liver tissue, gallbladder, bile, and blood were investigated. Anaerobic culture procedures were based on the use of a 'glove-box' with an oxygen-free atmosphere and pre-reduced, anaerobically sterilized media. Anaerobic transport was based on flushing of samples with oxygen-free carbon dioxide and transport-time less than 30 minutes. In regard to two B. fragilis strains (ss. fragilis) and in regard to Fusobacterium mortiferum, common duct occlusion significantly increased the number of infected animals compared to a control group of inoculated animals without common duct occlusion. Spontaneous infection did not arise in a control group of animals with common duct ligation. It is concluded that: 1) in biliary tract occlusion, anaerobic bacteria are able to invade the biliary tract from the blood stream, and 2) biliary tract occlusion produces sufficient anaerobic conditions for obligate anaerobic bacteria to multiply in the bile.

Animals↗
PubMed2002

Biliary tract cancer treatment: results from the Biliary Tract Cancer Statistics Registry in Japan.

BACKGROUND/PURPOSE: A registry project for cancers of the biliary tract accumulated a total of 11,030 cases for 10 years. In the present study, registered cases were analyzed for information bearing on problems with the treatment of cancer of the biliary tract. The Japanese classification of lymph nodes was also considered on the basis of the results of this study. METHODS: In 11,030 cases, the site of cancer was the gallbladder in 4,774, the bile duct in 4,833, and the papilla of Vater in 1,423. Those cases were analyzed with regard to patient survival according to the stage of disease and the extent of lymph node metastasis. RESULTS: More than 11,000 cases of cancer of the biliary tract have been registered to date from 158 member institutions of the Japanese Society of Biliary Surgery. While the 5-year survival rates for stage I gallbladder cancer and cancer of the papilla were 77% and 75%, respectively, those for stage I hilar or upper bile duct cancer and middle or lower bile duct cancer were 47% and 54%. For stage II and stage III disease, the 5-year survival rates were about 50% for gallbladder cancer and 30% or higher for cancer of the papilla, while survival was only 20% to 30% for bile duct cancer, regardless of specific site. For stage IV, the 5-year survival rate was unexpectedly high, being about 10% or higher for cancers at all sites, with 19% for cancer of the papillary region being the highest. Thus, there still seem to remain surgical indications for stage IV cancers. The lymph node metastasis rate was about 40% for cancers at all sites. Changes in surgical procedures to improve the 5-year survival rate in patients with n2 metastasis or less will be needed. Noncurative resection occurred frequently for cancers at all sites, particularly in cancers of the hilar or upper bile duct, accounting for 60% of cases or more. We have to recognize that measures to reduce inadvertent noncurative resection are fundamental to the treatment of cancer. CONCLUSIONS: Considering the survival results according to specific lymph nodes involved, we concluded that the Japanese classification of lymph nodes, particularly hepatoduodenal ligament lymph nodes, should be reexamined, while another procedure to remove such lymph nodes completely should be developed.

Ampulla of Vater↗
PubMed1996

[Biliary tract tumors].

Biliary tract cancers are rare neoplasms including gallbladder cancer (the commonest), extrahepatic biliary tract cancer and cancer of the ampulla of Vater. Descriptive epidemiology of biliary tract cancers as a whole has two peculiarities: incidence and mortality rates are higher for women than men, and in some specific populations. Mortality rates are highest among New Mexico American Indian women, in Chile and Japan, lowest in Great Britain and Greece. Mortality trends vary widely: the largest increases have been observed in Japan, Hong-Kong and Spain and the largest decreases in the Anglo-Saxon populations. Our knowledge of biliary tract cancer etiology is limited. Defined risks include genetic factors (family history of biliary tract cancers, ethnicity), history of gallbladder disease, and cholelithiasis. Risk factors reported in some studies, on which, however, information is not consistent and which need further study, include overweight, some menstrual and reproductive factors (multiparity, young age at first birth, late menopause), low education, cigarette smoking, selected bacterial infections, some intestinal diseases and diabetes.

Adolescent↗
PubMed1994

Biliary tract cancer.

Biliary tract cancer is a rare cancer in most parts of the world, but it is relatively common in some countries and ethnic groups, such as Japan, Central and South America, eastern Europe and in American Indians, and Hispanics. In some countries, such as Japan, Sweden, Finland and Italy, the age adjusted mortality of biliary tract cancer has been increasing, whereas in females in some other countries--Israel, The Netherlands, USA, Canada, Federal Republic of Germany, etc--mortality has been declining. The reasons for these geographical or ethnic variations and time trends for biliary tract cancer are not clear, but some unknown environmental risk factors or a genetic susceptibility are suspected. Not many analytical epidemiological studies on biliary tract cancer have been conducted yet and little is known about its aetiology apart from a close association with gall stones and a female preponderance of gall bladder cancer. Besides gall stones, some other factors such as obesity, pregnancy, female sex hormones, exposure in rubber and some other chemical industries and genetic factors have been suspected of being associated with gall bladder cancer directly or indirectly through cholelithiasis. As an artificial factor, the effect of the prevalence of cholecystectomy on biliary tract cancer must be considered. More studies are needed in the future to elucidate the aetiology of biliary tract cancer and to establish measures to prevent this cancer.

Americas↗
PubMed2006

Aberrant promoter hypermethylation in biliary tract carcinoma.

Biliary tract carcinoma is a relatively rare tumor with a poor survival rate. The molecular biological mechanisms underlying the development of biliary tract carcinomas are not well understood. Promoter methylation is an important epigenetic mechanism for suppressing tumor-suppressor gene activity. There is limited information regarding the abnormal methylation of cancer-related genes in biliary tract carcinoma; however, a few insights have been obtained into the role of epigenetic silencing in the progression of biliary tract carcinoma. In this review, we summarize recent data on gene silencing by promoter hypermethylation, and we discuss the implications for biliary tract carcinomas.

Bile Duct Neoplasms↗
PubMed1974

Biliary tract excretion of cefazolin, cephalothin, and cephaloridine in the presence of biliary tract disease.

The biliary tract excretion of three cephalosporins, cefazolin, cephaloridine, and cephalothin, was compared in patients with biliary tract disease. In the absence of obstruction, mean antibiotic levels in bile from gall bladder and common duct in patients undergoing cholecystectomy were highest for cefazolin (17 and 31 mug/ml, respectively) than either cephaloridine (7 and 9 mug/ml) or cephalothin (1 and 4 mug/ml). Biliary tract levels generally paralleled serum levels. In no patient with cystic duct obstruction were any of the cephalosporins detectable in appreciable amounts in gall bladder bile. In patients with T-tube drainage given each of the three different cephalosporins on separate days, concentrations of cefazolin in bile were many-fold higher than either cephaloridine or cephalothin. Peak levels of cefazolin in T-tube bile averaged 51 mug/ml after intravenous and 26 mug/ml after intramuscular administration, whereas mean peak levels of cephalothin and cephaloridine were only 6 and 16 mug/ml, respectively. Here, too, T-tube levels reflected serum concentrations and obstruction to biliary flow impaired excretion of each of the drugs.

Biliary Tract↗
PubMed1981

[Chemotherapy of biliary tract infections. XIV. Biliary excretion and gallbladder tissue levels of piperacillin (author's transl)].

Piperacillin, a new injectable synthetic penicillin, was evaluated against biliary tract infections. 1. Two grams of piperacillin was intravenously administered to patients received cholecystectomy. The mean level in gallbladder bile of PIPC was 795.6 microgram/ml except for 3 cases in obstruction of the cystic duct. The mean gallbladder tissue level was 31.2 microgram/g. The gallbladder tissue level in the cases with obstruction of the cystic duct was high levels as 71.3 microgram/g and 79.5 microgram/g. 2. The excretion of PIPC into bile was compared with TIPC and APPC using crossover method. When administered 2 g of PIPC, the peak biliary levels were 950 microgram/ml to 2,120 microgram/ml at 2 hours and 20 minutes to 2 hours and 40 minutes after the administration, and biliary recoveries during 6 hours were 2.84% to 11.6%. The peak levels and biliary recoveries were lower after administration of TIPC 2 g. Mn and Zn were excreted enormously together with APPC into human bile. 3. The influence on clinical laboratory findings was negligible. Therefore, PIPC may be expected to show excellent effects of biliary tract infections except rare occurrence of drug eruption.

Adult↗
PubMed1983

[Foreign bodies in the biliary tract. II. Unusual foreign bodies in the biliary tract. Review of the literature].

The authors have collated 21 cases of unusual foreign bodies, other than parasites, in the biliary tract. The collection includes 6 penetrating bodies, 4 ingested by patients who had undergone previous bilio-digestive anastomosis or a sphincterotomy, and 11 foreign bodies ingested by patients who had never had previous surgical treatment. They consider that the real frequency is certainly greater than might be expected from a review of the literature. They discuss the different ways of penetrating the biliary tract and stress the interest of wide biliodigestive anastomosis and large Y loops, as recommended by Roux, to prevent lithiasis forming on food residue trapped at the level of the anastomosis or upstream.

Biliary Tract↗
PubMed1998

Biliary tract complications in laparoscopic cholecystectomy. A multicenter study of 148 biliary tract injuries in 26,440 operations.

BACKGROUND: The higher risk of biliary tract injury is considered the most significant disadvantage of laparoscopic cholecystectomy. METHODS: A national multicenter retrospective study was performed to determine the frequency, etiology, and treatment of biliary tract injuries between January 1, 1991, and December 31, 1994. Follow-up was by questionnaire. RESULTS: Some 148 biliary tract complications were observed during 26,440 laparoscopic cholecystectomies. There was no significant correlation found between the number of LCs performed in one institute and the incidence of biliary tract injuries and postoperative bile leakage, but in the 2nd year of practice, the incidence of both complications decreased. In institutes with more conversions, more cases of bile leakage were also observed. A significant positive relationship was found between biliary tract injuries and postoperative bile leaks. There was no significant relationship between usage of intravenous and intraoperative cholangiography and ERCP. In univariant analysis of the type of injury, the primary treatment modality did not affect the outcome of injury or entail the necessity of reoperation. Obscure anatomy leads to significantly more main bile duct injuries. According to multivariant analysis, the outcome is significantly influenced unfavorably by the necessity of repeated interventions and advanced age. CONCLUSIONS: The definitely higher risk of bile duct injury mentioned in early studies was not confirmed.

Adolescent↗
PubMed1991

Demonstration of transient bacterobilia by foreign body implantation in feline biliary tract.

The biliary tract of cats is known to be free of autochthonous bacteria above the sphincter of Oddi. In this experiment we investigated whether transient bacterobilia occurs in the biliary system under normal conditions. Polyethylene tubes and human cholesterol stones were implanted surgically into the gallbladder of cats. Sham cholecystostomy was performed as control operation. These cats were euthanized at two, six, and 12 weeks, and the implants were removed, cultured, and studied by scanning electron microscopy (SEM). Cultures and SEM also were undertaken for material scraped from the mucosal surface of the biliary tract from these animals. Colonization of bacteria on the polyethylene tubes and the gallstones was found six and 12 weeks after implantation. Adherent bacterial biofilms were demonstrated on the surfaces of these implants. This experiment showed that transient bacterobilia exists in the feline biliary tract. The foreign body implants have facilitated the adhesion of planktonic bacteria in the bile onto their surfaces and have initiated the formation of adherent biofilms within which these bacteria persisted until the system was sampled.

Acinetobacter↗
PubMed2005

[Liver transplantation for biliary tract disease].

Biliary tract diseases have always been one of the important indications for liver transplantation. These biliary tract diseases include congenital atresia of biliary duct, biliary diseases with tendency of malignant transformation, malignant biliary diseases, primary biliary cirrhosis, and secondary biliary cirrhosis. The right time to consider liver transplantation for the above biliary diseases includes situations when transplantation is the only approach to treat the disease, the only effective approach to treat the disease, or one of the effective approaches to treat the disease. Currently there is still no commonly accepted pre-operative evaluation standard for biliary disease-related liver transplantation. However, it is important to obey the following principles. First, the diagnosis should be confirmed; secondary, the necessity or urgency of the liver transplantation should be clarified; and third, the patient and his/her family should understand the whole procedure of transplantation the risk and advantage of the surgery, and the potential life-long intake of immunosuppressors. This article will briefly review all these relavant issues based on the authors' personal experience and clinical cases.

Biliary Atresia↗
PubMed1989

[Cultured biliary tract epithelial cells/alkaline and neutral elution as a model for the detection of carcinogens to the biliary tract epithelium].

Alkaline and neutral elution techniques were applied to detect chemical carcinogens in biliary tract cancer using biliary tract epithelial cells in culture. Since biliary tract epithelial cells actively grow in culture, DNA breaks induced by carcinogens in the [14C] thymidine-prelabeled DNA could be detected as radioactivities in the eluted fractions. Our study demonstrated that aflatoxin B1, 20-methylcholanthrene and dimethylnitrosamine induced DNA single-strand breaks in the biliary tract epithelial cells by the use of this system. Cultured biliary tract epithelial cells/alkaline and neutral elution offers a sensitive and organ-specific model for the detection of chemical carcinogens to the biliary tract epithelium.

Aflatoxin B1↗
PubMed1983

[Foreign bodies in the biliary tract. I. Postoperative foreign bodies in the biliary tract. Review of the literature (71 cases) apropos of 4 personal cases].

Starting out from four cases which they personally treated, the authors have made a complete review of the literature concerning biliary foreign bodies, and list 92 cases, with the following breakdown - 71 operative residues, 15 ingested bodies and 6 penetrating bodies. They attempt to analyse the mechanics of the formation of lithiasis around post-operative residues and assess its real frequency. They come to the following conclusions: most of these cases can be avoided by careful cleaning before closure of the choledocotomy, by the use of good-quality, correctly cut T-tubes and drainage material, by cutting the cystic duct as short as possible, and by exclusive use of resorbable fine thread in the biliary tract and the cystic artery.

Adult↗