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PubMed1981

Utility and accuracy of ultrasonically measured gallbladder wall as a diagnostic criteria in biliary tract disease.

Biliary tract sonography has achieved wide acceptance as a screening test for chronic calculous disease. However, the clinical usefulness of biliary sonography is limited by the inability of this test to identify patients with acalculous cholecystitis or to separate patients with calculous cholecystitis from those with asymptomatic calculi. A prospective blinded study of 106 patients undergoing cholecystectomy was performed to determine if, cholecystosonography could visualize the gallbladder wall accurately and to evaluate gallbladder wall thickening as a predictor of disease. Of these patients, 88 had a sonographically visible gallbladder wall and in 95% of the patients the ultrasonic and direct surgical measurements of the gallbladder wall agreed within 1 mm. To determine the sonographic size range of gallbladder wall thickness in the normal population, the width of the gallbladder wall in the fasting state was measured in 100 patients without biliary tract disease. One percent of the normal population had thickened gallbladder walls, in contrast to 96% of the patients with acute calculous or acalculous cholecystitis. Gallbladder wall thickness appears to be an accurate noninvasive technique for diagnosing patients with acute calculous and acalculous cholecystitis in the absence of other entities which thicken the gallbladder wall such as ascites and hypoproteinemic states.

Biliary Tract Diseases↗
PubMed1986

[Biliary excretion and clinical evaluation of cefoperazone in the biliary tract infections].

Biliary excretion Cefoperazone (CPZ) in a dose of 1 g was intravenously injected to each of 13 cases with obstructive jaundice. Entire bile was collected through percutaneous transhepatic cholangiodrainage (PTCD) catheter in every 1 hour for 6 hours. The mean concentration of CPZ in serum was 112.1 +/- 17.8 micrograms/ml (mean +/- S.E.) at 1 hour and 55.1 +/- 19.2 micrograms/ml at 6 hours after injection. The mean recovery of CPZ in bile within 6 hours was 1.13 +/- 0.60%. Average CPZ concentrations in bile were 64.0 +/- 45.8 micrograms/ml in the 1 hour fraction, 142.7 +/- 78.4 micrograms/ml in the 2 hours fraction and 72.2 +/- 34.0 micrograms/ml in the 6 hours fraction. Biliary excretion of CPZ was low in cases where the serum concentration of total bilirubin was high, but maximum CPZ level in bile in patients with higher serum bilirubin concentrations than 30 mg/dl was still more than 3 micrograms/ml. Clinical evaluation. CPZ was administered to 43 patients with biliary tract infections. The efficacy ratio was 88.4% (excellent and good cases) in all cases, and especially high in cases with cholecystolithiasis. But no difference in efficacy ratio was observed among cases with cholecystolithiasis, choledocholithiasis without gallstone and cases subjected to PTCD. In 10 patients examined by ultrasonography, 8 cases showed reduced diameters of gallbladder. No adverse effect of CPZ was noted in any cases. These results suggest that a fairly large portion of CPZ was excreted through bile and that CPZ is a very useful drug for the treatment of biliary tract infections.

Adult↗
PubMed1992

[Chemotherapy of biliary tract infections (XXXVII). Excretion into bile and gallbladder tissue levels of levofloxacin and its clinical effect in biliary tract infections].

Evaluations were made on biliary excretion and penetration into the gallbladder tissue of levofloxacin (LVFX, DR-3355), a new quinolone antibacterial agent, and its clinical efficacy in biliary tract infections. 1. Gallbladder tissue concentrations and biliary concentrations of LVFX at 2-6 hours at oral administration of 100 mg were 0.58-1.99 micrograms/g and 0.49-5.63 micrograms/ml, respectively. These tissue and biliary levels are almost equal or somewhat higher than the serum levels (0.55-1.63 micrograms/ml) of the compound. 2. The concentrations of LVFX and optical isomer DR-3354 in the serum, gallbladder tissue, and bile were determined after a single or a concomitant administration of LVFX 100 mg and/or ofloxacin (OFLX) 100 to 200 mg. The concentration ratio of LVFX to DR-3354 paralleled with the ratio of the 2 compounds administrated. 3. At a dose of 100 mg, the glucuronide of LVFX in the common duct bile was detected at proportions between 0.9 and 36.0%. 4. A total of 11 patients with biliary tract infections, including 6 cholecystitis 3 cholangitis, and 1 each of cholecystocholangitis and liver abscess was treated with LVFX at 100-200 mg t.i.d. for 3-14 days. Clinical results were excellent or good in 8 cases and fair in 3 cases, resulting in an efficacy rate of 72.7%. 5. A side effect and an abnormal change in laboratory findings were observed in both 1 case each and they were both mild. It was concluded that LVFX showed good penetration to the biliary tract as does OFLX, and that it would be a useful oral agent for the treatment of biliary tract infections.

Adult↗
PubMed1980

Reconstruction of the biliary tract using biliary-duodenal interposition of a defunctionalized jejunal limb.

Interposition of a defunctionalized limb of jejunum between the confluence of the hepatic ducts and the duodenum seems to have some advantages. Biliary-jejunal anastomosis can be performed in a wider diameter, if necessary; duodenal function is kept almost normal, and the isolated segment of jejunum prevents the duodenojejunal reflux from getting to the biliary tract. The records of 19 patients upon whom hepatico-jejuno-duodenostomy was performed were reviewed. Seventeen patients had iatrogenic lesions and benign strictures of the common bile duct. Two patients had malignant tumors of the common bile duct. The postoperative follow-up period ranged from six months to five years. The average postoperative time was ten days. Two transient bile leaks were observed. Two patients had postoperative episodes of cholangitis. In both, the hepatico-jejunostomy was narrow, and stones were found in the intrahepatic position. A new and wider cholangiojejunostomy was performed. All of the patients were investigated roentgenographically after contrast material was given orally. Only two of the patients were found to have an enteric-biliary reflux which partially filled the intrahepatic biliary branches, but this was only observed at the time the abdomen was compressed.

Bile Ducts↗
PubMed1976

Route of infection in extrahepatic biliary tract disease. II: Bacterial recovery from gallbladder bile and gallbladder wall in human biliary tract disease.

Bacterial recovery from gallbladder wall and gallbladder bile was investigated in 73 patients with extrahepatic biliary tract diseases. The technique of anaerobic culture was based on the use of a 'glove-box' and prereduced anaerobically sterilized media. Transport of samples was based on evacuation of atmospheric air with oxygen-free carbon dioxide and a transport time less than 30 minutes. When samples of bile and tissue were obtained simultaneously before operations on the biliary tract were begun and handled by one of the authors to avoid contamination, no significant difference in bacterial recovery between bile and tissue was observed. If samples were handled routinely by the staff or if biopsy from the gallbladder wall was not obtained until after operation on the biliary tract was finished, bacterial recovery from gallbladder tissue was significantly more frequent compared to bile. Under these last mentioned circumstances, the difference in bacterial recovery was due to bacterial species like Staph. aureus, Staph. albus, P. acnes and Difteroids.

Adult↗
PubMed1981

Differential in vitro immune responses to biliary tract antigens in primary biliary cirrhosis and chronic active hepatitis.

Cellular immune reactions against normal biliary tract antigens have been investigated in 21 patients with primary biliary cirrhosis (PBC) and 18 with chronic active hepatitis (CAH) using the leucocyte migration inhibition test with partially purified antigens from normal human gall-bladder bile. Four antigen fractions, containing (either separately or together) three previously-described biliary antigens, were employed: (1) Antigen I; (2) Canalicular antigen; (3) Canalicular and Ductular antigens; (4) All three antigens. Seventeen (81%) of the PBC patients showed migration inhibition with all four fractions. Five (28%) of the CAH patients showed inhibition with three fractions but none exhibited sensitization to the fraction containing only the antigen derived from the bile canalicular portion of the hepatocyte membrane. In experiments with purified lymphocyte sub-populations from PBC patients, leucocyte migration inhibitory factor production was shown to be a function of T-lymphocytes. The antigenic selectivity with respect to the responses in CAH patients suggests that sensitization to biliary tract antigens is probably not a secondary phenomenon resulting from "unmasking" of antigens after bile duct damage has occurred but may be more directly related to the disease process.

Adult↗
PubMed1990

Mouse strain differences in susceptibility to sporidesmin-induced biliary tract injury.

Biliary tract injury was examined in four inbred strains of mice orally dosed with 500 micrograms of the fungal toxin sporidesmin. Semiquantitative histological analysis was used to assess the grade of necroinflammatory changes in the gall bladder, intra- and extrahepatic biliary tree and lobular parenchyma. Injury was greatest in the C57BL/6 and C3H strain mice and was least in SJL/J mice. In these strains injury was greatest at 4 days and had regressed by 10 days. In BALB/c mice the damage, although similar to that in SJL/J mice at 4 days, persisted at the same severity at day 10 and was accompanied by periductal fibrosis and occasionally by obliteration of ducts typical of sclerosing cholangitis. Analysis of the time-course of development of the lesions in C57BL/6 mice showed that the primary target for the toxin is the biliary epithelium. The severity of the lesions within the liver increased centripetally and the worst affected ducts were found at the confluence of the lobar ducts with the common bile duct. The variation in the degree of damage and rate of healing between strains may be due to differences in sporidesmin excretion in bile or interactions with biliary epithelial cells and/or efficacy of protective cellular repair mechanisms.

Animals↗
PubMed1985

Percutaneous biliary drainage as an initial therapy in sepsis of the biliary tract.

Percutaneous biliary drainage offers a rapid, low-risk, effective method of decompressing the biliary tract in the patient with cholangitis and sepsis. A definite surgical procedure can be delayed until the patient is stabilized. The procedure provides anatomic detail that can be used to plan surgical treatment. In some patients who do not have surgically correctable lesions, operation can be avoided altogether.

Adult↗
PubMed2000

[Biliary tract cancers].

Biliary tract cancer is the second most common primary hepatobiliary cancer, after hepatocellular carcinoma. The most frequent localisation is the gallbladder. Mean age of diagnosis is 65 years. The exact cause remains unknown despite well documented risk factors. The majority of these tumours are adenocarcinomas. Symptoms, frequently non specific, are occasionally typical including jaundice, right upper quadrant mass or fatigue and weight loss. Magnetic resonance imaging is becoming the main diagnostic tool, replacing retrograde or transhepatic cholangiography. Surgical resection remains the only treatment that may allow long term survival. However, it is possible in only one third of patients.

Adenocarcinoma↗
PubMed2004

Mac-2-binding protein is a diagnostic marker for biliary tract carcinoma.

BACKGROUND: Biliary tract carcinoma is a deadly disease, accounting for nearly 4500 malignancy-related deaths each year in the United States. Early detection has the potential to improve survival for patients with biliary tract malignancies, enabling curative surgical resection. Early detection approaches would benefit from an accurate, minimally invasive diagnostic test. To identify novel diagnostic markers, the authors recently completed a comprehensive proteomic study of bile samples from patients with biliary carcinoma. One of the proteins identified by tandem mass spectrometry was Mac-2-binding protein (Mac-2BP). The authors evaluated the performance of Mac-2BP and its ligand, galectin-3, as diagnostic markers for patients with biliary carcinoma. METHODS: Levels of Mac-2BP, galectin-3, and CA19-9 were measured using an enzyme-linked immunosorbent assay (ELISA) in bile samples from patients with biliary tract carcinoma (n = 26), benign biliary conditions (n = 32), and primary sclerosing cholangitis (n = 20). Serum levels of Mac-2BP and galectin-3 also were determined using ELISA. Mac-2BP tissue expression was investigated by immunohistochemical methods using a biliary carcinoma tissue microarray. RESULTS: Biliary Mac-2BP levels were elevated by a factor of approximately 3 in the biliary carcinoma group compared with the group of patients who had PSC or another type of nonneoplastic biliary disease. In contrast, Mac-2BP levels were not elevated in serum samples from patients with biliary carcinoma. According to the immunohistochemical analysis, Mac-2BP was expressed in 34 of 36 patients (94.4%) with biliary tract carcinoma. As a diagnostic marker for biliary carcinoma, Mac-2BP levels were as accurate as biliary CA19-9 levels, with an area under the curve (AUC) of 0.70 on receiver operator characteristic analysis. The use of both of these bile markers in combination, however, led to significantly better diagnostic accuracy compared with the accuracy achieved using CA19-9 alone (AUC, 0.75; P < 0.001). Serum and biliary galectin-3 levels did not differ in the biliary carcinoma group relative to the control groups. CONCLUSIONS: Biliary Mac-2BP levels, especially when used in conjunction with biliary CA19-9 levels, showed promise as a novel diagnostic marker for biliary tract carcinoma.

Aged↗
PubMed1981

[Chemotherapy on the biliary tract infections. XIII. Miloxacin, a novel chemotherapeutic agent, its excretion into bile and clinical effect on the biliary tract infections (author's transl)].

Miloxacin, a novel chemotherapeutic agent, has been reported to have very potent antibacterial activity to E. coli, Klebsiella, Proteus and other Gram-negative rods and be excreted into bile at high levels. Therefore, the effectiveness of miloxacin against biliary tract infections and its excretion into bile in patients were investigated. The results were as follows: i) Comparative studies on the excretion of miloxacin, nalidixic acid (NA) and cephalexin (CEX) into bile of patients operated in gallbladder were performed by a crossover method. The maximum concentration of miloxacin after oral administration of 500 mg ranged from 18.2 to 24.0 micrograms/ml and were much higher than those of NA (5.3 micrograms/ml) and CEX (3.4 micrograms/ml). The mean recovery of miloxacin within 6 hours was 0.256% and much greater than those of NA (0.075%) and CEX (0.027%). ii) Into bile, intact miloxacin and its metabolites (the glucuronides of miloxacin and M-2) were excreted but M-1 was scarcely excreted. Regression analysis of the concentrations by the bioassay compared with those intact miloxacin by the HPLC method gave a good correlation with r = 0.96. iii) The clinical effectiveness against the biliary tract infections was investigated in 29 cases. Miloxacin showed the excellent effect in 8 cases and the good effect in 17 cases, giving an effective ratio of 86.2%. Especially, all of the cases dosed with miloxacin over 34 mg/kg in a day showed excellent or good results. iv) The rates of clinical effectiveness were 85.7, 80.0% and 71.4% in E. coli, Klebsiella and Proteus infections, respectively. The antibacterial activity of miloxacin against 27 strains isolated in this test was more potent than those of NA and CEX. v) During the clinical tests, none of any side effect with miloxacin was observed in both of subjective and objective symptoms. These results show that miloxacin is expected to be fully applicable on the therapy of biliary tract infections.

4-Quinolones↗
PubMed1995

Long-term management of biliary tract complications.

Biliary tract complications represent an important problem after transplantation. They are not only important in the immediate posttransplantation period, but perhaps of even greater importance in the long-term management of transplant recipients. One of the major changes that has occurred over the past several years is an increasing use of nonoperative therapy, either via endoscopic or percutaneous routes. In many cases of biliary leak, stones, and T-tube malposition, nonoperative management may be curative. The exact role they play in the management of strictures, particularly diffuse stricturing and isolated hepatic duct strictures, remains to be determined. At the least, it provides temporary drainage before initiating surgical therapy. In addition to being efficacious, nonsurgical management is quite safe. In 64 cases of biliary complications managed nonoperatively, complications occurred at UCSF in only four patients. One patient developed bleeding along the percutaneous catheter tract and required replacement with a larger diameter catheter to tamponade the bleeding. Two patients developed hemobilia secondary to intrahepatic pseudoaneurysms caused by the percutaneous drainage catheter. One patient developed an osteomyelitis of a rib related to an indwelling percutaneous biliary catheter that responded to antibiotics and rib resection. Finally, understanding several of the biliary complications that occur after transplantation (ie, sphincter of Oddi dysfunction) will require additional research and hopefully will determine the pathophysiology of these complications. This should lead to more rational therapy.

Biliary Tract Diseases↗