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PubMed2004

[Acute myeloid leukemia presenting with obstructive jaundice and granulocytic sarcoma of the common bile duct].

A 55-year-old man presented with jaundice and edema of the right leg. Tests of the peripheral blood and bone marrow showed leukocytopenia with 6% blasts and 38.3% of myeloperoxidase-positive blasts, respectively. Computed tomography (CT) scanning disclosed thickening of the common bile duct wall. Granulocytic sarcomas were also found at the left chest wall and the pelvic floor. Endoscopic retrograde cholangiopancreatography confirmed the narrowing of the common bile duct. Biopsy specimens of the common bile duct and pelvic masses revealed myeloblastic infiltration. After placement of a naso-biliary drainage tube, chemotherapy consisting of cytarabine (100 mg/m2/ day for 7 days) and idarubicin (12 mg/m2/ day for 3 days) was commenced. The dose of idarubicin was not modified. No serious complications, including delayed hematopoietic recovery, were observed after chemotherapy, and a complete remission was obtained 35 days later. Jaundice and liver dysfunction also gradually improved. The patient continues to receive consolidation therapy and remains in remission 8 months after the onset of his illness.

Common Bile Duct Neoplasms↗
PubMed2006

[An oxygen pressure in hepatic tissue of experimental animals in modelling of obstructive jaundice and its treatment].

Efficacy of application of oxygen-transporting preparations in the treatment of obturation jaundice was studied. In experimental conditions while modelling obturation jaundice in animals there were revealed signs of failure of the oxygen delivery to hepatic cells, shown by significant lowering of the oxygen pressure (pO2) in hepatic tissue. To compensate such revealed disorders it is expedient to apply preparations, which owe oxygen-transporting function, such as perftoran or ozonized isotonic solution of sodium chloride. Incorporating perftoran and ozonized isotonic solution of sodium chloride in conventionally accepted complex impedes the tissue hypoxia occurrence, which starts after biliary system decompression, it promotes restoration of hepatic cells functional state in more early terms.

Animals↗
PubMedDate not supplied

Giant splenic artery aneurysm presenting as unusual cause of obstructive jaundice.

Giant splenic aneurysms larger than 8 cm (GSAA) are rare and often asymptomatic but present an increased risk of dramatic rupture, a life-threatening complication. The management of these aneurysms is especially challenging. We probably report the first case of GSAA revealed by clinical mechanical jaundice due to direct compression of the biliary tree. The lesion was diagnosed during abdominal ultrasound in a 68-year-old patient but determination of the specific splenic origin and extensive anatomic preoperative evaluation were achieved by MDCT. The case illustrates the new high quality performances of MDCT in the evaluation of complex vascular abdominal situations and is presented with a brief review of the relevant literature.

Aged↗
PubMed2003

Obstructive jaundice alters LFA-1alpha expression in rat small intestine.

Translocation of bacteria and endotoxtin has long been documented in obstructive jaundice, and altered intestinal barrier function is considered to be one of the important mechanisms for this phenomenon. The regulation of gastrointestinal mucosal response to injury is thus of important clinical as well as biological relevance. Integrins play a critical role in enterocyte migration, which is essential to mucosal healing. This study is designed to evaluate the integrins status in obstructive jaundice. Male Sprague-Dawley rats (N = 37) were randomized to three groups. Group 1 (N = 12) underwent common bile duct ligation (CBDL), group 2 (N = 12) underwent common bile duct ligation with oral glutamine administration (CBDL + G), and group 3 (N = 13) underwent a sham operation (sham control). After seven days, segments of proximal jejunum and distal ileum were harvested, and cell surface immunohistochemical expression of LFA-1alpha and VLA-6 were evaluated and recorded. The staining intensities were graded on a scale of 0-4. Comparisons among the three groups were performed. There was no significant difference in VLA-6 staining on small intestine among the three groups (P > 0.05). There was also no significant difference in LFA-1alpha staining the on jejunum between group 1 (CBDL) and group 3 (sham control) (P > 0.05). However, the LFA-1alpha staining on the ileum in group 1 (CBDL) significantly decreased when compared with group 3 (sham control) (P = 0.008). With oral glutamine administration (0.2 g/kg body weight, once daily), LFA-1alpha staining on the ileum was significantly restored in group 2 (CBDL + G). In conclusion, obstructive jaundice for one week down-regulates LFA-1alpha expression on rat ileum. With oral glutamine administration, such down-regulation of LFA-1alpha expression on rat ileum can be restored. Such a phenomenon is intriguing and deserves further evaluation and elucidation.

Animals↗
PubMed1997

Endoscopic palliation of malignant obstructive jaundice using resterilized accessories: an audit of success, complications, mortality and cost.

OBJECTIVE: To assess the success, complications and cost of endoscopic endoprosthesis placement for palliation of obstructive jaundice caused by malignancy. METHODS: Four hundred and two consecutive patients with obstructive jaundice due to nonresectable malignancy undergoing endoscopic stenting were studied. Commercial or home-made 7F or 10F endoprostheses were placed using minor modifications of the standard technique. The accessories were sterilized and reused. RESULTS: Endoprosthesis placement was successful in 291 patients (72.4%, 95% CI 67.7-76.7)-241 in one attempt, 49 in two attempts, and one in three attempts. Fifty nine patients (14.6%, 95% CI 11.4-18.6) had procedure-related complications, including cholangitis (30), pancreatitis (15), perforation (3) and bleeding (11). The incidence of cholangitis was significantly higher in bifurcation blocks than in other lesions (17.6% vs 4.7%, p = 0.0005). The success rate did not differ between distal and proximal lesions (68.1% vs 72.9%). The procedural cost per patient could be reduced from Rs 14,850 to Rs 6565 by reusing accessories after sterilization, and using home-made stents. CONCLUSIONS: Endoscopic endoprosthesis placement is a safe and effective method for palliation of malignant obstructive jaundice. Preparation of indigenous stents and reuse of accessories can reduce the cost of the procedure by over 50%.

Adult↗
PubMed1999

[Analysis of complications and deaths in aged patients with obstructive jaundice].

The reasons of complications and deaths in 98 aged patients with obstructive jaundice were analysed in the paper. Among them, 52 cases were diagnosed as benign obstruction, 46 cases as malignant obstruction; 92 patients were treated by surgical management(15 died), 6 patients were treated without operation(4 died). The results showed that effective management on time and intensive perioperative care are important to minimize the mortality rate. Malignant obstructive jaundice was more harmful to the patients' renal function no the mortality rate would be increased. The operations, internal drainage and pressure reduction of biliary duct, were performed on time, thus the survival rate was improve.

Aged↗
PubMed2003

Limy bile: a case of obstructive jaundice and review of 26 cases.

BACKGROUND: A number of reports on limy bile have been published but obstructive jaundice due to limy bile is quite rare. We report a case of obstructive jaundice due to limy bile and review 26 cases of limy bile diagnosed in our institution. CASE OUTLINE: A 39-year-old woman was admitted to our hospital with epigastric pain and jaundice. Abdominal ultrasonography and computed tomography revealed limy bile in the common bile duct and a gallbladder stone with biliary obstruction. Percutaneous transhepatic biliary drainage was performed. The limy bile drained out through the catheter over a few weeks. Cholecystectomy and choledochotomy with choledocholithotomy were subsequently performed. DISCUSSION: The strategy for managing patients with limy bile is individualized based on symptoms, the clinical conditions, and the location of the limy bile, and any associated biliary stones or lesions causing cystic duct obstruction.

Aged↗
PubMed1999

[Endoscopic drainage with polyethylene endoprosthesis of malignant obstructive jaundice].

AIM: To evaluate the efficacy and complications of endoscopic drainage of malignant obstructive jaundice with plastic endoprosthesis as well as to identify possible factors related with occlusion. PATIENTS AND METHODS: One-hundred and forty patients with malignant obstructive jaundice were retrospectively evaluated. The site of obstruction was proximal in 35 patients (25.0%), distal in 64 (45.7) and ampullary in 41 (29.3). Amsterdam or pigtail polyethylene prostheses of variable caliber and length were used. Drainage was preoperative in 41 patients and palliative in 99. Seventy-seven patients who underwent with palliative drainage were followed up long-term. RESULTS: Drainage was satisfactory in 132 patients (94.2%). Early morbidity was 10.7% (14/140) and early mortality related with the technique was 5% (7/140). Time free of obstruction was 4.6 +/- 1.0 months and in 47/77 (60%) the prostheses were still working at the end of follow-up. The actuarial rate of obstruction at 6 months was 42%, the majority (61%) occurring in the first 3 months. The median survival was 5.9 +/- 1.3 months. Of all the factors analyzed, greater permeability was found only in the ampullary tumors (p < 0.01) and in prostheses of caliber equal or superior to 10 French (p < 0.01). CONCLUSIONS: Endoscopic biliary drainage using plastic prostheses is satisfactory in the majority of patients with malignant jaundice. It has a low complication rate and provides acceptable palliation: the majority of patients do not require prostheses to be replaced and, when they becomes clogged, substitution usually solves the problem. Ampullary tumors and prostheses of higher caliber (> or = 10F) have been associated with greater permeability.

Adult↗
PubMed1994

Obstructive jaundice caused by the deposition of amyloid-like substances in the extrahepatic and large intrahepatic bile ducts in a patient with multiple myeloma.

Obstructive jaundice has rarely been reported in liver amyloidosis. We report here an autopsy of a 55-year-old woman with multiple myeloma and obstructive jaundice due to the deposition of amyloid-like substances in the walls and lumina of the extrahepatic bile duct and intrahepatic large bile ducts, resulting in obstruction and narrowing of the bile ducts. The amyloid-like deposits were negative with Congo red stain, and were negative immunohistochemically for IgG, IgA, IgM, kappa chain, beta-2-microglobulin, and amyloid A and P components. However, they were positive for lambda chain, and ultrastructurally composed of non-branching filaments with a diameter of 7-10 nm. This is the first case of obstructive jaundice due to histologically confirmed amyloid-like deposits in the biliary system.

Amyloid↗
PubMed1995

Clinical values of CA19-9, CA125 and CEA in malignant obstructive jaundice.

BACKGROUND: Serum CA19-9, CA125 and CEA are glycoproteic tumor markers and they have been used for detecting patients with pancreatobiliary diseases in whom obstructive jaundice is common. This study was designed to investigate whether cholestasis may interfere with the clinical application of these tumor markers or not. METHODS: Radioimmunoassay for serum CA19-9, CA125 and carcinoembryonic antigen (CEA) was obtained from 86 patients with hyperbilirubinemia, including 50 patients with malignant jaundice (pancreatic carcinoma 20, biliary tract carcinoma 30) and 36 patients with benign jaundice (choledocholithiasis 33, acute cholangitis 3). Clinical follow-up for the utility of these markers on the patients with obstructive jaundice was conducted. RESULTS: In patients with malignant jaundice, higher positive rates of CA19-9 (94% vs 56%, p < 0.01), CA125 (52% vs 17%, p < 0.01) and CEA (42% vs 6%, p < 0.01) than in those with benign jaundice were found. In diagnosis of malignant tumors, sensitivity was superior in CA19-9 (94%) than in CA125 (52%) and CEA (42%), but the latter two had higher specificities (83% and 95%). In malignant jaundice, elevated serum bilirubin levels were correlated with CA125 (r = 0.34, p < 0.05) but not with CA19-9 levels. In benign jaundice, serum bilirubin were correlated with CA19-9 (r = 0.58, p < 0.001) and CA125 (r = 0.45, p < 0.01) levels. The correlation between serum bilirubin and CEA levels was not significant in either group. After effective drainage, all markers decreased significantly in patients with benign jaundice but not in those with malignant diseases. CONCLUSIONS: Elevated serum CA19-9, CA125 and CEA levels were observed in both benign and malignant pancreatobiliary diseases with obstructive jaundice. Longitudinal follow-up of these markers and other complementary studies are essential for diagnosis of malignant tumors when cholestasis is present.

Adult↗
PubMed1993

[Endoscopic retrograde biliary drainage for malignant obstructive jaundice].

This paper reports 19 cases of malignant obstructive jaundice treated by endoscopic retrograde biliary drainage (ERBD). Since 1989, ERBD is a palliative treatment of inserted into the obstructed bile duct by endoscopy. This method can efficiently relieve biliary obstruction. Elimination jaundice reduces some discomforts such as irritating pruritus. It also increases the appetite and improve patient's general physical condition. Temporary preoperative decompression of the bile ducts in seriously jaundiced patients should result in a significant reduction postoperative morbidity and mortality. There were 9 patients of this group who underwent operation after a short period of drainage, These patients weren't found any postoperative complication. ERBD also be used for palliative decompression of the bile duct in cases of inoperable cancer. The method was carried out in 7 inoperable patients of this group. Results were satisfactory.

Adult↗