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PubMed1985

Hemostatic defects in experimental obstructive jaundice.

To elucidate the etiology of hemostatic abnormalities in cases of obstructive jaundice, we occluded the bile duct of rats for one week and found that the moderately jaundiced rats exhibited a marked reduction in the value of Hepaplastin test and Thrombotest with minimum histological changes in liver. All other coagulation and fibrinolysis profiles were within normal limits. These findings exclude the occurrence of a hypercoagulable state or hypofibrinolytic state in the jaundiced rats due to bile duct occlusion. Similar results were obtained in rats with tube choledochostomy. The abnormalities were almost completely prevented by the daily parenteral administration of vitamin K. These observations suggest that malabsorption of vitamin K may be the sole etiologic factor producing hemostatic defects in case of uncomplicated obstructive jaundice.

Animals↗
PubMed1995

Biliary IgA secretion in obstructive jaundice: the effects of endoscopic drainage.

BACKGROUND: Immunoglobulin A is the predominant immunoglobulin in the bile. Data on the effects of biliary obstruction on IgA secretion are few. METHODS: The serum and bile IgA levels in patients with common duct stones (n = 27) or with malignant obstructive jaundice (n = 20) were collected by insertion of nasobiliary catheters. Single samples of common duct bile from patients with gallstones (n = 24) were collected as controls. Bile samples collected were measured for total IgA, secretory IgA, and free secretory component levels by sandwich enzyme-linked immunosorbent assays. RESULTS: Bile total IgA, secretory IgA, and free secretory component in the common duct stones group (82.7 +/- 11.4 microgram/ml, 18.4 +/- 1.7 microgram/ml, 0.74 +/- 0.15 microgram/ml) and the malignant obstructive jaundice group (81.6 +/- 10.7 microgram/ml, 18.2 +/- 2.4 microgram/ml, 0.57 +2- 0.12 microgram/ml) were found to be significantly lower than those of the control gallstone patients (104.8 +/- 3.4 microgram/ml, 33.2 +/- 2.9 microgram/ml, 1.03 +/- 0.12 microgram/ml) (P < 0.05). Serum secretory IgA levels in the common duct stones (26.53 +/- 1.75 microgram/ml) and malignant obstructive jaundice groups (26.03 +/- 3.48 microgram/ml) were significantly higher than the gallstone group (18.45 +/- 4.56 microgram/ml). The bile-to-serum concentration ratio of total IgA, secretory IgA, and free secretory component levels rose significantly within 48 hours after relief of obstruction. CONCLUSIONS: Biliary obstruction secondary to both calculus or malignancy of the hepatobiliary system causes suppression of bile IgA secretion and elevated serum level of secretory IgA. Bile secretory IgA secretion recovers with endoscopic drainage of the obstructed system.

Aged↗
PubMed1985

[Transpapillary bile duct endoprostheses in obstructive jaundice].

12 patients were treated with endoscopic transpapillary biliary endoprosthesis. The indication for biliary drainage was malignant obstructive jaundice in 10 and benign obstructive jaundice in 2 cases. The effectiveness of drainage is indicated by the disappearance of jaundice. The lifetime of the endoprosthesis was maximal 4 months and the survival of the tumor patients maximal 6 months. If the endoprosthesis is occluded replacement by a new one is necessary. Nonsurgical biliary drainage is an alternative method to palliative operation and should be preferred in general inoperability and in patients with irresectable tumors.

Ampulla of Vater↗
PubMed1990

[Reduction of erythrocyte membrane band 4.2 protein in patients with obstructive jaundice].

Alteration of erythrocyte membrane proteins was studied in patients with obstructive jaundice in comparison with healthy controls. Analysis of the erythrocyte membrane proteins by SDS-PAGE revealed a slightly reduced protein 4.2 (MW 72 kDa). The erythrocytes with reduced protein 4.2 contained normal amounts of all other membrane proteins. In this study, it was demonstrated that the reduction of 4.2-protein is a common alteration in abnormal erythrocytes, target cells, and is observed in obstructive jaundice.

Adolescent↗
PubMed1980

Obstructive jaundice in the absence of sonographic biliary dilatation.

Four patients evaluated for obstructive jaundice had an ultrasonic examination without evidence of biliary dilatation. Subsequent percutaneous transhepatic cholangiographic examinations demonstrated an obstructive etiology without dilatation of the biliary system. Findings in these patients emphasize that the absence of sonographic biliary dilatation does not exclude the diagnosis of obstructive jaundice.

Cholangiography↗
PubMed1978

Computed tomographic diagnosis of obstructive jaundice in the absence of intrahepatic ductal dilatation.

Six patients with obstructive jaundice had computed tomography (CT) scans showing a dilated extrahepatic biliary tree in the absence of intrahepatic ductal dilatation. Dilated extrahepatic bile ducts were most easily identified by means of intravenous injection of urographic contrast material, which permitted them to be seen as low density structures. Findings in these patients emphasize that (1) demonstration of dilated intrahepatic bile ducts is not a prerequisite for the CT diagnosis of obstructive jaundice and (2) careful CT evaluation of the extrahepatic biliary tree is necessary to identify patients with isolated dilatation of the common hepatic or common bile duct.

Adult↗
PubMed2003

Hepatocellular apoptosis after hepatectomy in obstructive jaundice in rats.

AIM: To investigate the hepatocellular apoptosis after hepatectomy in obstructive jaundice and biliary decompression rats. METHODS: After bile duct ligation for 7 days, rats were randomly divided into OB group in which the rats underwent 70% hepatectomy, OB-CD group in which the rats underwent hepatectomy accompanied by choledochoduodenostomy, CD-Hx group in which the rats underwent choledochoduodenostomy and then received 70% hepatectomy on the fifth day after biliary decompression. The control group (Hx group) only underwent hepatectomy. RESULTS: The level of total serum bilirubin and serum enzymes was significantly lower in CD-Hx group than in OB-CD and OB groups on day 1, 3 and 5 after hepatectomy. The apoptotic index was significantly lower in CD-Hx group than in OB-CD and OB groups on day 3 and 5. The oligonucleosomal DNA fragments and Caspase-3 activity were also lower in CD-Hx group than in OB-CD and OB groups 3 days after hepatectomy, without differences between CD-Hx and Hx groups. CONCLUSION: Hepatocellular apoptosis plays vital roles in jaundice rats, and biliary decompression is more effective in treatment of patients with severe jaundice before operation.

Animals↗
PubMedDate not supplied

Evaluation of hepatic functional reserve in rats with obstructive jaundice by asyaloglycoprotein receptor.

BACKGROUND/AIMS: Until now, there has been no adequate means of evaluating the liver functional reserve in cases with obstructive jaundice. 99mTC-GSA (99mTechnetium-DTPA-Galactosyl-human serum albumin) is a new liver-imaging agent which binds specifically to the asyaloglycoprotein-receptor on the membrane of hepatocytes. So, the liver imaging by GSA excludes the influence of the reticuloendothelial system. Therefore, the uptake of 99mTC-GSA is considered to be a useful method for the estimation of liver functional reserve in cases with obstructive jaundice. METHODOLOGY: In this study, we examined the uptake rate and specific binding capacities of 99mTC-GSA to receptors on the membrane of hepatocytes following 1, and 2 weeks of bile-duct ligation and 1 week after reduction of jaundice using the rat model. RESULTS: The hepatic uptake rate decreased as the period of jaundice was prolonged and returned to nearly normal by the reduction of jaundice. The value of specific binding capacities at 2 weeks after bile-duct ligation decreased significantly compared to the value of the control and the reduced group (P < 0.05). The cause of decrease in specific binding capacities was indicated as the decrease of affinity constant especially in the high affinity part. These results coincide with the change of binding capacities of insulin and glucagon receptors with obstructive jaundice, which accurately reflect the severity of hepatocyte injury. CONCLUSIONS: Taking together these results, 99mTC-GSA liver scintigraphy is thought to be a useful method to evaluate the liver functional reserve in cases with jaundice.

Albumins↗
PubMed2003

Tuberculous lymphadenitis as a cause of obstructive jaundice: report of a case.

We report a rare case of obstructive jaundice caused by enlarged tuberculous lymph nodes compressing the common bile duct in the retropancreatic region, mimicking pancreatic cancer. A 32-year-old man was admitted to our hospital with a 1-month of history of jaundice. An abdominal computed tomography (CT) scan showed a tumor in the pancreatic head, but an endoscopic retrograde cholangiopancreatogram (ERCP) showed a normal pancreatic duct system. Positron emission tomography with 2-[fluorine-18]-fluoro-2-deoxy- d-glucose (FDG-PET) revealed a hot spot only in the pancreatic head. Under a presumptive diagnosis of malignancy, a laparotomy was performed and an intraoperative biopsy specimen revealed epithelioid granuloma with caseous necrosis, which led us to suspect tuberculous lymphadenitis. This diagnosis was confirmed by culture, and antituberculous therapy was commenced postoperatively. The patient has not suffered any further episodes of obstructive jaundice. This case report demonstrates that positive FDG-PET results should be interpreted carefully when diagnosing tumors of the pancreatic head.

Adult↗
PubMed1983

[Experimental study on acute gastric ulceration in rat--including influence of obstructive jaundice and vagotomy].

Prognostic indicator for acute gastric ulceration was experimentally investigated using water immersed and restrained rats, with special interest in influence of obstructive jaundice and effect of vagotomy. The results obtained are as follows: Intragastric pH and gastric mucosal potential difference (PD) faithfully reflected the ulcer index. This shows that continuous monitoring of these two parameters may be of clinical use as indicator for acute gastric ulceration in critically ill or postoperative patients. Water immersing and restraint stress ulcer may be caused by imbalance between gastric offensive and defensive factors as a result of progressively increasing gastric secretion and progressively deteriorating gastric mucosal barrier. Gastric ulceration was enhanced in rats with obstructive jaundice, probably because of compromised defensive factor. Prophylaxis of acute gastric ulceration with or without obstructive jaundice may not be attained by vagotomy alone; an adequate maintenance of defensive factor seems to be also necessary.

Acute Disease↗
PubMedDate not supplied

A traumatic neuroma associated with obstructive jaundice after laparoscopic cholecystectomy.

A traumatic neuroma of the biliary tract is rarely associated with biliary obstruction. The authors describe a case of obstructive jaundice that occurred after laparoscopic cholecystectomy. Obstructive jaundice developed in a 39-year-old woman 8 months after laparoscopic cholecystectomy. The stricture was resected and a Rouxen-Y hepaticojejunostomy was performed. Histological examination revealed a traumatic neuroma and a fibrous scar around the biliary duct. To our knowledge, a traumatic neuroma of the biliary tract after laparoscopic cholecystectomy has not been reported previously. Thermal injury may cause the late onset of a fibrous scar and traumatic neuroma. Therefore, traumatic neuroma should be included in the differential diagnosis when late-onset biliary tract obstruction develops after laparoscopic cholecystectomy.

Adult↗
PubMed1977

A safe method of intrahepatic biliary drainage in obstructive jaundice.

In malignant disease with severe obstructive jaundice, survival after operative intervention is extremely low. Simple external biliary drainage is desirable for these patients, as a preliminary procedure for radical operation or long-term palliation. Intrahepatic biliary drainage at the anterior edge of the liver can be performed easily and safely under local anesthesia in case of obstruction of the proximal bile ducts, just as cholecystostomy is indicated for obstruction of the common bile duct.

Bile Duct Neoplasms↗
PubMed1997

External biliary jejunal drainage through a percutaneous endoscopic gastrostomy for tube-fed patients with obstructive jaundice.

We describe a new procedure, which can help patients with obstructive jaundice improve their quality of life (QOL). Although percutaneous transhepatic biliary drainage (PTBD) can relieve jaundice, the procedure has some disadvantages. Percutaneous endoscopic gastrostomy (PEG) is a useful method for providing nutritional support to patients unable to swallow. We have combined these two techniques. We used the combination ofa 20-F catheter and a 9-F jejunal catheter for PEG. The PTBD catheter and the 9-F jejunal catheter are connected outside the patient's body. Externally drained bile from the PTBD catheter can flow back into the jejunum, and the opening between the 20-F catheter and the 9-F jejunal catheter is used for tube feeding. This procedure was adopted in a patient. Since the procedure, the patient's nutritional status and daily living activities have improved. We conclude that the procedure is useful for tube-fed patients with obstructive jaundice.

Aged↗
PubMed2005

Endobiliary brush cytology during percutaneous transhepatic cholangiodrainage in patients with obstructive jaundice.

BACKGROUND: Nonsurgical pathologic diagnosis of malignant bile duct stricture with a high sensitivity and specificity is desirable for therapeutic scheme. Percutaneous transhepatic endobiliary brush cytology in detecting obstructive jaundice is evaluated. METHODS: Fifty-eight consecutive patients with obstructive jaundice underwent percutaneous transhepatic cholangiodrainage (PTCD). During the process, a brush was inserted into the bile duct through the preexisted percutaneous transhepatic 8-F sheath, then exfoliated cells were collected from the bile duct stenosis and sent for cytologic diagnosis. The suspicious results were considered of negative diagnosis. All patients had relevant clinical data and follow-up results (15 months to 3 years). Statistical analysis was performed with the chi-square test and Fisher's exact test of probabilities, and a P value</=0.05 was considered significantly different. RESULTS: Of all patients, 42 were diagnosed as having malignant stenosis according to brush cytology. Atypical hyperplasia was found in 9 patients and was suspicious of cholangiocarcinoma. Seven patients were found to have benign strictures. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of brush cytology were 75%(42/56), 100%(2/2), 100%(42/42), 12.5%(2/16), and 75.9%(44/58), respectively. No complications were related to the procedures. In all patients with malignant stenosis, the sensitivity of brushing in diagnosis of cholangiocarcinoma was greater than that in those with non-cholangiocarcinoma (P<0.05). The site of stenosis did not influence the sensitivity and technical success (P>0.05). CONCLUSION: The results of this study indicate that cytological brushing of biliary stricture during PTCD is a useful method to establish a diagnosis of malignant biliary stenosis with a high sensitivity, but the negative predictive value is not satisfied.

Adult↗
PubMed1995

Obstructive jaundice caused by neuroblastoma managed with temporary cholecystostomy tube.

Neuroblastoma presenting as obstructive jaundice is very rare. The authors present two cases of neuroblastoma, one primary and one recurrent, manifesting as a malignant obstruction of the extrahepatic biliary system. Various methods of biliary decompression were considered in these children including transhepatic or retrograde biliary stenting and internal cholecystoenteric bypass. An attempt at percutaneous transhepatic stent placement failed in one case. In each patient, a simple insertion of a cholecystostomy tube proved effective. Immediately postoperatively, both patients had rapid resolution in symptoms and a decrease in bilirubin levels. Transient mild cholangitis in both children was successfully treated with antibiotics. Chemotherapy reduced the tumor size in each case, and the cholecystostomy tubes were removed within 3 weeks, after cholangiography showed patency of the distal common bile ducts. Temporary cholecystostomy tube drainage and systemic chemotherapy proved to be a safe, simple, and effective method for managing obstructive jaundice caused by neuroblastoma in these two cases.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Effect of biliary drainage on serum 7 alpha-hydroxycholesterol level in patients with obstructive jaundice.

Percutaneous transhepatic biliary drainage was performed in 15 patients with obstructive jaundice and the serum 7 alpha-hydroxycholesterol level was monitored for 2 weeks by capillary gas-liquid chromatography-mass spectrometry. Before biliary drainage, the serum 7 alpha-hydroxycholesterol level was 130 +/- 52 pmole/ml, which was significantly lower than the normal value (238 +/- 100 pmole/ml). After biliary drainage, the serum 7 alpha-hydroxycholesterol level was decreased to 117 +/- 48 pmole/ml on the first day. There were two groups of patients as classified by the behavior of the serum 7 alpha-hydroxycholesterol level after the third day. In one group of patients (responders), the serum level increased significantly up to 525 +/- 83 pmole/ml at the end of the 2 weeks. In another group (nonresponders), the serum level did not increase and remained 145 +/- 86 pmole/ml. The serum bilirubin level tended to improve faster in the responders (decline index = -0.234 +/- 0.152) than in the nonresponders (decline index = -0.057 +/- 0.067; P < 0.05) and a statistically significant correlation was found between the decline index and the total 7 alpha-hydroxycholesterol level on Days 7 or 14. As the serum 7 alpha-hydroxycholesterol level is considered to reflect hepatic bile acid synthesis, which is one of the important functions of the liver, we conclude that the increased serum 7 alpha-hydroxycholesterol level after biliary drainage in the responders indicates recovered liver function and that the low serum level in the nonresponders suggests more severe hepatocellular damage in patients with obstructive jaundice.

Aged↗
PubMed2005

Hepatic injury in rats with obstructive jaundice: roles of the protein kinase C signal pathway and cytoprotection of fructose.

BACKGROUND: Fructose is cytoprotective during bile salt-induced apoptosis of hepatocytes by regulating protein kinase C (PKC). This study was undertaken to explore the regulating mechanism of hepatic injury in rats with obstructive jaundice, and to detect the PKC signal pathway. METHODS: Rat hepatocytes were isolated by in situ collagenase perfusion and primary culture, and pretreated with various concentrations of PKC agonist phorbol myristate acetale (PMA) and inhibitor chelerythrine for 20 minutes. After pretreatment, 50 mumol/L glycochenodeoxycholate (GCDC) was added for additional 24 hours. Subsequently, the cells were detected by FCM and TUNEL. After adding with different concentrations of fructose and 100 mumol GCDC, the hepatocytes were evaluated by FCM and TUNEL. Experimental obstructive jaundice was induced with fructose and without fructose via double ligation of the bile duct for 3, 7, 14, and 21 days. Apoptotic status in the liver of all rats was detected with TUNEL, and PKC protein in the liver of obstructive jaundice (OJ) with the immunohistochemistry method. RESULTS: PMA increased GCDC-induced apoptosis and chelerythrine decreased GCDC-induced apoptosis in a concentration-dependent manner. Adding with different concentration of fructose and 100 mumol GCDC, the decreased apoptotic rate was related to the concentration of fructose. The apoptotic rate of the liver was related to times of OJ. PKC and apoptosis index (AI) were the highest after a 14-day ligation of the bile duct without use of fructose. AI and PKC were decreasing from a 14-day ligation of the bile duct with fructose. CONCLUSIONS: PKC takes part in the regulation, occurrence, and progression of hepatic injury in OJ. Fructose is cytoprotective during bile salt-induced apoptosis of hepatocytes by regulating PKC.

Alkaloids↗
PubMedDate not supplied

Obstructive jaundice in gastric carcinoma: cause, site, and relationship to the primary lesion.

OBJECTIVE: Obstructive jaundice is frequently present in patients with advanced gastric carcinoma. The purpose of this study was to assess the cause and preferential site of bile duct obstruction in patients with gastric carcinoma and to evaluate correlativity of biliary obstruction with the nature of the primary gastric lesion. METHODS: Cholangiographic findings of 54 patients with metastatic gastric carcinoma presenting with obstructive jaundice were reviewed retrospectively. The level of the bile duct obstruction was divided into four segments: segment 1, from an individual intrahepatic duct to the biliary hilum; segment 2, common hepatic duct (CHD) involvement from the biliary hilum to the level of the cystic duct; segment 3, the proximal half of the common bile duct (CBD); segment 4, the distal half of the CBD. To evaluate the characteristics of the primary gastric lesion, operative records and pathologic findings were reviewed. RESULTS: Obstruction sites were segment 1 in eight patients (15%), segment 2 in 25 (46%), segment 3 in 17 (32%), and segment 4 in four (7%). The causes of obstruction were metastatic lymphadenopathy in the hepatoduodenal ligament (50 of 54) and direct invasion of the primary or recurrent tumor (four of 54). The location of the primary gastric lesions was the antrum, antrum and body, and body in 36 (67%), 17 (31%), and 1 (2%), respectively. Borrmann type 3 lesions were present in 72% of cases, and type 2 lesions in the remaining 24%. Histologic type was undifferentiated adenocarcinoma in 91% of patients, and differentiated adenocarcinoma in the remaining. Serosal invasion was shown in 96% of the patients. CONCLUSION: Our results show that the cause of bile duct obstruction in advanced gastric carcinoma is predominantly metastatic lymphadenopathy in the hepatoduodenal ligament, and its preferential site is around the level of the cystic duct. Obstructing lesions showed characteristic cholangiographic findings.

Adenocarcinoma↗