SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Bile from 25 patients with obstructive jaundice was cultured for both aerobic and anaerobic organisms. Twenty one samples were positive for culture. Mixed bacterial growth was seen in 5 (20%) of the bile samples 25 aerobes and one anaerobic were isolated. Escherichia coli was the commonest aerobic isolate and Bacteroides fragilis was the single anaerobe isolated. Majority of the aerobes isolated were sensitive to gentamycin.
Twenty-six patients with obstructive jaundice were investigated for RBC immune function. It was found that C3b receptor's E rosette forming rate in jaundiced patients was significantly lower than that of nonjaundiced patients, and the C3b receptor's E rosette forming inhibitory rate was higher than that of nonjaundiced patients. The RBC immune function disturbance may contribute to the postoperative sepsis in jaundiced patients.
Metastatic pancreas tumors from breast cancer are comparatively uncommon and patients with this tumor usually remain asymptomatic during their life. A 55-year-old woman presented with obstructive jaundice following mastectomy for invasive ductal carcinoma. We diagnosed obstructive jaundice due to a pancreatic tumor demonstrated on computed tomography and performed percutaneous transhepatic cholangio-drainage. Although the patient recovered from the jaundice, she had exacerbation of pneumonia from which she died. At autopsy, invasive ductal carcinoma was found in the pancreas tumor. Immunohistochemical staining was performed to confirm whether the pancreatic tumor was primary or secondary. Human milk fat globules 1 and 2 and gross cystic disease fluid protein-15, which characteristically exist in normal breast tissue or breast carcinoma, were expressed both in the primary breast tumor and the pancreatic tumor. In contrast, both the anti-estrogen receptor and anti-progesterone receptor antibodies stained positively in the primary breast cancer; however, neither of them was positive in the metastatic pancreatic tumor. We report a rare case of a patient who presented with obstructive jaundice from a pancreatic tumor metastasizing from breast cancer and in whom immunohistochemical staining using the antibodies unique to the mammary gland was effective for the diagnosis of this secondary tumor.
OBJECTIVE: To investigate the effect of inflammatory transmitter on renal function in obstructive jaundice. METHODS: 15 patients with obstructive jaundice (OJ) as the experimental group and 15 non-joundiced patients as the control group were involved in this study. The plasma ET, LPS, TNF-alpha, IL-6, IL-8 and urine REP, TFR, ALB were measured in 15 patients with OJ before and 1, 4, 7 days after surgery and in 15 patients without jaundice as controls. RESULTS: The levels of plasma ET, LPS, TNF-alpha, IL-6, IL-8 and urine RBP, TFR, ALB increased significantly at multiple time points as compared with those in the non-OJ patients (P < 0.05), and the changes of plasma ET, LPS, TNF-alpha, IL-6, IL-8 are the same as those of urine RBP, TFR, ALB. CONCLUSION: These data suggest that there is interaction between ET, LPS, TNF-alpha, IL-6, IL-8 and the damage to renal function with OJ after surgery.
Oxidized low density lipoprotein (ox-LDL) molecule is one of the most important modified lipoproteins produced during the oxidative stress. Modified lipoproteins have been defined as being part of the immune inflammatory mechanisms in association with oxidant stress. We have reported the accumulation of ox-LDL in Balb/c mice liver after bile duct ligation previously. Here, we investigated this finding in human beings with obstructive jaundice. Our study demonstrates that obstructive jaundice results in tremendous accumulation of ox-LDL in the liver tissue of patients.
INTRODUCTION: The aim of this study was to investigate the effect of Saccharomyces boulardii treatment on preventing bacterial translocation in an obstructive jaundice animal model. MATERIALS AND METHODS: Sixty adult rats were divided into five groups: group 1 - the sham-operated group; group 2 - the common bile duct ligation group; group 3 - the S. boulardii group; group 4 - the ampicillin-sulbaktam group; and group 5 - the S. boulardii plus ampicillin-sulbaktam group. The saline, antibiotics and S. boulardii were given, respectively, for a 7-day period as a single dose per day via temporary orogastric intubation. Seven days following the obstructive jaundice, the animal had laparatomy under sterile conditions. Segments of ileum were removed for histopathological examination. Blood, liver, spleen and mesenteric lymph nodes were taken for microbiological culture. RESULTS: Bacterial translocation rates were 0% in the sham-operated group, 83% in group 2, 42% in group 3, 42% in group 4 and 33% in group 5. Bacterial translocation significantly increased in group 2 compared to groups 3, 4 and 5 (P = 0.001). The bacterial counts (CFU/g) of group 2 were significantly higher than those of groups 3, 4 and 5 (P = 0.001). Histopathological examination of ileum specimens revealed a significant decrease in the heights of villi in groups 2-5 compared to the sham-operated group (P = 0.001). The mean villus height in groups 3 and 5 was significantly higher than that of group 4 (P = 0.001). CONCLUSIONS: S. boulardii was found to be effective in the successful control of translocation and improvement of intestinal barrier function.
BACKGROUND/AIMS: The prognosis of icteric type hepatocellular carcinoma is extremely poor, not only because of obstructive jaundice, but also because of difficulties for early diagnosis. The aim of this study is to evaluate characteristics of icteric hepatocellular carcinoma for early diagnosis. METHODOLOGY: Eight patients with icteric hepatocellular carcinoma among 326 patients with hepatocellular carcinoma in our hospitals were retrospectively examined by laboratory data, image studies and pathology studies. RESULTS: Most cases were already advanced, with a portal tumor thrombus at the time of diagnosis. Imaging studies fail to reveal tumors because this type of hepatocellular carcinoma has an irregular faint margin and has lost the characteristic pattern of hepatocellular carcinoma, such as capsular formation or early enhancement. Pathology observations demonstrated poorly or moderately differentiated hepatocellular carcinoma in all our cases. CONCLUSIONS: This type of hepatocellular carcinoma should be considered in cirrhotic patients with obstructive jaundice or in patients with high tumor marker levels even if image studies fail to reveal tumors. For better prognosis, combination therapies such as biliary drainage, support for portal flow as well as treatment for the hepatocellular carcinoma, are necessary.
OBJECTIVE: To evaluate the influence of internal drainage on status of nutritional markers in patients with obstructive jaundice. DESSING: Prospective longitudinal study. SETTING: University hospital, Spain. SUBJECTS: 39 patients with obstructive jaundice (18 benign and 21 malignant obstructions). INTERVENTIONS: Nutritional state was assessed before and 10 days after endoscopic drainage. MAIN OUTCOME MEASURES: One anthropometric (body weight <95% of ideal) and two biochemical (albumin <35 g/L and prealbumin < 170 mg/L) as an indication of protein calorie malnutrition. Retinol binding protein and transferrin concentrations, total lymphocyte count, and nutritional prognostic index (NPI) were also measured. RESULTS: Thirty patients (77%) had protein calorie malnutrition. After internal drainage, 6 patients with benign obstruction and 11 with malignant tumours remained malnourished. No anthropometric variables or concentrations of proteins with long half-lives were affected by drainage. However, prealbumin (p < 0.01) and transferrin (p < 0.01) concentrations, and total lymphocyte count (p < 0.001) increased significantly in both groups. NPI also improved significantly after drainage from 43 (9) compared with 37 (5) in benign obstructions (p < 0.05) and 58.7 (14) compared with 52 (12) in malignant (p < 0.05), although in the latter group the mean nutritional risk index remained high. CONCLUSIONS: Concentrations of some of the visceral proteins studied (prealbumin and transferrin) improved 10 days after internal biliary drainage for both benign and malignant obstruction. However, many patients with malignant tumours remained malnourished with a high nutritional risk index.
Serum secretory IgA, IgA-containing circulating immune complexes (IgA-CIC), complement components, and major immunoglobulins were measured in patients with biliary tract stones and/or tumors of the biliary tract or pancreas. The levels of secretory IgA and total IgA were increased in patients with and without obstructive jaundice. The levels of both C3 and C4 were significantly higher in patients with or without obstructive jaundice than in healthy controls. In patients with obstructive jaundice the increased levels of secretory IgA, total IgA, and IgA-CIC were correlated with the increase of C3 but not with that of C4.
Eleven (3%) of 340 patients with hepatocellular carcinoma (HCC) presented with obstructive jaundice. The tumor extensively infiltrated the major bile ducts in eight patients. Jaundice was relieved by endoscopic endoprosthesis in four patients, nasobiliary drainage in two patients, percutaneous transhepatic stenting in one patient, and surgical intubation in one patient. The survival interval of these eight patients (mean +/- SD) was 35 +/- 20 days. Three patients had tumor fragments in the common bile ducts. In two patients, major hepatic resection was done after initial tube decomposition of the biliary system. One patient remained tumor-free on follow-up at 24 months, and the other patient had recurrent tumor detected on follow-up at 17 months after surgery. The tumor was irresectable in the third patient. Multiple surgical and endoscopic procedures kept the bile duct patent for 17 months before the patient died of the disease. Not all patients who present with obstructive jaundice due to HCC are terminally ill. With proper management, good palliation and occasional cure are possible.
Percutaneous transhepatic cholangiography (PTC) using Chiba needle was employed to diagnose obstructive jaundice in 31 subjects. It was successful in all 27 (87%) subjects who had dilatation of the biliary tree. Out of them, 15 had features suggestive of carcinoma, 9 had features of stone and 3 had features of stricture of the common bile duct (CBD). Surgery was done in 11 cases and PTC diagnosis of carcinoma of CBD in 4 and stricture of the same in one subject were confirmed. While in the remaining 6 subjects with a PTC diagnosis of CBD stone, 4 were found to be so and 2 had stricture of the duct. Three subjects had complications such as bile peritonitis, cholangitis and shock. In majority of the cases, the biochemical parameters were inconclusive. These results suggest that PTC may be useful in the diagnosis of obstructive jaundice and this procedure should be employed more widely.
We report the case of a previously well 89-years-old-healthy man who presented at least four episodes of intermittent obstructive jaundice during the eight months prior to admission in our Hospital. Studies revealed a duodenal diverticulum arising near of the ampulla of Vater. We believed the diverticulum was responsible for the intermittent obstructive jaundice and we performed a choledochoduodenostomy. He had no postoperative complications and was discharged from the hospital asymptomatic. This case documents an uncommon presentation of this disease generally asymptomatic with intermittent obstructive jaundice episodes.
Sepsis is a common and occasionally lethal complication of obstructive jaundice. The reasons for the increased susceptibility to infection are not fully understood. This study was conducted to examine lymphocyte subsets and natural killer cells of patients with obstructive jaundice in perioperative period. In these patients, when compared with normal controls, there was a significant reduction in the percentage of Leu 4 (pan T lymphocytes), Leu 3a (T helper cells) and Leu 7 (natural killer cells) before operation, and the immune suppression induced by surgical operation was more marked and persistent.
A foreign body in the common bile duct is a rare cause of obstructive jaundice. In the present case a shell splinter migrating into the common bile duct caused obstructive jaundice 9 years after the original injury.
Preoperative administration of the simple bile salt sodium deoxycholate has been shown in this study to prevent postoperative endotoxaemia and renal failure in patients with obstructive jaundice. Fifty-four per cent of jaundiced patients not given the salt were found to have systemic endotoxaemia, associated with renal impairment in two-thirds of the cases. No patient given sodium deoxycholate 500 mg 8 hourly for 48 hours before operation had portal or systemic endotoxaemia, and none had evidence of renal impairment (P less than 0 X 02, X2 with Yates' correction). The incidence of endotoxaemia in untreated jaundiced patients was very significantly greater than in non-jaundiced patients undergoing elective upper abdominal surgery (P less than 0 X 005), but this difference is abolished by the prophylactic administration of the oral bile salt. The mechanism of action of bile salts in preventing endotoxin absorption from the small bowel has been investigated, and the lack of any significant alteration in the small bowel microbial flora in obstructive jaundice suggests that a direct effect on the endotoxin molecule is involved. Nearly 20 per cent of patients with obstructive jaundice still develop postoperative renal insufficiency, but preoperative prophylactic use of sodium deoxycholate should reduce this very significantly.
The diagnostic value of ultrasonography and percutaneous cholangiography was compared in 114 consecutive patients with obstructive jaundice. The final diagnosis was obtained by surgery or autopsy. Transhepatic cholangiography diagnosed obstruction and its level in all patients, whereas ultrasonography failed to find obstruction in 3 patients and was unable to determine the level in 11 patients. The cause of obstruction was correctly assessed in 106 patients by transhepatic cholangiography and in 74 by ultrasonography. In 15 patients with obstruction caused by common duct calculi ultrasonography only diagnosed the five, and in 9 patients malignant obstruction was diagnosed as calculi. Ultrasonography is a reliable tool for diagnosis of obstructive jaundice and in most cases for localisation of the level of the obstruction. However, diagnosis of the cause of obstruction and of its precise topography requires direct cholangiography.
BACKGROUND: Some studies suggest that behavioral complications of cholestasis, such as fatigue and pruritus, may be associated with altered neurotransmission in the brain. Because inhaled anesthetics primarily act on ion channels and receptors on the neuronal cell membrane and alter synaptic transmission in the central nervous system, it is possible that altered sensitivity to inhaled anesthetics may occur in cholestatic patients. Therefore, the authors compared the minimum alveolar concentration (MAC)-awake of desflurane in obstructive jaundiced patients with the MACawake in nonjaundiced patients. METHODS: Patients underwent inhalational induction of anesthesia with desflurane. MACawake was determined in each patient by observing the response to a verbal command (open eyes on request). An end-tidal anesthetic concentration was maintained at an initial target level of 1.4% for 15 min before a command. If a positive response was observed, the concentration of desflurane was increased by 0.1% and again kept constant for 15 min. The verbal command was then continued. This process was repeated until an end-tidal concentration was reached at which the patient did not respond to command. The anesthetic concentration midway between the value permitting the response and that just preventing the response was defined as MACawake for each patient. RESULTS: The MACawake of desflurane for patients with obstructive jaundice (1.78 +/- 0.19%) was significantly less than those observed for the control group (2.17 +/- 0.25%; P < 0.001) and correlated significantly with serum total bilirubin (r = -0.67, P = 0.0004). CONCLUSIONS: The MACawake of desflurane is reduced in obstructive jaundiced patients compared with nonjaundiced controls.
A case of obstructive jaundice due to granulomatous blastomycosis is presented. The patient had complained of abdominal pain in the right hypochondrium and jaundice. During hospitalization, the laboratory tests showed evidence of obstructive jaundice and complementary tests a distended gallbladder, dilatation of the intra and extrahepatic bile ducts with enlarged lymph nodes of the hepatic hilus. During the operation a cholestatic liver, distended gallbladder and enlarged lymph nodes around the common bile duct were found. Histopathology of the lymph nodes revealed South American blastomycosis. The medical management consisted of amphotericin B. At present the patient is alive and well.