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PubMed1981

[Does obstructive jaundice adversely affect wound healing? Experimental study in rats (author's transl)].

The effect of obstructive jaundice on wound healing has been investigated in an experimental study of gastric and abdominal wounds in rats following ligation and division of the common bile duct. Our study demonstrates that the obstructive jaundice does not modify the healing of gastric defect whatever the post-operative time. On the opposite, the healing of a parietal defect in these animals showed histological evidence of delayed healing compared with controls. The bursting strength of the abdominal incision was also lowered, but not that of the stomachs. These findings suggest the biochemical changes in the wounds of jaundiced animals interfered with wound repair. The possible causes of this delay in healing and its clinical implications require further investigations by cytokinetic and radioisotope studies.

Abdominal Muscles↗
PubMed1997

Renal endothelin system in obstructive jaundice: its role in impaired renal function of bile-duct ligated rats.

1. Obstructive jaundice predisposes the kidney to acute renal failure. Endothelin (ET), a potent renal vasoconstrictor and modulator of the tubular action of arginine vasopressin, has been suggested to play a pathogenetic role in acute renal failure. In the present study we therefore investigated renal function and the renal ET system in rats on day 4 after bile-duct ligation (BDL) or sham-operation (SO), without (n = 7 in each group) and with treatment with bosentan, a combined ETA/ETB receptor blocker, (n = 5 in each group). 2. On day 4 after BDL, serum bilirubin had increased to 226 +/- 10 mumol/l (SEM) as compared with 6 +/- 2 mumol/l in SO rats. Endogenous creatinine clearance, an index of glomerular filtration rate, was significantly reduced to 0.7 +/0 0.1 ml min-1 g-1 of kidney weight after BDL as compared with 1.1 +/- 0.1 ml min-1 g-1 of kidney weight after SO (P < 0.05). Bosentan prevented the decrease in glomerular filtration rate (1.0 +/- 0.2 ml min-1 g-1 of kidney weight), as well as polyuria and defective concentrating ability, in BDL rats. 3. Plasma ET concentration on day 4 after surgery (28.2 +/- 1.5 pmol/l) was higher (P < 0.01) in BDL than in SO rats (12.9 +/- 1.5 pmol/l) and rose further in bosentan-treated BDL and SO rats (43.4 +/- 5.1 compared with 21.9 +/- 6.6 pmol/l). Urinary ET excretion was significantly higher in BDL rats than in SO rats (1.58 +/- 0.22 compared with 1.28 +/- 0.18 pmol 24 h-1 100 g-1 of body weight; P < 0.05). 4. ET synthesis by glomeruli isolated from BDL rats was lower [81 +/- 19 fmol h-1 (mg of protein)-1] than that from SO-rats [139 +/- 28 fmol h-1 (mg of protein)-1; P < 0.05], whereas papillary ET synthesis was higher in BDL [10 +/- 3 fmol h-1 (mg of protein)-1] than in SO rats [4 +/- 1 fmol h-1 (mg of protein)-1; P < 0.05]. 5. The results indicate that BDL is associated with increased plasma ET concentration and suppression of GFR. Enhanced renal inner medullary collecting-duct ET synthesis, which is reflected by increased urinary ET excretion, may reduce distal tubular water absorption in BDL rats. Increased circulating and renal papillary ET synthesis may thus contribute to renal dysfunction and predispose the kidney to acute renal failure in obstructive jaundice.

Acute Kidney Injury↗
PubMed2001

The abnormal lipid spectrum in malignant obstructive jaundice in relation to endotoxin sensitivity and the result of preoperative biliary drainage.

BACKGROUND: Biliary obstruction changes the spectrum of lipoproteins, which are now known to bind and neutralize endotoxin. Postoperative septic complications related to an increased susceptibility to endotoxin occur frequently in patients with obstructive jaundice. The effect of preoperative biliary drainage on changes in the lipoprotein spectrum and its relation to endotoxin sensitivity was studied. METHODS: Abnormalities in the lipoprotein spectrum were assessed in 15 patients with malignant obstructive jaundice before and 3 weeks after endoscopic biliary drainage. Changes in endotoxin responsiveness were assessed by using endotoxin-neutralizing reagents (anti-CD14 monoclonal antibody, polymyxin B, and recombinant bactericidal permeability increasing protein) to block cytokine production in whole blood cell cultures that were stimulated by cholestatic plasma taken before and after drainage. RESULTS: Drainage normalized very-low-density, low-density, and high-density lipoprotein cholesterol fractions from, respectively, 43% to 19%, 50% to 65%, and 6% to 16% (P <.01). Ex vivo stimulation of whole blood with predrainage cholestatic plasma was 20-fold higher (P <.001) than with postdrainage plasma. Blocking the endotoxin response during the stimulation with predrainage cholestatic plasma with anti-CD14 monoclonal antibody, polymyxin B or recombinant bactericidal permeability increasing protein resulted in attenuation of the inflammatory response, reducing tumor necrosis factor-alpha levels at least 5-fold. CONCLUSIONS: Preoperative biliary drainage normalizes the changed lipid profile and the endotoxin-stimulating capacity of cholestatic plasma, and this signifies a change in sensitivity to endotoxin.

Bile Ducts↗
PubMed1991

[Diagnosis and treatment of obstructive jaundice of non-neoplastic origin].

The results of surgical treatment of 853 patients with obstructive jaundice of non-tumor genesis and initial bilirubin level in the blood of 100 mumol and higher are analysed. Individualization of therapeutic-tactical approach with the use of preoperative diagnosis of the level of obstruction of the bile ducts and severity of the state of a patient, and as well their preoperative decompression with the use of endoscopic methods permit to accomplish a number of measures aimed at reduction of the incidence of purulent-necrotic complications and lethality, improve the long-term results of treatment of the patients with obstructive jaundice.

Biliary Tract Surgical Procedures↗
PubMed1982

Percutaneous transhepatic drainage in obstructive jaundice: advantages and problems.

This study is a critical prospective assessment of 37 patients with obstructive jaundice, treated by percutaneous transhepatic biliary drainage. The median duration of drainage was 18 days (range 44-55), and during this period clearance of bilirubin and improvement in creatinine clearance were obtained. Only 10 patients gained weight. Three patients required early laparotomy. Thirty-three patients underwent definitive surgery. Of these, 8 died without leaving hospital. The incidence of infection rose during drainage, and infected bile was clinically significant. Two deaths were associated with infection, arising in the drainage system, producing intrahepatic abscesses around the drain track. While the evidence for a staged approach in the severely ill patient with obstructive jaundice is substantial, the procedure of percutaneous transhepatic tubal drainage carries significant hazards, underemphasized in previous reports. Further controlled assessment is required before this technique is accepted as the initial best option for decompression of the obstructed biliary tract.

Adult↗
PubMed1990

Acute renal failure in obstructive jaundice in cholangiocarcinoma.

This study was aimed at defining the natural history of renal failure in obstructive jaundice due to cholangiocarcinoma, which is an important health problem in northeastern Thailand. Sixty-four patients among a total of 130 patients with obstructive jaundice secondary to cholangiocarcinoma who developed acute renal failure were studied retrospectively. Analysis was made with respect to clinical features, laboratory findings, and outcome. The development of renal failure before surgery was observed in all patients. It was nonoliguric in 80% and was associated with severe jaundice, gram-negative infection (42%), hypotension (31%), hypoproteinemia (30%), hyponatremia (56%), and hypokalemia (63%). The mean duration of renal failure was 2 weeks. All patients underwent surgery for the relief of jaundice. Seventy-seven percent of the patients survived and had recovery of renal function after the relief of jaundice. Twenty-three percent of the patients died of infection. Clinical data highlight the higher serum bilirubin levels and the frequent occurrence of hyponatremia, hypokalemia, and hypotension in renal failure. Their possible roles in contributing to the development of renal failure are discussed.

Adenoma, Bile Duct↗
PubMed1997

[Comparison of combined (endoscopic sphincterotomy + laparoscopic cholecystectomy) and classical treatment of obstructive jaundice in the course of cholelithiasis].

UNLABELLED: Since August 1993 till December 1996, 672 patients with the gallstone disease were submitted to the laparoscopic cholecystectomy (LC). In 78 (11.7%) of them, the endoscopic sphincterotomy (ES) was performed before LC for the treatment of the coexistent obstructive jaundice caused by bile duct stones (Group I). ES was successful in 70 patients (90%). The laparoscopic cholecystectomy was done after the bilirubinemia reached the level within the normal ranges. This period (4 days to 35 days) was dependent on the level of hyperbilirubinemia at presentation. In 12 cases both procedures were performed at the same time. LC was successful in 67 patients (96%). The mean period between ES and LC was 2.7 days. The mean time of hospital stay was 6.3 days. In other 52 patients open cholecystectomy with T drainage was done for the treatment of the gall stone disease complicated by the obstructive jaundice (Group II). Comparing the two group of patients, the significantly shorter time of treatment and hospital stay as well as the lower incidence of complications was observed in Group I. CONCLUSION: ES and LC in patients with the obstructive jaundice caused by stones results in lower morbidity and shorter time of treatment when comparing with patients treated by classical open cholecystectomy with T drainage.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

Profile of hepatocyte growth factor in patients with obstructive jaundice.

BACKGROUND/AIMS: Hepatocyte growth factor is a potent growth-stimulating factor of many kinds of tissue. Hepatocyte growth factor was demonstrated in the blood of various liver diseases, and its concentration was reported to correlate with liver function after partial hepatectomy. In this study, we monitor the dynamics of bile hepatocyte growth factor in patients with obstructive jaundice. METHODOLOGY: In a university hospital, 68 paired blood and bile samples from 42 patients with hyperbilirubinemia were determined with ELISA. The hepatocyte growth factor bile/blood ratio and both daily hepatocyte growth factor clearance and output were calculated for each pair. The correlations between these values with other biochemical parameters were then determined. RESULTS: The blood hepatocyte growth factor concentration correlated positively with serum bilirubin (r = 0.556, p < 0.001) level, whereas bile hepatocyte growth factor concentration, hepatocyte growth factor bile/blood ratio, hepatocyte growth factor clearance and daily hepatocyte growth factor output correlated negatively with serum bilirubin level (p = 0.006, < 0.001, < 0.001 and 0.002, respectively). Similar strong positive correlations also were found to exist between these hepatocyte growth factor measurements and other liver function parameters. CONCLUSIONS: In this study we demonstrated that the hepatocyte growth factor was significantly higher in bile than in blood and that the excretion of hepatocyte growth factor in the bile was decreased in patients with obstructive jaundice. The higher blood hepatocyte growth factor level in patients with obstructive jaundice might be due to decreased hepatocyte growth factor excretion. The higher hepatocyte growth factor level in bile also might explain why liver cirrhosis occurs after prolonged jaundice.

Bile↗
PubMedDate not supplied

Alcoholic chronic pancreatitis with simultaneous multiple severe complications--extrahepatic portal obliteration, obstructive jaundice and duodenal stricture.

The major complications of chronic pancreatitis are malabsorption, diabetes mellitus, pancreatic calcification and pseudocysts. Sinistral portal hypertension due to splenic vein thrombosis, obstructive jaundice and duodenal stricture have also been reported as complications of chronic pancreatitis. However, a case having all these three complications at the same time is relatively rare. We present a case of chronic alcoholic pancreatitis complicated with simultaneous multiple severe complications. Although biliary drainage is usually a useful treatment for reducing the bilirubin level in the patients with obstructive jaundice, jaundice was hardly improved by the percutaneous transhepatic cholangio-drainage (PTCD) in this case. We discussed the cause of the failure in reducing the jaundice and reviewed the previous reports of complications of pancreatitis.

Adult↗
PubMed1983

The role of tubuloglomerular feedback in acute impairment of renal function in obstructive jaundice.

Acute renal functional impairment not infrequently accompanies liver dysfunction and, particularly with bile duct obstruction, may be extremely severe. Recent studies suggest that tubuloglomerular feedback (TGF) activated by circulating non-electrolyte factors which occur during liver dysfunction may contribute to the intense renal vasoconstriction thought to be central to the functional renal impairment. In this study, serum from two patients with obstructive jaundice (OJ) and renal impairment, and from rats with OJ due to bile duct ligation were either dialysed or treated with furosemide, known to block electrolyte-mediated TGF. These sera, when perfused into loops of Henle in rat nephrons, induced a significant fall of 28% in stop-flow pressure, an indirect measure of glomerular capillary pressure thus implying arteriolar vasoconstriction. These findings are consistent with the hypothesis that circulating, non-electrolyte factors, which stimulate TGF, occur in cases of obstructive jaundice and that these may contribute to the renal impairment.

Acute Kidney Injury↗
PubMed2003

Effects of glycine on plasma and liver tissue changes of TNF-alpha, ET-1 and nitric oxide contents in rats with obstructive jaundice.

AIM: To evaluate the effect of glycine on plasma and liver tissue changes of tumor necrosis factor-alpha (TNF-alpha), endothelin-1 (ET-1) and nitric oxide (NO) contents in rats with obstructive jaundice. METHODS: Ninety healthy Wistar rats of both sexes weighing 275+/-25 g were randomly divided into sham-operated, bile duct-ligated, and bile duct-ligated plus glycine-treated groups, the latter was performed with 5% glycine solution substituting for tap water drunk ad libium for 5 days before and 6 days after operation. Blood and liver tissue were sampled at the time of sacrifice on the 8th day post operation. Plasma total bilirubin, endotoxin, levels, as well as TNF-alpha, ET-1 and NO contents in liver tissue were determined. RESULTS: Plasma endotoxin and total bilirubin levels were significantly higher in both bile duct-ligated and bile duct-ligated plus glycine-treated rats than in sham-operated animals (P=0.000613, 0.00921 and 0.00737, 0.00841 respectively), whereas they did not display any statistically significant difference between the former groups (P=0.417 and 0.374 respectively). Likewise, TNF-alpha, ET-1 and NO contents in both plasma and liver tissue were significantly increased in both bile duct-ligated and bile duct-ligated plus glycine-treated rats compared with sham-operated animals(P=0.00813, 0.00793, 0.00671, 0.00804, 0.00872, and 0.00947 in plasma and 0.00531, 0.00785, 0.00912, 0.00981 and 0.00635 in liver tissue respectively). However, these inflammatory mediators in both plasma and liver tissue were significantly reduced in bile duct-ligated rats fed on 5% glycine solution compared with that without (P=0.00953, 0.00891, 0.0795, 0.00867, 0.0697 and 0.00907 in plasma and liver tissue respectively). CONCLUSION: Reduction of TNF-alpha, ET-1 and NO contents in plasma and liver tissue of rats fed on glycine may be helpful to alleviate pathological lesions in obstructive jaundice.

Animals↗
PubMed1989

Thromboxane as a possible hepatotoxic factor increased by endotoxemia in obstructive jaundice.

In a study using rats, we investigated whether liver damage induced by endotoxemia in obstructive jaundice is associated with thromboxane (TX) in order to acertain whether its vasoconstrictive and platelet aggregating properties play a role in reducing liver blood flow. The rats were divided into the following 5 groups; a control group, an endotoxin (Et) group, a bile duct ligation (BDL) group, a bile duct ligation and endotoxin (BDL + Et) group and an OKY046 (Thromboxane synthetase inhibitor) treated bile duct ligation + endotoxin (OKY-BDL + Et) group. The blood TXB2 levels in the Et, BDL and BDL + Et groups were higher than those in the control group. The liver TXB2 levels in the Et and BDL + Et groups were also higher than those in the control group. Liver phospholipids and liver blood flow decreased in the BDL + Et group, whereas in the OKY-BDL + Et group they returned close to the control group levels by decreasing the TXB2 levels in both the liver and blood to normal. These results suggest that the high level of TX in the blood and liver tissue may further aggrevate the liver during endotoxemia in obstructive jaundice by inhibiting liver blood flow.

Animals↗
PubMed1997

The effect of oral sodium taurocholate on endotoxemia and intestinal anastomotic wound healing in rats with obstructive jaundice.

The effect of sodium taurocholate (ST) on endotoxemia and intestinal anastomotic wound healing in obstructive jaundice was evaluated in a rat model. A total of 108 Wistar rats were divided into three main groups. Thus, 36 animals were given ileal anastomosis (IA) alone (IA group), 36 were given IA with bile duct ligation (BDL) (IA + BDL group), and 36 were given IA with BDL and oral sodium taurocholate (ST) (IA + BDL + ST group). These three main groups were then divided into three equal subgroups, A, B, and C, which were killed on postoperative days (POD) 3, 5, and 9, respectively. In the IA + BDL + ST group, ST was administrated perioperatively and ceased from POD 5 onwards. The anastomotic hydroxyproline level and bursting pressure were significantly lower in the IA + BDL animals compared with the others on POD 3, 5, and 9 (P < 0.008). Endotoxemia was prominent in the IA + BDL group from POD 3 (P = 0.011). After ST was stopped, 42% of the AI + BDL + ST animals developed endotoxemia by POD 9 (P = 0.008). Anastomotic wound healing was better in the IA + BDL + ST group (P < 0.01). These findings suggest that endotoxemia and its adverse effects on wound healing in obstructive jaundice can be prevented by the oral administration of ST.

Anastomosis, Surgical↗
PubMed1995

Metabolic effect of parenteral nutrition in dogs with obstructive jaundice.

OBJECTIVE: To assess the effect of total parenteral nutrition (TPN) on macronutrient metabolism in obstructive jaundice. METHODS: Forty adult mongrel dogs were equally divided into four groups: group I (PO-control) received sham ligation of common bile duct (CBDL) and was fed dog chow and water ad libitum; group II (PO-CBDL) underwent CBDL and was fed dog chow; group III (TPN-control) received sham CBDL and TPN; and group IV (TPN-CBDL) underwent CBDL and received TPN. Blood chemistries, plasma amino acids and liver histologies were studied before (Day 1) and at the end (Day 14) of the experiment. RESULTS: A significant elevation of bilirubin and alkaline phosphatase was observed in dogs with CBDL. Blood glucose was not changed significantly in any group. Significant increases in triglyceride and cholesterol were present in CBDL dogs. Significant differences in the concentrations of a few plasma amino acids, including an elevation of phenylalanine, were found in TPN dogs. A significant increase in aromatic amino acids (AAA) and a noticeable depression of the molar ratio of branched-chain amino acids (BCAA) to AAA was present in TPN-CBDL dogs, as was a significant increase in blood ammonia. CONCLUSION: In the presence of obstructive jaundice, TPN does not significantly affect carbohydrate or lipid metabolism. However, a derangement in protein metabolism with the standard TPN solution in current use suggests that either a modification of amino acid composition or an increase in total energy to protein energy ratio in TPN solution may be necessary to obviate such a consequence.

Alkaline Phosphatase↗
PubMed1990

The role of bile acids in the development of endotoxemia during obstructive jaundice in the rat.

The role of bile acids in the development of endotoxemia during obstructive jaundice was studied in rats. Endotoxin was not found in portal and peripheral plasma of control rats. The bile ducts of seven rats were ligated. On day 7 following bile duct ligation, six animals showed portal endotoxemia and five peripheral. Oral administration of sodium ursodeoxycholate reduced this frequency to 1/7 for portal plasma and 0/7 in the case of peripheral plasma. Subsequently the influence of a bile salt mixture (85% taurocholate, 15% taurodeoxycholate) on the binding and uptake of Salmonella abortus equi lipopolysaccharide by cultured rat Kupffer cells was studied. In control preparations, the percentage cell-associated lipopolysaccharide increased with time and reached a plateau after about 2 h of incubation at 37 degrees C. In the presence of 0.3, 0.6 and 1 mumol bile salts/ml the cell-associated lipopolysaccharide was about 5%, 13% and 29% lower, respectively, of that in control cultures. Tauroursodeoxycholate (1 mM) did not inhibit the lipopolysaccharide uptake by cultured rat Kupffer cells. Based on these observations, it is likely that both phenomena, i.e., (a) the low amount of bile acids in the intestines and (b) the high serum bile acid level, account for the high frequency of endotoxemia in the peripheral blood during obstructive jaundice.

Administration, Oral↗
PubMed1982

[Treatment and prevention of infections with cefoxitin sodium in patients with biliary tract infections and obstructive jaundice].

UNLABELLED: A total of 24 patients who was hospitalized in the Internal Medicine Wards of Yamaguchi University attached Hospital and the university's 3 related hospitals were administered with cefoxitin. The breakdown of the patients treated with cefoxitin was 7 with cholecystitis, 7 with choledochitis and the remaining 10 for the prevention of infections with obstructive jaundice. Daily doses of 2-6 g of cefoxitin were administered for 6-40 days by intermittent intravenous drip infusion in divided doses. RESULTS: 1. Of 14 patients with biliary tract infections, 10 (71.4%) responded favorably with cefoxitin. 2. Of 10 patients with obstructive jaundice used for the prevention of infections, 8 (80%) responded favorably with cefoxitin. 3. No untoward side effects were observed. 4. Cefoxitin proved to be a safe and effective antibiotic in the treatment of biliary tract infections and for the prevention of infections in patients with obstructive jaundice.

Adult↗