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PubMed1993

Immunotherapy with Tinospora cordifolia: a new lead in the management of obstructive jaundice.

OBJECTIVE: Immunosuppression associated with deranged hepatic function and sepsis results in poor surgical outcome in extrahepatic obstructive jaundice. The effect of an ayurvedic agent, Tinospora cordifolia (TC), which has been shown to have hepatoprotective and immunomodulatory properties in experimental studies, on surgical outcome in patients with malignant obstructive jaundice was evaluated. METHODS: Thirty patients were randomly divided into two groups, matched with respect to clinical features, impairment of hepatic function (as judged by liver function tests including antipyrine elimination) and immunosuppression (phagocytic and killing capacities of neutrophils). Group I received conventional management, ie vitamin K, antibiotics and biliary drainage; Group II received Tinospora cordifolia (16 mg/kg/day orally) in addition, during the period of biliary drainage. RESULTS: Hepatic function remained comparable in the two groups after drainage. However, the phagocytic and killing capacities of neutrophils normalized only in patients receiving Tinospora cordifolia (28.2 +/- 5.5% and 29.47 +/- 6.5% respectively). Post-drainage bactobilia was observed in 8 patients in Group I and 7 in Group II, but clinical evidence of septicemia was observed in 50% of patients in Group I as against none in Group II (p < 0.05). Post-operative survival in Groups I and II was 40% and 92.4% respectively (p < 0.01). CONCLUSION: Tinospora cordifolia appears to improve surgical outcome by strengthening host defenses.

Adolescent↗
PubMedDate not supplied

The role of insulin and glucagon in experimental obstructive jaundice.

BACKGROUND/AIMS: The oxidative phosphorylation of liver mitochondria is regulated by the amount of portal insulin available to the hepatocytes. Thus, hepatic energy is mediated by the values of blood sugar and insulin. Insulin and glucagon are the main fuel homeostats in the liver. This study was performed to investigate the concept of energy mediated by glucose, during the process of obstructive jaundice and its recovery. METHODOLOGY: Experimental Wistar rats were studied, with bile duct tied for 4, 7 and 14 days respectively. The serum concentration and relative tissue concentration of insulin and glucagon were measured. And the common bile duct was tied for 4, 7 and 14 days, then relieved by time sequences for 4, 7 and 14 days. Serum concentration and relative tissue concentration of insulin and glucagon were also measured. RESULTS: When the common bile duct was tied for 4, 7, and 14 days respectively, the serum concentration and relative tissue concentration of insulin declined (p < 0.05) and glucagon concentration was elevated (p < 0.05). When the common bile duct was tied for 4, 7 and 14 days, then relieved by time sequences for 4, 7 and 14 days, the concentrations of insulin in both groups appeared to decline at first (p < 0.05) and then progressively increase (p < 0.05). The concentrations of glucagon exhibit the reverse behavior. Both serum and tissue concentration are elevated at first (p < 0.05), then progressively decline (p < 0.05). CONCLUSIONS: These studies indicated that, during obstructive jaundice, more fuel is demanded to make up for the energy deficiency. In spite of surgical or non-surgical relief of obstructive jaundice, the energy reserve is still not sufficiently recovered. The recovery of the hepatic energy reserve takes longer than we expected.

Animals↗
PubMed1996

[Continuous therapy with albendazole for hepatic alveolar echinococcosis associated with obstructive jaundice].

To observe clinical results of continuous therapy with albendazole for hepatic alveolar echinococcosis associated with obstructive jaundice, we treated 6 patients continuously with albendazole at a dosage of 20 mg.kg-1.d-1. Jaundice disappeared and serum bilirubin level returned to normal within 1-2.5 months in the patients. Ultrasound and/or CT scanning of liver before treatment displayed irregular heterogenous lesions, obscure hilar region with marked intrahepatic biliary dilatation. In one severe jaundiced patient, the common bile duct and the pancreatic duct were dilated and the portal and splenic veins were also distended with marked splenomegaly. Two patients were followed up for 3-9 year after cessation of treatment, their hepatic lesions were almost completely calcified and considered cured. The other four patients were still subjected to treatment one year later. CT and ultrasound scanning showed marked improvement of intrahepatic lesions and disappearance of intrahepatic biliary dilatation. Liver function tests returned to normal except that serum globulin remained elevated in 2 cases. Clinical observation and CT scanning of liver indicated that continuous therapy with albendazole is effective in the treatment of hepatic alveolar echinococcosis associated with obstructive jaundice. No adverse side reactions were seen.

Adult↗
PubMed1986

Mechanisms of acute gastric mucosal lesion accompanying obstructive jaundice--role of bile acids in plasma.

The mechanism of acute gastric mucosal lesion (AGML) accompanying obstructive jaundice was studied in male Wistar rats, with special reference to the effect of bile acids in plasma on mucosubstances in the gastric mucosa. Following ligation of the common bile duct, total plasma level of bile acids increased 24 folds over the control level, and gastric mucosal mucus contents, measured biochemically or histochemically, significantly decreased. Effect of increased bile acids in the blood stream on the gastric mucosa was estimated by continuous intravenous administration of sodium taurocholate. After 24 hours infusion, both gastric acid output and gastric mucus contents significantly decreased. Further imposition of restraint and water immersion stress produced AGML significantly earlier than in control rats with continuous intravenous infusion of 0.9% NaCl. These data suggest that the increased plasma level of bile acids play an important role on the reduction of the gastric-mucosal defense mechanism in obstructive jaundice directly through their toxic effects, and that this easily results in the formation of AGML under additional stresses.

Acute Disease↗
PubMed1995

Increased renal susceptibility to gentamicin in the rat with obstructive jaundice. Role of lipid peroxidation.

To study whether renal susceptibility to nephrotoxic stimuli is increased in obstructive jaundice, the effect of gentamicin on the renal function in bile duct-ligated rats was investigated. Gentamicin (50 mg/kg/day, subcutaneously) or saline was given to bile duct-ligated rats or sham-operated rats for six days. Mortality in the bile duct-ligated group that received gentamicin was 64% whereas that in the other groups was 0%. In the bile duct-ligated group, although serum creatinine and blood urea nitrogen were minimally affected, focal granulo-vacuolar degeneration in the proximal tubule was observed, which was accompanied by an increase in renal malondialdehyde. Gentamicin significantly increased serum creatinine and blood urea nitrogen levels and caused marked degeneration in the proximal tubule in the bile duct-ligated group, which was accompanied by a further increase in renal malondialdehyde, while these changes were not observed in the sham group. The kidney in obstructive jaundice appears to be susceptible to gentamicin. Enhanced production of oxygen radicals may be responsible for this effect.

Animals↗
PubMed2002

Promotion of bacterial translocation by major liver resection in obstructive jaundice in rats colonised predominantly with indigenous Escherichia coli.

The influence of major liver resection in obstructive jaundice on bacterial translocation was evaluated in rats that were colonised predominantly with a genetically labelled strain of Escherichia coli. The strain, JNW14, originally isolated from rat faeces, was labelled with bacitracin, neomycin and streptomycin resistance markers. Fifty-two specific-pathogen-free male Wistar rats were divided into three experimental groups and were treated as follows: group 1 (n = 8), sham ligation of common bile duct; group 2 (n = 7), common bile duct ligation (CBDL); and group 3 (n = 37), 70% hepatectomy 7 days after CBDL. The rats were treated with the above antibiotics and then given E. coli strain JNW14 in their drinking water. Translocation of E. coli JNW14 from the gastrointestinal tract to the mesenteric lymph nodes (MLNs), lungs, liver, spleen and portal vein was evaluated in each group. In group 3 (CBDL plus hepatectomy), the incidence of translocation of E. coli JNW14 to the liver and spleen after hepatectomy was significantly higher than in groups 1 and 2. This result indicates that major liver resection in obstructive jaundice promotes bacterial translocation to systemic organs. Furthermore, the numbers of viable E. coli JNW14 in the MLNs in the lung culture-positive rats were significantly higher than those in the lung culture-negative rats, suggesting that lymphatic-thoracic duct systemic circulation is a major route of bacterial translocation.

Alanine Transaminase↗
PubMed1980

The diagnosis and treatment of obstructive jaundice secondary to malignant lymphoma: a problem in multidisciplinary management.

Approximately 1.3% of patients with lymphoma develop obstructive jaundice secondary to lymphomatous involvement of the extrahepatic biliary system. This may occur either as an initial or as a late manifestation of disease. Clinically and radiographically the condition may mimic a variety of more common causes of obstructive jaundice. Surgical exploration may be necessary to confirm the diagnosis, but local radiotherapy would appear to be the preferred mode of treatment. Rapid progression to systemic disease occurs in the majority of patients, necessitating multidrug chemotherapy. Control of jaundice by radiotherapy is good, but long-term prognosis is poor. Supervening sepsis and gastrointestinal bleeding caused the majority of deaths, suggesting that adjunctive nutritional support, immunologic enhancement, and stress ulcer prophylaxis may be necessary if survival is to be improved.

Adult↗
PubMed2006

Obstructive jaundice due to isolated tuberculosis of the pancreas: endoscopic treatment instead of surgery?

The optimal treatment for relieving biliary obstruction due to isolated pancreatic tuberculosis has not so far been defined, and most previously reported patients were treated surgically. We describe a 17-year-old, immunocompetent girl who was admitted with obstructive jaundice caused by a tuberculous mass in the head of the pancreas. Antituberculous therapy alone failed to alleviate the jaundice, and she was therefore treated by stent insertion and, subsequently, balloon dilation of the common bile duct stricture. At follow-up 5 years later, magnetic resonance cholangiopancreatography showed no evidence of stricture in the common bile duct.

Adolescent↗
PubMed2002

Effects of biliary drainage in obstructive jaundice on microcirculation, phagocytic activity, and ultrastructure of the liver in rats.

BACKGROUND/PURPOSE: Biliary drainage before surgery for obstructive jaundice has been thought to be indispensable, because these patients tend to develop various complications after the surgery. We developed jaundiced rat models, and studied the effects of biliary drainage on the hepatic blood flow rate, portal pressure, and phagocytic activity. METHODS: We generated rats with obstructive jaundice by surgical ligation followed by cutting of the common bile duct; some jaundiced rats then underwent biliary drainage. Lipopolysaccharide (LPS) was intraperitoneally administered to some rats. Control rats underwent open abdominal surgery alone. Ultrastructural changes of the liver sinusoidal endothelial cells were examined by scanning electron microscopy. RESULTS: The hepatic blood flow rate and phagocytic activity in the jaundiced rats and the LPS-treated jaundiced rats were lower than those in the control rats. Biliary drainage improved the hepatic blood flow rate in both the jaundiced rats and the LPS-treated jaundiced rats to the control levels. Scanning electron microscopic observation of the liver sinusoids showed that, in the jaundiced rats, the endothelial cells were hypertrophic and there was a reduced number of fenestrae. In jaundiced rats that underwent biliary drainage, the hypertrophy was reduced, and the number of fenestrae was increased in comparison with those in the jaundiced rats without the drainage. CONCLUSIONS: These findings indicate that biliary drainage was effective in jaundiced and LPS-treated jaundiced rats.

Alanine Transaminase↗
PubMed1991

Obstructive jaundice. Nonsurgical options for 'surgical' jaundice.

The development of nonoperative methods of biliary drainage has altered traditional concepts regarding management of medical and surgical jaundice. Patients with newly diagnosed obstructive jaundice typically are elderly and have an unresectable neoplasm. Because surgical cure is often impossible and operation is usually risky in such patients, decompression of the biliary tree by endoscopic retrograde cholangiopancreatography and endoscopically inserted biliary stents has become an increasingly popular means of palliation. Percutaneous transhepatic cholangiography and surgical bilidigestive bypass remain important alternatives. Selection of optimal management for the individual patient requires an in-depth evaluation by a skilled team consisting of the primary care physician, endoscopist, interventional radiologist, and surgeon.

Aged↗
PubMed1982

Endoscopic retrograde cholangiopancreatography and transhepatic cholangiography in patients with suspected obstructive jaundice. A randomized study.

To establish principles for choosing between endoscopic retrograde and percutaneous transhepatic cholangiography, we randomized 52 consecutive jaundiced patients with clinically suspected obstructive jaundice. The bile ducts were visualized in 85% by the endoscopic and in 84% by the transhepatic route. A conclusive diagnosis was reached in 89% and 68% of the patients, respectively, but the difference is not significant (0.10 less than P less than 0.20). If the planned type of cholangiography failed, the other method was tried. By comparing the total numbers of investigations, a conclusive diagnosis was achieved in 91% by endoscopic and 69% by transhepatic route, which is significantly different (P less than 0.05). We therefore prefer to do endoscopic cholangiography initially with transhepatic cholangiography as the complementary method.

Adult↗
PubMed1989

Management of malignant obstructive jaundice.

This study compares the efficacy of percutaneous transhepatic drainage (PTD) versus operative biliary decompression for patients with malignant obstructive jaundice. The utilization of preoperative PTD as a surgical adjuvant is also examined. The records of 90 patients with obstructed jaundice from two large community hospitals were reviewed. In the group of patients undergoing curative resections, no advantage was noted for the patients who received preoperative PTD. The patients receiving only surgery left the hospital 8 days sooner. For the patients undergoing palliative treatment, the group receiving only the surgery had the lowest morbidity and mortality and the longest survival rates. The patients receiving only PTD had the shortest hospital stay, but also had many complications, the highest mortality rate, and the shortest survival rate. The group receiving preoperative PTD followed by surgical decompression had more complications and stayed in the hospital longer, with no change in postoperative mortality.

Aged↗
PubMedDate not supplied

Malignant gastrointestinal stromal tumor of the ampulla of Vater presenting with obstructive jaundice.

Malignant gastrointestinal stromal tumor (GIST) consists a rare neoplasm, developing in small intestine and stomach. The presenting manifastations include weakness, weight loss, nausea, melena and anaemia. The present case refers to a 65 years old female patient with a GIST of the ampulla of Vater presenting with obstructive jaundice. Diagnosis was achieved pre-operatively by biopsies collected through diagnostic ERCP. The tumour was locally excised, with preservation of the ampulla. The histological analysis suggested low grade GIST positive for both CD 117 (c-kit) and CD34. Two years after the surgery the patient remains free of disease. Malignant GIST of the ampulla of the Vater is extremely rare as only few similar cases have been described in the literature. This is the first time a GIST being presented as obstructive jaundice ever reported. Despite the unavailability of EUS-FNA, the diagnosis was set preoperatively and the tumor was resected.

Aged↗
PubMed1986

Influence of obstructive jaundice on acute gastric ulcer, intragastric pH and potential difference in rats.

To elucidate the influence of obstructive jaundice on the process of acute ulceration of the stomach under stress loading and to investigate the preventative effect of vagotomy, a series of experimental studies were carried out using SD rats. Animals were divided into four groups: Control, jaundice, vagotomy and jaundice with vagotomy. Each group was subjected to the water immersion-restraint stress and changes in the potential difference of gastric mucosa (PD), the intragastric pH (pH) and the score of ulcer index at sacrifice (UI) were measured. The process of acute ulceration under the stress loading was shown to be accelerated by the weakening of defensive factors in the case of obstructive jaundice. To monitor changes of pH and PD was found to be useful to predict the manifestation of gastric lesion. Vagotomy seemed to be partly effective to prevent the ulceration evidenced by lowering aggressive facter (an increase of pH), but it may also decrease the defensive factor because the vagotomy produced a significant lowering of PD.

Animals↗
PubMed1998

Endoscopic treatment of a case of obstructive jaundice secondary to portal cavernoma.

Biliary changes secondary to portal hypertension are uncommon. These patients do not usually present clinical or biochemical evidence of cholestasis. This report describes one case of obstructive jaundice due to portal cavernoma. The obstructive jaundice appeared in adulthood in a patient who had developed the portal cavernoma during childhood. Endoscopic retrograde cholangiography allowed both the diagnosis and the palliative treatment of the stenosis of the common bile duct, avoiding risky surgical treatment.

Adult↗
PubMedDate not supplied

Obstructive jaundice secondary to hepatocellular carcinoma rupture into the common bile duct: choledochoscopic findings.

BACKGROUND/AIMS: Hepatocellular carcinoma presenting as obstructive jaundice caused by floating tumor debris in the common bile duct is rare. We report choledochoscopic findings in this rare condition. METHODOLOGY: From January 1981 to December 1995, 28 patients received surgical treatment for obstructive jaundice secondary to hepatocellular carcinoma rupture into the common bile duct. Among them, intra-operative choledochoscopy was performed in 18 patients. RESULTS: Choledochoscopic findings revealed tumor thrombus and an intraluminal yellowish nodular mass in all patients, blood clots in the bile duct in 8 patients, and the appearance of acute erythematous cholangitis in 4 patients. Choledochoscopy revealed that the site of hepatoma rupture was from the right intrahepatic duct in 9 patients, from the left hepatic duct in 7 patients, and from the hepatic hilum in 2 patients. Choledochoscopically guided hepatic resection was performed in 4 patients. CONCLUSIONS: Intra-operative choledochoscopy reveals the characteristic finding of an intraluminal yellowish nodular mass in patients with malignant obstruction of the bile duct due to hepatocellular carcinoma. Hepatic resection with a free margin of the involved hepatic duct can be achieved by a choledochoscopically guided operation.

Adult↗
PubMed2005

EUS-guided trucut biopsy in establishing autoimmune pancreatitis as the cause of obstructive jaundice.

BACKGROUND: The diagnosis of autoimmune pancreatitis can be difficult and often requires a larger specimen than can be provided by FNA alone to determine if the tissue sample obtained with EUS trucut biopsy (TCB) is sufficient to allow adequate histologic review to establish the diagnosis of autoimmune pancreatitis. METHODS: EUS TCB was performed in patients presenting with obstructive jaundice who were suspected of having autoimmune pancreatitis based on their clinical, laboratory and imaging studies. The charts were retrospectively reviewed to determine the feasibility of TCB. RESULTS: Between August 2002 and June 2004, 3 patients with obstructive jaundice and suspected autoimmune pancreatitis (AIP) underwent EUS TCB. In each case, a diagnosis of pancreatic cancer also was considered, and surgical resection was the planned therapy before the patient underwent EUS TCB. Histologic review of the TCB specimens established the diagnosis of AIP in two patients and identified nonspecific changes of chronic pancreatitis in the third patient. EUS-guided FNA was performed in two of the 3 patients and failed to establish the diagnosis in either patient. Other than mild transient abdominal pain (n = 1), no complications were identified. CONCLUSIONS: This preliminary study suggests that EUS TCB can safely establish the diagnosis of AIP. Doing so helps guide management and may help to avoid unnecessary surgery. Prospective studies are needed to verify these findings and to more clearly define the role of EUS TCB in these patients.

Aged↗
PubMed1994

Serum 7 alpha-hydroxycholesterol reflects hepatic bile acid synthesis in patients with obstructive jaundice after external biliary drainage.

To examine the hypothesis that serum levels of 7 alpha-hydroxycholesterol reflect bile acid synthesis in the liver, we analyzed serum 7 alpha-hydroxycholesterol and bile acid output in 13 patients with obstructive jaundice after relief of biliary obstruction. Before biliary drainage, the serum level of 7 alpha-hydroxycholesterol was 92 +/- 12 pmol/ml (mean +/- S.E.M.) and was significantly lower than the control value (226 +/- 26 pmol/ml, p < 0.01). After biliary drainage, serum 7 alpha-hydroxycholesterol level and biliary bile acid outputs began to rise in some patients, indicating reversible liver dysfunction. In other patients, serum 7 alpha-hydroxycholesterol levels and bile acid outputs did not increase, suggesting severe or irreversible liver dysfunction. On and after the third day of biliary decompression, serum 7 alpha-hydroxycholesterol levels correlated well with bile acid excretion (p < 0.01, r = 0.93). Other liver function parameters, such as serum bilirubin, serum bile acids, albumin, and bile flow, also revealed significant correlation with serum 7 alpha-hydroxycholesterol levels. We conclude that the serum 7 alpha-hydroxycholesterol level clearly reflects bile acid synthesis in the liver and that it may serve as a useful parameter for the assessment of hepatic functional recovery in patients with obstructive jaundice after biliary drainage.

Aged↗