[Apropos of the diagnosis of obstructive jaundice].
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We describe a female infant with obstructive jaundice due to inflammatory stenosis of the choledochus. It was surrounded and narrowed by a xanthogranulomatous lesion, extending from xanthogranulomatous cholecystitis (XGC). The obstructive jaundice was released by a cholecystectomy, resection of the choledochus, and hepaticojejunostomy. This is the first reported case of infantile XGC associated with obstructive jaundice.
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Mediators responsible for renal changes in obstructive jaundice are not specified. This study is designed to study the role of endothelin-1 (ET-1) in obstructive jaundice in rats. Animals were randomly placed into five experimental groups. Group 1 (N = 3) was the sham-operated group. Group 2 (N = 8) after common bile duct (CBD) ligation, received bosentan, which is a nonselective endothelin receptor blocker, 50 mg/kg/day for seven days. Group 3 (N = 7) received 1 microg/kg/day captopril. Group 4 (N = 7) was given both drugs orally for seven days. Group 5 (N = 6) after CBD ligation, received Arabic gum as the vehicle. Blood was drawn from the infrahepatic vena cava for the determination of ET-1, bilirubin, creatinine, protein oxidation products, hyaluronic acid, and beta-N-acetyl-hexosaminase. Liver tissue samples were obtained to determine glutathione levels. ET-1, protein oxidation products, hyaluronic acid, bilirubin, and creatinine levels increased significantly in the control group when compared with sham. Bosentan effectively prevented ET-1 elevation but could not reverse creatinine or bilirubin elevation. Captopril with or without bosentan was cytoprotective but did not reverse increased creatinine levels. It is concluded that increased ET-1 in obstructive jaundice may be one of the contributing factors of renal damage.
Histopathological changes and energy charge of the canine brain under the experimental obstructive jaundice were investigated. The common bile duct was ligated in group A (n = 25), and biliary decompression was carried out in group B after the duration of the obstructive jaundice, (n = 11). The results were as follows. 1) Simple atrophy, pyknosis, neuronophagia, and ghost cell were observed in nerve cells. 2) The changes of nerve cells appeared after 7 days of the obstructive jaundice at the basal ganglia, putamen and red nucleus. After 13 days of the obstructive jaundice, they spread widely to the thalamus, cerebral cortex and substantia nigra. 3) According to decreasing ratio of serum bilirubin concentration, B group was classified into 4 groups. Poorly decompressed groups III and IV showed severe histological changes than fairy decompressed groups I and II. 4) Energy charge of the substantia nigra after 7 days of the obstructive jaundice decreased to 0.65 comparing with 0.77 of control group. The results indicate that obstructive jaundice should be decompressed as early as possible.
Hepatocellular carcinoma (HCC) with obstructive jaundice due to biliary tumor thrombi is uncommon, and few studies have examined the outcome of hepatectomy for HCC with this unusual entity. This study examined the clinicopathologic factors influencing the outcomes of 17 HCC patients with obstructive jaundice due to biliary tumor thrombi undergoing hepatectomy. The clinical features of 17 HCC patients with obstructive jaundice due to biliary tumor thrombi (group A) undergoing hepatectomy from 1986 to 1998 were reviewed. The clinical features and factors influencing the outcome of 555 HCC patients without biliary tumor thrombi (group B) undergoing hepatectomy were used for comparison. Of 572 patients with surgically resected HCCs, 17 (3.0%) were classified into group A. Right upper quadrant pain, physical signs of jaundice, low albumin level, elevated bilirubin level, small tumor size, more vascular invasion, and tumor rupture were characteristic of group A patients. Multivariate stepwise logistic regression analysis revealed no independently significant factor differentiating group A patients from group B patients. The disease-free survival was similar between the group A and B patients, although group B patients exhibited significantly better overall survival (p = 0.014). Vascular invasion may adversely influence overall survival in group A patients undergoing hepatic resection (p = 0.0709). When feasible, hepatic resection is the preferred treatment for HCC patients with obstructive jaundice due to biliary tumor thrombi. It can achieve a disease-free survival comparable to that of HCC patients without biliary tumor thrombi. However, HCC patients with biliary tumor thrombi had significantly worse overall survival than did those without biliary tumor thrombi, especially those with concomitant vascular invasion.
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