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PubMedDate not supplied

The effect of granulocyte colony stimulating factor on the immune parameters in experimental obstructive jaundice.

BACKGROUND/AIMS: Obstructive jaundice is an important clinical problem. It may cause complications such as renal insufficiency, cardiovascular sequels, coagulation defects, gastrointestinal bleeding, delayed wound healing, secondary biliary cirrhosis and sepsis. We investigated the effect of GM-CSF on immunological parameters in the experimental obstructive jaundice. METHODOLOGY: In our experimental study we studied four groups that consisted of 28 rats. The 1st group consisted of sham rats, the 2nd group consisted of sham and GM-CSF applied rats and the 3rd and 4th groups consisted of rats that had obstructive jaundice. In the 4th group we applied 4 micrograms/kg GM-CSF subcutaneously to the rats for 7 days. We measured the levels of neutrophils, lymphocytes, leukocytes, interferon-alpha, CD32, CD34 and CD64 in all groups. RESULTS: In the jaundice group neutrophil, lymphocyte and leukocyte counts were found to be significantly lower compared to the other groups (P < 0.005). interferon-alpha and CD levels were found to be lower in the jaundice group compared to the other groups. In the GM-CSF applied jaundice group neutrophils, lymphocytes, leukocytes and interferon-alpha levels were found to be higher. CD34- CD64 levels were insignificantly increased in the GM-CSF group whereas CD32 levels were significantly increased. CONCLUSIONS: We believe that in the prevention of serious septic complications which have a high mortality risk, GM-CSF application to restore the macrophage-neutrophil functions should be supported by advanced clinical studies.

Animals↗
PubMed2005

Burkitt's lymphoma: an unusual cause of obstructive jaundice.

Biliary obstruction secondary to malignancy is a common clinical problem. Rarely, biliary obstruction is due to non-Hodgkin's lymphoma. Obstructive jaundice in these patients usually presents late in the course of the disease. Burkitt's lymphoma is a subtype of non-Hodgkin's lymphoma. Unlike other forms of non-Hodgkin's lymphoma, Burkitt's lymphoma presents as an extranodal disease. We present the case of a patient suffering from non-endemic Burkitt's lymphoma whose initial presenting symptom was obstructive jaundice.

Aged↗
PubMed2003

The effect of endoscopic retrograde cholangiopancreatography on the serum IL-18 and erythrocytes antioxidative capacity in biliary obstructive jaundice.

INTRODUCTION: Obstructive jaundice is an important clinical problem. It may cause transient hemolysis and shortened erythrocyte life span as well as cytokine induction. An increase in lipid peroxidation has been noted as evidence of oxidative damage in red cells due to cholestasis. The influence of endoscopic retrograde cholangiopancreatography (ERCP), mechanical lithotrepsy and stone extraction on the antioxidative capacity of the erythrocyte and immune response is still unclear. METHODS: Superoxide dismutase (SOD), catalase (CAT) and glutathione (GSH) content of red blood cells (RBC), and serum interleukin (IL-18) were measured in 20 patients with calcular obstructive jaundice before and 4 weeks after ERCP intervention and compared with 10 matched healthy volunteers. RESULTS: A significant decrease (p<0.05) in SOD and CAT activities and glutathione concentration but a significant increase (p<0.05) in serum IL-18 were observed in cholestatic patients compared with the healthy control and were significantly correlated with variable of hepatic dysfunction (alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, alkaline phosphatase (ALP) and gamma glutamyl transferase (GGT). After ERCP, serum IL-18 and antioxidant capacity of red blood cells were significantly improved and returned to normal concentration (p<0.05). CONCLUSIONS: In biliary obstruction, serum IL-18 is increased and antioxidative capacity is decreased, and have a direct correlation with biochemical markers of liver injury. After ERCP intervention, the altered antioxidative capacity as well as serum IL-18 was completely restored to normal.

Alanine Transaminase↗
PubMedDate not supplied

Endo-laparoscopic approach in the management of obstructive jaundice and malignant gastric outflow obstruction.

BACKGROUND/AIMS: Only a minority of patients with tumor at the pancreaticoduodenal junction is suitable for resection, palliation is however often required relieving the obstructive jaundice and gastric outflow obstruction (GOO). This study evaluates endo-laparoscopic approach as a palliative treatment of obstructive jaundice and malignant gastric outflow obstruction. METHODOLOGY: A retrospective review of a prospectively maintained database. During the period from 1992-2002, patients with diagnosis of unresectable tumor at the pancreaticoduodenal junction were evaluated. If the tumor was confirmed to be unresectable, patients would be offered either open double bypass or laparoscopic gastrojejunostomy (LGJ) +/- endoscopic or percutaneous transhepatic stenting for any obstructive jaundice, the choice of approach would depend on whether the endoscopic access was still maintained. RESULTS: Out of 942 patients with tumors around the pancreaticoduodenal junction during the study period from 1992-2002, there were 34 patients (13 male & 21 female) with median age 69 years (range, 48-87) selected for LGJ. Of these 34 patients, 3 of them underwent endoscopic biliary stenting whereas 16 jaundice patients were palliated by transhepatic biliary drainage. When the results were compared to the 35 open double bypass (roux-en-Y choledochojejunostomy and gastrojejunostomy) during the same study period, the median operation time was significantly shorter (80 vs. 135 minutes; P=0.0001) and median intraoperative bleeding was significantly less in the endo-laparoscopic group (0 vs. 100mL; P=0.0001). Two patients in the endo-laparoscopic group were converted to open because of tumor infiltration of the small bowel mesentery causing difficulty in construction of gastrojejunostomy. Although the overall complication rate (13 vs. 17; P=0.387) and incidence of delayed gastric emptying (7 vs. 7, P=0.952) were similar in both groups, the incidence of wound infection was remarkably less common in the endo-laparoscopic group (0 vs. 6, P=0.012). The 15 postoperative complications (13 patients) in the endo-laparoscopic group (38.2%) included prolonged gastric stasis (7), biliary sepsis (2), chest infection (2), myocardial ischemia (2), gastrointestinal bleeding (1) and extensive ischemic stroke (1). Median time to resume diet was statistically shorter in endo-laparoscopic group (5 vs. 7 days, P=0.009) however the hospital stay was similar in both groups (11.5 vs. 14 days, P=0.238). The hospital mortality rate was again comparable between the two groups (6 vs. 5, P=0.703). The short median survival in the endolaparoscopic group (3 vs. 7 months; P=0.0001) might just be a reflection of selection bias. CONCLUSIONS: With the advent of laparoscopic and endoscopic surgery, palliation of both gastric outflow obstruction and obstructive jaundice can also be accomplished using the endo-laparoscopic approach. In comparing to the open double bypass, operation time, intraoperative blood loss and incidence of wound infection are significantly less and patients can have early resumption of diet. However, the results can be improved further with a better patient selection and perioperative optimization.

Aged↗
PubMed1983

Extrabiliary obstructive jaundice.

Extrabiliary obstructive jaundice is only encountered in biliary digestive anastomosis when the draining bowel itself is obstructed. In two patients, the cause of obstruction was a local tumour recurrence.

Adult↗
PubMed1994

Neutrophil priming by cytokines in patients with obstructive jaundice.

Patients with obstructive jaundice frequently suffer postoperative complications. We have investigated the relationship of obstructive jaundice to the neutrophil oxidase response and the "priming" of the response by the cytokines TNF alpha, interleukin-1 (IL-1), IL-6, and IL-8. On stimulation with f-met-leu-phe (fmlp), the respiratory burst in neutrophils from jaundiced patients was greatly increased compared with controls (p < 0.01), jaundiced patients having the highest respiratory burst levels were those with the poorest prognosis. Neutrophils from controls were primed by all the cytokines tested, whereas "jaundiced" cells were primed only by IL-1, and not by TNF alpha, IL-6, or IL-8, which in fact produced slight inhibition. We conclude that neutrophils from obstructive jaundiced patients have raised oxidative responses which may be due to "pre-priming" in vivo by cytokines, such as IL-6, IL-8, or TNF alpha. This exaggeration of the oxidative response in circulating neutrophils may contribute to the peri-operate complications of patients with obstructive jaundice.

Aged↗
PubMed1983

Endoscopic-radiological findings in metastatic obstructive jaundice.

Metastatic obstructive jaundice usually results from an occlusion of the common hepatic or bile duct. More rarely, the underlying cause is a disseminated intrahepatic infiltration that has led to the occlusion of the bile canaliculi. The endoscopic-radiological examination techniques usually permit a reliable differentiation between neoplasms originating primarily in the biliary tract, and ductal occlusions caused by metastatic disease. In addition to this, both ERC and PTC permit the placement of an internal or external biliary drain during one and the same procedure. ERC represents a highly suitable method for the follow-up monitoring or documentation of the therapeutic effect of biliary drainage, radiotherapy and/or polychemotherapy. With the aid of regular follow-up examinations, recurrent disease can be detected early on, and appropriately treated.

Breast Neoplasms↗
PubMed2002

Effects of granulocyte colony-stimulating factor (g-csf) on neutrophil phagocytosis during experimental obstructive jaundice.

BACKGROUND: Obstruction ofthe extrahepati(biliary tree produces profound depression of many components ofthe immune system. G-CSF improves diseasedfiinction fneutrophils in various conditions. In this study, we planned to investigate the changes on neutrophil phagocytosis in obstruct;ve jaundice and the effect ofG-CSF adm;nistration on thisfiinction. METHODS: Rats were divided into 5 groups as follows: the sham group and four other groups that underwent double ligation and division of common bile duct. Two of these four groups (Group 3 and 5) received G-CSF during experiment. Neutrophil hagocytosis index was determinedforgroup2and 3 attheend ofthe 15 daysand forgroup 1, 4and 5 attheend of the21 days. RESULTS: Neutrophil phagocytosis index significantly increased at the end ofthe 15th day after the bile duct ligation (Group 2) and significantly decreased at the end ofthe 21th day after the bile duct ligation (Group 4). Neutrophil phagocytosis index in G-CSF-treated groups was significantly increased at the end ofthe 15'h days (Group 3) and increased at the end of the 21th day (Group 5). CONCLUTION: As a result, neutrophil phagocytosis index is improved if G-CSF is administered later in the course of prolonged jaundice.

Animals↗
PubMed2001

Effect of 5-lipoxygenase inhibition on Kupffer cell clearance capacity in obstructive jaundiced rats.

BACKGROUND: Obstructive jaundice is a common surgical problem. It may cause hepatic and Kupffer cell dysfunction. Previous studies demonstrated that 5-lipoxygenase inhibition prevents hepatic injury. However, its effect on Kupffer cell clearance capacity has not been determined yet. MATERIALS AND METHODS: Rats were divided into four groups. In group 1 (sham control group), only bile duct dissection was performed. In other groups bile ducts were ligated and divided. In groups 1 and 2 saline, in group 3 ethanol, and in group 4 a 5-lipoxygenase inhibitor AA-861 was given intraperitoneally to the animals. Rats were sacrificed 14 days after the operations. Serum alkaline phosphatase, total bilirubin, and alanine aminotransferase levels were determined. Kupffer cell clearance capacity was measured using an in situ isolated hepatic perfusion technique. Hematoxylin-eosin-stained liver samples were evaluated under light microscope for histopathologic scoring. RESULTS: Rats in the sham control group had significantly lower serum ALP and bilirubin values than those in the experimental groups with biliary obstruction. AA-861 administration significantly decreased serum ALT levels and histopathologic scores. There was no significant difference in ALT levels and histopathologic scores between the sham control and AA-861 groups. Kupffer cell clearance capacity was found to be significantly increased in the AA-861 group compared to other experimental groups with obstructive jaundice. CONCLUSIONS: This study shows that leukotriene synthesis inhibition using AA-861 prevents hepatic damage and improves Kupffer cell clearance capacity in obstructive jaundiced rats. This may have significant implications for the management of patients with obstructive jaundice.

Alanine Transaminase↗
PubMed1990

[A case of prolonged jaundice after surgical treatment of obstructive jaundice caused by a carcinoma of the head of the pancreas relieved with dibutyryl cyclic AMP].

Recently, we experienced a case of obstructive jaundice caused by a carcinoma of the head of the pancreas which could not be relieved by reduction surgery. The operation performed was a cholecystectomy and supraduodenal choledochotomy with T-tube insertion. Glucagon and insulin were, therefore, administered with the aim towards the recovery of the liver function to be induced by the enhancement of the liver regeneration. The treatment, however, was not effective. Then, dibutyryl cyclic AMP was administered to the case by intravenous drip infusions at the rate of 5 micrograms/kg/min. Thereafter, the value of serum total bilirubin was reduced remarkably. A prolonged and intense obstructive jaundice is generally accompanied by damage to the liver function, and the condition carries a high risk of postoperative complication. In this paper, the effectiveness of dibutyryl cyclic AMP on liver cell damage caused by prolonged obstructive jaundice are reported.

Aged↗
PubMed1995

Alternation of monocyte function in patients with obstructive jaundice.

Patients with obstructive jaundice have a high susceptibility to infection in the process of treatment and the reason for this is not fully understood. It was postulated that it may bear some relations to abnormalities of immune function. In this article, 28 cases of obstructive jaundice were selected to investigate alternation of monocyte immune function with the purpose of exploring mechanism of high susceptibility to infection from the perspective of immunology. The results showed that interleukin 1 production by monocytes significantly decreased and prostaglandin E2 increased, HLA-DR expression of monocytes was remarkably depressed. HLA-DR expression of monocytes was further decreased with recovery slower than non-jaundiced patients after operation. All this may be responsible for high susceptibility to infection in the process of treatment of obstructive jaundice.

Adult↗
PubMed1989

Obstructive jaundice in chronic pancreatitis.

Significant obstructive jaundice in chronic pancreatitis is generally considered to be rare. Eleven of 57 consecutive patients with proven chronic pancreatitis have developed significant obstructive jaundice of more than transient duration. Eight presented as jaundice complicating known pancreatitis and three as jaundice of unknown cause. Life table analysis showed a steady rise in the risk of developing jaundice up to the end of 10 years from the onset of chronic pancreatitis. Jaundice was found to occur in the presence of more "destructive" disease, and jaundiced patients had a higher incidence of pancreatic calcification, diabetes and malabsorption at the time of presentation with jaundice. Obstructive jaundice caused by chronic pancreatitis was found to carry a good prognosis for jaundice, for pain and for life. Only one of the 11 patients died in hospital. It is important to distinguish chronic pancreatitis from cancer in these patients. Pre-operative and intra-operative cytology have been helpful. Stent insertion is not an appropriate method of treatment for these patients because of the benign nature of the disease and the possibility of exacerbating the pancreatitis. It is important to be aware of another form of "malignant masquerade" causing obstructive jaundice.

Adolescent↗
PubMed1998

Obstructive jaundice: a unique presentation of primary obstructive megaureter.

A case of giant hydronephrosis leading to obstructive jaundice due to primary obstructive megaureter in an adult is the subject of this presentation. Giant hydronephrosis due to primary obstructive megaureter in adults is uncommon. This is also the first case of obstructive jaundice due to primary obstructive megaureter reported in the literature. The patient was initially treated with a percutaneous nephrostomy till the jaundice resolved. This was followed by definitive surgery in the form of ureteral tailoring and reimplantation along with nephroplication and nephropexy, with a successful outcome.

Adult↗
PubMedDate not supplied

[Ultrasonography in the differential diagnosis of obstructive jaundice: comparison with endoscopic retrograde cholangiopancreatography].

A retrospective study comparing ultrasound (US) and endoscopic retrograde cholangiopancreatography (ERCP) as practiced on 42 jaundiced patients. Obstruction of the bile ducts was demonstrated in 21 by US and in 33 by ERCP, this latter method was taken as the gold standard for comparison, and thus the sensibility of US for detecting obstructive jaundice was 64% and specificity was 89%. Choledocolithiasis and papillary stenosis were the most frequent etiologies, diagnosed in 26 cases by ERCP and in 14 cases by US. Of the 36 patients with gallbladder, US demonstrated gallstones in 28 cases (78%) and ERCP in 18 (50%). We conclude from this study that US has a high sensibility and specificity in patients in whom obstructive jaundice is suspected.

Adolescent↗