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Results for “Jaundice, Obstructive”

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PubMed2001

[Diagnoses and treatments by transcutaneous transhepatic approach in patients with obstructive jaundice].

In 298 patients with obstructive jaundice, including 271 (90.9%) with tumoral genesis, endobiliary interventions were performed: transcutaneous transhepatic cholecystectomy--in 76, external cholangiostomy--in 155, external-internal cholangiostomy--in 97, endoprosthesis of biliary ducts (BD)--in 23. Of 155 patients, to whom external drainage of BD was done, recanalization of obstructed portion was performed in 53. Of 102 patients, to whom external drain was adjusted, in 23.1% the complications occurred. Hospital mortality had constituted 22%. The BD perforation was noted in 8 observations. The patients life span, in whom the external-internal BD drainage was done, was 7.8 months, an efficacy of endoprosthesis had constituted 97.3%. The life span of such patients was (9.2 +/- 2.4) months at average.

Cholestasis, Intrahepatic↗

PubMed1983

Sinus bradycardia in obstructive jaundice--correlation with total serum bile acid concentrations.

Obstructive jaundice is often listed among the causes of sinus bradycardia. The latter is usually attributed to the effect of bile salts on the sino-atrial node. The purpose of this study was to determine the frequency of sinus bradycardia (heart rate less than 50/min) in 50 patients with severe or moderate cholestasis, and to relate sinus rate and intracardiac conduction to total serum conjugated bile acid concentrations. The latter were measured using a solid-phase 125I radio-immunoassay. The mean sinus rate (+/- SD) in the patients was 74.1 +/- 11.6/min (range 47-100/min). One patient had a sinus rate of less than 50/min and 2 had rates of 50-60/min. The mean total serum conjugated bile acid concentration was 251.1 +/- 198.8 mumol/l (range 13-1000 mumol/l). There was no correlation in individual patients between total serum bile acid concentration and sinus rate (r = +0.097), P-R interval (r = +0.210) or corrected Q-T interval (r = -0.085). We conclude that sinus bradycardia is not a feature of obstructive jaundice and that high serum bile acid concentrations do not exert a slowing effect on the sino-atrial node.

Adult↗

PubMed1980

The value of polymixin B in endotoxaemia due to experimental obstructive jaundice and mesenteric ischaemia.

The role of polymixin B in endotoxaemia due to obstructive jaundice and mesenteric ischaemia has been examined. Rats made jaundiced by common bile duct ligation were challenged with intragastric endotoxin. Rats given polymixin B infusions had improved survival (11/15) compared with controls (4/14). Mesenteric ischaemia was induced in rats by clipping the mesenteric artery. Limulus assay revealed marked endotoxaemia in controls. Polymixin B infusions reduced the degree of endotoxaemia. Pre-treatment with non-absorbable intestinal antibiotics markedly reduced endotoxaemia. Polymixin B infusions gave no advantage of survival (3/10) compared with controls (2/10), but all animals pre-treated with intestinal antibiotics survived (12/12). The difference in results found between obstructive jaundice and mesenteric ischaemia may be due to different degrees of endotoxaemia. Polymixin B may have a place in the prophylaxis of endotoxaemia in clinical obstructive jaundice.

Animals↗

PubMedDate not supplied

Differences in biliary lipid excretion after major hepatectomy in obstructive jaundiced rats with preoperative internal, external, or no biliary drainage.

Necessity of preoperative biliary drainage for patients with obstructive jaundice is still controversial. We recently reported that liver regeneration after major hepatectomy was better restored in a rat model of obstructive jaundice with preoperative internal biliary drainage than that without biliary drainage or with external biliary drainage. The aim of this study was to investigate the differences in biliary lipid excretion after hepatectomy in obstructive jaundiced rats with or without preoperative internal or external biliary drainage. After bile duct ligation for 7 days, rats were randomly divided into the three groups; obstructive jaundice-hepatectomy (OJ-Hx), internal biliary drainage-hepatectomy (ID-Hx), and external biliary drainage-hepatectomy (ED-Hx) groups. 70% hepatectomy and internal biliary drainage were carried out 7 days after biliary decompression in the latter two groups and without biliary decompression in the OJ-Hx group. On the day of and on days 1, 2, 3 and 7 after hepatectomy, the liver weight, DNA synthesis rate, biliary lipids excretion rates, and bile acid composition were determined. In the ID-Hx group, the DNA synthesis rate and relative liver weight were significantly higher than those of the OJ-Hx and ED-Hx groups. The excretion rates of biliary lipids were disturbed in the ED-Hx group compared with those in the ID-Hx group and the values in the OJ-Hx group were in-between the ID-Hx and ED-Hx group. The liver regeneration rate was significantly correlated with bile flow and excretion rates of biliary lipids. The maintenance of enterohepatic circulation of biliary lipids before hepatectomy may be important for the liver regeneration.

Animals↗

PubMed1996

Intestinal barrier dysfunction in clinical and experimental obstructive jaundice and its reversal by internal biliary drainage.

Intestinal mucosal barrier function in obstructive jaundice was assessed in an animal model and in patients. The effect of internal biliary drainage in patients was also examined. Bile duct ligation for 1 week in the rat resulted in significant bacterial translocation (in seven of 12 animals following ligation versus none of the shamoperated controls, P < 0.01). Intestinal permeability, measured by the urinary recovery of orally administered polyethylene glycol, was also significantly increased (+66.2 per cent for ligation versus -11.6 per cent for sham, P < 0.01). A prospective study was performed on 33 patients with obstructive jaundice undergoing internal biliary drainage, and results were compared with those in six non-jaundiced patients undergoing laparotomy or endoscopic retrograde cholangiopancreatography and in 11 health volunteers. The lactulose: mannitol ratio was used as an intestinal permeability index. Mean(s.e.m.) intestinal permeability assessed before operation was significantly increased in jaundiced patients compared with control patients (0.050(0.010) versus 0.016(0.003), P < 0.005). The mean(s.e.m.) lactulose: mannitol ratio in the healthy volunteers was 0.020(0.003), which was similar to that in control patients. In the jaundiced group of patients the intestinal permeability index fell to within normal levels after 28 days of internal biliary drainage (0.050 before operation versus 0.021 at 28 days, P < 0.02). These data indicate that intestinal barrier function is impaired in obstructive jaundice and that this impairment is reversed by return of bile to the gastrointestinal tract.

Animals↗

PubMed1995

Hepatic cytokeratin changes in obstructive jaundice: before and after biliary drainage.

We investigated the changes in hepatic cytokeratins in obstructive jaundice by immunohistochemistry. The results can be summarized as follows: 1) In accordance with the progression of the jaundice, the lobular and cellular distribution of cytokeratin reactivity in hepatocytes expanded. 2) Cytokeratin reactivity in obstructive jaundice was improved by removal of the bile duct obstruction (decompression), but this decompressive effect deteriorated in the case of prolonged jaundice. 3) It is suggested that the specific lobular and cellular distribution and/or the changes in cytokeratin aggregation might be of value in determining the stage and in predicting the prognosis of obstructive jaundice.

Animals↗

PubMed1992

Effect of activated protein C on impaired fibrinolysis in rats with obstructive jaundice.

We studied the effect of activated protein C (APC) on impaired fibrinolysis using a rat model in which disseminated intravascular coagulation (DIC) is induced by the intravenous injection of endotoxin in rats with obstructive jaundice. An intravenous injection of endotoxin in rats with obstructive jaundice resulted in pulmonary hemorrhages and a marked increase in the plasma levels of tissue-type plasminogen activator (t-PA) antigen and plasminogen activator inhibitor activity. Prophylaxis with APC before the injection of endotoxin resulted in a decrease of the number of lung hemorrhages and an accelerated release of t-PA antigen. Thus, DIC in obstructive jaundice may be due to impairment of fibrinolysis and an increased susceptibility of endothelial cells to endotoxin. APC may be effective as a treatment for patients with obstructive jaundice associated with DIC.

Animals↗

PubMed1993

[Study on the relation of human red cell membrane protein band 4.2 to red cell aging--in cases of obstructive jaundice].

The relation of human red cell membrane protein band 4.2 to red cell aging both in normal controls and in cases of obstructive jaundice was studied. The studied subjects were 9 people aged 20 to 73 years, the serum bilirubin levels of whom ranged from 4.8 to 26.7mg/dl. And normal controls were 9 people aged 20 to 30 years. First, we separated red cells into several fractions depending on red cell aging by the method of Vettore et al. The analyses of polyacrylamide gel electrophoresis (PAGE) of each RBC membrane sample by Fairbanks' system revealed the results as follows. Primarily, it was observed that in comparison with band 4.1, band 4.2 both in normal controls and in cases of obstructive jaundice increased depending on red cell aging. Secondly, it was suggested that the decrease of band 4.2 protein in cases of obstructive jaundice should not be due to the higher level of serum bilirubin but to the lower level of red cell aging. Because the obstructive jaundice could shorten the life span of red cells and make the average aging level of red cells younger.

Adult↗

PubMedDate not supplied

A self-expandable metallic stent in combination with cholangioscopic microwave coagulation therapy and chemotherapy with oral TS-1 against obstructive jaundice due to recurrent gastric cancer: a case report of successful treatment.

Obstructive jaundice is a terminal symptom of gastric cancer. A 45-year-old female patient had a recurrent gastric cancer at the pancreas head and it caused obstructive jaundice. She was treated with percutaneous transhepatic cholangio-drainage, followed by radiotherapy and chemotherapy with cisplatin, epirubicin and 5-FU, which resulted in a prominent response and a self-expandable metallic stent was placed into the bile duct. After 11 months, however, the tumor recurred and the bile duct was obstructed again by an invading tumor. She was retreated with percutaneous transhepatic cholangio-drainage for jaundice, followed by chemotherapy with oral TS-1. Her recurrent tumor dramatically responded again, and cholangioscopic microwave coagulation therapy was applied for the first time through a cholangio-drainage route and an additional metallic stent was inserted into the bile duct. After these therapies she has been disease--free for more than 2 years. In conclusion, the placement of a self-expandable metallic stent in combination with cholangioscopic microwave coagulation therapy and TS-1 was very effective in managing the obstructive jaundice due to the local recurrence of gastric cancer.

Administration, Oral↗

PubMed2002

Kupffer cell phagocytosis blockade decreases morbidity in endotoxemic rats with obstructive jaundice.

OBJECTIVE AND DESIGN: The consequences of Kupffer cell phagocytosis blockade were studied in endotoxemic rats with obstructive jaundice. MATERIAL OR SUBJECTS: 159 male Wistar rats. TREATMENT: Obstructive jaundice was induced by bile duct ligation (BDL). Gadolinium chloride (1 mg/100 g iv) was given 6 days after BDL to inhibit Kupffer cell activity and the animals were challenged with 1 microg/g endotoxin 24 h later. METHODS: Endotoxin sensitivity, tumor necrosis factor-alpha and interleukin-6 production were studied, liver and lung injury were assessed by neutrophil infiltration assay, tissue adenosine triphosphate, aspartate aminotransferase, alanine aminotransferase level determinations and histology, respectively. For statistics non-parametric methods were used. RESULTS: BDL sensitized the animals to endotoxin, increased endotoxin-induced tumor necrosis factor-alpha and interleukin-6 production and reduced ATP contents of the liver and the lung. Kupffer cell blockade significantly increased the resistance against endotoxin, diminished the inflammatory cytokine release and reduced endotoxin-induced tissue injury in BDL animals. CONCLUSION: Attenuation of Kupffer cell function decreases endotoxin-induced lethality and morbidity in obstructive jaundice.

Adenosine Triphosphate↗

PubMed1988

Obstructive jaundice from open vessel clip.

Obstructive jaundice occurred 3 years after cholecystectomy in a 49-year-old man. At surgery a large stone was discovered in the common bile duct. Pathologic examination showed that the stone had formed around an open vessel clip. Migration of an open vessel clip to the biliary system with subsequent stone formation has not been reported previously.

Cholestasis↗

PubMedDate not supplied

Endoscopic and percutaneous intervention in malignant obstructive jaundice.

Most patients with malignant obstructive jaundice have inoperable disease at presentation. There is debate regarding the best approach to palliate these patients, i.e., surgical versus endoscopic versus percutaneous drainage. The purpose of this article is to review the current literature in an unbiased fashion, and to present a rationale for management. A multi-disciplinary approach is needed if we are to provide the best care for patients with standardization of definitions, complications, and outcomes between specialities such that meaningful comparisons can be made between studies. The need for prospective randomized trials is clear from the currently deficient literature.

Bile Duct Neoplasms↗

PubMed1996

Pathophysiological changes caused by occlusion of blood flow into the liver during hepatectomy in dogs with obstructive jaundice: effects of intestinal congestion.

Obstructive jaundice was produced in adult mongrel dogs by cholecystectomy and ligation of the common bile duct. Two weeks later 40% hepatectomy was performed during 10 min occlusion of hepatic inflow (group I). Liver tissue lipid peroxide levels increased significantly and superoxide dismutase activity decreased. The portal endotoxin (Et) concentration increased markedly after reperfusion and peripheral blood Et and serum beta-N-acetyl hexosaminidase levels increased markedly, beginning 3 h after reperfusion. The phagocytic index increased transiently after reperfusion, but decreased markedly thereafter. Hepatocyte degeneration and necrosis became severe, intestinal villi were damaged and the 1 week survival rate was 23.1%; deaths were due to liver failure. These changes were prevented by construction of a portosystemic bypass and a 1 week survival rate of 70% (group II) was achieved. When the ischaemic time was prolonged to 20 min with the portosystemic bypass (group III), the pathological changes resembled those seen in group I, although no changes were observed in portal or peripheral blood Et levels. These findings suggest that major hepatectomy in the presence of severe jaundice should be carefully performed so that the ischaemic time is minimized during portosystemic bypass in an attempt not only to prevent production of Et in portal venous blood due to intestinal congestion, but also to reduce ischaemia-reperfusion injury.

Animals↗

PubMed1980

The identification of risk factors and their application to the management of obstructive jaundice.

In the presence of obstructive jaundice, surgical procedures are associated with high rates of mortality and morbidity. In an endeavour to identify risk factors associated with a poor outcome, a detailed prospective study of 28 jaundiced patients has been performed. Factors associated with a fatal outcome of operation were serum bilirubin level > 300 mumol/1, glomerular filtration rate < 50 ml/min, the presence of an abnormal level of fibrin degradation products (FDP) in serum, and the presence of endotoxaemia. Postoperative deep venous thrombosis was associated with low serum albumin, normal liver enzymes and rapid kaolin clotting time. Postoperative haemorrhage occurred in patients with FDP or endotoxaemia. Patients with normal renal function or elevated levels of liver enzymes were protected from sepsis. Based on the identification of these risk factors and of those patients with inoperable disease, a plan for management is proposed.

Bilirubin↗

PubMed1975

Morphological characteristics of neonatal obstructive jaundice.

In cases of neonatal obstructive jaundice, liver biopsy material has been studied electronmicroscopically. In bile duct atresia, morphologic changes are extensive and they develop early. The severity of destruction is related to the quantity of accumulated bile deposits. Hypoxia due to the disturbance of microcirculation plays an important part in the damage. In cases of inspissated bile syndrome, the changes are less severe and they prove reversible.

Blood Group Incompatibility↗

PubMed1990

[Obstructive jaundice from benign hepatic cysts].

Obstructive jaundice secondary to benign, non-parasitic hepatic cysts is rare, since there are only 19 previously reported cases. We reported a case of polycystic disease of the liver and kidneys in which relief of developing jaundice was obtained by hepatic lobectomy and fenestration procedure for the multiple cysts. Immense occupancy and porta hepatis proximity of the cysts were triggers for developing jaundice. Urgent resection of the major cysts is recommended for extremely progressing jaundice.

Cholestasis↗

PubMed1986

Cardiovascular function in obstructive jaundice: experimental observations.

Patients with obstructive jaundice are more susceptible to post-operative shock than are nonjaundiced patients. This paper reviews the presently available experimental information, and concludes that jaundice blunts the contractile response of cardiac and vascular smooth muscle to sympathetic stimulation. Moreover, the experimental studies indicate that altered peripheral catecholamine metabolism may account for these attenuated responses.

Animals↗

PubMed2002

Effect of bile acid replacement on endotoxin-induced tumor necrosis factor-alpha production in obstructive jaundice.

There is a high incidence of perioperative morbidity and mortality in patients with obstructive jaundice due to sepsis. Tumor necrosis factor-a (TNF-alpha) is considered a crucial mediator in inducing and processing the inflammatory cascade. We hypothesize that obstructive jaundice leads to an increased endotoxin-induced TNF-alpha production and that intestinal bile acid replacement can prevent this phenomenon. Sprague-Dawley rats were randomized to three groups of 12 animals each. Group 1 underwent common bile duct ligation (CBDL) with oral intestinal bile acid (deoxycholic acid 5 mg/100 g body weight/3 times daily) replacement (CBDL + bile acid); group 2 underwent common bile duct ligation with the same amount of normal saline replacement orally (CBDL + saline); and group 3 underwent a sham operation (sham control). After 2 days, endotoxin was given to the animals, and after 90 minutes, tissues (liver and lung) and blood were collected for checking the TNF-alpha levels and biochemical analyses. Comparisons among these three groups were performed and recorded. While serum and tissue (liver and lung) TNF-alpha levels of group 2 (CBDL + saline) were significantly increased after endotoxin challenge, these elevations were reduced to control levels (sham control) following oral replacement of intestinal bile acid (CBDL + bile acid). Obstructive jaundice leads to an increased endotoxin-induced TNF-alpha production and intestinal bile acid replacement can inhibit this phenomenon.

Animals↗