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At least 163 records · Page 9Linked to original sources

PubMed1997

beta-Glucuronidase in common duct bile, methodological aspects, variation of pH optima and relation to gallstones.

beta-Glucuronidase of human or bacterial origin may deconjugate bilirubin diglucuronide, causing pigment gallstones. Intrinsic interference by biliary compounds must be minimized for accurate assay of beta-glucuronidase. We report a modified ion-pair extraction of interfering substances by tetrahexylammonium chloride (THAC) in ethyl acetate in the presence of albumin, and a microtitre plate assay for biliary beta-glucuronidase activity in bile with the substrate p-nitrophenol-glucuronide. Adding albumin improved the recovery of beta-glucuronidase activity to 99.8% (CV 1.9%), and 92.2% of the bilirubin in bile samples was extracted in one step. Competitive inhibition was overcome by increasing the substrate concentration. In endoscopically obtained common duct bile from 44 patients, five different beta-glucuronidase activity peaks were identified, at pH 3.9, 4.8, 5.3, 5.8 and 7.2. The pH profiles were classified into one bacterial pattern and five patterns for presumed human beta-glucuronidase. Of the latter patterns, four displayed dual activity peaks. In a second sample, obtained at follow up in four patients, their original pH profile was maintained. In conclusion, using the modified purification and assay system, we found functionally diverse subcategories of human beta-glucuronidase with respect to activity at variable pH. Our results indicate that several pH optima have to be taken into consideration in order to clarify the role of human biliary beta-glucuronidase in the pathogenesis of pigment gallstones. Bacterial beta-glucuronidase activity was associated with duodenal diverticula (p < 0.05) and common duct stones (p < 0.05).

Adult↗

PubMed1988

Delayed common bile duct obstruction in acute pancreatitis.

Common bile duct obstruction during acute pancreatitis usually occurs in the early symptomatic phase of the illness, involves only the distal portion of the common bile duct, and subsides with clinical improvement. We present two cases of persistent common bile duct obstruction that developed 2-3 months after complete clinical subsidence of the initial episode of severe acute pancreatitis and involved a long segment of the common bile duct. After surgical decompression, there was no recurrence of common bile duct obstruction or pancreatitis.

Acute Disease↗

PubMedDate not supplied

Why does laparoscopic common bile duct exploration fail?

Laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis carries an overall ductal clearance rate of between 85% and 95%. We present our single institute experience with LCBDE. Between July 1999 and July 2003, 60 patients (42 females, 18 males; median age, 59.5 years) with proven choledocholithiasis underwent LCBDE for common bile duct (CBD) clearance. The method failed to clear the CBD in six patients, resulting in a 90% overall success rate. Conversion to a conventional open approach (n = 1), hand-assisted LCBDE (n = 1), T-tube placement followed by multiple postoperative endoscopic retrograde cholangiopancreatography (ERCP; n = 2), and endobiliary stent placement followed by single successful postoperative ERCP in each case (n = 2) were chosen as treatment options when the laparoscopic method failed to clear the CBD. LCBDE is a feasible and safe method of managing CBD stones. Impacted stones at the lower end of the CBD or in the ampulla of Vater represent the most likely factors leading to failure of LCBDE. Laparoscopic endobiliary stent placement followed by postoperative ERCP represents the most attractive alternative in these difficult cases of impacted stones.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMedDate not supplied

[Retrograde cholangiopancreatography (ERCP) and endoscopic sphincteropapillotomy (ES) in the diagnosis and treatment of common bile duct (CBD) lithiasis].

The common bile duct (CBD) stones often gives real difficulties of diagnosis and treatment. The ultrasound (US) does not offer in a significant percentage of cases certain diagnostic data, and the unconventional imaging techniques such as computer tomography (CT) are yet less accessible. ERCP appeared in the last period as an optional method for the diagnosis of common bile duct stones, and, moreover, permitted the development of the nonsurgical treatment possibilities. ES and the extraction of stones revealed in this frame as preferable, especially in the high surgical risk cases. This study presents the results of ERCP performed in 547 and the therapeutic value of ES in 284 cases with CBD stones (conclusions of the ERCP and ES used in the clinical practice, in our clinic, in the last three years). In 81.69% cases ES managed the dezobstruction of the CBD, with a frequency of complications of 4.33% and a related mortality rate of 0.78%.

Adult↗

PubMed1949