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At least 19 recordsLinked to original sources
PubMed1988

Beta-glucuronidase activity related to bacterial growth in common bile duct bile in gallstone patients.

Beta-glucuronidase activity in the bile may be of importance in the etiology of pigment gallstones. This enzyme is of hepatic or bacterial origin. We have described a method to measure the activity of bacterial beta-glucuronidase in human bile, using 4-nitrophenyl-beta-D-glucopyranosiduronic acid as substrate. The method was used to measure the beta-glucuronidase activity in the bile from 51 patients with gallstone disease. This activity was related to the presence of beta-glucuronidase-producing bacteria in the bile. Escherichia coli, Bacteroides species, and Clostridium perfringens were the only species found to produce beta-glucuronidase. Patients with beta-glucuronidase-producing bacteria had on an average significantly higher enzyme activity in the bile than patients without such bacteria (p less than 0.01). The limitations of using artificial substrates in this type of studies are discussed.

Aged↗
PubMed1996

Value of routine intraoperative cholangiography in detecting aberrant bile ducts and bile duct injuries during laparoscopic cholecystectomy.

A prospective study was performed to determine the frequency and type of bile duct abnormalities, and to determine whether routine use of intraoperative cholangiography during laparoscopic cholecystectomy might aid in the prevention of bile duct injuries. Overall, anatomical aberrations of the bile ducts were found in 98 (19 per cent) of 513 cholangiograms. The most common anomalies were at the hepatic confluence and constituted different types of right hepatic subsegmental ducts draining separately into the biliary tree (n = 43, 8.4 per cent), either close to the cystic duct or directly into the cystic duct. Three bile duct injuries (0.5 per cent) occurred during the study period. These results show that routine intraoperative cholangiography is feasible and provides valuable information about the anatomy of the biliary tract, thereby improving the safety of laparoscopic cholecystectomy. If an injury to the biliary tract occurs early during operation, the cholangiogram allows the surgeon to detect the injury, to make a prompt repair and thereby reduce the morbidity associated with a delayed diagnosis. Routine use of intraoperative cholangiography is strongly recommended.

Acute Disease↗
PubMed1966

The effect of bile duct ligation, bile duct cannulation, and hypothermia on alpha-naphthylisothiocyanate-induced hyperbilirubinemia and cholestasis in rats.

The hyperbilirubinemic and cholestatic responses to alpha-naphthylisothiocyanate (ANIT) in the rat were altered by subjecting test animals to various environmental and surgical manipulations. Studies utilizing hypo- and hyperthermic conditions showed that a positive correlation exists between the rectal temperature and the effects of ANIT. In addition, it was observed that ANIT produced an apparent poikilothermic response, in that treated rats were unable to maintain normal rectal temperatures. Bile duct ligation inhibited the cholestatic and altered the hypothermic responses to ANIT treatment. Cannulation of the bile duct prior to ANIT administration significantly inhibited the hyperbilirubinemia and cessation of bile flow. These data demonstrate the importance of an intact enterohepatic circulation and normal body temperature in the actions of ANIT. The effect of the various parameters on the ANIT-induced hyperbilirubinemia and cholestasis suggests the involvement of a biotransformation product of ANIT.

1-Naphthylisothiocyanate↗
PubMed1966

Bile acids in the rat: studies in experimental occlusion of the bile duct.

Bile acids in the plasma, urine, and small intestine of adult male rats with occluded bile ducts have been studied using a method of high specificity for their determination. After bile duct ligation cholic acid rapidly accumulates in the plasma for 8 hr, remains high for a further 8 hr, and subsequently diminishes; bile acids disappear from the small intestine. During the first 12 hr after bile duct ligation the excretion of trihydroxy acids in the urine was 10 times that of the dihydroxy acids. Subsequently the two excretion rates became equal. Because bile acids have been implicated in the etiology of hepatic damage following bile duct ligation, studies have been made of the effect on the liver of removing (with cholestyramine) and supplementing (with cholic acid) the intestinal bile acid pool. The addition of cholestyramine to the stock diet prevented the rise in trihydroxy bile acids after bile duct ligation, but did not prevent the development of histological abnormalities in the liver. Supplementing the diet with cholic acid raised the plasma cholic acid levels but had little effect on the hepatic histological findings.

Animals↗
PubMedDate not supplied

Prognostic significance of proliferative cell nuclear antigen in carcinoma of the extrahepatic bile duct.

Bile duct cancers are still difficult to cure, and even if curatively resected locoregional recurrences are frequent. Biologic proliferative activity of the cancer may influence postoperative recurrence and the prognosis. A retrospective study was performed with the medical records of 44 consecutive patients who underwent surgery for histologically extrahepatic bile duct cancer (stage 3 or 4) at Osaka Police Hospital during the period 1980 to 1992. Univariate analysis suggested that the stage according to the UICC classification, curability, DNA ploidy, proliferating cell nuclear antigen (PCNA), S-phase and G2M-phase fractions, and histologic differentiation were significant prognostic factors. The Cox's proportional hazard model indicated that PCNA and histologic differentiation were independent prognostic factors for crude and cause-specific survival. When PCNA was omitted from the analysis, DNA ploidy and histologic differentiation were independent prognostic factors for both crude and cause-specific survival. These results suggested that proliferative activity influenced the postoperative prognosis of extrahepatic bile duct cancer.

Bile Duct Neoplasms↗
PubMed1989

Subtotal duodenopancreatectomy for pancreatic duct, distal bile duct and periampullary carcinoma: short- and long-term results.

Ninety patients with pancreatic duct, distal bile duct, and ampullary carcinoma underwent pancreatic resection. Following a standard policy of resection based on surgical findings, all the patients who had resection first underwent subtotal extended pancreatectomy (n = 68) and if they were considered not to fulfill the criteria for this operation, total pancreatectomy (n = 22). Thus, 68 of the 90 patients (72%) were managed with subtotal pancreatic resection irrespective whether they had ampullary, pancreatic duct, or distal common bile duct carcinoma. On the basis of our results, subtotal duodenopancreatectomy is regarded as the method of choice for many patients with pancreatic duct, distal bile duct, or ampullary carcinoma.

Adult↗
PubMed1976

The contribution of the extrahepatic bile ducts to bile formation.

This study was performed to determine the contribution of the extrahepatic bile ducts to bile flow in the rhesus monkey. Bile flow from the two sides of the liver was divided. The major extrahepatic bile ducts remained connected to one side of the liver only. Bile flow, and the concentrations of [14C]erythritol, bicarbonate, bile acid, and bilirubin in bile samples from the two sides of the liver, in the fed state were measured and compared. An estimate of the net flow from the extrahepatic ducts was obtained from the [14C]-erythritol concentrations on the two sides of the liver and the bile flow rate on the side with the extrahepatic ducts. The [14C]erythritol bile-plasma ratio was significantly lower in bile collected from the side with the extrahepatic bile ducts, than in bile from the other side of the liver. About 10% of total hepatic bile flow originated in the extrahepatic bile ducts, in the fed state. The bicarbonate-[14C]erythritol concentration ratio was significantly higher in bile from the side with the extrahepatic bile ducts. Bicarbonate - bile acid, and bicarbonate-bilirubin concentration ratios were also significantly higher in bile from the side of the liver with the extrahepatic ducts. The extrahepatic bile ducts have a physiologically significant role in the secretion of bile water. Bicarbonate is secreted in association with water in the extrahepatic ducts.

Animals↗
PubMed1986

Bile peritonitis after removal of T-tubes from the common bile duct.

Bile peritonitis can occur when a T-tube is electively removed from the common bile duct, but this is regarded as a rare complication. Plastic T-tubes are known to increase the risk and should not be used. Latex rubber T-tubes are preferred but the complication can still occur. We present three patients with this complication despite the use of a latex T-tube. A questionnaire was sent to 107 surgeons in the South East Thames Region. The replies showed that the complication is far more common than generally realized. Based on these replies the risk of bile peritonitis each time a latex T-tube is electively removed from the common bile duct is calculated to be 0.84 per cent or 1 in every 119 explorations.

Aged↗
PubMed1992

Relationship of cholecystectomy and detachment of the common bile duct to chronic bile duct dilation.

A combination of a cholecystectomy and detachment of the supportive tissue surrounding the extrahepatic bile duct results in chronic bile duct dilation. To clarify whether this cholangiectasis is due to the detachment of the surrounding tissue or to the cholecystectomy, we have studied 4 groups of adult mongrel dogs, i.e., a control group given a sham operation (n = 20), a group given cholecystectomy (n = 20), a group that had the surrounding tissue detached from the bile duct (n = 20), and a group given both a cholecystectomy and detachment of the surrounding tissue (n = 29). On examination by cholangiography at 1, 2, 3, and 4 weeks after the initial laparotomy, no significant cholangiectasis was found in dogs subjected to either cholecystectomy alone or to detachment of the surrounding tissue alone. In contrast, in dogs subjected to a cholecystectomy combined with detachment of the bile duct, the bile duct gradually dilated, resulting in significant cholangiectasis at 4 weeks. However, the intrabiliary pressure, the residual pressure, and the actual resistance value, which are indices of a passage disturbance in the sphincter of Oddi, were normal in all 4 groups. It is therefore concluded that both the extirpation of the gallbladder, and the lack of supportive tissue surrounding the bile duct were responsible for the resulting cholangiectasis.

Animals↗
PubMed1995

Evidence of preservation injury to bile ducts by bile salts in the pig and its prevention by infusions of hydrophilic bile salts.

Preservation injury to bile ducts is a serious problem in liver transplantation, especially when preservation exceeds 12 hours. The authors hypothesized that the injury was caused by contact of bile ducts with bile salts during cold preservation and might be preventable by infusion of more hydrophilic bile salts. Swine livers were harvested after intraportal infusions of saline (control), of the hydrophobic bile salt taurodeoxycholate, or of the hydrophilic bile salts tauroursodeoxycholate or dehydrocholate. The effect of infusing a combination of hydrophilic and hydrophobic bile acids was also studied. Bile samples were taken before and during the infusions. Then livers were perfused with UW solution, ducts were flushed retrograde with UW, and livers were stored at 0 to 1 degree C for 20 hours. Bile ducts were harvested after preservation, and coded microscopic slides of the specimens were examined by light microscopy. There was large variability in baseline bile salt concentration. Injury after preservation consisted of sloughing and pyknosis of surface and glandular epithelium. The histologic injury score determined after preservation was directly related to bile salt concentration in bile ducts at the time of flushing. During bile salt infusions, the infused bile salt replaced most or all of the other bile salts present in bile. Severe postpreservation injury of intrahepatic ducts occurred after taurodeoxycholate infusions, but injury was minimal when either of the two hydrophilic bile salts was infused. The mixture of bile acids produced intermediate results. Retrograde flushing with UW does not prevent injury to intrahepatic ducts. The authors conclude that the injury is caused by contact with bile salts, is dependent on bile salt concentration and composition, and is preventable.

Adenosine↗
PubMed1997

[Surgery and cystic malformations of the bile ducts].

Bile duct cysts are usually diagnosed during infancy and childhood, although 20-30% become symptomatic in adults, sometimes as late as the seventh decade of life. The Todani modification of the Alonso-Lej classification is now generally accepted and has clarified a previously confusing literature. Treatment is surgical: resectional rather than the traditional drainage procedures are indicated. This aggressive approach decreases but does not abolish the risk of cancer in the hepato-bilio-pancreatic tree. The patients must therefore be followed up for life.

Adult↗
PubMed1985

Age and sex dependency of bile duct diameter and bile duct pressure--an ERC manometry study.

Using ERC-manometry diameters of the common bile duct (CBD) the common hepatic duct (CHD) as well as CBD pressure before and after opacification were determined in 35 non-cholecystectomized patients without extrahepatic cholestasis. We found a significant rise of both CBD and CHD diameters as well as CBD pressure recorded before the injection of contrast medium with increasing age. (p less than 0.005, less than 0.001 and less than 0.05 respectively). Following the opacification CBD pressure became elevated. Again this increase tended to be more pronounced in older patients although this association was lacking statistical significance. In the presence of comparable age female patients (n = 16) exhibited higher CBD and CHD diameters (n.s.) as well as CBD pressure values (p less than 0.05) than male patients (n = 19). We conclude that in the absence of extrahepatic cholestasis bile duct diameter as well as bile duct pressure rise significantly with increasing age. Furthermore women tend to have higher diameters and pressure values than men.

Adult↗
PubMed1977

Excretion of metroindazole in human bile. Investigations of hepatic bile, common duct bile, and gallbladder bile.

Excretion of metronidazole (MNZ) in the normal and in the diseased biliary tract was investigated in 58 patients after oral or intravenous administration of MNZ. After oral administration MNZ appeared rapidly in hepatic bile, and throughout the period of absorption and elimination almost identical concentrations of MNZ were found in serum and hepatic bile. After intravenous administration no significant differences were found between concentrations of MNZ in common duct bile and serum in the non-obstructed common duct; in common duct obstruction, concentrations of MNZ in common duct bile were 56--99 per cent of corresponding concentrations in serum. MNZ was concentrated in normal gallbladders. In patients with gallbladder stones and preserved function of the gallbladder and in patients with no function of the gallbladder but a patent cystic duct, no significant differences were found between concentrations of MNZ in gallbladder bile, common duct bile, and serum. In most gallbladders with the cystic duct blocked by a stone, no MNZ was found in gallbladder bile.

Administration, Oral↗