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At least 19 recordsLinked to original sources

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

Common bile duct pressure and Oddi sphincter pressure in patients with common bile duct stones with and without juxta-ampullar diverticula of the duodenum.

Resting common bile duct pressure and Oddi sphincter pressure were measured in 16 patients with common bile duct stones, 8 having in addition a juxta-ampullar diverticulum. Pressure measurements were performed with an infused catheter introduced through an endoscope under direct vision. No significant differences in fasting common bile duct pressures were observed between the two groups. The Oddi sphincter had a phasic activity, and the peak pressure was similar in both groups.

Aged

Common bile duct and Oddi sphincter pressure before and after endoscopic papillotomy in patients with common bile duct stones.

Pressures in the Oddi sphincter and common bile duct were determined before, immediately after and several weeks after endoscopic papillotomy. Fifteen patients were included in the study. Significant decreases in Oddi sphincter and common bile duct pressures were found and the decrease in Oddi sphincter pressure was to some extent dependent upon the length of the papillotomy.

Adult

Medial indentation of the duodenal sweep by common bile duct dilatation.

The dilated common bile duct has long been recognized as a cause for a smooth, tubular impression across the duodenal bulb or immediate postbulbar duodenum. Only scattered references suggest that a smooth indentation on the medial aspect of the descending duodenum might also be due to an enlarged, tortuous common duct. Three cases of this condition are reported. The dilated common duct impression can mimic a pancreatic mass. While computed tomography, ultrasonography, or transhepatic cholangiography readily suggest the true diagnosis, potential pitfalls in patient management are possible when the first radiographic procedure is an upper gastrointestinal series.

Adult

[Hydrodynamic and radiologic examination of the common bile duct].

The operative study of the common bile duct was carried out with the hydrodynamics methods (flow and resting pressure) in 433 patients and with the operative cholangiography in 383 patients. The hydrodynamics explorations pointed-out a margin of mistake due to falses positives and negatives of the 2.7% and the operative cholangiographies of the 8.6%. The association of both methods, hydrodynamics and radiologycs, allowed us to estimate that the diagnostic mistake is reduced to 0%. It is established in this work the necessity of carring out the flow, the measure of the resting pressure and the cholangiographies; in all the patients that are operated on the biliary tract because the diagnostic accuracy is the 100%. It is discussed the value of the diameter of the common bile duct for affirming the eventual existence of obstruction of the lower part of the common bile duct and the values are correlated, measured in mm., with pathological founds. It is considered the value of the hydrodynamics methods in the diagnostic of the stenosis of the sphincter of Oddi.

Adolescent

Sonography of the common bile duct: value of the right anterior oblique view.

The common hepatic and proximal common bile ducts (common duct) lie anteriorly and generally to the right of the portal vein in the porta hepatis. This constant anatomic relationship can be used to demonstrate the common duct and to differentiate it from the portal vein by gray scale ultrasonography. The patient is scanned longitudinally from the right anterior abdominal wall with the ultrasound beam directed posteromedially until two tubular structures are demonstrated in the porta hepatis. The more anterior tubular structure in this projection is the common duct. If the common duct is less than 3 mm in diameter, it may not be clearly delineated. In these cases the absence of common duct dilatation can be inferred. The usefulness of this view for detecting common duct dilatation was evaluated in a series of 101 consecutive cases proven by surgery, autopsy, or cholangiography. The overall accuracy was 96% (four false negative studies; no false positives). We conclude that sonography should be the imaging procedure of choice for suspected extrahepatic biliary obstruction if the serum bilirubin level precludes intravenous cholangiography.

Adenoma, Bile Duct

Intravenous cholangiography in different degrees of common bile duct obstruction. An experimental study in the dog.

A total of 83 cholangiograms was performed in three cholecystectomized dogs equipped with Thomas cannulas through which complete and different degrees of incomplete common bile duct obstruction were produced. With incomplete common bile duct obstruction, the iodine concentration in the bile necessary for radiographic visualization of the common duct was always obtained for all three tested iodipamide dosages of .3, .6, and 1.2 ml/kg, infused over 30 minutes. The largest dose resulted in the highest biliary iodine concentrations. With increasing obstruction, an increasing delay of the biliary iodipamide excretion was noted. With complete common bile duct obstruction the iodine concentration in the bile necessary for radiographic visualization of the common duct was never obtained, even with an iodipamide dose increased to 1.8 ml/kg and/or prolongation of the contrast material infusion time from 30 minutes to 2 and 6 hours. Nevertheless, the highest biliary iodine concentration in complete common bile duct obstruction resulted with the largest iodipamide dose (1.8 ml/kg) and the shortest infusion time (30 minutes).

Animals

Surgical significance of the histopathology of the common bile duct.

Silver biopsies of the common bile duct were obtained from 15 patients with clinical and surgical evidence of cholangitis. The most pronounced histologic changes were edema, congestion, and marked mucous gland hypertrophy and hyperplasia. No ulceration, intramural abscess, or areas of necrosis were found. Clinical cholangitis is not associated with necrotizing changes in the duct wall. This fact is the histologic basis for satisfactory healing of choledochal enteric anastomoses performed in the presence of cholangitis.

Adult

Gallstone-linked tubular stenosis of the common bile duct.

The transpancreatic segment of the distal common bile duct can be extrinsically stenosed by a pure gallstone-linked pancreatic disorder. It has a specific roentgen configuration--long, tubular and smooth. In two instances it was associated with severe suppurative complications. Precholedochotomy cholangiography is required to identify such long segment benign tubular stenosis of the distal common bile duct as an indication for management alternatives and as a guide to judicious common bile duct exploration.

Aged

New cholangiographic sign of common bile duct obstruction: initial opacification of intrahepatic ducts.

A previously undescribed sign of common bile duct obstruction during intravenous cholangiography - initial visualization of proximal intrahepatic ducts - was observed in 26 patients with surgically proven obstructive disease of the distal common duct. In all cases, opacification of intrahepatic biliary radicles occurred on standard interval films prior to visualization of the extrahepatic common bile duct, the reverse of the normal sequence. The abnormal opacification pattern reflects stasis of bile flow in the presence of distal obstruction and seems analogous to the urographic finding of opacified intra-renal calyces as the initial manifestation of distal ureteral obstruction. Recognition of the alteration in the initial cholangiographic opacification sequence signals the need for delayed films to confirm the diagnosis of a distal choledochal obstruction.

Aged

[Idiopathic congenital dilatation of the common bile duct and pregnancy. Report of one case, reflexions and comments (author's transl)].

Congenital idiopathic dilatation of the common bile duct, called commonly and incorrectly congenital cyst of the common bile duct, is sometimes diagnosed during pregnancy. The latter may be the source of severe complications. The disease should thus be treated rapidly, even if the pregnancy is at a late stage. In a case of this type we carried out surgical treatment in two stages: firstly simple external drainage of the common bile duct and of the gall bladder and only after labour has been brought to term by Caesarian section, for breech presentation, was a cystojejunostomy carried out on a Y shaped jejunal loop.

Adult

Spiral filling defect in the common bile duct.

A spiral filling defect in the common bile duct was found in an elderly woman with intermittent obstructive jaundice. A large, smooth papilla was shown on hypotonic duodenogram. At laparotomy, mucus strans were found in the DUCT, and ampullary carcinoma in the duodenum. The significance of the mucus strand and large duodenal papilla is discussed.

Adenocarcinoma

Nonoperative internal drainage of obstructive common bile ducts.

A new nonoperative method for internal drainage of common bile duct obstructions by endoscopic retrograde cannulation of the papilla of Vater is described. After introduction of a tube in the common bile duct, a substantial decrease in serum activity of bilirubin, alkaline phosphatase, and gamma-glutamyl transferase was found. In addition, a rapid improvement of the clinical condition could be observed. No serious complications occurred. It is concluded that internal drainage of common bile duct obstructions might be of great value in the preoperative treatment of patients with common bile duct obstructions.

Aged

Squamous cell carcinoma of the common bile duct.

Squamous cell carcinoma of the common bile duct in a young woman was treated with pancreatoduodenectomy and chemotherapy. She died eight months after diagnosis. Clinical presentation and aggressiveness of the tumor are similar to adenocarcinoma. Radical resection is the treatment of choice, particulary in young patients.

Adult