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Wang T, Liu S, Zheng YB, Song XP, Sun BL, Jiang WJ, Wang LG. Clinical Study on Using 125I Seeds Articles Combined with Biliary Stent Implantation in the Treatment of Malignant Obstructive Jaundice. Anticancer Res 2017; 37:4649-4653. [PMID: 28739766 DOI: 10.21873/anticanres.11867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/01/2017] [Accepted: 06/07/2017] [Indexed: 02/08/2023]
Abstract
Aim: To study the feasibility and curative effect of125I seeds articles combined with biliary stent implantation in the treatment of malignant obstructive jaundice. Patients and Methods: Fifty patients with malignant obstructive jaundice were included. Twenty-four were treated by biliary stent implantation combined with intraluminal brachytherapy by 125I seeds articles as the experimental group, while the remaining 26 were treated by biliary stent implantation only as the control group. The goal of this study was to evaluate total bilirubin, direct bilirubin and tumor markers (cancer antigen (CA)-199, CA-242 and carcinoembryonic antigen (CEA)), as well as biliary stent patency status and survival time before and after surgery. Results: Jaundice improved greatly in both groups. The decreases of CA-199 and CA-242 had statistical significance (p=0.003 and p=0.004) in the experimental group. The ratio of biliary stent patency was 83.3% (20/24) in the experimental group and 57.7% (15/26) in the control group (p=0.048). The biliary stent patency time in the experimental group was 1~15.5 (mean=9.84) months. The biliary stent patency time in the control group was 0.8~9 (mean=5.57) months, which was statistically significant (p=0.018). The median survival time was 10.2 months in the experimental group, while 5.4 months in control group (p<0.05). Conclusion:125I seeds articles combined with biliary stent implantation significantly prolongs biliary stent patency time and survival time for patients with malignant obstructive jaundice possibly by inhibiting the proliferation of vascular endothelial cells and the growth of tumor.
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Affiliation(s)
- Tao Wang
- Department of Interventional Therapy, Yuhuangding Hospital, Yantai, P.R. China
| | - Sheng Liu
- Department of Interventional Therapy, Yuhuangding Hospital, Yantai, P.R. China
| | - Yan-Bo Zheng
- Department of Interventional Therapy, Yuhuangding Hospital, Yantai, P.R. China
| | - Xue-Peng Song
- Department of Interventional Therapy, Yuhuangding Hospital, Yantai, P.R. China
| | - Bo-Lin Sun
- Department of Interventional Therapy, Yuhuangding Hospital, Yantai, P.R. China
| | - Wen-Jin Jiang
- Department of Interventional Therapy, Yuhuangding Hospital, Yantai, P.R. China
| | - Li-Gang Wang
- Department of Interventional Therapy, Yuhuangding Hospital, Yantai, P.R. China
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102
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Abstract
A 22-year-old man presented to the emergency department on Christmas Day with a 5-day history of myalgias, cough, dyspnea, nonbilious emesis, and nonbloody diarrhea. Although he had been ill for several days, he ultimately sought treatment because of intractable vomiting. He reported feeling feverish, although he had not measured his temperature, and noted one episode of hemoptysis.
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Affiliation(s)
- Sara Mixter
- From the Divisions of General Internal Medicine (S.M., R.S.M., L.P.) and Infectious Disease (S.C.K.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore; and the Department of Medicine and the Division of Infectious Disease, University of California, San Francisco, San Francisco (H.H.)
| | - Reza Sedighi Manesh
- From the Divisions of General Internal Medicine (S.M., R.S.M., L.P.) and Infectious Disease (S.C.K.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore; and the Department of Medicine and the Division of Infectious Disease, University of California, San Francisco, San Francisco (H.H.)
| | - Sara C Keller
- From the Divisions of General Internal Medicine (S.M., R.S.M., L.P.) and Infectious Disease (S.C.K.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore; and the Department of Medicine and the Division of Infectious Disease, University of California, San Francisco, San Francisco (H.H.)
| | - Laura Platt
- From the Divisions of General Internal Medicine (S.M., R.S.M., L.P.) and Infectious Disease (S.C.K.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore; and the Department of Medicine and the Division of Infectious Disease, University of California, San Francisco, San Francisco (H.H.)
| | - Harry Hollander
- From the Divisions of General Internal Medicine (S.M., R.S.M., L.P.) and Infectious Disease (S.C.K.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore; and the Department of Medicine and the Division of Infectious Disease, University of California, San Francisco, San Francisco (H.H.)
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103
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Angelico R, Khan S, Dasari B, Marudanayagam R, Sutcliffe RP, Muiesan P, Isaac J, Mirza D, Roberts KJ. Is routine hepaticojejunostomy at the time of unplanned surgical bypass required in the era of self-expanding metal stents? HPB (Oxford) 2017; 19:365-370. [PMID: 28223041 DOI: 10.1016/j.hpb.2016.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 12/11/2016] [Accepted: 12/22/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepaticojejunostomy is routinely performed in patients when inoperable disease is found at planned pancreatoduodenectomy; however, in the presence of self-expanding metal stent (SEMS) hepaticojejunostomy may not be required. The aim of this study was to assess biliary complications and outcomes in patients with unresectable disease at time of planned pancreaticoduodenectomy stratified by the management of the biliary tract. MATERIAL AND METHODS Retrospective analysis of patients undergoing surgery in January 2010-December 2015. Complications were measured using the Clavien-Dindo scale. RESULTS Of 149 patients, 111 (75%) received gastrojejunostomy and hepaticojejunostomy (double bypass group) and 38 (26%) received a single bypass in the presence of SEMS (single bypass group). Post-operative non-biliary [7 (18%) vs 43 (38%), (p = 0.028)] and biliary [0% vs 12 (11%), (p = 0.037)] complications were lower in the single bypass group. Hospital readmissions were significantly higher in the double bypass group (p = 0.021). Overall survival and the time to start chemotherapy were equivalent (p = n.s.). CONCLUSIONS Complications are more common following double bypass compared to single bypass with SEMS suggesting that gastric bypass is adequate surgical palliation in presence of SEMS. This study adds further evidence that preoperative SEMS should be used in preference to plastic stents for suspected periampullary malignancy.
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Affiliation(s)
- Roberta Angelico
- The Liver and Pancreas Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom; Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00146 Rome, Italy
| | - Shakeeb Khan
- The Liver and Pancreas Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom
| | - Bobby Dasari
- The Liver and Pancreas Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom
| | - Ravi Marudanayagam
- The Liver and Pancreas Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom
| | - Robert P Sutcliffe
- The Liver and Pancreas Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom
| | - Paolo Muiesan
- The Liver and Pancreas Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom
| | - John Isaac
- The Liver and Pancreas Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom
| | - Darius Mirza
- The Liver and Pancreas Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom
| | - Keith J Roberts
- The Liver and Pancreas Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom.
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104
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Vandenabeele LAM, Dhondt E, Geboes KP, Defreyne L. Percutaneous stenting in malignant biliary obstruction caused by metastatic disease: clinical outcome and prediction of survival according to tumor type and further therapeutic options. Acta Gastroenterol Belg 2017; 80:249-255. [PMID: 29560690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND STUDY AIMS Obstructive jaundice caused by metastatic disease leads to deterioration of general condition and short survival time. Successful decompression can offer symptom control and enable further treatment with chemotherapy, which can improve survival. PATIENTS AND METHODS Ninety-nine percutaneous transhepatic cholangiography (PTC) procedures with metallic stent placement were performed in 93 patients between 2007 and 2013. Files were retrospectively studied and a review of patients' demographics, clinical and laboratory parameters, treatment and survival was performed. Kaplan-Meier survival analysis with log-rank test was done in function of bilirubin level, tumor type and treatment with chemotherapy. RESULTS Hyperbilirubinemia resolved in 73% of procedures. Median survival time after the procedure was 48 (95%CI 34.8 - 61.1) days. If additional chemotherapy was possible, a median survival of 170 (95%CI 88.5 - 251.4) days was noted versus 32 (95%CI 22.4 - 41.5) days without chemotherapy (p < 0.01). Survival rates greatly differed between primary tumor type, with the largest benefit of PTC in colorectal cancer. In 35 % of the procedures minor or more severe complications were noted. The 30-day mortality was 33%, with 3 procedure related deaths. CONCLUSION PTC with metallic stenting can bring symptom relief and enable further treatment with chemotherapy, which can lead to a longer survival time, especially in colorectal cancer. However, in patients in whom palliative stenting failed to resolve the hyperbilirubinemia survival is short.
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Affiliation(s)
- Lisbeth A M Vandenabeele
- University Hospital of Ghent, Department of Gastroenterology, De Pintelaan 185, 9000 Ghent, Belgium
| | - Elisabeth Dhondt
- University Hospital of Ghent, Department of Interventional Radiology, De Pintelaan 185, 9000 Ghent, Belgium
| | - Karen P Geboes
- University Hospital of Ghent, Department of Gastroenterology, De Pintelaan 185, 9000 Ghent, Belgium
| | - Luc Defreyne
- University Hospital of Ghent, Department of Interventional Radiology, De Pintelaan 185, 9000 Ghent, Belgium
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105
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Abstract
RATIONALE Septo-optic dysplasia (SOD) is a rare congenital disorder that may cause jaundice in infants. However, it is usually prone to neglect and misdiagnosis in infants with cholestasis because endocrine disorder such as panhypopituitarism is rare in the cause of infantile cholestasis. We report a case of SOD concurrent with acquired cytomegalovirus (CMV) infection, who presented with prolonged jaundice as the first clinical sign. PATIENT CONCERNS The patient was a 2-month-old male infant who presented with cholestasis, combined with fever and panhypopituitarism. DIAGNOSES He was diagnosed with SOD and acquired CMV infection. INTERVENTIONS He was treated with hormone replacement therapy and ganciclovir. OUTCOMES After correction of the pituitary hormone deficiency and ganciclovir treatment, significant improvements of cholestasis, retinal lesions, and growth rate were seen in our patient. LESSONS Although an endocrine disorder such as panhypopituitarism is rare in the cause of neonatal or infantile cholestasis, we must keep this reason in mind.
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Affiliation(s)
- U Chan
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Wai-Tao Chan
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Wei-Hsin Ting
- Division of Endocrinology and Metabolism, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Che-Sheng Ho
- Division of Neurology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Hsi-Che Liu
- Division of Hematology-Oncology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
- MacKay Medical College, Taipei, Taiwan
| | - Hung-Chang Lee
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
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106
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Song YZ, Deng M. [Sodium taurocholate cotransporting polypeptide deficiency manifesting as cholestatic jaundice in early infancy: a complicated case study]. Zhongguo Dang Dai Er Ke Za Zhi 2017; 19:350-354. [PMID: 28302211 PMCID: PMC7390148 DOI: 10.7499/j.issn.1008-8830.2017.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/03/2017] [Indexed: 06/06/2023]
Abstract
Sodium taurocholate cotransporting polypeptide (NTCP) deficiency is caused by SLC10A1 mutations impairing the NTCP function to uptake plasma bile salts into the hepatocyte. Thus far, patients with NTCP deficiency were rarely reported. The patient in this paper was a 5-month-19-day male infant with the complaint of jaundiced skin and sclera for 5.5 months as well as abnormal liver function revealed over 4 months. His jaundice was noticed on the second day after birth, and remained visible till his age of 1 month and 13 days, when a liver function test unveiled markedly elevated total, direct and indirect bilirubin as well as total bile acids (TBA). Cholestatic liver disease was thus diagnosed. Due to unsatisfactory response to medical treatment, the patient underwent exploratory laparotomy, cholecystostomy and cholangiography when aged 2 months. This revealed inspissated bile but unobstructed bile ducts. Thereafter, his jaundice subsided, but the aminotransferases and TBA levels gradually rose. Of note, his mother also had mildly elevated plasma TBA. Since the etiology was unclear, no specific medication was introduced. The infant has been followed up over 2 years. The aminotransferases recovered gradually, but TBA levels fluctuated within 23.3-277.7 μmol/L (reference range: 0-10 μmol/L). On SLC10A1 genetic analysis at 2 years and 9 months, both the infant and his mother proved to be homozygous for a pathogenic variant c.800C>T(p.S267F), and NTCP deficiency was thus definitely diagnosed. The findings suggest that, although only mildly increased plasma TBA is presented in adults with NTCP deficiency, pediatric patients with this disorder exhibit persistent and remarkable hypercholanemia, and some patients might manifest as cholestatic jaundice in early infancy.
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Affiliation(s)
- Yuan-Zong Song
- Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China.
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107
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Hasimu A, Gu JP, Ji WZ, Zhang HX, Zhu DW, Ren WX. Comparative Study of Percutaneous Transhepatic Biliary Stent Placement with or without Iodine-125 Seeds for Treating Patients with Malignant Biliary Obstruction. J Vasc Interv Radiol 2017; 28:583-593. [PMID: 28162906 DOI: 10.1016/j.jvir.2016.11.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/03/2016] [Accepted: 11/11/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To prospectively evaluate safety and efficacy of biliary stent placement with iodine-125 (125I) seeds in patients with malignant obstructive jaundice (MOJ). MATERIALS AND METHODS From July 2011 to June 2014, 55 patients were enrolled (group A, 11 men and 17 women, mean age 70.93 y ± 8.58; group B, 14 men and 13 women, mean age 70.26 y ± 9.71). All patients were randomly assigned to placement of a biliary stent with 125I seeds (group A) or biliary stent only (group B). After stent placement, outcomes were measured regarding relief of MOJ. Clinical success rate, survival time, and safety were recorded. P < .05 was considered to indicate significant difference. RESULTS Stents were successfully placed in all 55 patients. MOJ was relieved in all patients, and there were no significant differences in complications related to stent insertion between the 2 groups. Mean and median stent patency were 191 days ± 19.8 (95% confidence interval [CI], 152-230 d) and 179 days ± 191.4 (95% CI, 87-267 d) in group A and 88.3 days ± 16.3 (95% CI, 61-114 d) and 77 days ± 88.2 (95% CI, 65-86 d) in group B (P < .001, log-rank test). Mean and median survival time were 222.6 days ± 21.0 (95% CI, 181-263 d) and 241 days ± 18.2 (95% CI, 179-270 d) in group A and 139.1 days ± 14.5 (95% CI, 110-167 d) and 142 days ± 16.3 (95% CI, 83-177 d) in group B (P < .001, log-rank test). CONCLUSIONS 125I seeds combined with biliary stent placement could significantly improve stent patency. The procedure seems to be safe and to extend survival compared with self-expandable biliary stent placement.
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Affiliation(s)
- Asihaer Hasimu
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China
| | - Jun-Peng Gu
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China
| | - Wei-Zheng Ji
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China
| | - Hai-Xiao Zhang
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China
| | - Di-Wen Zhu
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China
| | - Wei-Xin Ren
- Department of Radiology, The First Affiliated Hospital of XinJiang Medical University, Urumqi, XinJiang830054, China.
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108
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Abstract
Surgical treatment is not commonly recommended in the management of autoimmune pancreatitis. The article describes a dilemma in diagnostics and treatment of a 68-year old man with the mass in the head of the pancreas that mimicked pancreatic cancer and that was diagnosed as a type 1 autoimmune pancreatitis (IgG4-related pancreatitis) after a surgical resection. Diagnosis of the autoimmune pancreatitis is a real clinical challenge, as in the current diagnostic criteria exists some degree of overlap in the findings between autoimmune pancreatitis and pancreatic cancer (indicated by the similarity in radiologic findings, elevation of IgG4, sampling errors in pancreatic biopsy, and the possibility of synchronous autoimmune pancreatitis and pancreatic cancer). Despite the generally accepted corticosteroids as the primary treatment modality in autoimmune pancreatitis, we believe that surgical resection remains necessary in a specific subgroup of patients with autoimmune pancreatitis (Fig. 4, Ref. 37).
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109
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Yamabe A, Irisawa A, Shibukawa G, Sato A, Fujisawa M, Arakawa N, Yoshida Y, Igarashi R, Maki T, Yamamoto S, Ikeda T, Abe Y, Hoshi K. Inflammatory Bile Duct Obstruction during the Healing Stage of Severe Acute Pancreatitis. Intern Med 2017; 56:1037-1040. [PMID: 28458308 PMCID: PMC5478563 DOI: 10.2169/internalmedicine.56.7859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The patient was a 62-year-old woman with a history of severe acute pancreatitis complicated by walled-off necrosis (WON), who developed obstructive jaundice during the recovery phase from WON. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) revealed the complete obstruction of the distal bile duct, and endoscopic ultrasonography (EUS) revealed thickening of the duct wall, with a uniform distribution, and a relatively well-preserved layered structure. A cytopathological examination using ERCP showed no malignancy. The underlying etiology of this case may have been the formation of a cicatricial stricture during the resolution of WON, in addition to fibrosis caused by the spreading of inflammation from pancreatitis.
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Affiliation(s)
- Akane Yamabe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Ai Sato
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Mariko Fujisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Noriyuki Arakawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Yoshitsugu Yoshida
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Ryo Igarashi
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Takumi Maki
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Shogo Yamamoto
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Tsunehiko Ikeda
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Yoko Abe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Koki Hoshi
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
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110
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Jin H, Pang Q, Liu H, Li Z, Wang Y, Lu Y, Zhou L, Pan H, Huang W. Prognostic value of inflammation-based markers in patients with recurrent malignant obstructive jaundice treated by reimplantation of biliary metal stents: A retrospective observational study. Medicine (Baltimore) 2017; 96:e5895. [PMID: 28099348 PMCID: PMC5279093 DOI: 10.1097/md.0000000000005895] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We aimed to assess the therapeutic effect of reimplantation of biliary metal stents by percutaneous transhepatic cholangial drainage (PTCD) in patients with recurrent malignant obstructive jaundice (MOJ). Furthermore, we explored the prognostic value of inflammation-based markers in these patients.We reviewed 33 cases of recurrent MOJ after implantation of biliary metal stents by PTCD, all of which underwent reimplantation of stents under digital subtraction angiography guidance. Levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin were compared between before and after reimplantation (1 week, 1 month, and 3 months postoperatively). Preoperative clinical data were collected to calculate the inflammation-based markers, including systemic immune-inflammation index (SII, neutrophil × platelets/ lymphocyte), platelets-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR). The primary outcome was overall survival (OS), which was estimated by the Kaplan-Meier method and Cox regression analysis.The levels of ALT, AST, total bilirubin, and direct bilirubin significantly reduced after the reimplantation operation. During a median follow-up time of 10 months, 18 (54.5%) patients died. Gender, albumin, SII, PLR, NLR, and MLR were found to be associated with OS by the log-rank test and univariate analysis. Multivariate Cox analysis identified elevated levels of SII and PLR as significant factors for predicting poor OS.Reimplantation is clinically feasible in patients with recurrent MOJ after implantation of biliary metal stents. SII and PLR are independent, useful inflammation-based prognostic models for predicting outcomes in these patients.
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111
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Roy SK, Lambert A. Obstructive jaundice: a clinical review for the UK armed forces. J R Nav Med Serv 2017; 103:44-48. [PMID: 30088740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Obstructive jaundice is a clinical condition that indicates the possibility of a significant underlying disease process. This clinical review considers the pathophysiology, investigation and management of patients with obstructive jaundice and considers the particular challenges that medical personnel may face when deployed away from the United Kingdom (UK). It aims to give guidance with regard to the short- and long-term investigation and management of such patients.
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112
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Franceschet I, Zanetto A, Ferrarese A, Burra P, Senzolo M. Therapeutic approaches for portal biliopathy: A systematic review. World J Gastroenterol 2016; 22:9909-9920. [PMID: 28018098 PMCID: PMC5143758 DOI: 10.3748/wjg.v22.i45.9909] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/12/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
Portal biliopathy (PB) is defined as the presence of biliary abnormalities in patients with non-cirrhotic/non-neoplastic extrahepatic portal vein obstruction (EHPVO) and portal cavernoma (PC). The pathogenesis of PB is due to ab extrinseco compression of bile ducts by PC and/or to ischemic damage secondary to an altered biliary vascularization in EHPVO and PC. Although asymptomatic biliary abnormalities can be frequently seen by magnetic resonance cholangiopancreatography in patients with PC (77%-100%), only a part of these (5%-38%) are symptomatic. Clinical presentation includes jaundice, cholangitis, cholecystitis, abdominal pain, and cholelithiasis. In this subset of patients is required a specific treatment. Different therapeutic approaches aimed to diminish portal hypertension and treat biliary strictures are available. In order to decompress PC, surgical porto-systemic shunt or transjugular intrahepatic porto-systemic shunt can be performed, and treatment on the biliary stenosis includes endoscopic (Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy, balloon dilation, stone extraction, stent placement) and surgical (bilioenteric anastomosis, cholecystectomy) approaches. Definitive treatment of PB often requires multiple and combined interventions both on vascular and biliary system. Liver transplantation can be considered in patients with secondary biliary cirrhosis, recurrent cholangitis or unsuccessful control of portal hypertension.
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113
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Affiliation(s)
- Michael H Bourne
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Lynn A Fussner
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Eva M Carmona
- Advisor to Residents and Consultant in Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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114
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Yang M, Yan Z, Luo J, Liu Q, Zhang W, Ma J, Zhang Z, Yu T, Zhao Q, Liu L. A pilot study of intraluminal brachytherapy using 125I seed strand for locally advanced pancreatic ductal adenocarcinoma with obstructive jaundice. Brachytherapy 2016; 15:859-864. [PMID: 27364870 DOI: 10.1016/j.brachy.2016.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/21/2016] [Accepted: 05/23/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE To investigate the safety and feasibility of intraluminal brachytherapy using 125I seed strand for locally advanced pancreatic ductal adenocarcinoma with obstructive jaundice. METHODS AND MATERIALS From January 2010 to February 2015, 18 consecutive patients diagnosed with locally advanced, nonmetastatic, inoperable pancreatic ductal adenocarcinoma with obstructive jaundice were enrolled and underwent intraluminal brachytherapy using 125I seed strand. Dose calculation was performed using a software. The procedure-related and radiation complications were assessed. Obstruction-free survival and overall survival were calculated using the Kaplan-Meier method. RESULTS The technique successful rate of 125I seed strand implantation was 100%. Successful bile drainage was achieved in all patients. The estimated mean accumulating dose (R = 5 mm, z = 0, 240 days) was 167.2 Gy, from 164.19 to 170.05 Gy. Two patients had adverse event of Grade 3, one of Grade 4. Stent dysfunction occurred in 1/18 (5.6%) patients. The mean and median obstruction-free survival time were 10.61 months (95% confidence interval [CI]: 7.04, 14.18) and 7.26 months (95% CI: 2.14, 12.38). The mean and median overall survival time were 11.91 months (95% CI: 7.39, 16.43) and 7.26 months (95% CI: 2.14, 12.38). CONCLUSIONS Intraluminal brachytherapy using 125I seed strand may be consider as a safe treatment option for the therapy of locally advanced pancreatic duct adenocarcinoma complicated by obstructive jaundice with acceptable complication rates.
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Affiliation(s)
- MinJie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China
| | - ZhiPing Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China
| | - JianJun Luo
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China
| | - QingXin Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China
| | - JinQing Ma
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China
| | - ZiHan Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China
| | - TianZhu Yu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China
| | - Qian Zhao
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China
| | - LingXiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China.
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Song TJ, Lee JH, Lee SS, Jang JW, Kim JW, Ok TJ, Oh DW, Park DH, Seo DW, Lee SK, Kim MH, Kim SC, Kim CN, Yun SC. Metal versus plastic stents for drainage of malignant biliary obstruction before primary surgical resection. Gastrointest Endosc 2016; 84:814-821. [PMID: 27109456 DOI: 10.1016/j.gie.2016.04.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 04/07/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Preoperative biliary drainage (PBD) with stent placement has been commonly used for patients with malignant biliary obstruction. In PBD, the placement of fully covered self-expandable metal stents (FCSEMSs) may provide better patency duration and a lower incidence of cholangitis compared with plastic stents. We aimed to evaluate which type of stent showed better outcomes in PBD. METHODS In this multicenter, prospective randomized trial, we compared PBD with FCSEMSs versus plastic stents in 86 patients with malignant biliary obstruction between January 2012 and December 2014. Patients with obstructive jaundice were randomly assigned to undergo PBD either with plastic stents or FCSEMS placement. RESULTS Baseline characteristics were not significantly different between the 2 groups. Endoscopic stent placement was technically successful in all patients. Procedure-related adverse events were not significantly different between the 2 groups (plastic vs FCSEMS group; 16.3% vs 16.3%, P = 1.0). Reintervention was required in 16.3% of the plastic stent group and 14.0% of the FCSEMS group (P = .763). The interval to surgery after PBD (plastic vs FCSEMS group; 14.2 ± 8.3 vs 12.3 ± 6.9 days, P = .426) was not significantly different between groups. Surgery-related adverse events occurred in 43.6% of the plastic stent group and 40.0% of the FCSEMS group (P = .755). CONCLUSIONS In patients with resectable malignant biliary obstruction, the outcomes of PBD with plastic stents and FCSEMSs were similar. Considering the cost-effectiveness, PBD with plastic stents may be preferable to FCSEMS placement. (Clinical trial registration number: NCT01789502.).
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Affiliation(s)
- Tae Jun Song
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Hoon Lee
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Soo Lee
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Woong Jang
- Department of Internal Medicine, Eulgi University College of Medicine, Daejeon, Korea
| | - Jung Wook Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Tae Jin Ok
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Wook Oh
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Do Hyun Park
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Wan Seo
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung Koo Lee
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Myung-Hwan Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Song Cheol Kim
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chul Nam Kim
- Department of Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sung Cheol Yun
- Department of Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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116
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Hirose Y, Sakata J, Soma D, Katada T, Ishikawa H, Miura K, Ohashi T, Takizawa K, Takano K, Kobayashi T, Kameyama H, Wakai T. [Resection for a Locally Advanced Duodenal Adenocarcinoma with Obstructive Jaundice and Hepatic and Pancreatic Invasion - A Case Report]. Gan To Kagaku Ryoho 2016; 43:2077-2079. [PMID: 28133227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 64-year-old woman diagnosed with duodenal adenocarcinoma with duodenal stenosis and obstructive jaundice was referred to our hospital. Computed tomography revealed a tumor measuring 9×6 cm in the second portion of the duodenum that had invaded the liver(S6)and head of the pancreas. After percutaneous transhepatic biliary drainage for obstructive jaundice, the patient underwent subtotal stomach-preserving pancreaticoduodenectomy, partial resection of the liver(S6), and partial resection of the colon. Histologic examination showed the primary tumor to be moderately and poorly differentiated adenocarcinoma with hepatic and pancreatic invasion; lymph node metastasis was not found. The patient received S-1 for 1 year and remains alive and well with no evidence of disease 15 months after resection.
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Affiliation(s)
- Yuki Hirose
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
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117
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Muto M, Kimura T, Sato N, Watanabe J, Endo K, Marubashi S, Kenjo A, Gotoh M. [A Case of Axillary Lymph Node Metastases from Distal Bile Duct Cancer]. Gan To Kagaku Ryoho 2016; 43:2410-2412. [PMID: 28133338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 67-year-old man suffered from obstructive jaundice due to distal bile duct cancer. He underwent surgery after percutaneous biliary drainage and did not received adjuvant chemotherapy afterwards. Two years after surgery, some subcutaneous nodules were detected in the left axilla and the lateral chest on enhanced CT imaging. The nodules were diagnosed as metachronous distant metastases from bile duct cancer based on pathological findings. He was treated postoperatively with S-1 and new lesions have not been detected during the 3 months after the surgery. Surgical intervention in combination with chemotherapy might be beneficial in selected patients with recurrent bile duct cancer.
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Affiliation(s)
- Makoto Muto
- Dept. of Regenerative Surgery, Fukushima Medical University
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118
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Kurniawan J, Hasan I, Gani RA, Simadibrata M. Mortality-related Factors in Patients with Malignant Obstructive Jaundice. Acta Med Indones 2016; 48:282-288. [PMID: 28143989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM to obtain survival rate and mortality-related factors of malignant obstructive jaundice patients. METHODS all medical records of obstructive jaundice inpatient at Cipto Mangunkusumo Hospital, Jakarta from January 2010 to December 2013 were reviewed retrospectively. The following factors were analyzed in terms of mortality: age, gender, sepsis, hypoalbumin, serum bilirubin level, serum CA 19-9 level, billiary drainage, non-ampulla Vateri carcinoma, and comorbid factors. RESULTS total 181 out of 402 patients were enrolled in this study with male proportion was 58.6%, and patients aged 50 years or above was 57.5%. Multivariate analysis showed that only sepsis, unsuccessful or no prior biliary drainage and Charlson comorbid score ≥4 were independent predictors of mortality. Patients with significant prognostic factors had median survival 14 days compared with overall median survival 26 days. Score ≥2 identified as the highest prognostic score threshold with sensitivity 68%, specificity 75%, and AUC on ROC curve 0.769. CONCLUSION sepsis, unsuccessful or no prior bilirary drainage, and Charlson comorbid score ≥4 are factors significantly associated with shortened survival in malignant obstructive jaundice patients. Prognostic score ≥2 was determined to classify patients into high risk mortality group. Mortality of patients with those significant prognostic factors can be predicted in 76.9%.
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Affiliation(s)
- Juferdy Kurniawan
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
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119
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Farrukh SZUI, Siddiqui AR, Haqqi SA, Muhammad AJ, Dheddi AS, Khalid SK. Comparison Of Ultrasound Evaluation Of Patients Of Obstructive Jaundice With Endoscopic Retrograde Cholangio-Pancreatography Findings. J Ayub Med Coll Abbottabad 2016; 28:650-652. [PMID: 28586609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Ultrasonography has proven to be quite effective in differentiating hepatocellular from obstructive cause of jaundice in various studies. This study was conducted with the aim to determine the efficacy of ultrasonography and Endoscopic Retrograde Cholangio-Pancreatography (ERCP) in the diagnosis of obstructive reason of jaundice. METHODS In this descriptive case series, 200 patients with >15 years age of either gender with cholestatic liver enzymes were included, i.e., those patients who had an ultrasound prior to ERCP at the department of gastroenterology of Patel Hospital, Karachi. Patients known to have liver disease with cholestatic jaundice had imaging other than ultrasound were excluded. The results of ultrasonography and ERCPs were compared in particularly looking for the cause of obstruction. RESULTS Out of total 200 patients, mean age was 41.22±12.46 years with 107 (53.5%) females. Ability of ultrasound in correctly diagnosing obstructive reason for stone CBD was found to be 72.5%, dilated CBD without reason 41.7%, proximal obstruction, 63.15%, distal CBD obstruction 60%, and sludge 66.7%. Overall ability of ultrasound in correctly diagnosing the cause of obstruction was 64.17%. CONCLUSIONS Ultrasound is recommended as the initial examination, which provides a guide to choose patients for either a more advanced noninvasive imaging like MRCP or to an invasive procedure like ERCP.
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Affiliation(s)
| | | | - Syed Afzal Haqqi
- Department of Gastroenterology and Hepatology Patel Hospital Karachi, Pakistan
| | - Asif Jan Muhammad
- Department of Gastroenterology and Hepatology Patel Hospital Karachi, Pakistan
| | - Abdul Samad Dheddi
- Department of Gastroenterology and Hepatology Patel Hospital Karachi, Pakistan
| | - Saad Khalid Khalid
- Department of Gastroenterology and Hepatology Patel Hospital Karachi, Pakistan
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120
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Dronov AI, Zemskov SV, Kryuchina EA. [Not Available]. Klin Khir 2016:26-30. [PMID: 30479109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Lethality, morbidity, survival indices and metabolic consequences of total pancreatec' tomy (TP), performed in patients, suffering pancreatic tumors, were analyzed. There were retrospectively analyzed 35 TP оperations, including 5— urgent, 30 — elective, performed in a single center. General lethality have constituted 20% (7 patients died), and after elective ТP — 6.7% (2 died). Complications rate after elective TP have consti' tuted 40%; survival mediana—18 mo; indices of a 3—year survival — 40%, and a 5— year one — 13.3%. Most frequently revealed metabolic changes after ТP — pancreatic exocrine insufficiency, pancreatogenic diabetes, changes in a lipid metabolism in hepatocytes. Our experience witnesses expediency of ТP introduction into surgical practice in specialized centers of Ukraine with results, which are matching a worldwide.
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MESH Headings
- Adenocarcinoma, Mucinous/metabolism
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/surgery
- Adenocarcinoma, Papillary/metabolism
- Adenocarcinoma, Papillary/mortality
- Adenocarcinoma, Papillary/pathology
- Adenocarcinoma, Papillary/surgery
- Aged
- Complex Regional Pain Syndromes/diagnosis
- Complex Regional Pain Syndromes/etiology
- Complex Regional Pain Syndromes/mortality
- Complex Regional Pain Syndromes/pathology
- Exocrine Pancreatic Insufficiency/diagnosis
- Exocrine Pancreatic Insufficiency/etiology
- Exocrine Pancreatic Insufficiency/mortality
- Exocrine Pancreatic Insufficiency/pathology
- Female
- Humans
- Jaundice, Obstructive/diagnosis
- Jaundice, Obstructive/etiology
- Jaundice, Obstructive/mortality
- Jaundice, Obstructive/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Pancreas/metabolism
- Pancreas/pathology
- Pancreas/surgery
- Pancreatectomy/methods
- Pancreatic Neoplasms/metabolism
- Pancreatic Neoplasms/mortality
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/surgery
- Postoperative Complications/diagnosis
- Postoperative Complications/mortality
- Postoperative Complications/pathology
- Quality of Life
- Retrospective Studies
- Survival Analysis
- Ukraine
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121
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Ramírez-Guillén F, Rosas-Carrasco O, Cajuste-Sequeira F, Barriga-Pérez Gil B, Cabanillas-Morel A, Rosales-Salinas AE, Peña-Pérez JA. [Jaundice secondary to bile duct obstruction by polycystic liver disease]. GAC MED MEX 2016; 152:715-718. [PMID: 27792710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Polycystic liver disease is an autosomal dominant disorder commonly associated with autosomal dominant polycystic kidney disease. It is a rare disease that usually occurs asymptomatically in 85% of cases and diagnosis is incidentally. We present the case of 57 years old woman with progressive pruritus and jaundice secondary to stenosis of the common hepatic duct and common bile by liver cyst, rare presentation which only has been documented in case reports: Deepak, et al., Wittig, et al. and Howard, et al.1-3.
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Affiliation(s)
| | - Oscar Rosas-Carrasco
- Hospital Ángeles Mocel, Ciudad de México, México
- Instituto Nacional de Geriatría, Ciudad de México, México
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122
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Moole H, Bechtold M, Puli SR. Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review. World J Surg Oncol 2016; 14:182. [PMID: 27400651 PMCID: PMC4940848 DOI: 10.1186/s12957-016-0933-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/28/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In patients requiring surgical resection for malignant biliary jaundice, it is unclear if preoperative biliary drainage (PBD) would improve mortality and morbidity by restoration of biliary flow prior to operation. This is a meta-analysis to pool the evidence and assess the utility of PBD in patients with malignant obstructive jaundice. The primary outcome is comparing mortality outcomes in patients with malignant obstructive jaundice undergoing direct surgery (DS) versus PBD. The secondary outcomes include major adverse events and length of hospital stay in both the groups. METHODS Studies using PBD in patients with malignant obstructive jaundice were included in this study. For the data collection and extraction, articles were searched in MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, etc. Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian-Laird method (random effects model). RESULTS Initial search identified 2230 reference articles, of which 204 were selected and reviewed. Twenty-six studies (N = 3532) for PBD in malignant obstructive jaundice which met the inclusion criteria were included in this analysis. The odds ratio for mortality in PBD group versus DS group was 0.96 (95 % CI = 0.71 to 1.29). Pooled number of major adverse effects was lower in the PBD group at 10.40 (95 % CI = 9.96 to 10.83) compared to 15.56 (95 % CI = 15.06 to 16.05) in the DS group. Subgroup analysis comparing internal PBD to DS group showed lower odds for major adverse events (odds ratio, 0.48 with 95 % CI = 0.32 to 0.74). CONCLUSIONS In patients with malignant biliary jaundice requiring surgery, PBD group had significantly less major adverse effects than DS group. Length of hospital stay and mortality rate were comparable in both the groups.
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Affiliation(s)
- Harsha Moole
- Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
- Department of Medicine, University of Illinois College of Medicine Peoria, 530 NE Glen Oak Ave, Peoria, IL, 61637, USA.
| | - Matthew Bechtold
- Department of Gastroenterology and Hepatology, University of Missouri, Columbia, MO, USA
| | - Srinivas R Puli
- Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
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123
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Li M, Li K, Qi X, Wu W, Zheng L, He C, Yin Z, Fan D, Zhang Z, Han G. Percutaneous Transhepatic Biliary Stent Implantation for Obstructive Jaundice of Perihilar Cholangiocarcinoma: A Prospective Study on Predictors of Stent Patency and Survival in 92 Patients. J Vasc Interv Radiol 2016; 27:1047-1055.e2. [PMID: 27241392 DOI: 10.1016/j.jvir.2016.02.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/12/2016] [Accepted: 02/28/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate prognostic factors for stent patency and survival in patients with perihilar cholangiocarcinoma (pCCA) who underwent percutaneous biliary stent placement. MATERIALS AND METHODS This prospective study followed 92 consecutive patients with pCCA who underwent metal stent placement between January 2013 and July 2014. Of the total number of patients, 11 had ascites, and 36 had biliary obstruction for > 1 month at the time of stent placement. Cumulative patency and survival rates were assessed with Kaplan-Meier curves, and independent predictors were calculated with Cox regression. A new formula was developed to predict patient survival. RESULTS Tumor size was significantly associated with stent patency (hazard ratio = 2.425; 95% confidence interval, 1.134-5.168). Independent predictors of survival included lymph node metastasis, intrahepatic mass lesion, cancer antigen 19-9 (CA19-9), ascites, and duration of jaundice. A new equation was developed to assess risk: R = 7 × (duration of biliary obstruction-0 if < 30 d, 1 if > 30 d) + 7 × (CA19-9-0 if < 500, 1 if > 500) + 7 × (ascites-0 if none present, 1 if ascites present) + 10 × (lymph node metastasis-0 if no metastasis, 1 if metastasis present) + 9 (intrahepatic mass lesion-0 if absent, 1 if present). Among patients who developed stent occlusion, patients who underwent recanalization of the occluded stent had longer survival compared with patients who did not undergo recanalization (109 d vs 29 d, P = .001). CONCLUSIONS Prognostic factors for survival after percutaneous stent placement in patients with pCCA were tumor stage, duration of jaundice, CA19-9, and ascites. Tumor size affected stent patency. Prognosis for patients with reintervention after occlusion of the stent improved.
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Affiliation(s)
- Mingwu Li
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China
| | - Kai Li
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China
| | - Xingshun Qi
- State Key Laboratory of Cancer Biology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China
| | - Wenbin Wu
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China
| | - Luanluan Zheng
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China
| | - Chuangye He
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China
| | - Zhanxin Yin
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China
| | - Daiming Fan
- State Key Laboratory of Cancer Biology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China
| | - Zhuoli Zhang
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Guohong Han
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Chang le Road, Xi'an 710032, China.
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124
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Gallego Otaegui L, Sainz Lete A, Gutiérrez Ríos RD, Alkorta Zuloaga M, Arteaga Martín X, Jiménez Agüero R, Medrano Gómez MÁ, Ruiz Montesinos I, Beguiristain Gómez A. Obstructive jaundice caused by a pancreaticoduodenal pseudoaneurysm. Rev Esp Enferm Dig 2016; 108:366-367. [PMID: 27324520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Obstructive jaundice caused by a pancreaticoduodenal pseudoaneurysm, probably related to a chronic pancreatitis.
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Affiliation(s)
| | - Aitor Sainz Lete
- Cirugía Hepatobiliopancreática, Hospital Universitario de Donostia, ESPAÑA
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125
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Abstract
Systemic IgG4 disease can have a wide spectrum of clinical presentation, which can mimic several other disease entities. In this report, we describe a series of two patients with IgG4-related disease who were referred to us initially with the diagnosis of acute cholecystitis and the second patient with metastatic pancreatic adenocarcinoma with peritoneal metastasis respectively.
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Affiliation(s)
- Divya Yadav
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Xiuli Liu
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, United States
| | - Prabhleen Chahal
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States.
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126
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Seth A, Palmer TR, Campbell J. Obstructive Jaundice from Metastatic Squamous Cell Carcinoma of the Lung. J La State Med Soc 2016; 168:107-109. [PMID: 27389381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Obstructive jaundice from metastatic lung cancer is extremely rare. Most reported cases have had small cell cancer of lung or adenocarcinoma of lung as primary malignancy metastasizing to the biliary system. We report the case of a patient presenting with symptoms of obstructive jaundice found to have metastatic involvement of hepatobiliary system from squamous cell cancer (SCC) of lung. ERCP (endoscopic retrograde cholangiopancreatography) with biliary stenting is the procedure of choice in such patients. Our case is made unique by the fact that technical difficulties made it difficult for the anesthesiologists to intubate the patient for an ERCP. As a result percutaneous transhepatic cholangiogram (PTC) with internal-external biliary drainage was performed.
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Affiliation(s)
- Abhishek Seth
- Department of Gastroenterology and Hepatology, Overton Brooks VA Hospital, LSUHSC, Shreveport, LA
| | - Thomas R Palmer
- Department of Gastroenterology and Hepatology, Overton Brooks VA Hospital, LSUHSC, Shreveport, LA
| | - Jason Campbell
- Department of Interventional Radiology, CHRISTUS Highland Medical Center, Shreveport, LA
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127
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Sasahira N, Hamada T, Togawa O, Yamamoto R, Iwai T, Tamada K, Kawaguchi Y, Shimura K, Koike T, Yoshida Y, Sugimori K, Ryozawa S, Kakimoto T, Nishikawa K, Kitamura K, Imamura T, Mizuide M, Toda N, Maetani I, Sakai Y, Itoi T, Nagahama M, Nakai Y, Isayama H. Multicenter study of endoscopic preoperative biliary drainage for malignant distal biliary obstruction. World J Gastroenterol 2016; 22:3793-3802. [PMID: 27076764 PMCID: PMC4814742 DOI: 10.3748/wjg.v22.i14.3793] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/03/2016] [Accepted: 01/30/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the optimal method of endoscopic preoperative biliary drainage for malignant distal biliary obstruction.
METHODS: Multicenter retrospective study was conducted in patients who underwent plastic stent (PS) or nasobiliary catheter (NBC) placement for resectable malignant distal biliary obstruction followed by surgery between January 2010 and March 2012. Procedure-related adverse events, stent/catheter dysfunction (occlusion or migration of PS/NBC, development of cholangitis, or other conditions that required repeat endoscopic biliary intervention), and jaundice resolution (bilirubin level < 3.0 mg/dL) were evaluated. Cumulative incidence of jaundice resolution and dysfunction of PS/NBC were estimated using competing risk analysis. Patient characteristics and preoperative biliary drainage were also evaluated for association with the time to jaundice resolution and PS/NBC dysfunction using competing risk regression analysis.
RESULTS: In total, 419 patients were included in the study (PS, 253 and NBC, 166). Primary cancers included pancreatic cancer in 194 patients (46%), bile duct cancer in 172 (41%), gallbladder cancer in three (1%), and ampullary cancer in 50 (12%). The median serum total bilirubin was 7.8 mg/dL and 324 patients (77%) had ≥ 3.0 mg/dL. During the median time to surgery of 29 d [interquartile range (IQR), 30-39 d]. PS/NBC dysfunction rate was 35% for PS and 18% for NBC [Subdistribution hazard ratio (SHR) = 4.76; 95%CI: 2.44-10.0, P < 0.001]; the pig-tailed tip was a risk factor for PS dysfunction. Jaundice resolution was achieved in 85% of patients and did not depend on the drainage method (PS or NBC).
CONCLUSION: PS has insufficient patency for preoperative biliary drainage. Given the drawbacks of external drainage via NBC, an alternative method of internal drainage should be explored.
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128
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Cañete-Ruiz A, Nuñez-Gomez L, Moreira Vicente V, Cuño Roldán JL, Zaera de la Fuente C, Sierra Morales M. Significantly elevated CA 19-9 levels in a patient with choledocholithiasis. Gastroenterol Hepatol 2016; 40:300-302. [PMID: 27056254 DOI: 10.1016/j.gastrohep.2016.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Angel Cañete-Ruiz
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - Laura Nuñez-Gomez
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Victor Moreira Vicente
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Jose Luis Cuño Roldán
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Celia Zaera de la Fuente
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - María Sierra Morales
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, España
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129
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Koncoro H, Putra IKWD, Wibawa IDN. Obstructive Jaundice as a Complication of Macrocystic Serous Cystadenoma of the Pancreas. Acta Med Indones 2016; 48:129-133. [PMID: 27550882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Macrocystic serous cystadenoma is an unusual and essentially benign pancreatic tumor. Herein, we report on a 40-year-old woman diagnosed with macrocystic serous cystadenoma who presented with obstructive jaundice. A cystic lesion in the head and body of the pancreas was revealed by abdominal computed tomography. Intraoperative pancreatic cyst aspiration ruled out mucinous cystic neoplasm which has a malignant potential. The pancreatic cyst fluid cytology was basophilic amorph materials concluded as benign cystic lesion. Internal drainage was performed instead of pancreatic resection which showed good outcome. Biliary obstruction is a rare complication of serous cystadenoma. This case describes an unusual clinical presentation of macrocystic serous cystadenoma.
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Affiliation(s)
- Hendra Koncoro
- Department of Internal Medicine, Faculty of Medicine, University of Udayana - Sanglah Hospital, Denpasar, Bali, Indonesia
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130
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Cardoso BA, Leal R, Sá H, Campos M. Acute liver failure due to primary amyloidosis in a nephrotic syndrome: a swiftly progressive course. BMJ Case Rep 2016; 2016:bcr2016214392. [PMID: 26965175 PMCID: PMC4785491 DOI: 10.1136/bcr-2016-214392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 11/04/2022] Open
Abstract
AL amyloidosis is a clonal plasma cell proliferative disorder characterised by extracellular tissue deposits of insoluble fibrils derived from κ or λ immunoglobulin light chains. The most common organs affected by AL amyloidosis are the kidney, presenting with nephrotic syndrome and/or progressive renal dysfunction, and the heart, with restrictive cardiomyopathy. Hepatic deposition of fibrils occurs in half the cases but the liver is rarely the predominantly affected organ. The most common presentation of hepatic amyloidosis is hepatomegaly with elevated alkaline phosphatase. Acute liver failure with cholestasis and jaundice is a rare complication, with a prevalence of approximately 5%, and is usually associated with a worse prognosis. We report a case of a 39-year-old man admitted to our nephrology department with an unusual presentation of primary amyloidosis with nephrotic syndrome and acute liver failure, complicated by obstructive cholestasis resulting in death 2 months after diagnosis.
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Affiliation(s)
| | - Rita Leal
- Department of Nephrology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Helena Sá
- Department of Nephrology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Mário Campos
- Department of Nephrology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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131
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Takatori Y, Kato M, Sakaguchi E, Banno S, Abe K, Takada Y, Hirata T, Wada M, Kinoshita S, Takabayashi K, Kikuchi M, Kikuchi M, Fujiyama Y, Uraoka T. A case of extramedullary involvement of acute monocytic leukemia that presented as obstructive jaundice. Gastrointest Endosc 2016; 83:666-7; discussion 667. [PMID: 26422978 DOI: 10.1016/j.gie.2015.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/21/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Yusaku Takatori
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Motohiko Kato
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Emi Sakaguchi
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Shigeo Banno
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Keichiro Abe
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yoshiaki Takada
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Tetsu Hirata
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Michiko Wada
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Satoshi Kinoshita
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Kaoru Takabayashi
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Miho Kikuchi
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Masahiro Kikuchi
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yoichi Fujiyama
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Toshio Uraoka
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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132
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Koh YX, Lee SY, Chok AY, Chung AY. Icteric Intraductal Hepatocellular Carcinoma and Bile Duct Thrombus Masquerading as Hilar Cholangiocarcinoma. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2016; 45:113-116. [PMID: 27146465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Ye Xin Koh
- Department of General Surgery, Singapore General Hospital, Singapore
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133
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Sipliviy VA, Yevtushenko DV, Naumova OV, Andreyeshchev SA, Yevtushenko AV. [MORPHOLOGICAL CHANGES OF THE LIVER IN OBTURATION JAUNDICE, CAUSED BY CHOLEDOCHOLITHIASIS, DEPENDING ON ITS DURATION]. Klin Khir 2016:20-23. [PMID: 27244912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Abstract The results of surgical treatment of 184 patients for obturation jaundice, caused by choledocholithiasis, were analyzed. Morphological changes of the liver were studied in 20 patients. There were three groups of patients delineated, depending on the obturation jaundice duration: up to 7 days, from 8 to 14 days, more than 15 days, and also a group of patients after the bile outflow restoration. The obturation jaundice occurrence in choledocholithiasis is accompanied by significant morphological changes in the liver, severity of which is enhancing while the obturation jaundice persistence increasing. While persistence of obturation jaundice through 8 days and more the connective tissue volume is enhancing, a relative volume of hepatocytes is reducing and a stromal-parenchymatous index is increasing. The bile outflow restoration secures significant reduction of intensity of alterative and inflammatory changes in hepatic parenchyma, as well as activation of reparative processes in the tissue. In cholangitis, caused by P. aeruginosa and E. coli, according to morphological investigations data, in the liver a diffuse purulent cholangitis on background of chronic changes in accordance to duration of the obturation jaundice persists.
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134
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Yurchenko VV. [Acute cholangitis in interstenosis space accompanied by two-component unit of the main bile duct]. Voen Med Zh 2016; 337:31-35. [PMID: 27263209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Palliative treatment of obstructive jaundice with the help of biliary endoprosthesis due to the possible complication of post-intervention in the form of insolvency stent deformation or dislocation. The study features in the postoperative period of the main bile duct endoprosthesis about their two-component unit, described the syndrome of the closed space of the bile ducts. On the basis of observation of 14 patients with the given anatomical feature of endoscopic, who were underwent stenting, was assessed frequency of the syndrome and possibilities of its prevention. Interstenosis space expansion of the main bile duct can be a reason for local cholangitis. For the prevention of cholangitis, it should be carried out a separate drainage of interstenosis space with the help of endoprosthesis or by proximal supra-stenotic extension of two or more stents.
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135
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Abstract
When cholestasis occurs in patients receiving total parenteral nutrition, it is the result of many pathogenic pathways converging on the hepatic acinus. The result may be a temporary rise in liver function tests. The resulting fibrosis, portal hypertension, and jaundice are hallmarks of type 3 intestinal-associated liver disease to which children are more susceptible than adults. The key to prevention is in identifying high-risk scenarios, meticulous monitoring, and personalized prescription of parenteral nutrition solutions combined with an active approach in reducing the impact of inflammatory events when they occur by prompt use of antibiotics and line locks.
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Affiliation(s)
- Sue V Beath
- The Liver Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, West Midlands, B4 6NH, UK.
| | - Deirdre A Kelly
- The Liver Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, West Midlands, B4 6NH, UK
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136
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Ferri MJ, Saez M, Figueras J, Fort E, Sabat M, López-Ben S, de Llorens R, Aleixandre RN, Peracaula R. Improved Pancreatic Adenocarcinoma Diagnosis in Jaundiced and Non-Jaundiced Pancreatic Adenocarcinoma Patients through the Combination of Routine Clinical Markers Associated to Pancreatic Adenocarcinoma Pathophysiology. PLoS One 2016; 11:e0147214. [PMID: 26808421 PMCID: PMC4726554 DOI: 10.1371/journal.pone.0147214] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 12/30/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is still no reliable biomarker for the diagnosis of pancreatic adenocarcinoma. Carbohydrate antigen 19-9 (CA 19-9) is a tumor marker only recommended for pancreatic adenocarcinoma follow-up. One of the clinical problems lies in distinguishing between this cancer and other benign pancreatic diseases such as chronic pancreatitis. In this study we will assess the value of panels of serum molecules related to pancreatic cancer physiopathology to determine whether alone or in combination could help to discriminate between these two pathologies. METHODS CA 19-9, carcinoembryonic antigen (CEA), C-reactive protein, albumin, insulin growth factor-1 (IGF-1) and IGF binding protein-3 were measured using routine clinical analyzers in a cohort of 47 pancreatic adenocarcinoma, 20 chronic pancreatitis and 15 healthy controls. RESULTS The combination of CA 19-9, IGF-1 and albumin resulted in a combined area under the curve (AUC) of 0.959 with 93.6% sensitivity and 95% specificity, much higher than CA 19-9 alone. An algorithm was defined to classify the patients as chronic pancreatitis or pancreatic cancer with the above specificity and sensitivity. In an independent validation group of 20 pancreatic adenocarcinoma and 13 chronic pancreatitis patients, the combination of the four molecules classified correctly all pancreatic adenocarcinoma and 12 out of 13 chronic pancreatitis patients. CONCLUSIONS Although this panel of markers should be validated in larger cohorts, the high sensitivity and specificity values and the convenience to measure these parameters in clinical laboratories shows great promise for improving pancreatic adenocarcinoma diagnosis.
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MESH Headings
- Aged
- Area Under Curve
- Bilirubin/blood
- Biomarkers, Tumor/blood
- C-Reactive Protein/analysis
- CA-19-9 Antigen/blood
- Carcinoembryonic Antigen/blood
- Carcinoma, Pancreatic Ductal/blood
- Carcinoma, Pancreatic Ductal/complications
- Carcinoma, Pancreatic Ductal/diagnosis
- Carcinoma, Pancreatic Ductal/physiopathology
- Diagnosis, Differential
- Diagnostic Tests, Routine
- Female
- Humans
- Insulin-Like Growth Factor Binding Protein 3/blood
- Insulin-Like Growth Factor I/analysis
- Jaundice, Obstructive/etiology
- Jaundice, Obstructive/physiopathology
- Male
- Middle Aged
- Pancreatic Neoplasms/blood
- Pancreatic Neoplasms/complications
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/physiopathology
- Pancreatitis, Chronic/blood
- Pancreatitis, Chronic/diagnosis
- ROC Curve
- Sensitivity and Specificity
- Serum Albumin/analysis
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Affiliation(s)
- María José Ferri
- Clinic Laboratory, Dr. Josep Trueta University Hospital, Girona, Spain
- Department of Biology, University of Girona, Girona, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Girona, Spain
| | - Joan Figueras
- Hepato-biliary and Pancreatic Surgery Unit, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Esther Fort
- Gastroenterology Unit, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Miriam Sabat
- Gastroenterology Unit, Hospital Santa Caterina, Salt, Girona, Spain
| | - Santiago López-Ben
- Hepato-biliary and Pancreatic Surgery Unit, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | | | | | - Rosa Peracaula
- Department of Biology, University of Girona, Girona, Spain
- * E-mail:
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137
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Gadzhiev DN, Tagiev EG, Gadzhiev ND. DIRECTED CYTOKINE THERAPY IN COMPLEX TREATMENT OF PATIENTS WITH OBSTRUCTIVE JAUNDICE OF CHOLELITHIC GENESIS. Vestn Khir Im I I Grek 2016; 175:67-70. [PMID: 30457275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The article analyzed the results of surgical treatment of 137 patients with obstructive jaundice of benign genesis. An immune status was studied in serum in dynamics before surgery. The rates of CD3, CD4, CD8, CD19, Ig A, M, G were determined on the first, third, seventh and fourteenth days after operation. The levels of TNFα, IFNγ, IL-2, IL-6, IL-4, IL-10 were investigated in serum and at the same time TNFα, IL-4, IL-6 were noted in the bile duct and IL-6 - in urine. Obstructive jaundice of cholelithiс genesis is characterized by disbalance of immune and cytokine status. The depth of disbalance depends on the degree of hepatic dysfunction and presence of purulent cholangitis. The directed cytokine therapy by ronkoleykin influenced positively on elimination of disbalance in immune and cytokine status and this therapy improved results of surgery in postoperative period.
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138
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Carmona YF, Tyberg A, Zerbo S, Sharaiha R, Kahaleh M. Transgastric biliary brushing: a novel endoscopic technique. Gastrointest Endosc 2016; 83:257-8. [PMID: 26324385 DOI: 10.1016/j.gie.2015.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/12/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Yamel Flores Carmona
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Amy Tyberg
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Steven Zerbo
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Reem Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, New York, USA
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139
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Il’Kanich AY, Darvin VV, Klimova NV, Vardanyan TS. DIAGNOSTICS AND TREATMENT OF OBSTRUCTIVE JAUNDICE AT CHRONIC OPISTHORCHIASIS. Vestn Khir Im I I Grek 2016; 175:17-21. [PMID: 30427642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A comparative analysis of possibilities of visual methods of diagnostics was made in order to reveal the causes of obstructive jaundice in chronic opisthorchiasis. There was estimated the possibility of topical diagnostics of rate and character of the bile passages block while conducting MR-imaging cholangiography. Types of architectonics of the bile passages were specified in chronic opisthorchiasis. A differentiated algorithm of treatment was developed and applied in relation to the obtained data.
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140
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Jijón Crespín R, Ortiz Sánchez ML, Vargas Acosta A, Antonio Pons J, Navarro Noguera E, Estrella Diez E, Sánchez Velasco E, Carrilero Zaragoza G, Pereñíguez López A, Muñoz M, Antón G, Fernando Carballo L. [Portal hypertension and cholestatic jaundice as a form of presentation of systemic amyloidosis]. Gastroenterol Hepatol 2016; 39:22-23. [PMID: 25958123 DOI: 10.1016/j.gastrohep.2015.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 02/21/2015] [Accepted: 02/23/2015] [Indexed: 06/04/2023]
Affiliation(s)
| | | | - Angel Vargas Acosta
- Servicio de Aparato Digestivo, Hospital Virgen de la Arrixaca, Murcia, España
| | - Jose Antonio Pons
- Servicio de Aparato Digestivo, Hospital Virgen de la Arrixaca, Murcia, España
| | | | | | | | | | | | - María Muñoz
- Servicio de Aparato Digestivo, Hospital Virgen de la Arrixaca, Murcia, España
| | - Gonzalo Antón
- Servicio de Aparato Digestivo, Hospital Virgen de la Arrixaca, Murcia, España
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141
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Abstract
This report describes two cases with obstructive jaundice caused by poorly differentiated gastric adenocarcinoma. Computed tomography scans showed circumferential stenosis in the hilar bile ducts. Endoscopic retrograde cholangiopancreatography showed dilatation of the bilateral hepatic ducts and stenosis of the common hepatic ducts from the bifurcation of the bilateral hepatic ducts. The first diagnoses were hilar cholangiocarcinoma and biliary drainage decreased serum bilirubin; however, both patients died of cancer within a short period of time. Autopsies revealed lymphatic vessel invasion and possible subepithelial invasion by gastric adenocarcinoma into the hilar bile ducts. A differential diagnosis should thus be required in suspected cases of hilar cholangiocarcinoma.
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142
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Abstract
The majority of gallstone patients remain asymptomatic; however, interest toward the gallstone disease is continuing because of the high worldwide prevalence and management costs and the development of gallstone symptoms and complications. For cholesterol gallstone disease, moreover, a strong link exists between this disease and highly prevalent metabolic disorders such as obesity, dyslipidemia, type 2 diabetes, hyperinsulinemia, hypertriglyceridemia and the metabolic syndrome. Information on the natural history as well as the diagnostic, surgical (mainly laparoscopic cholecystectomy) and medical tools available to facilitate adequate management of cholelithiasis and its complications are, therefore, crucial to prevent the negative outcomes of gallstone disease. Moreover, some risk factors for gallstone disease are modifiable and some preventive strategies have become necessary to reduce the onset and the severity of complications.
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Affiliation(s)
- P Portincasa
- a Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri" , University of Bari Medical School , Bari , Italy
| | - A Di Ciaula
- b Division of Internal Medicine , Hospital of Bisceglie , Bisceglie , Italy
| | - O de Bari
- a Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri" , University of Bari Medical School , Bari , Italy
- d Department of Internal Medicine, Division of Gastroenterology and Hepatology , Saint Louis University School of Medicine , St. Louis , MO , USA
| | - G Garruti
- c Department of Emergency and Organ Transplants, Section of Endocrinology, Andrology and Metabolic Diseases , University of Bari Medical School , Bari , Italy
| | - V O Palmieri
- a Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri" , University of Bari Medical School , Bari , Italy
| | - D Q-H Wang
- d Department of Internal Medicine, Division of Gastroenterology and Hepatology , Saint Louis University School of Medicine , St. Louis , MO , USA
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143
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Virgilio E, Chieco PA, Salaj A, Tozzi F, Desideri F, Di Giulio E, Cavallini M. Conservative Management of Pneumoperitonitis after Percutaneous Transhepatic Insertion of Metallic Biliary Stents. Am Surg 2015; 81:E418-E419. [PMID: 26736148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Edoardo Virgilio
- Department of Medical-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology of "Sapienza", University of Rome, St. Andrea Hospital Rome, Italy
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144
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Yuza K, Sakata J, Soma D, Ando T, Hirose Y, Ishikawa H, Miura K, Tatsuda K, Ohashi T, Takizawa K, Nagahashi M, Kameyama H, Kobayashi T, Kosugi SI, Wakai T. [Signet-Ring Cell Carcinoma of the Ampulla of Vater--Report of a Case]. Gan To Kagaku Ryoho 2015; 42:1767-1769. [PMID: 26805166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 62-year-old man presented with pruritus caused by obstructive jaundice. He was diagnosed with carcinoma of the ampulla of Vater and underwent pylorus-preserving pancreaticoduodenectomy. Histologic examination revealed signet-ring cell carcinoma without nodal metastasis. The patient underwent a partial resection of the small bowel for small bowel obstruction 38 months after the initial resection. Histologic examination disclosed signet-ring cell carcinoma at the surface of the resected small bowel, and the diagnosis of peritoneal recurrence was confirmed. He received oral S-1(100 mg/day) every other day for 14 months until bowel obstruction caused by peritoneal carcinomatosis became apparent. The patient died of the disease 58 months after the initial resection.
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Affiliation(s)
- Kizuki Yuza
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
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145
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Fujiwara Y, Omori T, Sugimura K, Miyata H, Miyoshi N, Akita H, Gotoh K, Takahashi H, Kobayashi S, Noura S, Ohue M, Sakon M, Yano M. [Introduction of Chemotherapy for Advanced Gastric Cancer Showing Oncologic Emergency Caused by Peritoneal Dissemination--Report of Tow Cases]. Gan To Kagaku Ryoho 2015; 42:2058-2060. [PMID: 26805263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Here, we report 2 patients with gastric cancer and peritoneal dissemination who were successfully treated with chemotherapy after undergoing treatment for an oncologic emergency caused by peritoneal dissemination. Case 1 involved obstruction of the sigmoid colon caused by peritoneal dissemination. After urgent colostomy, S-1/IP IV paclitaxel chemotherapy was introduced. The patient continued the therapy for 2 years and 2 months. Case 2 involved acute renal failure due to bilateral ureter obstruction and obstructive jaundice caused by peritoneal dissemination. This patient underwent emergency treatment consisting of Double-J ureteral stent insertion and endoscopic nasobiliary drainage. He was successfully started on chemotherapy with S-1/oxaliplatin/IP paclitaxel. He continued the therapy for 8 months without symptoms. Aggressive treatment might be effective for advanced gastric cancer showing oncologic emergency.
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Affiliation(s)
- Yoshiyuki Fujiwara
- Dept. of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
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146
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Okamura S, Mikami K, Murata K, Nushijima Y, Okada K, Yanagisawa T, Fukuchi N, Ebisui C, Yokouchi H, Kinuta M. [Long-Term Multidisciplinary Therapy for Multiple Liver Metastases from Colorectal Cancer with Biliary Drainage for Occlusive Jaundice--A Case Report]. Gan To Kagaku Ryoho 2015; 42:1740-1742. [PMID: 26805157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Here, we report the case of a 43-year-old man who was diagnosed with sigmoid colon cancer with synchronous multiple liver metastases following resection of a primary lesion. Subsequent mFOLFOX+BV therapy elicited a marked response in the liver metastases, which led to the patient undergoing hepatic (S7) radiofrequency ablation (RFA), hepatic resection (lateral segmentectomy and partial [S5] resection), and cholecystectomy. Six months later, transluminal RFA was repeated because liver (S7) metastasis recurred, and 8 courses of XELOX plus BV therapy were administered. As obstructive jaundice due to recurrence of the liver metastases developed after a 6 months hiatus in chemotherapy, we endoscopically inserted a biliary stent. Despite reducing IRIS plus BV therapy, obstructive jaundice developed again, and 3 intrahepatic biliary stents were inserted with percutaneous transhepatic biliary drainage. To date, the patient has been alive for 4 years since the initial resection of the primary lesion after undergoing consecutive systemic chemotherapy with different regimens. Some studies have shown that in cases of obstructive jaundice caused by advanced gastrointestinal cancer, longer survival could be expected by reducing the severity of jaundice, suggesting that resuming chemotherapy as well as improving the severity of jaundice could contribute to better outcomes. The patient in the present case was successfully treated twice with biliary drainage for occlusive jaundice and chemotherapy, suggesting that a combination of multidisciplinary therapy and adequate local therapy such as biliary drainage could be important for the treatment of metastatic liver cancer.
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147
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Tono T, Kawasaki Y, Hashimoto M, Ikeda Y, Senba H, Okubo Y, Katayama T, Ishii T, Shinozaki K, Hayashi H, Yasuda S, Ohtsuru M. [Adjuvant Surgery for Initially Unresectable Locally Advanced Pancreatic Cancer following Gemcitabine and S-1 Chemotherapy--A Case Report]. Gan To Kagaku Ryoho 2015; 42:2373-2375. [PMID: 26805368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A man in his 60s was admitted with obstructive jaundice. A hypovascular tumor, 55 mm in diameter, was detected in the pancreas head on imaging. The superior mesenteric vein showed severe stenosis bilaterally and the roots of all branches were invaded by the tumor. The tumor was diagnosed as unresectable pancreatic cancer, and chemotherapy of gemcitabine and S-1 was administered, resulting in a remarkable reduction of the tumor size. Following 7 courses of chemotherapy, a subtotal stomach-preserving pancreatoduodenectomy was carried out. Microscopic examination revealed no residual cancer cells in the resected specimen, indicating that pathological complete remission was obtained. Although some reports suggest that surgical treatment for patients with initially unresectable pancreas cancer who show excellent response to chemotherapy may improve the prognosis, further studies are needed.
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148
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Furukawa T, Takahashi H, Tanaka K, Muto T. [Unresectable Gallbladder Cancer Successfully Treated with Gemcitabine Chemotherapy]. Gan To Kagaku Ryoho 2015; 42:1723-1725. [PMID: 26805151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report a case of unresectable gallbladder cancer successfully treated with gemcitabine (GEM). A 77-year-old man was admitted to our hospital in April 2010 with jaundice. He was diagnosed as having gallbladder cancer that had invaded the liver and hepatic artery, along with lymph node metastasis. The tumor was considered unresectable, and he received chemotherapy with GEM. Each course of treatment consisted of 1,000 mg/m2 GEM administered once a week for 3 weeks followed by a week of no treatment. After the 3rd course, computed tomography revealed reduction in liver invasion and disappearance of lymph node metastasis. After the 18th course, the tumor had completely disappeared, and the patient achieved a complete response. GEM monotherapy was continued for 5 years, even though the tumor had disappeared. The patient is alive and has been disease-free for more than 5 years.
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149
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Sormaz IC, Keskin M, Sönmez RE, Soytaş Y, Tekant Y, Avtan L. Obstructive jaundice secondary to endoclip migration into common bile duct after laparoscopic cholecystectomy. MINERVA CHIR 2015; 70:381-383. [PMID: 26488761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Obstructive jaundice is a rare condition due to foreign body in common bile. In this article we report a 69 year-old man who was diagnosed obstructive jaundice secondary to the endoscopic clip migration. The patient had been performed laparoscopic cholecystectomy 5 years ago and had recovered without any complications. He presented with abdominal pain and jaundice. The magnetic resonance cholangiopancreatography (MRCP) revealed filling defect in choledoch consistent with a bile duct stone. The endoscopic retrograde cholangiopancreatography (ERCP) exhibited an endoclip migration into the common bile duct which caused bile duct stone. Endoclips can migrate into bile duct and cause obstructive jaundice. ERCP is the first option for its treatment.
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Affiliation(s)
- I C Sormaz
- Department of General Surgery, Faculty of Medicine, Istanbul University Instanbul, Turkey -
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150
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Prachayakul V, Aswakul P. Endoscopic ultrasound-guided biliary drainage: Bilateral systems drainage via left duct approach. World J Gastroenterol 2015; 21:10045-10048. [PMID: 26379410 PMCID: PMC4566375 DOI: 10.3748/wjg.v21.i34.10045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/26/2015] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasound (EUS)-guided biliary drainage is accepted as a less invasive, alternative treatment for patients in whom endoscopic retrograde cholangiopancreatography has failed. Most patients with malignant hilar obstruction undergo EUS-guided hepaticogastrostomy. The authors present the case of a 77-year-old man with advanced hilar cholangiocarcinoma who had undergone a roux-en-Y hepaticojejunostomy several months prior. He developed progressive jaundice and a low-grade fever that persisted for one week. The enteroscopic-assisted endoscopic retrograde cholangiopancreatography failed, thus the patient was scheduled for EUS-guided biliary drainage. In order to obtain adequate drainage, both intrahepatic systems were drained. This report describes the technique used for bilateral drainage via a transgastric approach. Currently, only a few different techniques for EUS-guided right system drainage have been reported in the literature. This case demonstrates that bilateral EUS-guided biliary drainage is feasible and effective in patients with hilar cholangiocarcinoma, and thus can be used as an alternative to percutaneous biliary drainage.
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