Protective and therapeutic experience of perioperative safety in extremely elderly patients with biliary diseases

To explore the protective and therapeutic measures of improving perioperative safety in extremely elderly patients with biliary diseases, so as to improve the therapeutic efficacy of surgery. A retrospective case–control study of 412 elderly patients with biliary diseases was carried out from July 2013 to July 2019. Seventy eight cases were divided into the high age (HA) group (≥80 years) and 334 into the middle–low age (MLA) group (60–79 years). In the HA compared with MLA group, 1. Preoperative coexisting diseases: the occurrence of coexisting coronary heart disease (CHD), hypertension, chronic bronchitis with emphysema, hypoproteinemia, and anemia were significantly increased; 2. Laboratory examinations: function of liver, kidneys, heart, lungs, and blood coagulation significantly declined; 3. Surgical procedures: open cholecystectomy with transcystic common bile duct (CBD) exploration significantly higher, while laparoscopic cholecystectomy significantly lower; 4. Operative effects: intraoperative blood loss, operation time, postoperative hospital stay, and length of hospitalization significantly increased or prolonged; 5. Postoperative complications: postoperative respiratory failure, pulmonary infection, anemia and electrolyte disorder significantly increased; 6. Therapeutic outcomes: no significant difference in the therapeutic effects. Although the surgical risk was significantly increased, there was no significant difference in the therapeutic efficacy in the HA compared with MLA group, suggesting that surgical treatment in extremely elderly patients with biliary diseases is safe and feasible. The key is to actively treat preoperative coexisting diseases, strictly adhere to surgical indications, reasonably select surgical procedures, precisely perform the operation, closely monitor and control intraoperative emergencies, timely prevent and treat postoperative complications, so as to improve the perioperative safety of extremely elderly patients with biliary diseases.

Rapid and simultaneous analysis of direct and indirect bilirubin indicators in serum through reagent-free visible-near-infrared spectroscopy combined with chemometrics

Indirect (IBil), direct (DBil) and total (TBil) bilirubin are important clinical indicators of hepatobiliary diseases, which require rapid detection in diagnosis and treatment. IBil and DBil have a structural relationship with several macromolecules in hepatobiliary metabolism. Here, the rapid analysis models for bilirubin indicators using serum visible-near-infrared (Vis-NIR) spectroscopy were established. Norris derivative filter with optimisation was used for spectral pretreatment; the optimal parameters (derivative order, number of smoothing points, number of differential gaps) were (2, 15, 9) for IBil; (2, 13, 9) for DBil, respectively. Equidistant combination-partial least squares (EC-PLS) was used for large-scale wavelength screening. Wavelength step-by-step phase-out PLS (WSP-PLS) was used for secondary wavelength optimisation. The wavelength models of the optimal EC-WSP-PLS for IBil and DBil included 11 and 18 wavelengths, respectively. In independent validation, the root-mean-square errors and correlation coefficient for prediction (SEP, R_P), and ratio of performance-to-deviation (RPD) were 0.90 μmol L^-1, 0.975, and 4.4 for IBil; 0.71 μmol L^-1, 0.955, and 3.3 for DBil, respectively. TBil was subjected to spectral analysis, and the summation of the prediction values of IBil and DBil was compared. The latter was obviously better, and SEP, R_P, RPD were 0.82 μmol L^-1, 0.990, 7.1, respectively. The results for IBil, DBil and TBil indicated high correlation, low error and good overall prediction ability and confirmed the feasibility of the simultaneous analysis of bilirubin indicators through reagent-free serum Vis-NIR spectroscopy. The proposed method is crucial for the rapid screening of large populations and the treatment of hepatobiliary diseases.

Association of Arterial Hypertension with Hepatobiliary Pathology: The Occurrence of Comorbidity and Features of Metabolic Processes

Comorbidity of hypertension and hepatobiliary pathology has negative medical and social consequences, including an increase in the indicators of hospital admissions, disability and mortality.

OBJECTIVE

The aim was to study the occurrence of hypertension combined with hepatobiliary diseases depending on social status, gender and age in 2003-2017 and their influence on indicators of metabolic processes in patients with a therapeutic profile.

METHODS

A cross-sectional study using the inpatients' medical record database of the clinic of Federal Research Centre for Basic and Translational Medicine (Novosibirsk, Russia), which collects demographics, diagnoses (using ICD-10 codes), procedures and examinations of all inpatients from 2003-2017 was conducted. The incidence of comorbidity of hypertension and hepatobiliary pathology depending on age, gender and social status, based on the analysis of 13496 medical records was examined. A comparative analysis of biochemical parameters characterizing the main types of metabolism (lipid, protein, carbohydrate and purine) was carried out in 3 groups of patients: with hypertension; with hepatobiliary pathology, and with a combined pathology.

RESULTS

During the years 2003-2005, there was the greatest frequency of this comorbidity in workers, in women, in the age group 60 years and older. In 2009-2017, the highest incidence was observed in the male administrative staff. In patients with this comorbidity, more pronounced changes in carbohydrate, protein, lipid and purine metabolism were found in comparison with groups of patients with isolated diseases.

CONCLUSION

The results highlight the need to improve the system of prevention and treatment of comorbidity taking into account sex, age, occupation and features of metabolism.

[Blood serum cholecystokinin and clinical-functional variability of biliary pathology]

RESULTS

Basal and stimulated serum CCK concentrations were not statistically significant differences (p > 0.05) with the control group in patients studied in the whole and in patients subgroups, formed by the diagnosis of biliary pathology and the character of gallbladder emptying. Increased stimulated CCK concentration was found in patients with symptomatic variants. Reduce of serum-cholecystokinin concentration growth (ACCK) after intake of Sorbitol was revealed in subgroup of patients with low-symptom variant. Reduced sensitivity of the gallbladder to CCK was observed in subgroups of patients with gallbladder hypokinetic dyskinesia and one with symptomatic variant of biliary pathology.

CONCLUSION

The sensitivity of the gallbladder neuromuscular apparatus to CCK is associated with clinical and functional variability of the biliary pathology.

Portal biliopathy in patients with non-cirrhotic portal hypertension: does the type of surgery affect outcome?

OBJECTIVES

After portosystemic anastomoses for biliopathy, some patients continue to suffer biliary obstruction. The effects of splenectomy and devascularization of the abdominal oesophagus and upper stomach are unclear. The aim of the current study was to determine the features of portal biliopathy (PB) in patients with non-cirrhotic portal hypertension, and to investigate outcomes in these patients after surgical procedures.

METHODS

A retrospective study of 56 patients who underwent surgery for PB during 1996-2010 was conducted. Data on presenting features, treatment received and outcomes were analysed.

RESULTS

In total, 41 of these patients had extrahepatic portal venous obstruction and 15 had non-cirrhotic portal fibrosis. Forty patients underwent shunt surgery and 16 underwent splenectomy and devascularization. Median bilirubin levels fell from 1.8 mg/dl (range: 0.4-5.9 mg/dl) to 1.0 mg/dl (range: 0.3-5.4 mg/dl) after shunt surgery and from 1.9 mg/dl (range: 0.6-4.0 mg/dl) to 1.2 mg/dl (range: 0.6-5.2 mg/dl) after splenectomy-devascularization. On follow-up, five of 33 patients had persistent jaundice after successful shunt surgery. These patients had a history of multiple endoscopic stentings and three patients had demonstrated a dominant common bile duct stricture preoperatively.

CONCLUSIONS

Portal biliopathy was reversed in 38 of 43 patients by either portosystemic shunting or splenectomy-devascularization. In five patients, direct biliary decompressive procedures were required because of shunt blockage or a non-reversible biliary stricture.

Extremely high values of CA 19-9 in liver hydatidosis and frank biliary rupture

Elevation of carbohydrate antigen 19-9 has been observed in jaundiced patients with benign biliary tract diseases. No clear answer has explained that relationship. Patients with liver hydatidosis and frank intrabiliary rupture could present obstructive jaundice due to the presence of liver cyst material in the bile duct. We present two cases of huge elevation of carbohydrate antigen 19-9 in jaundiced patients with liver hydatidosis and biliocystic communication, and we assess the different theories presented in the medical literature today.

Gallbladder sludge on ultrasound is predictive of increased liver enzymes and total bilirubin in cats

The purposes of this retrospective study were to assess the prevalence of gallbladder sludge (GBS) in a population of cats presented for abdominal ultrasound in a teaching hospital and to determine its association with increased serum alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total bilirubin (TB). Gallbladder sludge was detected in 152 (14%) of the cats undergoing abdominal ultrasound between 2004 and 2008. This population was compared to a control group of 32 cats without GBS. Alanine aminotransferase, ALP, and TB mean values were significantly higher in cats with GBS than in controls (P ≤ 0.0005) and odds for increased values in cats with GBS were 4.2 [95% confidence interval (CI): 1.6 to 11.0], 9.5 (95% CI: 2.2 to 41.7), and 4.1 (95% CI: 1.5 to 11.5), respectively (P ≤ 0.007). In conclusion, GBS is an uncommon ultrasonographic finding in cats that is predictive of increased liver enzymes and TB. More studies are needed to establish potential links between GBS and hepatobiliary disease in cats.

Bilirubin levels predict malignancy in patients with obstructive jaundice

BACKGROUND

Differentiating between benign and malignant causes of obstructive jaundice can be challenging, even with the advanced imaging and endoscopic techniques currently available. In patients with obstructive jaundice, the predictive accuracy of bilirubin levels at presentation was examined in order to determine whether such data could be used to differentiate between malignant and benign disease.

METHODS

A total of 1,026 patients with obstructive jaundice were identified. Patients were divided into benign and malignant groups. The benign patients were subgrouped into those with choledocholithiasis and those with inflammatory strictures of the biliary tree. Bilirubin levels at presentation and other demographic data were obtained from case records.

RESULTS

Area under the curve (AUC) values for bilirubin as a predictor of malignancy were highly significant for all benign presentations and for those with benign biliary strictures (AUC: 0.8 for both groups; P < 0.001). A bilirubin level > 100 µmol/l was determined to provide the optimum sensitivity and specificity for malignancy in all patients and in those without choledocholithiasis (71.9% and 86.9%, 71.9% and 88.0%, respectively). The application of a bilirubin level > 250 µmol/l achieved specificities of 97.1% and 98.0% in each subgroup of patients, respectively.

CONCLUSIONS

In patients with obstructive jaundice, bilirubin levels in isolation represent an important tool for discriminating between benign and malignant underlying causes.

[Physical exercise in combined outpatient rehabilitation of patients with ischemic heart disease associated with biliary dysfunction]

AIM

To study prevalence of gastrointestinal symptoms (GIS) including gall-bladder dysfunction (GBD) in coronary patients after acute coronary event (ACE) and effects of early physical exercise (PE) of moderate intensity in coronary patients with GBD on efficacy of outpatient rehabilitation.

MATERIAL AND METHODS

A two-stage trial was conducted. Stage 1: 237 coronary patients responded to questionnaire detecting incidence of GIS including GBD 8 weeks after ACE. Stage 2: 85 coronary patients with verified GBD were examined for efficacy of rehabilitation. Of them, 43 patients entered PE group while 42 patients entered a control group. The latter received standard therapy without PE. The efficacy of the treatment was evaluated by clinical, device and biochemical findings at baseline and 12 months later.

RESULTS

Of 237 coronary patients 217 (91.7%) patients 2 months after ACE had symptoms of coronary insufficiency, 192 (81.3%) had GIS, 78.9% had GBD. Patients from PE group significantly improved exercise tolerance (bicycle exercise test reached 79.3 +/- 15 and 121.3 +/- 14.5 bt (p < 0.05), respectively. These patients demonstrated improvement of gall-bladder contraction, a decrease in the level of total cholesterol from 6.12 +/- 0.4 to 4.7 +/- 0.2 mmol/l (p < 0.05), of LDLP cholesterol from 3.85 +/- 0.21 to 2.86 +/- 0.32 mmol/l (p < 0.05), thioldisulphide coefficient from 13 +/- 0.3 to 2.7 +/- 0.4 (p < 0.01). The intergroup analysis 12 months after the study revealed significant differences in favor of the PE group. A weekly number of anginal attacks reduced from 5.1 +/- 1.5 to 1.3 +/- 1.4 (p < 0.01).

CONCLUSION

The exercise program is rather effective and can be practiced outpatiently in coronary patients after ACE associated with GBD. It can be also used for secondary prophylaxis of cholestasis in coronary patients with biliary problems.

[Capabilities of complex therapy of chronic biliary pancreatitis with concomitant obesity using multinutrient functional complexes "Grinization"]

Author studied 64 patients with chronic biliary pancreatitis and obesity. In most cases the observed patients had also a diagnosis of non-alcoholic steatohepatitis. It was shown that in combined pathology there were revealed atherogenic blood lipid profile, disorders of liver functional state, sonographic changes of pancreas, liver, and gallbladder. Inclusion of multinutrient functional complexes "Grinization" in complex therapy improved sonography results, blood lipid levels, and eliminated biochemical manifestations of hepatocytes' cytolysis and cholestasis.

The effect of colic on oxygen extraction in horses

Blood oxygen transport and oxygen extraction were assessed in horses with colic. A gravity score (GS) ranging from 1 to 3 was attributed to each colic case with healthy horses used as controls. Jugular venous and carotid arterial blood samples were collected and concentrations of 2,3-diphosphoglycerate, adenosine triphosphate, inorganic phosphate and chloride were determined. pH and partial pressures of carbon dioxide (PCO(2)), and oxygen (PO(2)) were also measured. Oxygen equilibrium curves (OEC) were constructed under standard conditions and oxygen extraction ratios calculated. Haemoglobin oxygen affinity measured under standard conditions (P50(std)) was unchanged in colic horses compared with healthy controls. Horses with the highest GS, i.e. 3 had lower blood pH values than healthy animals. Arterial and venous partial pressures of oxygen at 50% haemoglobin saturation (P50(a) and P50(v)) were significantly higher in horses suffering from colic (GS=3) than in healthy horses. The oxygen extraction ratio was also significantly increased in colic horses with a GS of 3. A rise in the oxygen extraction ratio detected in the most severely affected animals seemed to reflect the compensatory properties of the oxygen transport system where extraction of oxygen from the blood increases when systemic oxygen delivery decreases, as might be anticipated in horses with colic.

Disialotransferrin, determined by capillary electrophoresis, is an accurate biomarker for alcoholic cause of acute pancreatitis

OBJECTIVES

Serum disialotransferrin is a specific marker of heavy alcohol consumption. We tested its accuracy and probability in detecting alcoholic cause of acute pancreatitis (AP).

METHODS

Blood samples from 271 consecutive AP patients, admitted to the Helsinki University Central Hospital emergency unit, were analyzed.

RESULTS

The median (range) disialotransferrin value was significantly higher (P = 0.001) in AP patients with alcoholic (n = 172) 1.6% (0.3%-14.4) than with biliary (n = 60) 0.7% (0.3%-1.3%) or other causes (n = 39) 0.8% (0.3%-4.1%). In receiver operating curve analysis, disialotransferrin, as a single analyte, was significantly (P = 0.001-0.0001) more accurate (area under the curve [AUC], 0.88; 95% confidence interval [CI], 0.84-0.92) in detecting alcoholic AP as compared with glutamyl transferase (AUC, 0.51; 95% CI, 0.45-0.57), aspartate aminotransferase (AUC, 0.57; 95% CI, 0.51-0.63), alanine aminotransferase (AUC, 0.63; 95% CI, 0.57-0.69), erythrocyte mean cell volume (AUC, 0.72; 95% CI, 0.67-0.78), amylase (AUC, 0.74; 95% CI, 0.67-0.78), C-reactive protein (AUC, 0.65; 95% CI, 0.59-0.71), and bilirubin (AUC, 0.55; 95% CI, 0.49-0.62). At a disialotransferrin cutoff of 1.2%, giving an 8% false-positive rate, the positive likelihood ratio was 8.47. Thus, a positive disialotransferrin test result, performed within 24 hours of admission, increased the probability of alcoholic AP from pretest 64% to posttest 94%.

CONCLUSIONS

Disialotransferrin, determined by capillary electrophoresis, is accurate, simple, and a rapid single biomarker of the alcoholic cause of AP.

Evaluation of plasma protein C activity for detection of hepatobiliary disease and portosystemic shunting in dogs

OBJECTIVE

To determine the diagnostic value of protein C (PC) for detecting hepatobiliary disease and portosystemic shunting (PSS) in dogs.

DESIGN

Prospective study.

ANIMALS

238 clinically ill dogs with (n = 207) and without (31) hepatobiliary disease, including 105 with and 102 without PSS.

PROCEDURES

Enrollment required routine hematologic, serum biochemical, and urine tests; measurement of PC activity; and a definitive diagnosis. Total serum bile acids (TSBA) concentration and coagulation status, including antithrombin activity, were determined in most dogs. Dogs were grouped into hepatobiliary and PSS categories. Specificity and sensitivity were calculated by use of a PC cutoff value of 70% activity.

RESULTS

Specificity for PC activity and TSBA concentrations was similar (76% and 78%, respectively). Best overall sensitivity was detected with TSBA, but PC activity had high sensitivity for detecting PSS and hepatic failure. Protein C activity in microvascular dysplasia (MVD; PC > or = 70% in 95% of dogs) helped differentiate MVD from portosystemic vascular anomalies (PSVA; PC < 70% in 88% of dogs). A receiver operating characteristic curve (PSVA vs MVD) validated a useful cutoff value of < 70% activity for PC.

CONCLUSIONS AND CLINICAL RELEVANCE

Combining PC with routine tests improved recognition of PSS, hepatic failure, and severe hepatobiliary disease and signified a grave prognosis when coupled with hyperbilirubinemia and low antithrombin activity in hepatic failure. Protein C activity can help prioritize tests used to distinguish PSVA from MVD and sensitively reflects improved hepatic-portal perfusion after PSVA ligation.

Serum IgG4 concentrations in pancreatic and biliary diseases

BACKGROUND

Recently, it has been reported that the serum concentration of IgG4, a minor component of IgG subclasses, is increased in autoimmune pancreatitis. However, data regarding IgG4 concentrations in other pancreatic or biliary diseases have been insufficient.

METHODS

Serum IgG4 was measured in 116 patients with pancreatic or biliary diseases (35 autoimmune pancreatitis, 24 chronic pancreatitis except autoimmune pancreatitis, 11 primary sclerosing cholangitis, 23 pancreatic cancer, 3 islet cell tumor, 2 papilla cancer, 15 bile duct cancer, and 3 gallbladder cancer patients). The cut-off concentration of IgG4 was 135 mg/dl.

RESULTS

Increased serum IgG4 was observed in 33 of 35 patients with autoimmune pancreatitis, 0 of 24 with chronic pancreatitis, 4 of 11 with primary sclerosing cholangitis, 0 of 23 with pancreatic cancer, 0 of 3 with islet cell tumor, 0 of 2 with duodenal papilla cancer, 0 of 15 with bile duct cancer and 0 of 3 with gallbladder cancer patients.

CONCLUSIONS

Serum IgG4 was increased in autoimmune pancreatitis and was within normal limits for other pancreatic or biliary diseases except primary sclerosing cholangitis.

[A cytokine status in chronic alcoholic and biliary pancreatitis]

AIM

To determine characteristics of a cytokine status in chronic pancreatitis (CP) depending on etiological factor, stage of the disease, complications, therapy. Material and methods. 72 patients had chronic alcoholic pancreatitis (CAP), 38 patients--chronic biliary pancreatitis (CBP). Control group consisted of 20 healthy subjects.

RESULTS

At early stages and height of CAP exacerbation, concentrations of IL-1beta, IL-6, IL-8, TNF-gamma and TNFalpha were elevated (951.1 +/- 104.2 pg/ml; 172.8 +/- 24.3 pg/ml; 432.6 +/- 68.5 pg/ml; 823.3 +/- 97.5 pg/ml; 158.7 +/- 19.6 pg/ml, respectively). Regenerative processes in CP were accompanied with IL-4 elevation to 614.9 +/- 64.6 pg/ml. In CAP without complications and with them the levels of cytokines differed significantly. The level of TGF-beta1 stimulating development of fibrosis was in CAP patients 627.8 +/- 92.2 pg/ml, in CAP patients with complications--796.8 +/- 102.5, in the controls--40.2 +/- 4.6 pg/ml (p < 0.05). In early stages of CBP exacerbation, IL-1beta rose to 527.2 +/- 62.7 pg/ml, IL-6--to 80.9 +/- 11.4 pg/ml, IL-8--to 290.4 +/- 46.8 pg/ml, INF-gamma to 853.3 +/- 91.6 pg/ml; TNF-alpha--to 79.7 +/- 8.3 pg/ml, TGF-beta1--534.1 +/- 78.4 pg/ml. With attenuation of acute syndromes and development ofregeneration, levels of IL-4 went up (226.7 +/- 32.4 pg/ml).

CONCLUSION

CP is accompanied by increase in cytokine contents depending on the etiological factor, variants of course, stage, presence of complications.

Acute biliary pancreatitis in the era of minimally invasive surgery

PURPOSE

Opinions about early endoscopic sphincterotomy and time of laparoscopic cholecystectomy in acute biliary pancreatitis are still controversial. Some authors reserved this procedure only for cases in which the stones were visualized during ERCP or patients had clinical symptoms of acute cholangitis. The aim was the assessment of the dynamic of changes of proinflammatory cytokines and white blood cells in time in patients with acute biliary pancreatitis after performed endoscopic sphincterotomy and laparoscopic cholecystectomy.

MATERIAL AND METHODS

We enrolled 43 consecutive patients with clinically diagnosed mild forms of acute biliary pancreatitis. All were treated by early endoscopic sphincterotomy and laparoscopic cholecystectomy performed during the first 48 hours after admission. The course of the disease was monitored by measurement of the level of proinflammatory cytokines.

RESULTS

Marked decrease of the level of proinflammatory interleukins within 24 hours after endoscopic sphincterotomy was observed. Mean values of IL-6 and IL-8 were statistically lower immidiately after this procedure (p < 0.001). Subsequent decrease was achieved after laparoscopic cholecystectomy. The mean values of TNF-alpha and IL-12p40 were relatively constant throughout the study period.

CONCLUSION

All patients suffering from mild acute biliary pancreatitis should be treated by using minimally invasive procedures. However, such a only treatment should be reserved for experienced centers.

Epidemiology of typhoid carriers among blood donors and patients with biliary, gastrointestinal and other related diseases

Enteric fever due to Salmonella Typhi is a major public health problem. Typhoid carriers have high titres of Vi agglutinins in their sera. We worked out the baseline data for Vi agglutinins from 705 healthy blood donors (controls) by ELISA and compared it with 446 patients with biliary, gastrointestinal and other related diseases (cases). The samples were divided into five groups based on the disease condition of the patients from whom they were collected. Group A (n=196) consisted of patients with stones in the gall bladder/common bile duct and Group B (n=27) with gall bladder carcinoma. Group C (n=33) comprised patients with carcinoma of the pancreas/ampulla, obstructive jaundice and/or cholangiocarcinoma. Group D (n=112) had patients with acute/chronic pancreatitis, abdominal pain, intestinal obstruction, peritonitis, carcinoma oesophagus, chronic diarrhoea, gastrointestinal bleeding and dyspepsia. Group E (n=78) included patients with miscellaneous diseases. The mean absorbance value obtained for healthy subjects +3 standard deviations was taken as the cut-off value for a positive typhoid carrier. In Group A, 10.2% samples were positive; in Group B, 7.4%; in Group C, 12.0%; in Group D, 9.8% and in Group E, 9.0%. There was a highly significant (P <0.001) increase in the presence of Vi agglutinins in the cases compared to the controls. High prevalence of typhoid carriers occurs in patients with biliary, gastrointestinal and other related diseases. Vi serology employing highly purified Vi antigen offers a practical and cost-effective way of screening for S. Typhi carriers.

[The role of leukocytes in mechanism of action of balneopeloidotherapy]

Treatment with alkaline sulfide mud activates oxidant activity of neutrophils which stimulate body defense and adaptation but can provoke balneoreactions. Lysosomic membranes remain stable as mud does not stimulate phagocytosis. Peloid therapy stimulates a monocytic (macrophagal) lineage of hemopoiesis directed to elimination of intracellular microflora and products of inflammation. Radon therapy depresses oxidant and non-oxidant neutrophil activity thus diminishing damage to tissues and vessels and relieving inflammation.

Biochemical and radiological predictors of malignant biliary strictures

AIM: Differentiation of benign biliary strictures (BBS) from malignant biliary strictures (MBS) remains difficult despite improvement in imaging and endoscopic techniques. The aim of this study was to identify the clinical, biochemical and or radiological predictors of malignant biliary strictures.

METHODS: We retrospectively reviewed all charts of patients who had biliary strictures (BS) on endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous cholangiography (PTC) in case of unsuccessful ERCP from March 1998 to August 2002. Patient characteristics, clinical features, biochemical, radiological and biopsy results were all recorded. Stricture etiology was determined based on cytology, biopsy or clinical follow-up. A receiver operator characteristic (ROC) curve was constructed to determine the optimal laboratory diagnostic criterion threshold in predicting MBS.

RESULTS: One hundred twenty six patients with biliary strictures were enrolled, of which 72 were malignant. The mean age for BBS was 53 years compared to 62.4 years for MBS (P = 0.0006). Distal bile duct stricture was mainly due to a malignant process 48.6% vs 9% (P = 0.001). Alkaline phosphates and AST levels were more significantly elevated in MBS (P = 0.0002). ROC curve showed that a bilirubin level of 84 μmol/L or more was the most predictive of MBS with a sensitivity of 98.6%, specificity of 59.3% and a positive likelihood ratio of 2.42 (95%CI: 0.649-0.810). Proximal biliary dilatation was more frequently encountered in MBS compared to BBS, 73.8% vs 39.5% (P = 0.0001). Majority of BBS (87%) and MBS (78%) were managed endoscopically.

CONCLUSION: A serum bilirubin level of 84 μmol/L or greater is the best predictor of MBS. Older age, proximal biliary dilatation, higher levels of bilirubin, alkaline phosphatase, ALT and AST are all associated with MBS. ERCP is necessary to diagnose and treat benign and malignant biliary strictures.

C-reactive protein in patients with gallbladder and biliary tract diseases

C-reactive protein (CRP) assay is widely used as a clinical tool for the evaluation of bacterial infections. No study has been undertaken to evaluate the presence of CRP and/or the estimation of this protein in the bile of patients with diseases of the gallbladder (GB). In the present study, we estimated the quantity of CRP in bile (n=358) as well as serum samples (n=186) obtained from patients with GB and biliary tract diseases, using the semiquantitative Avitex CRP kit. Bacteriological study was also done on the bile samples. CRP was positive in the bile of 56 patients, (15.6%) many of who had bacteriobilia. CRP was also present in 49 of the serum samples studied (26.3%). Control serum samples did not show any CRP within detectable limits. Hitherto, this is the first report that investigated the level of CRP in the bile of patients with GB and biliary tract diseases, along with biliary bacterial profile.

Clinical importance of gamma glutamyltransferase in the Ankara-Pursaklar region of Turkey

OBJECTIVE

The aim of this study is to determine the etiologies of serum gamma glutamyltransferase (GGT) elevation and relations between multiple etiologies prevalent in the Pursaklar region of Ankara in Turkey.

PATIENTS AND METHODS

The patients referred to the Family Medicine and Internal Medicine departments with various complaints from the Pursaklar region of Ankara between July 2000 and July 2002 were evaluated, and values for GGT, alkaline phosphatase (ALP), and alanine aminotransferase (ALT) levels were determined. GGT elevation was classified as being associated with hepatic, biliary, and other origins.

RESULTS

For GGT elevation, hepatobiliary etiologies were more prevalent. The most prevalent hepatic etiology was nonalcoholic steatohepatitis, followed by biliary etiologies. The most prevalent etiology of biliary origin was cholelithiasis. Other etiologies, in order of prevalence, were drug exposure and urinary infection. There were no gender-related differences for distribution of GGT elevation; however, the GGT values for women were higher than those for men.

Serum MUC5AC mucin as a potential marker for cholangiocarcinoma

Aberrant expression of MUC5AC mucin is obvious in cholangiocarcinoma tissues, however, this mucin has never been detected in the serum. Using immunoblotting marked with antibody vs. MUC5AC core protein, we could detect MUC5AC mucin in the serum of 112 from 179 cholangiocarcinoma patients (62.6% sensitivity), two of the 62 with benign hepatobiliary diseases, six of the 60 with hepato-gastrointestinal cancer, and none in either the 60 active opisthorchiasis or 74 healthy persons. Detection of serum mucin in the serum of cholangiocarcinoma patients corresponded well to the MUC5AC expressed in individual tissues. Serum MUC5AC may be used to enhance the diagnostic accuracy of cholangiocarcinoma.

[Changes in lipoprotein (a) and the relation between lipoprotein (a) and endothelin in patients during upper abdominal surgery]

OBJECTIVE

We observed the changes in both serum lipoprotein(a) [Lp(a)] and plasma endothelin (ET) during upper abdominal surgery under intravenous combined with inhalation anesthesia and we also analyzed their correlativity.

METHODS

Fifteen patients, scheduled for upper abdominal surgery, were anesthetized with total does of fentanal 8-12 micrograms.kg-1 and inhalation of 1-2 MAC enflurane. Serum Lp(a) and plasma ET at pre-anesthesia, pre-operation, 1 h from the start of operation and 30 min after operation were determined.

RESULTS

The average concentrations of Lp(a) and ET were increased at 1 h from the start of operation compared with pre-anesthesia, but had no statistical significance. Lp(a) and ET were significantly higher at 30 min after operation than pre-anesthesia(P < 0.05).

CONCLUSION

Lp(a) and ET have a close relation in advancing cardio-cerebral blood vessel diseases.

Elevated serum PIIINP and laminin in inflammatory bowel disease indicate hepatobiliary and pancreatic dysfunction

BACKGROUND/AIMS

Levels of S-PIIINP (serum aminoterminal propeptide of type III procollagen) have been shown to be increased in patients with primary sclerosing cholangitis and inflammatory bowel disease. The aim of the study was to investigate the serum concentrations of PIIINP and laminin in inflammatory bowel disease patients, their relationship with inflammatory bowel disease-associated hepatobiliary and pancreatic dysfunction, and to correlate them with clinical, endoscopic, and histologic variables.

METHODOLOGY

S-PIIINP and S-laminin were measured in 222 consecutive inflammatory bowel disease patients, who were screened for abnormal liver and pancreatic enzymes and for pancreatic exocrine hypofunction with the p-aminobenzoic acid test (215 patients). The patients with abnormal screening results were further scheduled for endoscopic retrograde cholangiopancreatography, liver biopsy, secretin test and ultrasound.

RESULTS

S-PIIINP and S-laminin were abnormally high in 19% and 40% of all inflammatory bowel disease patients, respectively. The elevated levels of the fibrosis markers were associated with laboratory signs of either hepatobiliary or pancreatic disease. Hepatobiliary disease was found in 37 (17%) of inflammatory bowel disease patients, 15 of whom had primary sclerosing cholangitis. The median levels of S-PIIINP and S-laminin were significantly higher in patients with hepatobiliary disease than in those without (P < 0.0001 and P < 0.001, respectively), being most strikingly elevated in primary sclerosing cholangitis. Abnormal pancreatic screening tests were found in 67 (30%) patients. High levels of S-PIIINP and S-laminin were also significantly associated with low values in p-aminobenzoic acid (P < 0.001 and P < 0.005) and secretin (P < 0.01 and P < 0.05) tests, but not with inflammatory bowel disease category, endoscopic or histological disease extent, frequency of bowel resection or actual clinical activity.

CONCLUSIONS

In inflammatory bowel disease, increased S-PIIINP and S-laminin are associated with hepatobiliary and pancreatic disorders.

High serum alkaline phosphatase levels, a study in 181 Thai adult hospitalized patients

BACKGROUND

Alkaline phosphatase (ALP) is an important enzyme mainly derived from the liver, bones and in lesser amounts from intestines, placenta, kidneys and leukocytes. An increase in ALP levels in the serum is frequently associated with a variety of diseases. This study was done in order to determine the diseases associated with a high ALP level among Thai adult hospitalized patients.

METHOD

A review was made of medical records of inpatients with high ALP level above 1000 IU/L in King Chulalongkorn Memorial Hospital, Thailand from January 1999 to December 1999. Excluded were cases of (a) patients who have bone involvements with malignancies, (b) pediatric patients younger than 15 years old and c) HIV-seropositive patients.

RESULTS

A total of 181 hospitalized patients with eligible medical records were identified (96 males and 85 females, mean age 49.4 +/- 16.1 years). Their ALP levels ranging from 1,001 to 3,067 IU/L, these patients were divided into four groups.

CONCLUSION

High serum ALP levels in hospitalized patients were commonly found in three major groups having obstructive biliary diseases, infiltrative liver disease and sepsis. The study results were in accordance with previous reports in developed countries. Nonetheless, cholangiocarcionoma and some tropical diseases unique to our setting were also detected in these cases, where there was a marked elevation of serum ALP.

PIVKA-II during perioperative period in patients with hepato-biliary-pancreatic diseases

BACKGROUND/AIMS

In this study, we examined the influence of clinical treatments in the perioperative period upon PIVKA-II (plasma levels of protein induced by vitamin K absence or antagonist-II) in patients with hepatocellular carcinoma and pancreatobiliary diseases.

METHODOLOGY

During a perioperative period, plasma PIVKA-II levels were measured in 144 patients with various hepatobiliary and pancreatic diseases by two types of EIA kit, using the conventional monoclonal antibody MU-3 and the new monoclonal antibody 19B7; Thrombotests were given at the same time.

RESULTS

PIVKA-II of hepatocellular carcinoma patients showed higher reactivity with MU-3 than with 19B7. On the other hand, PIVKA-II of pancreatobiliary malignancies showed higher reactivity to 19B7 than it did to MU-3. In hepatocellular carcinoma patients, there was no correlation between PIVKA-II and Thrombotest levels; however, a significant correlation was found in patients with obstructive jaundice due to pancreatobiliary cancer. PIVKA-II levels decreased gradually to normal range within about 2 weeks after the curative operation. PIVKA-II levels in the patients receiving antibiotics containing N-methyl-thiotetrazole without administration of vitamin K remained high as long as the antibiotics were administered, but decreased to normal range as soon as the administration was finished.

CONCLUSIONS

PIVKA-II which is produced by hepatocellular carcinoma may be different from that produced by obstructive jaundice due to pancreatobiliary malignancies. The clinical treatments in perioperative period, such as the administration of antibiotics containing N-methyl-thiotetrazole or vitamin K, readily influence PIVKA-II levels. Therefore, abnormal PIVKA-II levels must be carefully interpreted in the diagnosis of hepatocellular carcinoma and pancreatobiliary malignancies.

Cholecystokinin in acute alcoholic and biliary pancreatitis

BACKGROUND

Recent studies have shown that cholecystokinin (CCK) agonist, cerulein can induce acute pancreatitis in animals. The role of CCK in the induction of acute pancreatitis in humans is unclear. We investigated plasma CCK levels in alcoholic and biliary pancreatitis on admission and during the episode of acute pancreatitis.

METHODS

Plasma CCK concentrations were determined by a specific and sensitive radioimmunoassay using CCK antiserum (Euro-Diagnostica, Malmö, Sweden) in 35 patients with acute alcoholic pancreatitis, in 27 patients with acute biliary pancreatitis, in 34 patients with nonpancreatic acute abdominal pain, and in 43 healthy subjects. The mean time from the first symptoms to the plasma sample was 31 (+/- 3.7) h in alcoholic pancreatitis patients and 25 (+/- 5.1) h in biliary pancreatitis patients. We also determined CCK levels in 20 patients during the episode of acute pancreatitis. Normal fasting level of CCK is < or = 1.12 pmol/L according to manufacturer.

RESULTS

Basal plasma CCK concentrations were significantly lower both in alcoholic pancreatitis (mean +/- SEM, 0.04 +/- 0.03 pmol/L, p < 0.0001) and biliary pancreatitis patients (0.17 +/- 0.13 pmol/L, p < 0.0001) than in nonpancreatic acute abdominal pain patients (1.23 +/- 0.32 pmol/L) or healthy subjects (1.18 +/- 0.20 pmol/L). Plasma CCK levels also remained low until the patient was well-recovering and had started oral diet.

CONCLUSION

Basal plasma CCK concentrations are significantly decreased in acute alcoholic and biliary pancreatitis after the first day from the beginning of the symptoms until the patient was well-recovering.

Time-resolved immunofluorometric assay of trypsin-1 complexed with alpha(1)-antitrypsin in serum: increased immunoreactivity in patients with biliary tract cancer

BACKGROUND

Increased serum concentrations of trypsin immunoreactivity occur in patients with biliary tract cancer. To characterize this trypsin, we developed a sensitive time-resolved immunofluorometric assay for trypsin-1 complexed with alpha(1)-antitrypsin (AAT) and studied the concentrations of this complex in sera from healthy individuals (n = 130) and patients with benign biliary disease (n = 32), biliary tract cancer (n = 17), pancreatic cancer (n = 27), and hepatocellular cancer (n = 12).

METHODS

We used a trypsin-1-specific monoclonal antibody on the solid phase and a europium-labeled polyclonal antibody to AAT as tracer. The detection limit was 0.42 microgram/L. The validity of the trypsin-1-AAT test for detection of biliary tract cancer was compared with trypsin-2-AAT and CA19-9.

RESULTS

Increased concentrations of trypsin-1-AAT (>33 microgram/L) were found in 76% of patients with biliary tract cancer, and the concentrations were significantly higher than in those with benign biliary disease (P <0. 0001). The median concentration of trypsin-1-AAT in serum from patients with biliary tract cancer was 3.7-fold higher than in healthy controls, 2.6-fold higher than in patients with benign biliary tract disease, 1.7-fold higher than in patients with pancreatic cancer, and 2.0-fold higher than in patients with hepatocellular cancer.

CONCLUSIONS

Of the markers studied, trypsin-1-AAT had the largest area (0.83) under the receiver operating curve in differentiating biliary tract cancer from benign biliary tract disease. Our results suggest that trypsin-1-AAT is a new potential marker for biliary tract cancer.

[The pathogenesis of biliary stone formation and its prevention in biliary tract diseases]

AIM

Elucidation of some pathogenetic mechanisms of cholelithiasis in biliary diseases.

MATERIALS AND METHODS

The examination of 45 patients suffering from gall bladder and biliary tracts lesions complicated with cholelithiasis included: measurements of bilirubin, bile acids and cholesterol in bile portions B and C; estimation of the cholatocholesterol coefficient; duodenomanometry; radioimmunoassay of thyroxine, thyrotropine, insulin, hydrocortisone and gastrin in peripheral blood.

RESULTS

A correlation was found between cholelithiasis and changes in intraduodenal pressure as well as secretion of hormones (gastrin, insulin, hydrocortisone, thyroxine, thyrotropine). Combined therapy including xenofalk and polyphepan in biliary diseases produced a good therapeutic response. Besides relief of clinical symptoms and improvement of intraduodenal pressure, positive changes were seen in bile lithogenicity.

CONCLUSION

The data obtained contribute to better understanding of cholelithiasis and planning of relevant preventive measures.

[Significance and changes of plasma endothelin in patients undergone upper abdominal surgery]

We observed the changes of plasma endothelin, hemodynamic and electrocardiogram in twelve patients undergone upper abdominal surgery under epidural anesthesia. The results showed that mean artery pressure, heart rate, cardiac output, cardiac index, systemic vascular resistance, maximum left atrial pressure, maximum ascendant speed of artery systolic pressure and mean ascendant speed of artery systolic pressure were all significantly lower during intraab-dominal exploration than that of preanesthesia (P < 0.01). Mean artery pressure and systemic vascualr resistance kept low levels to the end of operation. Plasma endothelin was significantly higher at 1 hour after skin resection than that of preanesthesia (P < 0.01) and was apparently negative related with cardiac output(CO) and cardiac index(CI) during exploration(CO r = -0.9221; CI r = -0.8768), two patients' with myocardial ischemia were specially higher. We conclude that plasma endothelin is closely related with cardiac function and myocardial ischemia during operation.

[The interrelationship of the intensity of free-radical oxidation to the level of serum bilirubin in lesions of the hepatobiliary system]

The level of lipid peroxidation (LPO) products increases in the blood of patients with chronic diseases of the liver and acute cholecystitis with mechanical jaundice. The values normalize after surgery for acute cholecystitis, whereas therapy for chronic diseases of the liver virtually does not correct them. These data demonstrate the relationship between intensity of free-radical oxidation and severity of hepatobiliary process and between plasma content of LPO products and level of serum bilirubin.

Serum interleukin 6 in the prognosis of acute biliary pancreatitis

BACKGROUND

Data concerning the interleukin 6 pattern in acute biliary pancreatitis are lacking.

AIM

To define the best cut-off point of this molecule in differentiating the severe form of acute biliary pancreatitis from the mild form and to evaluate its sensitivity, specificity and diagnostic accuracy in the prognosis of acute biliary pancreatitis in comparison with those of serum C-reactive protein.

PATIENTS

Forty-four patients with acute biliary pancreatitis: 27 patients with mild pancreatitis and 17 with the severe form of the disease.

METHODS

Serum interleukin-6 and C-reactive protein concentrations were assessed in all patients on admission and for the following 5 days.

RESULTS

Serum interleukin-6 levels were significantly higher (p < 0.02) in patients with severe acute biliary pancreatitis than in those with the mild form of the disease. No significant difference in serum C-reactive protein levels was found in the first 2 days in patients with mild biliary pancreatitis when compared to those with the severe form of the disease. Using a cut-off point of 2.7 pg/ml for serum interleukin-6 and 11 mg/dl for serum C-reactive protein, the sensitivity of the two molecules in assessing the severity of acute pancreatitis on the first day of the study was 87.5% for interleukin-6 and 6.3% for C-reactive protein, the specificity, 83.3% for interleukin-6 and 91.7% for C-reactive protein, and the accuracy 85.0% for interleukin-6 and 57.5% for C-reactive protein.

CONCLUSIONS

Serum determination of interleukin-6 in the first 24 hours of the disease is a better marker of the severity of acute biliary pancreatitis than C-reactive protein.

Prolonged decreases in plasma nitrate levels at early postoperative phase after hepato-pancreato-biliary surgery

Nitric oxide (.NO) is known to influence circulatory, neural, immunologic, and metabolic alterations. To evaluate the clinical significance of .NO production under surgical stress, serial measurements of plasma nitrite plus nitrate levels were performed in 45 surgical patients. Group A included 19 patients who underwent major surgery with uneventful postoperative courses. Group B included 18 patients who underwent laparoscopic cholecystectomy. Group C included 8 patients whose surgery was complicated by intra-abdominal abscesses. Eight healthy volunteers served as controls. Plasma nitrate levels were determined with a redox chemiluminescence .NO analyzer and coincided with measurements made by high-performance liquid chromatography (r = 0.868, p < 0.0001, 58 samples). During laparotomy, arterial nitrate levels correlated well with peripheral, portal, and hepatic venous nitrate levels (r = 0.966, 0.938, and 0.949, respectively; p < 0.0001). A significant decrease in nitrate from preoperative levels in groups A (postoperative day (POD) 1 and 3; p < 0.0005) and B (POD 1, p < 0.0001) was observed; nitrate levels in group C did not decrease for 14 days after surgery. Plasma nitrate levels in groups A and B were significantly different (POD 1 through 6, p < 0.05) and at POD 3 were significantly lower in group A (p < 0.005). Plasma nitrate levels measured before and after fasting or food intake were not significantly different. These results suggest that surgical stress leads to a decrease in the end product of .NO in the whole body, and that the greater the surgical stress the longer the duration of decreased .NO production.

[A new method for evaluating the rheological properties of the erythrocytes in surgical patients with endogenous intoxication]

An examination of 30 patients against the background of using both the operative and conservative methods of treatment was performed in order to study the rheological properties of blood and selection of the most informative tests for diagnosis of microcirculatory disturbances in diseases of the gastrointestinal tract and gastroduodenal area. The authors propose methods of investigation of deformability and viscosity of erythrocytes in patients with the surgical diseases in question. The methods are simple, quite handy for any surgical hospital and polyclinic laboratories. In addition to being used in investigations of the aggregative ability of erythrocytes and viscosity of the whole blood, these methods can be of use in express diagnosis of rheological disorders. The endogenous intoxication in patients with the diseases in question was found to be accompanied by deep rheological disturbances. The deformability of erythrocytes and their viscosity index which can pass ahead of the shifts in other parameters characterizing the hemocoagulative and rheological properties of blood are changed. A conclusion is drawn that the parameters of the erythrocyte deformability and viscosity can be an additional criteria of the adequacy of therapy used for patients with the diseases in question.

[Chemiluminescence in assessing lipid peroxidation function in patients with viral hepatitis B and concomitant involvement of the hepatobiliary system]

57 patients with viral hepatitis B (VHB) 34 to 62 years old and 43 patients suffering from VHB in the presence of chronic hepatobiliary pathologies, their age ranging between 37 to 59 years, were examined. Both groups demonstrated positive correlation between the level of spontaneous luminescence and malonic dialdegide, with the intensity of the induced chemiluminescence correlating with the level of dienic conjugates (r = +0.584; r = +0.681).

[The value of symptomatic yellowing of cytoplasm in leukocytes obtained from stomach contents in diagnosis of biliary gastritis]

Leucocyte cytoplasm is changed during long-term influence of bile in inflammation of gastric mucose. The symptom of gastric neutrophil yellow-cytoplasm has been analysed in 30-patient group after operation because of gastric peptic ulcer. The clinical usefulness is suggested in differential diagnosis of gastritis.

Measurement of serum bile acids concentrations for diagnosis of hepatobiliary disease in cats

Serum bile acid concentrations were measured after food had been withheld for 12 hours (fasting serum bile acid [FSBA] concentration) and 2 hours after a meal (post-prandial serum bile acid [PSBA] concentration) using a direct enzymatic procedure in 108 cats clinically suspected of having hepatobiliary disease. In all cats, liver tissue was examined histologically to confirm the diagnosis. Twenty-six cats did not have histologic evidence of hepatobiliary disease and served as controls. The remaining 82 cats had hepatobiliary disease including hepatic lipidosis (n = 20), portosystemic vascular anomaly (n = 24), hepatic necrosis (n =13), hepatic neoplasia (n = 8), or cholestatic hepatic disease(n = 17). Sensitivity and specificity of measuring FSBA and PSBA concentrations were calculated for each test alone and when results were interpreted in combination (ie, in series and in parallel), and were compared with sensitivity and specificity of routinely used serum biochemical tests, including measuring serum activities of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase, and measuring serum concentrations of cholesterol, BUN, and total bilirubin. When tests were considered individually, determination of FSBA and PSBA concentrations had higher specificity than did the other tests (using a cutoff of 15 mumol/L for FSBA concentration and of 20 mumol/L for PSBA concentration). Determination of PSBA concentration had the highest sensitivity of all single tests in cats with hepatic lipidosis, portosystemic vascular anomaly, or cholestasis; determination of alanine aminotransferase activity or PSBA concentration had the highest sensitivity for cats with hepatic necrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Biliary ascariasis. A case report

Ascaris lumbricoides is a worldwide intestinal infestation that may cause various complications. Biliary ascariasis, however, is a rare condition. We describe a child with biliary ascariasis. The patient's clinical symptoms were pain, vomiting and abdominal tenderness, and she was thought to have acute appendicitis. However, laboratory examination revealed high serum alkaline phosphatase and amylase levels, and ultrasonography and percutaneous cholangiography demonstrated biliary ascariasis. The patient was successfully treated with mebendazole and antispasmolytic drugs.

CA 242, a new tumour marker for pancreatic cancer: a comparison with CA 19-9, CA 50 and CEA

The serum expression of a novel tumour marker, CA 242, defined by monoclonal antibody C 242, was studied in 179 patients with pancreatic cancer. The results were compared with CA 19-9, CA 50 and CEA. CA 242 is a carbohydrate closely related, but not identical, to CA 19-9 and CA 50. The overall sensitivity of the CA 242 assay was 74%: 55% in stage I, 83% in stage II-III and 78% in stage IV disease. The specificity calculated from 112 patients with benign diseases was 91%. CA 19-9 had a higher sensitivity of 83%, but the specificity was only 81%. When comparing the markers by receiver operating characteristic analysis, the sensitivities were almost identical at all specificity levels. The CA 242 level was elevated in 7%, 15% and 7% of patients with benign pancreatic, biliary and liver disease respectively. The corresponding figures for CA 19-9 were 19%, 28% and 15% respectively. The sensitivity of CA 242 was higher than that of CA 50 and CEA at all specificity levels. In conclusion, tumour marker CA 242 seems to be a useful diagnostic tool for the diagnosis of pancreatic cancer, and is an alternative to CA 19-9. The advantage of CA 242 over CA 19-9 is its higher specificity when using the recommended cut-off levels of the assays.

A de-sialylated isoform of serum 5'-nucleotidase: clinical and biological significance in hepatobiliary disease

Using an electrophoretic technique on cellulose acetate, three multiple forms of the 5'-nucleotidase (5'NU) with mobilities alpha 1, alpha 2, and beta appear in the serum of healthy subjects. The difference between the alpha 1 and alpha 2 isoforms lies in their sialylation degree, the alpha 2-5'NU being a de-sialylated form. In 147 patients with different hepatobiliary diseases the alpha 2 isoform was present in only 19% of cases, and there was no significant difference in the activity of total 5'NU, alpha 1-5'NU and beta-5'NU between patients with or without alpha 2-5'NU, alpha 1-5'NU and beta-5'NU (P < 0.001), as with other biochemical indicators of liver damage. It is suggested that in hepatobiliary diseases an increase of the sialylation of serum 5'NU occurs, which would explain the absence of the desialylated alpha 2 isoform in the majority of cases. However, the decrease of hepatic receptors of asialoglycoproteins would lead to an increase of this de-sialylated isoform in the serum of certain patients.

Evaluation of an immunoradiometric assay for bone alkaline phosphatase mass concentration in human sera

The performance characteristics of an immunoradiometric assay for bone alkaline phosphatase mass concentration in human sera are reported. Within-run imprecision (n = 20) was 12.1% (mean = 7.8 micrograms/l) and 3.6% (mean = 22.8 micrograms/l), between-day imprecision (n = 8) was 10.1% (mean = 20.3 micrograms/l) and 2.8% (mean = 84.3 micrograms/l). There was a linear relationship between the concentrations of the standards employed and the counts per minute up to 120 micrograms/l. The detection limit was 0.3 micrograms/l. In 102 apparently healthy persons (51 males and 51 females; range of age: 18-56 years) the following reference intervals were established: 3.8-21.3 micrograms/l (males) and 3.4-15.0 micrograms/l (females). We compared the values obtained using the immunoassay with those obtained by precipitating of bone alkaline phosphatase with wheat-germ lectin (alkaline phosphatase activity concentration was determined at + 25 degrees C by the optimized standard method according to the Recommendations of the German Society for Clinical Chemistry). For the reference individuals the relationship between the results of the two methods is given by the following regression equation: Bone alkaline phosphatase activity concentration [U/l] = 14.81 + 3.28 x bone alkaline phosphatase mass concentration [micrograms/l] (r = + 0.783). In 89 sera from 32 patients before and after renal transplantation (range of bone alkaline phosphatase mass concentration: 2-39 micrograms/l) comparison between the two methods yielded a linear correlation coefficient of r = + 0.886.(ABSTRACT TRUNCATED AT 250 WORDS)

HPLC assay of conjugated bile acids in human fluids using on-line sample pretreatment on a standard isocratic chromatograph

A rapid and simple on-line purification procedure was developed for determining the conjugated bile acids in human fluids by high-performance liquid chromatography (HPLC). Biological samples were diluted and directly injected without further treatment onto a pre-column dry-packed with 40-microns octadecylsilica and installed at the injector loop position. After washing the pre-column with 40% methanol in acetate buffer and then with water, the retained compounds were back-flushed by the mobile phase onto the analytical column during the normal course of chromatography. The method was found to be accurate and reproducible. The levels of conjugated bile acids in serum, duodenal bile and gastric juice from patients with hepatobiliary and gastric diseases were determined by on-line pre-column clean-up and reversed-phase HPLC.

High performance liquid chromatographic determination of individual bile acids in serum for automatic diagnosis of various liver and biliary diseases

A reversed phase high performance liquid chromatographic method for the high sensitivity determination of individual bile acids in serum using a C18 column with a ternary solvent system combined with fluorometric techniques using immobilized enzymes is described. A computer-assisted diagnosis system using pattern recognition was developed to assist the clinical diagnosis of various liver and biliary diseases. A total consistency rate of 95% can be reached using this system.