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Tai M, Chen L, He Y, Wang F, Tian Z. Ultrasonographic evaluation of the gallbladder motor function in the diagnosis and prognosis of intrahepatic cholestasis of pregnancy. BMC Pregnancy Childbirth 2024; 24:17. [PMID: 38166795 PMCID: PMC10759328 DOI: 10.1186/s12884-023-06209-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Intrahepatic cholestasis of pregnancy (ICP) is characterized by skin pruritus, elevated liver enzymes, and increased serum total bile acids. Several previous studies have revealed that the fasting and ejection volumes of the gallbladder in cholestasis of pregnancy are greater than those in normal pregnancy. The goal of this study was to explore the gallbladder volume and evaluate the diagnostic and prognostic value of ultrasound in ICP. METHODS We prospectively recruited a cohort of 60 ICP patients at the First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China from January 2020 to December 2021 and compared their data with those from healthy pregnant women (n = 60). The gallbladder volume was evaluated by real-time ultrasound examination after overnight fasting and at 30, 60, 120, and 180 min after a liquid test meal of 200 mL, and the ejection fraction was calculated. Continuous data between two groups were compared by Student's t test. Differences were considered significant for p < 0.05. The diagnostic and prognostic value of the volume and ejection function of the gallbladder was analyzed by the receiver operating characteristic (ROC) curve. RESULTS The ICP group had significantly higher gallbladder basal volume (43.49 ± 1.34 cm3 vs. 26.66 ± 0.83 cm3, p < 0.01) and higher ejection fraction compared with the healthy group. The ejection fraction higher than 54.55% at 120 min might predict ICP diagnosis with 96.67% sensitivity and 88.33% specificity, and an AUC of 0.9739 (95% CI 0.9521-0.9956), while the gallbladder volume higher than 12.52 cm3 at 60 min might predict ICP severity with 59.18% sensitivity and 72.73% specificity, and an AUC of 0.7319 (95% CI 0.5787-0.8852). CONCLUSION Our results indicate abnormal volume and ejection function of the gallbladder in patients with ICP. The ejection fraction at 120 min can assist in the diagnosis if ICP exists, and the gallbladder volume at 60 min may assess the degree of severity of ICP.
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Affiliation(s)
- Minghui Tai
- Department of Ultrasound, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an City, Shaanxi province, 710061, China
| | - Long Chen
- Department of Ultrasound Medicine, Baoji High-Tech Hospital, Baoji, Shaanxi province, China
| | - Yajuan He
- Department of Ultrasound, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an City, Shaanxi province, 710061, China
| | - Fei Wang
- Department of Ultrasound, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an City, Shaanxi province, 710061, China.
| | - Zhen Tian
- Department of Ultrasound, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an City, Shaanxi province, 710061, China.
- Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an City, Shaanxi province, China.
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Kim WJ, Park PJ, Choi SB, Kim WB. Case report of pure single-port robotic left lateral sectionectomy using the da Vinci SP system. Medicine (Baltimore) 2021; 100:e28248. [PMID: 34941098 PMCID: PMC8701933 DOI: 10.1097/md.0000000000028248] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/25/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Since its first appearance in the early 1990s, laparoscopic hepatic resection has become increasingly accepted and recognized as safe as laparotomy. The recent introduction of robotic surgery systems has brought new innovations to the field of minimally invasive surgery, such as laparoscopic surgery. The da Vinci line of surgical systems has recently released a true single-port platform called the da Vinci SP system, which has 3 fully wristed and elbowed instruments and a flexible camera in a single 2.5 cm cannula. We present the first case of robotic liver resection using the da Vinci SP system and demonstrate the technical feasibility of this platform. PATIENT CONCERNS AND DIAGNOSIS A 63-year-old woman presented with elevated liver function test results and abdominal pain. Computed tomography (CT) and magnetic resonance cholangiopancreatography showed multiple intrahepatic duct stones in the left lateral section and distal common bile duct stones near the ampulla of Vater. INTERVENTIONS The docking time was 8 minute. The patient underwent successful da Vinci SP with a total operation time of 135 minute. The estimated blood loss was 50.0 ml. No significant intraoperative events were observed. OUTCOMES The numerical pain intensity score was 3/10 in the immediate postoperative period and 1/10 on postoperative day 2. The patient was discharged on postoperative day 5 after verifying that the CT scan did not show any surgical complications. CONCLUSION We report a technique of left lateral sectionectomy, without the use of an additional port, via the da Vinci SP system. The present case suggests that minor hepatic resection is technically feasible and safe with the new da Vinci SP system in select patients. For the active application of the da Vinci SP system in hepatobiliary surgery, further device development and research are needed.
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Affiliation(s)
- Wan-Joon Kim
- Division of Hepatobiliary Pancreas Surgery, Department of Surgery, Korea University Guro Hospital, Korea University Medical College, Seoul, Korea
| | - Pyoung-Jae Park
- Division of Transplantation Vascular Surgery, Department of Surgery, Korea University Guro Hospital, Korea University Medical College, Seoul, Korea
| | - Sae-Byeol Choi
- Division of Hepatobiliary Pancreas Surgery, Department of Surgery, Korea University Guro Hospital, Korea University Medical College, Seoul, Korea
| | - Wan-Bae Kim
- Division of Hepatobiliary Pancreas Surgery, Department of Surgery, Korea University Guro Hospital, Korea University Medical College, Seoul, Korea
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Bucher JN, Hollenbach M, Strocka S, Gaebelein G, Moche M, Kaiser T, Bartels M, Hoffmeister A. Segmental intrahepatic cholestasis as a technical complication of the transjugular intrahepatic porto-systemic shunt. World J Gastroenterol 2019; 25:6430-6439. [PMID: 31798279 PMCID: PMC6881513 DOI: 10.3748/wjg.v25.i43.6430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/25/2019] [Accepted: 11/07/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Segmental intrahepatic cholestasis caused by transjugular intrahepatic portosystemic shunt (TIPS) (SIC-T), is a rare complication of this technique and only referred by case reports. Thus, we conducted a systematic, retrospective analysis to provide evidence regarding prevalence and consequences of this TIPS-induced bile duct compression.
AIM To assess prevalence and outcome of SIC-T in a large TIPS-cohort.
METHODS In this retrospective cohort study, we screened the institutional databases for all consecutive patients that were treated by TIPS-placement or TIPS-revision between January 2005 and August 2013. We analyzed radiologic images for signs of biliary congestion. Cases that were indicative of SIC-T were reviewed by two independent radiologists and additional patient data was collected. Descriptive statistics of patient demographics, indications for TIPS and procedural details were registered. Logistic regression analysis was performed to identify predictors for the development of SIC-T.
RESULTS We analyzed 135 cirrhotic patients who underwent TIPS (mean age 55 years, 79% male gender). Etiology of cirrhosis was alcohol in most cases and indications for TIPS were mainly refractory ascites and recurrent variceal bleeding. TIPS revision was necessary in 31 patients. We identified 4 cases (2.9%) of SIC-T in direct proximity of the TIPS-stent. Diagnosis was confirmed by CT-scan, MRI or endoscopic retrograde cholangio pancreaticography (ERCP). In two patients TIPS was implanted via the right and in one through the medial hepatic vein. One patient received TIPS-prolongation by multiple revisions. Most patients were asymptomatic but one cholangitic abscess necessitated a transhepatic drain. Logistic regression analysis identified TIPS-placement other than from medial hepatic vein to right portal vein as risk factor (OR 21.0) for SIC-T.
CONCLUSION SIC-T ads to (mostly late) complications in the interventional treatment of cirrhotic portal hypertensions and can lead to cholangitic abscesses. Patients, particularly with multiple interventions, should be screened for SIC-T.
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Affiliation(s)
- Julian Nikolaus Bucher
- Department of Surgery, Munich University Hospital at Großhadern, Bavaria, Munich 81377, Germany
| | - Marcus Hollenbach
- Medical Department II–Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, University of Leipzig Medical Center, Saxony, Leipzig 04103, Germany
| | - Steffen Strocka
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, Saxony, Leipzig 04103, Germany
| | - Gereon Gaebelein
- Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, Saarland, Homburg 66421, Germany
| | - Michael Moche
- Department of Diagnostic and Interventional Radiology, Bavaria, Nuernberg 90411, Germany
| | - Thorsten Kaiser
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig Medical Center, Saxony, Leipzig 04310, Germany
| | - Michael Bartels
- Department for General and Visceral Surgery, Helios Park-Klinikum Leipzig, Saxony, Leipzig 04289, Germany
| | - Albrecht Hoffmeister
- Medical Department II–Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, University of Leipzig Medical Center, Leipzig 04103, Saxony, Germany
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Aselmann H, Egberts JH, Beckmann JH, Stein H, Schafmayer C, Hinz S, Reichert B, Becker T. [Robotic pylorus-preserving pancreaticoduodenectomy : Video article]. Chirurg 2018; 88:411-421. [PMID: 28451729 DOI: 10.1007/s00104-017-0414-3] [Citation(s) in RCA: 6] [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] [Indexed: 01/07/2023]
Abstract
Pylorus-preserving pancreaticoduodenectomy is one of the most complex procedures in general surgery. Laparoscopic pancreaticoduodenectomy was initially described in 1994; however, its worldwide distribution is so far limited to only a few specialist centers. Robotic surgery using the DaVinci® system can overcome many limitations of laparoscopic surgery. The system is a promising tool for a more widespread introduction of minimally invasive surgery for pancreatic diseases. Mortality rates of 0-5% and pancreatic fistula rates of 0-35% are described in the literature; therefore, thorough complication management is crucial in the postoperative course. The video presents a robotic pylorus-preserving pancreaticoduodenectomy for periampullary carcinoma in a female patient.
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Affiliation(s)
- H Aselmann
- Klinik für Allgemeine, Viszeral- Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
| | - J Hendrik Egberts
- Klinik für Allgemeine, Viszeral- Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
| | - J Henrik Beckmann
- Klinik für Allgemeine, Viszeral- Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
| | - H Stein
- Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - C Schafmayer
- Klinik für Allgemeine, Viszeral- Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
| | - S Hinz
- Klinik für Allgemeine, Viszeral- Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
| | - B Reichert
- Klinik für Allgemeine, Viszeral- Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
| | - T Becker
- Klinik für Allgemeine, Viszeral- Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
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Hong JB, Kang DH, Nam HS, Choi CW, Kim HW, Park SB, Kim SJ, Choi WH. Endoscopic reintervention for stent malfunction after stent-in-stent deployment for malignant hilar obstruction. Medicine (Baltimore) 2017; 96:e8867. [PMID: 29310368 PMCID: PMC5728769 DOI: 10.1097/md.0000000000008867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 12/19/2022] Open
Abstract
Endoscopic bilateral stenting has been increasingly performed for advanced hilar obstruction. As disease progresses, stent malfunction eventually occurs. However, endoscopic reintervention is difficult in these patients. We aimed to evaluate a suitable reintervention procedure for stent malfunction after stent-in-stent (SIS) deployment for malignant hilar obstruction.Among 52 patients with bilateral stenting performed using the SIS method between September 2009 and June 2016, 20 patients with stent malfunction were enrolled in this study. Reintervention was performed endoscopically or percutaneously. Technical and functional success rates were evaluated retrospectively.Technical and functional success rates of endoscopic reintervention were 83% (10/12) and 80% (8/10), respectively. Endoscopic bilateral and unilateral reintervention success rates were 75% (6/8) and 100% (4/4), respectively. For bilateral reintervention, either plastic or plastic and metal stents were used.Endoscopic reintervention could be considered for in-stent malfunction if patients are in fair condition after SIS placement for malignant hilar obstruction. Decisions regarding whether to use bilateral or unilateral drainage and the type of stent to use should depend on the conditions of the disease and the patient.
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Yakar T, Demir M, Gokturk HS, Unler Kanat AG, Parlakgumus A, Ozer B, Serin E. Nasobiliary Drainage for Benign Recurrent Intrahepatic Cholestasis in Patients Refractory to Standard Therapy. CLIN INVEST MED 2016; 39:27522. [PMID: 27917812] [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] [Received: 12/01/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Benign recurrent intrahepatic cholestasis (BRIC) is characterized by episodic cholestasis and pruritus without anatomical obstruction. The aim of this study was to evaluate the safety and efficacy of nasobiliary drainage (NBD) in patients with BRIC refractory to medical therapy and to determine whether the use of NBD prolongs the episode duration. METHODS This was a multicenter retrospective study consisting of 33 patients suffering from BRIC. All patients were administrated medical treatment and 16 patients who were refractory to standard medical therapies improved on treatment with temporary endoscopic NBD. Duration of treatment response and associated complications were analyzed. RESULTS Sixteen patients (43% females) underwent 25 NBD procedures. The median duration of NBD was 17 days. There were significant improvements in total and direct bilirubin and alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and gamma-glutamyl transpeptidase on the 3rd day of NBD. Longer clinical remission was monitored in the NBD group. Post-endoscopic retrograde cholangiopancreatography pancreatitis was observed in one of 16 cases. CONCLUSION NBD effectively eliminates BRIC in all patients and improves biomarkers of cholestasis. It can be suggested that patients with attacks of BRIC can be treated with temporary endoscopic NBD; however, the results of this study should be confirmed by prospective studies in the future.
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Park JS, Ko JS, Seo JK, Moon JS, Park SS. Clinical and ABCB11 profiles in Korean infants with progressive familial intrahepatic cholestasis. World J Gastroenterol 2016; 22:4901-4907. [PMID: 27239116 PMCID: PMC4873882 DOI: 10.3748/wjg.v22.i20.4901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 01/19/2016] [Revised: 02/29/2016] [Accepted: 03/14/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate clinical profiles and mutations of ABCB11 in Koreans with progressive familial intrahepatic cholestasis 2 and review the differences between Koreans and others.
METHODS: Of 47 patients with neonatal cholestasis, five infants had chronic intrahepatic cholestasis with normal γ-glutamyl transpeptidase. Direct sequencing analyses of ABCB11, including exons and introns, were performed from peripheral blood.
RESULTS: Living donor-liver transplantation was performed in four patients because of rapidly progressive hepatic failure and hepatocellular carcinoma. Three missense mutations were found in two patients: compound heterozygous 677C>T (S226L)/3007G>A (G1003R) and heterozygous 2296G>A (G766R). The mutations were located near and in the transmembranous space.
CONCLUSION: Alterations in the transmembrane of the bile salt export pump in the Korean infants were different from those previously reported in Chinese, Japanease, Taiwanese, and European patients.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 11
- ATP-Binding Cassette Transporters/genetics
- Asian People/genetics
- Biopsy
- Carcinoma, Hepatocellular/diagnostic imaging
- Carcinoma, Hepatocellular/ethnology
- Carcinoma, Hepatocellular/genetics
- Cholestasis, Intrahepatic/diagnostic imaging
- Cholestasis, Intrahepatic/ethnology
- Cholestasis, Intrahepatic/genetics
- Cholestasis, Intrahepatic/surgery
- DNA Mutational Analysis
- Disease Progression
- Female
- Gallstones/diagnostic imaging
- Gallstones/ethnology
- Gallstones/genetics
- Genetic Association Studies
- Genetic Predisposition to Disease
- Heterozygote
- Humans
- Infant
- Infant, Newborn
- Liver Transplantation/methods
- Living Donors
- Male
- Microscopy, Electron
- Mutation, Missense
- Phenotype
- Prognosis
- Republic of Korea
- Retrospective Studies
- Tomography, X-Ray Computed
- Ultrasonography
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Zou SJ, Chen D, Li YZ, Du DF, Chen ZS, Zhu XH. Monitoring Hepatocyte Dysfunction and Biliary Complication After Liver Transplantation Using Quantitative Hepatobiliary Scintigraphy. Medicine (Baltimore) 2015; 94:e2009. [PMID: 26559297 PMCID: PMC4912291 DOI: 10.1097/md.0000000000002009] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The significance of hepatobiliary scintigraphy (HBS) for hepatic graft function assessment was established mostly on retrospective studies and was not widely recognized due to the lack of quantitative data and variation in accuracy. This prospective study was performed to investigate the effectiveness of quantitative HBS for assessing hepatocyte dysfunction and biliary complication in liver transplant recipients.In 57 recipients who had undergone orthotopic liver transplantation, a total of 67 dynamic Tc-EHIDA scans were performed and quantitative parameters including the hepatocyte extraction fraction (HEF), time to maximum hepatic radioactivity (Tmax), and time for peak activity to decrease by 50% (T1/2) were calculated. The scintigraphic results based on the 3 parameters were compared against the final diagnosis. A ROC curve analysis was carried out to identify the cutoff value of Tmax for diagnosis of biliary stricture. Correlation between the parameters of postoperative HBS and conventional biochemical liver function indices were also analyzed.Quantitative Tc-EHIDA HBS had an overall sensitivity of 94.12% (16/17), specificity of 93.33% (42/45), and diagnostic accuracy of 93.55% (58/62) for detecting hepatocyte dysfunction and biliary complication in liver transplant recipients. The recommended cutoff value of Tmax for diagnosis of post-transplant biliary stricture was set at 15.75 min with a sensitivity of 100.0% and a specificity of 94.0%. The scintigraphic parameters (HEF, Tmax) were statistically significantly associated with the conventional liver function parameters.Quantitative Tc-EHIDA HBS offers a noninvasive imaging modality with high sensitivity and specificity to diagnose hepatocyte dysfunction as well as distinguish between patients with or without biliary stricture following liver transplantation. Furthermore, HEF and Tmax values obtained from dynamic HBS show good correlation with conventional liver function parameters.
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Affiliation(s)
- Si-Juan Zou
- From the Department of Nuclear Medicine (SJZ, YZL, XHZ); and Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (DC, DFD, ZSC)
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Lee JM, Lee SH, Chung KH, Park JM, Paik WH, Woo SM, Lee WJ, Ryu JK, Kim YT. Small cell- versus large cell-sized metal stent in endoscopic bilateral stent-in-stent placement for malignant hilar biliary obstruction. Dig Endosc 2015; 27:692-9. [PMID: 25708157 DOI: 10.1111/den.12466] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 02/16/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Although the large cell-sized biliary stent facilitates contralateral stent deployment through the mesh of the first metallic stent for stent-in-stent (SIS) technique, there are concerns about its vulnerability to tumor ingrowth. The aim of the present study was to compare the clinical outcomes of endoscopic bilateral SIS placement according to the cell size of a self-expandable metallic stent (SEMS). METHODS A total of 58 patients were enrolled who underwent endoscopic bilateral SIS placement of SEMS for malignant hilar biliary obstruction as a result of cholangiocarcinoma or gallbladder cancer. Finally, 43 patients who underwent successful stent insertion were included in the analysis and divided into the small cell-sized stent (SCS; n = 21) and the large cell-sized stent (LCS; n = 22) groups. We retrospectively compared comprehensive clinical and laboratory data in both groups. RESULTS There were no significant differences between the two groups in successful drainage (SCS vs LCS, 100% vs 100%, respectively), early complications (38.1% vs 18.2%), late complications (14.3% vs 22.7%), stent occlusion (42.9% vs 45.5%), tumor ingrowth (33.3% vs 45.5%) or overgrowth (9.5% vs 0%). Duration of stent patency and overall survival were not significantly different between the two groups (P = 0.086 and P = 0.320, respectively). CONCLUSIONS Endoscopic bilateral SIS placement for malignant hilar biliary obstruction shows no differences in stent patency, survival, complications and clinical course according to the cell size of SEMS.
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Affiliation(s)
- Jae Min Lee
- Departments of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Sang Hyub Lee
- Departments of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Kwang Hyun Chung
- Departments of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jin Myung Park
- Department of Internal Medicine, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Woo Hyun Paik
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sang Myung Woo
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Woo Jin Lee
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Ji Kon Ryu
- Departments of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Yong-Tae Kim
- Departments of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
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Liu X, Miao X, Liu X, Zhong D, Yao H, Wen Y, Dai W, Liu G. Laparoscopic left hemihepatectomy for treatment of left intrahepatic duct stones. Am Surg 2014; 80:E350-E351. [PMID: 25513906] [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: 06/04/2023]
Affiliation(s)
- Xiangfeng Liu
- Department of General Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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11
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Pfeifer L, Strobel D, Neurath MF, Wildner D. Liver stiffness assessed by acoustic radiation force impulse (ARFI) technology is considerably increased in patients with cholestasis. Ultraschall Med 2014; 35:364-367. [PMID: 24824763 DOI: 10.1055/s-0034-1366057] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To explore the impact of cholestasis on liver stiffness assessed by acoustic radiation force impulse (ARFI) technology. MATERIALS AND METHODS Over a period of four months, patients with sonographic cholestasis and increased cholestatic blood values (Bilirubin, γGT, AP > 2 times ULN) scheduled for endoscopic therapy were recruited. Exclusion criteria were: known liver disease; signs of cirrhosis at ultrasound (irregular liver veins and/or surface); heart insufficiency (NYHA III-VI). ARFI (Siemens S2000), ultrasound and blood examinations were performed before and in a subgroup after successful biliary drainage. RESULTS In total, 21 patients with cholestasis were included in the study. ARFI measurements were above the cut-off for cirrhosis (1.8 m/s) in all patients with a mean of 2.91 m/s ± 0.89 m/s without a history or signs of cirrhosis. Bilirubin, γGT and AP were elevated on average to 9.7 ± 5.3 mg/dl, 1192 ± 960 U/l and 730 ± 389 U/l. A subgroup of 10 patients was measured after successful drainage. ARFI measurements declined in all patients of that subgroup on average by 0.76 m/s at a mean time interval of 4.5 days (p < 0.001). CONCLUSION Cholestasis significantly increases liver stiffness assessed by ARFI. Therefore, it is important to exclude profound cholestasis when using ARFI for evaluating patients for liver fibrosis.
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Affiliation(s)
- L Pfeifer
- Departement of Internal Medicine 1, University of Erlangen
| | - D Strobel
- Departement of Internal Medicine 1, University of Erlangen
| | - M F Neurath
- Departement of Internal Medicine 1, University of Erlangen
| | - D Wildner
- Departement of Internal Medicine 1, University of Erlangen
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Fan X, Zhou Q, Zeng S, Zhou J, Peng Q, Zhang M, Ding Y. Impaired fetal myocardial deformation in intrahepatic cholestasis of pregnancy. J Ultrasound Med 2014; 33:1171-1177. [PMID: 24958403 DOI: 10.7863/ultra.33.7.1171] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To investigate changes in fetal myocardial deformation in intrahepatic cholestasis of pregnancy. METHODS Patients with intrahepatic cholestasis of pregnancy were divided into 2 groups according to the total maternal serum bile acid concentration: mild cholestasis (10-40 μmol/L) and severe cholestasis (>40 μmol/L). Fetal echocardiography and velocity vector imaging were performed on women with cholestasis and control patients. The left ventricular global longitudinal strain and strain rate were measured. Clinical characteristics, maternal serum bile acid levels, and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in umbilical vein blood were compared between groups. The relationships among fetal myocardial deformation, maternal total bile acids, and cord NT-proBNP were analyzed. RESULTS Twenty women with mild cholestasis, 20 with severe cholestasis, and 40 control patients were enrolled. There were no significant differences in maternal and gestational ages between the case and control groups. Maternal bile acids and NT-proBNP were significantly higher in fetuses of mothers with cholestasis than control fetuses. The left ventricular longitudinal strain (-10.56% ± 1.83% versus -18.36% ± 1.11%; P < .01), systolic strain rate (-1.63 ± 0.18 versus -2.04 ± 0.18 secondsz(-1); P < .01), and diastolic strain rate (1.37 ± 0.18 versus 1.83 ± 0.14 seconds(-1); P < .01) were significantly decreased in fetuses with severe cholestasis compared with control fetuses. There were positive correlations between fetal myocardial deformation and maternal total bile acids (r = 0.705, 0.643, and 0.690, respectively; P < .01) and between myocardial deformation and NT-proBNP (r = 0.672, 0.643, and 0.647; P < .01). CONCLUSIONS Fetal myocardial deformation is impaired in severe intrahepatic cholestasis of pregnancy. Further investigation is needed to determine whether fetal echocardiography and velocity vector imaging can help predict which fetuses of mothers with cholestasis are likely to have poor outcomes.
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Affiliation(s)
- Xuemei Fan
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
| | - Qichang Zhou
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China.
| | - Shi Zeng
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
| | - Jiawei Zhou
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
| | - Qinghai Peng
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
| | - Ming Zhang
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
| | - Yiling Ding
- Departments of Ultrasonography (X.F., Q.Z., S.Z., J.Z., Q.P., M.Z.) and Obstetrics and Gynecology (Y.D.), Second Xiangya Hospital, Central South University, Changsha, China
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13
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Paik WH, Park DH, Choi JH, Choi JH, Lee SS, Seo DW, Lee SK, Kim MH, Lee JB. Simplified fistula dilation technique and modified stent deployment maneuver for EUS-guided hepaticogastrostomy. World J Gastroenterol 2014; 20:5051-9. [PMID: 24803818 PMCID: PMC4009540 DOI: 10.3748/wjg.v20.i17.5051] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [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: 11/21/2013] [Revised: 01/05/2014] [Accepted: 02/17/2014] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the success rates, procedural time and adverse event rates of the modified methods in endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS). METHODS Twenty-eight patients in a prospective case series who underwent EUS-HGS (phase I). Forty-six patients in a matched case-control study (phase II). The simplified technique for fistula dilation was the primary use of a 4 mm balloon catheter with a stainless steel stylet. The stent deployment was modified by deploying the metal stent inside a bile duct (half of the stent) under EUS and fluoroscopic guidance and gently pulling the echoendoscope after full deployment of the stent inside the echoendoscope channel (remaining portion of the stent) under fluoroscopic guidance. This cohort was compared with a matched historical cohort. RESULTS In phase I, the technical and clinical success with the modified method was 96% (27/28) and 89% (24/27 as per-protocol analysis). The overall adverse event rate was 7%. In phase II, there was no difference in technical and clinical success, stent patency and overall adverse events in each group. However, the procedural time (15.3 ± 5.2 min vs 22.3 ± 6.0 min, P < 0.001) and early adverse events (0% vs 26%, P = 0.02) were statistically improved in case cohort compared with control cohort. CONCLUSION Compared with the conventional EUS-HGS technique, the procedural time was shorter and early adverse events were less frequent with our simplified and modified technique.
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14
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Schwarzenbach HR. [Jaundice and pathological liver values]. Praxis (Bern 1994) 2013; 102:727-729. [PMID: 23735764 DOI: 10.1024/1661-8157/a001333] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Jaundice corresponds to elevated bilirubin- levels, whereat one has to distinguish between direct and indirect serum-bilirubin. In the present Mini Review causes and differential diagnosis of jaundice are outlined. Ultrasound-diagnostic plays a major role in identifying intrahepatic or extrahepatic jaundice. Attention is given to the differential diagnosis of elevated liver enzymes in presence of jaundice, pointing out the distinction between hepatocellular and cholestatic parameters as well as the differentiation in acute or chronic increase. Moreover, the consequences of liver enzyme elevations including further diagnostic procedures, are highlighted. Finally, possibilities and limitations of modern diagnostic tests for liver fibrosis are briefly overviewed.
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15
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Dhir V, Vivekanandarajah S, Bhandari S, Bapat M, Maydeo A. Endoscopic ultrasound-guided cholangiography and intraluminal needle puncture through a tight subhilar bile duct stricture for biliary stenting following failed ERCP. Endoscopy 2013; 45 Suppl 2 UCTN:E5-6. [PMID: 23468154 DOI: 10.1055/s-0032-1326121] [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] [Indexed: 02/08/2023]
Affiliation(s)
- V Dhir
- Institute of Advanced Endoscopy, Mumbai, India.
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16
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Arnell H, Fischler B, Bergdahl S, Schnell PO, Jacobsson H, Nemeth A. Hepatobiliary scintigraphy during cholestatic and noncholestatic periods in patients with progressive familial intrahepatic cholestasis after partial external biliary diversion. J Pediatr Surg 2011; 46:467-72. [PMID: 21376194 DOI: 10.1016/j.jpedsurg.2010.09.042] [Citation(s) in RCA: 8] [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: 05/12/2010] [Revised: 09/15/2010] [Accepted: 09/16/2010] [Indexed: 12/29/2022]
Abstract
BACKGROUND The purpose of the study was to determine the distribution of excreted bile during cholestatic periods and in remission in patients with progressive familial intrahepatic cholestasis (PFIC) after surgery with partial external biliary diversion (PEBD), using hepatobiliary scintigraphy. METHODS Using intravenously administered technetium Tc 99m-labeled mebrofenin, the distribution of bile during periods of biochemical cholestasis and in remission was investigated in patients with PFIC operated with PEBD. Stomal bile, urine, and feces from the patients were collected during 24 hours after administration of technetium Tc 99m-labeled mebrofenin; and the fractions of remaining radioactivity in the 3 compartments and the remaining isotopic activity in the body were quantified using scintigraphy. RESULTS Nine patients (4 boys and 5 girls) were studied. The median age was 13 (range, 5-24) years, and they had been operated with PEBD at a median time of 10 (range, 4-14) years before entering the study. Thirteen scintigraphic examinations were analyzed: 8 during noncholestatic remission (n = 7 patients) and 5 during cholestasis (n = 3 patients). The patients studied during remission discharged a significantly larger fraction of isotopic activity through the stoma (median, 90% vs 22%; P < .05) and a significantly lower fraction through the urine (median, 2.5% vs 15%; P < .05) compared with the patients studied during cholestasis. CONCLUSION Hepatobiliary scintigraphy could detect substantial differences in the output of bile. Further studies are needed to determine whether these differences may explain the mechanism of the PEBD operation or merely are secondary to the degree of cholestasis.
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Affiliation(s)
- Henrik Arnell
- Division of Pediatrics, CLINTEC, Karolinska Institutet, Karolinska University Hospital, Huddinge and Solna, Stockholm, Sweden.
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17
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Strehlow SL, Pathak B, Goodwin TM, Perez BM, Ebrahimi M, Lee RH. The mechanical PR interval in fetuses of women with intrahepatic cholestasis of pregnancy. Am J Obstet Gynecol 2010; 203:455.e1-5. [PMID: 20684945 DOI: 10.1016/j.ajog.2010.05.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [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: 12/23/2009] [Revised: 03/23/2010] [Accepted: 05/19/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the fetal mechanical PR interval in intrahepatic cholestasis of pregnancy (ICP). STUDY DESIGN Fetal echocardiography was performed for women with ICP and control subjects. Clinical characteristics, total bile acids, and liver profile tests were compared between groups. RESULTS Fourteen women with ICP and 7 control subjects were enrolled. Total bile acids (28.3 vs 6.2 μmol/L; P < .001), aspartate aminotransferase (53 vs 23 IU/L; P = .002), alanine aminotransferase (63 vs 19 IU/L; P = .002), and the PR interval (124 vs 110 msec; P = .006) were significantly higher in fetuses with ICP than in control fetuses. On multivariable linear regression analysis, only the presence of ICP was associated significantly with an increase in the PR interval (95% confidence interval, 4-24 msec; P = .01). CONCLUSION The fetal cardiac conduction system is altered in ICP. Further investigation is needed to determine whether fetal echocardiography can help to predict which fetuses are at risk for death that is associated with ICP.
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Affiliation(s)
- Stacy L Strehlow
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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18
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Zhang K, He J, Dong M. Relationship between umbilical artery Doppler waveform analysis and perinatal prognosis in women with intrahepatic cholestasis of pregnancy. Int J Gynaecol Obstet 2010; 111:187-8. [PMID: 20705289 DOI: 10.1016/j.ijgo.2010.06.012] [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] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 06/17/2010] [Accepted: 07/14/2010] [Indexed: 01/16/2023]
Affiliation(s)
- Ke Zhang
- Women's Hospital, School of Medicine, Zhejiang University, China
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19
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Pan W, Xu E, Fang H, Deng M, Xu R. Surgical treatment of complicated hepatolithiasis using the ultrasound-guided fiberoptic choledochoscope. Surg Endosc 2010; 25:497-502. [PMID: 20614140 DOI: 10.1007/s00464-010-1200-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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: 12/02/2009] [Accepted: 05/23/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND The residual stones of postsurgical intrahepatic calculi have been among the most difficult problems in hepatobiliary surgery. Intraoperative ultrasound can clearly display the morphology of intrahepatic bile ducts and the distribution of calculi as well as the position of the choledochoscope and the calculus extraction instruments. Therefore, intraoperative ultrasound can guide the choledochoscope and its auxiliary equipment for calculus extraction. It is necessary to evaluate the effectiveness and safety of surgeries using an ultrasound-guided fiberoptic choledochoscope for the treatment of complicated hepatolithiasis. METHODS The 56 cases in group A were selected from patients who had complicated hepatolithiasis treated with calculus extraction therapy using an ultrasound-guided fiberoptic choledochoscope in the authors' hospital between January 2006 and June 2009. The 63 cases of complicated hepatolithiasis in group B were chosen from patients treated with calculus extraction surgeries using a fiberoptic choledochoscope without the guidance of ultrasound from September 2001 through December 2005. Transabdominal ultrasound, T-tube cholangiography, and computed tomography (CT) examination were performed on day 15 after the surgery to compare the complete stone clearance rate, the residual stone rate, and the incidence rate of postoperative complications between groups A and B. RESULTS The intrahepatic calculi were completely removed in 53 group A cases. The complete stone clearance rate was 94.6%, and the residual stone clearance rate was 5.4%. In group B, 51 cases had complete stone removal, for a stone clearance rate of 81% and a residual stone rate of 19%. The difference in the residual stone rates between the two groups is statistically significant (p=0.025). No hemobilia, biliary perforation, or other complications were observed in either group. CONCLUSION Use of the intraoperative ultrasound-guided fiberoptic choledochoscope in the treatment of complicated hepatolithiasis can significantly reduce the residual stone rate of intrahepatic biliary calculi and significantly improve the treatment effect of hepatolithiasis.
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Affiliation(s)
- Weidong Pan
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.
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20
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Thomas BW, Maxwell RA, Dyer A, Dart BW, Smith PW. Unusual sequelae of blunt liver injury: laparoscopic resection of a liver abscess and stent failure of an ischemic common bile duct stricture. Am Surg 2010; 76:E69-E70. [PMID: 21683000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
MESH Headings
- Accidents, Traffic
- Adult
- Bile Ducts, Intrahepatic/diagnostic imaging
- Bile Ducts, Intrahepatic/injuries
- Cholangiopancreatography, Endoscopic Retrograde
- Cholecystectomy, Laparoscopic
- Cholestasis, Intrahepatic/diagnostic imaging
- Cholestasis, Intrahepatic/etiology
- Cholestasis, Intrahepatic/surgery
- Debridement
- Drainage
- Humans
- Liver/diagnostic imaging
- Liver/injuries
- Liver Abscess/diagnostic imaging
- Liver Abscess/microbiology
- Liver Abscess/surgery
- Male
- Stents
- Tomography, X-Ray Computed
- Wounds, Nonpenetrating/complications
- Wounds, Nonpenetrating/diagnostic imaging
- Young Adult
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21
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Sakamoto S, Ochiai T, Yoshimura N, Uemoto S. Unusual biliary collaterals inside a transplanted liver. Transpl Int 2009; 22:1114-6. [PMID: 19619173 DOI: 10.1111/j.1432-2277.2009.00909.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Kawamoto H, Tsutsumi K, Fujii M, Harada R, Kato H, Hirao K, Kurihara N, Nakanishi T, Mizuno O, Ishida E, Ogawa T, Fukatsu H, Sakaguchi K. Multiple stenting in a patient with a high-grade malignant hilar biliary stricture: endoscopic four-branched partial stent-in-stent deployment of metallic stents. Endoscopy 2007; 39 Suppl 1:E167-8. [PMID: 17614071 DOI: 10.1055/s-2007-966612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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] [Indexed: 12/10/2022]
Affiliation(s)
- H Kawamoto
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine and Dentistry, Okayama City, Japan.
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23
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Affiliation(s)
- M Ramchandani
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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24
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Bardia A, Thompson CA, Podratz KC, Okuno SH. Bizarre big belly ball: intraabdominal abscess mimicking stauffer syndrome secondary to uterine leiomyosarcoma. EUR J GYNAECOL ONCOL 2007; 28:134-6. [PMID: 17479677] [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: 05/15/2023]
Abstract
BACKGROUND Stauffer syndrome, a very rare paraneoplastic syndrome, refers to reversible intrahepatic cholestasis in the setting of an abdominal malignancy. CASE A 60-year-old female with a past medical history of uterine leiomyosarcoma status post radical hysterectomy, presented three months later with right upper quadrant abdominal pain. Laboratory evaluation revealed intrabdominal cholestasis and ultrasound of the abdomen showed an echogenic solid mass consistent with a metastatic leiomyosarcoma, and it was felt that her hyperbilirubinemia was due to Stauffer syndrome. However, three days later, blood culture grew gram negative bacilli, and CT scan of the abdomen revealed multiple mesenteric masses with air bubbles consistent with an abdominal abscess. The abscess was drained under CT-scan guidance and her cholestasis gradually came back to nearly normal. CONCLUSION The case highlights the importance of considering infectious etiologies and Stauffer syndrome in the differential diagnosis of liver dysfunction in patients with intraabdominal malignancies.
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Affiliation(s)
- A Bardia
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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25
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Affiliation(s)
- David L Diehl
- Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, New York, USA
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26
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Adegbola O, Yang H, Zhuang H. Hepatobiliary Scintigraphy Monitoring Patency of Partial External Biliary Diversion in a Patient With Progressive Familial Intrahepatic Cholestasis. Clin Nucl Med 2006; 31:622-3. [PMID: 16985369 DOI: 10.1097/01.rlu.0000238266.40872.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Onikepe Adegbola
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
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27
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Sanseverino MTV, de Souza CFM, Gissen P, Sordi AO, Magalhães JA, Schüler-Faccini L. Increased nuchal translucency in arthrogryposis, renal dysfunction and cholestasis (ARC) syndrome and discovery of a Portuguese specific mutation in the VPS33B gene. Ultrasound Obstet Gynecol 2006; 28:233-4. [PMID: 16758438 DOI: 10.1002/uog.2822] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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28
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Krige JEJ, Beningfield SJ. The new DEAL--a novel technique using a double-entry access loop to facilitate bilateral intrahepatic biliary access for complex intrahepatic stones. S AFR J SURG 2006; 44:56-8. [PMID: 16878510] [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: 05/11/2023]
Affiliation(s)
- J E J Krige
- Department of Surgery, University of Cape Town, MRC Liver Research Centre, Groote Schuur Hospital, Cape Town
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29
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Müller D, Wiedmann M, Kluge R, Berr F, Mössner J, Sabri O, Caca K. [Is 18F-FDG-PET suitable for therapy monitoring after palliative photodynamic therapy of non-resectable hilar cholangiocarcinoma?]. Z Gastroenterol 2005; 43:439-43. [PMID: 15871065 DOI: 10.1055/s-2004-813935] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND If existing biliary drainage is insufficient, photodynamic therapy (PDT, laser treatment after application of a photosensitizer) is an already established adjunct to palliative therapy for progressing hilar cholangiocarcinoma (Klatskin tumours), since it prolongs survival and improves quality of life. Experimental studies of other tumour entities showed that (18)F-FDG-PET ( (18)F-fluorodeosxyglucose-positron emission tomography) may play a role in monitoring tumour response to PDT. Furthermore, previous studies have revealed a high accuracy of this method for the detection of hilar cholangiocarcinoma. Therefore, the aim of the present study was to investigate the feasibility of (18)F-FDG-PET as a follow-up screening method in patients with hilar cholangiocarcinoma who underwent PDT. PATIENTS AND METHODS 10 patients were examined by (18)F-FDG-PET before and 4 - 6 weeks after PDT. The following parameters were evaluated: maximum and mean SUV in the tumour, the ratio of maximum SUV in the tumour and mean SUV in the liver, the vital tumour volume, as well as bilirubin and CA 19 - 9 levels. RESULTS All tumours were detected by (18)F-FDG-PET. Within a period of 4 - 6 weeks after PDT the cholestasis parameter bilirubin decreased significantly. However, SUV-associated parameters did not show a significant change after treatment while the estimated vital tumour volume even increased. DISCUSSION PDT does not effect a relevant reduction of tumour mass in non-resectable hilar cholangiocarcinoma. However, PDT leads to a significant reduction of cholestasis. If (18)F-FDG-PET is suitable for monitoring the effect of new palliative therapeutic approaches, like brachytherapy, the use of modern chemotherapeuticals, COX-2 and receptor-tyrosine kinase inhibitors, perhaps also in combination with PDT, has to be further investigated.
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Affiliation(s)
- D Müller
- Klinik und Poliklinik für Nuklearmedizin, Universität Leipzig
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30
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Affiliation(s)
- J J Canete
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, USA
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31
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Jakobs R, Weickert U, Hartmann D, Riemann JF. [Interventional endoscopy for benign and malignant bile duct strictures]. Z Gastroenterol 2005; 43:295-303. [PMID: 15765303 DOI: 10.1055/s-2004-813546] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
During the past years several endoscopic and interventional techniques have been developed for the treatment of bile duct strictures and have had a strong impact on therapeutic regimens. Benign stenoses of the bile duct are mainly caused by cholecystectomy or liver resection or by inflammatory diseases. Insertion of an endoprosthesis insertion or balloon dilation is clinically successful in 60 to 90 % of these patients and will result in adequate opening of the stricture. To date, only bile duct stenosis in chronic pancreatitis are not improved satisfactorily by endoscopy. The insertion of an endoprosthesis is a cornerstone in the treatment of malignant obstructive jaundice in patients with cancer. Several comparative studies have demonstrated the advantages of self-expanding metal stents (SEMS) over plastic prostheses in terms of patency. A selective use of SEMS is mandatory, as the costs for SEMS are high and many patients with malignant jaundice will die with their first plastic prosthesis in situ without stent occlusion. In patients with hilar cholangiocarcinoma, the combination of photodynamic therapy and endoprosthesis insertion might result in a survival advantage. The use of bioabsorbable stent materials or coating of the stent with antiproliferative drugs will improve the treatment results in the future.
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MESH Headings
- Bile Duct Neoplasms/drug therapy
- Bile Duct Neoplasms/mortality
- Bile Duct Neoplasms/therapy
- Bile Ducts, Intrahepatic
- Catheterization
- Cholangiocarcinoma/drug therapy
- Cholangiocarcinoma/mortality
- Cholangiocarcinoma/therapy
- Cholangiopancreatography, Endoscopic Retrograde
- Cholangitis, Sclerosing/complications
- Cholecystectomy, Laparoscopic/adverse effects
- Cholestasis, Extrahepatic/diagnostic imaging
- Cholestasis, Extrahepatic/drug therapy
- Cholestasis, Extrahepatic/etiology
- Cholestasis, Extrahepatic/surgery
- Cholestasis, Extrahepatic/therapy
- Cholestasis, Intrahepatic/diagnostic imaging
- Cholestasis, Intrahepatic/drug therapy
- Cholestasis, Intrahepatic/etiology
- Cholestasis, Intrahepatic/surgery
- Cholestasis, Intrahepatic/therapy
- Endoscopy
- Follow-Up Studies
- Forecasting
- Humans
- Jaundice, Obstructive/diagnostic imaging
- Jaundice, Obstructive/drug therapy
- Jaundice, Obstructive/etiology
- Jaundice, Obstructive/surgery
- Jaundice, Obstructive/therapy
- Pancreatitis/complications
- Photochemotherapy
- Prospective Studies
- Prosthesis Implantation
- Retrospective Studies
- Stents
- Time Factors
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Affiliation(s)
- R Jakobs
- Medizinische Klink C, Klinikum der Stadt Ludwigshafen gGmbH.
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32
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Nichitaĭlo ME, Ogorodnik PV, Litvin AI, Ogorodnik IP. [Possibilities of miniinvasive interventions in isolated stenosis of lobar biliary ducts]. Klin Khir 2005:31-3. [PMID: 16134493] [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: 05/04/2023]
Abstract
In 2000-2004 yrs miniinvasive interventions for isolated stenosis of lobar biliary ducts were performed in 27 patients. The stenosis was caused by nontumoral (choledocholithiasis, primary sclerosing cholangitis) or malignant lesion of biliary ducts. Miniinvasive technologies included interventions, using laparoscopic and endoscopic transpapillary accesses. The authors consider expedient and justified the performance of such interventions in present contingent of patients, because this promotes improvements of immediate and late results of treatment and quality of life as well.
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MESH Headings
- Adult
- Aged
- Bile Duct Neoplasms/complications
- Bile Duct Neoplasms/diagnostic imaging
- Bile Duct Neoplasms/surgery
- Biliary Tract Surgical Procedures/methods
- Cholangiopancreatography, Endoscopic Retrograde
- Cholestasis, Extrahepatic/complications
- Cholestasis, Extrahepatic/diagnostic imaging
- Cholestasis, Extrahepatic/surgery
- Cholestasis, Intrahepatic/complications
- Cholestasis, Intrahepatic/diagnostic imaging
- Cholestasis, Intrahepatic/surgery
- Constriction, Pathologic/diagnostic imaging
- Constriction, Pathologic/etiology
- Constriction, Pathologic/surgery
- Female
- Humans
- Laparotomy
- Male
- Middle Aged
- Minimally Invasive Surgical Procedures/methods
- Ultrasonography
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33
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Abstract
Pheochromocytoma is a rare tumor of chromaffin cells that secrete catecholamines and several cytokines. The clinical manifestations are protean and may include hypertension, weight loss, sweating, palpitation, headache, anxiety, tremor, nausea, vomiting, and hypercalcemia. The tumor can mimic many unrelated diseases, leading to significant delay and difficulty in diagnosis. We report a case of a 37-yr-old male admitted with jaundice, dark urine, fever, and signs of a systemic inflammatory response. Abdominal computed tomography revealed a heterogeneously enhancing tumor between the pancreatic tail and left kidney. There was no evidence of obstruction to bile flow, neoplastic involvement of the liver or bile ducts, or infectious etiology. The tumor was removed and found to be a pheochromocytoma. Immunohistochemical analysis revealed the presence of interleukin-1beta in the tumor cells. After surgery, the jaundice resolved without further treatment, leading us to the conclusion that it was a paraneoplastic phenomenon possibly related to interleukin-1beta production. We suggest that occult pheochromocytoma should be added to the differential diagnosis of unexplained intrahepatic cholestasis.
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Affiliation(s)
- C H Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Taipei, Taiwan
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34
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Kim HC, Park SJ, Park SI, Park SH, Kim HJ, Shin HC, Bae WK, Kim IY, Lee HK. Multislice CT cholangiography using thin-slab minimum intensity projection and multiplanar reformation in the evaluation of patients with suspected biliary obstruction: preliminary experience. Clin Imaging 2005; 29:46-54. [PMID: 15864842] [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: 05/02/2023]
Abstract
Thirty-three patients with suspected biliary obstruction were prospectively evaluated with multislice CT cholangiography using thin-slab minimum intensity projection (MinIP) and multiplanar reformation (MPR) to determine its usefulness and to compare with the comparative studies of endoscopic retrograde cholangiography (ERC), magnetic resonance cholangiography (MRC), or percutaneous transhepatic cholangiography (PTC). CT cholangiography made correct diagnoses in all biliary obstructions except in two patients with common bile duct stones. The correspondence with the comparative study was 93.9%. Multislice CT cholangiography may be favorable in noninvasive evaluation of biliary obstructions.
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Affiliation(s)
- Hyun Cheol Kim
- Department of Diagnostic Radiology, Soonchunhyang University, Cheonan Hospital, Bongmyeong-Dong, Cheonan-Si, Chungcheongnam, Republic of Korea.
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35
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MESH Headings
- Cholangiopancreatography, Endoscopic Retrograde
- Cholecystectomy
- Cholelithiasis/complications
- Cholelithiasis/diagnostic imaging
- Cholelithiasis/surgery
- Cholestasis, Extrahepatic/diagnostic imaging
- Cholestasis, Extrahepatic/etiology
- Cholestasis, Extrahepatic/surgery
- Cholestasis, Intrahepatic/diagnostic imaging
- Cholestasis, Intrahepatic/etiology
- Cholestasis, Intrahepatic/surgery
- Collateral Circulation/physiology
- Combined Modality Therapy
- Dilatation, Pathologic
- Endosonography
- Gallstones/complications
- Gallstones/diagnostic imaging
- Gallstones/surgery
- Humans
- Hypertension, Portal/complications
- Hypertension, Portal/diagnostic imaging
- Hypertension, Portal/surgery
- Liver Function Tests
- Male
- Middle Aged
- Portal Vein/diagnostic imaging
- Portal Vein/surgery
- Recurrence
- Reoperation
- Sphincterotomy, Endoscopic
- Stents
- Thrombosis/complications
- Thrombosis/diagnostic imaging
- Thrombosis/surgery
- Tissue Adhesions
- Ultrasonography, Doppler
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Affiliation(s)
- Jason L Umphress
- Department of Internal Medicine, Division of Gastroenterology, University of California-Davis, Medical Center, 4150 V Street, Sacramento, CA 95817, USA
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36
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Irwin GJ, Maclennan AC, Carachi R. Interventional radiology cases from the royal hospital for sick children, glasgow: percutaneous metal biliary stent placement for palliation of intra-abdominal desmoplastic small round-cell tumour in a child. Eur J Pediatr Surg 2004; 14:130-2. [PMID: 15185163 DOI: 10.1055/s-2004-815862] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Percutaneous placement of metal biliary stents for palliation of malignant processes affecting the porta hepatis is a well established technique in adults. We describe a case where the technique has been used successfully to treat obstructive jaundice in a ten-year-old boy suffering from intra-abdominal desmoplastic small round-cell tumour.
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Affiliation(s)
- G J Irwin
- Department of Radiology, Royal Hospital for Sick Children, Yorkhill NHS Trust, Glasgow, United Kingdom.
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37
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Maurantonio M, Venezia L, Carulli L, Lombardini S, Gabbi C, De Santis M, Luppi G, Rigo G, Carulli N. [Cholestatic icterus: is there still a role for the clinic?]. Ann Ital Med Int 2004; 19:131-43. [PMID: 15317275] [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: 04/30/2023]
MESH Headings
- Cholangiopancreatography, Endoscopic Retrograde
- Cholecystectomy, Laparoscopic
- Cholestasis/diagnosis
- Cholestasis/diagnostic imaging
- Cholestasis/etiology
- Cholestasis/surgery
- Cholestasis, Extrahepatic/diagnosis
- Cholestasis, Extrahepatic/diagnostic imaging
- Cholestasis, Extrahepatic/etiology
- Cholestasis, Extrahepatic/surgery
- Cholestasis, Intrahepatic/diagnosis
- Cholestasis, Intrahepatic/diagnostic imaging
- Cholestasis, Intrahepatic/etiology
- Cholestasis, Intrahepatic/surgery
- Diagnosis, Differential
- Humans
- Jaundice, Obstructive/diagnosis
- Jaundice, Obstructive/diagnostic imaging
- Jaundice, Obstructive/etiology
- Jaundice, Obstructive/surgery
- Male
- Middle Aged
- Syndrome
- Tomography, Spiral Computed
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Mauro Maurantonio
- Dipartimento di Medicine e Specialità Mediche, Struttura Complessa di Medicina 3, Azienda Ospedaliera-Universitaria di Modena
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38
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Abstract
PURPOSE Late-onset hyperbilirubinemia in patients who have undergone a successful portoenterostomy (PE) for biliary atresia (BA) is usually considered evidence of ongoing severe liver failure. The authors recently have treated 2 patients who had acute hyperbilirubinemia years and months after a successful PE and had dilated intrahepatic cysts. A combined operative and percutaneous approach reestablished drainage and a reduction in their bilirubin levels. METHODS Data from 2 cases of BA and late-onset hyperbilirubinemia from obstruction were reviewed and analyzed. RESULTS Two patients (15-year-old boy and a 2.5-year-old girl) presented with increasing serum bilirubin after a PE for BA in infancy. Both had extensive preoperative workup, which showed intrahepatic biliary dilatation in one and a large bile lake in the other. They underwent attempted percutaneous transhepatic cholangiography and stenting, followed by an intraoperative transhepatic approach in which the dilated ducts were connected to the PE. A rapid and sustained reduction in the serum bilirubin level was noted in these patients. CONCLUSIONS When patients with BA after a successful PE present with sudden onset of hyperbilirubinemia, imaging for biliary obstruction should be carried out. If biliary dilatation is found, then a combined radiologic and operative approach may help improve the bile flow and delay the need for liver transplant.
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Affiliation(s)
- Saleem Islam
- Section of Pediatric Surgery, CS Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI 48109, USA
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39
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Giovanardi RO. Monolobar Caroli's disease in an adult. Case report. Hepatogastroenterology 2003; 50:2185-7. [PMID: 14696493] [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: 04/27/2023]
Abstract
Caroli's disease is the dilatation of the segmental intrahepatic bile ducts which generally presents in a diffuse form, but may occasionally involve only a single lobe, commonly the left one. We report the case of a 64-year-old male who presented with a clinical picture of obstructive jaundice, with Caroli's disease in segments II and III of the liver. Preoperative diagnosis was made using abdominal ultrasound and computed tomography scan, confirmed by endoscopic retrograde cholangiopancreatography. The treatment used was segmentectomy II and III (left lobectomy--Couinaud's classification) of the liver. Macroscopic examination of the resected specimen revealed cystic dilatation of the intrahepatic bile ducts and intrahepatic lithiasis. Histologically there was no evidence of malignancy. Liver resection is the treatment of choice for Caroli's disease confined to a single lobe or segment, eliminating the potential for cholangitis, lithiasis and carcinoma.
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MESH Headings
- Bile Ducts, Intrahepatic/pathology
- Caroli Disease/diagnostic imaging
- Caroli Disease/pathology
- Caroli Disease/surgery
- Cholangiopancreatography, Endoscopic Retrograde
- Cholestasis, Intrahepatic/diagnostic imaging
- Cholestasis, Intrahepatic/pathology
- Cholestasis, Intrahepatic/surgery
- Diagnosis, Differential
- Hepatectomy
- Humans
- Jaundice, Obstructive/diagnostic imaging
- Jaundice, Obstructive/pathology
- Jaundice, Obstructive/surgery
- Liver/pathology
- Liver Function Tests
- Male
- Middle Aged
- Tomography, X-Ray Computed
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Affiliation(s)
- Rafael Omar Giovanardi
- Department of Surgery, Fundação Universidade de Caxias do Sul, Department of Surgery, Hospital Geral, Caxias do Sul, Centro Hepatobiliar, Caxias do Sul, Brazil.
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40
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Ramacciato G, Amodio PM, Mercantini P, D'Angelo F, Ziparo V. Liver resection for intrahepatic lithiasis. Report of a case. Hepatogastroenterology 2003; 50:1889-90. [PMID: 14696426] [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: 04/27/2023]
Abstract
Intrahepatic primary lithiasis is extremely rare in the Western world. The development of endoscopic technique permitted a conservative treatment for this disease. Because of the high recurrence rate after conservative treatment due to the remaining biliary stricture and the risk of incidental cholangiocarcinoma, we believe that hepatic resection is the treatment of choice of unilateral liver intrahepatic primary lithiasis. Herein we present a case affected with intrahepatic primary lithiasis localized into the left biliary system that successfully underwent left hepatic lobectomy.
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Affiliation(s)
- Giovanni Ramacciato
- Department of Surgery Pietro Valdoni University of Rome, La Sapienza, V.le del Policlinico 155, 00161 Rome, Italy.
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41
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Hai S, Tanaka H, Kubo S, Takemura S, Kanazawa A, Tanaka S, Hirohashi K. Choledocholithiasis caused by migration of a surgical clip into the biliary tract following laparoscopic cholecystectomy. Surg Endosc 2003; 17:2028-31. [PMID: 14973757 DOI: 10.1007/s00464-003-4517-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 04/14/2003] [Accepted: 06/17/2003] [Indexed: 02/06/2023]
Abstract
As experience with laparoscopic cholecystectomy (LC) has increased, so have the number and variety of complications. We report a case of choledocholithiasis caused by migration of a surgical clip applied during LC. A 57-year-old Japanese man who had undergone LC 6 years previously was referred to our hospital with pruritus and jaundice. Magnetic resonance cholangiopancreatography and ultrasonography revealed a solid mass in the common hepatic duct and dilatation of the intrahepatic bile ducts. Abdominal arteriography demonstrated interruption of the right hepatic artery by surgical clips. Five days after a biopsy of the mass was performed through a percutaneous transhepatic biliary drainage tube, the mass moved to the terminus of the common bile duct along with one of the surgical clips. A basket catheter was used to remove the mass via endoscopy. Despite the fact that other clips in the common hepatic duct were partially exposed, the patient has been well for 2 years with no additional interventions.
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Affiliation(s)
- S Hai
- Hepato-Biliary-Pancreatic and Gastroenterological Surgery, Osaka City University, Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
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42
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Geier A, Gartung C, Dietrich CG, Lammert F, Wasmuth HE, Matern S. [Diagnosis of cholestatic disorders]. ACTA ACUST UNITED AC 2003; 98:499-509. [PMID: 14551707 DOI: 10.1007/s00063-003-1294-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 02/18/2003] [Accepted: 06/02/2003] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cholestasis is known as an etiologically diverse clinical entity which requires a broad differential diagnostic workup. In the majority of patients, history, clinical examination, clinical chemical analysis, and abdominal ultrasound enable the differentiation between extrahepatic and intrahepatic cholestasis. This review summarizes our current knowledge in the diagnosis of cholestatic disorders. METHODS In regard to clinical practice, diagnostic tools and new developments in imaging and molecular genetics are discussed including an algorithm for the diagnostic workup of cholestatic patients. CONCLUSION Ultrasound and computed tomography have represented the most important primary imaging techniques in hepatobiliary disorders over the last 2 decades. The direct visualization either by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) still remains the gold standard in the evaluation of the extrahepatic bile duct. In the past decade, magnetic resonance cholangiopancreatography (MRCP) has increasingly been established as a noninvasive alternative, thereby reducing the necessity of ERCP as an invasive exploration of the biliary system. Liver biopsy is indicated for the histologic grading and staging of intrahepatic cholestatic disorders. Recently, molecular genetic studies have elucidated several mutations in genes of hepatobiliary transporters which are responsible for hereditary forms of cholestasis in man. Thus, molecular genetics may be of interest in single cases of unclassified cholestasis or familial syndromes and will contribute to the routine diagnosis of hereditary cholestatic syndromes in the future. In summary, application of these diagnostic tools will finally lead to an unequivocal diagnosis in the majority of cholestatic patients with consecutive rational therapy.
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MESH Headings
- Biopsy
- Cholangiography
- Cholangiopancreatography, Endoscopic Retrograde
- Cholestasis/diagnosis
- Cholestasis/diagnostic imaging
- Cholestasis/genetics
- Cholestasis/pathology
- Cholestasis, Extrahepatic/diagnosis
- Cholestasis, Extrahepatic/diagnostic imaging
- Cholestasis, Extrahepatic/genetics
- Cholestasis, Intrahepatic/diagnosis
- Cholestasis, Intrahepatic/diagnostic imaging
- Cholestasis, Intrahepatic/genetics
- Diagnosis, Differential
- Humans
- Jaundice, Obstructive/diagnosis
- Jaundice, Obstructive/diagnostic imaging
- Jaundice, Obstructive/genetics
- Liver/pathology
- Magnetic Resonance Imaging
- Mutation
- Tomography, X-Ray Computed
- Ultrasonography
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43
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Nedogoda VV, Skvortsova ZS, Skvortsov VV. [Problem in intrahepatic cholestasis in pregnancy]. Eksp Klin Gastroenterol 2003:38-41, 112. [PMID: 12685010] [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: 03/01/2023]
Abstract
There are observations of 37 pregnant women with cholestasis. The study of the level of bile acids, b2-microglobuline, ferritin and ultrasound echography was shown to be the most valuable diagnostic test. Absolute and relative contraindications to the maintenance of pregnancy are suggested for this group of patients. It was proved that the long-term cholemia considerably aggravates the course of the disease. The problem of the maintenance of pregnancy in each case must be solved on an individual basis and with the use of adequate therapy.
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44
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Hirai I, Kimura W, Fuse A, Suto K, Sakurai F, Shibasaki H. Management of unresectable hilar bile duct cancer--preoperative diagnosis, treatment selection, and clinical outcome. Hepatogastroenterology 2003; 50:614-20. [PMID: 12828045] [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: 03/03/2023]
Abstract
BACKGROUND/AIMS Hilar bile duct cancer progresses slowly but easily invades the nearby portal vein or hepatic artery. Thus, in some cases, curative resection is impossible, so we need to determine the best non-surgical treatments for this tumor. METHODOLOGY We classified 98 patients with hilar bile duct cancer into 3 categories: a non-surgical group (34 cases), an exploratory laparotomy group (9 cases), and a surgical resection group (55 cases). Survival rates were examined in the light of clinical factors. RESULTS In the non-surgical group, extensive vessel invasion was the most common reason for unresectability (13 cases), with broad biliary extension the second most common (11 cases). In the exploratory laparotomy group the most common reason for unresectability was severe vessel invasion (6 cases). Cumulative 1- and 2-year survival rates for patients with unresectable tumors without distant metastasis were 26.9% and 7.2%, respectively. One- and 2-year survival rates for patients with unresectable tumors and with total bilirubin of less than 2 mg/dL on discharge were 36.8% and 9.8%, respectively. The 1-year survival rate with placement of an expandable metallic stent was as high as 55.6%; without the stent it was 7.1% (P = 0.005). Radiation therapy gave a better prognosis than did no radiation (P = 0.01). CONCLUSIONS Portal and arterial invasion were the principal reasons for unresectability. Use of an expandable metallic stent or radiation therapy, and a total bilirubin level of less than 2 mg/dL on discharge, were factors that enhanced survival in unresectable cases, but distant metastasis, dissemination, and poor general condition or liver function were negative factors for survival.
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Affiliation(s)
- Ichiro Hirai
- First Department of Surgery, Yamagata University School of Medicine, Yamagata, Japan.
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45
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Güitrón-Cantú A, Adalid-Martínez R, Gutiérrez-Bermúdez JA. [Postoperative biliary stenosis: long-term results of endoscopic treatment]. Rev Gastroenterol Mex 2003; 68:88-93. [PMID: 15127643] [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: 04/29/2023]
Abstract
BACKGROUND Endoscopic stent placement is often the initial therapy in symptomatic patients with postoperative strictures because patients are usually diagnosed at the time of ERCP. Although stent insertion rapidly relieves symptoms of biliary obstruction and can even be live-saving in patients with cholangitis, all stents eventually clog, necessitating regular stent changes every 3 to 4 months. Results from several groups suggested that placing multiple stents for months to years could dilate the stricture permanently and thus also treat patients with postoperative biliary strictures palliatively. OBJECTIVE The outcome of temporary biliary stent placement for postoperative bile duct stenosis was retrospectively evaluated. This is a review of our experience with endoscopic dilation and stent placement in postoperative biliary strictures. PATIENTS AND METHODS Thirty patients with postoperative strictures diagnosed with ERCP were treated with long-term endoscopic stent placement. One 10 Fr stent was placed at first whenever possible, and stents were exchanged every 3 months for a total of 18 months as median. RESULTS Four men and 26 women with mean age 42 years (range 16-69 years), and laparoscopic cholecystectomy in six and cholecystectomy (open procedure) in 24; surgical history was reviewed retrospectively. Five patients were lost to follow-up and 25 patients were followed for a median of 18 months. In all 25 patients, previous to stent placement, 8.5 or 10 Fr, a mechanical or hydrostatic dilation was necessary. Stents were exchanged every 3 months to avoid cholangitis caused by clogging. Three 10 Fr stents were inserted in one patient, two 10 Fr stents in 14 patients, one 10 Fr and one 8.5 Fr stent in nine patients, and in one patient, one 10 Fr stent. Six patients (24%) developed recurrent stenosis and required surgery. CONCLUSIONS Endoscopic treatment with mechanical or hydrostatic dilation and stent insertion may improve long-term results for patients with postoperative biliary strictures.
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MESH Headings
- Adolescent
- Adult
- Cholangiopancreatography, Endoscopic Retrograde
- Cholecystectomy/adverse effects
- Cholecystectomy, Laparoscopic/adverse effects
- Cholestasis/diagnostic imaging
- Cholestasis/etiology
- Cholestasis/surgery
- Cholestasis/therapy
- Cholestasis, Extrahepatic/diagnostic imaging
- Cholestasis, Extrahepatic/etiology
- Cholestasis, Extrahepatic/surgery
- Cholestasis, Extrahepatic/therapy
- Cholestasis, Intrahepatic/diagnostic imaging
- Cholestasis, Intrahepatic/etiology
- Cholestasis, Intrahepatic/surgery
- Cholestasis, Intrahepatic/therapy
- Dilatation/methods
- Endoscopy
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Palliative Care
- Postoperative Complications/etiology
- Postoperative Complications/surgery
- Postoperative Complications/therapy
- Reoperation
- Retrospective Studies
- Stents
- Time Factors
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Affiliation(s)
- Alfredo Güitrón-Cantú
- Departamento de Endoscopia Digestiva, Hospital de Especialidades No. 71, Instituto Mexicano del Seguro Social, Blvd. Revolución y Calle 26, C.P. 27000 Torreón, Coahuila
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46
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Abstract
OBJECTIVE The aim of this study was to investigate the value of using Levovist in the postvascular phase of sonography performed to assess hepatic hilar biliary obstruction. SUBJECTS AND METHODS In our prospective study, 50 patients underwent routine sonography followed by postvascular Levovist-enhanced pulse inversion imaging of the liver. Thirty-six patients had malignant disease (28 invasive parenchymal tumors and eight intraductal tumors), and 14 had benign disease. The 36 malignancies included 29 cholangiocarcinomas, six invasive gallbladder carcinomas, and one colon metastasis. Fourteen patients had benign disease: benign strictures (n = 5), primary sclerosing cholangitis (n = 5), chronic Mirizzi's syndrome (n = 1), varicosities of the parabiliary venous plexus (n = 1), and inflammatory liver lesions (n = 2). Sonographic findings in all 50 patients were correlated with findings from other imaging modalities (n = 50) as well as surgical specimens (n = 20), core biopsies (n = 3), and both clinical and imaging follow-ups (n = 24). RESULTS Seventeen (61%) of the 28 invasive intraparenchymal malignancies were visualized on routine sonograms, whereas all 28 (100%) were visualized on enhanced sonograms (p < 0.01). In 15 (88%) of 17 patients in whom tumor was seen on routine sonograms, contrast-enhanced sonography showed further mass extent, increased conspicuity, or satellite nodules not visualized on the baseline image. All eight noninvasive intraductal malignancies were correctly identified and staged on the routine sonography. In one of these patients, hepatic invasion was prospectively overcalled on the enhanced image. Of the 14 benign lesions, three had inflammatory periductal abnormalities seen exclusively or to advantage on the enhanced study. Correct prediction of resectability in the 16 patients with malignant disease who underwent surgery improved from 11 (69%) of 16 on unenhanced sonography to 15 (94%) of 16 on enhanced sonography (p = 0.13). CONCLUSION Detection and staging of malignant hilar obstructions are improved by the use of Levovist in the postvascular phase of sonography compared with routine sonography.
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Affiliation(s)
- Korosh Khalili
- Department of Medical Imaging, Toronto General Hospital, University Health Network, 200 Elizabeth St., Toronto, Ontario, Canada M5G 2C4
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47
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Ramseier E. [Benign recurrent intrahepatic cholestasis]. Praxis (Bern 1994) 2002; 91:2259-2261. [PMID: 12564043 DOI: 10.1024/0369-8394.91.51.2259] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Vorgestellt wird ein junger türkischer Patient, welcher sich mit einer intrahepatischen Cholestase präsentierte. Er erlebte mehrere Episoden mit Ikterus und Pruritus, welche jeweils für mehrere Wochen bis Monate persistieren und spontan abklangen. Die erste Episode erlitt er im Alter von fünf Jahren. Nach ausgedehnten Abklärungen mittels Bildgebung, laborchemischen Untersuchungen und Leberbiopsie konnte die Diagnose «benigne rekurrierende intrahepatische Cholestase» gestellt werden. Dies ist eine sehr seltene benigne autosomal-rezessive Erkrankung als Folge einer genetischen Mutation. Bei rekurrierenden Cholestasen mit Beginn im Kindesalter ist an diese Diagnose zu denken.
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Affiliation(s)
- E Ramseier
- Medizinische Universitäts-Poliklinik, Departement Innere Medizin, Kantonsspital Basel
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48
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Schnur S. [Principles of general ultrasonographic practice. Its use in jaundice]. MMW Fortschr Med 2002; 144:43-5. [PMID: 12593415] [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: 03/01/2023]
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49
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[Primary sclerosing cholangitis. Early dilatation saves lives]. MMW Fortschr Med 2002; 144:52. [PMID: 12422695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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50
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Conrad GR, Sinha P. Delayed postoperative stenosis of a right hepatic choledochojejunostomy. Clin Nucl Med 2002; 27:597-8. [PMID: 12170010 DOI: 10.1097/00003072-200208000-00013] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Gary R Conrad
- Department of Radiology, The University of Kentucky Chandler Medical Center, Lexington, Kentucky, USA.
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