Preoperative biliary drainage may improve the cytokine and acute-phase response derangements observed in patients with obstructive jaundice. We conducted a prospective longitudinal, before-after trial in our 600-bed teaching hospital. Twenty-four patients with obstructive jaundice were investigated, 11 with benign obstruction and 13 with malignant disease. Endoscopic internal biliary drainage was performed in all patients (7 by papillotomy and 17 by endoprostheses). Endotoxin, tumor necrosis factor alpha (TNF-a), interleukin-6 (IL-6), nitric oxide production, and C-reactive protein (CRP) were determined at admission and on days 2 and 7 after internal biliary drainage was accomplished. Bile cultures were obtained before and at the time of drainage. Endotoxin, IL-6, TNF-a, and CRP were significantly higher in patients with cancer. After internal drainage, endotoxin (11.4 vs. 2 EU/L; p <0.05), TNF-a (87.5 vs. 48 pg/ml; p = 0.03), and IL-6 (324 vs. 232 pg/ml; p <0.05) plasma levels decreased significantly in the early postdrainage period in patients with cancer. Endotoxin, cytokines, as well as the CRP plasma values, however, increased again on day 7 after drainage. This trend was less marked in patients with benign obstruction. Patients with positive bile cultures after drainage displayed higher levels of CRP (115 vs. 62 mg/L; p = 0.03), IL-6 (598 vs. 330 pg/ml; p = 0.04), and endotoxin (10.6 vs. 4.8 EU/L; p = 0.02) than those with negative bile cultures. Biliary tract obstruction is associated with an increase in endotoxin levels, a positive acute-phase response, and plasma cytokine elevation. After biliary drainage a transitory improvement of these alterations was observed, although values remained high 1 week postdrainage. These findings were associated with positive bile cultures.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1007/s00268-002-6232-9 | DOI Listing |
Am J Transl Res
December 2024
Department of Interventional Radiology, The Second Affiliated Hospital of Anhui Medical University Heifei 230001, Anhui, China.
Objectives: To analyze the efficacy and influencing factors of percutaneous transhepatic cholangiography and biliary drainage (PTCD) in patients with malignant obstructive jaundice (MOJ).
Methods: The study included 151 MOJ patients admitted from January 2021 to January 2024. Seventy patients in the control group received endoscopic retrograde cholangiopancreatography (ERCP), while 81 patients in the research group underwent PTCD.
Cureus
December 2024
Surgical Oncology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND.
We report a rare case of adenosquamous carcinoma of the gall bladder (GB) causing portal vein tumor thrombus. A 40-year-old gentleman presented with acute-onset right upper abdominal pain. Ultrasonography revealed multiple calculi in the GB with wall thickening, suggesting acute cholecystitis.
View Article and Find Full Text PDFPediatr Radiol
January 2025
Department of Diagnostic and Interventional Radiology, Pediatric Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Biliary strictures, which are common in the first year after pediatric liver transplantation, are diagnosed and managed with percutaneous transhepatic cholangiography. In children undergoing percutaneous transhepatic cholangiography, early cholangitis is the most common complication while typical catheter-related complications are obstruction, dislodgement, kinking, or fracture. This case report discusses the unique presentation and management of a 5-year-old girl with an incidental percutaneous transhepatic biliary drainage-associated extrahepatic gallstone formation following treatment of biliary stricture after pediatric liver transplantation.
View Article and Find Full Text PDFDig Dis Sci
January 2025
Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, 100050, P.R. China.
Gastroenterol Rep (Oxf)
January 2025
Department of Biliary and Pancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China.
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!