Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0008370 (cholestasis)
 9,378 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Serum CA 19-9 was determined in 83 control subjects, 99 patients with pancreatic cancer, 104 with chronic pancreatitis and 137 with extra-pancreatic diseases mainly of gastrointestinal origin in order to evaluate whether hepatic factors can influence circulating CA 19-9 in pancreatic cancer. Sensitivity, specificity and accuracy of this test in determining pancreatic malignancy were: 74%, 83% and 57%. We divided patients into two groups: group A (159 cases) and group B (181 cases) with and without anatomical liver damage (presence of primary or metastatic cancer, cirrhosis, hepatitis, steatofibrosis, cholangitis). Group A presented higher CA 19-9 values as compared to group B. Significant correlations were found in group B but not in group A between CA 19-9 and ALT, ALP and total bilirubin. Multiple regression analysis (CA 19-9 dependent and ALT, ALP and total bilirubin predictor variables) was significant only in group B. The standardized partial regression coefficients found to be significant were those of ALP and total bilirubin. We can conclude that CA 19-9 is an index of pancreatic cancer with satisfactory sensitivity and specificity. The presence of anatomical liver damage seems to increase the value of this index, probably releasing CA 19-9 into the bloodstream. Extra-hepatic cholestasis may also be an important factor in elevating CA 19-9 probably by reducing the hepatic catabolism of this glycoprotein.
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PMID:How does liver dysfunction influence serum CA 19-9 in pancreatic cancer? 213 20

Regarding a case of little-differentiated adenocarcinoma of prostate in a 79-year old male patient undergoing antiandrogenic corticosteroid therapy (cyproterone acetate), the authors describe a rare complication related to treatment with the drug. Cytolytic icterus, without cholestasis, occurred eleven weeks after starting the treatment without metastasis of the primary cancerous lesion, and regressed when administration of the antiandrogenic agent was interrupted. This description is compatible with toxic hepatitis. This is a rare complication, which should be differentiated from stasis icterus consecutive to treatment with progestogens. Its diagnosis precludes also primary or drug-induced secondary tumors or degenerative hepatic lesions. A knowledge of this complication by the urologist is important, so the latter might not conclude too hastily to metastatic extension of primary cancer of prostate. Withdrawal of the patient from antiandrogenic therapy is mandatory, and management should incorporate complete biological investigation of liver function, CT scans and, depending upon the case, liver biopsy as the only means of studying this exceptionally rare complication.
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PMID:[Hepatitis after treatment with cyproterone acetate. Apropos of a case]. 214 71

Cytologic examination of bile obtained during surgery from intrahepatic bile ducts in patients with malignant proximal bile duct obstruction has shown a high incidence of tumor cells. Spill of bile occurs frequently during these operations and postoperative bile leakage often occurs. Typical implantation metastases were detected in three patients who underwent resective surgery for bile duct cancer. In addition, peritoneal spread of bile duct carcinoma was found on postmortem examination in seven of ten patients who died 6 to 27 months after resection of the hilar tumor. A relation between tumor-positive bile cytologic findings, tumor spill, and seeding during surgery is likely to exist. It is recommended that during surgery the utmost care should be taken to prevent spill of bile.
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PMID:Clinical significance of implantation metastases after surgical treatment of cholangiocarcinoma. 216 66

To assess how well chemotherapy is tolerated after solid organ transplantation, we reviewed our experience at the Children's Hospital of Pittsburgh with five patients aged 1 to 12 years. Four patients had a liver transplant, indications for which were hepatoblastoma in two patients, hepatic failure secondary to Wilms' tumor chemoradiotherapy in one patient, and familial intrahepatic cholestasis in one patient. A fifth patient received a cardiac transplant for unresectable angiosarcoma of the right atrium. After transplant, chemotherapy was given for the treatment of the primary malignancy in four of the patients. The patient with familial intrahepatic cholestasis received chemotherapy for secondary lymphoproliferative disease that had not responded to the cessation of immunosuppression. All patients other than this patient were on immunosuppression with prednisone (0.5 to 2 mg/kg daily) and cyclosporine (to maintain serum levels at 800 to 1000 ng/ml radioimmunoassay) throughout the duration of chemotherapy. Courses of chemotherapy included one or more of the following agents: Adriamycin (Adr, 20 mg/m2 daily, three patients), Cyclophosphamide (Ctx, 1 gm/m2, one patient), cisplatin (CDDP, 90 mg/m2, one patient), Vincristine (Vcr, greater than 0.75 to 1.5 mg/m2, three patients), Actinomycin D (Act-D, 7.5 micrograms/kg, one patient), Ifosfamide (I, 1800 mg/m2, one patient) and Etoposide (VP-16, 100 mg/m2, one patient). All patients received greater than or equal to 3 courses (range, 3 to 9; mean, 5) of chemotherapy every 3 to 4 weeks. Dose reductions were made because of neutropenia in three patients but none were greater than 50%. Severe rejection was seen in one patient who had, however, manifested evidence of rejection prior to his first postoperative course of chemotherapy. No nephro or cardiac toxicity was seen. This preliminary experience suggests that chemotherapy is well tolerated after solid organ transplantation.
Cancer 1990 Oct 01
PMID:Cancer chemotherapy after solid organ transplantation. 220 97

Ultrasonography (US) and computed tomography (CT) were performed on respectively 67 and 42 (altogether 72) patients, for the assessment of intrahepatic cholestasis. The diagnostic ability to differentiate between malignant (17 patients) and benign (55 patients) liver disease was analyzed. Coarse echogenicity of the liver led to inconclusive results in differentiating between cirrhosis (2 out of 29 patients) and malignant infiltration (4 out of 15 patients) by US. Other benign liver diseases in 23 patients, including acute hepatitis, chronic active hepatitis, fatty liver, and liver congestion, were correctly interpreted as benign. CT correctly disclosed malignant liver disease in all cases. A false positive diagnosis of malignancy was encountered in 4 (out of 17) patients with decompensated hepatic cirrhosis because of non-homogeneous expansive areas on CT in 3 cases. The true cause was in 2 patients non-uniform fatty infiltration, and in one patient with acute hepatitis A, small hypodense lesions. Among cholestatic patients, decompensated cirrhosis and malignant liver infiltration could not always be differentiated on US or CT.
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PMID:Ultrasonography and computed tomography in diffuse liver disease with cholestasis. 226 Dec 94

Male Sprague-Dawley rats were given single i.p. injections of 1,3-bis(2-chloroethyl)-1-Nitrosourea (BCNU) to investigate changes in hepatic microsomal cytochrome P-450 content and metabolic activity. On day 14 after treatment (20 mg/kg), cytochrome P-450 content had decreased by approximately 25% and ethylmorphine N-demethylase activity (nmol product/nmol P-450/min) had decreased by 36%. In contrast, ethylmorphine O-deethylase and 7-ethoxycoumarin O-deethylase activities were not significantly decreased by BCNU treatment. Hepatic delta-aminolevulinic acid synthetase activity was only 60% of control values, and microsomal heme oxygenase activity was slightly but not statistically elevated. Cytochrome P-450 content in control and BCNU-treated rats increased in a similar manner after phenobarbital or beta-naphthoflavone induction. Electrophoretic analysis of cytochrome P-450 proteins isolated from hepatic endoplasmic reticular membranes of treated and control rats suggested that alterations in these proteins occurred in BCNU-treated rats. These changes in cytochrome P-450 content and activity are very similar to those reported in isolated systems exposed to bile acids or in rats with experimentally produced cholestasis. BCNU has been shown to produce cholestasis, which precedes its effects on microsomal mixed-function oxygenase activity. Thus, the delayed effects of BCNU on microsomal drug metabolism are probably secondary to its interference with bile formation.
Cancer Chemother Pharmacol 1990
PMID:BCNU-induced quantitative and qualitative changes in hepatic cytochrome P-450 can be correlated with cholestasis. 229 10

Alkaline phosphatase (ALP) fast liver isoenzyme is now known as high-molecular-weight ALP. This ALP isoenzyme represents fragments of hepatic cell plasma membranes with various membrane-bound enzymes localized on the surface. High-molecular-weight ALP isoenzyme is present in patients' serum samples in conditions associated with intrahepatic and extrahepatic cholestasis and primary or metastatic hepatic malignancy. High-molecular-weight ALP isoenzyme may coexist with ALP of the normal liver and with ALP lipoprotein X. Alkaline phosphatase ultrafast liver isoenzyme is now known as ALP lipoprotein X complex.
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PMID:High-molecular-weight alkaline phosphatase and alkaline phosphatase lipoprotein X complex in cholestasis and hepatic malignancy. 234 63

In patients with chronic pancreatitis, common bile duct obstruction is reported in 3.2-45.6% of patients; however, only 5-10% of all patients with chronic pancreatitis require operative decompression of the bile duct. The cause of the intrapancreatic stricture of the common bile duct may be either a fibrotic inflammatory restriction, or compression by a pseudocyst. Obstruction of the duodenum is much less common than common bile duct obstruction in chronic pancreatitis occurring in less than 1-2% of patients with chronic pancreatitis. Colonic obstruction secondary to pancreatitis is very infrequent. The intrapancreatic strictures of chronic pancreatitis are characteristically smooth and tapering on endoscopic retrograde cholangiopancreatography (ERCP), but in some patients, they may have a sharp cut-off and closely resemble the appearance of carcinoma of the pancreas invading the bile duct. The natural history of these intrapancreatic strictures is variable. They may progress and be associated with cholangitis, biliary cirrhosis, common duct stones, or may remain stable for years or regress. Prior pancreaticojejunostomy is not protective against the development of intrapancreatic biliary strictures which may follow in 5-30% of patients, with most authors reporting an incidence of less than 10%. Evaluation of alkaline phosphatase, bilirubin, the presence of jaundice, or the appearance of an intrapancreatic stricture on ERCP is not predictive of whether cholangitis or biliary cirrhosis may or may not develop. The incidence of cholangitis and biliary cirrhosis in patients with intrapancreatic stricture is 9.4% and 7.3%, respectively. Laennec's cirrhosis occurs in a similar number of patients. Operation is indicated in patients with intrapancreatic strictures of the common bile duct in association with chronic pancreatitis in patients developing cholangitis, biliary cirrhosis, common duct stones, progression of the stricture, persistent high elevations of alkaline phosphatase and/or bilirubin for over a month or inability to rule out cancer of the pancreas or periampullary region. The operation of choice is choledochoduodenostomy or Roux-en-Y choledochojejunostomy to bypass the obstructed intrapancreatic portion of the common bile duct. Persistent duodenal obstruction for over 3 or 4 weeks is an indication for gastrojejunostomy. Pain is not a feature of common bile duct obstruction in the absence of cholangitis. In the presence of pain associated with chronic pancreatitis, longitudinal pancreaticojejunostomy is the operation of choice combined with Roux-en-Y choledochojejunostomy. Some of the newer operations, e.g., the Beger and Frey procedures, may make the necessity of a separate operation for biliary decompression superfluous.
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PMID:Treatment of chronic pancreatitis complicated by obstruction of the common bile duct or duodenum. 240 39

Tumour-associated antigens CA 50 and CA 19-9 were determined in serum of 208 patients. Specificity of both neo-antigens as tumour markers was equally good, at 100% and 95%, in patients without malignancy or gastrointestinal disease, respectively, using an upper limit of normal of 17 U/ml for CA 50 and 37 U/ml for CA 19-9. Benign diseases of the upper gastrointestinal tract, such as pancreatitis, cholestasis or cirrhosis of the liver, reduce the specificity of CA 50 more than of CA 19-9. For example, specificity of CA 50 is only 33% for choledocholithiasis, but 74% with CA 19-9. The sensitivity of both closely related sialogangliosides in malignancies of the upper GI tract is similar, with the usual normal limits: in pancreas carcinoma 77% for CA 50, 81% for CA 19-9; in biliary tract carcinoma 80% for CA 50, 90% for CA 19-9; in gastric carcinoma 40% for CA 50, 50% for CA 19-9. But if one equalizes the upper limits of normal for both markers to a common 95% specificity, the tumour-indicating sensitivity of CA 19-9 clearly surpasses that of CA 50. Malignant tumours not recognized by increased levels of CA 19-9 also escape serological diagnosis with CA 50.
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PMID:[Comparison of CA 50 and CA 19-9 tumor markers in benign and malignant diseases of the upper gastrointestinal tract]. 241 74

Assessment of 5'-Nuc activity in 86 patients with diffuse hepatic diseases with and without cholestasis, mechanical jaundice of varying origins, and 20 donors has demonstrated the sensitivity of this test. High 5'-Nuc activity was seen in cases of chronic hepatic lesions with cholestasis and mechanical jaundice due to cancer of the prostatic head. A moderate 5'-Nuc rise was seen in casts of choledocholithiasis and active cirrhosis without cholestasis. Different correlations seen in the examined groups, in comparison to other cholestatic parameters, make it possible to use serum 5'-Nuc determination as an independent test.
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PMID:[5'-nucleotidase activity in the blood in chronic diseases of the liver and biliary tract]. 254 11


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