Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Forty-three patients were operated on for iatrogenic lesions of the bile duct. Only one patient had a biliary lesion which occurred in the course of distal gastric resection. All other lesions were observed during cholecystectomy. Injury of the bile duct was detected intraoperatively in sixteen cases. In 10 patients, lesions were observed in the postoperative period and in 17 patients, the post-operative diagnosis was made on the basis of symptoms of stenosis of the bile duct. Satisfactory results can be obtained by suturing the common bile duct and splinting with a T-tube where the lesion is partial and detected in the course of surgery. In the case of patients with strictures, an anastomosis (choledochojejunostomy Roux-en-Y loop) should be performed. Strictures involving hepatic bifurcation and the right hepatic duct have a higher incidence of restenosis, and transhepatic splinting of the anastomosis can therefore produce better results. Long-term transhepatic drainage has the advantage that replacement of the drain is relatively straightforward and complete dislocation impossible. Four of our patients died postoperatively, three of multiple septic organ failure due to preoperative biliary peritonitis or cholangitis, and one of a pulmonary embolism. Satisfactory long-term results after correction of an iatrogenic lesion of the bile duct can be obtained if the corrective procedure is undertaken immediately, prior to the onset of biliary cirrhosis.
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PMID:The therapy of iatrogenic lesions of the bile duct. 208 27

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

From January 1956 to December 1985, 1316 cases of gallstones were operated in our hospital. Among them, gallbladder stones accounted for 43.2%, common dile duct stones 34.6% and intrahepatic stones 22.2%. Hospital deaths occurred in 59 cases, with a mortality rate of 4.5%, and this was obviously decreased to 2.4% in the last decade. Operative risk factors included: high-age with major organ diseases; acute biliary infections, especially acute obstructive suppurative cholangitis (AOSC); reoperations etc. Control of these factors is the key to reducing the motality rate. Mortality due to cholecystectomy has dropped considerably in recent years. The main causes of death after operations for common bile duct stones is septic shock due to AOSC. Thus, early diagnosis and surgical treatment of common bile duct stones are very important in reducing the incidence of acute biliary infection and AOSC. If these occur, biliary drainage should be done as soon as possible. The main causes of death after operations for intrahepatic stones were stubborn biliary infection due to residual stones or biliary stenosis and hepatic failure due to biliary cirrhosis. It must be emphasized that the treatment of intrahepatic stones should be early and complete. Operative procedures should be determined according to individual conditions.
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PMID:[Analysis of causes of death following surgery for gallstones]. 214 15

Infants with idiopathic perinatal fibroinflammatory obliteration of the lumen of the extrahepatic biliary tree ("biliary atresia") invariably died of biliary cirrhosis before surgical techniques were devised to permit drainage of bile into the duodenum. Survival rates in operated patients now approach 75 percent at 10 years. While definitive diagnosis of biliary atresia without the use of cholangiography at laparotomy is difficult, because other disorders have similar clinical features, early diagnosis is important. The earlier surgery is undertaken, the more successful it is. With delay, irreversible changes occur in the liver that produce portal hypertension. This and liver failure eventually make liver transplantation necessary even in some operated patients. Hepatic disease associated with biliary atresia is in part due to delay in diagnosis, but complications of surgical therapy, such as ascending cholangitis, also play a role. With prolonged survival and as numbers of liver transplant recipients rise, new therapy-related complications, such as those associated with immunosuppression, will become more important in surgically treated biliary atresia.
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PMID:Biliary atresia and its complications. 218 2

Biliary mucinous cystadenocarcinoma is an extremely rare tumour. Less than 50 cases have been reported. It is usually a multilocular cystic tumour covered with mucous producing epithelium, with papillary excrescences containing mucinous mass arising from bile ducts. The size of the tumour varies from 3.5 to 25 cm in diameter. It is more frequent in women. The majority of patients belong to the middle age population. We present a 63-year-old man who had been suffering from an epigastric and right subcostal pain of unknown aetiology for over 35 years. During the last 10 years he suffered from multiple attacks of cholangitis with high temperature, rigor, chills, pain and obstructive jaundice. Five years ago he had the attack of pancreatitis with retroperitoneal fatty necrosis for which he was operated on in another institution and cholecystectomy and pancreatic necrectomy were carried out. The attacks of cholangitis continued they were more serious and more frequent until June 1987, when the "cyst" in the left lobe of the liver, dilated bile ducts and "polyps" in the common bile duct were diagnosed by ultrasonography. During the operation advanced biliary cirrhosis, portal hypertension, splenomegaly, very dilated common bile duct full of jelly and the "cyst" in the liver filled with jelly, were found. The removal of the jelly and choledochojejunostomy resulted in temporary relief. Two months later he was reoperated for recurrent obstructive jaundice during which left lobectomy, partial excision of the cyst and cystojejunostomy between the rest of the cyst and another Roux-en-Y jejunal limb, were carried out.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Biliary mucinous cystadenocarcinoma of the liver]. 221 37

Of 178 patients with sclerosing cholangitis treated since 1950, 88 patients had associated inflammatory bowel disease, 72 had no such history, and 18 had iatrogenic injury or stone disease. A total of 233 biliary operations were performed, with a 75% rate of temporary improvement after initial operation. Subsequent operations resulted in a lower success rate and a higher mortality rate. Radiologic findings included predominant extrahepatic, intrahepatic, and diffuse disease in 29%, 28%, and 43% of patients, respectively; no survival differences were noted. Seventy-five of one hundred three deaths (73%) were related to liver failure, bleeding, or sepsis. Of 14 patients undergoing portosystemic shunt, 13 died of surgical complications or related disease. Orthotopic liver transplantation was performed in 16 patients and resulted in eight deaths, mainly in patients who had previously undergone extensive surgical treatment. No survival differences were seen between the patients with inflammatory bowel disease, those without the condition, or those who had colectomy. Surgical treatment in patients with sclerosing cholangitis should be minimized. Orthotopic liver transplantation should be offered as the treatment of choice for patients with portal hypertension, refractory cholangitis, advanced cirrhosis, or progressive liver failure.
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PMID:Surgical aspects of sclerosing cholangitis. Results in 178 patients. 222 20

Transient esophageal ulceration is a common finding after sclerotherapy of varices. A small proportion of these ulcers become chronic and resistant to conventional therapy. Such chronic ulcers have been associated with pain, stricture formation, and recurrent hemorrhage. The use of omeprazole, a proton pump inhibitor, was examined in the current study in the treatment of 10 patients (6 women, 4 men; age range, 27-86 years) with cirrhosis (PBC, 4; sclerosing cholangitis, 2; chronic active liver disease, 2; alcohol, 1; and cryptogenic, 1) who developed an esophageal ulcer after a mean of 13 (range, 8-21) sessions of sclerotherapy. The ulcers had been present for 3-54 months despite prolonged treatment with high-dose H2-receptor antagonists and sucralfate. In each case one or more complications had occurred: severe pain in 3, stricture formation in 4, and recurrent hemorrhage in 7 cases. After an 8-week course of omeprazole, 40 mg daily, endoscopy confirmed complete healing of the ulceration in all 10 cases with symptom resolution. In 2 cases the ulcer recurred, with associated bleeding within 6 weeks of discontinuing the treatment in 1 patient. Both cases responded to repeat therapy. These results confirm the efficacy of omeprazole for postsclerotherapy ulceration and imply that acid-pepsin has a role in perpetuating such ulcers.
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PMID:Omeprazole in the management of intractable esophageal ulceration following injection sclerotherapy. 222 99

Primary sclerosing cholangitis is a rare disease of unknown etiology. Sclerosis of the bile ducts may actually be the final result of multiple factors such as autoimmune, bacterial, congenital, drug, or viral injury. The most commonly associated diseases are ulcerative colitis and chronic pancreatitis. Except in the earliest stages of the disease, liver histologic findings are not specific. Most patients present with jaundice, pain, and pruritus, although an increasing number of asymptomatic patients with inflammatory bowel disease and abnormal liver function are being identified. Cholangiography is key to the diagnosis and is usually pathognomonic except in the unusual case where primary sclerosing cholangitis is confused with cholangiocarcinoma. Many forms of medical therapy have been tried, including antibiotics, azathioprine, cholestyramine, colchicine, cyclosporine, D-penicillamine, steroids, and ursodeoxycholic acid. To date, none of these medications has been proved to alter the course of this disease. Recent reports of ursodeoxycholic acid trials have been encouraging, but long-term results of ongoing randomized trials have yet to be published. In recent years, balloon dilatation of biliary strictures has been accomplished via endoscopic and percutaneous transhepatic approaches. However, in patients with primary sclerosing cholangitis, these nonoperative manipulations must be done repeatedly, may entail multiple general anesthetics, and are difficult to perform. We believe that a direct surgical approach to the biliary tree with long-term transhepatic stenting is indicated in selected patients with severe hilar or extrahepatic stricturing, persistent jaundice or recurrent cholangitis, and no evidence of cirrhosis. Hepatic transplantation should be reserved for patients with primary sclerosing cholangitis who have well-established cirrhosis and have not responded to other therapeutic measures.
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PMID:Primary sclerosing cholangitis. 224 21

The Registry provides information about 904 children with biliary atresia from more than 100 institutions. There was a 1.4 to 1 female predominance; racial distribution was 62% caucasian, 20% black, 11% Hispanic, 4.2% asian, and 1.5% American Indian. Eight hundred sixteen (90%) underwent corrective surgery (median age at operation, 69 days). Intraoperatively, 70% had totally obliterated extrahepatic bile ducts, 22% had patency of the gallbladder and distal common duct, whereas only 8% had "correctable" biliary atresia (proximal duct patency). A variety of reconstructions were used, but the majority of patients had a Roux-en-Y portoenterostomy with or without exteriorization. Follow-up was available for 670 children (74%) with average length of follow-up of 5 years (range, 1 to 16 years). Five-year actuarial survival was 48% following Kasai's operation, but was less than 10% (at 3 years) if no operative correction was done. Survival was unaffected by sex, type of reconstruction, or cholangitis. Predictors of a bad outcome were (1) caucasian race; (2) operative age greater than 60 days; (3) presence of cirrhosis at initial biopsy; (4) totally nonpatent extrahepatic ducts; (5) absent ducts at the level of transection in the liver hilus; and (6) subsequent development of varices or ascites. Identification of factors predictive of the ultimate outcome provide a basis for either continued efforts with management of Kasai's operation or for early referral for liver transplantation.
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PMID:Biliary atresia registry, 1976 to 1989. 226 62

A 25 year old female was operated on three times due to a choledochal cyst rupture occurring on the 6th postpartum day. In the last operation, a hepaticojejunostomy with Braun's anastomosis was performed and a temporary internal stent was applied. The internal stent was removed on the 70th postoperative day. The patient is still living with the risk of secondary biliary cirrhosis and cholangitis.
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PMID:Rupture of a choledochal cyst during postpartum period. 227 61


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