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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pruritus is a frequent symptom in chronic cholestatic liver disease. To date, no single causative mechanism has been identified. We examined venous plasma concentrations of the known pruritogen, histamine, using a highly sensitive radioenzymatic assay in 42 patients with chronic cholestatic liver disease, and in normal controls. The mean plasma histamine level was significantly greater in chronic cholestatic liver disease patients (275 (117) pg/ml; X (SD) than in controls (140 (72) pg/ml, n = 20) (p less than 0.0001). No significant differences were found between histamine concentrations in the two chronic cholestatic liver disease subgroups: primary biliary cirrhosis and sclerosing cholangitis. Histamine concentrations were significantly greater (p less than 0.01) in the pruritic (319 (132) pg/ml) as compared with the non-pruritic (227 (75) pg/ml) chronic cholestatic liver disease patients. The histaminase activity was equivalent in patients and controls. The finding of raised histamine concentrations in chronic cholestatic liver disease suggests in vivo mast cell activation and a potential role for its mediators in the pruritus characteristic of these disorders.
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PMID:Raised histamine concentrations in chronic cholestatic liver disease. 210 78

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

In several overseas centres endoscopic biliary drainage is now a standard procedure in the initial or definitive management of biliary tract obstruction. We report the first nine patients in whom this procedure was carried out in our unit. Four patients presented with acute cholangitis due to cholelithiasis. Urgent endoscopic biliary drainage improved the general condition in three patients prior to subsequent elective surgery. In one other patient with huge common bile duct calculi a biliary stent prevented recurrent episodes of cholangitis. Endoscopic endoprostheses were used in three patients with malignant biliary tract obstruction. Two had terminal metastatic disease and endoscopic drainage provided adequate palliation of jaundice and pruritus in one. Endoprosthesis blockage necessitated percutaneous drainage in the other patient. The third patient with carcinoma of the head of the pancreas was improved by endoscopic drainage prior to an open surgical bypass procedure. Another patient with obstructive jaundice due to terminal gall bladder carcinoma experienced relief of jaundice and pruritus following endoscopic insertion of a nasobiliary drain. We anticipate that endoscopic biliary drainage will become increasingly used in Singapore.
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PMID:Experience with endoscopic biliary drainage in Singapore. 239 99

At the instance of a female patient with obstructive jaundice due to inoperable carcinoma of the head of the pancreas is reported on the percutaneous transhepatic cholangiodrainage. With the help of this non-operative palliative drainage of the system of bile ducts in malignant tumors of the biliopancreatic area an at least transitory relief with regression of the jaundice and the excruciating pruritus is achieved. With regard to the relatively high complication rate of the percutaneous drainages performed without laparotomy (haemorrhage, cholangitis, sepsis) and to the possibly already early loss of function by occlusion or dislocation of the catheter the indication for such an approach is strictly to be made.
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PMID:[Percutaneous transhepatic bile duct drainage (PTCD)]. 241 32

Fourteen patients with sclerosing cholangitis underwent percutaneous cholangioplasty and stent placement with balloon-angioplasty and biliary-drainage catheters. There was initial clinical improvement in 13 of the 14 patients; one patient did not improve and died 1 month after the procedure. One of the 13 survivors developed encephalopathy and received a liver transplant 9 months after cholangioplasty; during the 9 months before transplantation, serum bilirubin and alkaline phosphatase levels returned to normal, and pruritus decreased. Restenosis of a duct following stent removal prompted repeat cholangioplasty in five of the 13 patients. Four of these five patients benefited from repeat cholangioplasty, and the fifth underwent liver transplantation 10 months after the second cholangioplasty. The other seven of the 13 survivors became either asymptomatic (n = 3) or less symptomatic than before cholangioplasty (n = 4) and did not require repeat cholangioplasty or liver transplantation during 10-42 months of follow-up.
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PMID:Sclerosing cholangitis: palliation with percutaneous cholangioplasty. 246 61

Cholestatic syndromes present symptomatically with pruritus and biochemically either with elevated levels of serum bile acid as an early manifestation of hepatocellular disease or with elevated levels of serum alkaline phosphatase if the disease originates in the biliary tree. Slow progression to cirrhosis occurs, with recurrent cholangitis and/or pancreatitis as the major problems if the obstruction is in the larger duct system. Maintenance of nutrition and relief of pruritus are important supportive measures. Colchicine and ursodeoxycholic acid administered orally have been proposed as useful therapies for delaying the progression to cirrhosis. Liver transplantation has proven successful in those patients in whom spontaneous remission does not occur.
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PMID:Cholestatic liver disease and its management. 265 62

Eleven patients with benign strictures (after choledochojejunostomy, n = 10; chronic pancreatitis, n = 1) and 16 with malignant biliary strictures (cancer of the pancreas, n = 7; cholangiocarcinoma, n = 5) were treated with a self-expanding metallic biliary stent. The patients with benign disease had failed treatment with surgical reconstruction and transhepatic balloon dilation. All patients had immediate relief of jaundice and cholangitis. In a follow-up period of 6-21 months, nine of the 11 patients with benign disease had no difficulties with infection, pruritus, or recurrent jaundice. In patients with malignant strictures, the stent produced relief of biliary obstruction unless recurrent tumor invaded the bile ducts. With careful patient selection, this stent appears to be useful in the management of biliary obstruction, particularly in benign disease.
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PMID:Gianturco expandable metallic biliary stents: results of a European clinical trial. 266 61

Thirty patients with high biliary tract strictures were treated by a new surgical endoprosthesis, the tolerance of which has been tested experimentally. It is flexible, radiopaque and incompressible with spurs which prevent migration. Following choledochotomy, the endoprosthesis is positioned surgically above the sphincter of Oddi, thereby avoiding ascending cholangitis. Twenty-nine cases presented with neoplastic compression by an inoperable cancer and one case had an early postoperative stricture with loss of substance after right hepatectomy for hepatic metastases. The 29 cancers included 13 gallbladder cancers, 11 cholangiocarcinomas, 10 of which were hilar, and 5 metastatic compressions due to gastrointestinal adenocarcinomas. In three cases, there was loss of substance of biliary tract after intubation. The operative mortality was 3.3% (one pulmonary complication). Resolution of jaundice was obtained in all but 2 cases and pruritus always resolved. The mean survival of the patients with cholangiocarcinoma was 12.2 months while that of patients with gallbladder cancer was 6.33 months with indices of satisfaction, calculated by Bismuth's method, varying between 71% (gallbladder cancer) and 93.5% (hilar cholangiocarcinoma). The patient operated for benign stricture secondary to a hepatectomy scar for metastases died from lung metastases without jaundice after 48 months. The only late complications were 2 cases of cholangitis treated medically, one of which was due to obstruction of the endoprosthesis at the 13th month. The authors conclude that this new type of surgical endoprosthesis constitutes an alternative in the palliative treatment of neoplastic hilar compressions.
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PMID:[Intubation of proximal biliary stenoses using a new surgical endoprosthesis]. 281 41

Although choledochal cyst is generally considered a disorder of childhood, in approximately 20% of patients a cyst is first recognized in adult life. We reviewed nine adults who underwent operation for choledochal cyst from 1974-1985 at Yale New Haven Hospital. Presenting symptoms included: crampy right upper quadrant pain, jaundice, pruritus, cholangitis, pancreatitis, hepatomegaly, and elevated liver function tests. Seven patients had undergone previous biliary surgery. The eight patients with type I cysts underwent complete excision of the cysts with Roux-Y choledochojejunostomy. One patient with a type IVa cyst underwent Roux-Y cystjejunostomy. All patients had complete resolution of biliary symptoms. There were no deaths, serious complications, or development of biliary malignancy in the 6 months to 13 years of follow-up. Optimum treatment of choledochal cyst is complete excision with reconstruction by Roux-Y choledochojejunostomy.
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PMID:Choledochal cysts in the adult. 298 Jul 68

Lupus anticoagulant, an immunoglobulin that prolongs the partial thromboplastin time, has been associated with thrombotic events, including deep venous thrombosis, pulmonary emboli, and Budd-Chiari syndrome. In this report, primary sclerosing cholangitis was diagnosed in a man with a 10-year history of multiple thrombotic events related to a circulating lupus anticoagulant. Progressive jaundice and pruritus developed, and sclerosing cholangitis was confirmed by direct cholangiography. Sclerosing cholangitis is the second hepatobiliary disease reported in association with a lupus anticoagulant.
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PMID:Primary sclerosing cholangitis in the presence of a lupus anticoagulant. 309 67


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