摘要:

The past year saw a marked increase in the number of papers dealing with canalicular bile water flow; details of its control are now emerging. While bile acid molecular biologists dug in, bilirubin enthusiasts hit back with the breath-taking elucidation of the conjugation enzyme genes and the defect in the Crigler-Najjar syndrome. Interest in the therapeutic use of ursodeoxycholic acid continued and was associated with a surge of interest in the cytotoxic and cytoprotective effects of bile acids.

ISSN:0267-1379    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The past year has seen contributions to our understanding of gallstone pathogenesis from epidemiologic data and from studies of bile physical chemistry and the nucleation of cholesterol microcrystals. The importance of biliary bile acids, phospholipid composition, and mucus glycoprotein secretion in stone formation was investigated further, as was the role of biliary calcium, a component of both cholesterol-rich and pigment stones. Finally, more information on the natural history of biliary sludge, a precursor of gallstones, has come to light.

ISSN:0267-1379    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Gallbladder stasis has long been thought to contribute to cholesterol gallstone pathogenesis, but it has been difficult to define the exact role of impaired biliary motility and the mechanisms by which it evolves. Recent studies suggest that abnormal lipid composition of bile influences gallbladder contractility, perhaps by modifying the composition of gallbladder membranes so that transduction of smooth muscle regulatory signals is impaired.

ISSN:0267-1379    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Many of the advances in research concerning biliary infections in the past year have focused on elucidation of mechanisms of disease in humans and in animal models. The influence of biliary obstruction and sepsis on the reticuloendothelial system in an animal model is reported as are the effects of endotoxin administration on biliary immunoglobulins. Microsporidiosis has emerged as a new etiology of cholangitis in patients who are seropositive for HIV and who were previously thought to have idiopathic disease. Risk factors and classification of patients with acute cholangitis along with factors that influence the development of cholangitis and its severity are reported. Progress in the understanding of biliary infections and their pathogenesis has occurred, but many important questions remain unanswered. This article reviews the mechanisms of infection of the biliary tract with emphasis on the immune factors, the hepatobiliary complications of AIDS, ascending cholangitis, animal models of infection, and factors that are altered during acute cholecystitis. Briefly mentioned are new reports on the management and clinical evaluation of both cholangitis and acute cholecystitis.

ISSN:0267-1379    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Recent publications in biliary tract endoscopy focus on the role of expandable metallic stents for the treatment of biliary strictures and the new challenges and questions imposed on the biliary endoscopist by laparoscopic cholecystectomy. Although one randomized controlled study comparing the Wallstent (Schneider AG, Bülach, Switzerland) with conventional plastic prostheses showed longer patency, there have been disturbing reports of tumor ingrowth, technical failures, and complications. There is evidence that preoperative endoscopic retrograde cholangiopancreatography need only be performed in selected patients suspected of having bile duct stones. Biliary injury after laparoscopic surgery can usually be managed by endoscopic intervention alone. Controversy continues over the diagnosis and management of sphincter of Oddi dysfunction. Endoscopic ultrasonography can detect and stage biliary malignancies with great accuracy; however, the impact of this modality on treatment needs to be evaluated.

ISSN:0267-1379    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Laparoscopic cholecystectomy has become the standard treatment for gallstones. It has advantages over open cholecystectomy and medical therapies. During laparoscopic cholecystectomy, either routine or selective cholangiography is acceptable treatment. Bile duct injury is a serious problem in laparoscopic cholecystectomy, but it seems to be decreasing in incidence. One of the main mechanisms of bile duct injury is when there is an aberrant right hepatic duct present. Bilomas are another problem and endoscopic retrograde choledochopancreatography and endoscopic sphincterotomy are useful in dealing with this problem. The results of laparoscopic cholecystectomy for acute cholecystitis are improving and the incidence of treating choledocholithiasis by laparoscopic means is also increasing. However, there are no comparative clinical trials with standard therapies. Radical resection of gallbladder carcinoma is increasing in frequency with some good results. Surgery for bile duct carcinoma is continuing to improve in association with more precise methods of staging the disease. An association has been reported between cholangiocarcinoma and hereditary nonpolyposis colorectal carcinoma. Such patients should be followed by abdominal ultrasound and liver function tests in order to make an early diagnosis.

ISSN:0267-1379    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The medical therapy of gallstone disease has undergone many changes in the past decade. Two types of dissolution agents have been developed: oral bile acids and contact-dissolving chemicals. In addition, biliary lithotripsy has been used extensively and has been found to be quite successful when used with oral bile acids. The success of these therapies is largely dependent on the type of gallstone being treated. With the success of laparoscopic cholecystectomy, medical therapy of gallstones has become focused on certain patient populations. The strategy in the coming years will be to develop a comprehensive treatment approach for all types of gallstone patients. Most likely, dissolution therapy will be recommended for the elderly or those who cannot undergo cholecystectomy. Small radiolucent gallstones will be particularly amenable to oral bile salt therapy. Larger radiolucent stones, between 5 to 15 mm, will be candidates for biliary lithotripsy. The challenge for medical therapy in the future will be to develop a noninvasive, rapidly acting, oral dissolution agent that will be capable of dissolving cholesterol and noncholesterol portions of gallstones.

ISSN:0267-1379    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Biliary disease in infants and children is due to congenital abnormalities such as biliary atresia and choledochal cysts, as well as genetic disorders such as hemoglobinopathies and cystic fibrosis. Several new models for the pathogenesis of extrahepatic biliary atresia and congenital intrahepatic bile duct diseases have been proposed during the past year. Liver transplantation is being increasingly recognized as the ultimate treatment for biliary atresia, even after a successful Kasai operation. Roux-en-Y hepaticojejunostomy is the recommended standard operation for choledochal cysts, although several modifications have now been introduced (the anatomy of the pancreaticobiliary junction is thought to be important in the incidence of postoperative complications). Infants and children are increasingly recognized as having asymptomatic cholelithiasis, which often resolves with time. Three additional cases of hepatocellular carcinoma associated with arteriohepatic dysplasia (Alagille syndrome) have also been reported, and the authors suggest yearly screening with hepatic ultrasound examinations as well as monitoring serum α-fetoprotein levels. Ursodeoxycholic acid is a promising new treatment for patients with cystic fibrosis and hepatobiliary disease, and several small clinical trials have been performed.

ISSN:0267-1379    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0267-1379    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0267-1379    

出版商:OVID    

年代:1993

数据来源: OVID