ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Much of the research into bile physiology during the past 12 months has dealt with some aspect of bile acid biosynthesis, including defects of cholesterol side-chain oxidation associated with clinical problems. A pharmacologic interest is illustrated by several papers dealing with “designer” bile acids, the second-messenger role of arachidonic acid oxidation products, and the effects of lipid-lowering agents on biliary chemistry. Each year our understanding of the diverse biologic activities of bile acids increases. This year is no exception, with new insights into the role of bile acids in milk digestion in the neonate and in the biliary excretion and intestinal absorption of ferrous iron. Despite further work on the mechanisms of bile acid-induced cytotoxicity and cytoprotection, there is little new information on the therapeutic efficacy of ursodeoxycholic acid in chronic liver disease.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Gallbladder and sphincter of Oddi motility disorders are well recognized. Gallbladder dyskinesia may be confirmed by the use of cholecystokinin, cholescintigraphy, and calculating the gallbladder ejection fraction. This investigation selects a group of patients who improve after cholecystectomy. Studies have evaluated the efficacy of sphincter of Oddi manometry and have shown it to be highly reproducible. Using manometry, reflexes that might influence sphincter of Oddi motility have been described.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Investigations into gallstone pathogenesis this year continue to emphasize kinetic factors that determine whether gallstones form once supersaturation of bile occurs. Studies of biliary phospholipid and cholesterol vesicles show two peaks that may be important in cholesterol precipitation. The larger void-volume peak is present in bile from most patients with cholesterol gallstones, whereas the smaller peak's eluting just before micelles correlates with nucleation time in bile. Evidence is presented showing that much of the promoting activity in fractions separated on concanavalin A columns is due to biliary immunoglobulins. In addition, alterations in gallbladder absorptive function, gallbladder contractility, and secretion of mucin, which might contribute to gallstone formation, are examined. Results of dissolution therapy with ursodeoxycholate and chenodeoxycholate are reviewed. Nucleation time in bile and volume of stones in the gallbladder are good predictors of gallstone dissolution in patients with “pure” cholesterol gallstones. A combination of ursodeoxycholate and chenodeoxycholate seems to be superior to either agent alone, but ursodeoxycholate is superior in treating obese patients undergoing rapid weight loss. A relatively new contact dissolution agent, D-limonene, was tested in 200 patients with retained common duct stones. Forty-eight percent of stones were completely dissolved by this agent, but 84% of patients experienced some degree of abdominal pain during treatment. The incidence of gallstones was reexamined in several groups of patients. The high incidence of gallstone disease in elderly patients emphasizes the increasing risk of gallstones with increasing age, and high incidences of gallstones with hemolytic anemia and cirrhosis were again supported. Finally, a high incidence of common duct stones in immigrants from southeast Asia, compared with Americans and Europeans, warrants routine cholangiography in this population.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The scope and importance of biliary infections from both a clinical and scientific perspective is rapidly changing. During this past year, considerable attention in the literature has focused on infections that are increasing in frequency in the United States and throughout the world, as a result of evolving demographics and continued spread of the acquired immunodeficiency syndrome epidemic. Pyogenic cholangitis remains a challenge for us to treat and significant controversy remains regarding optimal management. The myriad hepatobiliary manifestations of human immunodeficiency virus infection have led to a resurgence in the interest in parasitic and viral infections. Our understanding of infections and their pathogenesis and sequelae has progressed, although there are still many important questions that remain unanswered.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Laparoscopic cholecystectomy has stimulated an unprecedented interest in the radiology of the gallbladder. The search for nonoperative methods of treating gallstones continues, but there has been a relative diminution of interest in interventional radiologic techniques for the treatment of gallstone disease. However, this is more than counterbalanced by a plethora of articles on diagnostic studies of the gallbladder, many of them related directly to laparoscopic cholecystectomy. Extracorporeal shock wave lithotripsy for gallstones is a technique that still has a place in the era of laparoscopic cholecystectomy and radiologic methods have been used to target it at those patients for whom it is most effective. Percutaneous interventional techniques are becoming increasingly sophisticated. The barriers between minimally invasive surgery and interventional radiology are becoming blurred, with the use of small-caliber endoscopes through radiologically created access routes. In the treatment of malignant disease, the use of self-expandable stents is now becoming routine and there are several papers on methods of dealing with stent occlusion.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The field of biliary endoscopy continues to expand. The place of endoscopic sphincterotomy in the treatment of ductal stones is firmly established, and the problem of large stones has been solved. The advent of laparoscopic cholecystectomy has implied a more active role for the biliary endoscopist in managing ductal stones and has overshadowed interest in endoscopic access to the gallbladder. Stenting remains the mainstay of palliative treatment of malignant jaundice and is also useful in benign strictures and biliary fistulae.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In the past 2 years, a revolution of unprecedented scope has occurred in biliary surgery. Laparoscopic cholecystectomy, first performed in 1987, has now become the procedure of choice to treat cholelithiasis. Because laparoscopic surgery proliferated in the absence of controlled clinical trials, concerns have been raised regarding its complications. This article reviews the technique of laparoscopic cholecystectomy, examines its feasibility and complications, and discusses the evolving role of intraoperative cholangiography and the approach to common bile duct stones. In a separate section, we review the year's literature on gallstone pancreatitis and on surgical treatment of benign biliary strictures.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Several large series have been reported describing extensive surgery for gallbladder cancer; prolonged survival, however, has not been shown compared with more conservative treatment. Although in the case of bile duct tumors, excision of adjoining structures might confer some benefit and further improvement might be seen by the use of radiotherapy. Accurate preoperative imaging is beginning to be beneficial in the selection of patients for the different modalities of treatment.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The success of treating patients with biliary atresia is related to the remaining liver function. The latter is related to age. Therefore, early diagnosis is important; even 2-week-old babies with jaundice should be screened. If screening indicates the possibility of biliary atresia, the only way to conclusively exclude biliary atresia is cholangiography. Endoscopic retrograde cholangiopancreatography is being more frequently utilized to successfully outline the biliary tree in these young patients. The Kasai procedure has a 5-year success rate of about 30%. This success rate may be increased by utilizing an antireflux valve fashioned from the enteric limb to prevent a persistent incidence of reflux cholangitis. Biliary atresia may arise from environmental insults (cytomegalovirus), or more uncommonly congenital defects (anomalous pancreaticobiliary union). Extrahepatic biliary cysts are more common than the intrahepatic variety. The former are associated with anomalous pancreaticobiliary unions and cholangiocarcinoma. These associations support the mechanism of pancreatic juice reflux into the biliary tree. Therefore, excision of the cyst is the treatment of choice. Caroli's disease (intrahepatic biliary cysts) may be diagnosed by observing intracystic vascular dots (Marchal's sign), utilizing ultrasound or computed tomography.

ISSN:0267-1379    

出版商:OVID    

年代:1992

数据来源: OVID