The pattern of fall of serum bilirubin after operative relief of obstructive jaundice. A preliminary report

This is the beginning of a prospective study on patients who have obstructive jaundice to see how the serum bilirubin falls after operative relief of the obstruction. Seven of such patients have been studied; four had carcinoma of the head of the pancreas while the other three had choledocholithiasis. The patients with carcinoma had relief of the jaundice through a biliary-enteric anastomosis and those with common bile duct stones had choledochotomy with stone extraction which was completed with insertion of a T-tube. Serial bilirubin estimations were then performed post-operatively to chart the pattern and rate of descent of this in each patient. Our observations suggest that the pattern of fall of serum bilirubin after successful decompression of the extra-hepatic biliary tree exhibit a distinct pattern regardless of the surgical procedure performed for the relief of the obstruction.

Perfuração espontânea de colédoco em adolescente

Spontaneous perforation of the common bile duct is rare. It happens predominantly in children and it is related to obstructive disease of the biliary tract. We present a case of an 18 year-old male patient, with ulcerative rectocolitis associated with malignant tumor of the head of pancreas. The patient developed an acute abdomen syndrome and laparotomy, a spontaneous perforation of common bile duct was evidenced. The authors make a revision of the clinical aspects of that pathology

Abdominal hyperalgesia in secretory phospholipase A(2)-induced rat pancreatitis: Distinct roles of NK1 receptors

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Biliary tract reconstruction using jejunal tube: an experimental study in dogs

BACKGROUND: To physiologically reconstruct the biliary tract, Crema et al suggested the application of the Monti principle to the biliary tract, already used in humans for the urinary tract. With this technique, a jejunal segment is transversely retubularized. This study aimed to evaluate the efficacy of jejunal tube interposition between the common bile duct and duodenum in dogs.METHODS: Thirteen dogs underwent a laparoscopic common bile duct ligature, followed by a biliodigestive connection by jejunal tube interposition after one week. The levels of glutamic-pyruvic and glutamic-oxalacetic transaminases, total bilirubins, alkaline phosphatase and gamma-glutamyltransferase were assessed before surgery and thereafter weekly until euthanasia, which was performed 6 weeks after biliodigestive connection.RESULTS: Data on 9 dogs were analyzed statistically. The dogs presented with obstructive jaundice after common bile duct ligature, as confirmed by biochemical examination. They showed a statistically significant reduction in cholestasis after biliodigestive connection by jejunal tube interposition and were healthy until the end of the experiment.CONCLUSION: A statistically significant reduction was seen in total bilirubin and canalicular enzymes (alkaline phosphatase and gamma-glutamyltransferase) in the 9 dogs 6 weeks after biliodigestive conviction by jejunal tube interposition.

Ascorbic acid supplementation has a cytoprotective effect on secondary biliary cirrhosis: experimental study in young rats

Objective: To test whether ascorbic acid supplementation has any cytoprotective effect on a model of secondary biliary cirrhosis in young rats.Methods: We studied 40 Wistar rats weaned at the 21st postnatal day. Each group of 10 was subjected to one of the following four treatments, until 49th postnatal day, when they suffered euthanasia: 1) LC-double ligature and resection of the common bile duct and daily administration of ascorbic acid [100 mg/g of body weight (bw)]; 2) LA-double ligature and resection of the common bile duct and daily administration of aqueous vehicle (1 mL/g bw); 3) SC-sham operation and daily administration of ascorbic acid (100 mg/g bw); 4) SA-double ligature and resection of the common bile duct and daily administration of aqueous vehicle (1 mL/g bw). The rats were weighed daily. on the 27th day after the operation they received an intra-peritoneal injection of 1.5 mg/g bw of sodium pentobarbital, and the pentobarbital sleeping time was measured. Blood was collected for serum alanine aminotransferase and aspartate aminotransferase activity measurements, serum albumin and globulin concentrations, and the liver was assessed for liver water and fat content. Data were submitted to two-way ANOVA and paired comparisons between groups were tested using the SNK method. Significance level was set at 0.05.Results: Ascorbic acid supplementation attenuated the effects of cholestasis: decreased the pentobarbital sleeping time, serum globulin, and the liver fat content.Conclusions: Our results corroborate the hypothesis that ascorbic acid supplementation has a cytoprotective effect in secondary biliary cirrhosis.

Adaptação do modelo experimental de colestase extra-hepática em ratos jovens

Os autores descrevem a adaptação da técnica de ligadura e ressecção do ducto biliar comum descrita na literatura, enfatizando suas vantagens na recuperação pós-cirúrgica. Este trabalho foi realizado no Laboratório Experimental do Departamento de Pediatria da FMB-UNESP.

Influence of acute pancreatitis on the in vitro responsiveness of rat mesenteric and pulmonary arteries

Background: Acute pancreatitis is an inflammatory disease characterized by local tissue injury and systemic inflammatory response leading to massive nitric oxide (NO) production and haemodynamic disturbances. Therefore, the aim of this work was to evaluate the vascular reactivity of pulmonary and mesenteric artery rings from rats submitted to experimental pancreatitis.Male Wistar rats were divided into three groups: saline (SAL); tauracholate (TAU) and phospholipase A(2) (PLA(2)). Pancreatitis was induced by administration of TAU or PLA(2) from Naja mocambique mocambique into the common bile duct of rats, and after 4 h of duct injection the animals were sacrificed. Concentration-response curves to acetylcholine (ACh), sodium nitroprusside (SNP) and phenylephrine (PHE) in isolated mesenteric and pulmonary arteries were obtained. Potency (pEC(50)) and maximal responses (E(MAX)) were determined. Blood samples were collected for biochemical analysis.Results: In mesenteric rings, the potency for ACh was significantly decreased from animals treated with TAU (about 4.2-fold) or PLA(2) (about 6.9-fold) compared to saline group without changes in the maximal responses. Neither pEC(50) nor E(MAX) values for Ach were altered in pulmonary rings in any group. Similarly, the pEC(50) and the E(MAX) values for SNP were not changed in both preparations in any group. The potency for PHE was significantly decreased in rat mesenteric and pulmonary rings from TAU group compared to SAL group (about 2.2- and 2.69-fold, for mesenteric and pulmonary rings, respectively). No changes were seen in the E(MAX) for PHE. The nitrite/nitrate (NO(x)(-)) levels were markedly increased in animals submitted to acute pancreatitis as compared to SAL group, approximately 76 and 68% in TAU and PLA(2) protocol, respectively.Conclusion: Acute pancreatitis provoked deleterious effects in endothelium-dependent relaxing response for ACh in mesenteric rings that were strongly associated with high plasma NO(x)(-) levels as consequence of intense inflammatory responses. Furthermore, the subsensitivity of contractile response to PHE in both mesenteric and pulmonary rings might be due to the complications of this pathological condition in the early stage of pancreatitis.

Choledochal cyst: A case associated with traumatic hemobilia

A case of choledochal cyst associated with traumatic hemobilia is presented. The symptomatology appeared only because of bleeding into the biliary tract following an automobile accident. The cyst was resected and a choledochal cystoduodenum anastomosis performed. The early result (12 mth) was very good.

Litíase intrahepática primária. Relato de caso e revisão da literatura.

Primary intrahepatic lithiasis is an entity defined by intrahepatic stones exclusively located in the IH ducts above the emergence of the common bile duct. The disease is classified in two types: Eastern type (stones formed primarily in intrahepatic ducts; frequent in Japan) and Western type (stones formed in the extrahepatic bile system, usually in gallbladder, which migrate up to the intra-hepatic ducts). The mechanisms of lithogenesis in the entity are as yet not fully understood; multiple factors seem to operate synergistically: anatomical changes of the intrahepatic ducts, metabolic disorders, infections, idiopathic alteration. All these factors may facilitate biliary stasis leading ultimately to stone formation. We report on a case of and review the literature on primary intrahepatic lithiasis, which is a rare occurrence in the West and a disease of difficult surgical approach and high mortality.

Water-soluble extract of Coleus barbatus modulates weight gain, energy utilization and lipid metabolism in secondary biliary cirrhosis: an experimental study in young rats.

PURPOSE: To test if a water extract of Coleus barbatus (WEB) has any effect on weight gain, food energy utilization and lipid metabolism in young rats with obstructive cholestasis. METHODS: Forty 21 day old (P21) Wistar rats, in groups of 10, were submitted to one of the following treatments: a sham operation with daily water or WEB administration, double ligature and resection of the bile duct with daily water or WEB administration. At P49 they were submitted for euthanasia when the following were determined: ingested feed (IF), energy utilization (EU) and weight gain (WG) from P29 to P49, together with total serum cholesterol (TC) and triacylglycerol (TG) concentrations, liver wet weight (LWW) and fat content (LFC). Two Way ANOVA and the S.N.K. test for paired comparisons were employed to study the effects of cholestasis and those of WEB and their interactions (p < or = 0.05). RESULTS: Cholestasis, independently of WEB, and WEB, independently of cholestasis both reduced IF, EU, and WG but there was no significant interaction between the two factors. Cholestasis, independently of WEB, increased LWW, LFC, the TC and TG The WEB, independently of cholestasis, reduced these values, and there was a significant interaction between the two factors; such that these effects were more accentuated in animals with cholestasis. CONCLUSION: The WEB reduced IF, WG, and EU, both in the presence and absence of cholestasis in the same proportion. It also partially inhibited the increase in LWW, LFC, TC and TG caused by cholestasis.

Efeito da suplementação de vitamina C (vit.C) sobre os efeitos decorrentes das alterações nutricionais da cirrose biliar secundária: estudo experimental em ratos jovens

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

Efeitos da administração de vitamina A hidrossolúvel sobre as lesões e a disfunção hepática na colestase obstrutiva: estudo experimental em ratos jovens

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

Efeitos a longo prazo de alterações de dieta numa fase precoce da vida sobre o crescimento posterior: estudo experimental em ratos jovens

Pós-graduação em Pediatria - FMB

Efeito da vitamina E-TPGS hidromiscível sobre as alterações nutricionais e a lesão hepática na colestase crônica

Pós-graduação em Pediatria - FMB

Inhibition of inducible nitric oxide synthase-derived nitric oxide as a therapeutical target for acute pancreatitis induced by secretory phospholipase A(2)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)