Laparoscopic Right Hemicolectomy and Cholecystectomy for a Cholecystocolic Fistula

A cholecystocolic fistula (CF) is an uncommon complication of the gallbladder and colonic disease. We report a case of a CF that was successfully managed by using a laparoscopic right hemicolectomy and cholecystectomy. A 49-yr-old woman was admitted to the Department of Internal Medicine because of intermittent and progressive right upper quadrant pain. She was obese (body mass index: 34 kg/m2) and had a previous history of three abdominal surgeries. She was diagnosed with a CF by using abdominal computed tomography. The fistula between the gallbladder and the hepatic flexure of the colon was also characterized by using technetium-99m diisopropyl iminodiacetic acid ((99m)Tc-DISIDA) cholescintigraphy, a double-contrast Barium enema, and colonoscopy. Multiple polyps with severe inflammation were observed around the orifice of the fistula. Because of the risk of malignancy and appendicolith on CT, a laparoscopic en block excision of the gallbladder and the right colon following adhesiolysis was performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 9. This case shows that the laparoscopic combined resection is safe and effective in the experienced hands of the laparoscopic surgeon even though a CF has traditionally been considered as a contraindication to laparoscopic surgery. While the incidence of successful management of biliary-enteric fistulas through laparoscopic repair is increasing, this is the first report of a laparoscopic combined resection of a CF in an obese patient with severe intraabdominal adhesion.

Application of ursodeoxycholic acid in hepatobiliary scintigraphy for neonatal hyperbilirubinemia: comparison with phenobarbital

Early differentiation of biliary atresia from neonatal hepatitis is of utmost importance, since on time surgery of biliary atresia significantly improves the outcome. Hepatobiliary scintigraphy is an integral part of diagnosis work-up of these patients; however its specificity for diagnosis of biliary atresia is suboptimal. In this study we evaluated the value of ursodeoxycholic acid pre-treatment for improvement of hepatobiliary scintigraphy specificity. Thirty consecutive infants with direct heperbilirubinemia were included into the study. All infants underwent hepatobiliary scintigraphy with [99m]Tc-bromo iminodiacetic acid [[99m]Tc-BRIDA] twice [first after pre-treatment with phenobarbital and the other time after pre-treatment with ursodeoxycholic acid]. Of 30 patients included into our study 13 had final diagnosis of extrahepatic biliary atresia and 17 had neonatal hepatitis. Bowel was visualized in 11 patients with neonatal hepatitis after phenobarbital pre-treatment and in 16 after ursodeoxycholic acid pretreatment which amounts to 80% and 96.6% specificity for diagnosis of biliary atresia with phenobarbital and ursodeoxycholic acid respectively. All patients had complications of phenobarbital administration [lethargy, poor feeding, irritability, hypotonia, etc] to some extent. These findings decreased significantly after discontinuation of phenobarbital and were not present with ursodeoxycholic acid. Ursodeoxycholic acid is a safe and efficient drug for pre-treatment of patients with neonatal cholestasis syndrome who are going to undergo hepatobiliary scintigraphy. Compared to phenobarbital, this drug has fewer complications and is more efficient

Bile leak detection by radionuclide scintigraphy.

INTRODUCTION: Bile leak after liver injury has been reported to be a complication associated with significant mortality. Tc99m-IDA (Tc: Technetium) nuclear scan allows rapid and noninvasive diagnosis of bile leak. OBJECTIVE: An accidental case was referred for the detection of suspicious bile leak. METHODS: The ultrasound could not detect any abnormality. Dynamic Hepatobiliary Scintigraphy (DHBS) using radiolabeled tracer was performed. RESULTS: DHBS promptly detected the site of leak. CONCLUSION: This technique should be opted because it has been found to be quite sensitive, specific and accurate for detecting the bile leak, whereas, Ultrasound and CT imaging are less sensitive and nonspecific. Though, they are initially helpful in determining the presence of abdominal fluid collections, they are unable to differentiate between a seroma, lymphocele, hematoma or bile leak. Hepatobiliary scintigraphy is more accurate because it can demonstrate continuity of these fluid collections with the biliary tree. Further, hepatobiliary scintigraphy can provide real-time assessment of hepatocytes function and bile progression from the liver to the intestine.

Oriented immobilization of papain on metal chelating carriers / 生物工程学报

Based on the technology of protein separation with immobilized metal ion affinity chromatography (IMAC), a method for oriented immobilization of papain has been selected. Papain was successfully immobilized on magnetic agarose carriers. Cu2+ with iminodiacetate (IDA) was used as the chelating ligand to be correlated with the histidine on papain (His-81). The optimum immobilization conditions of enzyme were as flows: Cu2+ 0.15 x 10(-2) mol/g carriers, time was 4h, enzyme load was 30 mg/g carrier, pH was 7.0, respectively. The pH and temperature were 8.0 and 70 degrees C for immobilized enzyme. The recovery activity of immobilized enzyme was retained 68.4%. The carrier could be recovered from the spent immobilized enzyme, to be reused. After 5 times, the reimmobilization of papain on the regenerated matrix was 79.71% effective with the retention of maximum enzyme activity. The cost of carriers used for industrial applications is very important. The regenerability of carriers is therefore, relevant. The mild conditions used for immobilization, the high recovery of immobilized preparations, the stability and the regenerability of the matrix are the main features of the method reported here. All above indicate this method can be applicable and promising in enzyme immobilization field.

Hepatobiliary clearance of labelled mebrofenin in normal and D-galactosamine HCl-induced hepatitis rats and the protective effect of turmeric extract.

This study was carried out to see the hepatobiliary clearance of 99m Tc-Mebrofenin radiopharmaceutical in D-galactosamine induced hepatic rats. Furthermore, protective effect of turmeric extract has been studied in these hepatitis rats. Hepatitis was induced with intraperitoneal injection of D-galactosamine (400 mg/kg b. wt) in these rats. 1% turmeric extract was given along with their normal diet for 15 days. Turmeric extract treatment significantly increased the hepatic uptake of radioactivity and accelerated the excretion of 99m Tc-Mebrofenin as compared to control rats. (P < 0.001). In D-galactosamine administered rats, a significant delay was observed in 99m Tc-Mebrofenin excretion as compared to controls. However, D-galactosamine administered rats, pretreated with turmeric extract or concurrently treated with turmeric extract showed a near normal pattern of 99m Tc-Mebrofenin excretion. Hence, it can be suggested that turmeric extract may improve the liver function by detoxification.

Role of biliary scintigraphy in management of bile leak.

BACKGROUND: Endoscopic biliary drainage is effective in the management of patients with postoperative bile leak. Evidently, it cannot be used in patients with completely tied-off common bile duct (CBD). AIM: To ascertain whether biliary excretion scintigraphy could reliably detect patients with tied-off CBD so that endoscopic retrograde cholangiography (ERC), an invasive test, could be avoided. METHODS: Twelve patients with active bile leak (11 postcholecystectomy, one posttraumatic), in whom the biliary system was imaged by both 99m technetium mebrofenin biliary scintigraphy and ERC, were evaluated. RESULTS: Bile leak was demonstrated in all the 12 patients by scintigraphy. In six of these, there was no visualization of radionuclide activity in the intestines; in three of these six patients, ERC showed a patent CBD potentially amenable to endoscopic drainage, whereas in the remaining three, there was complete obstruction presumably due to CBD tie-off during surgery. CONCLUSION: Biliary excretion scintigraphy is unreliable for detecting complete biliary obstruction in patients with bile leak.

Enolizable carbonyl and imino metabolites may act as endogenous sources of reactive oxygen species

Highly reactive oxyradicals and electronically excited triplet carbonyls can be generated in vitro by iron complexes and heme enzyme-catalyzed aerobic oxidation of synthetic or naturally occurring substances capable of enolization in aqueous medium. Monoenols and enamines, obtained by (alpha-methyne-carbonyl and -imine enolization, undergo dioxygen insertion and ultimately originate triplet species; e.g., isobutanal, 3-methylacetoacetone, Schiff bases. In turn, (alpha-hydroxy- and (alpha-aminocarbonyls (e.g., carbohydrates, 5-aminolevulinic acid) tautomerize to enediols and enolamines and yield oxyradicals, initiated by electron transfer to dioxygen, as polyphenols (e.g., 6-hydroxydopamine) and polyphenolamines do. Free radicals and excited species have been implicated in several normal and pathological processes. We here briefly review our contributions to this research area, emphasizing a possible in vivo prooxidant role for 5-aminolevulinic acid, the heme precursor accumulated in several porphyric disorders (e.g., lead poisoning, acut intermittent porphyria, tyrosinosis).

Cholescintigraphic detection of biliary leaks.

We report four cases in whom post-traumatic or post-surgical biliary leak was detected using dynamic 99mtechnetium-iminodiacetic acid (IDA) cholescintigraphy. This technique is a non-invasive, safe, simple and sensitive method of documenting the presence, location and extent of biliary leaks. Further, it can be repeated and hence, is useful in evaluating the response to treatment. Surgery is indicated when a moderate extravasation of labeled bile suggests that the leak is the chief pathway of bile drainage, with relatively little bile entering the intestine.

Synthesis of different 5-methyl amino and 5-imino derivatives of 6-methyl-2-thiouracil

Condensations of 5-chloromethyl-6-methyl-2-thiouracil III and the corresponding 5-formyl analogue IV with different amines were completely studied

Thoracic stomach: comparative evaluation of endoscopy, gastric aspirate analysis and hepatobiliary scintigraphy in the diagnosis of duodeno-gastric reflux.

Twenty patients with thoracic stomach were subjected to hepatobiliary scintigraphy for the diagnosis of duodenogastric reflux. The results of the radionuclide studies were correlated with those of endoscopy and biochemical estimation of total intragastric bile acid. Hepatobiliary scintigraphy was found to be more sensitive (91.6%) and accurate (95%) than endoscopy (25% and 55% respectively) and biochemical estimation of total intragastric bile acid content (66.6% and 80% respectively). Being noninvasive and physiological, radionuclide study appears suitable for routine clinical use in the diagnosis of duodeno-gastric reflux.

Preparaçäo de conjuntos de reativos liofilizados de iodofenin para marcar com 99mTC, utilizados em estudo hepatobiliar / Preparation of lyophylized agents kits of iodofenin for labeling with 99mTC, utilized in hepatobiliary study

Prepararam-se conjuntos de reativos liofilizados do ácido trimetil iodoacetanilido iminodiacético (IODOFENIN) para marcar com 99mTc, contendo em cada frasco 20 mg de iodofenin 0,2 mg de SnCl2.2H2O, pH5,5. Realizaram-se controles de qualidade radioquímico e biológico. No controle de pureza radioquímica analisaram-se os seguintes parâmetros: a) volume de 99mTc(1,3 e 5 mL), b) atividade de 99mTc (37, 370, 1110 e 1850 MBq) e c) tempo de estocagem do conjunto de reativo (1, 3, 6 e 12 meses). Os resultados demonstraram que o produto apresenta uma pureza radioquímica de 95-99// nos parâmetros estudados, com uma estabilidade de 12 meses para seu uso. Utilizaram-se ratos (Wistar) de peso médio 200 g para avaliar o comportamento biológico. Neste estudo observou-se uma captaçäo de 67// pelo fígado, aos 5 minutos decrescendo em 2 horas e apresentando no decorrer do metabolismo uma alta captaçäo gastro-intestinal (98//). Na bilis, o produto manteve a sua integridade (93//) até 20 minutos após sua eliminaçäo

Variations in normal hepatobiliary scintigraphy in Indian population.

Hepatobiliary scintigraphy was performed with Tc99m iminodiacetic acid (IDA) analog, in 100 apparently healthy adults, to study the variations in the normal hepatobiliary scintigraphy. Gall bladder (GB) was visualised in 43% at 15 min; 87% at 30 min, 90% at 45 min and 99% at 60 min and the small intestine (SI) was visualised in 24% at 15 min, 69% at 30 min, 76% at 45 min and 92% at 60 min. Left hepatic duct was prominent in 45%. Reciprocal relation between SI and GB was observed in 21%.

Refluxo enterogástrico após gastrectomia parcial: estudo comparativo entre a anastomose à Billroth I e a derivaçäo em Y de Roux / Enterogastric reflux after partial gastrectomy: a comparative study of Billroth I anastomosis and Roux-en-Y diversion

O refluxo do contéudo do intestino proximal para o coto gástrico pode ocasionar lesäo da mucosa gástrica, resultando no desenvolvimento de gastrite. Diversos procedimentos cirúrgicos têm sido propostos para previnir o refluxo, dentre eles a derivaçäo em Y de Roux. Foram comparados, no que diz respeito ao refluxo enterogástrico, pacientes submetidos à gastrectomia parcial com reconstituiçäo por gastroduodenostomia e por anastomose em Y de Roux. O refluxo foi avaliado pela injeçäo endovenosa de 99m TcDISIDA, seguida de aspiraçäo do conteúdo gástrico, calculando-se o índice de refluxo enterogástrico (percentagem do total de radiotraçador injetado recuperada no aspirado gástrico). Com base nos resultados obtidos, conclui-se que o refluxo enterogástrico é significativamente maior nos pacientes submetidos à anastomose à Billroth I do que nos pacientes operados pela derivaçäo em Y de Roux

Reflujo duodeno gástrico: evaluación gamagráfica en úlcera gástrica y gastritis crónica / Duodenogastric reflux: gammagraphic evaluation in gastric ulcer and chronic gastritis

A 70 pacientes divididos en tres grupos: A) Control (14); B) Ulceras Gástricas (31), C) Gastritis Crónica (25) se les efectuó una determinación de R.D.G. con Cámara Gamma y Tc99 HIDA. Un segundo estudio se realizó a las 48-72 horas a 30 pacientes a los efectos de evaluar la reproductibilidad del método, la que alcanzó un 80%. En los pacientes con UG y CG se encontró la existencia de RDG en una proporción significativamente mayor que entre los controles sanos (P 0.01). A su vez la magnitud de dichos reflujos fue significativamente superior en las GC y en las UG tipo III. De acuerdo con estos resultados, se atribuye al R.D.G. un papel significativo en la patogenia de un porcentaje importante de pacientes con UG y GC