Síndrome colestásico como forma de presentación de linfoma no Hodgkin. Reporte de un caso pediátrico / Cholestatic syndrome as a presentation of non-Hodgkin lymphoma. A pediatric case report

La ictericia colestásica se debe a la alteración de la secreción de bilirrubina conjugada; es una de las posibles causas la alteración del flujo biliar por obstrucción de la vía biliar extrahepática. El linfoma es la tercera neoplasia más frecuente en pediatría, mientras que los tumores pancreáticos son poco frecuentes y, en su mayoría, lesiones benignas. Las manifestaciones clínicas de los tumores de localización retroperitoneal son poco específicas y suelen ser tardías, por lo que la sospecha clínica debe ser alta. El objetivo del siguiente trabajo es presentar el caso de un niño de 7 años con síndrome colestásico en el que se halló un tumor en la cabeza del páncreas que comprimía la vía biliar extrahepática. El diagnóstico del tumor fue linfoma no Hodgkin (LNH). Se destaca la infrecuencia de este tumor en esta localización en la edad pediátrica

Cholestatic jaundice is due to an alteration in conjugated bilirubin secretion; a possible cause is an altered bile flow resulting from an obstruction of the extrahepatic bile duct. A lymphoma is the third most common neoplasm in pediatrics, while pancreatic tumors are rare and mostly benign. The clinical manifestations of retroperitoneal tumors are not very specific and are usually late, so a high level of clinical suspicion is required. The objective of this study is to describe the case of a 7-year-old boy with cholestatic syndrome with a tumor in the head of the pancreas compressing the extrahepatic bile duct. The tumor diagnosis was non-Hodgkin lymphoma (NHL). It is worth noting that the presence of a tumor in this location in pediatric age is uncommon

The application of Compont gel in chronic obstructive jaundice rats model

Abstract Purpose: To establish a new rat model, the pathogenesis of which is closer to the clinical occurrence of chronic obstructive jaundice with liver fibrosis. Methods: 90 SD rats were randomly divided into 3 groups. Group A common bile duct ligation, group B common bile duct injection compont and group C injection saline. The serum of three groups was extracted, and the liver function was detected by ELISA. HE staining, Masson staining and immunohistochemistry were used to detect liver pathology. Results: Group B showed a fluctuant development of jaundice, obstructive degree reached a peak at 2 weeks, and decreased from 3 weeks. HA, LA and PCIII were significantly higher than control group. 3 weeks after surgery, liver tissue fibrosis occurred in group B, and a wide range of fiber spacing was formed at 5 weeks. Immunohistochemistry showed that hepatic stellate cells were more active than the control group. Conclusion: Intra-biliary injection of Compont gel is different from the classic obstructive jaundice animal model caused by classic bile duct ligation, which can provide an ideal rat model of chronic obstructive jaundice with liver fibrosis.

Effect of silymarin on oxidative stress and liver histopathology in experimental obstructive jaundice model

ABSTRACT PURPOSE: To investigate the effect of silymarin on oxidative stress and hepatic injury induced by obstructive jaundice in an experimental model. METHODS: Thirty Wistar-Albino type female rats were divided into 3 groups each including 10 rats. Only laparotomy was performed in group 1. Bile duct ligation was performed in group 2. In group 3, bile duct ligation was performed and orogastic silymarin 300 mg/kg/day dose was given for seven days. At the end of seven days, rats were sacrificed. The blood and liver tissue samples were taken to be examined biochemically and histopathologically. RESULTS: The plasma and liver levels of malondialdehyde were significantly lower in silymarin group than in the bile duct ligated group. Although liver levels of GSH were significantly higher in silymarin group than in the bile duct ligated group, there was no significant difference between the plasma GSH levels of these groups. In silymarin group; the enlargement of hepatocytes, dilatation of canaliculi and the edema were regressed. CONCLUSION: Silymarin diminished the harmful effects of obstructive jaundice on liver.

Evidence-Based Decompression in Malignant Biliary Obstruction

As recent advances in chemotherapy and surgical treatment have improved outcomes in patients with biliary cancers, the search for an optimal strategy for relief of their obstructive jaundice has become even more important. Without satisfactory relief of biliary obstruction, many patients would be ineligible for treatment. We review all prospective randomized trials and recent retrospective non-randomized studies for evidence that would support such a strategy. For distal malignant biliary obstruction, an optimal strategy would be insertion of metallic stents either endoscopically or percutaneously. Evidence shows that a metallic stent inserted percutaneously has better outcomes than plastic stents inserted endoscopically. For malignant hilar obstruction, percutaneous biliary drainage with or without metallic stents is preferred.

Papilomatose das vias biliares / Biliary papillomatosis

A papilomatose das vias biliares (PVB) é uma afecção rara, descrita inicialmente por Caroli, em 1959. Até o ano de 2001, apenas cerca de 50 casos foram descritos na literatura mundial. O diagnóstico da PVB dificilmente é realizado no pré-operatório, pois os achados de exames de imagem e endoscópicos quase sempre são inespecíficos, e muitas vezes apenas sugerem o diagnóstico de neoplasia das vias biliares. O objetivo da presente publicação é relatar um caso de PVB tratado por hepatectomia esquerda com o diagnóstico provável de colangiocarcinoma da confluência dos hepáticos. O diagnóstico definitivo de PVB só foi estabelecido após estudo anatomopatológico da peça cirúrgica. São comentados aspectos relacionados ao diagnóstico diferencial, às opões de tratamento propostas para a PVB, bem como o prognóstico dos pacientes submetidos à ressecção.

Biliary papillomatosis (BP) is a rare disease, initially described for Caroli, in 1959. Until the year of 2001, only about 50 cases had been described in world-wide literature. The diagnosis of the BP hardly is carried through in pre-operatory, therefore the findings of image examinations and endoscopies almost always are not specifics, and many times only suggest diagnosis of neoplasia of biliary ducts. The objective of present publication is to relate a case of BP treated for left hepatectomy with probable diagnosis of cholangiocarcionoma of hepatics ducts confluence. Definitive diagnosis of BP alone was established after anatomopathological study of surgical specimen. Aspects related to differential diagnosis, treatment options proposals for the BP, as well as prognostic of the patients submitted to surgery are commented.

Oxidized low-density-lipoprotein accumulation is associated with liver fibrosis in experimental cholestasis

OBJECTIVE: The aim of the present study was to examine the probable relationship between the accumulation of oxLDL and hepatic fibrogenesis in cholestatic rats. INTRODUCTION: There is growing evidence to support the current theories on how oxidative stress that results in lipid peroxidation is involved in the pathogenesis of cholestatic liver injury and fibrogenesis. One of the major and early lipid peroxidation products, OxLDL, is thought to play complex roles in various immuno-inflammatory mechanisms. METHODS: A prolonged (21-day) experimental bile duct ligation was performed on Wistar-albino rats. Biochemical analysis of blood, histopathologic evaluation of liver, measurement of the concentration of malondialdehyde (MDA) and superoxide-dismutase (SOD) in liver tissue homogenates, and immunofluorescent staining for oxLDL in liver tissue was conducted in bile-duct ligated (n = 8) and sham-operated rats (n = 8). RESULTS: Significantly higher levels of MDA and lower concentrations of SOD were detected in jaundiced rats than in the sham-operated rats. Positive oxLDL staining was also observed in liver tissue sections of jaundiced rats. Histopathological examination demonstrated that neither fibrosis nor other indications of hepatocellular injury were found in the sham-operated group, while features of severe hepatocellular injury, particularly fibrosis, were found in jaundiced rats. CONCLUSION: Our results support the finding that either oxLDLs are produced as an intermediate agent during exacerbated oxidative stress or they otherwise contribute to the various pathomechanisms underlying the process of liver fibrosis. Whatever the mechanism, it is clear that an association exists between elevated oxLDL levels and hepatocellular injury, particularly with fibrosis. Further studies are needed to evaluate the potential effects of oxLDLs on the progression of secondary biliary cirrhosis.

Colestasis gravidica: a propósito de un caso / Cholestasis gravidarum: a purpose of a case

La Colestasis Gravídica en un síndrome que habitualmente se produce en el tercer trimestre del embarazo y se resuelve en el embarazo. Se caracteriza clínicamente por la presencia de prurito, ictericia o ambos sin otra disfunción hepática importante. En el siguiente trabajo se reporta caso de paciente femenino de 24 años III gestas II para FUR: 12/8/06 quien refiere de 6 días de evolución orinas coluricas, prurito generalizado predominio de manos y tórax, exámenes para clínicos con aumento de un transaminasas, fosfatasas alcalinas, se diagnóstica colestasis gravídica, patología de baja incidencia de 1/300 y 1/2000 embarazos, se considera importante realizar una revisión académica del mismo.

Prótesis metálicas autoexpandibles en el manejo poliativo de la ictericia obstructiva maligna: experiencia local / Self-expandable metallic stents in the management of poliativo malignant obstructive jaundice: local experience

La ictericia obstructiva es una manifestación frecuente de las neoplasias que afectan la vía biliar. La obstrucción maligna del tracto biliar puede ser causada por Carcinoma ampular, Carcinoma Pancreático, Carcinoma del ducto biliar y Enfermedad metastásica. Estos tumores suelen tener mal pronóstico, de forma que una minoría son resecables en el momento del diagnóstico (10-20 por ciento) y, de ellos sólo una escasa proporción tienen expectativas de curación. Desde su primera descripción en el año 1979 las endoprótesis biliares se han tornado en un importante componente del manejo multimodal de este complejo problema clínico. Las prótesis biliares endoscópicas proveen pilación efectiva en estos pacientes, aliviando la ictericia y mejorando el estado nutricional y calidad de vida durante el tiempo restante de vida del paciente. Las prótesis metálicas autoexpandibles ofrecen un diámetro mayor que las plásticas y se asocian a una tasa de oclusión mas baja, eliminando la necesidad de recambio. En este trabajo presentamos nuestra experiencia en el tratamiento paliativo definitivo de la ictericia obstructiva maligna. Desde el 20-10-2000 hasta mayo del 2003, hemos colocado un total de 22 prótesis metálicas autoexpandibles en vía biliar. Un caso correspondió a una estenosis "benigna" del ducto hepático común que complicó una Cirugía de vesícula biliar. Los restantes 21 casos correspondieron a estenosis malignas siendo discriminadas de la siguiente manera: 12 casos de Tumores de cabeza de páncreas, 6 tumores del ducto biliar, 2 tumores de papila duodenal y un caso de infiltración de la pared coledociana por tumor de Vesicula biliar. El rango de edad de estos pacientes osciló entre 49 y 94 años con una edad promedio de 66 años. La sobrevida de estos pacientes ha oscilado entre 5 dìas y 2 años. No se presentaron complicaciones en el momento de la colocación de la prótesis. De los Tumores del ducto biliar, dos estaban localizados en la bifurcación.