ABSTRACT
Of 27 patients with primary sclerosing cholangitis, 4 were found on investigation and subsequently at operation to have gross lobar atrophy. The disease was particularly severe in the hilar region. Three of the four patients were asymptomatic prior to the onset of jaundice. The presence of atrophy precipitated laparotomy to exclude cancer in two cases. Marked disparity in size between liver lobes precluded a hilar approach to relieve extrahepatic obstruction in two patients. Prolonged follow-up excluded coincident malignant disease. Selective liver atrophy should be considered part of the disease spectrum in primary sclerosing cholangitis.
Subject(s)
Cholangitis, Sclerosing/complications , Liver/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Atrophy , Cholangiography , Cholangitis, Sclerosing/diagnostic imaging , Female , Humans , Liver/diagnostic imaging , Male , Middle Aged , Radionuclide Imaging , UltrasonographyABSTRACT
Presented is a patient with primary sclerosing cholangitis, extrahepatic bile duct obstruction, and associated occlusion of the main portal vein, who was treated by peripheral biliary drainage. Radiological follow-up showed considerable improvement of the ductal strictures and bile excretion through the normal anatomical route. The patient remains well and anicteric 60 months after surgery.
Subject(s)
Cholangitis/therapy , Cholestasis, Extrahepatic/surgery , Adult , Cholangiography , Cholangitis/complications , Cholangitis/diagnostic imaging , Cholestasis, Extrahepatic/diagnostic imaging , Cholestasis, Extrahepatic/etiology , Humans , Liver Function Tests , Male , Sclerosis , SuctionABSTRACT
Three patients with postcholecystectomy unilateral hepatic duct stricture and subsequent liver atrophy were treated conservatively, with a successful outcome of up to three years follow up. A better understanding of the pathophysiological sequelae of segmental hepatic duct obstruction suggests that in such circumstances reconstructive surgery, with its attendant risks, may not invariably be necessary.
Subject(s)
Cholestasis/therapy , Hepatic Duct, Common , Liver/pathology , Adult , Aged , Atrophy , Cholecystectomy/adverse effects , Cholestasis/etiology , Female , Humans , MaleABSTRACT
A refined bronchoscopic method of sampling bronchial secretions is presented. The results show that this gives higher yields of aerobic pathogens than examination of expectorated sputum and the method also avoids pharyngeal contamination in suspected cases of anaerobic lung infection. Our results indicate that anaerobic organisms do not play a major role in causing sputum purulence in patients with chronic bronchitis, bronchogenic carcinoma or with less florid degrees of bronchiectasis. Anaerobic infections did not appear to occur as often as suggested by some reports from the United States.
