Long-term outcome of cholecystoenterostomy as a definitive biliary drainage procedure for benign disease.

Our aim was to examine the long-term success of cholecystoenterostomy performed for the relief of benign extrahepatic biliary obstruction. Concern about the ability of cholecystoenterostomy to provide reliable long-term biliary decompression has led many to abandon its use for benign biliary obstruction. Thirty-four patients who underwent cholecystoenterostomy for benign biliary obstruction over a 17-year period were reviewed. Patients were followed until cholecystoenterostomy failure, death, or to date. Failure was defined as recurrent biliary obstruction or cholangitis requiring therapeutic intervention. Mean follow-up was 8.0 years. Early postoperative morbidity occurred in 11 patients (32%), but only one early complication (cholangitis) was related directly to the cholecystoenteric anastomosis. Five patients (15%) experienced late biliary tract complications related directly to the cholecystoenterostomy including recurrent biliary stones with biliary obstruction in four and anastomotic stricture in one. All required reoperation and conversion to choledochoenterostomy at a mean of 112 months. Cholecystoenterostomy can provide reasonably effective long-term biliary decompression in selected patients with benign biliary obstruction.

Effect of polyamines and cations on the in vitro methylation of histones.

Na+ (0.05-0.15 M) increases both the rate and extent of methylation of chromosomal bound histone H4, while spermidine markedly inhibits this reaction. The effects of spermidine could be mimicked by increasing the concentration of Mg2+ or Ca2+ to 5-10 mM. At the concentrations listed above, these cations have no significant effect on the methylation of free or chromosomal bound histone H3, nor do they affect the rate r extent of methylation of soluble histone H4. Apparently, the accessibility of histone H4 to the methyltransferase is influenced by chromatin structure. Increasing concentrations of Na+ alter the conformation of chromatin (DNA) in such a way as to expose lysing residues in the N-terminal region of histone H4 to the methyltransferase, whereas Mg2+ or spermidine acts in an opposite manner.