Benign biliary strictures: treatment with percutaneous cholangioplasty.

Results of percutaneous balloon cholangioplasty of 17 patients with 28 benign biliary strictures were compared with those of published radiologic and surgical series to determine whether stricture location was related to therapeutic success and whether a patient should undergo percutaneous or surgical therapy. Treatment was considered successful if there was no anatomic evidence of recurrent stricture or need for surgery (mean follow-up, 32 months). Treatment was successful in all nine (100%) intrahepatic (zone 1) strictures, 11 of 12 (92%) extrahepatic-extrapancreatic (zone 2) strictures, one of three (33%) intrapancreatic (zone 3) strictures, and three of four (75%) bilienteric anastomotic (zone 4) strictures. Restenosis occurred in five patients; cholangioplasty was ultimately successful in two of those patients after redilation and stent placement. On the basis of these results and those of published radiologic and surgical series, the authors believe that cholangioplasty is the treatment of choice for zone 1 strictures and is as effective as surgery for zone 2 and 4 strictures. Patients with zone 2 and 4 strictures with concomitant portal hypertension or a history of multiple previous biliary surgical procedures should be considered good candidates for cholangioplasty. Zone 3 strictures may be better treated surgically than percutaneously.

Retinoids induce U937 cells to express macrophage phenotype.

The effects of two retinoids, all-trans-retinoic acid (t-RA) and 13-cis-retinoic acid (c-RA) were studied in a model of osteoclast precursors. The model employs the U937 cell line induced to differentiate when incubated with 1 alpha,25-dihydroxyvitamin D3 and conditioned medium from stimulated human lymphocytes. t-RA and c-RA (10(-8) to 10(-6) M) inhibited cellular growth rates and increased surface adherence. However, t-RA and c-RA both partially blocked the differentiation induced by 1,25(OH)2D3 and lymphokines. Thus, retinoids alone promoted the differentiation of U937 cells but partially blocked the differentiation induced by a vitamin D metabolite and lymphokines. These results suggest that vitamins A and D may exert antagonistic effects on the recruitment of osteoclast precursors.