Prospective randomized pilot trial of selective biliary cannulation using pancreatic guide-wire placement.

BACKGROUND AND STUDY AIMS: In difficult cases of selective bile duct cannulation, several expanded techniques are available which have only been partially evaluated in randomized studies. This study describes a prospective, randomized trial investigating a further technique for obtaining selective biliary access--pancreatic duct wire placement. PATIENTS AND METHODS: During a six-month study period, 107 consecutive patients required deep selective biliary cannulation. Accessing the bile duct using a catheter failed within 10 min in 53 of the patients, who were randomly assigned to either pre-insertion of a guide wire into the pancreatic duct or persistence with a conventional catheter. The success rate and complication rate were compared between these two groups. RESULTS: In the pancreatic duct-guide wire group (n=27), the success rate was significantly greater than in the conventional group (93% vs 58%). No pancreatitis complications occurred within either group. CONCLUSIONS: Inserting a guide wire into the pancreatic duct to facilitate deep selective bile duct cannulation is better than persisting with a conventional catheter. Further studies will be needed to confirm these results and to compare this method with other sophisticated techniques for obtaining selective access to the bile duct.

A new surgical procedure consisting of ligation of the common hepatic artery and auto-transplantation of hepatocytes into the spleen for end stage liver cirrhosis accompanied by ascites.

The authors developed a new surgical procedure for end stage liver cirrhosis associated with ascites. This procedure consists of ligation of the common hepatic artery and hepatocyte inoculation into the spleen (method A) and in this study is compared with common hepatic artery ligation alone (method B). Six of the eleven dogs operated by method A survived for six months or more with a significant (P < 0.01) difference in the three month survival in comparison with method B. In the hemodynamic study of both methods, the portal vein pressure and portal resistance decreased as a result of operation, but in method B, they returned to preoperative levels and in method A the low levels persisted for more than one year. In our method, liver function improved remarkably after three months. The hepaplastin and the cholinesterase levels increased after three months in method A with a significant difference (P < 0.01) in comparison with method B. The labeling index (L.I.) of intrasplenic hepatocytes also increased three months later. We emphasize that our method is an ideal procedure not only to improve portal haemodynamics but also to improve liver function, in end stage cirrhosis.

Ternary complex formation and reduced folate in surgical specimens of human adenocarcinoma tissues.

BACKGROUND AND METHODS: Various factors, including thymidylate synthase, thymidine kinase, 5-fluorouracil phosphorylation and degradation pathways, folate concentrations, and the stability of ternary complex, which influence thymidylate synthase inhibition rate of fluoropyrimidines, were studied in 87 human adenocarcinoma tissues. RESULTS: The activity of the 5-fluorouracil degradation pathway was not significantly lower than the activity of the 5-fluorouracil phosphorylation pathway. The activity of the catabolism pathway of 5-fluorouracil should be considered in human adenocarcinoma tissue during chemotherapy. On the other hand, the means plus or minus standard deviations (means +/- SD) of the concentration of 5,10-methylenetetrahydrofolate and tetrahydrofolate were 0.69 +/- 0.54 and 1.25 +/- 0.69 nM, respectively, for the adenocarcinoma tissues without previous chemotherapy. CONCLUSIONS: Because the half-life of tritium-labeled ternary complex and folate concentration in cytosol were correlated well, the differences in folate concentration among tumors must influence the dynamic equilibrium of ternary complex formation. Moreover, these results show that the ratio of 5,10-methylenetetrahydrofolate concentration to thymidylate synthase concentration influences the thymidylate synthase inhibition rate in tumor, and that the new synthesis of 5,10-methylenetetrahydrofolate and tetrahydrofolate from other endogenous reduced folates is also important in tumors with high thymidylate synthase concentrations.