[Echinococcosis of intra- and extrahepatic bile ducts. Report of a case at the Central Military Hospital]. / Hidatidosis en vías biliares intra y extrahepáticas. Reporte de un caso en el Hospital Militar Central.

We present a woman 34 years old with echinococcosis of intra and extra hepatic biliary ducts including gallbladder. We found alive cysts, dead cysts and fragments of germinative membranes of a complicated cyst in left lobe (I - II) with clinical findings of obstructive jaundice; pain; cholecystitis and great dilation of biliary ducts. We performed left lobectomy, exploration of biliary ducts, transduodenal sphincteroplasty, cholecystectomy. We haven't had complications. We present ultrasound images of the pathologic pieces.

Adaptive hepatic changes in mild stenosis of the common bile duct in the rat.

Adaptive hepatic changes were investigated in rats with mild stenosis of the common bile duct and in sham-operated controls. The studies were performed 24 h and 7-12 days postoperatively. A continuous intravenous infusion of taurocholic acid at stepwise-increasing rates was performed to explore the responses to bile acid effects. During the infusion, bile flow and the outputs of bile acids, phospholipids, cholesterol, alkaline phosphatase and gamma glutamyl transpeptidase were studied. At the end of the infusion, hepatic morphometric measurements were performed. In other experimental sets, biliary excretions of horseradish peroxidase, a marker of microtubule-dependent vesicular transport in the hepatocyte, and sulphobromophthalein, a well-known organic anion model, were studied. In other rats, bile acid pool size and composition were determined by depletion of bile. The results in rats with mild stenosis maintained for 24 h showed a greater susceptibility to the toxicity of taurocholic acid, as revealed by the abrupt decrement in bile flow at high rates of infusion, and increased outputs of phospholipids and canalicular enzymes. Conversely, rats with mild stenosis maintained for 7-12 days showed decreased bile acid maximum secretory rate and biliary outputs of phospholipids and canalicular enzymes, as well as hepatocyte hypertrophy. These findings may explain the limited hepatic and systemic repercussion of experimental mild stenosis of the common bile duct and help us to understand the early stages of constriction of the common bile duct in man.

Síndrome ductopênica / Vanishing Bile Duct Syndrome

O autor faz uma revisão da patologia da síndrome ductopênica (SD), de suas causas e de seu papel na patogenia da colestase crônica. São considerados na sua gênese fatores congênitos, metabólico, imunológicos, circulatórios e fibrogênicos. As causas de SD são subdivididas em congênitas e adquiridas, sendo analisadas entre as primeiras a tresia de vias biliares extra-hepáticas ressaltando-se a importância do patologista na classificação morfológica da porta hepatis de pacientes submetidos à cirurgia de Kasai, com vistas ao prognóstico da mesma. Na atresia de vias biliares intra-hepáticas, são consideradas a forma sindromática com sua composição clínico-patológica e a não sindromática, suas causas mais frequêntes e sua historia natural , habitualmente mais grave. Entre as causas adquiridas são estudadas as drogas e sua importância crescente na gênese de SD, além de outros temas de interesse atual, como a SD resultante de lesões ductais encontradas na AIDS, na rejeição celular aguda e na rejeição crônica do enxerto hepático, assim como reação enxerto versus hospedeiro. è dado destaque especial às causas mais frequentes de SD no adulto, quais sejam a cirrose biliar primária e a colangite esclerosante primária. Sua análise segue um plano de comparação entre ambas, incluindos dados epidemiológicos e clínicos, doemças associadas e métodos de laboratório e imagem indispensáveis para seu diagnóstico. São mencionados dados anatomopatologicos ainda dentro de analogias que ligam ambas as condições, fazendo-se referência à tipagem de linfócitos, maração de antígenos de histocompatibilidade no tecido, dados sobre suscetibilidade genética e mecanismos patogênicos envolvidos . São Mencionadas ainda outras condições capazes de levar à SD, entre as quais sarcoidose, histiocitose X doença de Hodgkin e sepsis, conceituando-se finalmente a ductopenia idiopática do adulto como diagnóstico de exclusão, sendo analisadas algumas hipóteses sobre sua etiopatogenia

Rat model of mild stenosis of the common bile duct.

Several techniques for developing incomplete obstruction of the common bile duct have been described but none of them properly represents a compression or constriction of the bile duct. In this study, a mild stenosis of the common bile duct was achieved in the rat by means of a double ligature including a cannula that could be easily slipped out of the ligatures. Sham-operated rats were used as controls. The studies, performed 7-10 days postoperatively, indicated that in ligated rats a duct constriction was produced, made evident by an increase of the biliary pressure, an upstream dilatation of the bile duct, an increase of the liver volume constituted by portal tracts, and ductular proliferation. Serum parameters were practically similar in ligated and control rats, except for a slight increase in serum bilirubin. Following intravenous injection of sodium taurocholate there were rapid increases of bile flow and bile salt output in both groups, but choleresis induced by sodium taurocholate was higher in ligated rats than in controls. The clearances of [14C]erythritol and [14C]sucrose suggested that ductular water contributing to bile flow and changes in biliary permeability were not involved in ligated rats. The limited repercussion of humoral effects and hepatic behaviour seen in ligated rats despite the morphological alterations induced make the mild stenosis of the bile duct a good model for the study of early stages of compression or constriction of the biliary tract.

Biliary tract disease due to Fasciola hepatica: report of a case.

We report a case of a 23 year old woman who presented with symptoms of biliary tract disease to our University Hospital in Bayamón, Puerto Rico. A diagnosis of chronic cholelithiasis was made and the patient was taken to surgery. An adult Fasciola hepatica was recovered from the common bile duct. We review the pathobiology of this uncommon zoonosis.

Biliary tract disease due to fasciola hepatica: report of a case

We report a case of a 23 year old woman who presented with symptoms of biliary tract disease to our University Hospital in Bayamón, Puerto Rico. A diagnosis of chronic cholelithiasis was made and the patient was taken at surgery. An adult Fasciola hepática was recovered from the common bile duct. We review the pathobiology of this uncommon zoonosis

[Congenital cystic dilatation of the common bile duct]. / Dilatación quística congénita del colédoco.

The congenital cystic dilatation of choledochal is a congenital malformation with little frequency in Mexico. It is of multifactorial etiology and it is known with different names. The work present its frequency, pathology, etiology, its clinic manifestations, the actual methods of cabinet and laboratory there are most frequently to be used in the preoperative diagnosis of the disease. It is proposed an algorithm for to study the icteric syndrome in infants and childhood who has suspicion of congenital cystic dilatation of choledochal. It is describe the surgical treatment and the mortality.

[Congenital cyst of the common bile duct. Surgical treatment with total excision of the cyst]. / Quiste congénito del colédoco. Tratamiento quirúrgico con excisión total del quiste.

Congenital choledochal cyst (CChC) has a very low frequency in our population; it is more frequent among females and its pattern of inheritance is multifactorial. The frequency of CChC in our population was 1 per 20,000 to 1 per 30,000 hospitalized patients in the pediatrics department of the Hospital Juarez and Hospital Infantil de Tacubaya, respectively. Four new cases of CChC are reported, two school children and two teenagers. Pre-operative diagnosis was accomplished clinically, which is the most precise non-invasive method. The most effective actual diagnostic methods include ultrasonography, CAT scan, and basic laboratory data, which can corroborate the clinical diagnosis of CChC with 100% certainty. The surgical treatment of CChC is controversial, but the surgical procedures of choice are choledochocystojejunostomy with total cyst removal, Roux's Y, and cholecystectomy. One case was treated with latero-terminal choledochocystojejunostomy and 3 cases with total removal of the cyst. The results were excellent.

[Hepatic fibropolycystic disease in Mexico. Study of 82 cases]. / Enfermedad fibropoliquística hepática en Mexico. Estudio de 82 casos.

We analyzed 82 cases of hepatobiliary fibropolycystic disease (FPD) that were seen at the Instituto Nacional de la Nutrición "Salvador Zubirán" in Mexico City in the thirty-year period comprised from 1956 to 1986. The different entities that compose FPD were distributed as follows: 61 (74%) cases of polycystic liver disease, 13 (16%) cases of choledochal cyst, and 8 (10%) cases of congenital hepatic fibrosis; there were 5 (6%) cases of Caroli's disease, 3 associated with congenital hepatic fibrosis and 2 with choledochal cyst. Polycystic liver disease predominated in females (67%) and presented at 54 +/- 12 years (mean +/- SEM) with pain, a mass, symptoms related to renal insufficiency or incidentally; polycystic kidneys were present in 61%. Liver function tests were normal in 94%. Choledochal cyst also predominated in females and presented at a mean age of 19 years with cholangitis. Liver function tests were abnormal in 69%. Congenital hepatic fibrosis (50% male) presented with variceal hemorrhage or cholangitis (in 3 patients associated with Caroli's disease). Polycystic kidneys were present in five patients. Four of the five patients with Caroli's disease were female and presented at a mean age of 19 years with cholangitis. It never presented as an isolated disease, but was associated more frequently to congenital hepatic fibrosis. The diseases that are part of the hepatobiliary polycystic disease vary in severity and thus the prognosis in an individual patient is determined by the type of fibropolycystic disease present. This is the largest series of this disease published in our country.