Clinical Characteristics of Choledochal Cysts With Intrahepatic Bile Duct Dilatations

Abstract Background: Whether the dilated intrahepatic bile duct (IHBD) has any effect on prognosis of choledochal cyst (CC) remains controversy. In the study, we aim to summarize the clinical characteristics and prognosis of those patients.Methods: A total of 192 children (47 males, 145 females) diagnosed with CC were identified in our hospital, including 127 without IHBD dilatation (group A) and 65 with IHBD dilatation (group B). A retrospective analysis was performed to explore the clinical characteristics of group B based on clinical indices, symptoms, and complications. Results: Compared with group A, incidences of jaundice and fever were significantly increased in group B (p=0.01 and 0.033, respectively). Preoperative total bilirubin (TB), direct bilirubin (DB), and indirect bilirubin (IDB) were also higher in group B than in group A (p=0.0052, 0.0005, and 0.0136, respectively), as were preoperative levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), and total bile acid (TBA) (p=0.0057, 0.0250, 0.0002, and 0.0242, respectively). Early postoperative GGT levels in group B remained abnormal and were significantly higher than in group A (p=0.0003). The risk of liver fibrosis or cirrhosis was significantly increased for group B compared with group A (p=0.012) and also occurred earlier in group B (p<0.001), among them, dilated IHBDs recovered to normal in 89.23% (7/65) of patients. Meanwhile, the incidence of postoperative pancreatitis increased significantly in group B as well (p=0.003).Conclusion: CC with IHBD dilatation was associated with significantly increased preoperative bilirubin levels, abnormal liver function, and higher incidence of liver fibrosis or cirrhosis early in the disease course. Timely radical surgery is recommended for such patients and postoperative extinction of the IHBD dilatation occurs early in most of those patients.

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Parameters Suggesting Spontaneous Passage of Stones from Common Bile Duct: A Retrospective Study

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2019/5382708 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Tawfik Khoury ◽

Mohamed Adileh ◽

Ashraf Imam ◽

Yosef Azraq ◽

Avital Bilitzky-Kopit ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Clinical Laboratory ◽

Medical Center ◽

Gamma Glutamyl Transferase ◽

Cbd Stones ◽

Spontaneous Passage ◽

Group A ◽

Group B ◽

Glutamyl Transferase

Background. Common bile duct (CBD) stones are common. However, they are known to pass spontaneously, which obviates the need for ERCP. Aim. The aim of this study is to identify specific predictors for spontaneous passage of CBD stones. Methods. Data was retrospectively collected for all patients who were hospitalized with clinical, laboratory, or ultrasonographic evidence of choledocholithiasis and who underwent magnetic resonance cholangiopancreatography (MRCP) in Hadassah Medical Center between 2005 and 2011. The patients were classified into 4 groups: group A (positive MRCP and positive ERCP), group B (positive MRCP but negative ERCP), group C (positive MRCP but did not undergo ERCP), and group D (negative MRCP that did not undergo ERCP) for choledocholithiasis. All positive MRCP-groups (A+B+C) were further grouped together into group E. We compared groups A versus B and groups E versus D. Results. Comparing groups A versus B, only gamma-glutamyl transferase predicted spontaneous passage of stones from CBD, as the level was significantly higher in group A (677±12.1) versus group B (362.4±216.2) (P=0.023). Patients with small stone diameter (P=0.001), distal stones (P=0.05), and absence of intrahepatic dilatation (P=0.047) tend to pass their stones spontaneously. Comparing groups D versus E, it was found that male gender (P=0.03), older age (P<0.001), high levels of GGT (P=0.022), high levels of alkaline phosphatase (P=0.011), high levels of total bilirubin (P=0.007), and lower levels of amylase (P<0.001) are predictors for positive MRCP studies for CBD stones. Conclusion. Identification of specific predictors is important to avoid unnecessary invasive endoscopic intervention.

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STUDY ON EVALUATION OF SERUM GAMMA-GLUTAMYL TRANSFERASE (GGT) LEVELS IN ACUTE CORONARY SYNDROME

10.36106/ijar/4109004 ◽

2021 ◽

pp. 39-40

Author(s):

Avtar Singh Dhanju ◽

Deepshikha Singla ◽

Pashaura Singh ◽

Ajay Chhabra ◽

Sukhraj Kaur

Keyword(s):

Acute Coronary Syndrome ◽

Cross Sectional Study ◽

Gamma Glutamyl Transferase ◽

Cross Sectional ◽

Gamma Glutamyl ◽

Coronary Syndrome ◽

Healthy Control ◽

Group A ◽

Group B ◽

Glutamyl Transferase

Aim: The present study was undertaken with the aim to evaluate serum Gamma Glutamyl Transferase (GGT) levels in patients of acute coronary syndrome. Methodology: This cross-sectional study was conducted on 50 cases with acute coronary syndrome (Group A) and 50 healthy control subjects (Group B) meeting inclusion and exclusion criteria. Results: There is signicant rise in serum GGT levels in patients presenting with ACS in Group A as compared to Group B. Conclusion: Higher levels of GGT in ACS patients with risk factors such as hypertension, dyslipidemia and smoking may serve as biomarker to predict the occurrence of ACS.

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Study of High sensitive C - reactive protein and Gamma-glutamyl transferase in Type 2 Diabetes Mellitus with Hypertension

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i3.2494 ◽

2020 ◽

Vol 11 (3) ◽

pp. 3478-3483

Author(s):

Ramya S ◽

Sureka Varalakshmi V ◽

Uma Maheswari K ◽

Chandan Bala R

Keyword(s):

Diabetes Mellitus ◽

Gamma Glutamyl Transferase ◽

C Reactive Protein ◽

Reactive Protein ◽

Significant Difference ◽

Group A ◽

Hs Crp ◽

Group B ◽

Glutamyl Transferase

C-reactive protein (CRP), produced by the hepatocytes is a primary inflammatory marker of T2DM. Higher levels of gamma-glutamyl transferase enzyme (GGT) and Hs CRP (High sensitive CRP)are associated with the complication of poor glycemic control.This study was aimed to find the association of Hs CRP and GGT for cardiovascular risk factors in Type 2 diabetes mellitus (T2DM)and Hypertension in the suburbs of Chennai. This study includes 57 subjects with T2DM and Hypertension (Group A) and 62 subjects with T2DM (GroupB) within the age group of 40-60 years. FBS, HbA1C, Hs CRP, GGT and blood pressure were determined. Statistical analysis was performed using Statistical Package for the SPSS 17 version. Mean values of FBS, blood HbA1C, Hs CRP and GGT were significantly higher among participants of Group A than Group B. Significant difference of FBS, HbA1C were found between the two groups. In contrast, no significant difference of GGT was found between the groups. Differences were considered statistically significant at two-sided P < 0.05. Within the group, Hs CRP shows the significance and positive correlation with FBS, SBP and DBP. Still, GGT does not show any significance in Group A. In contrast, in Group B, both Hs CRP and GGT shows the importance and positive correlation with FBS and HbA1C.It is concluded that high levels of HsCRP are associated with T2DM and Hypertension, indicating increased cardiovascular risk, and it should be included in regular monitoring of type-2 diabetic patients.

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Protective potentials of ethyl acetate-ethanolic fraction of Carica papaya leaves against acetaminophen-induced liver damage in rats

Notulae Scientia Biologicae ◽

10.15835/nsb12310629 ◽

2020 ◽

Vol 12 (3) ◽

pp. 556-567

Author(s):

Hussein O. B. OLOYEDE ◽

Halimat Y. LUKMAN ◽

Musa O. SALAWU

Keyword(s):

Ethyl Acetate ◽

Liver Damage ◽

Carica Papaya ◽

Female Rats ◽

Albino Rats ◽

Gamma Glutamyl Transferase ◽

Group A ◽

Extract Fraction ◽

Group B ◽

Glutamyl Transferase

The liver is an important organ performing vital roles that become affected when damaged. The protective potential of ethyl acetate-ethanolic fraction of Carica papaya leaves on acetaminophen-induced liver damage in female albino rats was investigated. Forty female rats were completely randomized into eight groups (A-H) of five rats each. Group A (control), received 1 ml of distilled water, group B (untreated) received 250 mgkg-1 bw of acetaminophen, group C received silymarin (50 mgkg-1 bw) followed by actaminophen (250 mgkg-1 bw), groups D-G received 100, 200, 400 and 600 mgkg-1 bw of ethyl acetate-ethanolic fraction of Carica papaya leaves respectively; followed by acetaminophen administration (250 mgkg-1 bw), while group H (toxicity control) received 600 mgkg-1 bw extract fraction daily. Ethyl acetate-ethanolic fraction of Carica papaya leaves significantly (p<0.05) decreased the activities of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma glutamyl transferase and bilirubin concentration and increased the concentrations of total protein and albumin in acetaminophen-induced liver damaged rats when compared with the untreated group. Prevention of liver damage was observed in the groups pre-administered 400 and 600 mgkg-1 bw of the extract fraction as well as the silymarin group. Activities of superoxide dismutase and catalase and the concentration of glutathione were significantly (p<0.05) increased while the concentration of malondialdehyde was significantly (p<0.05) decreased in rats pre-administered with silymarin or the extract fraction when compared with the acetaminophen-induced rats. Ethyl acetate-ethanolic fraction of Carica papaya leaves prevented acetaminophen-induced rat liver damage probably mainly due to the antioxidant constituents of the fraction.

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Effect of nanopolysaccharide (BSEPS) from Bacillus subtilis sp. on thioacetamide-induced liver fibrosis in rats

Bulletin of the National Research Centre ◽

10.1186/s42269-019-0244-1 ◽

2019 ◽

Vol 43 (1) ◽

Author(s):

Manal G. Mahmoud ◽

Mohsen S. Asker ◽

Mohamed E. El Awady ◽

Amal I. Hassan ◽

Nadia A. R. Zaharan ◽

...

Keyword(s):

Bacillus Subtilis ◽

Liver Fibrosis ◽

Transforming Growth Factor Beta ◽

Transforming Growth Factor ◽

Periodate Oxidation ◽

Hepatic Tissue ◽

Albino Rats ◽

Gamma Glutamyl Transferase ◽

Glutamyl Transferase ◽

Tgf Β1

Abstract Background Nanomedicine contributes to the efficiency of pharmacological treatments and progresses rapidly. The present study was designed to produce exopolysaccharide (BSEPS) from Bacillus subtilis sp. strain reported in our previous study was further characterized, and its BSEPS for synthesis of the nanoparticle Ag-BSEPS using microwave heating to determine the possible effects of a prepared solution containing Ag-BSEPS versus thioacetamide (TAA) evoked liver fibrosis in Wister albino rats. Nanoparticles with silver (Ag) core have been synthesized in an aqueous solution after exposure of BSEPS to periodate oxidation. Animals were split into four groups: I - control rats, water ad libitum for 6 weeks; II - rats were injected with TAA 200 mg/kg-1 3 times/week for 4 weeks IP; III - Ag-BSEPS 100 mg/kg-1 IP twice a week for 6 weeks; and IV - TAA, as group II followed by Ag-BSEPS as group III. The antifibrotic effects of Ag-BSEPS were appraised by determining different hepatotoxicity indices, oxidative stress, and inflammatory and liver fibrosis markers. Results Nanoparticles were obtained with a diameter size range of 50–100 nm characterized by SEM and TEM without using any harmful reagents. Results evinced considerably reduced activity of liver functions such as transaminases (AST, ALT), gamma-glutamyl transferase (GGT), and alkaline phosphatase (ALP) in the group which received TAA followed by Ag-BSEPS compared to the other group which received only TAA. In the current results, the administration of Ag-BSEPS showed an improvement in the proinflammatory cytokines. On the contrary, the antioxidant enzymes in liver homogenates revealed significant improvement (concentration of glutathione peroxidase (GSH-PX), superoxide dismutase (SOD), and catalase (CAT) increases) in animals with TAA-induced liver damage followed by Ag-BSEPS. Moreover, the activities of the fibrotic markers transforming growth factor-beta 1(TGF-β1) and type III pro-collagen (PCIII) were increased in liver tissues in the group which was given TAA alone as compared to the controls. The percentage of fibrosis of hepatic tissue had a positive correlation with the levels of PCIII and TGF-β1, followed by Ag-BSEPS compared to the TAA group without nanocomposite treatment. Microscopic examinations revealed inhibitory effects of Ag-BSEPS on inflammatory changes and deterrent of liver fibrosis. Conclusion It was suggested that the biochemical and histological amelioration observed in Ag-BSEPS (100 mg/kg-1 twice a week for 6 weeks) treated the fibrotic rats.

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Age-related differences in clinical characteristics of invasive group G streptococcal infection: Comparison with group A and group B streptococcal infections

PLoS ONE ◽

10.1371/journal.pone.0211786 ◽

2019 ◽

Vol 14 (3) ◽

pp. e0211786 ◽

Cited By ~ 2

Author(s):

Yoshihiro Fujiya ◽

Kayoko Hayakawa ◽

Yoshiaki Gu ◽

Kei Yamamoto ◽

Momoko Mawatari ◽

...

Keyword(s):

Clinical Characteristics ◽

Streptococcal Infection ◽

Streptococcal Infections ◽

Invasive Group ◽

Age Related ◽

Group A ◽

Group B

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Adding ursodeoxycholic acid to the endoscopic treatment and common bile duct stenting for large and multiple biliary stones: Will it improve the outcomes?

BMC Gastroenterology ◽

10.1186/s12876-020-01523-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ahmad Hormati ◽

Mohammad Reza Ghadir ◽

Seyed Saeed Sarkeshikian ◽

Faezeh Alemi ◽

Majid Moghaddam ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Ursodeoxycholic Acid ◽

The Elderly ◽

Success Rates ◽

Biliary Stones ◽

Cbd Stones ◽

Group A ◽

Bile Duct Stenting ◽

Group B

Abstract Background The role of common bile duct (CBD) stenting in the establishment of bile stream in the elderly patients and the ones who are not good candidates for surgery due to not responding to treatments was well documented in previous studies. The current study aimed at investigating the effect of adding Ursodeoxycholic acid (UDCA) to CBD stenting alone in order to reduce the size of large and multiple CBD stones. Methods Clinical outcomes including success rates in CBD stones clearance, incidence of pancreatitis, perforation, bleeding, as well as, decrease in size of stones and liver enzymes after a two-month period were assessed in the UDCA + CBD stenting group. Results A total of 64 patients referring to Shahid Beheshti Hospital in Qom, Iran with multiple or large CBD stones (above three or larger than 15 mm) received standard endoscopic therapies and UDCA + CBD stenting (group B) and controls only received standard endoscopic therapies with only CBD stenting (group A). The mean reduction in the size of stones in group B was significantly higher than that of group A (3.22 ± 1.31 vs 4.09 ± 1.87 mm) (p = 0.034). There was no difference in the incidence rate of complications including pancreatitis, cholangitis, bleeding, and perforation between the two groups (P > 0.05). Conclusion Adding UDCA to CBD stenting, due to decrease in the stone size and subsequently facilitation of the stones outlet, can be considered as the first-line treatment for patients with large and multiple CBD stones. Also, in the cases with large or multi stones may be effective in reducing size and subsequently stone retrieval. Trial registry The study protocol was approved by the Ethics Committee of Qom University of Medical Sciences (ethical code: IR.MUQ.REC.1397.075); the study was also registered in the Iranian Registry of Clinical Trials (No. IRCT20161205031252N8). This study adheres to CONSORT guidelines.

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Primary Closure Versus T-Tube Drainage Following Laparoscopic Common Bile Duct Exploration in Patients With Previous Biliary Surgery

The American Surgeon ◽

10.1177/0003134820947396 ◽

2020 ◽

pp. 000313482094739

Author(s):

Wan Zhen ◽

Wang Xu-Zhen ◽

Fu Nan-Tao ◽

Li Yong ◽

Xiao Wei-Dong ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Primary Closure ◽

Common Bile Duct Exploration ◽

Biliary Surgery ◽

Tube Drainage ◽

T Tube ◽

Significant Difference ◽

Group A ◽

Group B

Laparoscopic common bile duct exploration (LCBDE) has been recently introduced for management of CBD stone in patients with previous biliary surgery history. The aim of this study was to evaluate the safety and effectiveness of primary closure in patients with previous biliary surgery history compared to T-tube drainage. Eighty patients with previous biliary surgery history including laparoscopic cholecystectomy, open cholecystectomy, or open common bile duct exploration were enrolled in the retrospective study. The patients were divided into 2 groups according to the methods of choledochotomy closure. Group A: patients with primary closure after LCBDE (n = 51); group B: patients with T-tube drainage after LCBDE (n = 29). Group A exhibited a shorter postoperative hospital stay and lower hospitalization expenses compared to group B. There was no significant difference in conversion rate to open surgery, operating time, intraoperative blood loss, bile leakage rate, overall complication rate, and stone recurrence rate between the 2 groups. Biliary stricture was not observed in the 2 groups during the follow-up period. Primary closure following LCBDE is safe and effective for the management of CBD stones in patients with previous biliary surgery history.

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Role of enteric pathogens in the aetiology of neonatal diarrhoea in lambs and goat kids in Spain

Epidemiology and Infection ◽

10.1017/s0950268800001321 ◽

1996 ◽

Vol 117 (1) ◽

pp. 203-211 ◽

Cited By ~ 80

Author(s):

M. Muñoz ◽

M. Álvarez ◽

I. Lanza ◽

P. Cármenes

Keyword(s):

Escherichia Coli ◽

Synergistic Effect ◽

Cryptosporidium Parvum ◽

Clinical Characteristics ◽

Enteric Pathogens ◽

E Coli ◽

Neonatal Diarrhoea ◽

Group A ◽

Group B

SummaryFaeces samples from diarrhoeic and non-diarrhoeic lambs and goat kids aged 1–45 days were examined for enteric pathogens.Cryptosporidium parvumwas detected in both diarrhoeic lambs (45%) and goat kids (42%) but not in non-diarrhoeic animals. F5+(K99+) and/or F41+Escherichia colistrains were isolated from 26% and 22% of the diarrhoeic lambs and goat kids, respectively, although these strains, which did not produce enterotoxins ST I or LT I, were found with similar frequencies in non-diarrhoeic animals. A F5−F41−ST I+E. colistrain was isolated from a diarrhoeic lamb (0·6%). VerotoxigenicE. coliwas isolated from both diarrhoeic and non-diarrhoeic lambs (4·1% and 8·2%, respectively) and there was no association between infection and diarrhoea. The prevalence of group A rotavirus infection in diarrhoeic lambs was very low (2·1%). Groups A and B rotaviruses were detected in three (8·1%) and five (13·5%) diarrhoeic goat kids from two single outbreaks. Group C rotaviruses were detected in four non-diarrhoeic goat kids. An association of diarrhoea and infection was demonstrated only for group B rotavirus.Clostridium perfringenswas isolated from 10·8% of the diarrhoeic goat kids but not from non-diarrhoeic goat kids or lambs.Salmonella arizonaewas isolated from a diarrhoeic goat kid (2·7%) and the clinical characteristics of the outbreaks where these two latter enteropathogens were found different from the rest. Picobirnaviruses were detected in a diarrhoeic lamb. No coronaviruses were detected using a bovine coronavirus ELISA. No evidence was found of synergistic effect between the agents studied. Enteric pathogens were not found in four (8·7%) and three (20%) outbreaks of diarrhoea in lambs and goat kids, respectively.

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Treatment of Major Laparoscopic Bile Duct Injury: A Long-Term Follow-up Result

The American Surgeon ◽

10.1177/000313481107701226 ◽

2011 ◽

Vol 77 (12) ◽

pp. 1584-1588 ◽

Cited By ~ 3

Author(s):

Xiao Dong Xu ◽

You Cheng Zhang ◽

Pen Gao ◽

Farah Bahrani-Mougeot ◽

Ling Yi Zhang ◽

...

Keyword(s):

Bile Duct ◽

Bile Duct Injury ◽

Tertiary Care ◽

Secondary Operation ◽

Significant Difference ◽

Long Term Follow Up ◽

Group A ◽

Group B ◽

Group D

The goal of this study is to present the multiple institutions experience comparing the outcome of management between initial laparoscopic cholecystectomy (LC) surgeon and specialist as well as the outcome of different operative procedures to major bile duct injury (BDI) after LC. We have retrospectively collected data of 77 cases of perioperatively detected major BDI in LC at 15 general surgical institutions from 1997 to 2007. We classified 42 cases treated by an experienced biliary surgeon as Group A and 35 cases treated by the initial LC surgeon as Group B. Forty-eight cases were treated with duct-to-duct anastomosis as Group C and 29 cases were treated with Roux-en-Y choledochojejunostomy as Group D. The median duration of follow-up was 62 months. The outcome of groups was compared. In Group A, 7 of 42 (16.7%) patients developed a failure. Two of seven (28.6%) patients were treated by a secondary operation. In Group B, 24 of 35 (68.6%) patients developed a failure. Seventeen of 24 (70.8%) patients were treated by a secondary operation. One of 35 (2.85%) patients died. The significant differences were observed in failure and secondary operations (16.7 vs 68.6%, P < 0.01 and 28.6 vs 70.8%, P < 0.01). There is no significant difference Group C and Group D in failure rate (28.5 vs 11.7%, P > 0.05). A multiple institutional cooperative methodology between the local surgical institution and tertiary care centers provided a good way to limit further operations, failure. The reconstructive strategy is important and should be selected according to the type of injury and the diagnosed status of major BDI.

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