Cholestatic jaundice caused by imidazole derivatives is a rare complication of antithyroid drug therapy. We present a case of cholestatic jaundice with systemic hypersensitivity reaction, which developed in a 27-year old male one day after exposure to methimazole. The patient showed clinical improvement and gradual resolution of jaundice after the discontinuation of methimazole and treatment with prednisolone. Histologic findings of liver revealed bile pigment, predominantly in centrilobular area, and infiltration of chronic inflammatory cells in a few portal area without evidence of degeneration or necrosis of hepatocytes. Methimazole could be presumed as etiologic agent from clear chronological relationship and the lack of other causative factors. We report this unusual case with review of literature.
Adult ; Bile Pigments ; Drug Therapy ; Hepatocytes ; Humans ; Hypersensitivity ; Jaundice ; Jaundice, Obstructive* ; Liver ; Male ; Methimazole ; Necrosis ; Prednisolone

OBJECTIVES: This study aims at exploring genetic and clinical characteristics of multiplex Korean families with schizophrenia. METHODS: Thirty-three families having two or more schizophrenics by DSM-IV criteria within the second degree relatives were obtained from the clinics of general hospitals and mental hospitals. Sixty-nine affected and forty-five unaffected subjects from these families were interviewed using Korean version of Diagnostic Interview for Genetic Studies. Krawieka Rating Scale and The Schedule for the Deficit Syndrome were also applied for further evaluation of psychopathologies of the patients. Patterns of inheritances of the disease were analyzed by the inspection of the pedigrees. Parent-of-origin effect was evaluated by the comparison of the occurrence rate and the clinical characteristics between the subgroups of maternal and paternal origins. RESULTS: There were similar rates of maternal and paternal transmission in the families for which unilineal transmission of the disease was estimated. Only one family showed bilineal transmission. Observed patterns of transmission were not compatible with the recessive single locus model or sex-linked model. The most frequently observed non-schizophrenic disorders in these families were personality disorders/traits of schizophrenia spectrum. We could not find any clinical characteristics which might be unique to the patients from multiplex families. Parent-of-origin effect was not suggested. CONCLUSION: This study provides preliminary clinical and genetic data on the multiplex schizophrenia families which could be used for the determination of the genetic parameters and the boundaries of the phenotype in the linkage analyses.
Appointments and Schedules ; Bile Pigments ; Diagnostic and Statistical Manual of Mental Disorders ; Hospitals, General ; Hospitals, Psychiatric ; Humans ; Phenotype ; Schizophrenia* ; Wills

Fibrolamellar carcinoma (FLC) is a rare variant of hepatocellular carcinoma (HCC). A 26-year-old female presented a hepatic mass and mild elevation of liver enzymes. Viral markers were negative, and levels of tumor markers were normal. Radiologically, the mass was well demarcated with central dot-like calcification and hypervascularity. Under the diagnosis of hepatocellular carcinoma, right lobectomy was performed. The tumor was grayish yellow with central fibrosis and focal hemorrhage and invaded a septal bile duct. Non-neoplastic liver was unremarkable. Microscopically, the tumor consisted of large polygonal cells in sheets, cords, and pseudoglands that were interwound by dense collagenous stroma. Tumor cells had abundant deeply eosinophilic cytoplasm and large nuclei with prominent nucleoli. Intracellular bile pigments and pale bodies were present. Tumor cells were diffusely immunostained for cytokeratin 7 (CK7), but not for cytokeratin 20 (CK20). Strong expression of CK7 in the present case suggests dual differentiation of FLC.
Adult ; Bile Ducts ; Bile Pigments ; Biomarkers ; Carcinoma, Hepatocellular* ; Collagen ; Cytoplasm ; Diagnosis ; Eosinophils ; Female ; Fibrosis ; Hemorrhage ; Humans ; Keratin-20 ; Keratin-7* ; Keratins* ; Liver ; Biomarkers, Tumor

OBJECTIVETo study the effects of Jinhuang Yidan Granule (JYD) on the bile compositions of primary bile duct pigment calculus patients.

METHODSSixty-six patients with primary bile duct pigment calculus were randomly assigned to the control group (who took no Chinese medicine) and the JYD group (who took JYD). The bile from T-tube during the operation, 3, 10, and 40 days after medication were examined. The contents of bile acids, bilirubin (conjugated bilirubin, mono-conjugated bilirubin), glucoprotein, calcium ion, beta-glucuronidase, superoxide radical anion, and other components were detected and compared.

RESULTSThree days after taking JYD, the total bile acids increased, the total bilirubin and beta-glucuronidase decreased, showing statistical significance when compared with the control group (P < 0.05). In the JYD group, the total bile acid increased, the total bilirubin, the conjugated bilirubin, the mono-conjugated bilirubin, glucoprotein, calcium ion, beta-glucuronidase, superoxide radical anions decreased 10 and 40 days after medication, showing statistical significance when compared with the control group (P < 0.05, P < 0.01). The level of the total bile acid increased, the levels of the total bilirubin, the conjugated bilirubin, the mono-conjugated bilirubin, glucoprotein, calcium ion, beta-glucuronidase, superoxide radical anions decreased after 40-day medication in the two groups, showing statistical significance when compared with the peri-operative indices of the same group (P < 0 05, P < 0.01).

CONCLUSIONSJYD could significantly improve the pathologic bile compositions of the bile duct calculus, improve the environment of the biliary tract, showing certain preventive and therapeutic effects on bile pigment calculus of the primary bile duct calculus. Better effects may be obtained by long-term taking.

Adolescent ; Adult ; Aged ; Bile ; chemistry ; Bile Pigments ; analysis ; Choledocholithiasis ; pathology ; physiopathology ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy ; Young Adult

BACKGROUND/AIMS: Gallbladder (GB) mucin is one of the key factors in the gallstone formation. However, there is little information about the diversity of mucin secretion according to the stone composition. Epidermal growth factor receptor (EGFR) functions in proliferation including mucin secreting goblet cell hyperplasia. We compared the expressions of MUC3, MUC5AC, MUC6 and EGFR in the GB epithelium with cholesterol gallstones (GB-chol) group and pigment gallstones (GB-pig group). METHODS: GBs from elective laparoscopic cholecystectomy for the gallstone disease were studied. Stone composition was analyzed by the spectrophotometer. Immunohistochemical stain was performed using each monoclonal antibody. The percentage of stained proportion was scored by the NIH image program and the results were compared between both groups. RESULTS: Total 20 patients were enrolled (10 patients with cholesterol gallstones, 10 patients with pigment gallstones). The percentages of stained proportion for MUC3, MUC5AC, and MUC6 were 42+/-27%, 31+/-15%, and 17+/-9%, respectively in GB-chol group and 32+/-22%, 33+/-23%, and 15+/-10%, respectively in GB-pig group (p>0.05). The expression of EGFR was 50% (5/10) in the GB-chol group and 80% (8/10) in the GB-pig group respectively. CONCLUSIONS: There was no difference in the expressions of MUC3, MUC5AC, and MUC6 between the two groups. Further studies are needed to elucidate the role of EGFR in the gallstore formation.
Bile Pigments/analysis ; Cholelithiasis/chemistry/*metabolism ; Cholesterol/analysis ; Epithelium/metabolism ; Gallbladder/*metabolism ; Humans ; Immunohistochemistry ; Mucin 5AC ; Mucin-3 ; Mucin-6 ; Mucins/*analysis ; Receptor, Epidermal Growth Factor/*analysis

Hepatocellular carcinomas rarely metastasize to the ovaries. To our knowledge, only nine cases of metastatic hepatocellular carcinoma of the ovary have been reported in the literature. Here, we present an additional case in which an ovarian lesion was the initial presentation in a 43-year-old female patient. An exploratory laparotomy revealed a left ovarian solid mass measuring 6.5*4.0*3.5 cm, with a lobulated greenish brown sectioned surface. A subsequent ultrasonogram and CT scan revealed a concurrent hepatic mass, and laboratory tests showed high serum AFP and CA125 levels. Microscopically the tumor showed predominantly solid and trabecular patterns, and intercellular canaliculi containing bile pigments. A postoperative hepatic biopsy confirmed the hepatocellular carcinoma. The main differential diagnosis involved ovarian metastasis of the hepatocellular carcinoma, the hepatoid carcinoma of the ovary with liver metastasis, and a hepatoid yolk sac tumor. Diagnosis in such cases should be reached by careful clinical evaluation and a thorough pathologic examination accompanied by a histochemical and immunohistochemical work-up.
Adult ; Bile Pigments ; Biopsy ; Carcinoma, Hepatocellular* ; Diagnosis ; Diagnosis, Differential ; Endodermal Sinus Tumor ; Female ; Humans ; Laparotomy ; Liver ; Neoplasm Metastasis ; Ovary* ; Tomography, X-Ray Computed ; Ultrasonography

Adenocarcinoma is the major histology of gallbladder cancer. There are three subtypes of adenocarcinoma of the gallbladder: biliary, intestinal, and gastric foveolar subtypes. Also, there are three premalignant lesions of gallbladder adenocarcinoma: adenoma, biliary intraepithelial neoplasia (BilIN), and intracystic papillary neoplasm (ICPN). Premalignant lesion is hyperplasia of dysplastic epithelial cells with no evidence of stromal invasion. BilIN is invisible in gross inspection but can be microscopically identified around invasive tumor or chronic cholecystitis. ICPN is grossly identified as exophytic polypoid mass or diffuse friable thickening of mucosa and composed of mucinous epithelial cells with papillary and tubular arrangement. Dysplasia of BilIN and ICPN is classified by using a three-tiered system and high grade dysplasia is the same group with carcinoma in situ. Adenoma and ICPN have some ambiguities in definition and re-establishment of diagnostic criteria is needed for reproducibility of diagnosis. KRAS, TP53, and CDKN2A are the representative altered molecules in gallbladder cancer. Molecular alteration during dysplasia-carcinoma sequence is too heterogenous depending to the risk factors and type of premalignant lesion to explain the whole process by single process. Over-expression of COX2, mutation of TP53, impairment of mitochondrial DNA were reported in early hyperplastic or metaplastic epithelium. Loss of heterozygosity (LOH) of 3p, 8p chromosomes and amplification of HER2 were reported in low grade dysplasia and LOH of 9p, 18q, 22q, 17p chromosomes and mutation of CDK2A were reported in high grade dysplasia/carcinoma in situ.
Adenocarcinoma ; Adenoma ; Bile Pigments ; Carcinogenesis ; Carcinoma in Situ ; Cholecystitis ; Diagnosis ; DNA, Mitochondrial ; Epithelial Cells ; Epithelium ; Gallbladder Neoplasms ; Gallbladder ; Hyperplasia ; Loss of Heterozygosity ; Mucins ; Mucous Membrane ; Precancerous Conditions ; Risk Factors

OBJECTIVETo observe dynamically the effect of drugs for clearing heat and removing dampness (CHRD) on biliary components in rabbits with pigment gallstones (PGS).

METHODSForty rabbits were established into PGS model and randomly divided into 3 groups, the bacterial infection group, the CHRD low-dose group and the CHRD high-dose group. Besides, a normal group was set up with healthy rabbits for control. Changes of total bilirubin (TB), unconjugated bilirubin (UCB), total bile acid (TBA), Ca2+, bacterial and endogenous beta-glucuronidase (beta-Gase) in bile were observed.

RESULTSCHRD drugs significantly decreased the contents of UCB, Ca2+, bacterial and endogenous beta-Gase (P < 0.05), and increased TBA in bile (P < 0.05).

CONCLUSIONCHRD drugs have good effect in reducing the lithogenesis of the pigment gallstones.

Animals ; Bile ; drug effects ; metabolism ; Bile Pigments ; metabolism ; Calcium ; metabolism ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Gallstones ; drug therapy ; metabolism ; pathology ; Glucuronidase ; metabolism ; Male ; Phytotherapy ; Rabbits ; Random Allocation ; Treatment Outcome

Heme oxygenase (HO)-1 is an inducible enzyme that catalyzes the first and rate-limiting step in the oxidative degradation of free heme into ferrous iron, carbon monoxide (CO), and biliverdin (BV), the latter being subsequently converted into bilirubin (BR). HO-1, once expressed during inflammation, forms high concentrations of its enzymatic by-products that can influence various biological events, and this expression is proven to be associated with the resolution of inflammation. The degradation of heme by HO-1 itself, the signaling actions of CO, the antioxidant properties of BV/BR, and the sequestration of ferrous iron by ferritin all concertedly contribute to the anti-inflammatory effects of HO-1. This review focuses on the anti-inflammatory mechanisms of HO-1 actions and its roles in inflammatory diseases.
Bilirubin ; Biliverdine ; Carbon Monoxide ; Ferritins ; Heme ; Heme Oxygenase (Decyclizing) ; Heme Oxygenase-1 ; Inflammation ; Iron

Heme oxygenase (HO)-1 is an inducible enzyme that catalyzes the first and rate-limiting step in the oxidative degradation of free heme into ferrous iron, carbon monoxide (CO), and biliverdin (BV), the latter being subsequently converted into bilirubin (BR). HO-1, once expressed during inflammation, forms high concentrations of its enzymatic by-products that can influence various biological events, and this expression is proven to be associated with the resolution of inflammation. The degradation of heme by HO-1 itself, the signaling actions of CO, the antioxidant properties of BV/BR, and the sequestration of ferrous iron by ferritin all concertedly contribute to the anti-inflammatory effects of HO-1. This review focuses on the anti-inflammatory mechanisms of HO-1 actions and its roles in inflammatory diseases.
Bilirubin ; Biliverdine ; Carbon Monoxide ; Ferritins ; Heme ; Heme Oxygenase (Decyclizing) ; Heme Oxygenase-1 ; Inflammation ; Iron