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

Obstructive jaundice (OJ) is classified as extrahepatic OJ or intrahepatic OJ. Extrahepatic OJ is attributed to a variety of intricate etiological factors. Research has begun with Chinese medicine (CM), which can be used as an adjunctive therapy for extrahepatic OJ. Particular attention has been paid to the therapeutic effects and their mechanisms of single CM herb and relevant extracts. The roles of single CM or their extracts during adjunctive therapy for extrahepatic OJ have been described briefly. This review focuses on the effects and their mechanisms of relevant herbal medicines.
Animals ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Jaundice, Obstructive ; drug therapy ; Plant Extracts ; therapeutic use

PURPOSE: Although obstructive jaundice is a rare presentation, it is an ominous sign of poor prognosis in patients with gastric cancer. Thus, we investigated the incidence, the clinical features, the pathologic characteristics, the treatment modality, and the prognosis for obstructive jaundice in patients with gastric cancer. METHODS: A retrospective analysis was done for patients with gastric cancer who had presented with obstructive jaundice at Korea University Guro Hospital from January 1988 to December 1998. RESULTS: During that period, 2546 patients were diagnosed with gastric cancer, and obstructive jaundice was revealed in 20 (0.78%). The mean age was 58 13 years, and the sex ratio (male:female) was 5.7:1. Jaundice was the first presentation in two patients, and it developed in the other 18 patients during the follow-up period after the initial operation or chemotherapy. The level of total bilirubin was 16.7 8.1 mg/dl, and the cause of the jaundice was lymph-node enlargement at the porta hepatis. A percutaneous transhepatic biliary drainage (PTBD) was done in 17 patients, and improvement was seen in 13 (76%). The most common site of the obstruction was common hepatic duct (CHD) (60%). Antrally located, moderately differentiated and Borrmann type-III gastric cancers were commonly associated with obstructive jaundice. The mean duration from jaundice to death was 4.6 6.2 month. CONCLUSION: Obstructive jaundice is very rare in patients with gastric cancer and is associated with poor survival. Although the bilirubin level was decreased by a PTBD, the survival was not improved. An extended lymphadenectomy along the hepatoduodenal ligament is necessary to prevent obstructive jaundice due to recurrence particularly, in patients with antrally located, moderately differentiated and Borrmann type-III carcinomas.
Bilirubin ; Drainage ; Drug Therapy ; Follow-Up Studies ; Hepatic Duct, Common ; Humans ; Incidence ; Jaundice ; Jaundice, Obstructive* ; Korea ; Ligaments ; Lymph Node Excision ; Prognosis ; Recurrence ; Retrospective Studies ; Sex Ratio ; Stomach Neoplasms*

Pancreatic cancer is a leading cause of cancer-related morbidity and mortality, but any meaningful improvement in its prognosis remains elusive. The lack of early diagnostic methods means that many patients only present when symptoms develop, such as obstructive jaundice. Once a diagnosis of pancreatic cancer has been made in a patient with obstructive jaundice, then a decision should be made if the patient is a candidate for surgical resection. Patients who are candidates for surgical resection generally do not need preoperative biliary drainage, unless they present with cholangitis, or if they require neo-adjuvant chemotherapy. If preoperative biliary drainage is to be done, then patient factors and local expertise should guide appropriate interventions. The evidence for endoscopic retrograde cholangiopancreatography as a first-line therapy for biliary decompression is strong; However, the use of percutaneous transhepatic biliary drainage as well as endoscopic ultrasound-guided biliary drainage has generally not been found to be inferior. Finally, to ensure ongoing patency and minimize complications, an appropriate self-expanding metal stent should ideally be placed.
Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Decompression ; Diagnosis ; Drainage ; Drug Therapy ; Endoscopy ; Humans ; Jaundice, Obstructive ; Mortality ; Pancreatic Neoplasms ; Prognosis ; Stents ; Ultrasonography

Conventional radiation therapy (RT) is a widely recognized treatment for hepatocellular carcinoma (HCC). However, conventional RT plays only a limited role in HCC treatment because of its low efficacy and the low tolerance of the liver for this modality. Stereotactic body radiation therapy (SBRT) was recently developed and represents the most advanced radiation therapy technique currently available. It can deliver a high dose in a short time to well-defined hepatic tumors, with rapid dose fall-off gradients. We believe that SBRT with transarterial chemolipiodolization (TACL) may prove promising as a combined treatment modality for HCC due to its precision and relative safety. Here we present a case of successful treatment of advanced HCC with obstructive jaundice using this combined modality.
Carcinoma, Hepatocellular/complications/*therapy ; *Chemoembolization, Therapeutic ; Combined Modality Therapy ; Humans ; Jaundice, Obstructive/etiology/therapy ; Liver Neoplasms/complications/*therapy ; Male ; Middle Aged ; *Radiosurgery

Biopsy ; methods ; Drainage ; Humans ; Jaundice, Obstructive ; etiology ; therapy ; Lymph Node Excision ; methods ; Neoplasm Staging ; Pancreatic Neoplasms ; complications ; diagnosis ; pathology ; surgery ; Pancreaticoduodenectomy ; methods ; Salvage Therapy

OBJECTIVETo discuss the clinical value of percutaneous transhepatic cholangial drainage (PTCD) combined with nasojejunal tube for bile reinfusion and enteral nutrition for patients with malignant obstructive jaundice.

METHODSForty patients with malignant obstructive jaundice were randomly divided into bile reinfusion group (n=20) and exclusive external drainage group (control group, n=20), and the clinical data concerning the hepatic function, visceral protein and postoperative complications of the patients were collected.

RESULTSIn both of the two groups, the levels of ALT, AST, and TB-2 reduced significantly after the operation as compared with the preperative levels (P<0.05), and no significant difference was found in the postoperative hepatic function between the two groups (P>0.05). The postoperative levels of the visceral proteins such as ALB, TRF and PRE increased significantly after the operation (P<0.05), and the changes in ALB and PRE were comparable between the two groups (P>0.05). TRF was significantly higher in bile reinfusion group than in the control group.

CONCLUSIONPTCD combined with bile reinfusion and early enteral nutrition via the nasojejunal tube may facilitate the recovery of hepatic function and visceral proteins in patients with malignant obstructive jaundice.

Adult ; Aged ; Aged, 80 and over ; Bile ; chemistry ; Drainage ; methods ; Enteral Nutrition ; methods ; Female ; Humans ; Intubation, Gastrointestinal ; methods ; Jaundice, Obstructive ; therapy ; Liver Function Tests ; Male ; Middle Aged

Adsorption ; Adult ; Aged ; Bilirubin ; blood ; isolation & purification ; Cellulose ; analogs & derivatives ; chemistry ; Female ; Humans ; Jaundice, Obstructive ; therapy ; Male ; Membranes, Artificial ; Middle Aged ; Polyethyleneimine ; chemistry ; Serum Albumin ; analysis

OBJECTIVETo observe the alteration of plasma levels of thromboxane A2 (TXA2) and prostacyclin (PGI2) as well as changes of microcirculation in renal cortex of obstructive jaundice model rats, and to study the effect of Radix Salviae miltiorrhizae (SM) on them.

METHODSSD rats were randomly divided into three groups: the sham operation group (A), the common bile duct ligation model group (B), and the SM treated model group (C). Their blood plasma TXA2/PGI2 ratio (T/P), blood levels of urea nitrogen (BUN) and creatinine (Cr) were determined respectively in batches (8 rats from each group) on the 3 rd, 7th and 10th day, their capillary caliber (CC) in renal cortex was measured at the same time points using WX-9 type microcirculation microscope.

RESULTSCompared with Group A, T/P was higher and CC was smaller in Group B at all the time points. Levels of BUN and Cr increased on day 7 and day 10 after modeling (P<0.05), and they were increasing markedly along with the elongation of the obstructive time (P<0.05). As compared with Group B, T/P was lower and CC was expanded in Group C, with levels of BUN and Cr lowered on day 10 (P<0.05).

CONCLUSIONT/P elevation and renal microcirculation obstacle are the important factors for inducing renal injury in obstructive jaundice, and SM shows a protective effect on kidney against the injury.

Animals ; Drugs, Chinese Herbal ; therapeutic use ; Epoprostenol ; blood ; Jaundice, Obstructive ; drug therapy ; metabolism ; Male ; Phytotherapy ; Rats ; Rats, Sprague-Dawley ; Salvia miltiorrhiza ; chemistry ; Thromboxane A2 ; blood

BACKGROUND/AIMS: Little is known about the treatment or outcomes of hepatocellular carcinoma (HCC) complicated with bile duct invasion. METHODS: A total of 247 consecutive HCC patients with bile duct invasion at initial diagnosis were retrospectively included. RESULTS: The majority of patients had Barcelona Clinic Liver Cancer (BCLC) stage C HCC (66.8%). Portal vein tumor thrombosis was present in 166 (67.2%) patients. Median survival was 4.1 months. Various modalities of treatment were initially employed including surgical resection (10.9%), repeated transarterial chemoembolization (TACE) (42.5%), and conservative management (42.9%). Among the patients with obstructive jaundice (n=88), successful biliary drainage was associated with better overall survival rate. Among the patients with BCLC stage C, overall survival differed depending on the initial treatment for HCC; surgical resection, TACE, systemic chemotherapy, and conservative management showed overall survival rates of 11.5, 6.0 ,2.4, and 1.6 months, respectively. After adjusting for confounders, surgical resection and repeated TACE were significant prognostic factors for HCC patients with bile duct invasion (hazard ratios 0.47 and 0.39, Ps <0.001, respectively). CONCLUSIONS: The survival of HCC patients with bile duct invasion at initial diagnosis is generally poor. However, aggressive treatments for HCC such as resection or biliary drainage may be beneficial therapeutic options for patients with preserved liver function.
Bile Ducts* ; Bile* ; Carcinoma, Hepatocellular* ; Diagnosis ; Drainage ; Drug Therapy ; Humans ; Jaundice, Obstructive ; Liver ; Liver Neoplasms ; Portal Vein ; Prognosis ; Retrospective Studies ; Survival Rate ; Thrombosis