Intake of selected micronutrients and risk of colorectal cancer

We fabricated poly(DL-lactic-co-glycolic acid) (PLGA) 50:50 microparticles loaded with an antisense (AS) oligodeoxy-nucleotide (ODN) against the rat tenascin mRNA and determined the effect in vitro of the AS-ODN released on smooth muscle cell (SMC) proliferation and migration. AS-ODN was entrapped using a double-emulsion-solvent-extraction technique with high efficiency. Release of AS-ODN was characterized by a small initial-burst effect followed by a period of controlled AS-ODN release for up to 20 days. SMC proliferation studies exhibited dose-dependent growth inhibition with AS-ODN-loaded microparticles. Microparticles loaded with scrambled (SC) ODN showed less growth inhibition than AS-ODN. Moreover, only the AS-ODN-loaded microparticles inhibited migration. These results demonstrate the feasibility of entrapping an AS-ODN to rat tenascin in PLGA microparticles for controlled delivery to inhibit SMC proliferation and migration.     

Reconstructive operations on the biliary tract

Fifty cases in which reconstruction of the biliary system was carried out were reviewed. In 25 cases the operation was done during the treatment of malignant neoplasms. The other 25 patients were treated for benign conditions. Delayed stricture of the biliary anastomosis occurs more frequently following operation for benign post-traumatic obstruction than following reconstruction for other conditions. This is probably a result of: (1) greater regional scarring, (2) local infection, and (3) technical imperfections in the reconstituted biliary anastomosis. Certain primary malignant tumors may be difficult to recognize by both gross and microscopic examination. In six cases of biliary obstruction resulting from malignant neoplasms in the present series, exploration had been carried out some time previously, and in four of them an erroneous diagnosis of benign biliary obstruction was made.End-to-end anastomosis of the duct above and below the point of obstruction is the method preferred in the treatment of benign biliary stricture. Intrahepatic and extrahepatic biliary-enteric anastomoses have been used successfully in selected cases.     

Cystic dilatation of the biliary tract]

Cystic dilatation of the biliary tract is a rare disorder, more common in children, with a high morbidity and mortality rate. Death may follow one of the possible complications (recurrent cholangitis, biliary cirrhosis, cholangiocarcinoma). The Authors report the case of an asymptomatic adult woman. According to CT scan and ERCP the lesion found was classified as type IVb of Todani's classification. The cyst was removed and a Roux en-Y reconstruction was performed. This procedure is currently associated to a low mortality rate and the best long term results.     

Killing effects of 5-fluorouracil on human biliary tract cancer cell lines

Previous studies have established that a partially quaternized derivative of chitosan, N-trimethyl chitosan chloride (TMC), can be used as an absorption enhancer for large hydrophilic compounds across mucosal surfaces. This study evaluates and compares the effects of the degree of quaternization of TMC, in a neutral environment, on the permeability of intestinal epithelial cells in vitro, where normal chitosan salts are ineffective as absorption enhancers. The effects of TMC-H [61.2% quaternized, (0.05-1.5% w/v)], TMC-L [12.3% quaternized, (0.5-1.5% w/v)], and chitosan hydrochloride [0.5-1.5% w/v] on the transepithelial electrical resistance (TEER) and permeability, for the hydrophilic model compound [14C]mannitol, of intestinal epithelial Caco-2 cell monolayers, were investigated at pH values of 6.20 and 7.40. The viability of the monolayers was checked with the trypan blue exclusion technique. At a pH of 6.20, all the polymers caused a pronounced reduction (37-67% at 0.5% w/v concentrations) in the TEER of Caco-2 cells. On the contrary, at a pH of 7.40, only TMC-H was able to decrease the TEER values, even in a concentration as low as 0.05% w/v (35% reduction). Comparable results were obtained with the permeation of [14C]mannitol. Large increases in the transport rate (18-23-fold at 0.5% w/v concentrations) were found at pH 6.20, whereas only TMC-H was able to increase the permeation of [14C]mannitol at pH 7.40 (31-48-fold at 0.05-1.5% w/v concentrations of TMC-H). For all the polymers studied, no deleterious effects to the cells could be demonstrated with the trypan blue exclusion technique. It is concluded that highly quaternized TMC is a potent absorption enhancer and the potential use of this polymer, especially in neutral and basic environments where normal chitosan salts are not effective, is expected to be an important contribution to the development of effective delivery systems for hydrophilic compounds such as peptide drugs.     

Simultaneous operations in surgery of the biliary tract

The experience with simultaneous performance of the operations on the bile ducts and other organs in 802 patients, including 109 who underwent simultaneous operations on 2 or several organs for pathogenetically unrelated diseases (lethality--1.9%), 662--combined interventions on the anatomically and functionally connected organs for main disease and its complications (lethality 29%), is summarized. Simultaneous performance of the operations ensures the effective and radical surgical treatment.     

Exploration of the biliary tract by ultrasound laparoscopy

Laparoscopic ultrasound techniques, offering the advantages of both diagnostic laparoscopy and operatrice ultrasound exploration, can be used to detect stones in the main bile duct. We describe the technique of contact ultrasound in laparoscopic cholecystotomies.     

Gallbladder and biliary tract disease in AIDS

Biliary disease occurs in a subset of AIDS patients with CD4 counts of less than 100 per mm3. These patients present with right upper quadrant and epigastric pain, cholestasis, and usually abnormal findings on imaging. In 75% of patients, an associated opportunistic infection can be identified. In patients with biliary disease, pain is often relieved following endoscopic sphincterotomy, whereas cholecystectomy provides pain relief in patients with acalculous cholecystitis.     

The influence of biliary infection on the postoperative course after biliary tract surgery

A prospective clinicobacteriological study was undertaken in 167 patients undergoing biliary surgery so as to assess the possible influence of the endogenous preoperative biliary infection on postoperative morbidity. Bile cultures were positive in 33% (55 patients); in those undergoing cholecystectomy alone this finding was present in 23% while in those in whom a choledochotomy was also performed cultures were positive in 65%. The incidence of wound infection was found to be twice as high in those undergoin choledochotomy as in those undergoing cholecystectomy alone--37.8% vs. 18.5%. There was no appreciable difference in the rate of wound infection when a routine appendectomy was performed during biliary tract surgery. Among the 38 patients with wound infection, bile cultures were positive in 16. In 13 cases the offending organism in the wound was identical with that recovered from the bile coulture. This finding suggests an endogenous source for the wound infection. This study further indicated that wound infection is most likely to be encountered in patients with pathogenic organisms in the bile, in the aged and in those whose resistance to infection has been lowered by concomitant disease.     

X-ray diagnosis of liver and biliary tract diseases

The paper deals with combined diagnosis of hepatic and biliary diseases, involving a wide range of nosological entities. It shows the potentialities of currently available diagnostic techniques for the most common diseases. The authors examined 175 patients with acute and chronic hepatitis, 120 with hepatic cirrhosis, 486 with cystic changes, 324 with benign tumors, 292 with malignant tumors, 21 with hepatic abscess, 527 with cholecystitis, 566 with cholelithiasis. Cancer of the gall-bladder was in 10 patients, its polyps were in 18, cancers of the common bile duct and bile papilla were in 6 and 4 patients, respectively. A complex of the used diagnostic techniques involved ultrasonic scanning, X-ray computed tomography, hepatobiliary scintigraphy, angiography, retrograde cholangiopancreatography, transhepatic cholangiography, etc. The authors have demonstrated that each method used is highly diagnostically effective. At the same time they have shown the limits of each technique in the diagnosis of certain diseases. The authors' data suggest that the total efficiency of the applied complex of diagnostic means approaches 100%.     

Pneumopancreatogram associated with gas in the biliary tract

Cardiac arrest due to hyperkalaemia following suxamethonium in a patient with generalized spasticity due to head injury is reported and discussed.     

Operative endoscopy in the management of biliary tract neoplasms

Operative endoscopy of the biliary system has been employed with ever increasing frequency at the UCLA Hospital during the last three years. In addition to its established value with respect to disclosing unsuspected stones in the bile ducts, choledochoscopy has been of great value in terms of more accurate diagnosis and staging of periampullary and bile duct neoplasms. It has been observed that many biliary tract carcinomas are multicentric in origin and that cholangiography is not adequate to identify small intrahepatic ductal lesions. More than one cell type of bile duct carcinoma may be present in the same patient. Choledochoscopy should be used in addition to the conventional criteria for resectability in all patients with ductal or periampullary carcinoma. Use of this technic will spare some patients needless radical procedures and should improve long-term cure rates by identifying those patients with truly localized disease for curative resections.