金石散胶囊溶解胆石的临床研究

自１９８７年迄今,用金石散（４－６胶囊／次,２－３次／天）治疗胆结石患者１７７例,３月为一疗程,共２－４疗程。治疗前后均经Ｂ超检查以判断疗效。结果显示：１．服药一月,９０％病人的发热、腹胀、疼痛等临床症状消失。２、６２例胆囊结石经服药平均８．１８＋７．１４月后,３例结石完全消失（４．８４％）,３７例结石减少变小,总有效率６４．５２％;而临床类型型相似的另外２３例,用ＵＤＣＡ治疗作为对照组,总有效率     

Bile-duct diameter at the porta hepatis and liver biopsies in Indian children with biliary atresia

Fibrous remnants from the porta hepatis and wedge biopsies of the liver were studied in 60 patients with biliary atresia. The patients were divided into three groups on the basis of bile duct diameter — I: no ducts; II: <50 m; III: >50 m. The liver damage was classified into three grades on the basis of ductular and parenchymal histopathologic changes and extent of inflammatory pathology. There was no correlation between severity of hepatic damage and duct diameter, although the levels of serum bilirubin and alkaline phosphatase varied in direct proportion to the degree of hepatic damage. There was an inverse relationship between age and duct diameter, but neither correlated with bile flow at surgery or in the postoperative period. The data suggest that Indian children with biliary atresia follow a different clinical course compared to those from Japan and Western countries. Correspondence to: V. Bhatnagar     

B超,ERCP对胆管结石的诊断价值

报告疑有胆管结石的２００例术前Ｂ超,ＥＲＣＰ检查与手术的对照结果,分析了两种检查各自的优点及不足．结果认为Ｂ超可作为胆管结石的初选检查,再行ＥＲＧＰ确诊,以提高胆管结石的正确诊断率     

Biliary–enteric fistulas: report of five cases and review of the literature

Internal biliary fistulas (IBF) are seen rarely. Because the symptoms and signs of IBF are not specific and the diagnosis is not suspected, these patients are commonly investigated with plain abdominal films (PAF), ultrasonography (US), upper gastrointestinal series (UGIS), barium enema (BE), and computed tomography (CT), but not always with endoscopic retrograde cholangiopancreatography (ERCP). The purposes of this article are (a) to attract attention of radiologists to presumptive findings of IBF, so as not to misdiagnose this unsuspected and rare disease, and (b) review of the literature while presenting radiologic features of our cases. Five cases of IBFs in which extrahepatic biliary tree communicating with duodenum (four cases) and colon (one case) are reported. Diagnostic work-up of cases were done by PAF, US, UGIS, BE, and CT. Aerobilia, which cannot be explained using other means, ectopic gallstone and small bowel dilatation, nonvisualization of the gallbladder despite no history of cholecystectomy, and thick-walled shrunken gallbladder adherent to neighboring organs were suggestive findings of IBF in our study. Knowledge of imaging findings suggestive of IBF and a high index of suspicion increase the diagnostic rate of IBFs. Received: 4 June 1998; Revision received: 28 July 1998; Accepted: 14 October 1998     

Proliferation of intrahepatic bile-duct epithelium in biliary atresia

Proliferating cell nuclear antigen (PCNA) and transforming growth factor (TGF) are considered as markers of cell proliferation. The expression of PCNA and TGF was evaluated immunohistochemically using anti-PCNA antibody and TGF in 31 patients with biliary atresia (BA) (15 jaundice-free and 16 with persistent jaundice) and 6 control infants. The labeling indices (LI) for PCNA- and TGF-positive bile-duct epithelium in BA were 14.1±14.0% and 51.4±33.7%, respectively, which was significantly higher than in the controls (P <0.01). In BA, the number of PCNA-immunoreactive cells was higher in the peripheral bile ductules than in the central bile ducts of the portal tract (P <0.01). LI was not related to patient age at the time of hepatic portoenterostomy in two groups divided at the age of 60 days. Patients in the persistent jaundice group had greater expression of PCNA and TGF (21.7±16.0% and 76.9±20.7%, respectively) compared to those in the jaundice-free group (6.0±2.7% and 24.3±20.9%, P <0.001). PCNA and TGF expression in the bile-duct epithelium of the portal tract was closely related to prognosis in BA patients, and thus could be useful as a prognostic marker.     

Biliary secretion of sulindac and metabolites in man

The biliary secretion of sulindac and metabolites after a single 400 mg oral dose of the drug was studied in 3 elective gallbladder surgical patients following placement of an occludable T-tube in the common bile duct. Bile and systemic plasma were sampled at frequent intervals for up to 36 h postdose. The apparent biliary clearance (V?_cl,bilc) of the prodrug sulindac is about 25 times greater than that of the pharmacologically active sulfide metabolite. The total biliary flux of drug in normal man with an uninterrupted enterohepatic cycle, calculated from V?_cl,bile and historic mean plasma drug AUC values, averages 144 and 12·2 per cent of the dose as sulindac and the sulfide metabolite, respectively. Thus, enterohepatic recycling of the drug in man is principally in the form of the prodrug which not only limits exposure of the intestine to the active moiety but also sustains systemic concentrations of active drug upon reabsorption of the prodrug.     

Technical aspects of hepatic portal dissection in biliary atresia.

During the past 8 yr, 37 patients with a noncorrectable type of biliary atresia have undergone hepatic portoenterostomy or portocholecystostomy at the Kobe Children's Hospital. The hepatic portal dissections employed in this series were classified as "supraportal" (9 procedures), "portal" (25 procedures), and "infra-portal" (3 procedures) based on the level at which the fibrous mass at the porta hepatis was transsected as determined by the operative record and the pathologic findings. Successful biliary drainage was achieved in 19 out of 25 patients (76%) with a "portal" type of dissection, while 1 out of 9 with "supra-portal" and none out of 3 with "infra-portal" type dissections were successful in this respect. Of the 19 patients who achieved significant biliary flow, 8 have lived for 2--7 yr without jaundice and 3 others are jaundice-free for shorter intervals.     

Determinants of survival after Kasai's operation for biliary atresia using actuarial analysis.

Survival after Kasai's operation for "noncorrectable" biliary atresia is influenced by (1) age, (2) large bile ducts, and (3) concentration of the bile bilirubin. Critical values are: age less than 10.5 wk, any evidence of a large bile duct, and a bile bilirubin concentration greater than 8.8 mg/100 ml. Using these 3 factors, a predictive model is able to identify a favorable group with an 89% expected 4 yr survival.     

泽泻提取物不同组分对尿草酸钙结石形成的实验研究

目的 :研究泽泻提取物不同组分对尿草酸钙结石形成的影响 ,并确定其抑制尿草酸钙结石形成的有效部位。方法 :通过喂服泽泻提取物不同组分对乙二醇和氯化铵诱导的大白鼠肾草酸钙结石模型进行实验研究。结果 :服用泽泻醋酸乙酯浸膏的醋酸乙酯洗脱液大鼠的血清尿素氮 (BUN) ,肌酐 (Cr) ,肾钙 (Ca²⁺ )含量 ,24h尿Ca²⁺ 分泌量 ,肾组织的草酸钙晶体沉积均明显低于成石组 (P<0.05)。结论 :泽泻醋酸乙酯浸膏的醋酸乙酯洗脱液能抑制实验性高草酸尿症大白鼠体内肾草酸钙晶体的形成 ,是泽泻抑制尿草酸钙结石形成的有效部位。     

针灸治疗胆汁返流性胃炎近况

系统回顾及总结了近几年来有关针灸治疗胆汁返流性胃炎(BRG)的文献，认为针灸防治BRG具有肯定的临床疗效和优势，并为进一步探索提供思路。