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SUMMARY A prospective study of P.T.C. using the Chiba Needle in the diagnosis of cholestasis was carried out in 276 patients. The visualization of the biliary system by P.T.C. and the pathological diagnoses were confirmed in 253 patients. The accuracy of P.T.C. in the determination of the level and cause of cholestasis was 100.0% and 96.0% respectively. P.T.C, in our opinion, is still the diagnostic modality of choice, especially in surgically difficult patients. [ABSTRACT FROM AUTHOR]

Previous in vitro studies have shown that abdominal irradiation diminishes the uptake of many nutrients and that the extent of this effect can be modified by varying the type of dietary fatty acid. This study was undertaken to determine (1) the effect of dietary fish oil fatty acids (FO) on the in vivo absorption of D-glucose and (2) the effect of feeding isocaloric diets containing FO or beef tallow (BT) on the in vivo uptake of glucose 2 weeks after a single 600 cGy exposure to abdominal irradiation from a 137Cs source. Feeding FO reduced the jejunal and ileal maximal transport rate (Vmax) and Michaelis constant (Km) for glucose uptake in nonirradiated control animals. In irradiated rats the Vmax was higher and the Km was lower in animals fed BT than in those fed FO. The passive component of glucose uptake was higher in control rats fed FO than in those fed BT yet was lower in irradiated animals fed FO compared with those fed BT. Although the value of the Km fell with FO, the effective resistance of the intestinal unstirred water layer rose so that the uptake of lower concentrations of glucose was undisturbed. However, FO reduces the uptake of higher concentrations of glucose as a result of a decline in the value of the Vmax that is sufficiently large to override the enhanced passive permeability of the intestine to glucose.(ABSTRACT TRUNCATED AT 250 WORDS)

This study was undertaken to determine the effects of feeding isocaloric semisynthetic diets high in saturated fatty acids from beef tallow (BT) or high in polyunsaturated fatty acids from fish oil (FO), on the clinical control and the in vivo uptake of varying concentrations of D-glucose into perfused jejunal and ileal loops of intestine of rats with streptozotocin diabetes. Jejunal and ileal weights were greater in diabetic than in control rats fed BT or FO, but the percentage of the intestinal wall comprised of mucosa was lower, resulting in a similar mass of mucosa in diabetic and in control animals. Feeding FO increased the jejunal unstirred water layer (UWL) resistance in control rats but decreased ileal UWL in diabetic animals; UWL was lower in diabetic than in control rats fed FO but was similar in those fed BT. The passive permeability coefficient (Pd) of the intestine for L-glucose was greater in diabetic than in control rats fed BT but not in those fed FO; Pd was higher in control rats fed FO than BT. The maximal transport rate (Vmax) and Michaelis constant (Km) of jejunal D-glucose uptake were lower in control rats fed FO than BT. Jejunal Vmax was lower in diabetic than control rats fed BT, yet was higher for those fed FO. The ileal Vmax for D-glucose uptake was greater in diabetic than in control animals fed BT or FO.(ABSTRACT TRUNCATED AT 250 WORDS)

The causes of cholestasis in 276 patients with a total of 296 lesions were studied. Extrahepatic cholestasis was found in 58.4 percent of the patients, and 41.6 percent had intrahepatic cholestasis. Malignant disease was found in 34.8 percent of the patients (extrahepatic cholestasis in 20 and intrahepatic cholestasis in 70). Cholangiocarcinoma, especially the hilar intrahepatic type, seems to be the most prevalent in the medical literature. It is possible that the combination of opisthorchiasis and carcinogenic agents, such as nitrosamines, induce a precancerous stage at the hilar area. Some unknown factors, may be the immune system in immune surveillance that act as a catalyst leading to malignant transformation. Acute calculous cholecystitis, choledocholithiasis, and intrahepatic stones are more common in Thailand than in the western countries, and their causes have been discussed herein. The composition of stones is also different; pigment stones are found more often in Thailand. These differences between the western and oriental types of biliary calculi are significant in regard to diagnostic approach and management, and morbidity and mortality. In Thailand, Opisthorchiasis viverrini has significant influence in the development of several cholestatic diseases, such as hilar intrahepatic cholangiocarcinoma, biliary calculi, opisthorchiatic intrahepatic cysts, and aggregated dead opisthorchiatic worms blocking the biliary system. In tropical countries, infectious diseases such as virus B hepatitis; severe systemic infectious diseases such as salmonellosis; and amebiasis and tuberculosis were also important causes of intrahepatic cholestasis. In the category of congenital anomalies, the prevalence of choledochal cysts was higher than in the United States. The prevalence of other forms of congenital anomalies of the biliary system is unknown, but may be similar to the prevalence of choledochal cysts.

Eleven patients were documented as having opisthorchiatic solitary intrahepatic cyst by roentgenography--P.T.C., identification of opisthorchis ova in the bile during P.T.C. and operation. This clinical entity should be differentiated from other forms of intrahepatic cyst. We believe that it is an acquired form. The formation of opisthorchiatic solitary intrahepatic cyst is related to lower biliary tract obstruction and high pressure in the biliary system. Fever, pain in the right upper quadrant and jaundice are the major manifestations of opisthorchiatic solitary intrahepatic cyst. Surgical intervention is the therapeutic method.

Cholangiocarcinoma is the leading cause of cholestasis among patients with malignant tumors, 63.5 per cent, while carcinoma of the head of the pancreas is the most common cause in western countries. A clinical history of progressive cholestasis; signs and symptoms of cholestasis; slow progressive clinical course, and mostly importantly, 96.7 per cent stemming from an endemic area of opisthorchiasis are all shown in this study. The peak age for this disease in Thailand was about one decade younger than that in western countries. The anatomic lesions in 96.7 per cent were found in the hilar area of the liver and only 3.3 per cent in the lower third of the liver compared with a significant number of lesions in the middle and lower thirds of the liver, as reported in literature from the western countries. We believe that percutaneous transhepatic cholangiography prior to the operation will definitely help the surgeon in deciding upon the surgical approach. Surgical intervention of a cholangiocarcinomatous lesion is probably more difficult in Thailand than in western countries because of location. The incidence for cholangiocarcinoma associated with biliary calculi and for an opisthorchiatic cyst is 8.1 and 6.1 per cent. We would like to emphasize the close association between cholangiocarcinoma and the combination of opisthorchiasis with carcinogenic agents, such as nitrosamines in the favorite local dish. The animal experimental model, using Syrian golden hamsters, produced the same result and the same site for the lesion--the hilar area of the liver.

One hundred and eighty-nine patients were documented as having biliary tract disease. Two hundred and nine lesions were found. The prevalence of malignant disease of the biliary tract was represented by 30.1 per cent, and cholangiocarcinoma was a leading cause. The carcinogenesis of cholangiocarcinoma has been speculated. Acute cholecystitis represented 55 per cent of biliary tract disease in Thailand, which consisted of acute calculous cholecystitis and acute noncalculous cholecystitis, 94.8 and 5.2 per cent, respectively. Among acute calculous cholecystitis, the prevalence of cholelithiasis, choledocholithiasis and intrahepatic stones were 58.5, 68.8 and 15.6 per cent, respectively. The high prevalence of choledocholithiasis and intrahepatic stones requires elucidation. In the remaining surgical disease of the biliary tract, opisthorchiatic cyst was the most common cause. The diagnosis of opisthorchiatic cyst was made roentgenologically in association with the identification of Opisthorchis ova in the aspirated bile. Opisthorchiatic cyst appears to be a unique clinical entity, differing from other types of intrahepatic cysts. Another form of presentation of biliary tract opisthorchiasis is through obstruction of the common bile duct by an aggregated mass of dead worms. This condition is cured by surgical removal of the worms. It is worth while to mention that, among 189 patients with biliary tract disease, there were three documented instances of choledochal cysts. This probably indicates a high prevalence of choledochal cysts when compared with that for the United States. In the present study, a 36 year old female with a diagnosis of Caroli's disease, ascariasis of the common bile duct and choledocholithiasis is presented.