1/8. Studies on the functional disturbances of the papillary region using a pressure sensor.Investigation of the duodenal papilla and the bile duct by EPCG is essential to diagnose the organic and functional disturbances of the papillary region. We have developed a pressure sensor based on a semi-conductor in order to obtain a more objective observation of pathological conditions in the papillary region. Using a duodenofiberscope, the pressure sensor was placed on the tip of canula, and it was inserted into the papilla and measured the movements of the papillary region. The pressure sensor method was carried out in 18 normal subjects and 69 patients with various diseases. As the result of analysis of wave forms in normal subjects, regular wave form patterns were obtained. In about 71% of cases with biliary diseases irregular wave forms were observed. Irregular wave form patterns were also observed 40% of cases with cholecystolithiasis, while irregular patterns were revealed in 86% cases with choledocholithiasis. The pressure sensor method during for duodenofiberscopy is important diagnostic procedure for the determination of functional disturbances in the papillary region.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/8. Vaterian diverticula as a cause of acute pancreatitis.The association of duodenal diverticula and pancreatitis is rare. Various types of such diverticula are reviewed, especially intra- and extraluminal Vaterian diverticula in which common and pancreatic duct terminate. The pathogenesis of the pancreatitis in case of interposed Vaterian diverticula is thought to be mechanical by means of the creation of a closed Vaterian pouch in which higher pressures produce reflux of bile and pancreatic enzymes. Two patients with this particular type of duodenal diverticula are presented.- - - - - - - - - - ranking = 0.125keywords = pressure (Clic here for more details about this article) |
3/8. Motility and dysmotility of the biliary tract.Muscle fibers in the biliary tree, and therefore the potential for dysmotility, are located in the gallbladder and the sphincter of Oddi. Dysmotility at either site is a potential cause of biliary pain in the absence of stones, although significant controversy persists. Diminished gallbladder emptying measured by biliary scintigraphy is an indication for cholecystectomy, although studies are contradictory regarding clinical benefit. It is likely that careful selection of patients for cholescintigraphic testing, many of whom have had missed stones or sludge, will identify patients who benefit from cholecystectomy. However, given the increased incidence of gallbladder stasis in functional gastrointestinal disorders, wide use of this study in patients with abdominal symptoms leads to a frequent failure to respond to cholecystectomy. sphincter of oddi dysfunction (SOD) has been best studied in patients with biliary type pain who have had prior cholecystectomy. Much less understood is the association of SOD with idiopathic recurrent acute pancreatitis and chronic pancreatitis. The least-studied clinical association for SOD is in patients with biliary pain and intact gallbladders. Elevated basal sphincter of Oddi pressure is predictive of clinical response to sphincterotomy in patients with postcholecystectomy pain in two randomized sham-controlled studies. However, patients with suspected SOD have the highest complication rate from endoscopic retrograde cholangiogram and sphincterotomy, and, therefore, careful patient selection is mandatory.- - - - - - - - - - ranking = 0.125keywords = pressure (Clic here for more details about this article) |
4/8. Congenital cystic dilatation of the intrahepatic bile ducts (Caroli's disease).With reference to a patient with Caroli's disease (segmentally dilatated intrahepatic bile ducts), the clinical features of this rare but serious disease are described. The condition differs from other cystic dilatations of the bile ducts in that only the intrahepatic bile ducts are involved. Its pathogenesis is obscure. It is suspected that an embryonic developmental disorder in the wall of the bile ducts causes cysts via physiological periodical increases of pressure. The diagnosis is made accidentally by cholangiography via the T-drain during or after cholecystectomy. When Caroli's disease is suspected, echography can be a valuable diagnostic aid.- - - - - - - - - - ranking = 0.125keywords = pressure (Clic here for more details about this article) |
5/8. The presence of a positive pressure gradient from pancreatic duct to choledochal cyst demonstrated by duodenoscopic microtransducer manometry: clue to pancreaticobiliary reflux.A case of choledochal cyst is presented. The diagnosis was established by endoscopic retrograde cholangiopancreatography, which also demonstrated that the common bile duct joined the pancreatic duct at an abnormally long distance from the papilla. Duodenoscopic manometry using a microtransducer catheter showed that the pressure in the pancreatic duct was higher than that in the choledochal cyst by 1.1 mmHg. The cyst-to-duodenum pressure gradient of 3.5 mmHg was not different from the common duct-to-duodenum gradient in patients with other common biliary tract diseases, making the presence of a stenosis as an etiology of this entity unlikely. The bile aspirated from the gallbladder had an extremely high amylase content, suggesting influx of the pancreatic juice into the biliary system. The pancreaticobiliary reflux caused by the positive pressure gradient from the pancreatic duct to the choledochal cyst may be related to the development of the disease.- - - - - - - - - - ranking = 0.875keywords = pressure (Clic here for more details about this article) |
6/8. Biliary pressure measurement: an aid in the management of patients on internal biliary drainage.To aid in the management of patients with internal biliary drainage catheters, biliary pressure readings are routinely taken. If the pressure is below the secretory pressure of bile (20-30 cm H2O), adequate internal biliary drainage is assured. This is a fast, simple, and reliable technique which can be performed at home by the patient or a visiting nurse. The need to exchange a catheter can now be based on the objective measurement of the biliary pressure.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/8. Relationship between hepatic hemodynamics and biliary pressure in dogs: its significance in clinical shock following biliary decompression.The changes in the hepatic hemodynamics were promptly reflected in the biliary pressure in dogs. Both wedged hepatic venous pressure and portal venous pressure increased in response to the elevated biliary pressure, and conversely decreased following rapid biliary decompression, suggesting that the changes in the biliary pressure might affect the hepatic hemodynamics post-sinusoidally. It was supposed that too rapid biliary decompression might trigger the following consequences; 1) decrease in sinusoidal pressure, 2) increase in sinusoidal inflow, and 3) extravasation of intravascular fluid in the perivascular space. When these were not sufficiently compensated, they could trigger shock in the jaundiced patients.- - - - - - - - - - ranking = 1.25keywords = pressure (Clic here for more details about this article) |
8/8. Spontaneous perforation of bile ducts.The rarity of spontaneous perforation of bile ducts in the absence of trauma or previous biliary surgery is apparent by the few reports in the literature. In a review of the available literature, only 23 perforations of the common duct and 10 perforations of the common hepatic duct were found. This report adds two cases--one occurring in the distal common hepatic duct and one in a small superficial hepatic duct radical on the inferior surface of the liver. Choledochal calculi associated with infected bile and increased pressure in the proximal ductal system are the most common etiologic factors in spontaneous perforation of biliary ducts. Free bile or bile stained fluid in the peritoneal cavity with an intact gallbladder should alert the surgeon to the possibility of bile duct perforation. Recognition and proper surgical treatment as outlined are essential for successful management of this rare occurrence.- - - - - - - - - - ranking = 0.125keywords = pressure (Clic here for more details about this article) |