Fasciola hepatica infestation as a very rare cause of extrahepatic cholestasis

Fasciola hepatica,an endemic parasite in Turkey,is still a very rare cause of cholestasis worldwide.Through ingestion of contaminated water plants like watercress,humans can become the definitive host of this parasite.Cholestatic symptoms may be sudden but in some cases they may be preceeded by a long period of fever,eosinophilia and vague gastrointestinal symptoms.We report a woman with cholangitis symptoms of sudden onset which was proved to be due to Fasciola hepatica infestation by an endoscopic retrograde cholangiography.

Renal elimination of organic anions in cholestasis

The disposition of most drugs is highly dependent on specialized transporters. OAT1 and OAT3 are two organic anion transporters expressed in the basolateral membrane of renal proximal tubule cells, identified as contributors to xenobiotic and endogenous organic anion secretion. It is well known that cholestasis may cause renal damage. Impairment of kidney function produces modifications in the renal elimination of drugs. Recent studies have demonstrated that the renal abundance of OAT1 and OAT3 plays an important role in the renal elimination of organic anions in the presence of extrahepatic cholestasis. Time elapsed after obstructive cholestasis has an important impact on the regulation of both types of organic anion transporters. The renal expression of OAT1 and OAT3 should be taken into account in order to improve pharmacotherapeutic efficacy and to prevent drug toxicity during the onset of this hepatic disease.

THE CYTOTOXIC EFFECTS OF CRUDE BILE ON HUMAN PANCREATIC CANCER CELL LINES

Objective To identify effects of bile acids on pancreatic cancer, The ultrastructure and growth of PANC-1 and MIA PaCa-2 cell lines in crude bile modified medium were studied. Methods The growth of PANC-1 and MIA PaCa-2 cells in RPMI 164o with or without 1%, 2% and 4% of the purified crude bile (containing total bile acids 1o. 17mmol/L) was assessed for 2, 4, 6, 8d by using MTT assay to determine inhibitory rate- The cell surface and intracellular ultrastructure of PANC-1 cells was investigated by SEM and TEM at 24h and 48h, respectively. Results The proliferation of both cell lines in bile treated medium were greatly retarded (P <o. oo1). The inhibitory rate of 1 %, 2% and 4% bile on Panc-1 cells in 4d were 38%, 6o% and 66%, respectively (P <o. o5), on MIA PaCa-2 cells at 4d were 28%, 39% and 52%, respectively (P <o. o5). The ceIls grown in bile for 48h lost their microvilli, their mitochondria and other organelles became vacuolated. Conclusion The bile acids in bile has cytotoxicity on PANC-1 and MIAPACA-2 cells, which may inhiblt pancreatic cancer progress in patients clinically.

Comparison of treatment outcomes between biliary plastic stent placements with and without endoscopic sphincterotomy for inoperable malignant common bile duct obstruction

AIM:Considerable controversy surrounds the adoption of endoscopic sphincterotomy(ES)to facilitate the placement of 10F plastic stents(PS)and to reduce the risk of pancreatitis The aim of the study was to assess the possible advantages of ES before PS placement. METHODS:From 3/1996 to 6/2001,172 consecutive patients, who underwent placement of a single 10F-polyethylene stent for inoperable malignant strictures of the common bile duct,were randomly assigned to 2 groups.In group A(96 patients),a ES was performed before PS placement In Group B,96 patients had PS directly.Early complications(within 30 d)and late effects(from 30 d to stent replacement)were assessed.Patency interval was defined as the period between PS placement and obstruction or death.The success of stent replacement in the 2 groups was evaluated. RESULTS:Stent insertion was successful in 95.8%(92/96) of the pts in group A and in 93.7%(90/96)of the patients in group B(P>0.05).Early complications were more frequent in patients who underwent ES(6.5% vs4.4%)but the data were not significant(P>0.05).In group A pancreatitis developed in two patients and bleeding in three;whereas pancreatitis occurred in 2 patients in group B.Complications were managed conservatively.No procedure related mortality occurred.All late complications were acute cholangitis due to stent occlusion.We performed a stent replacement in 87 patients that was successful in 84 cases without differences between groups. CONCLUSION:Sphincterotomy does not seem to be necessary for placement of 10F-PS in patients with malignant common bile duct obstruction.