Acute obstructive suppurative cholangitis is most severe cholangitis and sometimes fatal, if early biliary drainage and administration of antibiotics are not performed.
By perfusion method of salicylic acid by liver microdialysis technique, we evaluated difference of hydroxylradical generation in the hepatic tissue after bacteria (E. coli, B. fragilis) were inoculated into common bile duct. Acute obstructive suppurative cholangitis caused by E. coligenerated more hydroxylradical than that caused by B. fragilis.
Hydroxylradical generation in the liver was suppressed after biliary drainage. Hydroxylradical generation was least when antibiotics was administrated after biliary drainage. It was concluded that antibiotics should be administrated after biliary drainage.

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We studied the immunohistochemical expression of Laminin, one of the components of the extracellular basement membrane, and Cathepsin B, one of the enzymes which degrades the extracellular basement membrane, in thirty-one cases of subserosal invasive gallbladder carcinoma. We tried to classify four types of Laminin by their staining state. Laminin types correlation could be seen to many of pathological facts. And we confirmed that the visual analysis system is useful for measuring the staining rate of Laminin and classifying the staining of Laminin. Only seven cases were positive in the Cathepsin B study and all of them were less than 3% of the staining rate in the Laminin study. We concluded that Cathepsin B degrades the components of the extracellular basement membrane such as Laminin.

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Recent data suggested that ET is secreted not only by vascular endothelial cell but also by bile duct epithelial cell. However, there are conflicting results regarding to the detection of ET in the bile. This inconsistence may be caused by the methodology of measurement. In this study, we investigated whether or not ET-1 is detectable in human bile by using conventional, modified EIA and CLEIA. ET-1 was detected using conventional EIA only in the white bile with minimal bilirubin and bile acid, not in the common bile with a plenty of bilirubin and bile acid. In the process of the conventional preparation of bile samples, bilirubin and bile acid have, competitive inhibition with ET-1, precluding the abstraction of ET from the bile samples. With our technical modification of the preparation, a component of bilirubin and bile acid was separated and removed from the bile samples using chloroform and ion exchange resin (Amberlite XAD-2). This modified EIA generated significantly better recovery rate of ET-1, up to 45±9% in the choledocal bile. On the other hand, CLEIA, utilizing chemiluminescent activity of horseradish peroxidase, enabled a specific, sensitive and precise quantitive determination of ET-1 without such a preparation of the bile samples, as described above. By this assay system, the mean recovery rate of 69±21% for ET-1 was obtained in the choledochal bile. This study demonstrated the presence of ET-1 in the bile.

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Recently, intraductal ultrasonography (IDUS) is widely used in preoperative diagnosis of malignancy in pancreatobiliary system. Here we report a case of early bile duct cancer with extend to the papilla of Vater, which precisely diagnosed by EUS and IDUS. The patient was admitted to our hospital with mild abnormality of liver function tests and with slight dilatation of extrahepatic bile duct on US. ERC disclosed a stricture at distal bile duct (Bi) and IDUS, intra-pancreatic duct scanning, show polypoid lesion in Bi. IDUS via percutaneous transhepatic route demonstrate the lubulated mass lesion in Bi which extend to intrapapillary bile duct (Ab). A locarized hypoechoic thickening of bile duct stick to the mass lesion was also detected, which considered to be reflect the subserosal invasion. EUS showed the mass lesion as irregular thickening of inner layer of bile duct without abnormality of outer hyperechoic layer of bile duct wall and muscular layer of duodenum. Pancreatoduodenectomy was performed, and histological findings of resected specimen disclosed a well differentiated bile duct cancer locused on Bi and Ab. The depth of invasion was within fibromuscular layer, and subserosal fibrosis at most deep site was also shown.

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A case of intramural type pericholecystic abscess which showed an interesting shape and progress in radiological findings and showed an interesting microscopic findings is reported. A 49year-old man was admitted to our hospital because of right upper abdominal pain and mass lesion. Abdominal imagings (ultrasonography, computed tomography, cholangiography) showed strange shape (record disk-like) cystic mass lesion at the right upper abdomen. Ten days later, an abdominal mass was disappeared suddenly. Abdominal CT scan revealed an air in the reduced mass lesion. Under the diagnosis of the pericholecystic abscess with bilio-enteric fistura, cholecystectomy and partial resection of the transverse colon were done. Microscopic findings revealed the extremely thickening of the serosal layer and the abscess formation of all over the subserosal area at the gallbladder body and fundus, whereas the epithelium and muscle layer showed not so severe inflammation.

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Endoscopic microwave coagulation therapy (EMCT) was successfully applied to female patients aged 79 and 82 with obstructive jaundice due to lower bile duct carcinoma, because of their refusal pancreatoduodenectomy (PD). A single 10-second exposure of microwave (50 W,2450 MHz) was delivered 15 to 20 times during each treatment to the cancerous tissue using a monopoler shielded wire electrode under guidance of a percutaneous cholangioendoscopy. Treatment was repeated a total of three or six times at intervals of 1 week, and an expandable metallic stent was plased after recanalization of bile duct and negative tests for cancer cells. Supplementary radiation therapy (50.4 Gy) was performed after EMCT, and no complications were encountered. Patients have subsequently lived well for 12 and 11 months without jaundice. These results indicate that EMCT for patients with lower bile duct cancer and high operative rick might be an effective alternative for PD.

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