Summary
Thirty-eight patients with external bile fistula created operatively for choledocholithiasis or malignant tumors were subjected to measurement of biliary mannitol clearance as an indicator of canalicular bile flow.
The clearance measurement was performed by the single injection method in 29 cases and the constant infusion method in 12 cases, either of which consisted of administering mannitol intravenously and then directly measuring its concentrations in the plasma and the bile by Tibbling’s method. The clearance value of either method was in good agreement with each other, and the bile fractions thus obtained were almost equal to those obtained from the clearance measurement done by Boyer, using radioisotope.
The bile fractions were measured in 8 patients with T-tube on the 2nd and 16th post-operative days. Ductal bile flow was easy to vary, accelerated in cholangitis or bile duct dilatation and decreased as the infection subsided or the obstruction was relieved, while canalicular bile flow steadly increased postoperatively. However, of the patients given biliary drainage for obstructive jaundice due to malignant tumors, 4 cases with persistant postoperative hyperbilirubinemia had the reduced canalicular flow. Three other patients presenting with excessive bile output showed not only low canalicular flow but also high ductal flow.
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References
McMaster HD, et al: Study on the total bile. J Exp Med 37:S95, 1923
Rundle FF, et al: Bile drainage after choledochostomy in man, with some observations on biliary fistula. Surgery 37: 903, 1955
Wheeler HO: Secretion of bile. In “Disease of the Liver”, edited by Schiff L, 3rd ed. Lippincott, Phil adelphia, 1963
Forker EL, et al: The clearance of mannitol and erythritol in rat bile. Proc Soc Exp Biol Med 126: 115, 1967
Forker EL, et al: Two sites of bile formation as determined by mannitol and erythritol clearance in the guinea pig. J Clin Invest 46: 1189, 1967
Wheeler HO, et al: Canalicular bile production in dogs. Am J Physiol 214: 866, 1968
Boyer JL, et al: Canalicular bile secretion in man. Studies utilizing the biliary clearance of14C mannitol. J Clin Invest 54: 773, 1974
Prandi D, et al: Canalicular bile production in man. Europ J Clin Invest 5: 1, 1975
Lindblad L, et al: Influence of cholic and chenodeoxycholic acid on canalicular bile flow in man. Gastroenterology 70: 1121, 1976
Preisig R, et al: Postoperative choleresis following bile duct obstruction in man. Rev Franc Etud Clin et Biol 14: 151, 1969
Tibbling G: A routine method for micro determination of mannitol in serum. Scand J Clin Lab Invest 22: 7, 1968
Saitoh S, et al: Evaluation of postoperative biliary secretion in man: Mannitol clearance measured by Tibbling’s method. Igaku no Ayumi 110: 225, 1979 (Jpn)
Saitoh S, et al: A study of postoperative bile secretion by mannitol clearance (Tibbling’s method). Jpn J Gastroenterol 78: 136, 1981 (Jpn)
Eggstein M: Eine neue Bestimmung der Neutralfette im Blutserum und Gewebe. II Mitteillung. Klin Wschr 44: 267, 1966
Barphelmai W, et al: Enzymatische Bestimmung von Glucose in Blut, Liquor und Harn. Klin Wschr 40: 585, 1962
Guldhammer EH, et al: Bile flow, pH, electrolytes, and bilirubin in hepatic bile following choledochotomy. Acta Chir Scand 133: 483, 1967
Hyon U, et al: Bile acid secretion following release of biliary obstruction. Gastroenterol Jpn 14: 553, 1979
Ohkawa H, et al: Effects of ursodeoxycholic acid administration on bile discharge and its constituents. Clinical Report 10: 40, 1976 (Jpn)
Hansson JA, et al: Clinical aspects of nonsurgical percutaneous transhepatic bile drainage in obstructive lesions of the extrahepatic bile ducts. Ann Surg 189: 58, 1979
Pierre KJ, et al: A new enzymatic method for determination of α-amylase. Clin Chem 22: 1219, 1976
Erlinger S, et al: Mechanisms and control of secretion of bile water and electrolytes. Gastroenterology 66: 281, 1974
Javitt NB: Hepatic bile formation (first of two parts). N Engl J Med 23: 1464, 1976
Lanman RC, et al: Rapid passage of mannitol into liver and bile. Life Sci 9: 1003, 1970
Barnhart JL, et al: Erythritol and mannitol clearances with taurocholate and secretin-induced cholereses. AmJ Physiol 234: E146, 1978
Shay H, et al: Possible effect of hydrocortisone on bilirubin excretion by the liver. N Engl J Med 257: 62, 1957
Fritz ME, et al: Control of bile flow in the cholecystectomized dog. Am J Physiol 204: 825, 1963
Morris TQ, et al: Character of glucagon induced choleresis. Fed Proc 26: 774, 1967
Wheeler HO, et al: Determinations of the flow and composition of bile in the unanesthetized dog during constant infusion of sodium taurocholate. J Clin Invest 39: 161, 1960
Jones RS, et al: Choleretic effects of secretin and histamine in the dog. Am J Physiol 217: 532, 1969
Zaterka S, et al: The effect of gastrin and histamine on secretion of bile. Gastroenterology 50: 500, 1966
Utili R, et al: Studies on the effects of E-coli endotoxin on canalicular bile formation in the isolated perfused rat liver. J Lab Clin Med 89:471, 1977
Russell TR, et al: The choleretic mechanisms of sodium taurocholate, secretin, and glucagon. Surgery 77:498, 1975
Strasberg SM, et al: Bile flow in the baboon. Secretin does not increasel4C-erythritol clearance. Gastroenterology 80: A1350, 1981
Balabaud C, et al: The assessment of the bile salt nonindependent fraction of canalicular bile water in the rat. J Lab Clin Med 89: 393, 1977
Wannagat FJ, et al: Bile acid-induced increase in bile acid-independent flow and plasma membrane NaK-ATPase activity in rat liver. J Clin Invest 61: 297, 1978
Baker AL, et al: Sodium taurocholate modifies the bile acid-independent fraction of canalicular bile flow in the rhesus monkey. J Clin Invest 64: 312, 1979
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Saitoh, S., Yoshida, M. Post-operative bile secretion in man. Gastroenterol Jpn 17, 324–333 (1982). https://doi.org/10.1007/BF02774578
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DOI: https://doi.org/10.1007/BF02774578