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An analysis of the role of radiotherapy in the management of gallbladder (GB) and extra-hepatic bile duct (EHBD) cancer its based upon thirteen patients irradiated in our hospital and a review of the literature. These patients were treated as part of curative or palliative management in conjunction with surgery, after surgical failure or recurrence, and as the only palliative modality. Doses ranged from 3800 to 7225 rad. Significant palliation was obtained in 92% of the patients; average total bilirubin value decreased from 9.1 mg.% before to 1.7 mg.% after radiotherapy. The mean survival of all patients was 12.7 months after surgery (7.1 in GB, 16.1 in EHBD), and was 7.3 months after initiation of radiotherapy (6.3 in GB, 8.0 in EHBD). Two patients were alive and well with no evidence of disease 12 and 16 months after radiotherapy, and local tumor control was achieved in two. Complications included possible biliary fibrosis. Based upon a critical review of the surgical, chemotherapeutic, and radiotherapeutic literature, it is concluded that present surgical therapy fails because of extensive regional disease in which local recurrences follow various simple and radical surgical maneuvers; palliative surgery often fails. Survival rates have been poor following any therapy at present, although encouraging results are seen with carefully planned megavoltage radiotherapy. A proposal its made to evaluate the role of radiotherapy systematically: as part of curative therapy post-operatively to decrease local recurrences and to increase the length and quality of survival; to treat incisional recurrences; as part of advanced disease management to increase the effectiveness and length of palliation; and in conjunction with chemotherapy to further consolidate therapeutic gains made with radiotherapy alone.

BACKGROUND AND AIMS: Bile acids (BAs) aid intestinal fat absorption and exert systemic actions by receptor-mediated signaling. BA receptors have been identified as drug targets for liver diseases. Yet, differences in BA metabolism between humans and mice hamper translation of pre-clinical outcomes. Cyp2c70-ablation in mice prevents synthesis of mouse/rat-specific muricholic acids (MCAs), but potential (patho)physiological consequences of their absence are unknown. We therefore assessed age- and gender-dependent effects of Cyp2c70-deficiency in mice.METHODS: The consequences of Cyp2c70-deficiency were assessed in male and female mice at different ages.RESULTS: Cyp2c70-/- mice were devoid of MCAs and showed high abundances of chenodeoxycholic and lithocholic acids. Cyp2c70-deficiency profoundly impacted microbiome composition. Bile flow and biliary BA secretion were normal in Cyp2c70-/- mice of both sexes. Yet, the pathophysiological consequences of Cyp2c70-deficiency differed considerably between sexes. Three-week old male Cyp2c70-/- mice showed high plasma BAs and transaminases, which spontaneously decreased thereafter to near-normal levels. Only mild ductular reactions were observed in male Cyp2c70-/- mice up to 8 months of age. In female Cyp2c70-/- mice, plasma BAs and transaminases remained substantially elevated with age, gut barrier function was impaired and bridging fibrosis was observed at advanced age. Addition of 0.1% ursodeoxycholic acid to the diet fully normalized hepatic and intestinal functions in female Cyp2c70-/- mice.CONCLUSION: Cyp2c70-/- mice show transient neonatal cholestasis and develop cholangiopathic features that progress to bridging fibrosis in females only. These consequences of Cyp2c70-deficiency are restored by treatment with UDCA, indicating a role of BA hydrophobicity in disease development.

The Mirizzi syndrome consists of the following four elements: 1. an anatomic arrangement of the cystic duct such that it lies almost parallel to the common hepatic duct; 2. impaction of a gall-stone in the cystic duct or neck of the gall-bladder; 3. partial mechanical obstruction of the common hepatic duct by the stone itself or the resulting inflammatory reaction; and 4. recurrent cholangitis or ultimately cholangitic cirrhosis due to the partial obstruction (Clemett and Lowman, 1965). This is an uncommon syndrome. We report the features on ultrasound examination in a patient we have recently seen.

Thirty-five swamp wallabies from Victoria, New South Wales and Queensland, Australia were examined for parasites. Thirty-nine species of nematodes, five species of cestodes and eight species of arthropods were found. Wallabies from Queensland and northern New South Wales had a less diverse helminth fauna (23 species) than did wallabies from southern New South Wales and Victoria (32 species). Rugopharynx spp. and Cloacina spp. occurred in large numbers in the stomach but provoked no pathological changes. Known pathogenic species (Globocephaloides trifidospicularis and Hypodontus macropi) were encountered in small numbers only and did not produce any lesions. Pathological changes associated with parasites were: gastric nodules associated with Labiostrongylus clelandi and Parazoniolaimus collaris, bronchopneumonia due to Marsupostrongylus spp., biliary fibrosis associated with Progamotaenia festiva and fibrous peritonitis, pleuritis, pericarditis and eosinophilic splenitis due to Breinlia mundayi. Echinococcus granulosus was the only parasite found which also occurs in domestic animals.