First case report of Solobacterium moorei bacteremia due to acute cholangitis in South Korea.

Solobacterium moorei is an anaerobic gram-positive bacillus that rarely causes bacteremia. Herein, we report a case of S. moorei bacteremia associated with acute cholangitis in a patient without malignancy. The patient had a history of chronic pancreatitis with pancreaticogastrostomy and presented with fever and abdominal pain. Computed tomography scans showed acute cholangitis and S. moorei identified in blood cultures were confirmed by matrix-assisted laser desorption/ionization-time of flight mass spectrometry and 16S rRNA sequencing. The patient was successfully treated with endoscopic retrograde biliary drainage and antibiotics including meropenem and piperacillin-tazobactam.

AAV-IL-22 modifies liver chemokine activity and ameliorates portal inflammation in murine autoimmune cholangitis.

There remain significant obstacles in developing biologics to treat primary biliary cholangitis (PBC). Although a number of agents have been studied both in murine models and human patients, the results have been relatively disappointing. IL-22 is a member of the IL-10 family and has multiple theoretical reasons for predicting successful usage in PBC. We have taken advantage of an IL-22 expressing adeno-associated virus (AAV-IL-22) to address the potential role of IL-22 in not only protecting mice from autoimmune cholangitis, but also in treating animals with established portal inflammation. Using our established mouse model of 2-OA-OVA immunization, including α-galactosylceramide (α-GalCer) stimulation, we treated mice both before and after the onset of clinical disease with AAV-IL-22. Firstly, AAV-IL-22 treatment given prior to 2-OA-OVA and α-GalCer exposure, i.e. before the onset of disease, significantly reduces the portal inflammatory response, production of Th1 cytokines and appearance of liver fibrosis. It also reduced the liver lymphotropic chemokines CCL5, CCL19, CXCL9, and CXCL10. Secondly, and more importantly, therapeutic use of AAV-IL-22, administered after the onset of disease, achieved a greater hurdle and significantly improved portal pathology. Further the improvements in inflammation were negatively correlated with levels of CCL5 and CXCL10 and positively correlated with levels of IL-22. In conclusion, we submit that the clinical use of IL-22 has a potential role in modulating the inflammatory portal process in patients with PBC.

[The ways of prophylaxis of the pancreatic injuries occurring on background of cholangitis and choledocholithiasis complicated by obturation jaundice: algorithm for diagnosis and treatment].

The results of treatment of 45 patients, in whom obturation jaundice have occurred on background of purulent cholangitis and biliary calculous disease, were summarized. preoperatively conservative therapy was conducted to the patients, including ozonotherapy during 9 - 10 days (main group) and 2 - 4 days (control group). All the patients were operated on. Conservative therapy, conducted during 9 -- 10 days, have permitted to improve clinical and laboratory indices more rapidly postoperatively, to prognosticate possibilities of the pancreatic gland damage, pancreatitis occurrence, as well as its exacerbation in future.

Liver abscess caused by multidrug-resistant Pseudomonas aeruginosa treated with colistin; a case report and review of the literature.

A 77-year-old man had undergone left-lobe liver resection and a choledochojejunostomy six years previously, and thereafter he suffered from a postoperative relapse of cholangitis. He was admitted to our hospital due to liver abscesses and bacteremia caused by multidrug-resistant Pseudomonas aeruginosa. Empirical treatment with piperacillin/tazobactam was started, and the patient initially recovered. However, he developed a second case of sepsis caused by piperacillin/tazobactam-resistant P. aeruginosa bacteremia originating from a new liver abscess. We changed the piperacillin/tazobactam to colistin and flomoxef and continued the two antibiotics for one month. During the antibiotic therapy, the patient successfully underwent bile duct stent placement.

[Intraductal photo-irradiation of bile in complex treatment of patients with cholangitis].

The authors have analyzed results of complex treatment of cholangitis patients by the application of intraductal photoirradiation. This method of treatment was shown to give more favorable course of the postoperative period.

[Clinical study on treatment of acute biliary tract infection with biliary drainage via endoscope combined with Chinese drug medication].

OBJECTIVE: To observe the curative effects of biliary drainage via endoscope (ENBD) combined with Chinese drug medication on acute biliary tract infection (ABTI) and the influence of treatment on complement 3 (C3), C-reactive protein (CRP) and interleukin-6 (IL-6). METHODS: Sixteen patients with ABTI were randomly assigned to two groups: the 9 patients in the combined treatment group (CTG) treated with ENBD combined with Chinese medicine and the 7 patients in routine treatment group (RTG) treated with ENBD alone. Another 18 patients with simple gallbladder stone were taken as the control group (CG). The curative effect was observed and the serum concentrations of C3, CRP and IL-6 were determined before and after treatment. RESULTS: Before treatment, the concentrations of CRP and IL-6 were significantly higher and C3 lower in all ABTI patients than those in patients with simple gallbladder stone (P < 0.05 or P < 0.01). After treatment, the general condition of patients was improved, the recovery time of intestinal tract function was shortened and the concentrations of C3, CRP and IL-6 significantly decreased in CTG, with the effects better than those in RTG respectively (P < 0.01 or P < 0.05). CONCLUSION: ENBD combined with Chinese drug medication shows favorable curative effects on ABTI. Treatment with Chinese medicine according to syndrome differentiation could decrease blood level of pro-inflammatory cytokines and promote recovery of the injured immune function.

Clinical observation on combined use of herbal medicine and acupuncture for treatment of 50 cases of biliary ascariasis complicated by infection.

50 cases of biliary ascariasis complicated by infection were treated by An Hui Zhi Tong Decoction combined with acupuncture. The cure rate was 72%, with a total effective rate of 96%, the therapeutic effect being better than that of the control group of 42 cases treated by western medicine. This therapy exerts good antipyretic effect, improves the symptoms quickly, and has no adverse side effects, thus its therapeutic effect is certain for treatment of biliary ascariasis complicated by infection.

[Anaerobic infection in abdominal surgery]. / Anaérobnaia infektsiia v abdominal'noi khirurgii.

The etiological pattern of non-clostridial anaerobic infection, its natural history and drug therapy in patients with its various types were studied and analyzed at the Surgery Research Center, Russian Academy of Medical Sciences. Peritonitis and cholangitis were examined in detail. Multimodality treatment of patients with acute peritonitis caused by a combination of aerobic and anaerobic pathogens by using hyperbaric oxygenation and therapy with directly acting antibiotics was found to enhance its efficiency, decrease therapy duration, prevent inflammation progression, and reduce mortality rates from 25.64 to 8.8%. The application to the techniques of preliminary decompression and the developed regimens of antibacterial therapy and hyperbaric oxygenation in the multimodality treatment for suppurative cholangitis noticeably yielded better therapeutical results, reduced mortality rates from 5.7 to 0% and these patients' hospital stay.

Treatment of biliary colic by water injection in the region of Qimen, Riyue, and Juque points.

Water injection was used in the treatment of 56 cases of biliary colic. The method was based on the writings of Zhang Zhongjing about the role of the Qimen point in treating diseases and clinical practice in this respect, water injection being performed at the most sensitive spot in the region defined by the lines joining the Qimen (Liv 14), Riyue (GB 24), and Juque (Ren 14) points. Pain disappeared in 32 (57.1%) of the 56 cases treated, and the total effective rate was 96.4%, showing a significantly better result compared with that of the control group treated with Western medicine (P < 0.05).

Acupuncture protection against experimental hyperbilirubinemia and cholangitis in rats.

Effects of acupuncture on experimental hyperbilirubinemia and cholangitis were studied in male rats (n = 33). The experimental group were treated with acupuncture, 18, 12 and 6 hr prior to and 6, 12 and 18 hr after oral administration of alpha-napthylisothiocyanate (ANIT, 100 mg per Kg). Rats were sacrificed 48 hours after challenge. Serum and liver samples were taken for biochemical and histological analysis, respectively. Results of this study revealed that rats treated with ANIT exhibited elevations in bilirubin, SGOT and SGPT as well as cholangitis. In rats receiving acupuncture and ANIT, biochemical and morphological parameters of liver injury were significantly reduced. Acupuncture therapy may be able to prevent ANIT-induced hyperbilirubinemia and cholangitis.

[Clinical observation on the treatment of acute cholangitis of a severe type with endoscopic retrograde biliary drainage and qingjieling].

In order to find out an effective approach for the improvement of therapeutic results of acute cholangitis of severe type (ACST) and its therapeutic and pathophysiologic problems, clinical observation has been made. In clinical practice, 38 patients with ACST were treated with ERBD and herbs (n = 20) or operative drainage (n = 18). The results suggested that the pressure of bile duct in the patients was very high (20-35 cmH2O). There were high levels of endotoxin in bile and blood, and level of fibronectin in serum was just 25% compared to that of normal level. The value of C3 in serum was only a half of normal level of C3. However, a high level of C-reactive protein in serum was determined. Positive rate of E. coli in bile was 84%. From the significant differences in the series of parameters between the ERBD-herb group and the operative drainage group, it was suggested that the ERBD-herb therapy was more effective than the operative method in promoting immunologic ability, relieving symptoms of ACST, minimizing complications and decreasing mortality. Some new pathophysiologic and therapeutic concepts of ACST have been proposed.