Complications of a severe autoimmune hemolytic anemia crisis: transfusional iron overload and gangrenous cholecystitis.

BACKGROUND: Evans syndrome is a rare autoimmune disorder that is defined by the simultaneous or sequential presence of two or more cytopenias without an obvious underlying precipitating cause. Evans syndrome usually follows a chronic relapsing and remitting course and is quite rare, making it difficult to evaluate in clinical studies. CASE REPORT: A 66-year-old male patient with a 17-year history of Evans syndrome presented with fulminant autoimmune hemolytic anemia (AIHA). He presented with a markedly elevated C-reactive protein (CRP; 46 mg/L [normal, 0-5 mg/L]) before onset of a decrease in hemoglobin. He required the transfusion of 20 units of red blood cells while awaiting response to aggressive immunosuppressive therapy including high-dose corticosteroids, intravenous immunoglobin therapy, and rituximab. He achieved a complete hematologic response. RESULTS: His postdischarge course was complicated by acute cholecystitis requiring laparoscopic cholecystectomy. In addition, his transfusional iron overload requiring 16 phlebotomies to reduce his ferritin level from 4933 µg/L to 326 µg/L, with phlebotomies ongoing every 2 weeks to achieve a ferritin level of less than 100 µg/L. CONCLUSION: Neither transfusional iron overload nor acute cholecystitis are well-recognized complications of a severe episode of AIHA. An elevated CRP has been recently recognized as an important prognostic marker in patients with immune thrombocytopenic purpura and this case suggests a need to evaluate its utility in AIHA.

[The influence of sinusoidal modulated currents on the fatty acid composition of plasma and blood erythrocytes in the patients presenting with chronic cholecystitis]. / Vliyanie sinusoidal'nykh modulirovannykh tokov na sostav zhirnykh kislot plazmy i eritrotsitov krovi u patsientov s khronicheskim kholetsistitom.

The objective of the present study was to evaluate the effectiveness of the treatment with sinusoidal modulated currents on lipid metabolism in the patients presenting with chronic cholecystitis in the state of remission. PATIENTS AND METHODS: The study included 25 patients with chronic non-calculosis cholecystitis in phase of remission and 20 healthy subjects (controls). We studied the serum lipid spectrum as well as the fatty acid composition of plasma and blood erythrocytes before and after therapy with sinusoidal modulated currents applied to the right-sided hypochondrium region. RESULTS AND DISCUSSION: The treatment of the patients with chronic cholecystitis in remission with the use of sinusoidal modulated currents produced moderate lipid-modulatory and membranotropic effects mediated through the activation of the processes of lipid metabolism that may result in the depletion of the pool of essential polyunsaturated fatty acids. CONCLUSION: The results of this study give evidence that it is advisable to treat the patients presenting with chronic cholecystitis by sinusoidal modulated currents in the combination with the oral intake of exogenous polyunsaturated fatty acids.

Cholelithiasis and cholecystitis in a dairy cow.

A 9-year-old Holstein cow was evaluated for colic and decreased milk production of 2 days' duration. Preoperative serum biochemical results suggested hepatic damage and cholestasis. On the basis of persistent signs of abdominal pain that were nonresponsive to analgesics, exploratory laparotomy was performed. The cow was found to have choleliths. Cholecystocentesis was performed, and samples were submitted for cytologic examination and bacterial culture. Bacterial culture yielded Escherichia coli and Clostridium perfringens. Using digital pressure, choleliths were reduced until they could be passed through the bile duct into the duodenum. The cow recovered from surgery without complications, and all serum biochemical test results returned to reference ranges. Cholelithiasis is rare in cattle but can result in signs of abdominal pain.

[Clinical study on plasma beta-endorphin levels in patients with wetness-heat zheng of the liver and gallbladder].

The plasma concentrations of beta-endorphin was determinated by radioimmunoassay in 75 patients with Wetness-Heat Zheng of Liver and Gallbladder, 23 patients with Insufficient Liver Zheng, 13 patients with Insufficient Spleen Zheng and 30 healthy subjects (control group). Compared with the control group, the plasma beta-EP levels were increased in Wetness-Heat Zheng of Liver and Gallbladder and Insufficient Liver Zheng. The patients with different diseases that were diagnosed to be Wetness-Heat Zheng of Liver and Gallbladder presented high levels of plasma beta-EP. It is suggested that the plasma beta-EP is an important change in the syndrome of Wetness-Heat Zheng of Liver and Gallbladder, and may be used as a diagnostic index.

[A comparison of different methods for quantum hemotherapy in treating complicated forms of acute cholecystitis in middle-aged and elderly patients]. / Sravnenie razlichnykh metodov kvantovoi gemoterapii pri lechenii oslozhnennykh form ostrogo kholetsistita u bol'nykh pozhilogo i starcheskogo vozrasta.

Quantum hemotherapy (QH) was used in complex treatment of elderly and senile patients operated upon for complicated forms of acute cholecystitis. Under examination there were 75 patients. Transfusion of UV irradiated donor plasma was found to be most effective of the QH methods used by us in the complex treatment of acute cholecystitis in elderly and senile patients.

Biliary tract infections treated with ciprofloxacin.

Thirty-two patients with severe biliary tract infections (cholecystitis and cholangitis) were treated with ciprofloxacin intravenously followed by oral ciprofloxacin. Complete clinical and bacteriological cure has been observed in 28 out of 32 patients and therapy failure occurred in four patients. Overall, no major adverse effects were encountered. These data suggest that intravenous ciprofloxacin followed by oral administration is an effective and safe agent for the therapy of severe biliary tract infections.

[The characteristics of the action of polyphytochol on the course of experimental hepatitis and cholecystitis]. / Osobennosti deistviia polifitokhola na techenie éksperimental'nogo gepatita i kholetsistita.

The effect of polyphytochol representing a combination of vegetable agents was studied on models of acute toxic hepatitis caused by CCl4 and cholecystitis. The efficiency of the drug in pathology of the hepatobiliary system was shown: it decreases cholestasis acting as a choleretic and bile-secreting drug, acts on the main pathogenetic links in hepatitis, exerts a marked membrane-stabilizing effect, influences favourably the processes of synthesis in the liver.