Investigation of the Role of T-cell Type 17 Transcription Factor in Early Diagnosis of Cholangitis Disease.

Context: Anti-mitochondrial antibody M2+ (AMA-M2+) primary bile cholangitis (PBC) is difficult to diagnose, and early diagnosis is the key to ensure effective treatment and the safety of patients. Objective: The study intended to investigate the role of T helper type 17 (Th17) cells and their transcription factors in the early diagnosis of AMA-M2+ PBC to provide an effective guarantee of the ability to predict the prognosis of patients in the future. Design: The research team designed a prospective controlled study. Setting: The study took place at the Affiliated Hospital of Hebei University in Baoding, Hebei, China. Participants: Participants were 30 patients with AMA-M2+ PBC at the hospital between November 2020 and August 2021 and 30 healthy controls who concurrently underwent physical examinations. Outcome Measures: The study measured liver function (LF) and secretion of Th17 and its transcription factors-forkhead box P3 (Foxp3) and RAR-related orphan receptor gamma (RORγt)-and inflammatory factors-interleukin-17 IL-17 and IL-22-in participants' peripheral blood. The study also evaluated Th17 and its transcription factors in AMA-M2+ PBC, determined the expression of phosphorylated proteins using Western blotting, and analyzed the relationship between Th17 and LF. Results: The Th17 in the intervention group's peripheral blood was significantly higher than that of the control group (P < .05), and the sensitivity and specificity of the AMA-M2+ PBC were 63.33% and 96.67%, respectively. The expression of Foxp3 and p-Foxp3 proteins for the intervention was significantly lower (P < .001), while RORγt and P-ROR γ T were significantly higher (P < .001). The levels of interleukin-17 (IL-17) and IL-22 for the intervention group were significantly higher than those for the control group. The Pearson correlation coefficient showed that alanine aminotransferase (ALT), alkaline phosphatase (ALP), and γ-glutamyl transpeptidase (GGT) were positively correlated with Th17 cells, RORγt, IL-17, and IL-22 and negatively correlated with Foxp3. Conclusions: Th17 plays an important role in the early diagnosis of AMA-M2+ PBC, and Th17 and its transcription factors are highly effective for the early diagnosis of AMA-M2+ PBC, which is expected to be a breakthrough in the future diagnosis of the disease.

Microbial profile and antibiotic sensitivity pattern in bile cultures from endoscopic retrograde cholangiography patients.

AIM: To identify the frequency of bacterial growth, the most commonly grown bacteria and their antibiotic susceptibility, and risk factors for bacterial colonization in bile collected from patients with different biliary diseases. METHODS: This prospective study was conducted between April 2010 and August 2011. Patients with various biliary disorders were included. Bile was aspirated by placing a single-use, 5F, standard sphincterotome catheter into the bile duct before the injection of contrast agent during endoscopic retrograde cholangiopancreaticography (ERCP). Bile specimens were transported to the microbiology laboratory in blood culture bottles within an anaerobic transport system. Bacteria were cultured and identified according to the standard protocol used in our clinical microbiology laboratory. The susceptibilities of the organisms recovered were identified using antimicrobial disks, chosen according to the initial gram stain of the positive cultures. RESULTS: Ninety-one patients (27% male, mean age 53.7 ± 17.5 years, range: 17-86 years) were included in the study. The main indication for ERCP was benign biliary disease in 79 patients and malignant disease in 12 patients. The bile culture was positive for bacterial growth in 46 out of 91 (50.5%) patients. The most frequently encountered organisms were Gram-negative bacteria including Escherichia coli (28.2%), Pseudomonas (17.3%) and Stenotrophomonas maltophilia (15.2%). There were no significant differences between patients with malignant and benign disease (58% vs 49%, P = 0.474), patients with acute cholangitis and without acute cholangitis (52.9% vs 50%, P = 0.827), patients who were empirically administered antibiotics before intervention and not administered (51.4% vs 60.7%, P = 0.384), with regard to the bacteriobilia. We observed a large covering spectrum or low resistance to meropenem, amikacin and imipenem. CONCLUSION: We did not find a significant risk factor for bacteriobilia in patients with biliary obstruction. A bile sample for microbiological analysis may become a valuable diagnostic tool as it leads to more accurate selection of antibiotics for the treatment of cholangitis.

Un caso de QT largo y torsades de pointes por ciprofloxacino / No disponible

No disponible

[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.

[Cholangitis with hepatic microabscesses caused by Salmonella enterica serovar choleraesuis]. / Cholangitis mit hepatischen Mikroabszessen durch Salmonella enterica Serovar Choleraesuis.

HISTORY AND ADMISSION FINDINGS: A 71-year-old man was admitted to the emergency unit of another hospital with a mild gastroenteritis and high fever. On admission g-GT and C-reactive protein (CRP) levels were markedly elevated. Under nonspecific antibiotic therapy with ampicillin/sulbactam the fever persisted and for the first time, on day 5, the patient complained of right-sided abdominal pain. An increase in the laboratory values indicated cholestasis. After changing the antibiotics to ceftriaxon and metronidazole, acute cholangitis being suspected, the fever subsided immediately and the CRP level decreased. The patient was discharged after seven days of antibiotic treatment. But he was once more admitted after four weeks to another hospital because of severely reduced general condition and mild fever. He was transferred to our unit after two weeks. INVESTIGATIONS AND DIAGNOSIS: The test values indicated cholestasis and CRP was markedly elevated, while aminotransferase activity was slightly increased and normocytic normochromic anemia developed. Viral hepatitis, autoimmune and metabolic liver diseases, toxic liver damage, extrahepatic cholestasis and an endocarditis were excluded. Bile was aspirated by endoscopic retrograde cholangiopancreatography and added to blood culture bottles. Salmonella enterica serovar choleraesuis var. Kunzendorf was isolated. TREATMENT AND FURTHER COURSE: The patient was treated with ciprofloxacin, 2 x 250 mg by mouth for a total of five weeks. After 17 days of treatment no Salmonella bacteria were grown from a newly aspirated bile sample and the patient became free of fever. CONCLUSION: Salmonella infections do not always present as gastroenteritis. Bacteremia should be considered in the differential diagnosis of such infections. If cholangitis persists, the aspiration of bile for microbiological tests can be a rational diagnostic step and facilitates treatment. Prolonged administration of antibiotics is necessary to avoid relapse. and follow-up is very important when treatment is finished.

Psoriasis pustulosa generalizada y hepatitis citolítica asociada a colangitis neutrofílica / Generalized pustular psoriasis and cytolytic hepatitis associated with neutrophilic cholangitis

La psoriasis pustulosa generalizada (PPG) de von Zumbusch puede asociarse a alteraciones hepáticas, resultando habitualmente en una hepatitis colestásica con colangitis neutrofílica. Describimos el caso de una mujer con un primer episodio de de PPG que presentó durante el mismo una elevación de los parámetros hepáticos de citolisis. La ecografía abdominal y los estudios serológicos no mostraron anomalías significativas. La biopsia hepática mostró la presencia de un infiltrado neutrofílico alrededor de los conductos biliares del espacio portal. En definitiva, este hecho sugiere que la colangitis neutrofílica en el contexto de esta enfermedad puede mostrar inicialmente otros patrones de alteraciones analíticas distintos del patrón colestásico clásicamente descrito

Generalized pustular psoriasis (GPP) of the von Zumbusch type may be associated with liver disorders, usually resulting in cholestatic hepatitis with neutrophilic cholangitis. We describe the case of a woman who experienced a first episode of GPP, during which she presented with an increase in hepatic cytolysis parameters. An abdominal ultrasound and serological studies did not show any significant anomalies. A liver biopsy showed the presence of a neutrophilic infiltrate around the bile ducts of the portal space. In short, this fact suggests that neutrophilic cholangitis in the context of this disease may initially show patterns of analytical alterations other than the classically described cholestatic pattern

Colangite obstrutiva aguda / Acute obstructive cholangitis

Os autores discutem vários aspectos da colangite obstrutiva aguda com ênfase especial ao quadro clínico, diagnóstico diferencial e tratamento. Com relaçäo à etiologia referem que a coledocolitíase constituía-se na principal causa da colangite aguda. Entretanto, nos últimos anos, especialmente em centros de atendimento terciário, as manipulaçöes biliares näo cirúrgicas, geralmente em pacientes com neoplasias malignas irressecáveis, tornaram-se as causas mais frequentes de colangite. Enfatizam que o prognóstico é ruim, se a terapêutica instituida for retardada ou mal indicada. Finalmente, referem que cabe ao médico entender que pacientes com colangite obstrutiva aguda devem ser sempre tratados em caráter de urgência, tanto no que diz respeito ao diagnóstico como à terapêutica

A case of primary sclerosing cholangitis.

A case of primary sclerosing cholangitis (PSC) is reported. A 16 year-old female developed right hypochondralgia and nausea without jaundice. Examination on admission showed elevation of SGOT, SGPT, Al-P, gamma-GTP and LAP activities, but T-Bil, AFP and CEA were within normal limits. Peripheral eosinocytes increased by 10%, and tests for HBsAg, antiHBs, antimitochondrial antibody and anti-smooth muscle antibody were all negative. ERCP revealed a narrowing of the proximal portion of the common the hepatic duct, and beading of the intrahepatic bile ducts. Liver scintigram and CT revealed no tumors in the liver, biliary tract or pancreas. Laparoscopy showed a smooth liver without swelling and a slightly swollen gallbladder. Histologically, the liver biopsy specimen showed ductal proliferation of small interlobular bile ducts and periductal fibrosis. No bile plugs, granuloma or distinct cholangitis were observed. No abnormal findings, including evidence of inflammatory bowel disease, were detected by barium enema. At present, one year after discharge, although her symptoms and liver function test abnormalities continue, she has been attending high school. Although 58 cases of PSC have been reported in Japan, juvenile cases occurring before the third decade number only 3 including ours.