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[PMID]:29465558
[Au] Autor:Xiao J; Xu P; Li B; Hong T; Liu W; He X; Zheng C; Zhao Y
[Ad] Endereço:Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
[Ti] Título:Analysis of clinical characteristics and treatment of immunoglobulin G4-associated cholangitis: A retrospective cohort study of 39 IAC patients.
[So] Source:Medicine (Baltimore);97(8):e9767, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Immunoglobulin (Ig)G4-associated cholangitis (IAC) is one of the common organ manifestations of IgG4-related systemic disease (ISD). IAC and autoimmune pancreatitis (AIP) may mimic sclerosing cholangitis, cholangiocarcinoma, or pancreatic carcinoma. Diagnosis is based on a combination of clinical, biochemical, radiological, and histological findings.To study the clinical presentation of and treatment strategy for IAC, we reviewed clinical, serologic, and imaging characteristics, as well as treatment response, in 39 patients with IAC. The majority of patients were men (82%). Clinical features on presentation included obstructive jaundice in 26 patients (67%) and abdominal pain in 20 (51%). Positive IgG4 immunostaining was seen in 27 patients. The median serum IgG4 level before treatment was 769.4 mg/dL (range, 309.1-1229.7 mg/dL). After the steroid therapy, the median serum IgG4 level in 23 patients was 247.0 mg/dL (range, 139.0-355.0 mg/dL). Cholangiograms were available in 36 (92%) patients. Stenosis of the lower part of the common bile duct was found in 26 of 39 patients. Stenosis was diffusely distributed in the intra- and extrahepatic bile ducts in 14 of 39 patients. Additionally, strictures of the bile duct were detected in the hilar hepatic lesions in 27 of 39 patients. AIP was the most frequent comorbidity (35/39 in this study) of IAC. Other affected organs included eyes (n = 6), salivary glands (sialadenitis, n = 10), lymph nodes (mediastinal and axillary, n = 3), kidneys (n = 2), and the retroperitoneum (retroperitoneal fibrosis, n = 2).Regarding treatment, 29 patients were treated with steroids, of whom one underwent pancreatoduodenectomy, and one underwent choledochojejunostomy. Eight patients were treated with biliary stents. The remaining 19 patients took prednisolone alone. Eight patients achieved spontaneous resolution. Four patients with suspected pancreatic cancer or cholangiocarcinoma underwent surgery, including 2 patients who also received postoperative steroids. All patients were regularly followed up for 9 to 36 months. Only 2 patients in the steroids treatment group relapsed to manifest obstructive jaundice and high serum IgG4 levels. These 2 patients were treated with steroids and biliary stents, resulting in complete remission.We also review the diagnostic and therapeutic management and discuss recent pathophysiological findings, which might aid in understanding the molecular mechanisms contributing to IAC and other manifestations of IgG4-related diseases (IgG4-RD). Biomarkers that are more accurate are needed to correctly diagnose IAC and prevent misdiagnoses and unnecessary therapeutic interventions.
[Mh] Termos MeSH primário: Doenças Autoimunes/imunologia
Doenças Autoimunes/terapia
Colangite/imunologia
Colangite/terapia
Imunoglobulina G/sangue
[Mh] Termos MeSH secundário: Adulto
Anti-Inflamatórios/uso terapêutico
Doenças Autoimunes/patologia
Procedimentos Cirúrgicos do Sistema Biliar/instrumentação
Procedimentos Cirúrgicos do Sistema Biliar/métodos
Colangite/patologia
Coledocostomia
Ducto Colédoco/patologia
Constrição Patológica
Feminino
Seres Humanos
Masculino
Meia-Idade
Pancreaticoduodenectomia
Pancreatite/imunologia
Prednisolona/uso terapêutico
Estudos Retrospectivos
Stents
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Inflammatory Agents); 0 (Immunoglobulin G); 9PHQ9Y1OLM (Prednisolone)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009767


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[PMID]:28470667
[Au] Autor:Tanaka T; Zhang W; Sun Y; Shuai Z; Chida AS; Kenny TP; Yang GX; Sanz I; Ansari A; Bowlus CL; Ippolito GC; Coppel RL; Okazaki K; He XS; Leung PSC; Gershwin ME
[Ad] Endereço:Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Davis, CA.
[Ti] Título:Autoreactive monoclonal antibodies from patients with primary biliary cholangitis recognize environmental xenobiotics.
[So] Source:Hepatology;66(3):885-895, 2017 09.
[Is] ISSN:1527-3350
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A major problem in autoimmunity has been identification of the earliest events that lead to breach of tolerance. Although there have been major advances in dissecting effector pathways and the multilineage immune responses to mitochondrial self-antigens in primary biliary cholangitis, the critical links between environmental factors and tolerance remain elusive. We hypothesized that environmental xenobiotic modification of the E2 subunit of the pyruvate dehydrogenase (PDC-E2) inner lipoyl domain can lead to loss of tolerance to genetically susceptible hosts. Previously we demonstrated that serum anti-PDC-E2 autoantibodies cross-react with the chemical xenobiotics 2-octynoic acid and 6,8-bis (acetylthio) octanoic acid and further that there is a high frequency of PDC-E2-specific peripheral plasmablasts. Herein we generated 104 recombinant monoclonal antibodies (mAbs) based on paired heavy-chain and light-chain variable regions of individual plasmablasts derived from primary biliary cholangitis patients. We identified 32 mAbs reactive with native PDC-E2, including 20 specific for PDC-E2 and 12 cross-reactive with both PDC-E2 and 2-octynoic acid and 6,8-bis (acetylthio) octanoic acid. A lower frequency of replacement somatic hypermutations, indicating a lower level of affinity maturation, was observed in the complementarity-determining regions of the cross-reactive mAbs in comparison to mAbs exclusively recognizing PDC-E2 or those for irrelevant antigens. In particular, when the highly mutated heavy-chain gene of a cross-reactive mAb was reverted to the germline sequence, the PDC-E2 reactivity was reduced dramatically, whereas the xenobiotic reactivity was retained. Importantly, cross-reactive mAbs also recognized lipoic acid, a mitochondrial fatty acid that is covalently bound to PDC-E2. CONCLUSION: Our data reflect that chemically modified lipoic acid or lipoic acid itself, through molecular mimicry, is the initial target that leads to the development of primary biliary cholangitis. (Hepatology 2017;66:885-895).
[Mh] Termos MeSH primário: Anticorpos Monoclonais/imunologia
Autoantígenos/imunologia
Autoimunidade/genética
Colangite/imunologia
Colangite/patologia
Xenobióticos/imunologia
[Mh] Termos MeSH secundário: Anticorpos Monoclonais/metabolismo
Autoantígenos/genética
Autoimunidade/imunologia
Feminino
Amplificação de Genes
Seres Humanos
Immunoblotting
Masculino
Mimetismo Molecular/genética
Reação em Cadeia da Polimerase em Tempo Real
Sensibilidade e Especificidade
Ácido Tióctico/imunologia
Ácido Tióctico/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Nm] Nome de substância:
0 (Antibodies, Monoclonal); 0 (Autoantigens); 0 (Xenobiotics); 73Y7P0K73Y (Thioctic Acid)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1002/hep.29245


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[PMID]:29443746
[Au] Autor:Wang Z; Liu X; Xu H; Qu L; Zhang D; Gao P
[Ad] Endereço:Department of Hepatology.
[Ti] Título:Platelet count to spleen thickness ratio is related to histologic severity of primary biliary cholangitis.
[So] Source:Medicine (Baltimore);97(7):e9843, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The aim of this study was to evaluate the ability of noninvasive markers to identify the histological severity of primary biliary cholangitis (PBC).Fifty-eight treatment-naïve PBC patients who had undergone liver biopsy were enrolled in our study. The patients' histological stages were based on the classifications of Ludwig and Scheuer. Aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis index based on the 4 factors (FIB-4), red blood cell distribution width to platelet ratio (RPR), and platelet count to spleen thickness (PC/ST) ratio were calculated. Using the area under the receiver operating characteristic curve (AUROC) to evaluate the accuracy of different markers for predicting the histological severity.Among the 58 treatment-naïve PBC patients, the patients of Scheuer stage I/II/III/IV were 17/25/11/5, respectively. PC/ST ratio (AUROC = 0.807) was superior to RPR (AUROC = 0.717), APRI (AUROC = 0.726), FIB-4 (AUROC = 0.722), and mean platelet volume (MPV) (AUROC = 0.671) in discriminating between stage I and stage ≥II. The AUROC of PC/ST ratio, RPR, APRI, FIB-4, and MPV were 0.939, 0.872, 0.816, 0.831 and 0.572, respectively, for Scheuer stage ≥III; 0.968, 0.795, 0.744, and 0.723, respectively for stage IV. The sensitivity and specificity of PC/ST ratio were 73.4%,79.1%; 81%,100%;88.7%,100% for detection of Scheuer stage ≥ II, Scheuer stage ≥ III and Scheuer stage IV, respectively.Our study findings indicated that compared with previous noninvasive test PRP, APRI, FIB-4 and MPV, PC/ST ratio shows the most accurate for distinguish the histologic severity of PBC patients.
[Mh] Termos MeSH primário: Colangite/sangue
Cirrose Hepática Biliar/sangue
Contagem de Plaquetas
Índice de Gravidade de Doença
Baço/patologia
[Mh] Termos MeSH secundário: Área Sob a Curva
Aspartato Aminotransferases/sangue
Biomarcadores/análise
Colangite/patologia
Índices de Eritrócitos
Feminino
Seres Humanos
Cirrose Hepática Biliar/patologia
Masculino
Meia-Idade
Valor Preditivo dos Testes
Curva ROC
Estudos Retrospectivos
Sensibilidade e Especificidade
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); EC 2.6.1.1 (Aspartate Aminotransferases)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009843


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[PMID]:29241849
[Au] Autor:Xu MM; Carr-Locke DL
[Ad] Endereço:The Center for Advanced Digestive Care, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
[Ti] Título:Early ERCP for severe cholangitis? Of course!
[So] Source:Gastrointest Endosc;87(1):193-195, 2018 01.
[Is] ISSN:1097-6779
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Colangiopancreatografia Retrógrada Endoscópica
Colangite
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171216
[St] Status:MEDLINE


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[PMID]:29369874
[Au] Autor:Aschenbrenner DS
[Ad] Endereço:Diane S. Aschenbrenner is an assistant professor at Notre Dame of Maryland University in Baltimore. She also coordinates Drug Watch: daschenbrenner@ndm.edu.
[Ti] Título:Excessive Dosing of Obeticholic Acid May Increase Risk of Liver Damage.
[So] Source:Am J Nurs;118(2):46, 2018 Feb.
[Is] ISSN:1538-7488
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Doença Hepática Induzida por Substâncias e Drogas/etiologia
Ácido Quenodesoxicólico/análogos & derivados
Fármacos Gastrointestinais/efeitos adversos
[Mh] Termos MeSH secundário: Ácido Quenodesoxicólico/administração & dosagem
Ácido Quenodesoxicólico/efeitos adversos
Colangite/tratamento farmacológico
Relação Dose-Resposta a Droga
Fármacos Gastrointestinais/administração & dosagem
Seres Humanos
Estados Unidos
United States Food and Drug Administration
[Pt] Tipo de publicação:NEWS
[Nm] Nome de substância:
0 (Gastrointestinal Agents); 0462Z4S4OZ (obeticholic acid); 0GEI24LG0J (Chenodeoxycholic Acid)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM; N
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE
[do] DOI:10.1097/01.NAJ.0000530245.53335.c8


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[PMID]:29275776
[Au] Autor:Al-Zahir MZ; AlAmeel T
[Ad] Endereço:Department of Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia.
[Ti] Título:Extrahepatic cholangiocarcinoma with prolonged survival: a case report.
[So] Source:J Med Case Rep;11(1):357, 2017 Dec 25.
[Is] ISSN:1752-1947
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cholangiocarcinoma has poor prognosis and short term-survival. Here, we report the case of a patient with unusually prolonged survival. CASE PRESENTATION: Our patient was a 56-year-old Arab man with a 6-month history of obstructive jaundice. A computed tomography scan of his abdomen revealed a mass at the confluence of the hepatic ducts with suspected malignant strictures on endoscopy. A positive tissue diagnosis was achieved more than 18 months after commencement of his symptoms. He remained functional throughout this period despite recurrent episodes of cholangitis. CONCLUSIONS: Cholangiocarcinoma is a presumably fatal disease, especially because patients tend to present late with unresectable disease. Many patient-related and disease-related factors may alter survival.
[Mh] Termos MeSH primário: Neoplasias dos Ductos Biliares/diagnóstico por imagem
Ductos Biliares Extra-Hepáticos/diagnóstico por imagem
Tumor de Klatskin/diagnóstico por imagem
[Mh] Termos MeSH secundário: Neoplasias dos Ductos Biliares/complicações
Neoplasias dos Ductos Biliares/patologia
Ductos Biliares Extra-Hepáticos/patologia
Colangiocarcinoma/complicações
Colangiocarcinoma/diagnóstico por imagem
Colangiocarcinoma/patologia
Colangiopancreatografia Retrógrada Endoscópica
Colangite/etiologia
Seres Humanos
Icterícia Obstrutiva/etiologia
Tumor de Klatskin/complicações
Tumor de Klatskin/patologia
Masculino
Meia-Idade
Taxa de Sobrevida
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180130
[Lr] Data última revisão:
180130
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171226
[St] Status:MEDLINE
[do] DOI:10.1186/s13256-017-1519-5


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[PMID]:29183005
[Au] Autor:Zheng J; Li Z; Wang T; Zhao Y; Wang Y
[Ad] Endereço:Department of Laboratory Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, China.
[Ti] Título:Microarray Expression Profile of Circular RNAs in Plasma from Primary Biliary Cholangitis Patients.
[So] Source:Cell Physiol Biochem;44(4):1271-1281, 2017.
[Is] ISSN:1421-9778
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND/AIMS: Circular RNAs (circRNAs) play a crucial role in the occurrence of several diseases, including autoimmune diseases. However, their role in primary biliary cholangitis (PBC) remains unclear. Here, we aimed to determine the circRNA expression profile in plasma from PBC patients and further explore the value of circRNA in diagnosing PBC. METHODS: CircRNA microarrays were used to determine circRNA expression profiles in plasma samples from 6 PBC patients and 6 healthy controls. Statistical analyses identified differentially expressed circRNAs, and these circRNAs were verified by qRT-PCR in 29 PBC patients and 30 healthy controls. MicroRNA (miRNA) target prediction software identified putative miRNA response elements (MREs), which were used to construct a map of circRNA-miRNA interactions for the differentially expressed circRNAs. RESULTS: Our results indicated that there were 18 up-regulated and 4 down-regulated circular RNAs in the plasma from PBC patients compared with that from healthy individuals. Among the differentially expressed circRNAs, hsa_circ_402458 (P=0.0033), hsa_circ_087631 and hsa_circ_406329 (P=0.0185) were up-regulated, and hsa_circ_407176 (P=0.0066) and hsa_circ_082319 were down-regulated in the PBC group versus the healthy group as demonstrated by qRT-PCR. In particular, hsa_circ_402458 was significantly higher in PBC patients not receiving UDCA treatment than in PBC patients receiving UDCA treatment (P=0.0338). The area under the receiver operating characteristic curve for hsa_circ_402458 for diagnosing PBC was 0.710 (P=0.005). For hsa_circ_402458, two putative miRNA targets, hsa-miR-522-3p and hsa-miR-943, were predicted. CONCLUSIONS: circRNA dysregulation may play a role in PBC pathogenesis, and hsa_circ_402458 shows promise as a candidate biomarker for PBC.
[Mh] Termos MeSH primário: RNA/sangue
[Mh] Termos MeSH secundário: Área Sob a Curva
Sequência de Bases
Ductos Biliares
Biomarcadores/sangue
Estudos de Casos e Controles
Colangite/metabolismo
Colangite/patologia
Análise por Conglomerados
Seres Humanos
MicroRNAs/química
MicroRNAs/metabolismo
Hibridização de Ácido Nucleico
Análise de Sequência com Séries de Oligonucleotídeos
RNA/química
Curva ROC
Reação em Cadeia da Polimerase em Tempo Real
Alinhamento de Sequência
Transcriptoma
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (MicroRNAs); 0 (RNA, circular); 63231-63-0 (RNA)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180118
[Lr] Data última revisão:
180118
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1159/000485487


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[PMID]:29245350
[Au] Autor:Wu X; Zhao P; Dong L; Zhang X
[Ad] Endereço:aDepartment of Pharmacy, Ruijin Hospital Suzhou Branch Affiliated to Shanghai Jiaotong University School of MedicinebDepartment of Pharmacy, Jiangsu Shengze Hospital, SuzhoucDepartment of Critical Care MedicinedDepartment of Pharmacy, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, PR China.
[Ti] Título:A case report of patient with severe acute cholangitis with tigecycline treatment causing coagulopathy and hypofibrinogenemia.
[So] Source:Medicine (Baltimore);96(49):e9124, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Tigecycline is the first member of the glycylcycline family. There are rarely reports of tigecycline causing coagulopathy and hypofibrinogenemia until now. We report a case on tigecycline-associated coagulopathy and hypofibrinogenemia and discuss the characteristics of the adverse reaction. PATIENT CONCERNS: A 47-year-old male patient with severe acute cholangitis who developed sepsis was treated with a high dosage (100 mg twice daily) of tigecycline. He experienced coagulopathy and hypofibrinogenemia as substantiated by increased levels of prolonged prothrombin time (PT), the international normalized ratio (INR) and activated partial thromboplastin time (APTT), and in particular, the fibrinogen (FIB) levels obviously decreased. DIAGNOSES: Coagulopathy and hypofibrinogenemia. INTERVENTIONS: We discontinued tigecycline and gave the patient several blood products to prevent spontaneous bleeding. OUTCOMES: The adverse reaction disappeared after the withdrawal of tigecycline. After 30 days of hospitalization, the patient discharged with symptom free. LESSONS: We suggest that coagulation parameters should be closely monitored in patients treated with tigecycline, specifically in patients who may be renal insufficiency, female or use the high-dose.
[Mh] Termos MeSH primário: Antibacterianos/efeitos adversos
Transtornos da Coagulação Sanguínea/induzido quimicamente
Minociclina/análogos & derivados
[Mh] Termos MeSH secundário: Afibrinogenemia/induzido quimicamente
Antibacterianos/uso terapêutico
Colangite/complicações
Seres Humanos
Masculino
Meia-Idade
Minociclina/efeitos adversos
Minociclina/uso terapêutico
Sepse/tratamento farmacológico
Sepse/etiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 70JE2N95KR (tigecycline); FYY3R43WGO (Minocycline)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009124


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[PMID]:29224663
[Au] Autor:O'Connell W; Shah J; Mitchell J; Prologo JD; Martin L; Miller MJ; Martin JG
[Ad] Endereço:Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA. Electronic address: william.o'connell@emoryhealthcare.org.
[Ti] Título:Obstruction of the Biliary and Urinary System.
[So] Source:Tech Vasc Interv Radiol;20(4):288-293, 2017 Dec.
[Is] ISSN:1557-9808
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Biliary and urinary obstructions can be managed endoscopically or cystoscopically, surgically or by percutansous intervention or drainage. If the obtructed system is infected, emergent decompression is needed. Early recognition and treatment is paramount in both conditions. Acute cholangitis can present many different ways, from mild symptoms to fulminant sepsis. It is usually a result of ascending bacterial colonization and biliary obstruction resulting in bacterial overgrowth. Therefore, those patients with recent biliary instrumentation or previous biliary modification are at higher risk. Charcot's triad of fever, right upper quadrant abdominal pain, and jaundice is only seen in 50%-70% of patients. Fever is seen in over 90% of cases, pain is seen in 70% of cases, and jaundice is seen in 60% of cases. Altered mental status and hypotension are associated with severe cases. All 5 symptoms of fever, right upper quadrant abdominal pain, jaundice, altered mental status, and hypotension are referred to as Reynold's Pentad. Acute pyonephrosis can also present many different ways, from minimal symptoms to fulminant sepsis. Fever, chills, and flank pain are the classic symptoms, although some patients may be relatively asymptomatic. Pyonephrosis may present with a classic triad of fever, flank pain, and hydronephrosis, or simply hydronephrosis and sepsis. Pyonephrosis usually occurs as a result of urinary obstruction with either an ascending infection of the urinary tract or hematogenous spread of a bacterial pathogen as the culprit. Up to 75% of cases are related to urinary stone disease. Patients are at increased risk for pyonephrosis when they haven anatomic urinary tract obstruction, certain chronic diseases (diabetes meliitus and AIDS), or are immunosuppressed due to immunodeficiency or medications, (chronic steroid therapy).
[Mh] Termos MeSH primário: Colangite/terapia
Colestase/terapia
Drenagem/métodos
Procedimentos Endovasculares/métodos
Icterícia Obstrutiva/terapia
Cálculos Renais/terapia
Nefrostomia Percutânea/métodos
Radiografia Intervencionista
Obstrução Ureteral/terapia
[Mh] Termos MeSH secundário: Adolescente
Idoso de 80 Anos ou mais
Angiografia
Colangite/diagnóstico por imagem
Colangite/etiologia
Colangite/fisiopatologia
Colestase/diagnóstico por imagem
Colestase/etiologia
Colestase/fisiopatologia
Drenagem/efeitos adversos
Procedimentos Endovasculares/efeitos adversos
Feminino
Seres Humanos
Icterícia Obstrutiva/diagnóstico por imagem
Icterícia Obstrutiva/etiologia
Icterícia Obstrutiva/fisiopatologia
Cálculos Renais/diagnóstico por imagem
Cálculos Renais/etiologia
Cálculos Renais/fisiopatologia
Masculino
Nefrostomia Percutânea/efeitos adversos
Fatores de Risco
Resultado do Tratamento
Ultrassonografia
Obstrução Ureteral/diagnóstico por imagem
Obstrução Ureteral/etiologia
Obstrução Ureteral/fisiopatologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE


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[PMID]:29069029
[Au] Autor:Tang Z; Yang Y; Meng W; Li X
[Ad] Endereço:aThe First Clinical Medical School of Lanzhou University bDepartment of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University cThe second department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China dClinical Medical College Cancer Center of Lanzhou University, Lanzhou, China.
[Ti] Título:Best option for preoperative biliary drainage in Klatskin tumor: A systematic review and meta-analysis.
[So] Source:Medicine (Baltimore);96(43):e8372, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The operative treatment combined with preoperative biliary drainage (PBD) has been established as a safe Klatskin tumor (KT) treatment strategy. However, there has always been a dispute for the preferred technique for PBD technique. This meta-analysis was conducted to compare the biliary drainage-related cholangitis, pancreatitis, hemorrhage, and the success rates of palliative relief of cholestasis between percutaneous transhepatic biliary drainage (PTBD) and endoscopic biliary drainage (EBD), to identify the best technique in the management of KT.PubMed, EMBASE, and Web of Science were searched systematically for prospective or retrospective studies reporting the biliary drainage-related cholangitis, pancreatitis, hemorrhage, and the success rates of palliative relief of cholestasis in patients with KT. A meta-analysis was performed, using the fixed or random-effect model, with Review Manager 5.3.PTBD was associated with lower risk of cholangitis (risk ratio [RR] = 0.49, 95% confidence interval [CI]: 0.36-0.67; P < .00001), particularly in patients with Bismuth-Corlette type II, III, IV KT (RR = 0.50, 95% CI: 0.33-0.77; P = .05). Compared with EBD, PTBD was also associated with a lower risk of pancreatitis (RR = 0.35, 95% CI: 0.17-0.69; P = 0.003) and with higher successful rates of palliative relief of cholestasis (RR = 1.20, 95% CI: 1.10-1.31; P < .0001). The incidence of hemorrhage was similar in these 2 groups (RR 1.29, 95% CI: 0.51-3.27; P = .59). The risk of biliary drainage-related cholangitis (RR = 1.96, 95% CI: 0.96-4.01; P = .06) and pancreatitis (RR = 1.62, 95% CI: 0.76-3.47; P = .21) was similar between endoscopic nasobiliary drainage groups and biliary stenting.In patients with type II or type III or IV KT who need to have PBD, PTBD should be performed as an initial method of biliary drainage in terms of reducing the incidence of procedure related cholangitis, pancreatitis, and improving the rates of palliative relief of cholestasis. Well-conducted randomized controlled trials with a universial criterion for PBD are required to confirm these findings.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos
Colestase/cirurgia
Drenagem/métodos
Complicações Pós-Operatórias/etiologia
Cuidados Pré-Operatórios/métodos
[Mh] Termos MeSH secundário: Idoso
Neoplasias dos Ductos Biliares/complicações
Neoplasias dos Ductos Biliares/cirurgia
Ductos Biliares/cirurgia
Procedimentos Cirúrgicos do Sistema Biliar/métodos
Colangite/etiologia
Colestase/etiologia
Endoscopia/métodos
Feminino
Seres Humanos
Tumor de Klatskin/complicações
Tumor de Klatskin/cirurgia
Masculino
Meia-Idade
Razão de Chances
Pancreatite/etiologia
Stents/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171123
[Lr] Data última revisão:
171123
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171026
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008372



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