Non-O1 Vibrio cholerae Bacteremia in Patients with Cirrhosis: 5-yr Experience from a Single Medical Center

Objectives: To assess the clinical features and susceptibility of cirrhotic patients to non-01 Vibrio cholerae bacteremia and to provide our therapeutic experiences in this rare and highly lethal infection. Methods: Twenty-eight blood culture isolates of non-01 V. cholerae were identified by our clinical microbiology laboratory between July 1989 and June 1994. Patients with underlying cirrhosis and the aforementioned bacteremia were retrospectively reviewed. Results: Twenty-one cirrhotic patients (16 male, five female; mean age, 50.9 yr; range 28–67 yr) were identified and classified as Child B (6 cases) and Child C (15 cases). Bacteremic episodes occurred most often from March to September. Seafood ingestion (seven cases) and seawater exposure (two cases) were risk factors, but nosocomial infections were also noted in six cases. Presenting symptoms and signs included ascites (95.2%), fever (81%), abdominal pain (52.4%), diarrhea (33.3%), and cellulitis with bullae Formation (19%). Concurrent spontaneous bacterial peritonitis was determined in 10 cases, seven with positive ascites cultures. Antibiotic therapy (either cephalothin with gentamicin or ceftriaxone alone) cured most of the bacteremic episodes. The overall case-fatality rate was 23.8%, hut 75% of the deaths were observed in patients with skin manifestation. Conclusions: Patients with decompensated cirrhosis are susceptible to non-01 V. cholerae bacteremia and should not ingest raw sea food or expose skin wounds to salt water. A high index of suspicion and early administration of antibiotics may lower the mortality rate.     

Clinical Practice Guidelines for the Medical and Surgical Management of Primary Intracerebral Hemorrhage in Korea

The purpose of this clinical practice guideline (CPG) is to provide current and comprehensive recommendations for the medical and surgical management of primary intracerebral hemorrhage (ICH). Since the release of the first Korean CPGs for stroke, evidence has been accumulated in the management of ICH, such as intracranial pressure control and minimally invasive surgery, and it needs to be reflected in the updated version. The Quality Control Committee at the Korean Society of cerebrovascular Surgeons and the Writing Group at the Clinical Research Center for Stroke (CRCS) systematically reviewed relevant literature and major published guidelines between June 2007 and June 2013. Based on the published evidence, recommendations were synthesized, and the level of evidence and the grade of the recommendation were determined using the methods adapted from CRCS. A draft guideline was scrutinized by expert peer reviewers and also discussed at an expert consensus meeting until final agreement was achieved. CPGs based on scientific evidence are presented for the medical and surgical management of patients presenting with primary ICH. This CPG describes the current pertinent recommendations and suggests Korean recommendations for the medical and surgical management of a patient with primary ICH.     

Mitochondrial adenosine triphosphatase activity of hepatocytes in obstructive jaundice

The activity of adenosine triphosphatase (ATPase) in the mitochondria of hepatocytes in extrahepatic cholestasis was studied calorimetrically. Elevation of Na⁺−K⁺-ATPase, Ca²⁺-ATPase, and Mg²⁺-ATPase activities in the mitochondria of hepatocytes was found in rats after bile duct ligation. Peak activity levels of these three enzymes were found in the group that had been ligated for 7 days. The activities were found to be extremely high in rats in very poor physical condition and with very poor motor activity 7 days after ligation. In a clinical study, these activities were examined in 44 patients classified into three groups: group I, those with non-jaundice cholelithiasis; group II, those with obstructive jaundice caused by common bile duct stones, and group III, those with obstructive jaundice caused by extrahepatic malignancy. All patients were operated on and liver specimens were collected for study. Na⁺−K⁺-ATPase activity was 0.86±0.18, 1.87±0.40, and 1.92±0.32. (M±SE) μmole pi/mg protein per hour for groups I, II, and III, respectivety. Mg²⁺-ATPase activity was 0.86±0.18, 1.87±0.34, and 1.50±0.35 μmole pi/mg protein per hour for groups I, II, and III. Ca²⁺-ATPase activity was 1.01±0.26, 2.51±0.44, and 2.08±0.51 μmole pi/mg protein per hour for groups I, II, and III. The values in groups II and III were significantly higher than those in group I. Elevation of these ATPase activities was clear in obstructive jaundice. These results may be due to the disturbed metabolism of hepatocytes or even to the cessation of metabolism, and hepatocytes try to reach a compensatory status during cholestasis.