Hepatic hemobilia: Hemorrhage from the intrahepatic biliary tract,a review

Hepatic hemobilia is defined as hemorrhage arising from pathological changes in the intrahepatic biliary tract. The main causes are iatrogenic trauma, cholangitis, tumors, and coagulopathy. The salient features of the hemobilia syndrome are described and their causes explained. The treatment, when necessitated by hemorrhage or clot formation, is either resection of the liver or occlusion of the responsible artery by ligature or embolization. The iatrogenic trauma may be operative, resulting from instrumental lesion of the bile ducts, needle biopsy, transhepatic cholangiography, biliary tract prosthesis, or inlaying hepatic artery catheters. Among the inflammatory etiologies, special attention is given to nematodes in the ducts, the tropical hemobilia. Spontaneous hemobilia may, just as nose bleeds or hematuria, result from treatment with anticoagulants.

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Résumé L'hémobilie d'origine hépatique répond à l'hémorragie qui provient de lésions situées au niveau des voies biliaires intra-hépatiques. Les causes principales en sont le traumatisme, l'angiocholite, les tumeurs et les troubles de la coagulation. Les caracteres saillants de l'hémobilie sont décrits ainsi que ses causes. Le traitement quand il devient nécessaire en raison de l'importance de l'hémorragie ou de la formation de caillots consiste à réséquer une partie du parenchyme hépatique ou à obtenir l'occlusion de la plaie vasculaire par ligature ou par embolisation.Le traumatisme peut être d'origine iatrogène, qu'il soit le fait d'une lésion instrumentale des canaux biliaires hépatiques, d'une biopsie du foie à l'aiguille, de la cholangiographie transhépatique, ou encore de la présence d'une prothèse au niveau des voies biliaires ou d'un cathéter artériel.Parmi les causes inflammatoires une attention spéciale doit être accordée à l'existence de nématodes au niveau des canaux biliaires intra-hépatiques qui sont à l'origine de l'hémobilie tropicale.L'hémobilie spontanée, comme l'épistaxis ou l'hématurie, peut être la conséquence d'un traitement anti-coagulant.ResumenLa hemobilia hepática se define como hemorragia proveniente de alteraciones patológicas en el tracto biliar intrahepatico. Las causas principales son el trauma iatrogénico, la colangitis, los tumores y la coagulopatía. Se describen las características sobresalientes del síndrome de hemobilia y se explican sus causas. El tratamiento, cuando se hace necesario por hemorragia o por formación de coágulos, es la resección del hígado o la oclusión de la arteria responsable por ligadura o por embolización. El trauma iatrogénico puede ser de origen operatorio, como resultado de lesión instrumental de los canales biliares, biopsia por aguja, colangiografía transhepática, prótesis en el tracto biliar y catéteres colocados en la arteria hepática. Entre las etiologías de naturaleza inflamatoria se presta atención especial a la presencia de nemátodos en los canales, la hemobilia tropical. Al igual de lo que ocurre con las epistaxis o las hematurias, la hemobilia espontanea puede ser consecuencia de tratamientos con anticoagulantes.

     

The Potential of Anti-Bullying Efforts to Prevent Academic Failure and Youth Crime. A Case Using the Olweus Bullying Prevention Program (OBPP)

Prevention Science - The effectiveness of bullying prevention programs has led to expectations that these programs could have effects beyond their primary goals. By reducing the number of victims...     

What happens after graft loss? A large,long-term,single-center observation

The number of patients returning to dialysis after graft failure increases. Surprisingly, little is known about the clinical and immunological outcomes of this cohort. We retrospectively analyzed 254 patients after kidney allograft loss between 1997 and 2017 and report clinical outcomes such as mortality, relisting, retransplantations, transplant nephrectomies, and immunization status. Of the 254 patients, 49% had died 5 years after graft loss, while 27% were relisted, 14% were on dialysis and not relisted, and only 11% were retransplanted 5 years after graft loss. In the complete observational period, 111/254 (43.7%) patients were relisted. Of these, 72.1% of patients were under 55 years of age at time of graft loss and only 13.5% of patients were ≥65 years. Age at graft loss was associated with relisting in a logistic regression analysis. In the complete observational period, 42 patients (16.5%) were retransplanted. Only 4 of those (9.5%) were ≥65 years at time of graft loss. Nephrectomy had no impact on survival, relisting, or development of dnDSA. Patients after allograft loss have a high overall mortality. Immunization contributes to long waiting times. Only a very limited number of patients are retransplanted especially when ≥65 years at time of graft loss.     

Distinct immunopathological mechanisms of EBV-positive and EBV-negative posttransplant lymphoproliferative disorders

EBV-positive and EBV-negative posttransplant lymphoproliferative disorders (PTLDs) arise in different immunovirological contexts and might have distinct pathophysiologies. To examine this hypothesis, we conducted a multicentric prospective study with 56 EBV-positive and 39 EBV-negative PTLD patients of the K-VIROGREF cohort, recruited at PTLD diagnosis and before treatment (2013–2019), and compared them to PTLD-free Transplant Controls (TC, n = 21). We measured absolute lymphocyte counts (n = 108), analyzed NK- and T cell phenotypes (n = 49 and 94), and performed EBV-specific functional assays (n = 16 and 42) by multiparameter flow cytometry and ELISpot-IFNγ assays (n = 50). EBV-negative PTLD patients, NK cells overexpressed Tim-3; the 2-year progression-free survival (PFS) was poorer in patients with a CD4 lymphopenia (CD4⁺<300 cells/mm³, p <  .001). EBV-positive PTLD patients presented a profound NK-cell lymphopenia (median = 60 cells/mm³) and a high proportion of NK cells expressing PD-1 (vs. TC, p = .029) and apoptosis markers (vs. TC, p < .001). EBV-specific T cells of EBV-positive PTLD patients circulated in low proportions, showed immune exhaustion (p = .013 vs. TC) and poorly recognized the N-terminal portion of EBNA-3A viral protein. Altogether, this broad comparison of EBV-positive and EBV-negative PTLDs highlight distinct patterns of immunopathological mechanisms between these two diseases and provide new clues for immunotherapeutic strategies and PTLD prognosis.     

Untersuchungen über die Ausspritzmethode zur Lokalisation der Mikroelektrodenspitze bei Potentialmessungen am proximalen Konvolut der Rattenniere

Summary In measurements of transtubular potential differences of the rat kidney, reported previously, the electrode tip could be localized by ejection of electrode fluid under microscopic observation. In the proximal tubule it was found in contrast to the distal tubule that all potential differences disappeared irreversibly upon fluid ejection. The present study is concerned with the mechanism underlying this effect.The localization of the puncturing electrode was controlled by a coupling pulse technique. Current pulses were injected into the tubular lumen through a first electrode, and the same tubule was punctured subsequently with a second electrode which measured the potential difference. It was found that in most impalements the puncturing electrode would stop within the tubular wall, although from microscopic inspection it appeared to have reached the tubular lumen. Furthermore, when fluid was ejected from the electrode tip, the electrode abruptly penetrated into the tubular lumen. Simultaneously the potential difference recorded hitherto disappeared. This coincidence suggests that the breakdown of the potential difference merely corresponds to the potential step between cellular compartment and tubular lumen and that it is not caused by a transtubular leak.Conclusive evidence against the development of leaks during fluid ejection was derived from microperfusion experiments. During perfusion of the tubular lumen with choline chloride solution proximal tubules develop a transtubular potential difference significantly different from zero (up to 30 mV, lumen positive). Whether the electrode entered the tubular lumen during the impalement immediately, or whether the penetration was only accomplished by fluid ejection, did not affect the magnitude of the positive potential differences recorded. Hence these experiments constitute proof that the method of fluid ejection permits reliable measurements of transtubular potential differences in the proximal tubule. They confirm our finding that under normal free flow conditions no transtubular potential difference exists across the proximal tubular epithelium of the rat kidney.

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Mit Unterstützung durch die Deutsche Forschungsgemeinschaft.     

Nocardia ignorata, a new agent of human nocardiosis isolated from respiratory specimens in Europe and soil samples from Kuwait

Nocardia ignorata is a recently described species identified on the basis of a single isolate of unknown origin. Here we describe the epidemiological, phenotypic, and phylogenetic characteristics of this new species, based on five new clinical and soil isolates.     

Acoustic voice analysis by means of the hoarseness diagram.

The hoarseness diagram (Michaelis, Fr?hlich, & Strube, 1998a) has been proposed as a new approach to describe different acoustic properties of voices. To test its performance in the analysis of pathologically disturbed and normal voices five requirements are suggested that should be met by any acoustic voice-analysis protocol to be used in voice research and clinical practice. The hoarseness diagram is then tested with regard to these requirements. Individual voices are found to show a satisfactory localization in the diagram. Aspects of stationarity are discussed in the context of four case studies. The different cases illustrate that changes in the acoustic analysis results are observed if the voice-generation conditions change, whereas results are stationary if phonation conditions do not change. Different pathological voice groups defined on grounds of the specific phonation mechanism are found to map to specific regions of the hoarseness diagram, with differences between group locations being significant. All results can be interpreted without exceptions if the two hoarseness diagram coordinates are taken to reflect the vibrational irregularity of the voice-generation mechanisms on the one side and the degree of closure of the vibrating structures on the other side. The hoarseness diagram and its underlying algorithms are thus shown to constitute a useful approach to acoustic voice analysis in research and clinical practice. The tests themselves demonstrate several application possibilities, including the quantitative monitoring of individual voices.     

Costs of the treatment of leg ulcers: initiating a quality assurance process

Reports on a study which aimed to initiate a quality assurance process among health care personnel in Sweden. An epidemiological survey concerning treatment of leg ulcers in a defined region in Sweden was conducted and the costs of treating leg ulcers at different levels of care were analysed. The epidemiological survey provided the data necessary to calculate the socio-economic costs for the treatment of leg ulcers. The weekly cost was found to be about 24 times higher for hospital inpatients than it was for patients treated at home. The quality assurance process has continued through an interdisciplinary regional consensus conference and the establishment of a consensus programme in the region, with targets and general suggestions for the care and treatment of leg ulcers. To maintain high quality in leg ulcer treatment in the region, an interdisciplinary reference group has been established with members from different clinics at the hospital and members from the primary health care.     

No association between secretor status of ABO blood group antigens and juvenile periodontitis

The aim of this study was to determine the association between secretor status of ABO blood group antigens and localized juvenile periodontitis (LJP). Forty-three patients with LJP (mean age 20.8 years) diagnosed according to Baer's criteria were selected. Thirty two periodontally healthy normal subjects (mean age 24.7 years) were use as control. Samples of blood and saliva were collected from patients and from control subjects. ABO blood group was determined by agglutination of erythrocytes with appropriate antisera. Determination of soluble ABO antigens in saliva was made by the haemagglutination inhibition assay. Subjects with O blood group were most frequent in both groups. The distribution of blood groups, and secretor and non-secretor status of ABO group antigens in LJP patients and control subjects was not significant. The results provide support for the hypothesis that there is no association between non-secretor status and LJP.