ABSTRACT
The results of surgical treatment of 137 patients, suffering obturation jaundice of non-tumoral etiology, were analyzed. In all the patients the cause of obturation jaundice was choledocholithiasis. Roncoleukin was infused intravenously additionally in a complex of therapy. A degree of hepatic dysfunction was determined, taking into account the cholestasis markers. In 23 patients purulent cholangitis have occurred on background of obturation jaundice. Concentration of cytokins TNF-α, IFN-γ, IL-1, IL-2, IL-4, IL-6, IL-10 in sera were determined, using immunoassay analysis. The cytokins dysbalance severity preoperatively and dynamics of its changes have depended upon the hepatic dysbalance degree and presence of purulent cholangitis; a dysbalance is deeper, when the hepatic dysfunction is higher. Application of pathogenetically substantiated purposeful cytokinotherapy, including roncoleukin, have promoted the cytokins dysbalance elimination and improvement of the patients treatment results.
Subject(s)
Cholangitis/drug therapy , Choledocholithiasis/drug therapy , Cholestasis/drug therapy , Immunologic Factors/therapeutic use , Interleukin-2/therapeutic use , Jaundice, Obstructive/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Biomarkers/blood , Cholangitis/immunology , Cholangitis/pathology , Cholangitis/surgery , Choledocholithiasis/immunology , Choledocholithiasis/pathology , Choledocholithiasis/surgery , Cholestasis/immunology , Cholestasis/pathology , Cholestasis/surgery , Common Bile Duct/drug effects , Common Bile Duct/immunology , Common Bile Duct/pathology , Common Bile Duct/surgery , Female , Humans , Injections, Intravenous , Jaundice, Obstructive/immunology , Jaundice, Obstructive/pathology , Jaundice, Obstructive/surgery , Liver/drug effects , Liver/immunology , Liver/pathology , Liver/surgery , Male , Middle Aged , Recombinant Proteins/therapeutic use , Th1-Th2 Balance/drug effectsABSTRACT
Efficacy of the ozonotherapy application as an important component of complex treatment in purulent cholangitis (PCH) was studied. In choledocholithiasis (without infectioning of bile) ozonotherapy may be prescribed as additional component at complex treatment. In PCH ozonotherapy application have promoted the improvement of laboratory indices in 6.6 times, comparing with such, occurring after basic therapy.
Subject(s)
Anti-Inflammatory Agents/pharmacology , Cholangitis/drug therapy , Choledocholithiasis/drug therapy , Jaundice, Obstructive/drug therapy , Ozone/pharmacology , Suppuration/drug therapy , Alanine Transaminase/blood , Alkaline Phosphatase/blood , Animals , Animals, Outbred Strains , Aspartate Aminotransferases/blood , B-Lymphocytes/drug effects , B-Lymphocytes/immunology , B-Lymphocytes/pathology , Bile/drug effects , Bile/microbiology , Bile Ducts/drug effects , Bile Ducts/immunology , Bile Ducts/microbiology , Bile Ducts/pathology , Bilirubin/blood , Candida albicans/drug effects , Candida albicans/growth & development , Candida albicans/isolation & purification , Cholangitis/immunology , Cholangitis/microbiology , Cholangitis/pathology , Choledocholithiasis/immunology , Choledocholithiasis/microbiology , Choledocholithiasis/pathology , Dogs , Escherichia coli/drug effects , Escherichia coli/growth & development , Escherichia coli/isolation & purification , Immunoglobulin A/blood , Immunoglobulin G/blood , Jaundice, Obstructive/immunology , Jaundice, Obstructive/microbiology , Jaundice, Obstructive/pathology , Staphylococcus aureus/drug effects , Staphylococcus aureus/growth & development , Staphylococcus aureus/isolation & purification , Suppuration/immunology , Suppuration/microbiology , Suppuration/pathology , T-Lymphocytes/drug effects , T-Lymphocytes/immunology , T-Lymphocytes/pathologyABSTRACT
BACKGROUND AND STUDY AIMS: Immunoglobulin G4 (IgG4)-associated cholangitis (IAC) is difficult to diagnose because on cholangiography the associated biliary tract strictures cannot be differentiated from cholangiocarcinoma or primary sclerosing cholangitis (PSC). Serum IgG4 levels show a low sensitivity and specificity and are unreliable, particularly in patients with related diseases such as PSC. As IAC takes place at the biliary epithelium, we hypothesized that IgG4 measurement in bile may have higher sensitivity compared with serum. METHODS: Bile and serum samples were collected during cholangiography in 67 patients, including 23 patients with PSC, 25 with cholangiocarcinoma, 14 with choledocholithiasis, and five with IAC. IgG4 was measured in both bile and serum. RESULTS: Bile IgG4 levels were markedly elevated in patients with IAC compared with patients with other biliary disorders. Whereas elevated serum IgG4 levels were found both in patients with PSC and IAC, biliary IgG4 levels were only increased in patients with IAC. CONCLUSIONS: The study demonstrates that bile IgG4 measurement is possible and may help to distinguish IAC from other diseases.
Subject(s)
Bile Duct Neoplasms/diagnosis , Bile Ducts, Intrahepatic , Bile/chemistry , Cholangiocarcinoma/diagnosis , Cholangitis/diagnosis , Immunoglobulin G/analysis , Adult , Aged , Aged, 80 and over , Area Under Curve , Bile Duct Neoplasms/immunology , Cholangiocarcinoma/immunology , Cholangitis/immunology , Cholangitis/pathology , Cholangitis, Sclerosing/diagnosis , Cholangitis, Sclerosing/immunology , Choledocholithiasis/diagnosis , Choledocholithiasis/immunology , Diagnosis, Differential , Female , Humans , Immunoglobulin G/blood , Male , Middle Aged , Prospective Studies , Sensitivity and Specificity , Young AdultABSTRACT
Autoimmune pancreatitis (AIP) is defined histologically by periductal and interacinar lymphocytic infiltration. Immunohistochemically, the majority of these lymphocytes are identified as T cells. Epithelial HLA-DR antigen expression was also described as a marker of autoimmunity in this type of chronic pancreatitis. We report 2 cases, a 56-year-old man and a 29-year-old woman, with AIP associated with immune-mediated inflammation of the main duodenal papilla (MDP). Serologically, antinuclear antibody positivity was detected in the male patient. The female patient, treated medically for ulcerative proctitis, had no serological evidence of autoimmune disease. Macroscopic papillitis was present only in the male patient, and endoscopic biopsy samples were taken from this swollen MDP. Since we could not exclude malignancy, a pancreatic head resection was performed in both patients. The histologic and immunohistochemical studies of the resected specimens showed periductal T-lymphocytic infiltration in the pancreatic and papillary tissues. Furthermore, HLA-DR-antigen expression was also demonstrated in epithelial cells of the pancreas and MDP. The immunohistological features of endoscopic biopsy samples from the swollen MDP were identical as in the surgically resected specimens. Immune-mediated inflammation of the MDP may be associated with AIP.
