Viszeralmedizin最新文献

{"title":"Acute and Chronic Inflammation of the Biliary System.","authors":"Vincent Zimmer, Matthias Glanemann, Frank Lammert","doi":"10.1159/000434668","DOIUrl":"https://doi.org/10.1159/000434668","url":null,"abstract":"Acute and chronic inflammatory biliary tract disease has ever since been in the vanguard of gastrointestinal medicine at the interface between surgical and medical care. Likewise, biliary system disorders demand the cooperation between high-volume specialized and community-based patient care, ranging from standard cholecystectomy over personalized assessment of bile duct strictures to liver transplantation for chronic cholestatic liver diseases. In this sense, inflammatory biliary diseases represent a timeless but vital topic forming the overarching theme of the current edition of VISZERALMEDIZIN to which we as Guest Editors warmly welcome you. \u0000 \u0000In this issue old acquaintances will be revisited and new ones be met – such as the emerging topic of the biliary mucosal barrier and the microbiome. This fascinating, novel topic, though still in its infancy, will be introduced by Verdier, Luedde and Sellge [1] from Aachen. Contrary to the paradigm of a sterile biliary milieu under healthy conditions, new data suggest a complex commensal colonization as well as specialized defence and tolerance mechanisms within the biliary system. The impact of this biliary mucosal barrier on chronic hepatobiliary diseases has to be substantiated further in the future. Schuld and Glanemann [2], Homburg, present a state-of-the-art update on the management of acute cholecystitis, representing one of the most common emergencies in visceral medicine. In contrast to the die-hards of hard rock still touring around the world, the recent ACDC trial has set a general standard of care with acute cholecystectomy being performed within the first 24 h after hospitalization that has been embraced and specified by interdisciplinary guidelines. Zimmer and Lammert [3] from Homburg present an update on the mostly endoscopic management of acute bacterial cholangitis and put adequate diagnosis including imaging microbiology and timing as well as modalities of biliary drainage into perspective. \u0000 \u0000Primary sclerosing cholangitis (PSC) as a chronic fibro-obliterative disease of the larger bile ducts is the remaining ‘black box’ of hepatology. For this highly cancer-prone disease of unknown aetiology, there are neither sufficient diagnostic tools nor treatment options available. Reasonable suggestions for patient care by experts in the field are presented by Ehlken and Schramm [4] from one of the centres providing excellent care for PSC in Hamburg. Remaining in the same topical corner, Kirchner and Ruemmele [5] from Regensburg have pioneered the emerging role of sclerosing cholangitis in critically ill patients (SC-CIP), representing a subgroup of secondary sclerosing cholangitis (SSC). Considering that full-blown SC-CIP tends to be progressive with patients requiring liver transplantation, the characterization of patient populations at particular risk represents a clinically relevant research topic. Besides SCC, immunoglobulin G4-associated cholangiopathy has attracted much attention in rec","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 3","pages":"153-4"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000434668","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34088776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute and Chronic Inflammation of the Biliary System.","authors":"Tim Lankisch Chair, Hüseyin Bektas, Alexander Dechêne, Hanno Ehlken, Gabriele I Kirchner, Hauke Lang, Christoph Schramm","doi":"10.1159/000434663","DOIUrl":"https://doi.org/10.1159/000434663","url":null,"abstract":"a Klinik fur Gastroenterologie, Hepatologie und Endokrinologie, Zentrum Innere Medizin, Medizinische Hochschule Hannover, Hanover, Germany, b Klinik fur Allgemein-, Viszeralund Transplantationschirurgie, Medizinische Hochschule Hannover, Hanover, Germany, c Klinik fur Gastroenterologie und Hepatologie, Universitatsklinikum Essen, Essen, Germany, d I. Medizinische Klinik und Poliklinik, Universitatsklinikum Hamburg-Eppendorf, Hamburg, Germany, e Klinik und Poliklinik fur Innere Medizin I, Universitatsklinikum Regensburg, Regensburg, Germany, f Klinik fur Allgemein-, Viszeralund Transplantationschirurgie, Universitatsmedizin Mainz, Mainz, Germany","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 3","pages":"200-3"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000434663","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34089742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limits of Surgical Resection for Bile Duct Cancer.","authors":"Fabian Bartsch,&nbsp;Stefan Heinrich,&nbsp;Hauke Lang","doi":"10.1159/000433482","DOIUrl":"https://doi.org/10.1159/000433482","url":null,"abstract":"<p><strong>Introduction: </strong>Perihilar cholangiocarcinoma is the most frequent cholangiocarcinoma and poses difficulties in preoperative evaluation. For its therapy, often major hepatic resections as well as resection and reconstruction of the hepatic artery or the portal vein are necessary. In the last decades, great advances were made in both the surgical procedures and the perioperative anesthetic management. In this article, we describe from our point of view which facts represent the limits for curative (R0) resection in perihilar cholangiocarcinoma.</p><p><strong>Methods: </strong>Retrospective data of a 6-year period (2008-2014) was collected in an SPSS 22 database and further analyzed with focus on the surgical approach and the postoperative as well as histological results.</p><p><strong>Results: </strong>Out of 96 patients in total we were able to intend a curative resection in 73 patients (76%). In 58/73 (79.5%) resections an R0 situation could be reached (R1 n = 14; R2 n = 1). 23 patients were irresectable because of peritoneal carcinosis (n = 8), broad infiltration of major blood vessels (n = 8), bilateral advanced tumor growth to the intrahepatic bile ducts (n = 3), infiltration of the complete liver hilum (n = 2), infiltration of the gallbladder (n = 1), and liver cirrhosis (n = 1). Patients with a T4 stadium were treated with curative intention twice, and in each case an R1 resection was achieved. Most patients with irresectable tumors can be suspected to have a T4 stadium as well. In a T3 situation (n = 6) we could establish five R0 resections and one R1 resection.</p><p><strong>Conclusion: </strong>The limit of surgical resection for bile duct cancer is the advanced tumor stage (T stadium). While in a T3 stadium an R0 resection is possible in most cases, we were not able to perform an R0 resection in a T4 stadium. From our point of view, early T stadium cannot usually be estimated through expanded diagnostics but only through surgical exploration.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 3","pages":"189-93"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000433482","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34089740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Should Cancer Surveillance in Primary Sclerosing Cholangitis Be Performed?","authors":"Hanno Ehlken,&nbsp;Christoph Schramm","doi":"10.1159/000431350","DOIUrl":"https://doi.org/10.1159/000431350","url":null,"abstract":"<p><strong>Background: </strong>Primary sclerosing cholangitis (PSC) is a chronic inflammatory disease affecting the intra- and extrahepatic bile duct system that can ultimately cause liver cirrhosis. Apart from the risk of progression to end-stage liver disease the prognosis of PSC is primarily determined by the risk to develop hepatobiliary or extrahepatic malignancies. A reasonable surveillance strategy for PSC patients must allow the detection of early cancer that will permit a potentially curative therapy.</p><p><strong>Methods: </strong>Current guidelines on malignancy within the context of PSC as well as the primary literature were reviewed for this article.</p><p><strong>Results: </strong>Here, we focus on a concise review of the three tumors most commonly associated with PSC: cholangiocellular carcinoma (CCA), gallbladder cancer, and colorectal carcinoma. For cancer surveillance in this patient group, endoscopy, cholangiography, cross-sectional imaging, and the use of serum tumor markers are principally available. Furthermore, for the diagnosis of CCA novel approaches were recently suggested to improve sensitivity and specificity to detect this malignancy.</p><p><strong>Conclusion: </strong>We review different aspects of cancer surveillance in patients with PSC. Since prospective data on the surveillance of malignant tumors is unavailable, we discuss a rational approach on how to perform cancer surveillance in patients with PSC.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 3","pages":"173-7"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000431350","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34089737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Bacterial Cholangitis.","authors":"Vincent Zimmer,&nbsp;Frank Lammert","doi":"10.1159/000430965","DOIUrl":"https://doi.org/10.1159/000430965","url":null,"abstract":"<p><strong>Background: </strong>Acute bacterial cholangitis for the most part owing to common bile duct stones is common in gastroenterology practice and represents a potentially life-threatening condition often characterized by fever, abdominal pain, and jaundice (Charcot's triad) as well as confusion and septic shock (Reynolds' pentad).</p><p><strong>Methods: </strong>This review is based on a systematic literature review in PubMed with the search items 'cholangitis' 'choledocholithiasis' 'gallstone disease' 'biliary infection', and 'biliary sepsis'.</p><p><strong>Results: </strong>Although most patients respond to empiric broad-spectrum antibiotic treatment, timely endoscopic biliary drainage depending on the severity of the disease is required to eliminate the underlying obstruction. Specific recommendations have been derived from the Tokyo guideline working group consensus 2006 and its update in 2013, albeit poorly evidence-based, providing a comprehensive overview of diagnosis, classification, risk stratification, and treatment algorithms in acute bacterial cholangitis.</p><p><strong>Conclusion: </strong>Prompt clinical recognition and accurate diagnostic workup including adequate laboratory assessment and (aetiology-oriented) imaging are critical steps in the management of cholangitis. Treatment is directed at the two major interrelated pathophysiologic components, i.e. bacterial infection (immediate antimicrobial therapy) and bile duct obstruction (biliary drainage). As for the latter, transpapillary endoscopic drainage by stent or nasobiliary drain and/or same-session bile duct clearance, depending on individual disease severity, represent first-line treatment approaches.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 3","pages":"166-72"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000430965","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34088779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update on Sclerosing Cholangitis in Critically Ill Patients.","authors":"Gabriele I Kirchner,&nbsp;Petra Rümmele","doi":"10.1159/000431031","DOIUrl":"https://doi.org/10.1159/000431031","url":null,"abstract":"<p><strong>Background: </strong>‛Sclerosing cholangitis in critically ill patients' (SC-CIP) is a cholestatic liver disease of unknown etiology and represents the most prevalent form of secondary sclerosing cholangitis.</p><p><strong>Methods: </strong>This overview is based on a systematic review of the literature searching for 'secondary sclerosing cholangitis', 'SC-CIP', 'cast syndrome', and 'ischemic cholangitis' in the database PubMed.</p><p><strong>Results: </strong>SC-CIP can develop in patients with sepsis and acute respiratory distress syndrome during a long-term intensive care unit (ICU) treatment. It is a rare cholestatic liver disease with a rapid progression to liver cirrhosis and hepatic failure. SC-CIP is initiated by an ischemic injury to the biliary tree with subsequent stenoses of biliary ducts, biliary casts, and infections, often with multi-resistant bacteria. Mechanical ventilation with high positive end-expiratory pressure, prone positioning, and a higher volume of intraperitoneal fat have been proposed as risk factors for developing SC-CIP. Patients with SC-CIP have a poor prognosis, with liver transplantation (LT) being the only curative treatment option.</p><p><strong>Conclusion: </strong>In patients with sepsis, long-term ICU therapy and ongoing cholestasis SC-CIP must be excluded by endoscopic retrograde cholangiopancreatography. Due to the poor prognosis, the option of LT should be evaluated in all patients with SC-CIP.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 3","pages":"178-84"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000431031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34089738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biliary Mucosal Barrier and Microbiome.","authors":"Julien Verdier,&nbsp;Tom Luedde,&nbsp;Gernot Sellge","doi":"10.1159/000431071","DOIUrl":"https://doi.org/10.1159/000431071","url":null,"abstract":"<p><strong>Background: </strong>The biliary system is in continuous contact with the complex microbiota of the intestine. Microbial products have recently been proposed as potential triggers for biliary diseases.</p><p><strong>Methods: </strong>The aim of this review is to provide a summary of the current knowledge regarding the role of the biliary and intestinal microbiome in biliary inflammatory diseases.</p><p><strong>Results: </strong>Previously, it was suggested that the healthy biliary system is a sterile organ, while acute cholangitis and cholecystitis may occur from ascending infections. Although non-inflammatory biliary colonization by certain bacteria such as Salmonella spp. has been already recognized since several decades, human and animal studies indicated only very recently that the gallbladder harbors a complex microbiota also under non-pathologic conditions. Novel findings suggested that - similar to the situation in the intestine - the biliary mucosa features a chemical, mechanical, and immunological barrier, ensuring immunological tolerance against commensals. However, microbial triggers might influence acute and chronic inflammatory disease of the biliary system and the whole liver.</p><p><strong>Conclusion: </strong>Although yet undefined, dysbiosis of the biliary or intestinal microbiota rather than a single microorganism may influence disease progression.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 3","pages":"156-61"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000431071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34088777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Diagnose Immunoglobulin G4-Associated Cholangitis: The Jack-of-All-Trades in the Biliary Tract.","authors":"Lowiek M Hubers,&nbsp;Ulrich Beuers","doi":"10.1159/000431028","DOIUrl":"https://doi.org/10.1159/000431028","url":null,"abstract":"<p><strong>Background: </strong>Immunoglobulin (Ig) G4-associated cholangitis (IAC) is an inflammatory disorder of the biliary tract displaying characteristic features of IgG4-related disease (IgG4-RD): elevation of IgG4 serum levels, infiltration of IgG4+ plasma cells in the affected tissue, and good response to immunosuppressive treatment.</p><p><strong>Methods and results: </strong>The clinical presentation of IAC is often misleading, mimicking other diseases of the biliary tract such as cholangiocarcinoma or primary and secondary sclerosing cholangitis. The HISORt criteria form the cornerstone in the diagnosis of IAC, combining histopathological (H), imaging (I), and serological (S) features including serum IgG4, other organ manifestations (O) of IgG4-RD and response to treatment (Rt). The accuracy of the HISORt criteria is limited. Novel diagnostic approaches are under evaluation.</p><p><strong>Conclusion: </strong>More accurate biomarkers are needed to correctly diagnose IgG4-RD and prevent misdiagnoses and unnecessary therapeutic interventions.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 3","pages":"185-8"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000431028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34089739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Transplantation for Patients with Cholestatic Liver Diseases.","authors":"Wenzel Schöning,&nbsp;Maximilian Schmeding,&nbsp;Florian Ulmer,&nbsp;Anne Andert,&nbsp;Ulf Neumann","doi":"10.1159/000431017","DOIUrl":"https://doi.org/10.1159/000431017","url":null,"abstract":"<p><strong>Background: </strong>Cholestatic liver diseases (CD) account for 11% of all liver transplantations (LT) in the Eurotransplant region. Despite the excellent long-term outcome that is considerably superior to all other indications for LT, transplant surgeons and physicians face nowadays - in the era of MELD (Model of End-Stage Liver Disease)-based allocation, organ shortage, and extended allocation policies - more and more challenges in this patient cohort, especially since there is no curative medical treatment for these entities.</p><p><strong>Methods: </strong>Based on a literature review and personal experience in liver transplantation for CD, we show the status quo of indication, allocation, and outcome as well as potential strategies to overcome long waiting times and organ shortage.</p><p><strong>Results: </strong>Concerning graft and patient survival, CD remain the 'best indications' for LT. Since the implementation of MELD-based allocation results in patients with primary sclerosing cholangitis (PSC) could be preserved on good levels only by the implementation and revision of standard exceptions. Recurrence of PSC after LT remains a challenge for transplant surgeons and physicians. New data has kindled a debate on biliary reconstruction in LT for PSC. Promising data on living donor LT motivate to push the boundaries in this direction.</p><p><strong>Conclusion: </strong>CD are excellent indications for liver transplantation since excellent long-term outcomes are achievable when the transplant is performed at the right time. The decisions concerning evaluation, listing, and allocation should be made by an interdisciplinary team of gastroenterologists and transplant surgeons.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 3","pages":"194-8"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000431017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34089741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Spontaneous Hepatic Rupture on Top of HELLP Syndrome: Case Report and Review of the Literature.","authors":"Achim Troja,&nbsp;Ahmed Abdou,&nbsp;Christiane Rapp,&nbsp;Swantje Wienand,&nbsp;Eduard Malik,&nbsp;Hans-Rudolf Raab","doi":"10.1159/000376601","DOIUrl":"https://doi.org/10.1159/000376601","url":null,"abstract":"<p><strong>Introduction: </strong>We report the case of a patient with antepartum HELLP syndrome and simultaneous rupture of the right liver lobe. An emergency caesarean section was performed and the liver rupture was managed surgically via perihepatic packing. The mother and her child recovered well and were discharged 19 days after admission.</p><p><strong>Case report: </strong>We describe a case report and review the literature. Based on our own experience and the most common clinical presentations of such patients, we were able to establish an algorithm for managing such cases.</p><p><strong>Conclusion: </strong>An association between liver rupture and HELLP syndrome is rare but was previously described in several case reports. In pregnant women with HELLP syndrome and acute onset abdominal pain, a potential spontaneous hepatic rupture should be taken into consideration.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 3","pages":"205-8"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000376601","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34089743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}