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Tadahiro Takada - One of the best experts on this subject based on the ideXlab platform.
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Prognostic factors of acute Cholangitis in cases managed using the Tokyo Guidelines
Journal of Hepato-Biliary-Pancreatic Sciences, 2012Co-Authors: Toshio Tsuyuguchi, Harutoshi Sugiyama, Yuji Sakai, Takao Nishikawa, Osamu Yokosuka, Toshihiko Mayumi, Seiki Kiriyama, Masamichi Yokoe, Tadahiro TakadaAbstract:Background/purpose In 2007, the Tokyo Guidelines (TG07) working group established diagnostic criteria for assessment of the severity of acute Cholangitis. This study aimed to analyze outcomes and identify predictors of mortality in patients with acute Cholangitis managed according to the TG07. Methods In this study, 215 consecutive cases of acute Cholangitis were reviewed. Risk factors associated with mortality or refractory Cholangitis, which is defined on the basis of prolonged hospitalization (>28 days) or disease resulting in fatality, were examined using multivariate logistic regression analysis. Results There were 52, 133, and 30 cases of mild, moderate, and severe Cholangitis, respectively. The overall mortality rate was 4.2 % (9/215). Mortality rates in patients with mild, moderate, and severe Cholangitis were 0, 2.3, and 20.0 %, respectively (moderate vs. severe, p = 0.001). Multivariate analysis showed that serum albumin levels ≤2.8 g/dl and PT-INR >1.5 were significant predictors of mortality. There were 57 patients (26.5 %) with refractory Cholangitis. Multivariate analysis showed that serum albumin level ≤2.8 g/dl, PT-INR >1.5, etiology and inpatient status were significant predictors of refractory Cholangitis. Conclusions The TG07 severity assessment criteria for acute Cholangitis were significantly predictive of mortality. Hypoalbuminemia is an important risk factor in addition to organ dysfunction.
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diagnostic criteria and severity assessment of acute cholecystitis tokyo guidelines
Journal of Hepato-biliary-pancreatic Surgery, 2007Co-Authors: Keita Wada, Tadahiro Takada, Henry A. Pitt, Toshihiko Mayumi, Yoshifumi Kawarada, Yuji Nimura, Fumihiko Miura, Masahiro Yoshida, Steven M Strasberg, Thomas R GadaczAbstract:Because acute Cholangitis sometimes rapidly progresses to a severe form accompanied by organ dysfunction, caused by the systemic inflammatory response syndrome (SIRS) and/or sepsis, prompt diagnosis and severity assessment are necessary for appropriate management, including intensive care with organ support and urgent biliary drainage in addition to medical treatment. However, because there have been no standard criteria for the diagnosis and severity assessment of acute Cholangitis, practical clinical guidelines have never been established. The aim of this part of the Tokyo Guidelines is to propose new criteria for the diagnosis and severity assessment of acute Cholangitis based on a systematic review of the literature and the consensus of experts reached at the International Consensus Meeting held in Tokyo 2006. Acute Cholangitis can be diagnosed if the clinical manifestations of Charcot’s triad, i.e., fever and/or chills, abdominal pain (right upper quadrant or epigastric), and jaundice are present. When not all of the components of the triad are present, then a definite diagnosis can be made if laboratory data and imaging findings supporting the evidence of inflammation and biliary obstruction are obtained. The severity of acute Cholangitis can be classified into three grades, mild (grade I), moderate (grade II), and severe (grade III), on the basis of two clinical factors, the onset of organ dysfunction and the response to the initial medical treatment. “Severe (grade III)” acute Cholangitis is defined as acute Cholangitis accompanied by at least one new-onset organ dysfunction. “Moderate (grade II)” acute Cholangitis is defined as acute Cholangitis that is unaccompanied by organ dysfunction, but that does not respond to the initial medical treatment, with the clinical manifestations and/or laboratory data not improved. “Mild (grade I)” acute Cholangitis is defined as acute Cholangitis that responds to the initial medical treatment, with the clinical findings improved.
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Pathophysiologic mechanisms in patients with Cholangitis or obstructive jaundice: Results of a cholangiographic study
Journal of Hepato-Biliary-Pancreatic Surgery, 1996Co-Authors: Tadahiro Takada, Hideki Yasuda, Fujio HanyuAbstract:Bacterial reflux from the biliary tract to the systemic circulation is considered to be the primary etiologic factor in bacteremia and the development of sepsis. However, as the pathophysiologic features of the biliary tract that may promote such a reflux of biliary bacteria remain unclear, we investigated, using direct cholangiography, the pathophysiologic relationship between the intrahepatic bile ducts and biliary reflux into the systemic circulation after the percutaneous infusion of a contrast material containing indocyanine green (ICG) into the circulating blood. The subjects were 19 patients who underwent percutaneous transhepatic cholangiography with drainage to treat either a biliary infection or obstructive jaundice, an 8 post-T-tube control patients with normal biliary drainage. The relationship between the biliary tract pressure and ICG reflux during cholangiography was also analyzed. An ICG reflux was observed in all 19 patients who had undergone percutaneous transhepatic cholangiography with drainage and in 2 of the 8 control patients. In all patients who showed positive ICG reflux, this occurred when the biliary pressure increased to 25cm H_2O. An ICG reflux was seen in the 16 patients with a positive bile culture, and in 7 of 13 patients with a negative bile culture. When we analyzed ICG reflux in relation to the morphology of the intrahepatic bile duct, we found that all 4 patients who had cholangitic hepatic abscesses also exhibited higher ICG reflux concentrations and the clinical symptoms of Cholangitis. Radiologically, all 7 patients with Cholangitis demonstrated many small intrahepatic branches, and they exhibited moderate ICG refluxes, whereas the 6 patients who had obstructive jaundice but no Cholangitis had fewer ICG refluxes and no clinical symptoms. This study demonstrated two possible pathophysiological routes for biliary reflux: (1) via cholangitic hepatic abscesses, with entry of the bacteria directly into the circulating blood, or (2) via the small intrahepatic biliary branches, in which entry of bacteria into the systemic circulation occurs through the cholangioles.
Nicholas F. Larusso - One of the best experts on this subject based on the ideXlab platform.
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bacterial Cholangitis in autosomal dominant polycystic kidney and liver disease
Mayo Clinic Proceedings: Innovations Quality & Outcomes, 2019Co-Authors: William P Martin, Nicholas F. Larusso, Lisa E Vaughan, Kotaro Yoshida, Naoki Takahashi, Marie E Edwards, Andrew Metzger, Sarah R Senum, Tetyana V Masyuk, Matthew D GriffinAbstract:Abstract Objective To describe first episodes of bacterial Cholangitis complicating autosomal dominant polycystic kidney disease (ADPKD) and autosomal dominant polycystic liver disease (ADPLD) and to identify risk factors for Cholangitis episodes among patients with ADPKD-associated polycystic liver disease (PLD). Patients and Methods We searched the electronic medical records at our tertiary referral center for episodes of Cholangitis in patients with ADPKD or ADPLD from January 1, 1996, through June 30, 2017. Cases were categorized as suspected or definite Cholangitis by expert review. Clinical, laboratory, and radiologic data were manually abstracted. A nested case-control study was conducted to investigate risk factors for Cholangitis in patients with ADPKD. Results We identified 29 cases of definite or suspected Cholangitis complicating PLD (24 with ADPKD-associated PLD and 5 with ADPLD). Among patients with definite Cholangitis in ADPKD-associated PLD (n=19) vs ADPLD (n=4), the mean ± SD age was 62.4±12.2 vs 55.1±8.6 years, and 9 (47.4%) vs 0 (0%), respectively, were male. The odds of gallstones (odds ratio [OR], 21.6; 95% CI, 3.17-927; P Conclusion Gallstones, prior cholecystectomy, duodenal diverticulosis, type 2 diabetes mellitus, prior endoscopic retrograde cholangiopancreatography, and prior kidney transplant constituted risk factors for Cholangitis among patients with ADPKD-associated PLD.
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Bacterial Cholangitis in Autosomal Dominant Polycystic Kidney and Liver Disease
Elsevier, 2019Co-Authors: William Martin, Mbchb P. Msc, Nicholas F. Larusso, Lisa E Vaughan, Naoki Takahashi, Andrew Metzger, Tetyana V Masyuk, Md ,kotaro Yoshida, Marie Edwards E. Bse, Bs ,sarah R. Senum, Matthew Griffin, Mbchb D. DmedAbstract:Objective: To describe first episodes of bacterial Cholangitis complicating autosomal dominant polycystic kidney disease (ADPKD) and autosomal dominant polycystic liver disease (ADPLD) and to identify risk factors for Cholangitis episodes among patients with ADPKD-associated polycystic liver disease (PLD). Patients and Methods: We searched the electronic medical records at our tertiary referral center for episodes of Cholangitis in patients with ADPKD or ADPLD from January 1, 1996, through June 30, 2017. Cases were categorized as suspected or definite Cholangitis by expert review. Clinical, laboratory, and radiologic data were manually abstracted. A nested case-control study was conducted to investigate risk factors for Cholangitis in patients with ADPKD. Results: We identified 29 cases of definite or suspected Cholangitis complicating PLD (24 with ADPKD-associated PLD and 5 with ADPLD). Among patients with definite Cholangitis in ADPKD-associated PLD (n=19) vs ADPLD (n=4), the mean ± SD age was 62.4±12.2 vs 55.1±8.6 years, and 9 (47.4%) vs 0 (0%), respectively, were male. The odds of gallstones (odds ratio [OR], 21.6; 95% CI, 3.17-927; P
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Are patients with cirrhotic stage primary sclerosing Cholangitis at risk for the development of hepatocellular cancer
Journal of hepatology, 1997Co-Authors: Denise M. Harnois, Nicholas F. Larusso, Jurgen Ludwig, Gregory J. Gores, Jeffery L. Steers, Russell H. WiesnerAbstract:Abstract Background/Aims: The risk of cholangiocarcinoma in primary sclerosing Cholangitis is widely recognized to be 8–30%, whereas the risk of acquiring hepatocellular carcinoma in primary sclerosing Cholangitis is unknown. As in other chronic liver diseases, the presence of hepatocellular carcinoma in a patient with primary sclerosing Cholangitis undergoing evaluation for orthotopic liver transplantation would clearly impact on the candidacy, diagnostic evaluation, and alternative treatment options. Thus, the aim of our study was to determine the prevalence of hepatocellular carcinoma in patient undergoing liver transplantation for primary sclerosing Cholangitis. Methods: The records of the 520 patients undergoing orthotopic liver transplantation our institution between 1985 and May 1995 were reviewed. Of the 134 patients with primary sclerosing Cholangitis, three (2%) had hepatocellular carcinoma. In the 386 patients without primary sclerosing Cholangitis under-going orthotopic liver transplantation, 22 (6%) had hepatocellular carcinoma. Results: Neither the duration of primary sclerosing Cholangitis (range 7–23 years) nor the presence of ulcerative colitis (two of three patients) distinguished those patients with primary sclerosing Cholangitis plus hepatocellular carcinoma from those with primary sclerosing Cholangitis alone. None of the three patients with primary sclerosing Cholangitis plus hepatocellular carcinoma had evidence for hepatitis B or C, alpha-1-antitrypsin deficiency, or hemochromatosis. None of the tumors was of the fibrolamellar variety of hepatocellular carcinoma. Conclusions: The prevalence of hepatocellular carcinoma in patients with primary sclerosing Cholangitis undergoing orthotopic liver transplantation is 2%. These data suggest that patients with advanced cirrhotic-stage primary sclerosing Cholangitis are at increased risk for developing hepatocellular carcinoma and should be screened for hepatocellular carcinoma as well as for cholangiocarcinoma prior to orthotopic liver transplantation.
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Cholangiocarcinoma complicating primary sclerosing Cholangitis.
Annals of surgery, 1991Co-Authors: Charles B. Rosen, David M. Nagorney, Russell H. Wiesner, Robert J. Coffey, Nicholas F. LarussoAbstract:Cholangiocarcinoma is more likely to develop in patients with primary sclerosing Cholangitis. Our aims were to describe the clinical presentation, course, and management of patients afflicted with both cholangiocarcinoma and primary sclerosing Cholangitis and to estimate the prevalence of cholangiocarcinoma in patients with primary sclerosing Cholangitis. A retrospective analysis was conducted of 30 patients with both primary sclerosing Cholangitis and cholangiocarcinoma managed at our institution during an 8-year period. Development of cholangiocarcinoma was heralded by rapid clinical deterioration with jaundice, weight loss, and abdominal discomfort. Cholangiocarcinoma complicating primary sclerosing Cholangitis often was detected at an advanced tumor stage, which precluded effective therapy, and overall median survival was 5 months. Earlier recognition and treatment of cholangiocarcinoma in such patients will be necessary to increase survival rates. Seventy patients with primary sclerosing Cholangitis were followed prospectively in a clinical trial of medical therapy for an average of 30 months. Twelve patients died and five were found at autopsy to have cholangiocarcinoma. The potential for cholangiocarcinoma to develop in patients with primary sclerosing Cholangitis may indicate that liver transplantation should be considered earlier in the course of the disease.
Giorgina Mieli-vergani - One of the best experts on this subject based on the ideXlab platform.
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Sclerosing Cholangitis in the paediatric patient.
Best practice & research. Clinical gastroenterology, 2001Co-Authors: Giorgina Mieli-vergani, Diego VerganiAbstract:Sclerosing Cholangitis in childhood is a heterogeneous condition, which has different aetiologies. Sclerosing Cholangitis may be inherited and diagnosed in the neonatal period (neonatal sclerosing Cholangitis); it may present later with features of autoimmunity (autoimmune sclerosing Cholangitis); or it may be associated with a variety of disorders, including Langerhans cell histiocytosis, immunodeficiency, psoriasis, cystic fibrosis, reticulum cell sarcoma and sickle cell anaemia. In contrast to the experience in adult patients, sclerosing Cholangitis occurring as an individual disease (primary sclerosing Cholangitis) is rare. The initiating events and possible pathogenic mechanisms differ in the various forms of sclerosing Cholangitis and are still obscure. Treatment and prognosis depend on the type of sclerosing Cholangitis present.
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Antineutrophil antibody: a test for autoimmune primary sclerosing Cholangitis in childhood?
Gut, 1993Co-Authors: Roger W. Chapman, Giorgina Mieli-vergani, P. Cheeseman, C. P. J. Charlton, J. A. Walker-smith, Kenneth A. FlemingAbstract:The detection of an antineutrophil antibody which is highly sensitive and specific for adult primary sclerosing Cholangitis using indirect immunoalkaline phosphatase has been previously described. In this study, the diagnostic potential of this method in childhood primary sclerosing Cholangitis is described. A range of 72 blinded children's sera (36 boys), aged six months to 21 years (10 primary sclerosing Cholangitis, eight autoimmune chronic active hepatitis, 10 alpha-1 antitrypsin deficiency, 12 extrahepatic bile duct atresia, 11 ulcerative colitis and 21 normal subjects) was assayed. Eight of the 10 primary sclerosing Cholangitis patients were correctly identified. Three patients with chronic active hepatitis also showed the characteristic primary sclerosing Cholangitis pattern of staining. No ulcerative colitis patients or any other patients showed this pattern of staining. All normal subjects were negative. As in adult primary sclerosing Cholangitis, there is a specific antineutrophil antibody in childhood primary sclerosing Cholangitis and this provides further evidence towards an autoimmune aetiology of this condition. The test may have diagnostic potential.
Walter A. Koltun - One of the best experts on this subject based on the ideXlab platform.
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Surgical management of ulcerative colitis in the presence of primary sclerosing Cholangitis.
Diseases of the colon and rectum, 2003Co-Authors: Lisa S. Poritz, Walter A. KoltunAbstract:INTRODUCTION: The surgical management of ulcerative colitis in the patient with primary sclerosing Cholangitis is controversial. METHODS: This study was designed as a retrospective chart review of all patients with primary sclerosing Cholangitis who were surgically treated for ulcerative colitis. RESULTS: Sixteen patients with primary sclerosing Cholangitis and ulcerative colitis were identified. The indication for ulcerative colitis surgery was dysplasia in 7 patients (44 percent), cancer in 2 (13 percent), intractability in 4 (25 percent), and unknown in 1. Final colon pathology demonstrated cancer in three patients and dysplasia in four. Two patients had biliary cancer discovered at the time of orthotopic liver transplantation. Thirteen patients were known to have primary sclerosing Cholangitis when they underwent surgery for ulcerative colitis; two patients with severe primary sclerosing Cholangitis underwent simultaneous orthotopic liver transplantation/total abdominal colectomy and did well with subsequent ileal pouch reconstruction. Two patients had orthotopic liver transplantation first and then ileal pouch-anal anastomosis (1 patient) or total abdominal colectomy (1 patient) and did well. Seven patients had well-controlled primary sclerosing Cholangitis on medication and underwent ileal pouch-anal anastomosis or total abdominal proctocolectomy without significant hepatic compromise. One patient with moderate primary sclerosing Cholangitis underwent ileorectal anastomosis and had severe liver failure postoperatively but survived. Another patient with worsening primary sclerosing Cholangitis after total abdominal colectomy has since developed persistent bleeding from peristomal varices. CONCLUSIONS: The overall cancer/premalignant lesion rate was high (50 percent in this study) in patients with primary sclerosing Cholangitis and ulcerative colitis. Complications associated with the surgical management of ulcerative colitis are largely dictated by the degree of liver disease present at the time of surgery. Patients with significant primary sclerosing Cholangitis that requires colectomy can undergo simultaneous orthotopic liver transplantation/total abdominal colectomy and then be candidates for subsequent ileal pouch-anal anastomosis reconstruction once liver function has improved. Patients with well-controlled primary sclerosing Cholangitis can undergo ileal pouch-anal anastomosis surgery safely.
Diego Vergani - One of the best experts on this subject based on the ideXlab platform.
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Sclerosing Cholangitis in the paediatric patient.
Best practice & research. Clinical gastroenterology, 2001Co-Authors: Giorgina Mieli-vergani, Diego VerganiAbstract:Sclerosing Cholangitis in childhood is a heterogeneous condition, which has different aetiologies. Sclerosing Cholangitis may be inherited and diagnosed in the neonatal period (neonatal sclerosing Cholangitis); it may present later with features of autoimmunity (autoimmune sclerosing Cholangitis); or it may be associated with a variety of disorders, including Langerhans cell histiocytosis, immunodeficiency, psoriasis, cystic fibrosis, reticulum cell sarcoma and sickle cell anaemia. In contrast to the experience in adult patients, sclerosing Cholangitis occurring as an individual disease (primary sclerosing Cholangitis) is rare. The initiating events and possible pathogenic mechanisms differ in the various forms of sclerosing Cholangitis and are still obscure. Treatment and prognosis depend on the type of sclerosing Cholangitis present.
