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Background/Aims Small duct primary sclerosing cholangitis is a rare clinical condition that may remain unrecognized. Diagnosis rests on clinical, biochemical, and histologic features consistent with primary sclerosing cholangitis but with normal cholangiogram findings. We report here a case of small duct primary sclerosing cholangitis in a patient who presented with jaundice. Methods Clinical Presentation. A 22-year-old Filipino gentleman with no known comorbids came in due to a 2-week history of jaundice with elevated transaminases, bilirubin and alkaline phosphatase. No other symptoms were noted. Hepatitis markers were all normal. Physical examination was unremarkable except for jaundice. Results Management. Magnetic resonance cholangiopancreatography was normal with no evidence of dilated intra- and extrahepatic ducts. Liver biopsy showed intrahepatic cholestasis with periductal fibrosis. Ursodeoxycholic acid was started which showed significant decrease in jaundice with improvement in biochemistries. Conclusions Recommendation. Small duct primary sclerosing cholangitis appears to have a more favorable prognosis than classic primary sclerosing cholangitis. However, further studies with long-term follow up are recommended to determine disease progression. [ABSTRACT FROM AUTHOR]

Background/Aims: This study was aimed at determining the factors associated with the development of benign biliary stricture (BBS) in patients who had sustained a bile duct injury (BDI) at cholecystectomy and developed bile leaks. Methods: A retrospective analysis of 214 patients with BDI who were referred to our center between January 1989 and December 2009 was done. Results: One hundred fifty-three (71%) patients developed BBS (group I), and 61 (29%) were normal (group II). By univariate analysis, female gender (p=0.02), open cholecystectomy as the index operation (p=0.0001), delay in the referral from identification of injury (p=0.04), persistence of an external biliary fistula (EBF) beyond 4 weeks (p=0.0001), EBF output >400 mL (p=0.01), presence of jaundice (p=0.0001), raised serum total bilirubin level (p=0.0001), raised serum alkaline phosphatase level (p=0.0001), and complete BDI (p=0.0001) were associated with the development of BBS. Furthermore, open cholecystectomy as the index operation (p=0.04), delayed referral (p=0.02), persistent EBF (p=0.03), and complete BDI (p=0.001) were found to predict patient outcome in the multivariate analysis. Conclusions: For the majority of patients with BDI, the risk of developing BBS could have been predicted at the initial presentation. [ABSTRACT FROM AUTHOR]

Background/Aims Klebsiella pneumoniae is the major cause of endophthalmitis associated with liver abscess, accounting for up to 60% of cases. Acute bacterial endophthalmitis is a vision-threatening condition and must be managed as an emergency. Methods The clinical complained of decreased vision and pain, eyelid edema, photophobia, and the presence of floaters. By characteristic ocular findings on detailed ophthalmoscopic examination in the setting of positive blood cultures or by positive vitreous or aqueous cultures difficult. Multiple clinic visits may be required to confirm the diagnosis. Results This 65-year-old male had past history of type 2 diabetes, hypertension, chronic kidney disease. This time, suffered from intermittent fever with chill for 4 to 5 days, drowsiness consciousness, and general weakness for 1 day, also with epigastric pain and poor intake. The laboratory data showed hyperglycemia, elevated blood osmolality, ketone body and C-reactive protein. The abdomen computed tomography revealed Liver abscess at lateral segment (about 4x2.6 cm) and probably small hepatic abscess or cyst at S7. However, sinus tachycardia with dyspnea were developed, emergency intubation was performed and transfer to intensive care unit. Initially strong antibiotic with meropenem and consult OPH to exclude endophthalmitis and the diagnosis with Senile cataract, nonproliferative diabetic retinopathy and chronic conjunctivitis. K. pneumonia bacteremia was noted later and we had kept antibiotic use. However, the patient had complained vision loss and consult OPH again for exclude endophthalmitis and bilateral retinal detachment and vitreous opacity was found. Orbital magnetic resonance imaging (MRI) was performed and revealed left intraocular linear diffusion restriction and increased bilateral scleral enhancement, in favor of endophthalmitis. OPH arrange intravitreal injection of antibiotic. After treatment, his condition was got improving and transfer to ward later but still vision loss oculus uterque. Conclusions In Taiwan, and other East Asian nations K. pneumoniae is the major cause of endophthalmitis associated with liver abscess, accounting for up to 60% of cases. Including decreased vision (the most common reason for visiting doctor) and pain, eyelid edema and the presence of floaters. Determined by the need to treat the underlying source of bacteremia. All patients also require IV of antibiotic, vitrectomy debrides the vitreous and leads to better visual outcome in severe cases of endophthalmitis. Span >OPH to exclude endophthalmitis and the diagnosis with senile cataract, nonproliferative diabetic retinopathy and chronic conjunctivitis. K. pneumonia bacteremia was noted later and we had kept antibiotic use. However, the patient had complained vision loss and consult OPH again for exclude endophthalmitis and bilateral retinal detachment and vitreous opacity was found. Orbital MRI was performed and revealed left intraocular linear diffusion restriction and increased bilateral scleral enhancement, in favor of endophthalmitis. OPH arrange intravitreal injection of antibiotic. After treatment, his condition was got improving and transfer to ward later but still vision loss oculus uterque. [ABSTRACT FROM AUTHOR]

Background/Aims Digestive hemorrhage by rupture of oesophageal varices is a serious complication of portal hypertension. Endoscopic examination, in addition to its diagnostic value, has an inescapable therapeutic interest. We report through this work our experience as an adult digestive endoscopy unit in the ligation of esophageal varices (EVL) in children. Methods Were included from March 2016 to April 2019 all children under the age of 16 years, presenting portal hypertension complicated rupture of EVL, addressed to benefit from EVL of the pediatric hospital. The endoscope and ligation kit used was the same as that used in adults. Results Of the 115 EVL performed during this period, 47 EVL were performed in children, or 40%. They were 20 children with an average age of 10 years, and a sex ratio of 3.The etiology of portal hypertension was dominated by the hepatopathy of undetermined etiology (six patients), followed by the portal cavernoma (five patients), hepato-renal polycystic disease (four patients) and fibrosis Hepatic congenital (three patient). EVL were classified as grade II in 13% of patients, grade III in 87%. Red signs were present in 14 patients and cardiac varicose veins in 10 patients. The average number of EVL sessions was 3:1 session in four patients (20%), 2 sessions in seven patients (35%), 3 sessions in four patients (20%), 4 sessions in three patients (15%), 5 sessions in one patient (5%) and 6 sessions at one patient (5%). No complication occurred. Three children died: 2 by a recurrent bleeding hemorrhagic and one of his polycystosis hepatorenal . Conclusions The EVL remains the treatment of first intention to be realized after hemodynamic stabilization in case of rupture of VO whatever the age of the child. Our preliminary results have shown that OVL can be performed under the same technical conditions as the adult. [ABSTRACT FROM AUTHOR]

Background/Aims Mitochondrial dysfunction is a major cause of hepatic ischemia/reperfusion (I/R) injury. Fibroblast growth factor 21 (FGF21), serving as a sensitive biomarker in patients with liver transplantation, enhances the mitochondrial capacity by increasing mitochondrial antioxidants and stimulating mitochondrial respiratory capacity. Here, we investigate the potential role of FGF21-targeting microRNAs in regulating mitochondrial function in liver I/R and the important role of FGF21 involved in. Methods C57BL/6 mice were subjected to 70% partial liver ischemia, followed by reperfusion. AML12 cells were incubated under hypoxia/reoxygenation condition to mimic I/R in vivo. Results We find that FGF21 is upregulated radically in mice with liver I/R, accompanied with mitochondrial ROS production and apoptosis. Using bioinformatics analysis and real-time PCR, we demonstrate that miR-99b-5p are significantly decreased that can target FGF21. miR-99b-5p overexpression attenuates liver I/R injury, as demonstrated by further upregulation of FGF21, the increased expression of mitochondrial antioxidants cytochrome c, TRX2, SOD1, combined with cleaved caspase-3 repression in vivo and in vitro; which was accompanied by decreased mitochondrial oxidative damage, apoptosis, and enhanced mitochondrial respiratory capacity. FGF21 activation by miR-99b-5p further alleviates systemic injury, as evidenced by reducing inflammatory cytokines release, and improving survival. Meanwhile, inhibition of miR-99b-5p has the opposite effect. Conclusions FGF21 is a key regulator of liver I/R by contribution to mitochondrial function. miR-99b-5p attenuates liver I/R injury through promoting FGF21 upregulation, which may represent a novel prophylactic approach to liver I/R injury. [ABSTRACT FROM AUTHOR]