piperidines and Cholecystitis

Dermatomyositis is a rare idiopathic inflammatory disease with diverse presentations that can have varying degrees of cutaneous and systemic involvement. This phenotypic heterogeneity makes DM a therapeutic challenge. Some therapeutic drugs, such as hormones and immunosuppressants, have poor therapeutic effects. In recent years, tofacitinib has been reported to be effective in the treatment of dermatomyositis.. We report a case of anti-MDA5 antibody-positive dermatomyositis that was relieved after treatment with tofacitinib, during which gallbladder gangrene and suppurative cholecystitis occurred. After cholecystectomy, we continued to use tofacitinib and achieved a good therapeutic effect.. Tofacitinib is effective in the treatment of anti-MDA5 antibody-positive dermatomyositis, but the risk of infection is increased. It can still be used after infection control. Close follow-up should be performed during the use of tofacitinib.

Topics: Autoantibodies; Cholecystitis; Dermatomyositis; Humans; Interferon-Induced Helicase, IFIH1; Lung Diseases, Interstitial; Piperidines; Pyrimidines

Myasthenia gravis (MG) is an autoimmune disease characterized by the production of antibodies against the acetylcholine receptor, muscle-specific kinase (MuSK), or other proteins at the neuromuscular junction. MG with antibodies against MuSK (MuSK-MG) has been described recently. Here, we report the first case of anesthetic management of a patient with MuSK-MG undergoing an open cholecystectomy. In our case, propofol and remifentanil-based anesthesia were used for successful management without using muscle relaxants. Patients with MuSK-MG have predominantly ocular, bulbar, and respiratory symptoms that may increase the risk of aspiration. Anesthesiologists need to pay attention to perioperative respiratory failure and respiratory crisis.

Topics: Analgesia, Epidural; Anesthesia, General; Anesthetics, Intravenous; Autoantibodies; Cholecystectomy; Cholecystitis; Female; Humans; Middle Aged; Myasthenia Gravis; Pain, Postoperative; Piperidines; Propofol; Receptor Protein-Tyrosine Kinases; Receptors, Cholinergic; Remifentanil

Topics: Acute Disease; Adult; Anesthesia, General; Cholecystectomy; Cholecystitis; Emergencies; Humans; Intraoperative Complications; Male; Mitochondrial Encephalomyopathies; Monitoring, Intraoperative; Piperidines; Postoperative Complications; Propofol; Remifentanil

Topics: Aged; Aged, 80 and over; Anesthetics, Combined; Anesthetics, Intravenous; Cholecystitis; Humans; Male; Myasthenia Gravis; Piperidines; Propofol; Remifentanil

In experimental cholecystitis there is a net fluid secretion into the gallbladder lumen and an increased release of prostaglandins. Indomethacin and opiates are known to inhibit this mucosal fluid secretion. Intraluminal or intra-arterial administration of prostaglandin E2 reduces basal gallbladder fluid absorption or induces a net fluid secretion to the lumen and also contracts the normal gallbladder. The use of a continuous perfusion technique in anaesthetized cats in this study shows that the effects of prostaglandin E2 on gallbladder function are blocked by intravenous morphine and loperamide. Naloxone does not affect the gallbladder responses to PGE2 administration. As a mechanism of action it is suggested that opiates inhibit secretory and contractile nerves that are activated by prostaglandins in the gallbladder wall. The findings suggest that the pain relieving effects of opiates in cholecystitis and biliary pain partly are due to blocking of the effects by prostaglandins on gallbladder function.

Topics: Animals; Cats; Cholecystitis; Dinoprostone; Female; Gallbladder; Loperamide; Male; Morphine; Muscle Contraction; Naloxone; Perfusion; Piperidines; Prostaglandins E; Water-Electrolyte Balance

Fluid secretion by the gallbladder mucosa is suggested to have a key pathophysiological role in acute cholecystitis, since it causes distension of the obstructed gallbladder. The present study investigates the actions of loperamide on the gallbladder function in experimental cholecystitis. Gallbladder fluid transport and motility were studied in vivo with a continuous perfusion technique. A net fluid secretion by the gallbladder mucosa was seen in cats in which cholecystitis was induced whereas there was a net fluid absorption from the gallbladder lumen in the control animals. The net fluid secretion in experimental cholecystitis was inhibited by loperamide (1 mg/kg), an effect that was blocked by naloxone (1 mg/kg), suggesting an involvement of specific opiate receptors. Loperamide (1 mg/kg) relaxed the normal gallbladder but had no significant effects on its fluid absorption. Since loperamide reduces mucosal fluid secretion in experimental cholecystitis without contracting the gallbladder wall, it is suggested that this peripherally acting opiate agonist could be useful in the treatment of patients with acute cholecystitis.

Topics: Animals; Cats; Cholecystitis; Disease Models, Animal; Female; Gallbladder; Loperamide; Male; Piperidines

Topics: Adult; Analgesics; Cholecystitis; Gastrointestinal Hemorrhage; Haloperidol; Humans; Intestinal Obstruction; Male; Neuroleptanalgesia; Nitrous Oxide; Peritonitis; Piperidines; Wounds and Injuries