Hepatology and Pancreatic Science

Background: I have designed a Q-shape biliary diversion pancreaticoduodenectomy (PD) to prevent delayedhemorrhage in case of pancreaticojejunostomy (PJ) leakage. However, eliminating PJ leakage is the ultimate goal. A PJ anastomosis technique, irrespective of soft pancreatic texture or duct-size, has been found.

Methods: Nine PDs were included. An end-to-side anastomosed proximal jejunal loop (30 cm), divided by a GIA stapler at its top and reapproximated using serosal sutures, was used for a choledochojejunostomy and PJs (4 fistulation, 2 duct-to-mucosa, 1 conventional and 2 whole-thickness mattress end-to-side sutures) at each divided loop. Finally, a gastro/duodenojejunostomy was made 30 cm distal to this looped jejunojejunostomy.

Results: There was no mortality. One minor PJ leakage healed spontaneously. One major PJ leakage had a delayed-hemorrhage crisis salvaged by continuous normal saline irrigation to neutralize the pH condition for bile and pancreatic juice interaction. The clinical courses were surprisingly uneventful and without fear of leakage in two PJs using whole-thickness mattress sutures. Secure ties without tearing were possible in the soft pancreatic texture.

Conclusion: Current evolutional strategies of biliary diversion reconstruction with whole-thickness-mattress PJ sutures plus normal saline irrigation can increase the safety of a pancreaticoduodenectomy by reducing PJ leakage and preventing the activation of pancreatic juice to eliminate a lethal delayed-hemorrhage.

Arsenic contamination in water is a major threat to human health and among the health hazards hyperglycemia is important. The current investigation was planned to find some remedial treatment of arsenic induced hyperglycemia by dietary supplementation of a traditional plant. This study was performed for a period of 30 days on adult male Wistar rats weighing 120-140 g. They were divided into three equal groups (n=6): Group Control (C), normal saline administered, Treatment Group 1 (T1), arsenic trioxide fed at the dose of 3 mg/kg/day for 30 days; and Treatment Group 2 (T2), arsenic trioxide at the dose of 3 mg/kg/day for 30 days along with powder of leaves of Costus igneus fed at the dose of 500 mg/kg/day for the last 15 days of arsenic treatment. The body weights and blood sugar levels were recorded on Days 1, 15 and 30. The animals were sacrificed on the 31st day and pancreas was collected for histological study of islets cells. The body weights of both the groups T1 and T2 decreased significantly (*p<0.05) after 15 days of arsenic treatment. A significant increase in body weight of T2 was found in the next 15 days of Costus supplementation in comparison to T1. The blood sugar levels of both T1and T2 increased significantly (*p<0.05) after 15 days of treatment but it was reduced significantly in T2 after the next 15 days of Costus supplementation. The histology of the pancreatic islets cells in T1 illustrated that larger number of islet cells shrunken with lower number of cell counts in comparison to C. However, in T2, cell counts and morphology was restored significantly by Costus supplementation demonstrating that Costus igneus may be an effective agent in protection from arsenic induced hyperglycemia. From these preliminary findings further studies are warranted to elucidate the molecular mechanism of this plant’s antihyperglycemic action.

Liver-splitting techniques been previously developed for ex vivo and in situ cadaveric liver transplantation, and more recently for in situ living donor liver transplantation or liver partition with a portal vein ligation for a staged hepatectomy. We report a novel and simplified technique using a long curved needle to make whole-thickness mattress sutures along the division line of the remnant liver above the inferior vena cava to control bleeding, and then bloodlessly splitting the liver with scissors within 40 min in a case of a left lobectomy with metastases from breast cancer. The patient was uneventfully discharged on the fourth postoperative day.

When a liver lobectomy or partition to enhance liver regeneration for a staged hepatectomy is necessary, this technique can be done straightforwardly without concern for the problems of venous return or congestion of the recipient or remnant donor liver. This technique is probably the simplest and fastest way for any surgeon and any facility.

Background: Hepatocellular carcinoma (HCC) is the fifth most basic type of disease on the planet. Regardless of such a variety of choices for HCC treatment, the cure rate for patients is generally low especially among patients who are ineligible for surgical or percutaneous methods. HCC is generally viewed as a chemotherapy-safe malady. These disadvantages require the proceeded with scan for novel HCC treatments. The plant Annona muricata has been accounted for to have acetogenins as major phytoconstitutent which are in charge of number of exercises and one of them is anticancer and antiproliferative impacts against different tumors. The present study was intended to assess the anticancer potential of aqueous extract of Annona muricata leaves (AEAML) against Huh-7 human liver cancer cells.
Methods: The cytotoxic impact of AEAML on Huh-7 cells was tried by MTT examine. Cells were tested with 0.5, 1.0, and 1.5 mg/ml concentrate of AEAML for 24 hours. The apoptotic genes Bax and Bcl-2 expression were assessed by utilizing RT-PCR, and after that decide the protein expression of caspase 3 and 9 by western blot. Comet assay was performed in Huh-7 cells for the DNA damage and apoptosis.
Results: Cell viability investigation uncovered the cytotoxic impact of AEAML on Huh-7cell line. RT-PCR of anti- apoptotic Bcl-2 and pro-apoptotic Bax demonstrated that there is down and up control, individually, of these two qualities with an unfriendly impact. Additionally, AEAML treatment set off the actuation of caspase-9 followed by caspase-3 protein expression. Also, AEAML incited DNA damage and apoptosis on Huh-7 cells as uncovered by Comet tail length.
Conclusion: Annona muricata has antiproliferative and cytotoxic impacts on Huh-7 cells, conceivably through apoptosis induction.

Aim: Lapse from symptom onset to surgery has been traditionally used for the operation timing of cholecystectomy. However, intraoperative gallbladder (GB) inflammation status has never been studied to verify its justification.
Methods: Meticulous intraoperative inflammation status of 260 consecutive laparoscopic cholecystectomy (LC) patients with symptomatic GB stone disease was prospectively graded (I-VI). Inflammation status in terms of lapse, incidence of difficult GB, complication and conversion rate from LC to open cholecystectomy was retrospectively analysed.
Results: Various inflammation grades were non-significantly different in each lapse group irrespective of the lapse time. Severity is not always proportionally increased to the lapse time in every patient. One hundred seventeen patients (45%) had inflammations beyond the GB that reached Calot’s triangle or the hepatoduodenal ligament (Grade IV~VI): 64 (54.7%) were Grade V or VI and were defined as difficult GB. There were no statistically significant differences in terms of incidence of difficult GB, or conversion rate between the lapse groups. When divided into any two lapse groups, only the ≤ 3 and >3 days groups showed a significant difference (P=0.039) in the incidence of difficult GB. But the conversion rate was not significantly different (P=0.388).
Conclusion: A majority of the patients were easily manageable despite the different lapse times. Less than onethird of the patients with difficult GB needed earlier LC to avert subsequent progression of dense fibrosis if delayed. Dichotomized lapse determination for LC without considering intraoperative inflammation status is not justified.

Background: From the earliest century, some authors including Friedrech had found that alcohol intake was associated with clinical pictures of acute pancreatitis, which has been confirmed to this day.
Material and method: In order to identify the incidence of acute pancreatitis by alcohol, an observational, retrospective and cross-sectional clinical study was performed at the Playa del Carmen Solidaridad Hospital, Quintana Roo, Mexico.
Results: During the study period, 100 cases of acute pancreatitis were collected from which 17 cases of alcoholic pancreatitis. Regarding sex, 3 cases were obtained for females and 14 for males. In terms of age the mean was 40, median 38, mode 34, SD 7.1, minimum 25 and maximum 52 years. Risk factors: 3 cases for Diabetes mellitus, 3 cases for smoking, 7 cases with hypertriglyceridemia, 5 cases with overweight, and 17 cases with positive alcoholism.
Conclusion: In our hospital the percentage it was 17% during five years with predominance for male gender in middle age population and ranking third in place of the lipid etiology.