Importance of Anatomical Variation of the Hepatic Artery for Complicated Liver and Pancreatic Surgeries: A Review Emphasizing Origin and Branching

Knowledge of anatomical variations of the hepatic artery from its origin to intrahepatic segmentation is of utmost importance for planning upper abdominal surgeries including liver transplantation, pancreatoduodenectomy, and biliary reconstruction. The origin and branching pattern of the hepatic artery was thoroughly described by the classification of Michels and Hiatt. Some rare variations of the hepatic artery were classified by Kobayashi and Koops. By the use of the multidetector computed tomography (MDCT) technique, the branching pattern of the hepatic artery can be visualized quite accurately. Unawareness of these arterial variations may lead to intraoperative injuries such as necrosis, abscess, and failure of the liver and pancreas. The origin and course of the aberrant hepatic arteries are crucial in the surgical planning of carcinoma of the head of the pancreas and hepatobiliary surgeries. In liver transplant surgeries, to minimize intraoperative bleeding complications and postoperative thrombosis, exact anatomy of the branching of the hepatic artery, its variations and intrahepatic course is of utmost importance. This review discusses variations in the anatomy of the hepatic artery from its origin to branching by the use of advanced imaging techniques and its effect on the liver, pancreatic, biliary and gastric surgeries

Pharmacognostical, Phytochemical And Invitro, Invivo Anti-Inflammatory Potential Of Ethanolic Extract Of Sarcostemma Brevistigma Stems

A multimillion-dollar boom is achieved every year by the ethnopharmaceutical companies, creating awareness around the globe to use herbal medicines to stay and live a healthy life. Nearly, two-thirds of the plants were discovered for herbal remedies, and some plants are even endangered to get extinct from the globe for their repeated utility. Sarcostemma brevistigma is one among the undiscovered medicinal plants which belongs to the family Asclepiadaceae found distributed in Indian states of Bihar, Bengal, Konkan, Tamil Nadu, and Kerala. The objective of this study was to investigate pharmacognostical, phytochemical features and invitro, invivo anti-inflammatory activity of ethanolic extracts of Sarcostemma brevistigma stems by using human red blood cells (HRBC) membrane stabilization assay, protein denaturation method and formalin-induced paw edema model. The different pharmacognostical parameters were evaluated as per standard protocols with some modifications. Qualitative analysis of various phytochemical constituents was determined by the well-known test protocol available in the literature. Phytochemical analysis revealed the presence of alkaloids, glycosides, steroids and triterpenoids, tannins, proteins and amino acid and carbohydrate. The ethanolic extract of the stem of Sarcostemma brevistigma were studied for in vitro anti-inflammatory activity by HRBC membrane stabilization method. Three different concentrations of extract 200µg/ml, 400µg/ml and 600µg/ml were used. Among which extract at concentration 600µg/ml showed 58.20% Inhibition of HRBC in hypotonic solution. All the results were compared with standard diclofenac sodium which showed 68.82% Inhibition at concentration 300µg/ml. The inhibitory concentration (IC50) of Sarcostemma brevistigma (Stem) in Protein denaturation is found to be 600µg/ml in comparison with diclofenac sodium 300µg/ml. Percentage inhibition of edema by extract containing ethanolic extract in rat’s left hind paw was observed to be 16.92+0.12% at 1 hr. and 26.93+0.16% at 4 hr. All the results were compared with standard voveran emulgel gel. The skin irritation test was conducted for a period of seven days. The results indicated that the control preparation, extract and marketed products did not cause any skin reaction. It can be assured that ethanolic extract of Sarcostemma brevistigma and the excipients did not cause any skin irritation and can be used in the gel formulation. Sarcostemma brevistigma extract showed appreciable anti-inflammatory property. Further analysis is to be carried out to isolate active chemical constituent responsible for anti-inflammatory activity and its mechanism involve

Formulation, characterization and evaluation of Tramadol Hydrochloride Hydrogel

The challenge in the formulation of novel systems for TDDS is to identify technologies and formulation excipients which simultaneously optimize drug permeation. Our main goal was to design and evaluate a recent alternative for the administration of tramadol HCl. Performed the preformulation study as different evaluation parameters Physiochemical Studies, Solubility Determination, Partition Coefficient, and Preparation of Calibration Curve simultaneously Preparation & Characterization of Hydrogel Formulation Homogeneity, pH Measurement, Drug Content, Viscosity, Spreadability, In-Vitro Permeation, FT-IR Studies. Results revealed that the present investigation, tramadol was successfully incorporated into different gel formulations. Among all gel formulations, tramadol gel (F13) proved to be the formula of choice, showing good characteristics and controlling the drug release for long period of time. Gel formulation F13 could be very promising and innovative topical alternative for pain management and arthritis and play a vital role in drug efficiency. These findings may open new avenues for the treatment through dermal by local application of tailored gel. However, further preclinical and clinical studies are recommended to support its efficiency claims in humans. Keywords: Tramadol HCl; In-Vitro Permeation; Hydrogel; FT-IR Studies; Characterizatio

Unraveling Variations in Celiac Trunk and Hepatic Artery by CT Angiography to Aid in Surgeries of Upper Abdominal Region

Understanding of variations in the course and source of abdominal arteries is crucial for any surgical intervention in the peritoneal space. Intricate surgeries of the upper abdominal region, such as hepato-biliary, pancreatic, gastric and splenic surgeries, require precise knowledge of regular anatomy and different variations related to celiac trunk and hepatic artery. In addition, information about the origin of inferior phrenic artery is important in conditions such as hepatocellular carcinoma and gastroesophageal bleeding management. The present study gives an account of anatomical variations in origin and branching pattern of celiac trunk and hepatic artery by the use of CT (computed tomographic) angiography. The study was performed on 110 (66 females and 44 males) patients in a north Indian population. Results unraveled the most common celiac trunk variation as hepatosplenic trunk with left gastric artery, which was observed in 60% of cases, more common in females than in males. Gastrosplenic and hepato-gastric trunk could be seen in 4.55% and 1.82% cases respectively. Gastrosplenic trunk was more commonly found in females, whereas hepato-gastric trunk was more common in males. A gastrosplenic trunk, along with the hepato-mesenteric trunk, was observed in 1.82% cases and was more common in males. A celiacomesenteric trunk, in which the celiac trunk and superior mesenteric artery originated as a common trunk from the aorta, was seen only in 0.91% of cases, and exhibited an origin of right and left inferior phrenic artery from the left gastric artery. The most common variation of hepatic artery, in which the right hepatic artery was replaced and originated from the superior mesenteric artery, was observed in 3.64%, cases with a more common occurrence in males. In 1.82% cases, the left hepatic artery was replaced and originated from the left gastric artery, which was observed only in females. Common hepatic artery originated from the superior mesenteric artery, as observed in 1.82% cases, with slightly higher occurrence in males. These findings not only add to the existing knowledge apart from giving an overview of variations in north Indian population, but also give an account of their correlation with gender. The present study will prove to be important for various surgeries of the upper abdominal region