Cystic Artery Variations and Associated Vascular Complications in Laparoscopic Cholecystectomy

Substantial knowledge of the arterial supply and its anatomical variations of the gall bladder and liver are important in all the hepatobiliary surgical procedures. The arterial supply of gallbladder called cystic artery (CA) is a vital structure required to get ligated or clipped in the path of laparoscopic cholecystectomy. The possible concerns like intra-operative bleeding or adjoining accidental injuries will almost always be focused on the research consisting of dissection and clipping with cystic artery. Pseudoaneurysm of the cystic artery has additionally been belonging to the presence of acute cholecystitis or pancreatitis. An original supply of CA is usually assessed depending on the existence of hepatic artery variants. Laparoscopic cholecystectomy is really a recent and arduous noninvasive procedure and might even result in substantial unintended effects possibly iatrogenic or in the form of post-procedural complications. The perfect knowledge of anatomy in addition to feasible variation of cystic artery is mandatory. An efficient operative strategy and consciousness are probably the key components with all the results and marginal likelihood of complications, which often can be ultimately attainable. Within this chapter, we have attempted to explore some variations of cystic artery, complications and management

Perihilar or (Hilar) Cholangiocarcinoma: Interventional to Surgical Management

Peri-hilar cholangiocarcinoma (PHC) or hilar cholangiocarcinoma (HCCA) characterizes a critical effort to assess significantly sick patients. The existing scenery and proof to the diagnosis and treatments for hilar cholangiocarcinoma are improving day by day. Patients with HCCA encounter numerous obstacles in acquiring efficient therapies. The condition is uncommon, and the majority patients don’t have any distinct risk factors, doing selection process inadequate. The initial signs and symptoms in many cases are non-specific, and in many patients the tumors are not resectable because of involvement of the perihilar structures. MRI with MRCP offers further information about the extent of biliary involvement. Furthermore, endoscopic stenting and percutaneous drain could be useful for intricate hilar strictures. Surgical resections with negative margins are related to good likelihood of survival for patients representing with HCCA. Regardless of the accessibility of curative treatment strategies such as operative resection and liver transplantation, most sufferers with HCCA shows with repeated, metastases or locally advanced disease with a poor prognosis. Within this chapter, we have tried to elaborate the modalities of treatment from intervention to surgical approach for HCCA

Coronarin K and L: Two Novel Labdane Diterpenes From Roscoea purpurea: An Ayurvedic Crude Drug

The main objective of cancer treatment with chemotherapy is to kill the cancerous cells without affecting the healthy normal cells. In the present study, bioactivity-guided purification of the n-chloroform soluble fraction from the methanol extract of Roscoea purpurea resulted in the identification of two new labdane diterpenes: coronarin K (1) and coronarin L (2), along with eight known compounds, coronarin A (3), bisdemethoxycurcumin (4), kaempferol 3-O-methyl ether (5), kaempferol (6), fenozan acid (7), 3-(3-methoxy,4-hydroxyphenyl)-2-propenoic acid ferulic acid (8), caffeic acid (9), and gallic acid (10). The structural identification of new compounds (1 and 2) were determined by detailed analysis of 1D (1H and 13C) and 2D NMR (COSY, HSQC, and HMBC) spectroscopic data. The relative configurations of 1 and 2 were determined with the help of NOESY correlations and comparison of optical rotations with known labdane diterpenes, with established stereochemistry, while structure of known compounds was established by direct comparison of their NMR data with those reported in the literature. This is the first report of isolation of this labdane diterpenes and phenolic classes of secondary metabolites in R. purpurea. In the preliminary screening, the methanol extract and its fractions were tested for the cytotoxic activity against a panel of four cancer cell lines (A549, HCT-116, Bxpc-3, and MCF-7); extract and its chloroform fraction were found to be active against the lung cancer cell line, A-549, with IC50 value <25 μg/ml. Owing to the notable cytotoxic activity of the chloroform fraction, the compounds (1–5) were screened for their cytotoxicity against all the cell lines by MTT assay. Coronarin K, 1 showed significant cytotoxic potential against lung cancer cell lines (A-549), with IC50 value of 13.49 μM, while other compounds did not show activity below 22 μM

Laparoscopic hepatectomy for hepatic colorectal metastases -- a retrospective comparative cohort analysis and literature review.

BACKGROUND: Laparoscopic hepatectomy (LH) for management of hepatic colorectal metastases (HCRM) is commonly being performed; however, there are limited reports comparing LH outcomes with those of open hepatectomy (OH) procedure. The aim of the present study was to compare perioperative outcomes between the LH and OH procedures performed at a single medical center. METHODS: From Jan 2008 to May 2012, 30 patients with pathologically confirmed HCRM underwent LH, and 140 patients underwent OH at our hospital. Patients' demographics, perioperative outcomes were retrospectively analyzed. RESULTS: 2 patients (6.7%) in the LH group underwent laparotomies for intraoperative hemorrhage. The LH group had an increased surgical duration (235 min vs. 365 min, (P<0.001), shorter hospital stay (7.5 days vs. 11.5 days, P<0.001), and fewer complications (26.2% vs. 55%, P<0.001) than the OH group. However, in a matched cohort comparison of 30 LH cases and 30 OH cases, no significant variations were observed in the following parameters: surgical duration (235 min vs. 255 min, P = 0.23), positive margin rates (6.7% vs. 0.0%, P = 0.27), or postoperative hematological changes. LH patients had less estimated blood loss (215 ml vs. 385 ml, P<0.001), less morbidity (26.2% vs. 50%, P = 0.02), shorter hospital stay (7.5 days vs. 11.5 days, P<0.001), and lower analgesic requests than with those in the OH group. CONCLUSIONS: LH for metastatic colorectal cancer is a safe and feasible treatment, even in patients who underwent prior laparotomy surgeries and provides significantly less morbidity and shorter hospital stay than OH, without compromising curability or increasing morbidity

Estimation & comparison of salivary glucose with blood glucose in diabetic individuals

Aim: Saliva play a diagnostic tool for oral and systematic diseases has multiple advantages over other body fluids especially . The aim of this study was to explore the potential of salivary glucose as a marker in diagnosis and monitoring of diabetes mellitus using glucoseoxidase method, and as a non-invasive method replacing an invasive blood glucose estimation method. Materials and methods: Fasting blood and unstimulated whole saliva were collected from 50 controls, 50 newly diagnosed diabetics, and 50 diabetics under treatment. Blood and salivary glucose were analyzed in the samples by glucose-oxidase method. Results: The mean level of salivary glucose was reported to be 0.53 ± 0.4mg/dl in controls, 1.14 ± 1.55mg/dl in newly diagnosed diabetics, and 1.22 mg/dl ± 1.99 in diabetics under treatment. Conclusion: The mean level of salivary glucose in diabetics was significantly higher than that in non-diabetics. A positive, linear and significant, yet weak correlation between salivary and blood glucose suggests some potential for saliva as a marker in diagnosis and monitoring of diabetes mellitus

Clinicopathologic characteristics of all included patients.

*<p>CEA:Cancer Embryo Antigen.</p

Characteristics comparison of the 30 patients who underwent LH with matched 30 patients who underwent OH procedure.

*<p>ASA: American Society of Anesthesiology.</p

Operative findings and postoperative laboratory test for matched cohort.

<p>ALT: Alanine aminotransferase; AST: aspartate aminotransferase; TBIL: Total bilirubin; post: postoperative.</p

Flow chart of attempted hepatectomy.

<p>Flow chart of attempted hepatectomy.</p