Bile Duct Cancer: Preoperative Evaluation and Management

Cholangiocarcinomas (CCAs) are malignant tumors that can develop anywhere along the biliary tree. Almost 10% of cholangiocarcinomas arise from the intra-hepatic bile ducts (iCCA); 50–60% from the bifurcation of the hepatic duct (perhilar cholangiocarcinoma, pCCA); and 20–30% from the distal bile duct (dCCA). The 7th edition of the AJCC staging system, released in 2010, divides the tumors into two major categories: perihilar (pCCA) and distal (dCCA) cholangiocarcinoma, given the differences in anatomy of the bile duct and consideration of local factors related to resectability. There are separate histological classifications for intrahepatic and extrahepatic cholangiocarcinoma. The majority of CCAs (90%) are well or moderately differentiated adenocarcinomas. Other features include invasiveness with early neural, perineural, periductal and lymphatic infiltration (more than 50% of cases at diagnosis) and longitudinal subepithelial infiltration along the wall of the bile duct up to 2 cm proximally and 1 cm distally. In this chapter the extrhepatic bile duct cancers are analyzed

Liver Trauma

Objective: The aim of this section is to assess the evolution in the management of liver injuries during the last two decades

Intrahepatic Cholangiocarcinoma

Aim: The authors give a complete overview on this disease from epidemiology to treatment

Surgical and Interventional Management of Complications Caused by Pancreatitis

Acute pancreatitis has a broad clinical spectrum: from mild, self-limited disease to fulminant illness resulting in multi-organ failure leading to a prolonged clinical course with up to 30% mortality in case of infected necrosis. Management of local complications such as pseudocysts and walled-off necrosis may vary from clinical observation to interventional treatment procedures. Gram negative bacteria infection may develop in up to one-third of patients with pancreatic necrosis leading to a clinical deterioration with the onset of the systemic inflammatory response syndrome and organ failure. When feasible, an interventional treatment is indicated. Percutaneous or endoscopic drainage approach are the first choices. A combination of minimally invasive techniques (step-up approach) is possible in patients with large or multiple collections. Open surgical treatment has been revised both in the timing and in the operating modalities in the last decades. Since 1990s, the surgical treatment of infected necrosis shifted to a more conservative approach. Disruption of the main pancreatic duct is present in up to 50% of patients with pancreatic fluid collections. According to the location along the Wirsung, treatment may vary from percutaneous drainage, endoscopic retrograde pancreatography with sphincterectomy or stenting to traditional surgical procedures. Patients may suffer from vascular complications in up to 23% of cases. Tissue disruption provoked by lipolytic and proteolytic enzymes, iatrogenic complications during operative procedures, splenic vein thrombosis, and pseudoaneurysms are the pathophysiological determinants of bleeding. Interventional radiology is the first line treatment and when it fails or is not possible, an urgent surgical approach should be adopted. Chylous ascites, biliary strictures and duodenal stenosis are complications that, although uncommon and transient, may have different treatment modalities from non-operative, endoscopic to open surgery

Management of Acute and Chronic Pancreatitis

Pancreatitis is a major public health issue worldwide. There is geographical variation in the burden of acute and chronic pancreatitis (CP). Globally, the age-standardized prevalence rate increased from 1990 to 2017. Acute pancreatitis (AP) is now one of the most common reasons for hospitalization with a gastrointestinal condition. The essential requirements for the management of AP are accurate diagnosis, appropriate triage, high-quality supportive care, monitoring for and treatment of complications, and prevention of relapse. Clinicians should be aware of the time course and the best management of AP, identifying which patient will have a severe course allowing earlier triage to an intensive care unit and earlier initiation of effective therapy. CP is a pathologic fibroinflammatory syndrome of the pancreas in individuals with genetic, environmental, and other risk factors who develop persistent pathologic responses to parenchymal injury or stress. Diagnosing the underlying pathologic process early in the disease course and managing the syndrome to change the natural course of disease and minimize adverse disease effects are the managing paradigm. In this review, we consider recent changes in the management of acute and CP, as well as common misunderstandings and areas of ongoing controversy

Chemical composition and in vitro cytotoxicity of Corynespora olivacea (V18) associated with Vochysia divergens/ Composição química e citotoxicidade in vitro de Corynespora olivacea (V18) associada a Vochysia divergens

Chemical investigation into the ethyl acetate extract of the endophytic fungus Corynespora olivacea (V18) associated with Vochysia divergens identified compounds 1 and 2. The compounds were characterized by spectroscopic methods including NMR (1D and 2D) and HRMS. The cytotoxicity of the crude extract and the isolated compounds against normal human lung fibroblast cells, lineage GM07492A, was evaluated by the XTT assay. To the best of our knowledge, this is the first chemical and biological screening of the cytotoxicity of C. olivacea derived from V. divergens

Chemical composition and in vitro cytotoxicity of Corynespora olivacea (V18) associated with Vochysia divergens / Composição química e citotoxicidade in vitro de Corynespora olivacea (V18) associada a Vochysia divergens

Chemical investigation into the ethyl acetate extract of the endophytic fungus Corynespora olivacea (V18) associated with Vochysia divergens identified compounds 1 and 2. The compounds were characterized by spectroscopic methods including NMR (1D and 2D) and HRMS. The cytotoxicity of the crude extract and the isolated compounds against normal human lung fibroblast cells, lineage GM07492A, was evaluated by the XTT assay. To the best of our knowledge, this is the first chemical and biological screening of the cytotoxicity of C. olivacea derived from V. divergens

Valor nutricional de folhas jovens de erva-mate

Yerba mate is largely used to produce drinks to human consume. In Spring the plants develop tender young leaves that could represent a new market niche in the yerba-mate industry; this period is called as ”pressafrinha” in this study. This study aimed to analyze the total and hydro soluble nutritional values of young leaves collected in the Spring season and its nutritional potential for human consumption. To represent the ”pressafrinha” young leaves, the collected vegetal material was limited to the third terminal bud. The total and hydro soluble chemical analysis of leaves in the provenances Cascavel (progeny 174), Ivaí (progeny 6), Barão de Cotegipe (progenies 68 and 69) included the following elements: P, K, Ca, Mg, Na, Fe, Mn, Cu and Zn. The content of elements in the beverage obtained from the infusion of young leaves of yerba mate in the recommended daily intake ranges from 0.5% to 11.5% and was in the following order: Cu > Mn > K > P > Mg > Fe > Zn > Ca > Na. Progenies and morphotypes of yerba mate showed little variation in the total nutrient content and did not differ in the content of soluble nutrients evaluated in young leaves. The extract obtained from young leaves of yerba mate presents potential to be used for human consumption.A Erva-mate é muito usada para produção de bebidas para consumo humano. Na primavera, a planta desenvolve folhas jovens que podem representar um novo nicho de mercado na indústria de erva-mate; este período é chamado nesse estudo de prea-safrinha. Este estudo teve por objetivo investigar os teores nutricionais totais e hidrossolúveis de folhas jovens de erva-mate coletadas na primavera e seu potencial nutricional para o consumo humano. Para representar folhas jovens da pre-safrinha, o material vegetal recolhido foi limitado ao terceiro botão terminal. A análise química total e hidrossolúvel de folhas das procedências Cascavel (progênie 174), Ivaí (progênie 6), Barão de Cotegipe (progênies 68 e 69) incluiu os seguintes elementos: P, K, Ca, Mg, Na, Fe, Mn, Cu e Zn.O conteúdo dos elementos da bebida obtida a partir da infusão de folhas jovens de erva-mate na ingestão diária recomendada variou de 0,5 a 11,5 % e se apresentou na seguinte ordem: Cu > Mn > K > P > Mg > Fe > Zn > Ca > Na. Progênies e morfotipos de erva-mate mostraram pouca variação no conteúdo total de nutrientes e não diferiram quanto ao conteúdo de nutrientes hidrossolúveis avaliados nas folhas jovens. Sendo assim, o extrato obtido a partir de folhas jovens de erva-mate apresenta potencial de uso para o consumo humano

Effect of liming on micronutrient availability to soybean grown in soil under different lengths of time under no tillage

The effect of liming on the availability of micronutrients to soybean cultivated during different numbers of years under no tillage (NT) was investigated. The treatments consisted of the number of years under NT (three, six, and nine years) and five rates of lime (0, 33, 67 and 100% of the amount calculated to raise soil base saturation to 70%) broadcast on soil surface plus the rate of 100% broadcast with incorporation in the 0-0.20 m layer of a clayey Red Oxisol. Soil and leaf samples were collected at two vegetative stages of the crop (vegetative V4 and blossoming R2). The soil was sampled at depths of 0-0.05, 0.05-0.10, 0.10-0.20, and 0.20-0.30 m. Surface liming had little effect on extractable soil micronutrient and nutrient concentrations in soybean leaves. In the area with three years under NT, all liming rates decreased the extractable soil Zn up to a depth of 0.20 m. Lime incorporation decreased the extractable soil Mn in the surface layer. There were no differences in the extractable soil micronutrients and nutrient concentrations in soybean leaves as a function of the number of years under NT. These data suggest that broadcasting lime at current rates on soils under NT does not necessarily lead to micronutrient deficiencies.