Cholangiocarcinoma cell lines: proteomic analysis and enhancing response to chemotherapy.

MD (Res)Cholangiocarcinoma (CCA) is a rare cancer with a poor prognosis. Much of medical research has focused on investigating cancers with a higher incidence and little focus has been devoted to this disease. The aim of this thesis was to perform a protein analysis of CCA and cholangiocyte cell lines. Differences between immortalised cancer and normal cells were sought in order to identify potential therapeutic targets and/or diagnostic tools. A variety of CCA cell lines were used, reflecting both intra and extrahepatic disease. The different subtypes of CCA through the developed and developing world are also represented so differences were also sought between them. Proteomic analysis was performed using DIGE with subsequent spot selection. Identified spots were extracted and processed using mass spectrometry. In addition, available chemotherapy agents were tested in vitro against the same cell lines to check for their action and how this could be enhanced. A benzodiazepine receptor antagonist (PK11195) was used to demonstrate apoptosis promotion in the presence of established cytotoxic agents (gemcitabine, etoposide, 5 fluorouracil and cisplatin). Cytotoxic assays were carried out using the SRB (Sulphorhodamine B) assay. Cell lines were tested for benzodiazepine receptor status using qRTPCR and response was correlatedLondon Bridge Hospital (HCA International); LAP research UK

Robotic Liver Surgery

Robotic liver surgery is an evolving specialty within liver surgery. The robotic platform allows some of the limitations in both open and laparoscopic surgery to be overcome. Indeed as the technology develops there is scope for the number of robotic liver resections to increase as well as their complexity. In this chapter we discuss the current robotic platform, review the current role of robotics in liver surgery and review the available data in the literature on patient outcome

Migrated fish bone induced liver abscess: medical management

Liver abscess secondary to a migrated ingested foreign body is an uncommon condition where early diagnosis helps management and improves prognosis. Abscess drainage with removal of the foreign body is the recommended management. We report the successful management of a patient with a liver abscess from a migrated fishbone that was treated medically with the foreign body left in situ

Open and Minimal Approaches to Pancreatic Adenocarcinoma

Surgical options and approaches to pancreatic cancer are changing in the current era. Neoadjuvant treatment strategies for pancreatic cancer combined with the increased use of minimal access surgical techniques mean that the modern pancreatic surgeon requires mastering a number of surgical approaches with to optimally manage patients. Whilst traditional open surgery remains the most frequent approach for surgery, the specific steps during surgery may need to be modified in light of the aforementioned neoadjuvant treatments. Robotic and laparoscopic approaches to pancreatic resection are feasible, but these surgical methods remain in their infancy. In this review article, we summarise the current surgical approaches to pancreatic cancer and how these are adapted to the minimal access setting with discussion of the patient outcome data

Systematic review and meta-analysis of case-matched studies comparing open and laparoscopic distal pancreatectomy: is it a safe procedure?

Distal pancreatectomies and enucleations have become the most popular laparoscopic pancreatic resections and in some centers outnumber the traditional open approach. The aim of this study was to systematically review the literature on the safety of laparoscopic distal pancreatectomies (LDP) in relation to open distal pancreatectomies in the management of adult patients and, where possible, perform a meta-analysis of reported outcomes

Endoscopic retrograde cholangiopancreatography in Ayrshire, Scotland: a comparison of two age cohorts

Background and aims There is an increased trend in prevalence of pancreato-biliary disease in the elderly population. Consequently there is an increasing demand for endoscopic retrograde cholangiopancreatography (ERCP). The aims of this study were to compare ERCP outcomes in patients over 80 with those aged between 60 and 79 years and with the published literature.Methods and results Data were collected from a prospectively maintained database. All patients over the age of 60 years who underwent ERCP from May 2010 to May 2012 were identified. Two cohorts were formed, group A: 60–79 years (n = 66) and group B: > 80 years old (n = 49). Data on indications for ERCP, outcome, complications and repeat procedures were collected. One hundred and fifteen patients between the age of 60 and 92 years were identified. Group A had a total of 89 ERCPs and group B 69. Cannulation, overall procedure success, complication and mortality rates were comparable between both groups. Group B contained two cases of perforation with one associated mortality (1.4%) which did not reach statistical significance. Conclusions ERCP in octogenarians is safe and effective when compared to patients aged 60–79