-
Surgical Case Reports Jan 2020The cholecystohepatic duct is a rare form of an aberrant hepatic duct that connects to the gallbladder. Although cholecystohepatic duct is reported to be a very rare...
BACKGROUND
The cholecystohepatic duct is a rare form of an aberrant hepatic duct that connects to the gallbladder. Although cholecystohepatic duct is reported to be a very rare anomaly, injury of cholecystohepatic duct during cholecystectomy may result in serious complications. Herein, we present a case of cholecystohepatic duct in the ventral branch of the right posterior inferior segmental bile duct detected during laparoscopic cholecystectomy.
CASE PRESENTATION
A 77-year-old woman with cholecystolithiasis had been referred to our hospital for surgery. Drip infusion cholecystocholangiography-computed tomography revealed a bile duct branch without communication between the intra- and extrabiliary systems, although the existence of this aberrant hepatic duct was not suspected preoperatively. A 4-port laparoscopic cholecystectomy was performed. After critical view of safety was confirmed, the cystic artery and duct were divided after double clipping. During antegrade mobilization of the gallbladder from the gallbladder bed, a thin, white cord-like material connecting the gallbladder neck and bed was detected. After clipping and dividing it, a cholecystohepatic duct injury was recognized through rechecking the results of the preoperative examinations. Biliary reconstruction was considered unnecessary because of the lesion's small drainage area. The postoperative course was uneventful, and an enhanced computed tomography performed 6 months after the surgery revealed a dilation in the ventral branch of the right posterior inferior segmental bile duct. The patient's liver function remained normal, and she had no symptoms of cholangitis 42 months after the surgery.
CONCLUSIONS
Although cholecystohepatic duct is a rare anomaly compared to other aberrant hepatic ducts, surgeons performing cholecystectomy should always keep its existence in mind to avoid serious postoperative complications. Ideally, preoperative detection of cholecystohepatic duct is preferable, but even if it is detected during surgery, the appropriate management according to the drainage area is also important.
PubMed: 31932993
DOI: 10.1186/s40792-020-0786-3 -
Frontiers in Pharmacology 2022BK (KCa 1.1, Slo-1) is a K channel characterized by an allosteric regulation of the gating mechanism by Ca binding and voltage, and a high unitary conductance. The... (Review)
Review
BK (KCa 1.1, Slo-1) is a K channel characterized by an allosteric regulation of the gating mechanism by Ca binding and voltage, and a high unitary conductance. The channel is expressed in many different tissues, where it is involved in the regulation or the fine-tuning of many physiological processes. Among other organs, BK is expressed in the pancreatic duct, a part of the gland important for the correct ionic composition of the pancreatic juice. Unfortunately, the pancreatic duct is also the site where one of the deadliest cancer types, the pancreatic duct adenocarcinoma (PDAC), develops. In the past years, it has been reported that continuous exposure of cancer cells to BK openers can have a significant impact on cell viability as well as on the ability to proliferate and migrate. Here, we first summarize the main BK channel properties and its roles in pancreatic duct physiology. Then we focus on the potential role of BK as a pharmacological target in PDAC. Moreover, we discuss how results obtained when employing BK activators on cancer cells can, in some cases, be misleading.
PubMed: 35685628
DOI: 10.3389/fphar.2022.906608 -
Annals of Palliative Medicine May 2020The thoracic duct is an important anatomical structure of the abdomen, chest and neck. An accurate understanding of the anatomy of the thoracic duct is critical to...
The thoracic duct is an important anatomical structure of the abdomen, chest and neck. An accurate understanding of the anatomy of the thoracic duct is critical to ensuring the safety and accuracy of the surgical procedure involving these areas, which can help surgeons reduce accidental injuries and provide more accurate diagnosis and intervention for patients with serious complications such as chylothorax, etc. In addition, it has great reference value to know the anatomy of thoracic duct in advance for the selection of treatment strategies in the treatment of refractory pleural effusion and ascites, chylothorax, and heart failure. Therefore, it is of practical value to be able to perform in vivo lymphangiography before surgery. However, the slender thoracic duct, the hidden position and the complicated anatomical structure variations pose a great challenge to the safety and accuracy of the surgical operation. This paper aims at a comprehensive discussion about anatomic variation of thoracic duct and the development of imaging techniques.
Topics: Chylothorax; Humans; Lymphography; Pleural Effusion; Thoracic Duct
PubMed: 32279512
DOI: 10.21037/apm.2020.03.10 -
CVIR Endovascular Oct 2022Thoracic duct stenosis or obstruction is one of the causes of chyluria. Although the diagnosis of chyluria is not difficult, treatment is still challenging. Although...
BACKGROUND
Thoracic duct stenosis or obstruction is one of the causes of chyluria. Although the diagnosis of chyluria is not difficult, treatment is still challenging. Although there have been no standard guidelines for the treatment of chyluria, interventional techniques now offer minimally invasive treatment options for chyluria such as interstitial lymphatic embolization, ductoplasty with balloon, or thoracic duct stenting. CASE PRESENTATION : Here, we report a case of chyluria due to obstruction of the junction between the thoracic duct and subclavian vein in a 64 -year- old female patient. The patient was treated with balloon plasty for lymphovenous junction obstruction and interstitial lymphatic embolization for chyluria. However, chyluria was recurrent after 6 months so intranodal lymphangiography was performed. Anterograde thoracic duct was accessed through a transabdominal to the cisterna chyli which showed that the thoracic venous junction was re-obstruction. The patient was successfully treated by placing a uncovered drug-eluting stent with the size of 2.5 mm x 15 mm in length for resolving the thoracic occlusion.
CONCLUSION
This report demonstrates the feasibility of using thoracic duct stenting in the treatment chyluria due to lymphovenous junction obstruction.
PubMed: 36260143
DOI: 10.1186/s42155-022-00333-y -
Heliyon Nov 2022Pancreatic fistula/PF is a challenging surgical complication. We could recently show that intestinal bacteria such as colonize the PF fluid even after a "sterile"...
BACKGROUND
Pancreatic fistula/PF is a challenging surgical complication. We could recently show that intestinal bacteria such as colonize the PF fluid even after a "sterile" operation like distal pancreatectomy/DP. Therefore, we explored the bacterial flora of the human pancreatic duct in a patient collective undergoing pancreatic surgery.
METHODS
In this observational study, upon transection of the pancreas during surgery, a swab was inserted into the main duct, and the micro-organismal content was correlated with clinical characteristics.
RESULTS
Between February 2017 and February 2020, an intraoperative swab from the pancreatic duct was obtained from a total of 54 patients who underwent pancreatico-duodenectomy/PD or DP. The swabs were sterile in 39 cases (72.2%), detected intestinal bacteria in 10 cases (18.5%), and other bacteria in 5 cases (9.3%). There was no correlation of the micro-organismal content of the pancreatic duct swab with bacteria detected in the PF fluid or bile. Preoperative ERCP was associated with a higher frequency of bacterial colonization of the pancreatic duct (33.3% vs. 6.7%, = 0.005). There was no correlation of the pancreatic duct swabs with postoperative complications.
DISCUSSION
The human main pancreatic duct is usually sterile, and its bacterial colonization does not correlate with the occurrence of PF. Therefore, the mechanisms leading to infection of PF warrant in-depth, mechanistic investigation.
PubMed: 36468092
DOI: 10.1016/j.heliyon.2022.e11771 -
The Tokai Journal of Experimental and... Sep 2023Magnetic resonance thoracic ductography (MRTD), concomitant with blood vessel imaging, provides useful anatomical information. The purpose of this study was to assess...
OBJECTIVE
Magnetic resonance thoracic ductography (MRTD), concomitant with blood vessel imaging, provides useful anatomical information. The purpose of this study was to assess the visibility of the thoracic duct and blood vessels simultaneously by MRTD using balanced turbo-field-echo (bTFE) and turbo spin-echo (TSE).
METHODS
MRTDs concomitant with blood vessel imaging on bTFE and TSE were obtained for 10 healthy volunteers with a 1.5T-magnetic resonance unit. Visibility of the thoracic duct, blood vessels in the thoracic region; motion artifacts; and overall image quality were scored by two radiologists using three-to-five-point scales; those were compared between bTFE and TSE.
RESULTS
The thoracic duct was generally well-visualized on MRTD sequences. The upper part of the thoracic duct was better visualized on TSE than on bTFE ( < 0.05). The blood vessels were well visualized on bTFE and TSE; the bilateral subclavian arteries and the right subclavian veins were better visualized on TSE than on bTFE (all < 0.05). Motion artifacts and overall image quality were better on TSE than on bTFE ( = 0.0039 and 0.0020, respectively).
CONCLUSION
MRTD concomitant with blood vessel imaging on TSE has better visibility of the thoracic duct and blood vessels than bTFE.
Topics: Humans; Thoracic Duct; Magnetic Resonance Imaging; Mammography
PubMed: 37635071
DOI: No ID Found -
Frontiers in Endocrinology 2022and encode distal-less homeodomain transcription factors that are present in the genome as a linked pair at a single locus. and have redundant roles in craniofacial,...
and encode distal-less homeodomain transcription factors that are present in the genome as a linked pair at a single locus. and have redundant roles in craniofacial, skeletal, and uterine development. Previously, we performed a transcriptome comparison for anti-Müllerian hormone (AMH)-induced genes expressed in the Müllerian duct mesenchyme of male and female mouse embryos. In that study, we found that transcripts were nearly seven-fold higher in males compared to females and transcripts were found only in males, suggesting they may be AMH-induced genes. Therefore, we investigated the role of and during AMH-induced Müllerian duct regression. We found that was detected in the male Müllerian duct mesenchyme from E14.5 to E16.5. In contrast, in female embryos was detected in the Müllerian duct epithelium. expression in Müllerian duct mesenchyme was restricted to males. expression was not detected in female Müllerian duct mesenchyme or epithelium. Genetic experiments showed that AMH signaling is necessary for and expression. Müllerian duct regression was variable in homozygous mutant males at E16.5, ranging from regression like controls to a block in Müllerian duct regression. In E16.5 homozygous mutants, Müllerian duct tissue persisted primarily in the region adjacent to the testes. In double homozygous mutant males Müllerian duct regression was also found to be incomplete but more severe than either single mutant. These studies suggest that and act redundantly to mediate AMH-induced Müllerian duct regression during male differentiation.
Topics: Animals; DNA-Binding Proteins; Female; Genes, Homeobox; Homeodomain Proteins; Male; Mice; Mullerian Ducts; Sex Differentiation; Transcription Factors
PubMed: 35909540
DOI: 10.3389/fendo.2022.916173 -
Tissue Engineering. Part A Sep 2022Although choledochojejunostomy is the standard technique for biliary reconstruction, there are various associated problems that need to be solved such as reflux...
Although choledochojejunostomy is the standard technique for biliary reconstruction, there are various associated problems that need to be solved such as reflux cholangitis. Interposition with an artificial bile duct (ABD) to replace the resected bile duct maintains a physiological conduit for bile and may solve this problem. This study investigated the usefulness of an ABD made of gelatin hydrogel nonwoven fabric (GHNF). GHNF was prepared by the solution blow spinning method. The migration and activity of murine fibroblast L929 cells were examined in GHNF sheets. L929 cells migrated into GHNF sheets, where they proliferated and synthesized collagen, suggesting GHNF is a promising scaffold for bile duct regeneration. ABDs made of GHNF were implanted in place of resected bile duct segments in rats. The rats were killed at 2, 6, and 12 weeks postimplantation. The implantation site was histologically evaluated for bile duct regeneration. At postoperative 2 weeks, migrating cells were observed in the ABD pores. The implanted ABD was mostly degraded and replaced by collagen fibers at 6 weeks. Ki67-positive bile duct epithelial cells appeared within the implanted ABD. These were most abundant within the central part of the ABD after 6 weeks. The percentages of Ki67-positive cells were 31.7 ± 9.1% in the experimental group and 0.8 ± 0.6% in the sham operation group at 6 weeks ( < 0.05), indicating that mature biliary epithelial cells at the stump proliferated to regenerate the biliary epithelium. Biliary epithelial cells had almost completely covered the bile duct lumen at 12 weeks (epithelialization ratios: 10.4 ± 6.9% at 2 weeks, 93.1 ± 5.1% at 6 weeks, 99.2 ± 1.6% at 12 weeks). The regenerated epithelium was positive for the bile duct epithelium marker cytokeratin 19. Bile duct regeneration was accompanied by angiogenesis, as evidenced by the appearance of CD31-positive vascular structures. Capillaries were induced 2 weeks after implantation. The number of capillaries reached a maximum at 6 weeks and decreased to the same level as that of normal bile ducts at 12 weeks. These results showed that an ABD of GHNF contributed to successful bile duct regeneration in rats by facilitating the cell migration required for extracellular matrix synthesis, angiogenesis, and epithelialization. Impact Statement Development of an artificial bile duct (ABD) enables physiological biliary reconstruction and may solve clinical problems associated with choledochojejunostomy. In this study, we created ABDs with gelatin hydrogel nonwoven fabric and implanted them in place of resected bile duct in rats. We evaluated the process of bile duct regeneration as well as decomposition of the ABD and demonstrated successful regeneration of resected bile duct, highlighting the possibility of this novel biliary reconstruction method to replace choledochojejunostomy.
Topics: Animals; Bile Ducts; Collagen; Gelatin; Hydrogels; Ki-67 Antigen; Mice; Rats; Regeneration
PubMed: 35383474
DOI: 10.1089/ten.TEA.2021.0209 -
European Journal of Histochemistry : EJH Oct 2020Cholangiocarcinoma (CCA) represents the second most common primary hepatic malignancy and originates from the neoplastic transformation of the biliary cells. The...
Cholangiocarcinoma (CCA) represents the second most common primary hepatic malignancy and originates from the neoplastic transformation of the biliary cells. The intrahepatic subtype includes two morpho-molecular forms: large-duct type intrahepatic CCA (iCCA) and small-duct type iCCA. Iron is fundamental for the cellular processes, contributing in tumor development and progression. The aim of this study was to evaluate iron uptake, storage, and efflux proteins in both lipopolysaccharide-inflamed small and large cholangiocytes as well as in different iCCA subtypes. Our results show that, despite an increase in interleukin-6 production by both small and large cholangiocytes, ferroportin (Fpn) was decreased only in small cholangiocytes, whereas transferrin receptor-1 (TfR1) and ferritin (Ftn) did not show any change. Differently from in vitro models, Fpn expression was increased in malignant cholangiocytes of small-duct type iCCA in comparison to large-duct type iCCA and peritumoral tissues. TfR1, Ftn and hepcidin were enhanced, even if at different extent, in both malignant cholangiocytes in comparison to the surrounding samples. Lactoferrin was higher in large-duct type iCCA in respect to small-duct type iCCA and peritumoral tissues. These findings show a different iron handling by inflamed small and large cholangiocytes, and small and large-duct type iCCA. The difference in iron homeostasis by the iCCA subtypes may have implications for the tumor management.
Topics: Aged; Aged, 80 and over; Antigens, CD; Bile Duct Neoplasms; Bile Ducts; Cation Transport Proteins; Cholangiocarcinoma; Epithelial Cells; Ferritins; Hepcidins; Humans; Iron; Middle Aged; Receptors, Transferrin
PubMed: 33131269
DOI: 10.4081/ejh.2020.3156 -
Acta Gastro-enterologica Belgica 2020Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive modality, and has a high risk of causing post-ERCP pancreatitis (PEP). Risk factors of PEP have been...
BACKGROUND AND AIMS
Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive modality, and has a high risk of causing post-ERCP pancreatitis (PEP). Risk factors of PEP have been investigated and conflicting results are present for most risk factors. The aim of this study was to evaluate the risk factors for PEP and to determine whether the risk factors differ due to the ERCP indication.
PATIENTS AND METHODS
A retrospective study was conducted which included 666 patients with 968 ERCP procedures. Some risk factors were evaluated for PEP, and they were also evaluated separately for patients with bile duct stones and patients who underwent ERCP for other reasons than bile duct stones.
RESULTS
In patients with bile duct stones detected on ERCP ; female gender, lower diameter of the common bile duct, placing a biliary plastic stent and not having a cholecystectomy history were risk factors for PEP, whereas in patients without bile duct stones the only risk factor for PEP was not having a prior endoscopic sphincterotomy.
CONCLUSIONS
Our study revealed that PEP risk factors depend on the indication of ERCP. To the best of our knowledge our study is the first study defining cholecystectomy as a protective factor for PEP in patients with bile duct stones and endoscopic sphincterotomy history as a protective factor for PEP in patients without bile duct stones. Our study also showed that female gender, lower diameter of the common bile duct and placing a plastic biliary stent were risk factors for PEP in patients with bile duct stones.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Female; Humans; Pancreatitis; Retrospective Studies; Risk Factors; Sphincterotomy, Endoscopic
PubMed: 33321017
DOI: No ID Found