Duct Infection Research Articles

Radical surgery for highly advanced gastric cancer with direct invasion to transverse colon, splenic serosa, and pancreas inducing pancreatic duct infection: A case report

Background: According to the GLOBOCAN 2020 results, gastric cancer is the fifth most commonly diagnosed cancer, and fourth most common cause of cancer death worldwide. An estimated 6-27% of patients with gastric cancer show invasion of the adjacent organs at diagnosis. In a previous study, curative resection was shown to significantly improve the prognosis of patients without peritoneal or liver metastases. Herein, we present a case of gastric cancer with invasion of the adjacent organs in a patient who underwent curative surgery. Case presentation: An 80-year-old woman presented with body weight loss and slight fever. Upper gastrointestinal endoscopy revealed Borrmann type 3 gastric cancer extending from the gastric fundus to the corpus. Contrast-enhanced computed tomography (eCT) revealed extensive invasion of the gastric cancer into the transverse colon and pancreas. The eCT also revealed gas in the pancreatic duct, indicating that the gastric lumen was connected to the pancreatic duct because of the tumor. We performed en-bloc tumor resection via total gastrectomy with D2 lymph node dissection, distal pancreatectomy, and partial colectomy. The patient was postoperatively diagnosed with T4b (SI: pancreatic, transverse colon, and splenic serosa), N0 Stage IIIA gastric cancer. The histological type was poorly differentiated adenocarcinoma. Adjuvant chemotherapy was initiated two months after surgery, but was continued for only two months because of severe adverse events. Two years after surgery, the patient remains well. Conclusion: Advanced gastric cancer with extensive invasion of the adjacent organs but no distant metastasis can be treated with en-bloc tumor resection.

Nipple Temperatures in Breast Thermography

Objective: Since the advent of microbolometer infrared imagers that allow qualitative and quantitative nipple temperature assessment, peer-reviewed guidelines have stated that normal differential nipple temperatures should not exceed 1.0 °C. This study is designed to examine the validity of this and other nipple temperature measurements in a clinical breast thermography population. Methods: 211 women between 27 and 83 years of age underwent standard breast thermography. Images of 422 breasts were taken and analyzed. Average area temperatures were obtained for both the breasts and nipples. Besides analyzing the combined data from all subjects, three subsets of data with different Thermobiological (TH) evaluations and a subset of women with bilateral breast implants were analyzed. Results: Absolute breast temperature declined about 1°C from age 27 to 83. Nipple temperature was unaffected by age. A strong correlation was found between ipsilateral breast and nipple temperatures. Nipple temperatures were cooler than the breast in 93.8% of 422 samples. Nipple temperature increased relative to the breast temperature as the TH evaluation increased. Average right breast and nipple temperatures were warmer than the Left in all data sets. Nipple temperature difference tends to rise faster than breast temperature difference. As the TH evaluation increased, differential breast temperatures remained constant while nipple differentials increased. Women with breast implants were found to have the least variation in breast and nipple temperatures. Conclusions: Normal nipple temperature is less than breast temperature by an average of 1.1°C. A cutoff value for maximum nipple temperature difference is graphically confirmed to be 1.0 °C. Maximum breast temperature difference cutoff is 0.5°C, and a vector sum of these differences should be less than 1.5°C. Nipple temperatures are controlled by sympathetic neural tone and by local nitric oxide concentration. Lactiferous duct infection and intraductal tumors (DCIS) increase intraductal NO, which is directed up the duct to the nipple. Increased nipple temperature may signal the presence of breast pathology.

Evaluation of Blood and Biliary Drainage Cultures and Mortality after Percutaneous Transhepatic Biliary Drainage Procedure

Introduction: Bacteremia and bile duct infection following percutaneous transhepatic biliary drainage (PTBD) are severe complications. Thus, the aim of this study was to investigate the risk factors of mortality and to evaluate the differences between blood and biliary drainage culture positive patients after PTBD. Materials and Methods: This is a retrospective study of 90 patients without any signs of infection prior to the PTBD procedures. Of these patients, we further divided them into three groups based on culture results: 1) first group was only bacteremic, 2) second group was only bile drainage culture-positive, and 3) third group was both bacteremic and bile drainage culture-positive. We compared clinical and laboratory parameters between these three groups and also evaluated the culture results in a high-resistance setting. Results: There were 90 patients who developed bacteremia, bile duct infections or both. In the laboratory findings, bacteremic patients showed significantly higher serum level of alanine aminotransferase (ALT) (p=0.001). Elevated neutrophil counts, lipase levels and carbapenem-resistant isolates were found to be the independent risk factors for 30-day mortality after PTBD. (p=0.01, p=0.01, and p=0.04, respectively). Gram-negative organisms were present in 71.2% of the cases; Escherichia coli was the most common species (28.1%) followed by Enterococcus faecium (18.1%), Klebsiella pneumoniae (15.8%) and Pseudomonas aeruginosa (9.9%). 51 (41.8%) of the cultured gram-negative bacteria were extended spectrum beta-lactamases positive and carbapenem resistance was found in 27 (15.8%) isolates. Conclusion: Elevated ALT level was only difference between three groups. Therefore, bacteremic and bile culture positive patients should be treated with the same care. Elevated neutrophil counts, lipase levels and carbapenem-resistant isolates were the independent risk factors for mortality. Finally, the choice of antibiotic prophylaxis should be reviewed according to the antimicrobial resistance profiles.

Duct Infection Prevention Counseling Acute Breathing

Infeksi Saluran Pernafasan Akut (ISPA) merupakan penyakit yang paling sering dilaporkan ke pelayanan kesehatan. Organisasi Kesehatan Dunia (WHO) memperkirakan kejadian Infeksi Saluran Pernafasan Akut (ISPA) di negara berkembang dengan angka kematian balita di atas 40 per 1000 kelahiran hidup adalah 15%-20% per tahun pada kelompok usia balita. Menurut siapa ± 13 juta anak balita meninggal setiap tahun dan sebagian besar kematian tersebut berada di negara berkembang ISPA merupakan salah satu penyebab utama kematian membunuh ± 4 juta anak balita setiap tahun. Tujuan dari The Devotion adalah untuk meningkatkan pengetahuan masyarakat tentang pencegahan ISPA. Metode yang digunakan adalah sosialisasi dengan mengadakan penyuluhan.Pelaksanaan Pengabdian ini di Puskesmas Kapas Kota Makassar dengan jumlah peserta sebanyak 34 ibu-ibu. Dari hasil ekstensi tersebut,

A Case of Extramedullary Plasmacytoma of the Biliary Tract with a Poor Prognosis

Extramedullary plasmacytoma (EMP) is a rare disease consisting of the presence of monoclonal plasma cells in tissues other than the bone. Most EMPs are located in the head and neck region. We present an extremely rare case of an EMP originating from the biliary tract in a 76-year-old male. This is the fifth report of a primary EMP arising from the biliary tract. He was diagnosed with jaundice, and he was referred for an additional examination. Abdominal ultrasonography revealed a tumor in the gallbladder and bile ducts, and a bile duct biopsy was performed via endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The pathological and immunohistochemical examination revealed that the tumor was a plasmacytoma originating in the biliary tract. Although endoscopic biliary drainage was performed, the bile duct infection was not well controlled due to obstructive jaundice caused by the tumor. Furthermore, the bleeding from the tumor during chemotherapy was uncontrolled. Pancreaticoduodenectomy and cholecystectomy were performed to control the infection and bleeding. Although chemotherapy was continued after surgery, the tumor of the intrahepatic bile duct enlarged. He died seven months after the diagnosis because of the treatment-resistant tumor.

Impact of Early Versus Late Approach on the Management of Acute Cholangitis in an Ecuadorian Level-4 Health Center

Introduction: Acute cholangitis is a bile duct inflammation and infection resulting from complete or partial obstruction due to different etiologies, including gallstones, malignant occlusion, etc. Clinical presentation includes intermittent fever with chills, right upper quadrant pain, and jaundice. With advances in minimally invasive techniques such as endoscopic techniques, the prognosis has improved in the last 30 years with a current mortality of 2.7 to 10%. Objective: compare the impact of the early versus late approach in the management of acute cholangitis according to the TG in patients admitted to the General Surgery Department of Luis Vernaza Hospital during 2018 to 2020. Methodology: Observational, retrospective, comparative and analytical study. Data was obtained from electronic medical records, organized using Microsoft Excel ®, and analyzed using SPSS 25.0 ®. Chi-square or Fisher's test were applied to compare the clinical characteristics by type of approach or severity scale. Statistical significance was established for p- value <0.05. Results: Ninety-eight patients were included, female: 54.08%. Grade II (moderate) cholangitis was the most frequent (64.29%). The main approach for biliary drainage was endoscopic (ERCP) (57.14%). A late approach (> 48 hours since hospital admission) was seen in 69.4%. Mortality by type of approach presented significant differences (p = 0.029): 0% with early approach vs. 14.71% with the late approach. Discussion: Patients with acute cholangitis were mainly approached late for biliary decompression; a worrying fact since it demonstrates non- compliance of fundamental TG recommendations were early or urgent bile duct decompression is described as a mainstay in acute cholangitis. Conclusions: Hospital stay was directly proportional to the type of approach (early or late). Mortality was higher in patients who underwent a late approach, and directly proportional to the severity. An early approach should always be preferred.

Increasing Living Liver Donor Pools: Liver Paired Exchange Versus ABO-incompatible Living Donor Liver Transplantation.

Increasing Living Liver Donor Pools: Liver Paired Exchange Versus ABO-incompatible Living Donor Liver Transplantation.

Factors related to stent patency and early elimination of jaundice using bile duct stent combined with iodine-125 seed implantation in malignant obstructive jaundice.

Biliary stents combined with percutaneous or endoscopic ultrasound-guided iodine-125 seed implantation into primary tumor have been confirmed to relieve malignant obstructive jaundice (MOJ), and prolong patient's stent patency. The aim of the study was to evaluate meaningful clinical application indications and better guide the application of this technology. Patients with MOJ, who have received bile duct stenting combined with iodine-125 (125I) seed implantation from October, 2010 to April, 2022, were retrospectively analyzed. Univariate and multivariate analyses were adopted to indicate factors of stent patency in MOJ and influencing factors of jaundice reduction at one week after surgery. A total of 90 patients were enrolled into the study, including 52 males (57.8%) and 38 females (42.2%), with a mean age of 68.66 ±12.53 years. The median stent patency was 8 months. No serious adverse events occurred during follow-up. Multivariate analysis showed that Child-Pugh score (HR = 2.221, 95% CI: 1.081-4.562), biliary infection (HR = 1.901, 95% CI: 1.084-3.335), and pre-operative jaundice duration (HR = 1.977, 95% CI: 1.106-3.533) were the independent risk factors for stent patency. Child-Pugh B/C (OR = 4.647, 95% CI: 1.080-19.982) and bile duct infection (OR = 3.583, 95% CI: 1.095-11.725) were the independent risk factors for jaundice reduction at one week after surgery. MOJ patients treated with biliary stents combined with 125I seed implantation, and patients with better pre-operative liver function and no biliary tract infection, present not only longer biliary stent patency, but also better early jaundice reduction.

Imbalanced immunobiological reactivity, infection and mutagenesis factors in the hepatobiliary system affected by a natural focal habitat factor — a trematode invasion by <i>Opisthorchis felineus</i>

An interaction between decreasing host anti-infective defense due to long-term invasion with Opisthorchis felineus in the hepatobiliary system, duct bile colonization by microflora and revealing the endogenous mutagenesis (carcinogenesis) factor in bile — secondary bile acids — is considered in the article. The role of organism genotype in pathogen-related immune response to Opisthorchis felineus trematode and helminth development in the hepatobiliary system has been shown. The role of dysregulated mechanisms of tissue homeostasis in induction of compensatory chronic homeostatic proliferation and somatic cell oncogenesis is discussed. The study results evidence that disturbed functioning of regulatory T cells, inhibition of the NK cell effector function and very high functional activity of memory B cells are of great importance in imbalanced host immunobiological reactivity, caused by chronic opistorchis invasion. Decreased host anti-infective protection causes intrahepatic bile duct infection with different bacterial species. Presence of secondary bile acids in hepatobiliary system was associated with biliary bacterial strains inhabiting intestinal tract: Proteus vulgaris, Proteus mirabilis, Citrobacter freundii, Bacteroides alcaligues faecalis, Clostridium, Streptococcus faecalis, Еscherichia coli — gut microflora agents. Participation of microbiota in bile acid biotransformation immediately in the duct bile has been confirmed in experiments in vitro. Experimental methods on Drosophila melanogaster and Salmonella typhimurium strains: TA100, TA98 allowed to find out that bile from chronic opistorchiasis patients exerts higher mutagenic activity compared to control groups. Mutational events in somatic and bacterial cells depend on the presence of secondary bile acids (deoxycholic, lithocholic) in duct bile, as well as the level of total bile acid concentration. The study data confirm the concept by Professor A.A. Shain about the presence of endogenous risk factor for developing primary cholangiocellular liver cancer such as secondary bile acids in the bile of chronic opistorchiasis patients. A concept of cholangiocarcinogenesis, based on mutational events, is added up with disturbance of generative cycle in tissue cells and their differentiation due to decreased chalone factor activity, as well as sensitivity threshold to it. Level of investigation and understanding of mechanisms underlying cholangiocarcinogenesis during chronic opisthorchis invasion will allow to develop pathogenetic approaches to correct homeostasis regulation and prevention of cholangiocarcinomas.

S1005 Meta-Analysis and Systematic Review of Pancreatic Stents in Preventing Post-ERCP Pancreatitis

Introduction: Pancreatitis is a common and potentially devastating complication of ERCP. Prior studies have shown that prophylactic pancreatic duct stent (PS) placement may be effective to reduce post-ERCP pancreatitis (PEP) in high-risk patients, such as patients with sphincter of Oddi dysfunction or prior history of pancreatitis. However, prior meta-analyses are missing relevant studies both contemporaneously and since published. We aim to perform a comprehensive analysis comparing PS placement to no PS placement to prevent PEP in high-risk patients. Methods: In conjunction with a health sciences librarian, Ovid Medline, Embase and Embase Classic, Cochrane Library, and Web of Science were searched from inception to March 26, 2021. Randomized controlled trials that directly compared PS placement versus no PS placement in preventing PEP were included. Our primary outcome was the incidence of PEP. Additional outcomes included incidence of mild PEP, moderate PEP, and severe PEP, as well as the incidence of adverse outcomes including hemorrhage, infection, and pancreatic duct perforation. Quantitative data was harmonized using random effects models. Results: The search yielded 1,668 citations, 444 of which were removed as duplicates. Each study was assessed by two reviewers. 116 articles were selected for full text review, and eighteen randomized controlled trials were identified of pancreatic stent placement to prevent post-ERCP pancreatitis. In sum, 1,295 patients were assigned to pancreatic stent prophylaxis and 1,299 to no stent placement. There was a significant reduction in odds of PEP in the PS group (Figure 1, OR 0.36 [95% CI 0.28-0.46]). In addition, PS placement was strongly protective against severe pancreatitis (Table 1, OR 0.25 [95% CI 0.07-0.81]). Stent placement was successful in 98% of cases (95% CI 95-100) and there was no difference in pancreatic duct perforation, bleeding, or infection (Table 1). Conclusion: Pancreatic stent placement is an effective intervention to reduce the incidence of PEP in high-risk patients. Further, pancreatic stent placement is particularly effective against the severe forms of PEP. There is no significant difference in major non-pancreatitis adverse events for pancreatic stent placement compared to no stent placed.Figure 1.: a. Kaplan-Meier (KM) survival curves of time to hospital utilization for inpatients undergoing ERCP, stratified by ASGE 2011 complexity score Figure 1b. Post-hoc analysis of KM survival curve for inpatients undergoing ERCP, ASGE 2011 grade 1 versus 4 Figure 1c. Post-hoc analysis of KM survival curve for inpatients undergoing ERCP, ASGE 2011 grade 2 versus 4 Figure 1d. Post-hoc analysis of KM survival curve for inpatients undergoing ERCP, ASGE 2011 grade 3 versus 4.Table 1.: Odds Ratio of Major Outcomes With Pancreatic Stent Placement ERCP = endoscopic retrograde cholangiopancreatography, PS = pancreatic duct stent, OR = odds ratio, CI = confidence interval.

Related factors for bile duct infection after surgical treatment of biliary dilatation

Objective: To analyze the related factors of bile duct infection in patients with biliary dilatation in the short and long term after operation. Methods: The data of the patients with biliary dilatation admitted in Peking Union Medical College Hospital between May 2012 and October 2020 were analyzed retrospectively. A total of 121 patients were enrolled in the study. There were 21 males(17.4%) and 100 females(82.6%),with age of (40.5±15.3) years(range: 18 to 80 years). Short-term infection was defined as bile duct infection occured within 30 days after operaion; long-term infection was defined as bile duct infectiion occured 30 days after operation The relationship between bile duct infection and clinicopathologic biliary dilatation features were analyzed using univariate and multivariate analyses. Results: There were 85 (70.2%),1 (0.8%), 32 (26.4%) and 3 (2.5%) patients with Todani type Ⅰ,Ⅲ,Ⅳ and Ⅴ, respectively. The mean follow-up time was (55.2±28.6) months (range: 1 to 101 months). There were 18 and 37 patients had short-term and long-term bile duct infection after surgery,respectively. Postoperative complications occurred in 18 patients and included ascites(n=6),biliary fistula(n=4),pancreatic fistula(n=2),gastroparesis (n=2),pleural effusion(n=1),abdominal infection(n=1),non-healing wound(n=1),and pancreatitis(n=1). Univariate analysis showed that preoperative history of bile duct infection,hilar anastomosis and Todani types were related factors for short-term bile duct infection,and postoperative complication was a related factor for long-term bile duct infection. Multivariate analysis showed that hilar anastomosis(OR=6.228,95%CI: 1.884-20.586,P=0.003) and preoperative history of bile duct infection(OR=3.701,95%CI: 1.137-12.043,P=0.030) were independent related factors for short-term bile duct infection after biliary dilatation operation,and age ≥45 years (OR=2.261,95%CI:1.004-5.093,P=0.049) and postoperative complication (OR=3.131,95%CI:1.094-8.958,P=0.033) were independent related factors for long-term bile duct infection after biliary dilatation operation. Conclusions: Hilar anastomosis and preoperative history of bile duct infection are independent related factors for short-term bile duct infection after biliary dilatation operation,and ≥45 years old and postoperative complication are independent related factors for long-term bile duct infection after biliary dilatation operation.

Identification of bacterial isolates from nasolacrimal duct infection in children with congenital nasolacrimal duct obstruction from Feiz teaching hospital, Isfahan

Dacryocystitis is a lacrimal sac and duct inflammation. It can be inherited or congenital. Two primary forms are acquired dacryocystitis, acute and chronic. The goal of this study is to recognize common bacteria causing nasolacrimal duct infection in children with congenital nasolacrimal duct obstruction and to determine their antimicrobial susceptibility profiles. This cross-sectional research was conducted from January to February 2017 in the Department of Ophthalmology affiliated to Isfahan University of Medical Sciences (center of Iran). Using phenotypic and genotypic approaches, identification of specimens was performed. Disc diffusion method was used for checking antibiotic susceptibility. All of the 59 isolates from the culture of specimens belonged to Gram-positive cocci. Staphylococcus epidermidis was the predominant species (n= 44, 74.6%) followed by Staphylococcus aureus (n= 11, 18.6%), Staphylococcus haemolyticus (n= 2, 3.4%) and each of Staphylococcus saprophyticus , and Streptococcus pneumoniae (n= 1, 1.7%). Totally, the highest resistance was found against erythromycin and tetracycline while, chloramphenicol, and ciprofloxacin showed the highest susceptibility. The current research is useful in evaluating the suitable antibiotic in our area for the systemic treatment of dacryocystitis. The most effective agents against the most common isolates were chloramphenicol and ciprofloxacin. Since the bacteriology of nasolacrimal duct infections varies from region to region, it is recommended that further studies in other areas of our country can be detected the etiology of bacterial pathogens involved in acute infections.

A Rare Case of Giant Dacryocystomucopyocele

Chronic dacryocystitis is frequently caused by Naso Lacrimal Duct (NLD) infection or obstruction. Mucocele is formed when chronic stagnation of tears occurs in the lacrimal sac. When mucocoele gets infected with pyogenic organisms, pyocele is formed. Proximal obstruction in mucopyocele causing encysted dacryocystomucopyocele presenting as an enormous swelling is very uncommon. Very few cases of giant encysted dacryocystomucopyocele are reported in literature. The authors report a 42-year-old male with an acquired, enormous dacryocystomucopyocele, which developed over only one and half years and produced upward displacement of the lower lid and mechanical obstruction for eye closure. Computed tomography of orbit and paranasal sinuses was done to confirm the diagnosis and find out the extent of cyst. Complete surgical excision of the cyst was performed. There was no recurrence of the swelling at last follow-up at 1 year.

The Existence of Periodontal Disease and Subsequent Ocular Diseases: A Population-Based Cohort Study.

Background and objectives: We aimed to evaluate the correlation between periodontal disease (PD) and following ocular diseases via the National Health Insurance Research Database in Taiwan. Materials and Methods: A retrospective cohort study was conducted. Subjects were regarded as having PD according to the diagnostic codes. For comparison, each subject with PD was matched to one non-PD individual from the database after exclusion. The main outcome was defined as the development of infectious keratitis, endophthalmitis, orbital cellulitis, lacrimal duct infection, uveitis and infectious scleritis. Cox proportional hazard regression was used to yield the adjusted hazard ratios (aHR) of ocular diseases between the study and control groups. Results: A total of 426,594 subjects were enrolled in both the study and control groups. In the multivariable analysis, significantly higher rates of infectious keratitis (aHR: 1.094, 95% CI: 1.030–1.161), uveitis (aHR: 1.144, 95% CI: 1.074–1.218) and infectious scleritis (aHR: 1.270, 95% CI: 1.114–1.449) were found in the study group. Concerning the PD interval, infectious keratitis (aHR: 1.159, 95% CI: 1.041–1.291) and infectious scleritis (aHR: 1.345, 95% CI: 1.055–1.714) would significantly occur in PD patients with an interval shorter than two years, individuals with a PD interval that ranged from two to five years were under a higher risk of developing uveitis (aHR: 1.184, 95% CI: 1.065–1.315) and infectious scleritis (aHR: 1.386, 95% CI: 1.125–1.708), and the rate of uveitis (aHR: 1.149, 95% CI: 1.038–1.272) was significantly higher if PD persisted more than five years. Conclusions: The presence of PD was moderately associated with the risk of developing infectious keratitis, uveitis and infectious scleritis.

Acute obstructive suppurative pancreatic ductitis in pancreatic malignancies.

Background and study aims Acute obstructive suppurative pancreatic ductitis (AOSPD) is a suppurative pancreatic duct infection with main pancreatic duct (MPD) or accessory pancreatic duct obstruction in the absence of a pancreatic pseudocyst or necrosis, which is experienced usually in chronic pancreatitis. The diagnosis is confirmed by the finding of pancreatic duct obstruction on endoscopic retrograde cholangiopancreatography (ERCP) with evidence of infection, such as a positive pancreatic juice culture or drainage of purulent pancreatic juice. Patients and methods We studied five patients with pancreatic ductal adenocarcinoma (PDAC) and one with chronic myelogenous leukemia (CML), who suffered from AOSPD. Results Of the 281 PDAC and 39 CML patients who we treated in the past 2 years in our hospital, five with PDAC (1.8 %) and one with CML (2.6 %) experienced AOSPD. Each patient had fever, abdominal pain, and increased blood C-reactive protein. Pancreatography found that each patient had a MPD stricture and an upstream dilatation. Four had a disruption of the MPD in the upper stream of the stricture. Nasopancreatic drainage was successfully performed in all patients. Pancreatic juice culture was positive for Klebsiella pneumonia, Enterobacter agerogenes, or Enterococcus cloacae in four patients. Conclusion AOSPD should be considered in pancreatic malignancy with fever and abdominal pain. Prompt diagnosis of AOSPD could avoid shortening of survival of patients with an already poor prognosis by infection.

Subtotal (segment II\u2013VIII) hepatectomy for bilateral diffuse hepatolithiasis with compensatory caudate lobe hypertrophy: a report of two cases

BackgroundHepatolithiasis often leads to atrophy–hypertrophy complex due to bile duct obstruction, inflammation or infection in the affected liver segments and compensatory response in the normal segments. In severe bilateral diffuse cases, main liver can all be atrophic, leaving the caudate lobe to be extremely hypertrophic. Subtotal (segment II–VIII) hepatectomy can be an option in selected patients under such circumstances. Since rare cases have been reported, our study aims to highlight the preoperative evaluation and key points of this procedure.Case presentationTwo patients with primary and secondary bilateral diffuse hepatolithiasis, respectively, were enrolled in this case series. The atrophy of the left and right liver with an exceeding hypertrophy of the caudate lobe were observed. Since the liver anatomy had completely been changed, contrast computed tomography, magnetic resonance imaging combined with 3D liver reconstruction were employed for comprehensive evaluation and pre-operational planning. The patients underwent standard subtotal (segment II–VIII) hepatectomy. During operation, the hepatoduodenal ligament around porta hepatis was dissected firstly to expose the hepatic artery, portal vein, bile duct and their branches successively. And then the vessels and bile duct to caudate lobe were preserved safely through cutting off the left and right hepatic artery, portal vein and bile duct at a safe point distal to the origin of the branches to caudate lobe. Operation time was 300 min and 360 min, respectively. Blood loss was 200 ml and 300 ml. No evidence of liver dysfunction, hepatolithiasis relapse or cholangitis was observed during the follow-up of 12 and 26 months.ConclusionsSubtotal (segment II–VIII) hepatectomy may be one of several treatments possible in selected patients with compensatory caudate lobe hypertrophy caused by bilateral diffuse hepatolithiasis.

Postsurgical Management of Dilated Biliary Tract in Children: Ultrasound-Guided Percutaneous Transhepatic Cholangial Drainage and Subsequent Percutaneous Ultrasound Cholangiography.

OBJECTIVE. The purpose of this study was to evaluate the feasibility of ultrasound (US)-guided percutaneous transhepatic cholangial drainage (PTCD) and consequent percutaneous US cholangiography in managing the dilated biliary tracts of children who have undergone hepatobiliary surgery. SUBJECTS AND METHODS. Sixteen children (11 boys, five girls; age range, 3-144 months) who underwent hepatobiliary surgery from December 2016 to October 2018 and had US evidence of biliary dilatation were included. All patients had undergone US-guided PTCD because of elevated postoperative serum bilirubin levels or bile duct infection. Immediately after the PTCD procedure, diluted sulphur hexafluoride microbubbles dispersion was injected through the PTCD tube to evaluate the anastomosis and the intrahepatic bile duct tree. Laboratory results, including those of serum bilirubin measurement, liver function tests, and routine blood tests, were evaluated before and after PTCD. Nine of 16 patients also underwent percutaneous transhepatic cholangiography (PTC). The percutaneous US cholangiography findings were evaluated and compared with the PTC findings. RESULTS. Liver enzyme levels decreased after PTCD with a statistically significant difference from the values before PTCD. Percutaneous US cholangiography showed that the anastomosis in 6 of the 16 patients (37.5%) was patent and depicted the morphologic featuresof intrahepatic bile duct tree in five of these patients. In the other 10 patients, the anastomosis was completely obstructed, and percutaneous US cholangiography depicted the morphologic features of intrahepatic bile duct tree in eight patients. In the nine patients who underwent PTC, the percutaneous US cholangiographic findings were the same as the PTC findings. CONCLUSION. US-guided PTCD is helpful in relieving jaundice and inflammation in children who have undergone hepatobiliary surgery and have biliary dilatation. Findings at consequent percutaneous US cholangiography are comparable to those of PTC in depicting the anastomosis in these patients.

Prelacrimal versus canine fossa approach for anterior maxillary sinus lesions

Introduction Extensive disease in the maxillary sinus is difficult to clear with standard instrumentation during traditional endoscopic sinus surgery, so access to the anterior and anterolateral walls of the maxillary sinus is often difficult despite the creation of a large maxillary antrostomy or the use of adjuvant surgical procedures such as canine fossa puncture to gain improved access and allow for good debridement of maxillary sinus. Objective To study the outcome of prelacrimal approach compared with canine fossa approach (CFA) for surgical treatment of anterior maxillary sinus diseases. Patients and methods A randomized prospective clinical study, in which 40 patients with recurrent anterior maxillary sinus lesion were divided into two equal groups: group I included 20 patients who underwent endoscopic prelacrimal recess approach (PLRA), and group II included 20 patients who underwent endoscopic CFA. Patients were evaluated between February 2018 and October 2019. The two groups were compared regarding facial pain, facial numbness, cheek swelling, nasal obstruction, epiphora, inferior turbinate destabilization, inferior turbinate-nasolacrimal duct flap status, crustations, synechiae, bleeding, infection, and antrochoanal polyp recurrence. Results Operation time was significantly longer in CFA group II (38 min) compared with PLRA group I (27 min) (P Conclusion PLRA is a safe and simple technique for manipulation of anterior maxillary sinus lesions with short operative time and minimal postoperative complications.

Validity and safety of endoscopic biliary stenting for biliary stricture associated with IgG4-related pancreatobiliary disease during steroid therapy.

Background Patients with IgG4-related sclerosing cholangitis and autoimmune pancreatitis frequently develop obstructive jaundice, which requires endoscopic biliary stenting (EBS) during steroid therapy to prevent bile duct infection from cholestasis and adverse steroid effects. However, it is controversial whether EBS during steroid therapy is advisable, because the procedure itself carries a risk of cholangitis and procedure-related adverse events. This study aimed to clarify the validity and safety of EBS for patients with biliary stricture associated with IgG4-related pancreatobiliary disease (IgG4-PBD) during steroid therapy. Methods We enrolled 59 patients who presented with biliary stricture exhibiting jaundice or liver dysfunction and who were treated with EBS. The incidences of recurrent biliary obstruction and acute cholangitis were compared for EBS cases with and without steroid administration. Results EBS was present in 55 periods with steroid administration and 110 periods without. The incidence of recurrent biliary obstruction was significantly lower in cases with steroids than in those without (1-month no obstruction rate: 100 % vs. 82 %; log-rank test P = 0.0015). The incidence of acute cholangitis related to stenting was significantly lower in cases with steroids than in those without (1-month no acute cholangitis rate: 100 % vs. 90 %; log-rank test P = 0.0278). Biliary stents could be removed without acute cholangitis, liver dysfunction, or stent replacement in 96 % of patients who underwent endoscopic retrograde cholangiopancreatography 1 month after commencing steroid administration. Conclusions EBS during steroid administration was both valid and safe in patients with biliary stricture associated with IgG4-PBD. Stents could be safely removed 1 month after steroid initiation.

Status of anxiety and depression in male patients with gonococcal infection in paraurethral ducts before and after paraurethral duct dilatation

Objective To verify the change of the anxiety and depression of patients anterior-posterior treatment at paraurethral duct dilitation after gonococcal infection of paraurethral duct. Methods Twenty-eight patients of paraurethral duct dilatation after male gonococcal infection of paraurethral duct were enrolled, and the patients were treated in the Department of Dermatology and Venerology, the First People＇s Hospital of Changshu City. The anxiety and depression of patients anterior-posterior treatment were assessed and compared with Hamilton depression scale and Hamilton anxiety scale. Results The total scores of Hamilton depression scale and Hamilton anxiety scale before treatment were positively correlated with course of disease (r=0.481, P=0.0095; r=0.549, P=0.0025). The total scores of Hamilton depression and anxiety before treatment were from 1 to 31 (18.9±7.5) and from 4 to 30 (14.9±6.8). The symptoms of depression and anxiety appeared in 11 patients and 15 patients respectively. The total scores of Hamilton depression andanxiety after treatment were from 0 to 8 (4.3±1.7) and from 0 to 8 (3.3±1.7). There was no symptom of depression and anxiety. The difference of the total score of Hamilton depression and anxiety before and after treatment had statistical significance (t=12.270, P<0.001, t=10.626, P<0.001). The difference of positive rate of depressive and anxious symptom before and after treatment had statistical significance too (χ2=9.05, P=0.003; χ2=13.06, P=0.000). Conclusions The sequelae of gonococcal paraurethral duct infection in male paraurethral duct dilatation can result in the anxiety and depression of patients, which should be treated. Effective therapy can relieve or cure the anxiety and depression of patients without the assistance of psychotropic drugs. Key words: Neisseria gonorrhoeae; Infection; Men; Paraurethral duct dilitation; Anxiety; Depression; Hamilton