Ductal Structures Research Articles

Extrahepatic bile duct reconstruction in pigs with heterogenous animal-derived artificial bile ducts: A preliminary experience.

BACKGROUNDExtrahepatic biliary duct injury (BDI) remains a complicated issue for surgeons. Although several approaches have been explored to address this problem, the high incidence of complications affects postoperative recovery. As a nonimmunogenic scaffold, an animal-derived artificial bile duct (ada-BD) could replace the defect, providing good physiological conditions for the regeneration of autologous bile duct structures without changing the original anatomical and physiologic conditions.AIMTo evaluate the long-term feasibility of a novel heterogenous ada-BD for treating extrahepatic BDI in pigs.METHODSEight pigs were randomly divided into two groups in the study. The animal injury model was developed with an approximately 2 cm segmental defect of various parts of the common bile duct (CBD) for all pigs. A 2 cm long novel heterogenous animal-derived bile duct was used to repair this segmental defect (group A, ada-BD-to-duodenum anastomosis to repair the distal CBD defect; group B, ada-BD-to-CBD anastomosis to repair the intermedial CBD defect). The endpoint for observation was 6 mo (group A) and 12 mo (group B) after the operation. Liver function was regularly tested. Animals were euthanized at the above endpoints. Histological analysis was carried out to assess the efficacy of the repair.RESULTSThe median operative time was 2.45 h (2-3 h), with a median anastomosis time of 60.5 min (55-73 min). All experimental animals survived until the endpoints for observation. The liver function was almost regular. Histologic analysis indicated a marked biliary epithelial layer covering the neo-bile duct and regeneration of the submucosal connective tissue and smooth muscle without significant signs of immune rejection. In comparison, the submucosal connective tissue was more regular and thicker in group B than in group A, and there was superior integrity of the regeneration of the biliary epithelial layer. Despite the advantages of the regeneration of the bile duct smooth muscle observed in group A, the effect on the patency of the ada-BD grafts in group B was not confirmed by macroscopic assessment and cholangiography.CONCLUSIONThis approach appears to be feasible for repairing a CBD defect with an ada-BD. A large sample study is needed to confirm the durability and safety of these preliminary results.

Histological quantification of decomposed human livers: a potential aid for estimation of the post-mortem interval?

The objective of this study was to determine if a novel scoring-based model for histological quantification of decomposed human livers could improve the precision of post-mortem interval (PMI) estimation for bodies from an indoor setting. The hepatic decomposition score (HDS) system created consists of five liver scores (HDS markers): cell nuclei and cell structure of hepatocytes, bile ducts, portal triad, and architecture. A total of 236 forensic autopsy cases were divided into a training dataset (n = 158) and a validation dataset (n = 78). All cases were also scored using the total body score (TBS) method. We specified a stochastic relationship between the log-transformed accumulated degree-days (log10ADD) and the taphonomic findings, using a multivariate regression model to compute the likelihood function. Three models were applied, based on (i) five HDS markers, (ii) three partial body scores (head, trunk, limbs), or (iii) a combination of the two. The predicted log10ADD was compared with the true log10ADD for each case. The fitted models performed equally well in the training dataset and the validation dataset. The model comprising both scoring methods had somewhat better precision than either method separately. Our results indicated that the HDS system was statistically robust. Combining the HDS markers with the partial body scores resulted in a better representation of the decomposition process and might improve PMI estimation of decomposed human remains.

Traumatic resin ducts induced by methyl jasmonate in Pinus spp

Exogenous MJ does not alter the resin duct structure of pines in the cortex, but increases the number, density and mean size of resin ducts in the secondary xylem, particularly in Pinus sylvestris and P. radiata. Methyl jasmonate (MJ) is an organic compound capable of modulating defence responses in plants. Exogenous application of MJ has been shown to modify the structure of the resin canal system in conifers by inducing the formation of dense concentric bands of traumatic resin ducts in the xylem. Because inducibility of resin ducts has been little explored across pine species, 3-year-old Pinus pinaster, P. pinea, P. sylvestris and P. radiata trees were sprayed with 0, 25 and 50 mM solutions of MJ, and plant growth, external symptoms and histology were assessed 60 days after treatment. Exogenous application of MJ diminished primary or secondary growth in all species (61 and 25%, respectively) and caused needle damage in P. sylvestris. Exogenous MJ did not alter the resin duct structure of Pinus spp. in the cortex. In the secondary xylem, however, the effect of MJ differed considerably between species: ducts, duct density and area covered by ducts increased in P. sylvestris and P. radiata, but not in P. pinaster and P. pinea. In MJ 50 mM-treated trees, resin duct abundance peaked at the first half of the ring in P. sylvestris and at one-third distance from the previous ring in P. radiata. In MJ treated P. radiata trees, large traumatic axial resin ducts, 120–160 µm in diameter, were aligned in the secondary xylem. The study helps to elucidate macroevolutionary aspects of inducibility of resin-based defences in the genus Pinus, where varying responses to MJ could reveal different defence strategies among species.

Choledochal cyst with aberrant right posterior duct

Choledochal malformation, previously known as “choledochal cyst” is the congenital dilatation of any portion of the biliary tree. Its incidence varies from 1 in 48,000 in UK to 1 in 1000 in Japan. Type 1 is the most common one. Surgical options include total cyst excision with roux en Y hepaticojejunostomy or hepaticoduodenostomy for type 1. Detailed knowledge about normal extrahepatic biliary tract and its variations is needed to prevent complications. These aberrations of the anatomical structures of vascular and ductal structures make any hepatobiliary surgery challenging to surgeons. The normal configuration is present in around 60% of the population. We report a rare case of choledochal cyst patient in which there was a right posterior duct aberration with double cystic ducts and one of the cystic ducts opened into the distal portion of aberrant duct. There was a need for double anastomosis of hepaticojejunostomy rather than one, as ligating the aberrant duct would have caused segmental cirrhosis and later atrophy. Failure to identify the aberrant vessel would have caused prolonged bile leakage in the postoperative period. Therefore, assessment of the biliary anatomy and identification of normal variants are challenging points in the surgical planning. • Choledochal malformation, previously known as “choledochal cyst” is a rare disease. • The aberrations of the anatomical structures of vascular and ductal structures make any hepatobiliary surgery challenging to surgeons. • We report a rare case of choledochal cyst patient in which there was a right posterior duct aberration with double cystic ducts and one of the cystic ducts opened into the distal portion of aberrant duct. • There was a need for double anastomosis of Roux en Y hepaticojejunostomy rather than one.

Analyzing regularity of interpolar air motion and heat dissipation coefficient distribution of a salient pole synchronous generator considering rotary airflow

The extreme attention should be paid to cooling performance of air-cooled synchronous generators in order to ensure that the temperature rise of each part is within the allowable range. It is necessary to know losses distribution, cooling airflow rate distribution laws, heat dissipation coefficient distribution and temperature distribution characteristics. Considering the influence of rotary airflow and yoke ventilation duct structure on air motion, the physical parameters and the motion characteristics of interpolar air were analyzed in three cases. These cases were considered respectively when the rotor was in a rotating or non- rotating state and the yoke ventilation ducts were intake air, and when the rotor was in a rotating state and the yoke ventilation ducts were not intake air. Based on Multi-Reference Frame, the finite volume method was used to solve the fluid-solid coupling numerical simulation of the solving domain. Taking a 250 MW air-cooled hydro-generator as an example, the air velocity of each air cooler was measured and the inlet air velocity of the rotor support was calculated. By calculating the average temperature of the excitation winding in the steady state, the measured value and the simulation result were compared, and the correctness of the calculation method was verified.

A human milk-mimicking fluid for PIV experiments

It is essential to formulate a refractive index (RI)-matched fluid to use in silicone phantom models for particle image velocimetry (PIV) experiments. In this work, an extensive effort to develop a non-Newtonian human milk-mimicking fluid (HMMF) with different concentrations of sodium iodide (NaI), glycerol (Gly), xanthan gum (XG), and distilled water (DW) is conducted. Measurements of RI and density are fitted onto a linear empirical expression relating to the NaI and Gly concentration. The Cross model was utilized to find the nonlinear viscosity model of raw human milk. HMMF solution is generated from a multi-constrained optimization. The matched HMMF, suitable for use in the lactating human breast phantom with bifurcated ductal structures, is achieved with composition of 15.69% NaI, 30.27% Gly, 54.02% water and 0.02% XG by weight percentage resulting in a non-Newtonian viscosity matched with that of human milk.

Building a Functional Salivary Gland for Cell-Based Therapy: More than Secretory Epithelial Acini.

A few treatment options exist for patients experiencing xerostomia due to hyposalivation that occurs as a result of disease or injury to the gland. An opportunity for a permanent solution lies in the field of salivary gland replacement through tissue engineering. Recent success emboldens in the vision of producing a tissue-engineered salivary gland composed of differentiated salivary epithelial cells that are able to differentiate to form functional units that produce and deliver saliva to the oral cavity. This vision is augmented by advances in understanding cellular mechanisms that guide branching morphogenesis and salivary epithelial cell polarization in both acinar and ductal structures. Growth factors and other guidance cues introduced into engineered constructs help to develop a more complex glandular structure that seeks to mimic native salivary gland tissue. This review describes the separate epithelial phenotypes that make up the gland, and it describes their relationship with the other cell types such as nerve and vasculature that surround them. The review is organized around the links between the native components that form and contribute to various aspects of salivary gland development, structure, and function and how this information can drive the design of functional tissue-engineered constructs. In addition, we discuss the attributes of various biomaterials commonly used to drive function and form in engineered constructs. The review also contains a current description of the state-of-the-art of the field, including successes and challenges in creating materials for preclinical testing in animal models. The ability to integrate biomolecular cues in combination with a range of materials opens the door to the design of increasingly complex salivary gland structures that, once accomplished, can lead to breakthroughs in other fields of tissue engineering of epithelial-based exocrine glands or oral tissues.

Numerical simulation of heat transfer behavior in EAGLE ID1 in-pile test using finite volume particle method

The EAGLE ID1 test was performed by the Japan Atomic Energy Agency to demonstrate the effectiveness of fuel discharge from a fuel subassembly with an inner duct structure. The experimental results suggested that the early duct wall failure observed in the test was initiated by high heat flux from the molten pool and the post-test analyses showed that the high heat flux may be enhanced effectively by molten steel. In this study, the mechanisms of heat transfer were analyzed using a fully Lagrangian approach based on the finite volume particle method. A series of physical behaviors in the pool were simulated to investigate the effect of the behaviors on molten pool-to-duct wall heat transfer in ID1 test. The present 2D particle-based simulation demonstrated that a large thermal load on the duct wall can be caused by direct contact of the liquid fuel releasing nuclear heat and high-temperature liquid steel.

ONCOCYTIC SIALOLIPOMA OF THE PAROTID GLAND: A REPORT OF 2 CASES

Oncocytic sialolipoma is an exceedingly rare tumor of the salivary gland (SG), being considered as a variant of SG lipomas. Clinically, swelling in the SG affected is observed, and this tumor is most common in the parotid gland of men. We report 2 cases of oncocytic sialolipomas affecting a 44-year-old man and a 49-year-old woman. Partial parotidectomy was performed in both cases. The histopathologic examination revealed well-circumscribed tumors with a biphasic pattern: the oncocytic epithelial component showing cells with different sizes organized in nests or ductal structures and a well-recognized adipocytic background. Immunohistochemical reactions were performed, and the oncocytic epithelial component was positive for CK7, CK14, and anti-mitochondrial antigen. After the surgical excision, no sign of recurrence was observed. As these tumors may have a clinical presentation similar to other benign and malignant SG tumors, histopathologic examination is mandatory to establish the proper diagnosis. Oncocytic sialolipoma is an exceedingly rare tumor of the salivary gland (SG), being considered as a variant of SG lipomas. Clinically, swelling in the SG affected is observed, and this tumor is most common in the parotid gland of men. We report 2 cases of oncocytic sialolipomas affecting a 44-year-old man and a 49-year-old woman. Partial parotidectomy was performed in both cases. The histopathologic examination revealed well-circumscribed tumors with a biphasic pattern: the oncocytic epithelial component showing cells with different sizes organized in nests or ductal structures and a well-recognized adipocytic background. Immunohistochemical reactions were performed, and the oncocytic epithelial component was positive for CK7, CK14, and anti-mitochondrial antigen. After the surgical excision, no sign of recurrence was observed. As these tumors may have a clinical presentation similar to other benign and malignant SG tumors, histopathologic examination is mandatory to establish the proper diagnosis.

AMELOBLASTOMA WITH ADENOID CHARACTERISTICS: A CASE REPORT

The ameloblastoma (AM) with adenoid characteristics is a rare variant with presence of ductile structures similar to adenomatoid odontogenic tumor (TOA), but with aggressive biologic behavior. A 24-year-old patient, male, white, presented with an increased volume in the anteroposterior region of the mandible, with no pain and slow growth. The clinical and tomographic diagnoses were dentigerous cyst and odontogenic keratocyst. Subsequently, after complementary biochemical examinations, surgical resection was performed, in which the final histopathologic diagnosis confirmed the AM, but was associated with ductal structures with cell proliferation in a solid and storiform pattern, similar to TOA. Due to the aggressive form of ameloblastoma, the patient is under periodic follow-up. Thus, the need for a careful assessment of the odontogenic tumors is emphasized, because in this case, the prognosis of TOA and AM is different, affecting the surgical therapy used.

Robotic-assisted excision of a prostatic utricle cyst in a 12-month boy with proximal hypospadia and 45X0/ 46XY karyotype

Prostatic utricle cysts result from incomplete regression of Mullerian duct structures and occur most frequently in males with perineal or peno-scrotal hypospadias. Utricular cysts may present with various signs and symptoms including urinary tract infection, pain and post-void incontinence, a palpable abdominal mass or recurrent epididymitis. We present a 12 months boy we treated due to proximal hypospadias in two stages, in association to a dysplastic undescended testis that was excised. The karyotype of the patient was 45X0/46XY and after successful hypospadias treatment, the mother complained of purulent discharge in the diapers. A sonogram showed a large cyst behind the bladder with heterogeneous content. The diagnosis of utricle cyst was confirmed by a NMR with detailed anatomy and low confluence of the neck of the cyst to the urethra. We performed a robotic excision of the cyst consisting of careful dissection between bladder and rectum and a safe ligation of the communication of it to the urethra. Patient outcome was uneventful. To the best of our knowledge this is the youngest patient with utricle cyst treated with robotic approach reported in the literature.

Phylogeny and systematics of the Proterodiplostomidae Dubois, 1936 (Digenea: Diplostomoidea) reflect the complex evolutionary history of the ancient digenean group.

The Proterodiplostomidae Dubois, 1936 is a relatively small family of diplostomoidean digeneans parasitising the intestines of reptilian hosts associated with freshwater environments in tropical and subtropical regions. The greatest diversity of proterodiplostomids is found in crocodilians, although some parasitise snakes and turtles. According to the most recent revision, the Proterodiplostomidae included 17 genera within 5 subfamilies. Despite the complex taxonomic structure of the family, availability of testable morphology-based phylogenetic hypotheses and ancient hosts, molecular phylogenetic analyses of the group were practically lacking. Herein, we use novel DNA sequence data of the nuclear lsrRNA gene and mitochondrial cox1 gene from a broad range of proterodiplostomid taxa obtained from crocodilian, fish, and snake hosts on four continents to test the monophyly of the family and evaluate the present morphology-based classification system of the Proterodiplostomidae in comparison with the molecular phylogeny. This first detailed phylogeny for the Proterodiplostomidae challenges the current systematic framework. Combination of molecular phylogenetic data with examination of freshly collected quality specimens and re-evaluation of morphological criteria resulted in a number of systematic and nomenclatural changes along with a new phylogeny-based classification of the Proterodiplostomidae. As the result of our molecular and morphological analyses: (i) the current subfamily structure of the Proterodiplostomidae is abolished; (ii) three new genera, Paraproterodiplostomum n. g., Neocrocodilicola n. g. and Proteroduboisia n. g., are described and Pseudoneodiplostomoides Yamaguti, 1954 is restored and elevated from subgenus to genus level; (iii) two new species, Paraproterodiplostomum currani n. g., n. sp. and Archaeodiplostomum overstreeti n. sp., are described from the American alligator in Mississippi, USA. Comparison of the structure of terminal ducts of the reproductive system in all proterodiplostomid genera did not support the use of these structures for differentiation among subfamilies (or major clades) within the family, although they proved to be useful for distinguishing among genera and species. Our study includes the first report of proterodiplostomids from Australia and the first evidence of a snake acting as a paratenic host for a proterodiplostomid. A key to proterodiplostomid genera is provided. Questions of proterodiplostomid-host associations parasitic in crocodilians are discussed in connection with their historical biogeography. Our molecular phylogeny of the Proterodiplostomidae closely matches the current molecular phylogeny of crocodilians. Directions for future studies of the Proterodiplostomidae are outlined.Electronic supplementary materialThe online version of this article (10.1007/s11230-020-09928-2) contains supplementary material, which is available to authorized users.

Evaluation of intrahepatic manifestation and distant extrahepatic disease in alveolar echinococcosis.

BACKGROUNDThe main endemic areas of alveolar echinococcosis (AE) are in Central Europe and Western China. Both the infiltration of intrahepatic vascular and bile duct structures as well as extrahepatic disease can lead to further complications and may increase morbidity in patients with AE.AIMTo evaluate vascular/biliary involvement in hepatic AE and its distant extrahepatic disease manifestations in an international collective was the aim.METHODSConsecutively, five experienced examiners evaluated contrast-enhanced abdominal computed tomography (CT) scans for 200 patients with hepatic AE of each of four locations (n = 50) in Germany, France and China. Therefore, we retrospectively included the 50 most recent abdominal contrast-enhanced CT examinations at each center, performed because of hepatic AE from September 21, 2007 to March 21, 2018. AE liver lesions were classified according to the echinococcosis multilocularis Ulm classification for CT (EMUC-CT). Distant extrahepatic manifestations were documented either by whole body positron emission tomography–CT or with the addition of thoracic CT and cranial magnetic resonance imaging. Vascular/biliary involvement of the hepatic disease as well as the presence of distant extrahepatic manifestations were correlated with the EMUC-CT types of liver lesion. Statistical analysis was performed using SAS Version 9.4 (SAS Institute Inc., Cary, NC, United States).RESULTSDistant extrahepatic AE manifestations were significantly more frequent in China than in Europe (P = 0.0091). A significant relationship was found between the presence of distant extrahepatic disease and AE liver lesion size (P = 0.0075). Vascular/biliary structures were involved by the liver lesions significantly more frequently in China than in Europe (P < 0.0001), and vascular/biliary involvement depended on lesion size. Different morphological types of AE liver lesions led to varying frequencies of vascular/biliary involvement and were associated with different frequencies of distant extrahepatic manifestations: Vascular/biliary involvement as a function of lesions primary morphology ranged from 5.88% of type IV liver lesions to 100% among type III lesions. Type IV differed significantly in these associations from types I, II, and III (P < 0.0001). With respect to extrahepatic disease, the primary morphology types IV and V of liver lesions were not associated with any case of distant extrahepatic disease. In contrast, distant extrahepatic manifestations in types I–III were found to varying degrees, with a maximum of 22% for type III.CONCLUSIONDifferent CT morphological patterns of hepatic AE lesions influence vascular/biliary involvement and the occurrence of distant extrahepatic manifestations. There are intercontinental differences regarding the characteristics of AE manifestation.

Transverse testicular ectopia with M\xfcllerian duct remnant in an incarcerated congenital inguinal hernia \u2013 a case report

BackgroundTransverse testicular ectopia (TTE) is a rare anomaly characterized by both testes descending through a single inguinal canal. In this report, the diagnosis of TTE was discovered in the event of an incarcerated congenital inguinal hernia in a neonate.Case presentationWe present a case of TTE accompanied by persistent Müllerian duct structures (PMDS) that had been discovered incidentally during inguinal exploration of a 26-day-old boy who presented with an incarcerated congenital inguinal hernia on the right side and left cryptochidism on the left side. The pathogenesis, approach and proposed management of TTE are discussed.ConclusionTTE is an extremely rare anomaly, especially in neonates, and should be suspected in patients presenting with inguinal hernia on one side and cryptorchidism on the other side.

A novel layered stack electromagnetic pump towards circulating metal fluid: Design, fabrication and test

In this paper, a novel structure of electromagnetic pump to efficiently drive metal fluid was proposed, which can be called layered stack electromagnetic pump. Firstly, the coupled interaction mechanism of multi-physics fields was numerically interpreted, and the parameter optimizations of DC-EMP were systemically conducted. The optimization results show that inserting insulation bars can significantly reduce current dissipation by 69.7% in center line. And using closed iron yoke is beneficial to obtain a strong and uniform magnetic field. Moreover, the low flow duct is good to obtain a large pressure head. Based on the optimization results, a five layer structure of flow duct was provided. And a prototype was fabricated and tested. It shows that such pump can provide pressure head 120 kPa @ 300 A and maximum flow rate 6.9 L/min @300 A. It works smoothly and silently, and even, can operate steadily after two year intermittent operation. And this pump operation temperature was limited below 120 °C. Finally, the challenges unsolved and further optimization measures were suggested. Overall, the layered stack DC-EMP presented here enables liquid metal to be rather promising heat transfer fluid in advancing the field of extreme heat flux heat dissipation and thermal energy transportation.

Subtype-specific characterization of breast cancer invasionusing a microfluidic tumor platform.

Understanding progression of breast cancers to invasive ductal carcinoma (IDC) can significantly improve breast cancer treatments. However, it is still difficult to identify genetic signatures and the role of tumor microenvironment to distinguish pathological stages of pre-invasive lesion and IDC. Presence of multiple subtypes of breast cancers makes the assessment more challenging. In this study, an in-vitro microfluidic assay was developed to quantitatively assess the subtype-specific invasion potential of breast cancers. The developed assay is a microfluidic platform in which a ductal structure of epithelial cancer cells is surrounded with a three-dimensional (3D) collagen matrix. In the developed platform, two triple negative cancer subtypes (MDA-MB-231 and SUM-159PT) invaded into the surrounding matrix but the luminal A subtype, MCF-7, did not. Among invasive subtypes, SUM-159PT cells showed significantly higher invasion and degradation of the surrounding matrix than MDA-MB-231. Interestingly, the cells cultured on the platform expressed higher levels of CD24 than in their conventional 2D cultures. This microfluidic platform may be a useful tool to characterize and predict invasive potential of breast cancer subtypes or patient-derived cells.

Twenty-Eight Cases of Extraocular Sebaceous Carcinoma: A Correlative Clinicopathological and Immunohistochemical Analysis of Extraocular Sebaceous Carcinomas and Benign Sebaceous Gland Tumors.

Extraocular sebaceous carcinoma (ESC) is a rare appendiceal skin tumor. In contrast to ocular sebaceous carcinoma, information about the exact cellular architecture of these lesions is scarce and the histogenesis of ESC is unknown. Here, we extend our previous study and investigate 28 extraocular carcinomas in comparison to 54 benign sebaceous tumors and 8 cases of normal sebaceous glands using a broad spectrum of antibodies against p63, several keratins, adipophilin, EMA, Ki67, androgen receptor, and mismatch repair proteins. This observational study demonstrates that p63- and K5/14-positive basaloid cells are key cells in normal sebaceous gland and in all sebaceous tumors and that these basaloid cells give rise to EMA+, adipophilin+ sebocytes, and K5/14+, K7±, K10± ductal structures. Finally, about half of ESC is associated with superficial in situ neoplasia, which provides evidence that at least part of these carcinomas arises from flat superficial in situ carcinoma. In contrast to the normal sebaceous gland, about half of all sebaceous tumors lack keratin K7. MMR protein IHC-profiles role will be discussed.

Probe-based confocal laser endomicroscopy for the diagnosis of pancreatic ductal structures.

The image-based diagnosis of pancreatic diseases can be difficult and requires pathological evaluation. Probe-based confocal laser endomicroscopy (pCLE) enables real-time observation of the microscopic tissue pattern of lesion and may be a useful assistance for the diagnosis. This study aimed to evaluate the feasibility and utility of pCLE for the diagnosis of pancreatic diseases. Thirty patients who underwent endoscopic retrograde cholangiopancreatography with pCLE for the evaluation of indeterminate pancreatic diseases from June 2015 to October 2018 were included in this study. The pCLE findings were interpreted according to the Miami Classification. Among a total of 30 patients, 12, 10, 4, and 4 patients received the definitive diagnoses of pancreatic ductal adenocarcinoma (PDAC), main duct intrapapillary mucinous neoplasm, autoimmune pancreatitis, and chronic pancreatitis, respectively. The diagnostic accuracy of pCLE for PDAC and pancreatitis (96.7% and 93.3%, respectively) was higher than that of cytology (76.7% and 63.3%, respectively) (P=0.0227 and 0.0048, respectively). The sensitivity of pCLE for PDAC was significantly higher (91.7%) than that of cytology (41.7%) (P=0.0094). Moreover, the specificity of pCLE for pancreatitis was significantly higher than that of cytology (90.9% vs 50%; P=0.0029). However, the diagnostic accuracies of pCLE and cytology for main duct intrapapillary mucinous neoplasm did not differ significantly (96.7% and 86.7%, respectively). Probe-based confocal laser endomicroscopy may be effective for the diagnosis of pancreatic diseases as adjunct modality. It requires technical learning and further evaluation of its usefulness.

Su1571 ENDOSCOPIC MANAGEMENT OF BILE LEAKS IN PATIENTS UNDERGOING SUBTOTAL CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS

The mainstay of management of acute cholecystitis (AC) is laparoscopic cholecystectomy. Although one of the most commonly performed procedures in the United States, it is not immune to the challenges of hostile anatomy where the relationship between the cystic duct and portal structures cannot be adequately defined despite converting to open cholecystectomy. One option is to perform a subtotal cholecystectomy (SC) to avoid injury to the portal structures. However, SC is associated with a high incidence of bile leak. The aim of this study is to evaluate the efficacy and safety of endoscopic management of bile leaks following SC for AC. A retrospective analysis of a prospectively collected database of all patients undergoing SC for AC at our institution between 7/1/2015 and 11/15/2019 was conducted. Demographics, surgical, endoscopic, clinical management, and follow-up data was analyzed. A total of 36 patients underwent SC for AC during the study period. The primary indication for the procedure was AC in 40% (n=6) of patients, followed by acute on chronic cholecystitis 33.3% (n=5), perforated gallbladders secondary to AC 20% (n=3), and chronic cholecystitis 6.7% (n=1). Surgical drains were placed in all patients. Bile leaks were occurred in 15 (42%) patients (mean age: 51.67±15.12 years; 53.3% males). Mean interval to post-operative ERCP was 0.80±0.94 days. Biliary sphincterotomy and stenting was successful in all cases. Single (n=4) or multiple (n=4) plastic stents were placed in 53% (n=8) patients; whereas the remainder 7 (47%) patients received a fully covered self-expanding metal stent (FCSEMS). One patient was lost to follow-up. Follow-up ERCP was performed after a mean interval of 70.2±53.8 days. Persistent bile leak was noted in 40% patients (4/8 in patients with plastic stents vs 2/6 in FCSEMS group; p=0.63) requiring repeat stent (all FCSEMS) placement. There was no difference in mean stent duration between patients with and without persistent bile leak (69.9±37.3 vs. 63.3±62.9 days; p=0.81). Complete resolution on subsequent ERCP was noted in all patients except 1 patient with additional bile duct injury and leak from hilum and right main duct who underwent 2 further ERCPs with subsequent resolution of leak and stricture. The patients were followed for a mean of 10.8±15.82 months. No procedure related adverse events or recurrent cholecystitis was noted. ERCP with biliary stent placement is an effective modality for endoscopic management of bile leak following SC; however, significant number had persistent bile leak requiring repeat stenting. Given these lower resolution rates with single ERCP (compared to >95% resolution reported for cystic duct leak following LC), FCSEMS should be preferably placed for prolonged duration in patients with bile leak following SC.

Laparoscopic Management of Persistent Müllerian Duct Syndrome

Persistent Mullerian duct syndrome (PMDS) is characterized by persistence of Mullerian derivatives in a phenotypically and genotypically normal male. These patients have 46 XY karyotype with normal male external genitalia, virilization, and internal Mullerian duct structures. Typically, these patients have unilateral or bilateral undescended testes, bilateral fallopian tubes, a uterus, and an upper vagina draining into a prostatic utricle, as reported by Diamond and Uy (n.d.). We report a case of PMDS in a 25-year-old male, which present with primary infertility with bilateral cryptorchidism.