Duct Obstruction Research Articles

Etiopathogenesis of primary acquired nasolacrimal duct obstruction (PANDO).

Primary acquired nasolacrimal duct obstruction, or PANDO, is a common adult lacrimal drainage disorder. The current treatment modality of dacryocystorhinostomy to bypass the obstructed nasolacrimal duct has excellent outcomes. However, the understanding of the disease etiopathogenesis needs to be revisited. There are not many studies that specifically assessed any hypothesis or ones that convincingly put forth the presumed or confirmed interpretations regarding the PANDO pathogenesis or the mechanisms or pathways involved therein. Histopathological evidence points to recurrent inflammation of the nasolacrimal duct, subsequent fibrosis, and the resultant obstruction. The disease etiopathogenesis is considered multifactorial. Several implicated suspects include anatomical narrowing of the bony nasolacrimal duct, vascular factors, local hormonal imbalance, microbial influence, nasal abnormalities, autonomic dysregulation, surfactants, lysosomal dysfunction, gastroesophageal reflux, tear proteins, and deranged local host defenses. The present work reviewed the literature on the etiopathogenesis of primary acquired nasolacrimal duct obstruction (PANDO) to gain insights into the present state of the understanding and the high-value translational implications of precisely decoding the disease etiology.

Experimental and numerical investigation on the premixed methane/air flame propagation in duct with obstacle gradients

This work experimentally and numerically investigates the effect of the obstacle gradient on the characteristics of the methane/air explosion in obstructed ducts. The obstacle gradient is expressed through various blockage ratios, and three different obstacle gradients are investigated, i.e., C357, C555, and C753. Noted that C357 means that the blockage ratios of three obstacles arranged sequentially in the duct are 0.3, 0.5 and 0.7 respectively, and so do C555 and C753. A two-dimensional (2D) model is adopted and the Scale-Adaptive Simulation method with the thickened flame model is considered. Experimental results show that the obstacle gradient significantly affects the flame evolution structure, flame propagation speed and overpressure. The obstacle gradient is accountable for the “tulip flames” appearing downstream of the obstacle. For the case with a fixed methane volume fraction, the average flame front speed is fixed. However, with the increasing obstacle gradient, the maximum flame front speed increases until it achieves the maximum at C357, and so does the maximum overpressure. The numerical simulation can predict the flame evolution behaviour precisely. It is evident that the generation of different flame shapes appearing is derived from the flow field evolution of unburned gas downstream of the flame front.

Regional differences in islet amyloid deposition in the residual pancreas with new-onset diabetes secondary to pancreatic ductal adenocarcinoma.

Islet amyloid deposition and reduced β-cell mass are pathological hallmarks in type 2 diabetes mellitus subjects. To date, the pathological features of the islets in diabetes secondary to pancreatic ductal adenocarcinoma (PDAC) have not been specifically addressed. To provide further insight into the relationship between islet amyloid deposition of the residual pancreas in PDAC patients and to explore whether regional differences (proximal vs distal residual pancreas) are associated with islet amyloid deposition. We retrospectively collected clinical information and pancreatic tissue removed from tumors of 45 PDAC patients, including 14 patients with normal glucose tolerance (NGT), 16 patients with prediabetes and 15 new-onset diabetes (NOD) patients diagnosed before surgery by an oral glucose tolerance test at West China Hospital from July 2017 to June 2020. Pancreatic volume was calculated by multiplying the estimated area of pancreatic tissue on each image slice by the interval between slices based on abdominal computer tomography scans. Several sections of paraffin-embedded pancreas specimens from both the proximal and/or distal regions remote from the tumor were stained as follows: (1) Hematoxylin and eosin for general histological appearance; (2) hematoxylin and insulin for the determination of fractional β-cell area (immunohistochemistry); and (3) quadruple insulin, glucagon, thioflavin T and DAPI staining for the determination of β-cell area, α-cell area and amyloid deposits. Screening for pancreatic histologic features revealed that duct obstruction with islet amyloid deposition, fibrosis and marked acinar atrophy were robust in the distal pancreatic regions but much less robust in the proximal regions, especially in the prediabetes and NOD groups. Consistent with this finding, the remnant pancreatic volume was markedly decreased in the NOD group by nearly one-half compared with that in the NGT group (37.35 ± 12.16 cm3 vs 69.79 ± 18.17 cm3, P < 0.001). As expected, islets that stained positive for amyloid (islet amyloid density) were found in the majority of PDAC cases. The proportion of amyloid/islet area (severity of amyloid deposition) was significantly higher in both prediabetes and NOD patients than in NGT patients (P = 0.002; P < 0.0001, respectively). We further examined the regional differences in islet amyloid deposits. Islet amyloid deposit density was robustly increased by approximately 8-fold in the distal regions compared with that in the proximal regions in the prediabetes and NOD groups (3.98% ± 3.39% vs 0.50% ± 0.72%, P = 0.01; 12.03% vs 1.51%, P = 0.001, respectively). In conclusion, these findings suggest that robust alterations of the distal pancreas due to tumors can disturb islet function and structure with islet amyloid formation, which may be associated with the pathogenesis of NOD secondary to PDAC.

Review of ABM Clinical Protocol #36: The Mastitis Spectrum

Recent scientific evidence debunks the concept of milk ducts obstructed by a collection of milk as it is not physiologically or anatomically possible.1 The Mastitis Spectrum is a recently revised guideline which challenges the common belief that ‘blocked ducts’ precede inflammatory mastitis, potentially followed by infective mastitis. The evidence now demonstrates that mastitis encompasses a spectrum of conditions, from mild to severe. Moreover, traditional strategies to augment milk removal to counteract milk stasis and breast massage to relieve ductal obstruction from milk ‘plugs’ lacks physiological validity. The Academy of Breastfeeding Medicine (ABM) Medicine Clinical Protocol #36 details management recommendations for all eventualities of The Mastitis Spectrum and will be referred to as the ABM Protocol in this review. The protocols can be found at: https://www.bfmed.org/protocols.

(461) Health Insurance Coverage for Infertility in the United States

Abstract Introduction As many as one in five heterosexual couples in the United States experience infertility. Medical advances can help resolve infertility, however access to treatment is often out-of-pocket and can be prohibitively expensive. State benchmark health insurance plans detail minimum coverage standards that all other state offerings must match with some exceptions. Objective The objective of this study was to evaluate differences in health insurance coverage for infertility. Methods The most recent state benchmark health insurance plans submitted to Centers for Medicare and Medicaid were examined. We identified provisions to cover or exclude treatment of infertility. A literature search was also performed to identify states with legislation relating to health insurance coverage for infertility. Results Data was available for all 50 states and the District of Columbia. Fifteen states had legislation requiring coverage of infertility benefits, and two states required employers to offer at least one such plan. In benchmark offerings, 19 states did not provide any minimum coverage for diagnosis or treatment of infertility. Twenty-five states offered some type of treatment, of which 9 covered treatments of underlying cause of infertility only (ie. Fibroids, ductal obstruction). Ten states offered coverage for prescription medications, 10 states offered coverage for artificial insemination, and six states provided coverage for assisted reproductive technologies such as in vitro fertilization. Only two states covered cryopreservation of ova, but only for patients actively undergoing treatment for infertility. Conclusions Diagnosis and treatment of infertility is not guaranteed to be covered by health insurance, and nearly half of states do not provide any minimum level of coverage in state benchmark plans. Health insurance coverage for the diagnosis and treatment of infertility is highly variable and continues to be a barrier faced by patients desiring to conceive. Disclosure No

Inhibitory Effects of Lactulose on Enteric Bacterial Dynamics and Gut Permeability in Bile-Duct Ligated Rats

Background and Aim: The prebiotic potential of lactulose is well known, but its effect to inhibit enteric bacterial dynamics and gut permeability has not yet been investigated in experimental studies. The present study aims to assess the effects of lactulose on the enteric bacterial dynamics gut permeability in a model of bile duct ligation in Wistar rats. Methods: Wistar rats were assigned into 3 groups, the Sham-operated control, bile duct ligated (BDL) and BDL+ Lac group on the 28th day of bile duct ligation. Animals of BDL + Lac groups were treated with lactulose (1.0 g/kg), administrated by gavage, once a day for 7 days. Bacterial translocation into the organs and bacterial overgrowth as the indicators of the enteric bacterial dynamics and the levels of DAO and D-lactate as the biochemical makers of the gut permeability were measured in each group. Results: The bacterial colony forming units (CFU) in spleen and liver of BDL+Lac group was significantly decreased compared with BDL model group (P&lt;0.01) and significant decrease of bacterial CFU was seen in the intestinal lavage in BDL+Lac group compared to BDL group (P&lt;0.01). On the other hand, Lactulose revealed significant inhibitory effect as evidence by decreasing plasma DAO activity and D-lactate levels (P&lt;0.01) in this model. Conclusion: These results indicate that lactulose can inhibit the enteric bacterial overgrowth, bacterial translocation (BT) and increasing gut permeability by opening the mucosa tight junction in ductal obstruction and obviate even systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) induced by obstructive jaundice.

PD20-12 DISPARITIES IN INFERTILITY COVERAGE IN THE UNITED STATES

You have accessJournal of UrologyCME1 Apr 2023PD20-12 DISPARITIES IN INFERTILITY COVERAGE IN THE UNITED STATES Arshia Sandozi, Dhaval Jivanji, Ariel Schulman, and Jacob Khurgin Arshia SandoziArshia Sandozi More articles by this author , Dhaval JivanjiDhaval Jivanji More articles by this author , Ariel SchulmanAriel Schulman More articles by this author , and Jacob KhurginJacob Khurgin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003286.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: One in five heterosexual couples in the United States experience infertility. The costs of diagnosis and treatment may not be covered by health insurance. This study aimed to evaluate disparities in infertility coverage in the United States. METHODS: State essential health benefit benchmark (EHB) insurance plans submitted to Centers for Medicare and Medicaid were reviewed. We identified provisions that detailed coverage or exclusions for infertility. A literature search was performed to identify states with legislation related to coverage for infertility. State demographic information was derived from Census data. RESULTS: Data was available for 50 states and the District of Columbia. Twenty states had legislation related to infertility coverage. Two states required employers to offer at least one such plan, and one state only prohibited exclusions for treatment based on the diagnosis of infertility. In benchmark offerings, 19 states did not provide any minimum coverage for diagnosis or treatment of infertility. Twenty-five states offered some type of treatment, of which 9 covered treatments only for underlying causes of infertility (i.e. fibroids, ductal obstruction). Ten states codified coverage for prescription medications, 10 states for artificial insemination, and six states codified coverage for assisted reproductive technologies such as in vitro fertilization (IVF). Two states codified cryopreservation of ova, but only for patients actively undergoing treatment for infertility. Higher state median income was significantly associated with a state-requirement to offer infertility coverage as well as coverage of artificial insemination (p=0.039), but not with other coverage options, including IVF. States with higher populations enrolled in Medicaid or Children’s Health Insurance Program were more likely to have requirements for some level of infertility coverage (p=0.039). CONCLUSIONS: Nineteen states do not codify any minimum level of infertility coverage in EHB benchmark plans. Higher state median income is associated with codification of coverage of artificial insemination, but most types of coverage are not significantly associated with income. Overall, health insurance coverage for the diagnosis and treatment of infertility is highly variable and continues to be a barrier faced by patients desiring to conceive. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e589 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arshia Sandozi More articles by this author Dhaval Jivanji More articles by this author Ariel Schulman More articles by this author Jacob Khurgin More articles by this author Expand All Advertisement PDF downloadLoading ...

Long-term outcomes of pancreatoscopy-guided electrohydraulic lithotripsy for the treatment of obstructive pancreatic duct stones.

Background and study aims Pancreatoscopy-guided electrohydraulic lithotripsy (EHL) has proven to be an effective first-line therapy in symptomatic chronic pancreatitis (CP) patients with obstructing pancreatic duct (PD) stones 1 . However, long-term outcomes of endoscopic EHL remain unknown. The aim of the present study was to evaluate the long-term treatment effects of EHL as first-line therapy and to compare with those obtained in a historical cohort of patients who underwent extracorporeal shockwave lithotripsy (ESWL) as primary treatment. Patients and methods An observational retrospective single-center long-term follow-up study was performed including 19 consecutive patients who previously underwent endoscopic EHL compared to 18 patients who underwent ESWL followed by endoscopic retrograde pancreatography (ERP). The primary endpoint was long-term treatment success after EHL or ESWL defined as no recurrence of symptomatic intraductal stones confirmed on imaging. Secondary endpoints for the EHL-population included long-term clinical success (i. e., a similar or lower Izbicki Pain Score or reduction in opiate usage as compared to 6-month follow-up), quality of life (QoL), pancreatic function and hospital re-admission rate. Results In the EHL group, 37 % of the patients developed recurrent symptomatic PD stones versus 61 % in the ESWL group after a median follow-up of 35.0 and 76.5 months. Of the patients with recurrence, 71 % versus 100 % underwent a reintervention. Median time to recurrence was 12.0 versus 13.0 months. Clinical success sustained in 58 % of the EHL patients. QoL was not significantly different compared with 6-month follow-up and baseline. Conclusions Also at long-term follow-up, endoscopic EHL as first-line treatment is moderately effective for symptomatic CP patients with treatment success rates that seems at least equally effective as ESWL.

Sialendoscopy in treatment of obstructive sialadenitis

Sialendoscopy is a relatively new mini-invasive method that allows direct visualisation and intervention in the salivary gland ductal system. The aim of the study was to evaluate the results of sialendoscopy in the treatment of obstructive sialadenitis. This is a 15-yearretrospective study analysing the treatment results of patients treated in the period of 2007-2022 at the Department of Oral and Maxillofacial Surgery, Comenius University Bratislava, Slovakia. The total number of performed sialendoscopies was 70, of which 44 (62.9 %) were performed on the submandibular gland and 26 (37.1 %) on the parotid gland; 46 procedures (65.7 %) were performed via natural ductal system opening without the need for surgical assistance while 24 sialendoscopies (34.3 %) required surgical assistance. The most frequent perioperative findings were the sialoliths (37) in quantities ranging from one to four. Non-calculi pathologies (23) included mucous plugs, strictures, plaque, erythema or foreign bodies. No pathology was found on 10 sialendoscopies. In 82 % (n = 55) of patients, sialendoscopy prevented the salivary gland from being excised. In 18 % (n = 12) of cases, sialendoscopy findings indicated that salivary gland excision was needed. The study acknowledges the significant benefit of sialendoscopy in the treatment of obstructive sialadenitis (Tab. 3, Fig. 6, Ref. 39). Text in PDF www.elis.sk Keywords: sialendoscopy, sialadenitis, duct obstruction, sialolith, minimally invasive surgery.

Mediastinal Pseudocyst in a Case of Chronic Pancreatitis: A Rare Presentation

Pancreatic pseudocysts are collections of fluid localised within the pancreas or in the peripancreatic space, which can occur following acute pancreatitis or in patients with a history of acute pancreatitis and chronic pancreatitis. They are well-known complications of pancreatitis. The pathogenesis of pancreatitis depends on its etiology, where enzyme-rich fluid and products of autoregulation accumulate in acute pancreatitis, and cysts are formed due to obstructed ducts in chronic pancreatitis. The development of pancreatic pseudocysts is more commonly associated with chronic pancreatitis than acute pancreatitis. Unless ruptured, pancreatic pseudocysts are usually not hazardous. Diagnosis of pseudocysts has become easier with advanced diagnostic techniques such as ultrasound and Computed Tomography (CT) scans. Patients presenting with abdominal pain and elevated pancreatic enzymes should be suspected of having pseudocysts. Approximately one-third of these cases resolve spontaneously. In the past, surgery was the only management method, but recently, with newer techniques such as percutaneous drainage and endoscopic cyst enterostomy, management has become easier. Percutaneous drainage, performed under local anaesthesia, is a cost-effective procedure with very low complications. The recurrence rate is higher with single-needle treatment, so catheters are used to decrease recurrence. Drainage should be the first choice of management, but with advancing technology and endoscopic techniques, it may become more useful in the future with skilled practitioners. In this case report, we will examine the case of a 30-year-old male who presented with symptoms of pain in the epigastric region and was diagnosed with a pancreatic pseudocyst. This case demonstrates a rare presentation where the pseudocyst extends into the mediastinum and thorax.

The clinical anatomy of the accessory submandibular gland: a comprehensive review.

An accessory submandibular gland is a rare variation. As such, there is limited literature regarding the embryology, anatomy, variations, clinical imaging, and pathology of the accessory submandibular gland. In this article, we review the existing literature on the accessory submandibular gland from clinical and anatomical perspectives. The goal of this review is to provide comprehensive knowledge of this variation which can be useful for oral and maxillofacial/head and neck surgeons, radiologists, and anatomists. Within this review, the embryologic origin as well as the anatomy of the accessory submandibular gland is detailed. Several imaging modalities which can be used to visualize the accessory submandibular gland are outlined as well as its variations. Lastly, this review investigates several reported clinical considerations regarding the accessory submandibular gland including sialoliths, Wharton's duct obstruction, and pleomorphic adenoma.

Pancreatitis-Associated PRSS1-PRSS2 Haplotype Alters T-Cell Receptor Beta (TRB) Repertoire More Strongly Than PRSS1 Expression

Pancreatitis-Associated PRSS1-PRSS2 Haplotype Alters T-Cell Receptor Beta (TRB) Repertoire More Strongly Than PRSS1 Expression

S1920 A Rare Case of Small Cell Lung Cancer With Pancreatic Metastasis Presenting as Obstructive Jaundice

Introduction: Small cell lung cancer (SCLC) is an aggressive high grade neuroendocrine carcinoma that accounts for 15% of all lung cancers & usually presents with early distant metastatic spread typically to liver, bone, brain & lung on diagnosis. Pancreas is a very uncommon site of metastasis. We present a rare case of SCLC metastasis to the pancreas presenting as obstructive jaundice upon initial presentation. Case Description/Methods: A 62-year-old male with a past medical history of recurrent pancreatitis presented to the emergency department with abdominal pain, nausea, vomiting, & jaundice. Routine blood work on admission were notable for elevated total bilirubin of 16.4 mg/dL along with elevation in alkaline phosphatase at 547 IU/L & elevation in AST & ALT to 120 U/L & 144 U/L, respectively. Imaging with CT followed by MRI abdomen showed focal enlargement of the pancreatic head with dilatation of the common bile duct & the main pancreatic duct along with innumerable rim-enhancing lesions within the liver consistent with metastasis. CT Chest was also done that showed a large right suprahilar mass with mass effect on the right main bronchus. CT guided biopsy of liver lesion was performed which confirmed small cell carcinoma on pathology. Worsening jaundice prompted ERCP with EUS which showed a large mass at the major papilla site. Pancreatic duct was cannulated & sphincterotomy was performed; However, biliary cannulation could not be completed due to the size of the mass & prior history of chronic pancreatitis cannulation. Patient subsequently underwent IR guided PTC drain placement with appropriate decrease in bilirubin. Chemotherapy was initiated with carboplatin/ etoposide for metastatic small cell cancer with spread to the pancreas & liver (Figure). Discussion: SCLC metastasis to pancreas is rare & majority of patients with pancreatic metastasis are asymptomatic upon incidental diagnosis by abdominal CT. Pancreatitis & obstructive jaundice are seldom found on initial presentation, as seen in our patient. Jaundice can result from biliary ductal obstruction if SCLC spreads to lymph nodes in the porta hepatis or the pancreatic head. Endoscopic ultrasound (EUS) is more sensitive than CT or MRI in the diagnosis of pancreatic malignancy. Metastasis to pancreas typically indicates advanced disease & clinicians should consider palliative treatment with surgical biliary bypass & chemotherapy in select patient groups which has shown to lead to clinically significant increased mean survival time.Figure 1.: MRI Abdomen with contrast transverse image showing rim-enhancing lesions within the liver and focal enlargement of the pancreatic head with dilatation of the common bile duct and the main pancreatic duct (A). Endoscopic imaging showing a large fungating mass was found at the major papilla (B).

Management Strategies for Benign Biliary Strictures

AbstractBiliary stricture is the abnormal narrowing of the biliary ductal system, leading to bile stasis and eventual ductal obstruction and dilatation. Common etiologies of biliary strictures can be broadly classified based on benign or malignant causes. The pathogenesis of benign biliary strictures (BBSs) can be a sequela of several causes, including iatrogenic, inflammatory, ischemic, infectious, and immunologic etiologies. Among the common causes of BBS, an iatrogenic biliary ductal injury sustained during hepatobiliary surgeries is the most frequently reported cause of BBS. Clinically, patients with BBS can present with obstructive biliary symptoms, and urgent biliary decompressive interventions are frequently required to prevent fatal complications. Cross-sectional imaging such as MR cholangiopancreatography enables timely evaluation of the stricture and facilitates therapeutic planning. The primary objective in managing biliary strictures (both benign and malignant) is to achieve permanent ductal patency and minimize the need for repeated interventions. A multidisciplinary team of gastroenterologists, interventional radiologists, and hepatobiliary surgeons is generally involved in caring for patients with BBS. This review provides a summary of clinically available endoscopic, percutaneous, and surgical biliary interventions for the management of patients with BBS.

Damage associated molecular patterns and neutrophil extracellular traps in acute pancreatitis.

Previous researches have emphasized a trypsin-centered theory of acute pancreatitis (AP) for more than a century. With additional studies into the pathogenesis of AP, new mechanisms have been explored. Among them, the role of immune response bears great importance. Pro-inflammatory substances, especially damage-associated molecular patterns (DAMPs), play an essential role in activating, signaling, and steering inflammation. Meanwhile, activated neutrophils attach great importance to the immune defense by forming neutrophil extracellular traps (NETs), which cause ductal obstruction, premature trypsinogen activation, and modulate inflammation. In this review, we discuss the latest advances in understanding the pathological role of DAMPs and NETs in AP and shed light on the flexible crosstalk between these vital inflammatory mediators. We, then highlight the potentially promising treatment for AP targeting DAMPs and NETs, with a focus on novel insights into the mechanism, diagnosis, and management of AP.

Integrative Analysis of Intrahepatic Cholangiocarcinoma Subtypes for Improved Patient Stratification: Clinical, Pathological, and Radiological Considerations.

Simple SummaryLiver cancer subtypes differ in prognosis and genetic alterations. An accurate diagnosis made on time is the key aspect of clinical decision-making. Hence, a correct diagnosis is of pivotal importance for individual patients. In this study, we identified the most relevant clinical, radiological, and histological parameters for an improved subtype diagnosis of intrahepatic cholangiocarcinoma. As a result of our study, the radiologist should consider factors such as growth pattern, location, and contrast agent behavior. For the pathologist, precursor lesions, mucin secretion, and a periductal-infiltrating growth are of utmost importance, while immunohistochemical analyses are essential for exclusion of extrahepatic malignancies, but have so far only value for iCCA subtype analysis in the context with other parameters.Intrahepatic cholangiocarcinomas (iCCAs) may be subdivided into large and small duct types that differ in etiology, molecular alterations, therapy, and prognosis. Therefore, the optimal iCCA subtyping is crucial for the best possible patient outcome. In our study, we analyzed 148 small and 84 large duct iCCAs regarding their clinical, radiological, histological, and immunohistochemical features. Only 8% of small duct iCCAs, but 27% of large duct iCCAs, presented with initial jaundice. Ductal tumor growth pattern and biliary obstruction were significant radiological findings in 33% and 48% of large duct iCCAs, respectively. Biliary epithelial neoplasia and intraductal papillary neoplasms of the bile duct were detected exclusively in large duct type iCCAs. Other distinctive histological features were mucin formation and periductal-infiltrating growth pattern. Immunohistochemical staining against CK20, CA19-9, EMA, CD56, N-cadherin, and CRP could help distinguish between the subtypes. To summarize, correct subtyping of iCCA requires an interplay of several factors. While the diagnosis of a precursor lesion, evidence of mucin, or a periductal-infiltrating growth pattern indicates the diagnosis of a large duct type, in their absence, several other criteria of diagnosis need to be combined.

Percutaneous biliary interventions in the treatment of obstruction of the bile ducts of tumor etiology: current trends

Palliative endobiliary interventions for malignant obstruction of the biliary tract at the planning stage require a multidisciplinary approach with mandatory consideration of all the anatomical features of the block and clinical manifestations of the pathology. Transhepatic stenting requires differentiated use of both the design features of biliary stents and the technology of their implantation and positioning. This article discusses the promise of intraductal ablation, brachytherapy, photodynamic therapy, and external beam radiation, which can prolong biliary stent patency and minimize the need for repeated intervention.

Explosion behavior of non-uniform methane/air mixture in an obstructed duct with different blockage ratios

An experimental investigation on explosion behavior of non-uniform methane/air explosion in obstructed duct with different blockage ratios is conducted. The methane/air mixture that the methane concentration decreases from top to bottom and from ignition end to opposite end of duct is tested. The results show that the vertical concentration gradient of methane upstream along the obstacle increases with blockage ratio. After ignition, the flame speed and overpressure increase exponentially when the flame propagates with a finger-liked shape. In the poorly mixed methane/air, the flame speed and overpressure reduce with the appearance of pronounced triple flame. The flame in duct without obstacle propagates with triple shape until it approaches the vent. In the obstructed duct, the flame speed increases again after the flame passes the obstacle and then the triple flame disappears as the flame becomes turbulent. In the more evenly mixed methane/air, the flame speed decreases with the disappearance of finger shaped flame. The flame speed decreases continuously in duct without obstacle but increases again when the flame passes the obstacle in obstructed duct, in which an incomplete mushroom-shape flame forms downstream the obstacle. Generally, both the flame speed and overpressure are larger in methane/air that mixes more fully.

Multi center experience of interrupted versus continuous parachuting suturing technique of hepatico-jejunostomy posterior layer anastomosis

Background: In Biliary enteric anastomosis procedures, hepatico-jejunostomies are a crucial step. Depending on the situation, the hepatico-jejunostomy operation procedure varies depending on the surgical school, and can be continuous or interrupted. Patients and Methods: A prospective comparative randomized study included 100 Patients complaining of malignant pancreatic tumour (65%), iatrogenic bile duct injury (20%), multiple common bile duct stones (10%) and liver transplantation of cirrhotic patients (5%) underwent hepatico-jejunostomy anastomosis to review a multi-center experience of hepatico-jejunostomy anastomosis in Theodor Bilharz Research Institute and Faculty of Medicine of Cairo University with regard to the types of anastomosis performed, early and late complications, and long-term patency and outcomes. Results: According to the type of suturing technique, hepatico-jejunostomy anastomosis patients are sub grouped into posterior interrupted sutures group A and posterior parachuting sutures group B. A significant direct correlation of leakage in group A with obstructive jaundice (r = 0.327 and p value = 0.02), CBD diameter (r = 0.408 and p value = 0.001), and Duct wall thickness (r = 0.408 and p value = 0.001) While there were inverse correlations with pre-operative stent (r = -0.375 and p value = 0.01).

A review of gallbladder mucocele – part 1: aetiopathogenesis and diagnosis

Gallbladder mucocele is defined as a build-up of immobile mucus within the gallbladder that can result in extrahepatic biliary obstruction, pressure necrosis of the gallbladder wall and ultimately, rupture. The incidence of this disease has increased steadily in veterinary medicine and now it is one of the most recognised extrahepatic biliary tract problems in the dog. This is not likely to solely be a result of an increased incidence of the disease, but more so the increasingly widespread use of ultrasonography to diagnose it. There are several proposed causes and predisposing factors of gallbladder mucocele, including mechanical or functional obstruction of the cystic duct, idiopathic dyslipidaemias, glucocorticoid excess and cholecystitis. Although clinicopathological changes are often present, they are not specific to the disease and the gold standard diagnostic imaging tool is ultrasonography.