Remote-controlled cholangiography injection device: first clinical study in China

Background X-ray cholangiography is of great value in the imaging of biliary tract diseases; however, occupational radiation exposure is unavoidable. Moreover, clinicians must manually inject the contrast dye, which may result in a relatively high incidence of adverse reactions due to unstable injection pressure. Thus, there is a need to develop a novel remote-controlled cholangiography injection device. Methods Patients with external biliary drainage requiring cholangiography were included. A remote-controlled injection device was developed with three major components: an injection pump, a pressure sensor, and a wireless remote-control panel. Image quality, adverse reactions, and radiation dose were evaluated. Results Different kinds of X-ray cholangiography were successfully and smoothly performed using this remote-controlled injection device in all patients. The incidence of adverse reactions in the device group was significantly lower than that in the manual group (4.17% vs. 13.9%, P = 0.001), and increasing the injection pressure increased the incidence of adverse reactions. In addition, the device helped operators avoid ionizing radiation completely. Conclusions With good control of injection pressure (within 10 kPa), the remote-controlled cholangiography injection device could replace the need for the doctor to inject contrast agent with good security and effectivity. It is expected to be submitted for clinical application.

Treatment of biliodigestive anastomotic strictures after transplantation of left lateral segment of the liver

Many studies have shown that biliary complications after transplantation of the left lateral segment (LLS) of the liver reduce graft and recipient survival. Thus, timely correction of biliary complications, and strictures in particular, improves long-term outcomes in transplantation. Objective: to analyze our own experience in correcting biliary strictures in LLS graft transplantation. Materials and methods. From February 2014 to April 2020, 425 LLS grafts were transplanted in children. 19 (4.5%) patients were diagnosed with biliary strictures at different times after transplantation (from 0.2 to 97 months). Results. Biliary strictures were more often formed a year after transplantation (17.8 ± 23.9 months). In 14 out of the 19 patients, internal-external biliary drainage was successfully performed with phased replacement of the catheter with one that was larger in diameter (from 8.5 Fr to 14 Fr). The catheters were removed in 8 patients after completion of the treatment cycle. Restenosis was not observed during follow-up (13 ± 8.7 months) after the internal-external biliary drainage catheter had been removed. In 5 cases, antegrade passage of a guide wire through the stricture was unsuccessful. As a result, biliary reconstruction was performed in 4 (21.1%) patients and retransplantation was required in 1 (5.3%) patient. Conclusion. An antegrade minimally invasive approach can successfully eliminate biliary strictures in most children after liver LLS graft transplantation. The proposed technique is effective and safe.

Functional Changes of Paneth Cells in the Intestinal Epithelium of Mice with Obstructive Jaundice and After Internal and External Biliary Drainage

Objective: To investigate the functional changes of Paneth cells in the intestinal epithelium of mice with obstructive jaundice (OJ) and after internal biliary drainage (ID) and external biliary drainage (ED). Methods: The experiment was divided into two stages. First stage: Mice were randomly assigned to two groups: (I) sham operation (SH); (II) OJ. The mice were sacrificed before the operation and on the 1st, 3rd, 5th and 7th day after the operation to collect specimens. Second stage: Mice were randomly assigned to four groups: (I) SH; (II) OJ; (III) OJ and ED; and (IV) OJ and ID. They were reoperated on day 5 for biliary drainage procedure. The specimens were collected on day 10. Results: The expressions of lysozyme and cryptdin-4 increased first and then decreased over time in group OJ, and the number of Paneth cells decreased gradually with the extension of OJ time（p<0.05. After the secondary operation on the mice to relieve OJ, the number of Paneth cells and expressions of lysozyme and cryptdin-4 in group ID increased more significantly than those in group ED（p<0.05）. Conclusion: OJ could cause intestinal Paneth cells to dysfunction in mice. ID was more significant than ED in restoring the function of Paneth cells. It might be one of the mechanisms that make ID superior to ED.

An Approach to Soft Tissue Mass In The Gall Bladder

Background: Soft tissue mass in gall bladder (GB) is a radiologic finding commonly encountered in surgical practice. It needs proper evaluation as there is a fair chance that it can be a malignant lesion. Gall bladder cancer (GBC) is considered an incurable disease with an extremely poor prognosis. However, there is good chance of survival if it can be diagnosed in earlier stages (stage Ib, II, selective III). Methods: All consecutive cases of soft tissue mass lesions of GB found in ultrasonogram of abdomen and admitted in Hepato-Biliary-Pancreatic Surgery (HBPS) unit of BIRDEM hospital, from January 2009- September 2016, were included in this study. Detailed history and thorough clinical examination was done in all cases. Pre-operative evaluations were done by ultrasound, Tumor marker (CA19.9) & CT scan,. CT scan was a crucial investigation for all the patients, as depending on the findings, decision was made whether a patient is eligible for a possible curative surgery or not. On-table frozen section biopsy or imprint cytology was done for tissue diagnosis. Radical resection was done for the histology/ cytology proved malignancy of gallbladder (stage Ib, II, selective III). Post-cholecystectomy patients also underwent full thickness excision of the umbilical port. In benign cases only cholecystectomy was done. Advanced GBC cases underwent FNAC for tissue diagnosis followed by palliative chemotherapy. Some needed endoscopic or surgical palliation in the form of percutaneous external biliary drainage, endobiliary prosthesis, triple bypass, hepaticojejunostomy, left duct anastomosis, gastrojejunostomy, ileotransverse anastomosis, external biliary drainage etc before chemotherapy. All the GBC patients were regularly followed according to a schedule. Results: We are reporting 334 cases of soft tissue mass lesions of GB. Female 191 (57.2%) and male 143 (42.81%), M : F = 1 : 1.3 ,,between the ages of 32 and 88 years. Of these, 81 patients (24.2%) turned out to be benign; another 81 patients (24.2%) were in early stage (Ib, II selective III). The rest of 172 patients (51.5%) showed signs of advanced malignancy in USG & CT scan. Post-operative complications occurred in 27 cases (8.1%). During follow-up, 34 patients (42%) have crossed their 5 years of disease free survival after curative surgery. Rest of the patients (44 cases), after curative surgery, are still under follow-up. The 172 patients in Stage III & IV disease who underwent some sort of palliative procedure, had a mean survival of 7.2 months. Conclusion: Soft tissue mass in gall bladder picked up by imaging has a very high chance to be malignant. Among these malignant patients, a good number has a chance of curative resection if evaluated and managed properly. Bangladesh Crit Care J March 2019; 7(1): 29-34