Imaging misdiagnosis and clinical analysis of significant hepatic atrophy after bilioenteric anastomosis: A case report

BACKGROUND The occurrence of long-term bilioenteric anastomotic stenosis can readily induce liver atrophy and hyperplasia,thereby causing significant alterations in the anatomical and morphological aspects of the liver.This condition significantly hampers the accuracy of preoperative imaging diagnosis,while also exacerbating the complexity of surgical procedures and the likelihood of complications.CASE SUMMARY A 60-year-old female patient was admitted to the hospital presenting with recurring epigastric pain accompanied by a high fever.The patient had a history of cholecystectomy,although the surgical records were not accessible.Based on preoperative imaging and laboratory examination,the initial diagnosis indicated the presence of intrahepatic calculi,abnormal right liver morphology,and acute cholangitis.However,during the surgical procedure,it was observed that both the left and right liver lobes exhibited evident atrophy and thinness.Additionally,there was a noticeable increase in the volume of the hepatic caudate lobe,and the original bilioenteric anastomosis was narrowed.The anastomosis underwent enlargement subsequent to hepatectomy.As a consequence of the presence of remaining stones in the caudate lobe,the second stage was effectively executed utilizing ultrasound-guided percutaneous transhepatic catheter drainage.Following the puncture,three days elapsed before the drain tip inadvertently perforated the liver,leading to the development of biliary panperitonitis,subsequently followed by pulmonary infection.The patient and her family strongly refused operation,and she died.CONCLUSION The hepatic atrophy-hypertrophy complex induces notable alterations in the anatomical structure,thereby posing a substantial challenge in terms of imaging diagnosis and surgical procedures.Additionally,the long-term presence of hepatic fibrosis changes heightens the likelihood of complications arising from puncture procedures.

Two surgical procedures for esophagogastric variceal bleeding in patients with portal hypertension

AIM:To determine the clinical value of a splenorenal shunt plus pericardial devascularization(PCVD)in portal hypertension(PHT)patients with variceal bleeding.METHODS:From January 2008 to November 2012,290 patients with cirrhotic portal hypertension were treated surgically in our department for the prevention of gastroesophageal variceal bleeding:207 patients received a routine PCVD procedure(PCVD group),and83 patients received a PCVD plus a splenorenal shunt procedure(combined group).Changes in hemodynamic parameters,rebleeding,encephalopathy,portal vein thrombosis,and mortality were analyzed.RESULTS:The free portal pressure decreased to 21.43±4.35 mmHg in the combined group compared with24.61±5.42 mmHg in the PCVD group(P<0.05).The changes in hemodynamic parameters were more significant in the combined group(P<0.05).The long-term rebleeding rate was 7.22%in the combined group,which was lower than that in the PCVD group(14.93%),(P<0.05).CONCLUSION:Devascularization plus splenorenal shunt is an effective and safe strategy to control esophagogastric variceal bleeding in PHT.It should be recommended as a first-line treatment for preventing bleeding in PHT patients when surgical interventions are considered.

Downregulation of microRNA-382 is associated with poor outcome of esophageal squamous cell carcinoma

AIM: To study the potential prognostic role of microRNA-382(miR-382) in esophageal squamous cell carcinoma(ESCC).METHODS: Forty six patients were divided into 2groups according to postoperative survival time:the poor outcome group(28 patients), who showed early metastasis but no recurrence, and died within 1year after surgery, 12 patients of the group received postoperative chemotherapy treatment that was given after early metastasis happening; the good outcome group(18 patients), who had no clinical metastasis and recurrence, and survived 5 years or more after surgery, all patients did not receive any postoperative treatment. Total RNA was extracted from the patients' formalin-fixed and paraffin-embedded esophageal cancer tissues. miR-382 level was evaluated using highthroughput real-time quantitative polymerase chain reaction analysis. The correlation between miR-382 level and clinicopathologic features was analyzed through COX regression model, and Kaplan-Meier analysis was used to analyze the relationship betweenmiR-382 level and patient survival time.RESULTS: miR-382 was differentially expressed in the two groups. Overall the average miR-382 level in the ESCC patients with good outcome was 9.8 ± 3.8,while miR-382 level in the ESCC patients with poor outcome was 3.0 ± 0.8. The differences of miR-382 levels between two groups were significant(P < 0.05).Kaplan-Meier analysis results showed that miR-382 expression level generally had a significant reversecorrelation with ESCC patient survival time(P <0.001), in which the patients with higher expressions of miR-382 had a longer survival time either among individuals with the same tumor stage or among the overall patients.CONCLUSION: miR-382 levels are reverse-correlated with ESCC poor outcomes, suggesting that miR-382 could be a potential predictive biomarker for both prognosis and treatment of ESCC.

The assembly of a composite based on nano-sheet graphene oxide and montmorillonite

Graphene oxide （GO） nano-sheets were synthesized using a modified Hummers＇ method from graphite powder. The Raman spectrum of GO displayed a D-band at 1359 cm-1 and a G-band at 1594 cm-l. The ID/IG value of GO was calculated to be 0.97, suggesting the formation of new sp2 clusters upon reduction. A method was designed to investigate the assembly of the GO/montmorillonite （MMT） composite. After the addition of GO, the typical peaks of montmorillonite in FT-IR spectra shifted, indicating the assembly between GO and MMT. The D-band and G-band reduced sharply in the GO/MMT composite. More importantly, the D-band （1344 cm-1） and G-band （1574 cm 1） shifted significantly and the ID/ IG value of the GO/MMT composite was calculated to be 1.13, showing a change in the GO structure. In the addition of 0.04 wt% GO to MMT, the value of interlayer space （d） was up to 13.0 Ameasured by XRD due to the insertion of GO into MMT. The evident increases in contents of carbon atoms （26.59%） and nitrogen atoms （3.44%） indicate that GO was successfully combined with MMT. The nano-pores and clay sheets were not observed in the SEM image of GO/clay, but obvious wrinkles, while flexible sheets were observed in the typical scanning electron microscopy images of GO. This further proves that GO was combining with clay. The TEM image shows that the GO nano-sheets were tiled on the surface of MMT sheets. This observation suggests that a stable assembly structure was formed between GO sheets and MMT sheets. The change in particle size of MMT with the addition of GO shows that interaction occurred between GO sheets and MMT sheets, which was further confirmed by the results of zeta potential. Adsorption and insertion were the main mechanisms to assemble GO and MMT.

Diagnosis and Treatment of Cholangiocarcinoma: A Consensus from Surgical Specialists of China

Cholangiocarcinoma refers to malignant tumors that develop in epithelial lining of biliary system, and it is divided into two categories according to tumor location, intrahepatic cholangiocarcinoma （ICC） and extrahepatic cholangiocarcinoma （ECC）. ICC occurs from the epithelial cells of the intrahepatic bile duct, its branches and interlobular biliary tree; and ECC is divided into hilar cholangiocarcinoma and distal cholangiocarcinoma by the circumscription at the confluence of cystic duct and the common hepatic duct.