Laparoscopic management of remnant gall bladder with stones: Lessons from a tertiary care centre's experience

Objective:Laparoscopic cholecystectomy is currently the gold standard for treating symptomatic gallstone disease.Despite its success,approximately 10%of patients may experience persistent biliary symptoms,leading to the post-cholecystectomy syndrome.A remnant gallbladder with cystic duct or bile duct stones is one of the causes of this syndrome.The objective of this study was to shed light on the clinical manifestations,evaluation,therapeutic strategies,and outcomes associated with laparoscopic management of symptomatic remnant gallbladders.Methods:This was a retrospective study,conducted over a five-year period(January 2017 to December 2022)at Apollo Hospitals in South India.All patients who underwent laparoscopic completion cholecystectomy for a remnant gall bladder were included.The following data were collected:patient demographics,symptoms,preoperative investigations,intraoperative details and post operative outcomes.Results:In total,36 patients were included and analysed.The majority of patients were male(25,69.4%),with a mean age of 50.7±12.1 years.The most common presentation was pain in the upper abdomen or right upper quadrant region(24,66.7%).The laparoscopic approach was attempted in all patients,with a success rate of 94.4%.Two patients required conversion to open surgery.Cholecystoenteric fistula to the colon was observed in one patient.Choledocholithiasis was observed in 7 patients(19.4%),and stone clearance was successfully achieved using endoscopic retrograde cholangiopancreatography in all patients preoperatively.Conclusion:Incomplete gall bladder removal either intentionally or unintentionally leaves a remnant gall bladder that is at risk for stone formation and infection.Patients who have this clinical entity with symptoms require a redo or complete cholecystectomy,a complex procedure associated with certain risks.This study highlights the feasibility and safety of laparoscopic completion cholecystectomy for the management of remnant gallbladder with cystic duct or bile duct stones.

Identification of genes associated with gall bladder cell carcinogenesis:Implications in targeted therapy of gall bladder cancer

Gall bladder cancer(GBC)is becoming a very devastating form of hepatobiliary cancer in India.Every year new cases of GBC are quite high in India.Despite recent advanced multimodality treatment options,the survival of GBC patients is very low.If the disease is diagnosed at the advanced stage(with local nodal metastasis or distant metastasis)or surgical resection is inoperable,the prognosis of those patients is very poor.So,perspectives of targeted therapy are being taken.Targeted therapy includes hormone therapy,proteasome inhibitors,signal transduction and apoptosis inhibitors,angiogenesis inhibitors,and immunotherapeutic agents.One such signal transduction inhibitor is the specific short interfering RNA(siRNA)or short hairpin RNA(shRNA).For developing siRNAmediated therapy shRNA,although several preclinical studies to evaluate the efficacy of these key molecules have been performed using gall bladder cells,many more clinical trials are required.To date,many such genes have been identified.This review will discuss the recently identified genes associated with GBC and those that have implications in its treatment by siRNA or shRNA.

Isolated traumatic gallbladder injury: A case report

BACKGROUND Isolated gallbladder injury(GI)(IGI)directly induced by abdominal trauma is rare.Symptoms,indications,and imaging examinations of IGI are frequently non-specific,posing tremendous diagnostic challenges,which are simple to overlook and may have severe implications.Improving doctors'understanding of gallbladder injury(GI)facilitates early detection and decreases the likelihood of severe consequences,including death.CASE SUMMARY We report a case of IGI caused by blunt violence(after falling from three meters with the umbilicus as the stress point)and performed laparoscopic repair of the gallbladder rupture,which helps clinicians understand IGI and reduce the severe consequences of delayed diagnosis.Through extensive medical history and dynamic abdominal ultrasound evaluation,doctors can identify GI early and begin surgery,thereby decreasing the devastating repercussions of delayed diagnosis.CONCLUSION This article aims to improve clinicians'understanding of IGI and propose a method for the diagnosis and treatment of GI.

Gall Bladder Stone in a Tertiary Care Teaching Hospital in Mogadishu-Three Year Retrospective Study

Introduction: Gallstone disease, also known as gallbladder stones or GBS, is almost always asymptomatic but can result in a number of problems, including ascending cholangitis and obstructive jaundice. The frequency of gallbladder stones among patients who were sent for abdominal ultrasound at Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, Somalia, during the period between January 2018 and June 2022 was assessed in this study. Methods: This is a record-based study that was carried out at the radiology department of Mogadishu Somali Turkey Training and Research Hospital on patients who were chosen for abdominal ultrasounds during the months of January 2018 and January 2022. The study focused on cases that occurred within those periods. Reports of abdominal ultrasounds served as the source of the collected data. Results: Records from 2352 patients are included in this study. They were divided into 451 (19.1%) males and 1901 (80.8%) females. Patients with GBS were present in 76.4 percent of cases. 73.2 percent of patients had big stones larger than 5 mm, while 53.4 percent of patients had several stones. GBS 1474 (77.5%) was substantially more common in females than in males (71.6%: 323/451) (P 0.008). The presence of small stones (less than 5 mm) was also shown to be significantly different between males and females (P = 0.015). Furthermore, compared with men, females had a considerably higher frequency of big GBS (5 mm) (P 0.015). Conclusion: In this study, it was discovered that females were significantly more likely than males to have GBS. Small stones were found much more frequently in the males. When compared to men, females had a considerably higher frequency of large GBS.

Study on Breeding of Rice Gall Midge (Orseolia oryzae)

[ Objective ] The paper is to explore the breeding of rice gall midge. [ Method ] The morphological characteristics, living habits, breeding method and resistance identification of rice gall midge are introduced. [ Result] TN1 can be used as feedstuff to feed rice gall midge, and water should be sprayed to keep moisture during the breeding process. The damage caused by mice, rice planthopper, ants and spiders during the breeding process should be paid attention, mice and ants can be controlled by water insulation method, rice planthopper and spiders can be controlled by tap water rinsing method and artificial capture method, respec- tively. [ Conlcusion] The study provides reference for further study on rice gall midge.

美国核电厂GALL报告解读

GALL报告是美国NRC颁布的用于指导审查核电厂执照更新申请的技术文件,它采用表单化形式,从具体的构筑物与部件层面出发,详细记录了材料、环境、老化效应与机理、老化管理大纲间逐一对应的关系。基于文献调研与分析,从开发背景、发展历史、内容框架、应用情况等方面介绍了GALL报告的基本信息,应是我国对该文件的首次全面解读,对我国建立核电厂老化管理大纲及有关核电厂延寿的核安全监管法规具有重要参考价值。

GALLE-DONAU(加诺)的基础研究及临床应用

目的 :研究GALLE -DONAU的理化特性和药理特点 ,并探讨其临床疗效。方法 :对国内6家大医院152例肝胆疾病患者应用GALLE -DONAU进行临床疗效及不良反应观察。结果 :黄疸消除87 5 % ,疼痛缓解93 6 % ,食欲改善84 1 % ,右上腹压痛缓解85 1 % ,总有效率达88 8 % ,提示该药有明显利胆、解痉、消炎作用。不良反应轻微 ,且停药后即恢复正常。结论 :GALLE -DONAU是一种安全、有效的利胆药 。

Laparoscopic management of a two staged gall bladder torsion

Gall bladder torsion(GBT) is a relatively uncommon entity and rarely diagnosed preoperatively. A constant factor in all occurrences of GBT is a freely mobile gall bladder due to congenital or acquired anomalies. GBT is commonly observed in elderly white females. We report a 77-year-old, Caucasian lady who was originally diagnosed as gall bladder perforation but was eventually found with a two staged torsion of the gall bladder with twisting of the Riedel's lobe(part of tongue like projection of liver segment 4A). This together, has not been reported in literature, to the best of our knowledge. We performed laparoscopic cholecystectomy and she had an uneventful postoperative period. GBT may create a diagnostic dilemma in the context of acute cholecystitis. Timely diagnosis and intervention is necessary, with extra care while operating as the anatomy is generally distorted. The fundus first approach can be useful due to altered anatomy in the region of Calot's triangle. Laparoscopic cholecystectomy has the benefit of early recovery.

THE INFLUENCE OF MULTIPLE FACTORS ON GALL BLADDER PRESSURE AFTER AURICULAR POINT STIMULATION

The study has explored 11 correlative variables which might affect the gallblad-der pressure GBP of patients with gall stone after auricular electrical stimulation by means of multiplestepwise regression. It was found that the size of gallbladder stone (X9), cholecystolithiasis (X4),sex (X1), and the baseline of GBP (X10) could affect the GBP change range (Y1) depressingly orreinforcingly. Also the baseline of GBP (Y1) could be affected by the variables X1 (sex), X2 (age),and X6 (long diameter of the gallbladder, LDGB), etc.. The result shows that the change in GBPafter auricular electrical stimulation is comprehensively influenced by multiple factors. And it providessome useful information for predicting the curative effect of auricular therapy on gallbladder stone inclinic.

Initial Stages in the Formation of Galls Induced by Geoica utricularia in Pistacia terebinthus Leaflets: Origin of the Two Vascular Bundles which Characterize the Wall of the Galls

Only a few species of aphids induce galls. Among these, Paracletus cimiciformis, Forda marginata, Forda formicaria, Geoica utricularia and Baizongia pistaciae induce galls on Pistacia terebinthus leaflets. Prior to present study the author examined microscopically P. terebinthus leaflets. He also studied the microscopic morphology of galls induced by the five species mentioned above. A clear microscopic difference between these galls is that in the wall of galls induced by the genera Paracletus and Forda a single vascular bundle is seen. The interpretation is that these galls are laminae of the modified leaflets. However, in the walls of the galls induced by the genera Geoica and Baizongia, two vascular bundles are observed. In the present paper a study of the early stages of development of galls produced by G. utricularia is described. The study was designed to explain the origin of the two vascular bundles present in the walls of these galls. The findings indicate that the aphid induces a massive development of the two vascular bundles present in the midvein of the leaflets of P. terebinthus: the main vascular bundle and the small supernumerary vascular bundle. Both these extremely developed vascular bundles occupy the walls of the galls induced by G. utricularia.

Isolation and Preliminary Identification of Antibacterial Active Substances of Antagonistic Actinomycetes against Peach Crown Gall(Agrobacterium tumefaciens)

[ Objective ] The paper was to isolate and preliminarily identify the antibacterial active substances of antagonistic actinomyeete strain G19 obtained from the soil highly affected by peach crown gall （Agrobacterium tumefaciens）. [ Method] The antibacterial substances of antagonistic actinomycete strain G19 were ex- tracted using protein precipitation method, then isolated and purified using high performance liquid chromatography and medium-pressure preparative chromatogra- phy. Its molecular weight was determined by MALDI-TOFMS method, and the related functional groups were verified through chemical color reaction. [ Result] Seven peptide portions were produced from the antibacterial substances of antagonistic actinomycete strain G19 with the molecular weights of 900 - 1 300 Da after isolation and purification. It could be also inferred that it contained Cys, and carried with H2O and Na＋. Color reaction of functional groups verified that the sub- stance was polypeptide containing glycosyl. [ Conclusion] The result provided basis for the final definition of the structure of antibacterial substances in antagonistic actinomycete strain G19.

Surgical outcome of carcinosarcoma of the gall bladder:A review

Carcinosarcoma,which comprises less than one percent of all gall bladder neoplasms,is characterized by the presence of variable proportions of carcinomatous and sarcomatous elements.Recently,several reports have described patients suffering from carcinosarcoma of the gall bladder.However,there are no large studies regarding the clinicopathologic features,therapeutic management,and surgical outcome of this disease because the number of patients who undergo resection of gall bladder carcinosarcoma at a single institution is limited.A Medline search was performed using the keywords 'gall bladder' and 'carcinosarcoma'.Additional articles were obtained from references within the papers identified by the Medline search.Optimal adjuvant chemotherapy and/or radiotherapy protocols for carcinosarcoma of the gall bladder have not been established.Curative surgical resection offers the only chance for long-term survival from this disease.The outcome of 36 patients who underwent surgical resection for carcinosarcoma of the gall bladder was poor;the 3-year overall survival rate was only 31.0% and the median survival time was 7.0 mo.Since the postoperative prognosis of carcinosarcoma of the gall bladder is worse than that of adenocarcinoma,new adjuvant chemotherapies and/or radiation techniques are essential for improvement of surgical outcome.

Pharmacognostic studies of insect gall of Quercus infectoria Olivier(Fagaceae)

Objective:To study the detailed pharmacognostic profile of galls of Quercus infectoria Olivier(Q.infectoria olivier)(Fagaceae),an important medicinal plant used in the Indian system of medicine.Methods:Samples of galls of Q.infectoria were studied by macroscopical,microscopical,physiochemical,phytochemical.fluorescence analysis and othjer methods for standardization as recommended by WHO.Results:Macroscopically,the crude drug is globose with horny appearances on external surface(1.4-2.3 cm in length and 1-1.5 cm in diameter),with greyish-brown to brownish-black in colour externally and dark brown buff colored.Surface is smooth with numerous horny protuberances giving rough touch,and witfi unpleasant odour.Microscopically,a wide zone of radially elongated parenchyma cells between upper and lower epidermis were found.The vascular strands were present at all places and radially elongated sclerides touched the lower epidermis.In physico-chemical studies,the moisture,total ash,acid insoluble ash,alcohol soluble,water soluble,petroleum ether,chloroform extractive value and tannin content were found to be 2.790,5.020,0.110,38.780,41.210,0.402,1.590 and 49.200 percentage respectively.Prcliminary phytochemical screening showed the presence of phenols,flavonoids,steroids,triterpenes,tannins,saponins and alkaloids.Cooclusions:The results of the present study serve as a valuable source of information and provide suitable standards for identification of this medicinally important plant drug material for future investigations and applications.

Outcome of gall bladder polypoidal lesions detected by transabdominal ultrasound scanning: A nine year experience

AIM: To determine the outcome of polypoidal lesions within the gall bladder (PLG) diagnosed by trans-abdominal scanning.METHODS: A nine-year (1993-2002) retrospective casenote review of all patients who underwent ultrasound scanning after referral to a single Upper GI Surgeon at a District General Hospital was conducted. Patients who were diagnosed with a PLG were included in our study. A database was constructed and patient details, investigations including ultrasound scan (USS) findings, treatment and histology and final diagnosis were recorded. RESULTS: Twenty-three (out of 651) patients were diagnosed pre-operatively by USS to have a polyp-likegall bladder lesion (PLG). Post cholecystectomy histological examination revealed 12 gallstones, 7 cholesterol polyps, 3 adenocarcinomas within polyps and 1 normal gall bladder. The specificity of USS in the diagnosis of PLG was 92.3%. All the true polyps were malignant. Overall USS had 66.66% sensitivity and 100% specificity in the pre-operative suspicion of malignancy. Using size greater than 10 mm as measured on USS as a cut-off, we find 100% sensitivity and 86.95% specificity with a positive predictive value of 50% in the diagnosis of malignancy in PLG.CONCLUSION: A large number of PLG are in fact calculi within diseased gall bladder. In cases of gall bladder polyps more then 10 mm in size on USS further imaging (crosssectional and/or EUS) is indicated prior to surgery. This will help in the optimal management of patients and avoid histological surprises.

GALL线评价Twin-Block治疗安氏Ⅱ类1分类的侧貌变化

目的:基于Andrews六要素的美学理论,尝试用GALL线评价Twin-Block治疗青少年Ⅱ^(1)错[牙合]引起的侧貌改变。方法:收集18例戴用Twin-Block矫治器7~13个月的10~13岁Ⅱ^(1)错[牙合]患者,用GALL线作为参考对矫治前后的头颅侧位片进行测量,并以传统的评价指标为对照,评价软硬组织的变化。结果:18例患者矫治后,以GALL线为参考平面测量指标在评价硬组织变化方面得出了与传统评价指标基本一致的结果:下颌骨长度明显增加,下颌位置前移;上前牙舌倾下前牙唇倾,面下1/3高度增加(P<0.01);但在评价软组织变化方面较传统指标更灵敏。结论:以GALL线为参考可直观的反映出Ⅱ^(1)错[牙合]患者矫治后的变化,较传统的测量方法更加直观及个性化。

GALL线评价快速扩弓联合前方牵引治疗替牙期骨性Ⅲ类错[牙合]的疗效

目的:运用Andrews口颌面协调六要素中的GALL线,尝试对快速扩弓联合前方牵引矫治骨性Ⅲ类错[牙合]的疗效评价分析。方法:共选取25名扩弓前牵矫治结束的7~12岁骨性Ⅲ类错[牙合]患者(男12,女,13),以GAll线作为参考平面分析矫治前(T1)和治疗后(T2)的头颅侧位片,并以传统的评价指标为对照,评价矫治前后软硬组织的变化。结果:治疗结束后,患者均发生了明显的上颌骨前移,下颌骨后移.SNA、ANB、PP-FH、MP-FH、L1-MP、U1-SN、MP-FH、B-GALL、Pog-GALL、U1FA-GALL、U1-GALL、L1-GALL、LL-E、LL-GALL、Ns-Sn-Pos治疗前后的数值,差异有统计学意义(P<0.05),SNB、Wits值、Y轴角治疗前后差值无统计学意义。结论:以GAll线为参考平面的测量指标的结果与传统评价指标大的结果基本一致,这种基于面部协调美学理论的评价方法能够有效直观的反映出错患者扩弓牵前矫治后的牙、颌、面关系的改善,较传统的评价测量方法更加直观及个性化。

Adaptation of faba bean varieties for yield, for yield components and against faba bean gall (Olpidium viciae Kusano) disease in South Gondar, Ethiopia

Faba bean(Vicia faba L.) has an important place in the Ethiopian national diet. It is consumed in various forms and contributes to the improvement of soil fertility. However,its production and productivity are affected by biotic and abiotic constraints. Among the biotic constraints, the emerging faba bean gall disease, caused by Olpidium uiciae, is the major and most destructive disease wherever faba bean is grown. Field experiments were conducted at two locations(Farta and Tach Gayint districts) to evaluate the reaction of faba bean varieties to faba bean gall disease and to assess them for yield and yield components during the 2014 and 2015 main cropping seasons. Thirteen faba bean varieties and one local check were plantecd in three replications Lusing a randomized complete block design. The disease incidence and severity of faba bean gall were recorded(on a 1-9 scale) five tinmes at10-day intervals. A combined analysis of variance showed za significant difference(P < 0.05)among faba bean varieties with respect to the incidence and severity of gall disease at both locations. Disease incidence, severity, and AUDPC were lowest for variety Turmsa at both locatiOons, but this variety showed lhigh yield only at tlhe Farta location. 'The lhighest yields were obtained from varieties Degaga(1157.74 kg ha ') and Nc58(828.97 kg ha ') at Farta and Tach Gayint, respectively and these varieties slhowed low faba bean gall severity and AUDPC. Thus, higher-yielding faba bean varieties such as Degaga and Nc58 are recommended for faba bean production areas in northwestern Ethiopia.

Two cases of neuroendocrine carcinoma of the gallbladder

Neuroendocrine carcinoma (NEC) of the gallbladder is a rare subtype of gallbladder tumor. Here, we report two cases of NEC in two patients initially suspected to have gallbladder carcinoma. No specific symptoms or abnormal blood test results were observed preoperatively. Abdominal computed tomography scans indicated intraluminal masses in the gallbladder and lymph node enlargement in the hepatic hilum. Radical cholecystectomy and regional lymphadenectomy were performed. The first patient also presented with liver invasion and therefore underwent resection of liver segment IV. A diagnosis of NEC was made upon postoperative pathological examination and immunohistochemical staining according to the WHO Classification of Tumors of the Digestive System (2010). One tumor was identified as poorly differentiated NEC and the other as poorly differentiated mixed adenoneuroendocrine carcinoma. Immunohistochemical staining data from both tumors showed positivity for chromogranin A and synaptophysin. The first patient received 4 cycles of chemotherapy consisting of cisplatin and etoposide. No metastases or recurrence were observed 12 mo following surgery. The second patient refused chemotherapy and presented with tumor recurrence 4 mo after surgery. In conclusion, NEC of the gallbladder is an aggressive tumor and the identification of a standardized optimal treatment still requires further research. Our experience together with published studies suggests that radical surgery and adjuvant chemotherapy may improve the prognosis.

Candida tropicalis infection in a term neonate with gall bladder masses and infective endocarditis

Candida endocarditis is extremely rare in term neonates,and gall bladder involvement due to candidemia has never been reported amongst neonates and infants.A term,appropriate for gestational age neonate developed Candida tropicalis blood stream infection in second week of life.He was started on conventional amphotericin B.However,he failed to show any clinical improvement,and candidemia keep on persisting.Repeat sanctuary sites screening revealed multiple echogenic masses in heart(vegetations) and gall bladder.On changing the treatment to liposomal amphotericin B and fluconazole,he recovered clinically,echogenic masses in gall bladder disappeared,and intracardiac vegetations decreased in size.

Gallbladder cancer harboring ERBB2 mutation on the primary and metastatic site: A case report

BACKGROUND Bile duct cancer constitutes gallbladder cancer(GBC),intrahepatic cholangiocarcinoma(ICA),and extrahepatic cholangiocarcinoma(ECA).These three entities show morphological and immunohistochemical resemblance so that it is difficult to differentiate between primary ICA and liver metastasis of GBC,which sometimes becomes a point of discussion in clinical practice.Although these cancers demonstrate significant differences in their mutational landscape,several reports demonstrated shared genomic alteration in paired primary and metastatic site aids in distinguishing metastatic recurrence from second primary cancers.CASE SUMMARY We present a 73-year-old female patient who underwent curative resection for GBC harboring epidermal growth factor receptor 2(ERBB2)activating mutation on next-generation sequencing(NGS)-based genomic testing.One year later,a hepatic lesion was observed on follow-up imaging and she underwent surgical resection for a pathological diagnosis.The histological findings of the hepatic lesion were similar to those of the primary lesion.Additionally,using NGS panel testing,the hepatic lesion was found to have ERBB2 activating mutation,which is the identical mutation detected in the sequencing result of the primary site.ERBB2 activating mutation occurs more frequently in GBC than ICA and ECA.Therefore,in the present case,we think this molecular finding potentiated the diagnosis of the liver mass toward a metastatic recurrence.Additionally,this patient underwent HER2-targeted treatment with lapatinib in combination with capecitabin and obtained clinical benefit.CONCLUSION This case illustrated NGS panel usefulness in distinguishing GBC recurrence from second primary cancer and HER2-targeted agent efficacy on ERBB2 mutated GBC.