Previsores de falha da colangiopancreatografia retrógrada endoscópica na limpeza de cálculos do ducto biliar durante o procedimento inicial - Um estudo prospectivo / Predictors of failure of endoscopic retrograde cholangiopancreatography in clearing bile duct stones during index procedure - a prospective study

ABSTRACT Background: Common bile duct (CBD) stones are known to complicate 10-15% of gallstone diseases. Endoscopic retrograde cholangiopancreatography (ERCP) is the therapeutic modality of choice for bile duct clearance in CBD stones but may fail to achieve stone clearance. This prospective study was done to identify the predictors of failure of CBD clearance with ERCP. Objective: This prospective study was done to identify the predictors of failure of CBD clearance with ERCP. Methods: All consecutive patients with bile duct stones undergoing ERCP at a tertiary care center were prospectively included from October 2020 to October 2021. The study's primary outcome was to identify and analyze factors that could predict the failure of complete CBD clearance. Results: A total of 120 patients (50.8% males, median age: 53.5 years) were included in the final analysis. Successful clearance of CBD stones during the index procedure was achieved in 70% of patients. At a cut-off stone diameter of >10.5 mm and CBD diameter of >12.5 mm, the AUC was 0.890 and 0.884, respectively, to predict failed clearance of CBD. On multivariate analysis, stone diameter ≥15 mm [odds ratio (OR) 16.97, 95% confidence interval (CI): 1.629-176.785], location of stones in hepatic ducts (OR 7.74, 95%CI: 2.041-29.332), presence of stricture distal to stone (OR 6.99, 95%CI: 1.402-34.726) and impacted stone (OR 21.61, 95%CI: 1.84-253.058) were independent predictors of failed bile duct clearance. Conclusion: Stone size and location are independent predictors of failed bile duct clearance. The endoscopist should consider these factors while subjecting a patient to biliary ductal clearance to plan additional intervention.

RESUMO Contexto: Cálculos do ducto biliar comum (CDC) são conhecidos por complicar 10-15% das doenças de cálculos biliares. A colangiopancreatografia retrógrada endoscópica (CPRE) é a modalidade terapêutica de escolha para a limpeza do CDC, mas pode falhar na sua remoção. Objetivo: Este estudo prospectivo foi realizado para identificar os previsores de falha na limpeza do CDC com CPRE. Métodos: Pacientes consecutivos com cálculos no ducto biliar submetidos a CPRE em um centro de atendimento terciário foram incluídos prospectivamente de outubro de 2020 a outubro de 2021. O principal resultado do estudo foi identificar e analisar fatores que poderiam prever a falha na limpeza completa do CDC. Resultados: Um total de 120 pacientes (50,8% homens, idade média: 53,5 anos) foram incluídos na análise final. A limpeza bem-sucedida dos cálculos de CDC durante o procedimento inicial foi alcançada em 70% dos pacientes. Com um diâmetro de corte de cálculos >10,5 mm e de diâmetro de CDC de >12,5 mm, a AUC foi de 0,890 e 0,884, respectivamente, para prever a falha na limpeza do CDC. Na análise multivariada, diâmetro da cálculos ≥15 mm [razão de chances (OR) 16,97, intervalo de confiança de 95% (IC): 1,629-176,785], localização dos cálculos nos ductos hepáticos (OR 7,74, IC95%: 2,041-29,332), presença de estreitamento distal ao cálculo (OR 6,99, IC95%: 1,402-34,726) e cálculo impactado (OR 21,61, IC95%: 1,84-253,058) foram previsores independentes de falha na limpeza do ducto biliar. Conclusão: O tamanho e a localização dos cálculos são previsores independentes de falha na limpeza do ducto biliar. O endoscopista deve considerar esses fatores ao submeter um paciente à limpeza ductal biliar para planejar intervenção adicional.

Utilização da cannabis sativa para tratamento de dor crônica em cães / Use of cannabis sativa for the treatment of chronic pain in dogs / Uso de cannabis sativa para el tratamiento del dolor crónico en perros

A Cannabis sativa é uma planta que apresenta vários benefícios terapêuticos para animais, como tratamento da dor neuropática, inflamatória e osteoartrose. A dor é bastante recorrente na rotina clínica, sendo importante seu manejo para que seja ofertada uma melhor qualidade e conforto de vida para o paciente. O estudo objetivou identificar, a partir de evidências científicas, as características da utilização medicinal do uso de Cannabis Sativa no tratamento da dor crônica no cão, utilizando um dos seus princípios ativos, canabidiol (CBD). Foi feito uma revisão bibliográfica onde foi realizada a busca de estudos experimentais e relatos de caso em bases de dados eletrônicos, sendo incluídas fontes contendo a utilização do CBD em animais, que abordaram controle da dor, assim como escore avaliativo da dor antes, durante e após o tratamento proposto. Após eleger e analisar 54 estudos percebe-se que na medicina veterinária o uso do canabidio é insuficiente, uma vez que o foco da maior parte dos estudos clínicos é voltado para medicina humana. Ainda assim, a utilização de CBD mostrou-se eficaz, confirmando uma nova alternativa para o controle da dor em animais.(AU)

Cannabis sativa is a plant that has several therapeutic benefits for animals, such as the treatment of neuropathic and inflammatory pain and osteoarthritis. Pain is quite recurrent in the clinical routine, and its management is important to offer a better quality and comfort of life for the patient. The study aimed to identify, based on scientific evidence, the characteristics of the medicinal use of Cannabis Sativa in the treatment of chronic pain in dogs, using one of its active principles, cannabidiol (CBD). A bibliographical review was carried out in which experimental studies and case reports were searched in electronic databases, including sources containing the use of CBD in animals, which addressed pain control, as well as pain assessment score before, during and after the proposed treatment. After choosing and analyzing 54 studies, it is clear that in veterinary medicine the use of CBD is few, and the focus of clinical studies is on human medicine. The use of CBD proved to be effective, thus confirming a new alternative for pain control in animals.(AU)

El cannabis sativa es una planta que tiene varios beneficios terapéuticos para los animales, como el tratamiento del dolor neuropático e inflamatorio y la osteoartritis. El dolor es bastante recurrente en la rutina clínica, y su manejo es importante para ofrecer una mejor calidad y comodidad de vida al paciente. El estudio tuvo como objetivo identificar, con base en la evidencia científica, las características del uso medicinal de Cannabis Sativa en el tratamiento del dolor crónico en perros, utilizando uno de sus principios activos, el cannabidiol (CBD). Se realizó una revisión bibliográfica en la que se buscaron estudios experimentales y reportes de casos en bases de datos electrónicas, incluyendo fuentes que contengan el uso de CBD en animales, que abordaran el control del dolor, así como la puntuación de evaluación del dolor antes, durante y después del tratamiento propuesto. Después de elegir y analizar 54 estudios, queda claro que en medicina veterinaria el uso de cannabidio es insuficiente, ya que el foco de la mayoría de los estudios clínicos está en la medicina humana. Aun así, el uso de CBD demostró ser efectivo, confirmando una nueva alternativa para el control del dolor en animales.(AU)

Enantiomeric characteristics of non-synthetic cannabidiol by two-dimensional nuclear magnetic resonance

SUMMARY Introduction: Cannabidiol (CBD) has become a promising bioactive for the next decades after the recent recognition of the medical potential of Cannabis derivatives by United Nations member countries, as it has no psychotropic potential as your isomer A9-tetrahydrocannabinol (Δ9-THC). The differentiation of these isomers has been studied for decades. Recent studies demonstrate that even with more subtle chemical characteristics, such as those of the CBD enantiomers, there are considerable bioactive differences. However, there are still not many studies on their chemical structures. Aim: This work aims to present experimental data obtained by Nuclear Magnetic Resonance (NMR) to better elucidate the three-dimensional structure of this enantiomeric bioactive. Materials and methods: For this, a sample of non-synthetic high purity CBD was subjected to different one-dimensional (1D-NMR) and two-dimensional (2D-NMR) analyses related to the hydrogen (1H) and carbon (13C) nuclei. Results and discussion: The 1D-NMR techniques used are sufficient to distinguish the CBD and Δ 9-THC isomers, but not to identify the enantiomeric characteristics of the non-synthetic CBD. Conclusions: It is concluded that the two-dimensional homonuclear (1H,1H) and heteronuclear (1H,13C) techniques analyzed are suitable to help distinguish CBD enantiomers.

Introducción: El cannabidiol (CBD) se ha convertido en un bioactivo prometedor para las próximas décadas tras el reciente reconocimiento del potencial medicinal de los derivados del Cannabis por parte de los países miembros de las Naciones Unidas, ya que no tiene potencial psicotrópico como su isómero Δ9-tetrahidrocannabinol (Δ 9-THC). La diferenciación de estos isómeros se ha estudiado durante décadas. Estudios recientes demuestran que incluso con características químicas más sutiles, como las de los enan-tiómeros del CBD, existen diferencias bioactivas considerables. Sin embargo, no existen muchos estudios sobre sus estructuras químicas. Objetivo: Este trabajo tiene como objetivo presentar datos experimentales obtenidos por Resonancia magnética nuclear (RMN) para dilucidar mejor la estructura tridimensional de este bioactivo enantiomérico. Materiales y métodos: Para ello, una muestra de CBD no sintético de alta pureza se sometió a diferentes análisis unidimensionales (RMN-1D) y bidimensionales (RMN-2D) relacionados con los núcleos del hidrógeno (1H) y carbono (13C). Resultados y discusión: Las técnicas de RMN-1D utilizadas son suficientes para distinguir los isómeros de CBD y Δ 9-THC, pero no para identificar las características enantioméricas del CBD no sintético. Conclusiones: Se concluye que las técnicas bidimensionales homonucleares (1H,1H) y heteronucleares (1H,13C) analizadas son adecuadas para ayudar a distinguir los enantiómeros del CBD.

Introdução: O canabidiol (CBD) se tornou um bioativo promissor para as próximas décadas após o recente reconhecimento do potencial medicinal dos derivados da Cannabis pelos países membros das Nações Unidas, uma vez que não tem potencial psicotrópico como seu isômero Δ 9-tetrahidrocanabinol (A9-THC). A diferenciação desses isômeros é estudada há décadas. Estudos recentes demonstram que mesmo com características químicas mais sutis, como as dos enantiômeros do CBD, há consideráveis diferenças bioativas. Todavia, ainda não há muitos estudos sobre suas estruturas químicas. Objetivo: Este trabalho tem como objetivo apresentar dados experimentais obtidos por Ressonância magnética nuclear (RMN) para melhor elucidar a estrutura tridimensional deste bioativo enantiomérico. Materiais e métodos: Para isso, uma amostra de CBD não sintético de alta pureza foi submetida a diferentes análises unidimensionais (RMN-1D) e bidimensionais (RMN-2D) relacionadas aos núcleos de hidrogênio (1H) e carbono (13C). Resultados e discussão: As técnicas de RMN-1D usadas são suficientes para distinguir os isômeros CBD e Δ 9-THC, mas não para identificar as características enantioméricas do CBD não sintético. Conclusões: Conclui-se que as técnicas bidimensionais homonucleares (1H,1H) e heteronucleares (1H,13C) analisadas são adequadas para auxiliar na distinção dos enantiômeros do CBD.

Effect of two oral formulations of cannabidiol on responses to emotional stimuli in healthy human volunteers: pharmaceutical vehicle matters

Objective: To compare plasma concentrations of cannabidiol (CBD) following oral administration of two formulations of the drug (powder and dissolved in oil), and to evaluate the effects of these distinct formulations on responses to emotional stimuli in healthy human volunteers. Methods: In a randomized, double-blind, placebo-controlled, parallel-group design, 45 healthy male volunteers were randomly assigned to three groups of 15 subjects that received either 150 mg of CBD powder; 150 mg of CBD dissolved in corn oil; or placebo. Blood samples were collected at different times after administration, and a facial emotion recognition task was completed after 150 min. Results: There were no significant differences across groups in the subjective and physiological measures, nor in the facial emotion recognition task. However, groups that received the drug showed statistically significant differences in baseline measures of plasma CBD, with a significantly greater difference in favor of the oil formulation. Conclusion: When administered as a single 150-mg dose, neither formulation of oral CBD altered responses to emotional stimuli in healthy subjects. The oil-based CBD formulation resulted in more rapid achievement of peak plasma level, with an approximate fourfold increase in oral bioavailability.

Efficacy of cannabinoids in fibromyalgia: a literature review / Eficacia de los cannabinoides en la fibromialgia: revisión de la literatura

Abstract Fibromyalgia is a chronic disease of unclear etiology, involving a neural oversensitization and impaired pain modulation, in addition to a clinical deficiency of the endocannabinoid system. Fibromyalgia is associated with a number of somatic and psychological disorders and hence multiple pharmacological approaches have been used, including opioids, antidepressants, antiepileptics, and more recently medical cannabis. This narrative review comprises a review of the current literature on the efficacy of cannabinoids in fibromyalgia. The studies describe a possible influence of cannabis on pain control in patients with fibromyalgia, with positive effects on quality of life and sleep. The use of cannabis seems to be beneficial in patients with fibromyalgia; however, more robust studies are still needed to establish is actual efficacy in pain management, quality of life and improvement of associated symptoms.

Resumen La fibromialgia es una enfermedad crónica, cuya etiología no es clara, en la que se involucra una sobresensibilización neural y disminución de la modulación del dolor, así como una deficiencia clínica del sistema endocannabinoide. Está asociada a una variedad de trastornos somáticos y psicológicos, por lo cual se han utilizado múltiples abordajes farmacológicos, entre ellos opioides, antidepresivos, antiepilépticos y, recientemente, cannabis medicinal. En esta revisión narrativa se hace una reseña de la literatura actual relacionada con la eficacia de los cannabinoides en la fibromialgia. Los estudios describen una posible influencia del cannabis sobre el control del dolor en pacientes con fibromialgia, con efectos positivos sobre la calidad de vida y el sueño. El uso del cannabis parece tener beneficios en los pacientes con fibromialgia; sin embargo, aún se requieren estudios más robustos para establecer su verdadera eficacia en el manejo del dolor, calidad de vida y mejoría de los síntomas asociados.

Management Modalities of Choledocholithiasis: Endoscopic Retrograde Cholangiopancreatography Versus Open Common Bile Duct Exploration and Laparoscopic Cholecystectomy

Background and Objective : Common bile duct stone typically requires surgical intervention, which primarily involves open CBD exploration + Laparoscopic cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic CBD exploration. Open CBD exploration has multiple complications, high mortality rate and long recovery time. Methodology : A total of 50 cases presenting as choledocholithiasis between July 2018 to August 2020 were taken for study. 1st group of 20 patients underwent open cholecystectomy with open CBD exploration. 2nd group of 20 patients underwent ERCP followed by interval (6 weeks) laparoscopic cholecystectomy. Results : ERCP found to be better when compared with open CBD exploration in terms of less post-operative complications (5% in ERCP vs 20% in Open CBD exploration) and less mean duration of hospital stay(5 days in ERCP vs 8 days in Open CBD exploration). Interpretation and Conclusion : For management of CBD stone patient, gold standard treatment is ERCP followed by Laparoscopic Cholecystectomy. While in patients with incomplete clearance of CBD stone after ERCP, CBD exploration either laparoscopically or by open approach should be preferred. While in patients with CBD stone greater than 2 cm size, direct open CBD exploration is the preferred option380008

Intranasal temperature-sensitive hydrogels of cannabidiol inclusion complex for the treatment of post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a psychiatric disease that seriously affects brain function. Currently, selective serotonin reuptake inhibitors (SSRIs) are used to treat PTSD clinically but have decreased efficiency and increased side effects. In this study, nasal cannabidiol inclusion complex temperature-sensitive hydrogels (CBD TSGs) were prepared and evaluated to treat PTSD. Mice model of PTSD was established with conditional fear box. CBD TSGs could significantly improve the spontaneous behavior, exploratory spirit and alleviate tension in open field box, relieve anxiety and tension in elevated plus maze, and reduce the freezing time. Hematoxylin and eosin and c-FOS immunohistochemistry slides showed that the main injured brain areas in PTSD were the prefrontal cortex, amygdala, and hippocampus CA1. CBD TSGs could reduce the level of tumor necrosis factor-

Potential Clinical Impact of Cannabidiol (CBD) in Canine and Feline Behavior: An Open-label Clinical Trial / 日本補完代替医療学会誌

Objective: CBD is a phytocannabinoid compound derived from the cannabis plant and has been gaining attention as a potential anxiolytic, anti-panic, and analgesic without the psychoactive effects associated with tetrahydrocannabinol; however, these beneficial therapeutic effects have not yet been explored in dogs and cats. Design: We conducted an open-label study in eight dogs and four cats with each diagnostic symptom and investigated the efficacy, tolerability, and safety of CBD products for treatment. The efficacy of CBD in dogs and cats with problematic behaviors, such as conflict-related, fear-related, repetitive or self-injury behaviors, were assessed. Methods: CBD at 0.15–1.85 mg/kg/day was administered twice daily on an empty stomach with a small piece of food. Behavioral symptoms were measured before the first application (day 0) and after 2 (day 14), 4 (day 28), or 8 weeks (day 56) of regular administration. The efficacy was assessed using a behavior index and rating the degree of overall owner satisfaction and veterinarian observational results. Result: At the end of the study, among the twelve animals that continued to receive this supplement for 8 weeks, four cases were rated as considerably decreased and six were rated as decreased. Conclusion: CBD was used at a dose of 0.3–1.7 mg/kg/day in 8 dogs and 4 cats for 8 weeks, then behavioral changes were observed in 10 subjects. No serious adverse events were observed, and there were no notable problems in safety and tolerability.

Experience with laparoscopic common bile duct exploration in failed endoscopic retrograde cholangiopancreatography cases at a tertiary care hospital

Background: Minimally invasive techniques for stone removal in common bile duct (CBD) are endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) or laparoscopic CBD exploration with LC (laparoscopic common bile duct exploration (LCBDE) and LC). Failed, multiple attempted or complications of ERCP leads to other surgical approaches where LCBDE is a preferable option by experts due to its added benefits.Methods:  We did LCBDE and LC in 40 cases of failed ERCP. Standard investigation protocol was followed in all cases and CBD were explored laparoscopically and stones were retrieved. Post retrieval choledochoscopy was done and sphincter of oddi was dilated by the dilators.Results: With careful selection of cases, stone calculi were retrieved successfully in 38 cases by laparoscopically and 2 cases by open method after conversion. Postoperative choledochoscopy were found normal. Bile leak seen in 3 cases, which were managed conservatively. Standard regime of postoperative care was taken followed by T-tube removal after cholangiogram on day 10-14. All patients survived the operation.Conclusion: We advocate that LCBDE is the most viable alternative for open surgery in failed ERCP cases for retrieval of CBD stones. This results in early recovery, better cosmetic scar, least complications with early resumption of routine life. Needs cautious patient selection and expertise in laparoscopic surgery.

Study on 60 cases of common bile duct stone, there different modality of management and its inference

Background: The aim of the study was to determine the best treatment modality for common bile duct stone become more challenging as large number of options available such as endoscopic, laparoscopic or open surgical methods, we need to choose specific therapy according to patient’s clinical conditions, and individual expertise.Methods: It is prospective study including 60 patient having common bile duct stone along with gall bladder stone, its different modality of management and its inference, conducted in Bhopal Memorial Hospital and Research Centre, Bhopal, during period of January 2017 to January 2020.Results: In 60 cases 41 patients undergoes to endoscopic retrograde cholangio pancreatography (ERCP) first, stone successfully removed in 34 patients and stent placed, one patients developed pancreatitis after ERCP, managed conservatively, In 6 patients retained stone after ERCP procedure, one patients developed surgical emphysema after procedure, managed with ICD and conservatively, and one patient had bleeding during sphincterotomy so its procedure abandoned and one of the patient failed to cannulate common bile duct (CBD).  21 patients undergo laparoscopic common bile duct explorations, 2 lap CBD exploration converted to open CBD exploration with cholecystectomy, due to adhesion at hepatocystic triangle. Five patients undergoes open CBD exploration, in one patient hepaticojejunostomy was done as patient was having CBD stone with stricture. No mortality during and after procedure.Conclusions: Management of CBD stone is depends upon individual expertise and available modality. If surgeons are expertise then lap CBD exploration with cholecystectomy without attempting to ERCP guide stone removal is best approach in majority of patients.

Common bile duct stones: its different aspects of presentation and management

Background: Common bile duct (CBD) stone management is a commonly occurring potential challenge for surgeons.Methods: A total of 38 patients who was admitted in admitted in surgery Department of Sri Ram Institute of Medical Sciences, Bareilly UP during the period of March 2019 to September 2019 were studied. The diagnosis was made using USG MRCP, relevant blood investigations. Patients were managed based on radiological findings by the best possible way and expertise available.Results: Out of the 38 patients, 14 (37.14%) were male and 24 (62.85%) were female. The mean age for male was 50.92 years and for female, it was 51.74 yrs. Most of the patients had pain abdomen and /or jaundice with a mean total bilirubin of 3 mg/dl. Patients are managed either by ERCP or by surgery (open/laparoscopic). Mortality is nil but morbidity is more for open procedures.Conclusions: There can be no definite algorithm for the management of CBD stones as the patients’ age, underlying general condition being the only standardizable factor with facilities for endoscopic, laparoscopic management being variably available from institution to institution and hence, necessitating tailoring the management of CBD stones depending upon the Institution’s resources.

Krukenberg Tumour Arising from Gall Bladder- A Rare Presentation

Introduction: Krukenberg tumours are rare, usually bilateral,metastatic ovarian tumours presenting in perimenopausalage women. It usually arises from the GIT (stomach/colon),however it may arise from other rare sites like breast, appendix,biliary tract and gall bladder. Imaging plays a definite role inthe diagnosis and management of such cases.Case report: In this paper, we report two interesting cases ofbilateral ovarian masses where the primary site of malignancywas GB. The first case showed synchronous metastases to theovary while the second one showed metachronous metastasesto the ovary.Conclusion: This report highlights the importance of keepingin mind the rare sites of primary tumour while dealing withbilateral ovarian masses.

Biological bases for a possible effect of cannabidiol in Parkinson's disease

Current pharmacotherapy of Parkinson's disease (PD) is palliative and unable to modify the progression of neurodegeneration. Treatments that can improve patients' quality of life with fewer side effects are needed, but not yet available. Cannabidiol (CBD), the major non-psychotomimetic constituent of cannabis, has received considerable research attention in the last decade. In this context, we aimed to critically review the literature on potential therapeutic effects of CBD in PD and discuss clinical and preclinical evidence supporting the putative neuroprotective mechanisms of CBD. We searched MEDLINE (via PubMed) for indexed articles published in English from inception to 2019. The following keywords were used: cannabis; cannabidiol and neuroprotection; endocannabinoids and basal ganglia; Parkinson's animal models; Parkinson's history; Parkinson's and cannabidiol. Few studies addressed the biological bases for the purported effects of CBD on PD. Six preclinical studies showed neuroprotective effects, while three targeted the antidyskinetic effects of CBD. Three human studies have tested CBD in patients with PD: an open-label study, a case series, and a randomized controlled trial. These studies reported therapeutic effects of CBD on non-motor symptoms. Additional research is needed to elucidate the potential effectiveness of CBD in PD and the underlying mechanisms involved.

Pharmacology Of Noval Cannabinoids

Cannabis is a plant rich in various compounds that have a variety of impacts on the physiology of humans and the effects of these metabolites have a significant role in managing a variety of clinical diseases. A substantial increase in the use of SC (synthetic cannabinoids) had seen in the last few years especially infrequent cannabis users. The SCs will generate psychoactive effects that were similar to cannabis. However, the composition and pharmacological characteristics of these drugs make them possibly hazardous. Like all drugs, cannabis’ pharmacokinetics depends on the route of administration. Several studies showed that the bioavailability is less in oral administration when compared to inhalation. The main reason for this decrease in oral bioavailability is that cannabinoids undergo the first-pass metabolism before entering into the systemic circulation whereas in inhalation, it enters the circulation directly through the lungs. Cannabis sativa is a psychoactive plant that contains more than 500 components of which 104 cannabinoids had been identified. Of these, 2 components such as Δ9-THC (Δ9-tetrahydrocannabinol) and CBD (cannabidol) were under the scientific investigation. Δ9-THC is the primary cannabinoid which was responsible for the consequences of psychotrophy. The potency of cannabis is assessed based on the THC concentration of a sample that is the main psychoactive cannabinoid in cannabis. The adverse effects are in direct relation to the concentration of THC in the product after regular cannabis use. It can be assumed that several cannabinoids will find their way into the pharmacies from preclinical research within a century.

Spontaneus Perforation of the Common Bile Duct in a 3 Years Old Boy

@#Peritonitis caused by biliary tract perforation is unsual. After other causes, such as trauma, biliary tract stone, cyst of choledocal duct, can be rule out, we should reconsider leakage or rupture of biliary tract. We report a 3 years old boy was administered to emergency room with abdominal distended, vomiting and diarrhea, low-grade fever, and diffuse abdominal pain. There’s no history of jaundice and abdominal pain before, neither trauma. Sign of peritonitis were found. The patient underwent laparotomy, perforation at common bile duct was found without any other disease. Intra abdominal drain was placed near the leak and primary repair was done with tube drain inside the duct. The pastient discharged after 8 days hospitalized uneventful.

Application and Development of Non-psychoactive Medicinal Cannabis / 中国实验方剂学杂志

Non-psychoactive medicinal cannabis is the cannabis that contain less than 0.3% of tetrahydrocannabinol (THC) and high content of cannabidiol (CBD) (more than 2.0% is reasonable), and mainly used for medicinal purpose. Cannabis have a long medical history, in this review, we retrospected the medicinal history of cannabis in China and the world. We summarized the cannabinoid especially CBD application of medicine in epilepsy, mental disease, tumor, analgesic and inflammatory, also the widely application in food, healthy products, cosmetics and other fields. Based on the problems like shortage of high CBD cultivars, weakness of fundamental research existed in non-psychoactive medicinal cannabis industry. We should fully utilize the genetic information of medicinal cannabis, establish the comprehensive identification system of non-psychoactive medicinal cannabis varieties, accelerate the breeding process of non-psychoactive medicinal cannabis cultivars, to ensure the safety and effectiveness of non-psychoactive medicinal cannabis. Strengthen the basic research on CBD and other cannabinoids to promote the application of non-psychoactive medicinal cannabis products and sustainable development of medical cannabis industry.

Cannabis: from plant condemned by prejudice to one of the greatest therapeutic options of the century / Cannabis: de planta condenada pelo preconceito a uma das grandes opções terapêuticas do século

BACKGROUNG: Cannabis sativa has a fascinating history and has been used by mankind for millennia. Many societies such as Greek, Roman, Chinese, African, Indian and Arabic take advantage of the plant's qualities, which are consumed as food, medicine, fuel, fibers or tobacco. The first reference found related to the therapeutic use of the plant data from 2700 B.C. and is present in the pharmacopoeia of the Chinese Emperor Shen-Nung, where this plant was recommended in the treatment of malaria, rheumatic pain, in irregular and painful menstrual cycles. The book "De Matéria Médica", written by the doctor Pedânio Dioscórides considered thefounder of pharmacology, exposes Cannabis as one of the natural substances that can relieve inflammatory pain. In Brazil, African slaves brought a cannabis during the colonial period, around 1549. Then, its use spread quickly among black slaves and Indians, who started to cultivate it. Once the plant was popularized among French intellectuals and English doctors in the Indian imperial army, it started to be considered in our country as an excellent medicine for men, until it was suppressed by the police authorities in the 1930s. Only 60 years later important findings were highlighted around Cannabis with the System Endocannabinoid and its receptors, neurotransmitters such as anandamide and 2-AG, revolutionizing the understanding of molecular signaling that modulates pain and analgesia, inflammation, appetite, gastrointestinal motility and sleep cycles, immune cell activity and hormones among others.We are in front of a huge revolution in the therapeutic area, in which phytocabinoids represent one of the great therapeutic options of the century. We need a widespread disclosure that CBD is not marijuana and that its use for recreational purpose has nothing to do with the use of medical cannabis. Scientific research is seriously committed to the use of the substance in various pathologies. The role of information is absolute, being the main tool to clarify a society

A cannabis sativa tem uma história fascinante e é utilizada pela humanidade há milênios. Muitas sociedades como a grega, a romana, a chinesa, a africana, indiana e árabe aproveitaram as qualidades da planta, fosse ela consumida como alimento, medicina, combustível, fibras ou fumo. A primeira referência encontrada relativa à utilização terapêutica da planta data de 2700 a.C. e está presente na farmacopeia do Imperador chinês Shen-Nung, onde esta planta era recomendada no tratamento da malária, de dores reumáticas, nos ciclos menstruais irregulares e dolorosos. O livro "De Matéria Médica", escrito pelo médico Pedânio Dioscórides considerado o fundador da farmacologia, traz a Cannabis como uma das substâncias naturais que podem aliviar dores de origem inflamatória. No Brasil, a Cannabis foi trazida por escravos africanos no período colonial, por volta de 1549. Em seguida, o seu uso disseminou-se rapidamente entre os negros escravos e índios, que passaram a cultivá-la. Devido à popularização da planta dentre intelectuais franceses e médicos ingleses do exército imperial da Índia, ela passou a ser considerada em nosso meio como excelente medicamento para muitos males, até ser reprimida pelas autoridades policiais na década de 1930. Descobertas importantes foram destaque no campo da Cannabis somente 60 anos depois com o Sistema Endocanabinoide e seus receptores, neurotransmissores como a anandamida e o 2-AG, revolucionando o entendimento da sinalização molecular que modula dor e analgesia, inflamação, apetite, motilidade gastrointestinal e ciclos de sono, atividade de células imunes, hormônios e muito mais. Estamos diante de uma enorme revolução na área terapêutica em que os fitocanabinoides representam uma das grandes opções terapêuticas do século. Precisamos de uma divulgação ampla de que o CBD não é maconha e que o uso recreativo da maconha nada tem a ver com o uso da Cannabis medicinal, que as pesquisas científicas estão seriamente empenhadas em estabelecer a eficácia da substância em várias patologias. O papel da informação é absoluto e se constitui na principal ferramenta para esclarecer a sociedade.

Determinación y comparación cualitativa de cannabinoides presentes en productos naturales comerciales del departamento del Cauca, Colombia / Determination and qualitative comparison of cannabinoids present in commercial natural products of the Cauca Department-Colombia

RESUMEN Actualmente, hay un creciente interés por el estudio de Cannabis sativa y sus componentes ya que se le atribuye propiedades terapéuticas en el tratamiento de enfermedades. En Colombia y específicamente en el departamento del Cauca se comercializan productos de cannabis tanto para fines no medicinales como terapéuticos. En consecuencia, es necesario el análisis de estos productos de manera que se pueda conocer la composición de los mismos y el posible efecto que pueda tener sobre la salud. El análisis de los componentes de estos productos se llevó a cabo empleando la cromatografía líquida de alta resolución (CLAR) y espectrometría de masas (EM), de tal manera que permitieron la identificación de las principales especies cannabinoides; Δ9-tetra hidrocannabinol (THC), cannabidiol (CBD), cannabinol (CBN), cannabigerol (CBG). La separación de los analitos se llevó a cabo mediante la implementación de una columna analítica C18 de fase reversa, elución isocrática 1 mL/ min, presión del sistema 800 PSI, una mezcla de acetonitrilo ACN y buffer fosfato (KHPO4) en relación 65/35 como fase móvil, volumen de inyección de 10 µL, un tiempo de análisis de 15 min, y detección a 220 nm.

SUMMARY Cannabis sativa has now experienced an increasing interest in the study of its components since it is attributed therapeutic properties in the treatment of diseases. In Colombia and specifically in the Cauca Department, Cannabis products are marketed both for non-medicinal and therapeutic purposes. Consequently, it is necessary to analyze these products in such a way that the composition of the products and their possible effect on health can be known. The analysis ofthe components of these products was carried out using high performance liquid chromatog-raphy (HPLC) and mass spectrometry (MS), in such a way that they allowed the identification of the main cannabinoid species; Δ9-tetra hydrocannabinol (THC), cannabidiol (CBD), cannabinol (CBN), cannabigerol (CBG). The separation of the analytes was carried out by means of the implementation of a reverse phase C18 analytical column, isocratic elution 1 mL/min, system pressure 800 PSI, a mixture of acetonitrile ACN and phosphate buffer (KHPO4) in relation 65/35 as mobile phase, injection volume of10 µL, analysis time of15 min, and detection at 220 nm.

Broken stent of endoscopic retrograde cholangiopancreatography mimicking a common bile duct stone: a case report

Long standing biliary stent for biliary stricture may have complications like cholangitis, cholecystitis, stent fracture and stent migration. Treatment includes re-do endoscopic retrograde cholangiopancreatography, removal of fractured stent and restenting. Authors report a case of fractured biliary stent mimicking as distal common bile duct stone. Patient presented with features of cholangitis with history of endoscopic stenting 6 years back but lost follow up thereafter. Ultrasound showed 2cm calculus in distal common bile duct and the stent was seen on endoscopy through the papilla in the duodenum. Contrast enhanced computed tomography of abdomen showed radio opaque dense shadow in the distal common bile duct suggesting possibility of broken biliary stent. Redo endoscopic retrograde cholangiopancreatography failed to remove the fractured stent. A new stent was placed without complications. Patient underwent open common bile duct exploration and the fractured stent was removed. Patient recovered completely after the procedure.

Role of Magnetic Resonance Cholangiopancreatography (MRCP) in the Evaluation of Patients with Obstructive Jaundice

Introduction: Obstructive jaundice is a common clinicalproblem and most common presentation in patients withbiliary ductal obstruction. The role of imaging is crucialfor detection of site and cause of obstruction and also todifferentiation of benign and malignant pathology. MRCP isused in patients with history of obstructive jaundice to identifyand confirm the presence of obstruction, its location, extent,probable cause and also to obtain a map of the biliary treethat will help the surgeon or the interventionist to determinethe best approach to each individual case. The main aim andobjective of the study was to determine the accuracy of MRCPin the evaluation of patients with obstructive jaundice.Method and Materials: In the evaluation of patientswith obstructive jaundice, MRCP was conducted in theDepartment of Radio Diagnosis, Sree Balaji Medical collegeand Hospital. A total number of twenty five patients sufferingfrom obstructive jaundice of all age groups and either sexwere included in this study. Total of Twenty five patients withclinical diagnosis of obstructive jaundice were included in thestudy. MRCP was done in all the patients and results werecompiled and compared with Operative/ ERCP findings andhistopathological reports.Results: A total of twenty five patients suffering fromobstructive jaundice underwent MRCP. Out of the twentyfive patients, ten patients had benign causes of obstructivejaundice, while fifteen patients had malignant causes ofobstructive jaundice. MRCP had an accuracy of 97% indetecting the cause of obstructive jaundice. In diagnosing thesite of obstruction MRCP had an accuracy of 100%.Conclusion: In the diagnosis of obstructive jaundice and toknow the cause, site and extent of the lesion MRCP being anon invasive, non ionizing procedure seems to be a accurateand better choice.