Discussion on diagnosis and treatment of hepatobiliary malignancies during the outbreak of novel coronavirus pneumonia / 中华肿瘤杂志

From December 2019, the new coronavirus pneumonia (COVID-19) broke out in Wuhan, Hubei, and spread rapidly to the nationwide. On January 20, 2020, the National Health Committee classified COVID-19 pneumonia as one of B class infectious diseases and treated it as class A infectious disease. During the epidemic period, the routine diagnosis and treatment of tumor patients was affected with varying degrees. In this special period, we performed the superiority of the multi-disciplinary team of diagnosis and treatment, achieved accurate diagnosis and treatment of patients with hepatobiliary malignant tumors, provided support for these patients with limited medical resources, and helped them to survive during the epidemic period.On the basis of fully understanding the new coronavirus pneumonia, the treatment strategy should be changed timely during the epidemic, and more appropriate treatment methods should be adopted to minimize the adverse effect of the epidemic on tumor treatment.

Incidence of Cholelithiasis in Different Age Group

Objective: In this study our main goal is to evaluate theincidence of cholelithiasis in different age group.Method: This prospective study was done at Department ofSurgery, Rangpur Medical College Hospital Rangpur,Bangladesh from 1 July 2006 to 30 June 2008 where total 200patients were evaluated, of which 48 patients were male andremaining 152 patients were female.Results: In the study most of the patients where female 76%and 60.72% female patients took hormonal contraceptives.Also, 75% male patients had multiple stones whereas femalehad 71.71%.Conclusion: From our study we can conclude that,cholelithiasis is the commonest disease of hepatobiliary systemwhich is more common in female than male. In female the peakage group is 31-50 years where as in male it is 41-60 years.Various etiological factors are responsible for development ofcholelithiasis. Further study is needed for better outcome.

Research progress in EMT and fibrosis of hepatobiliary system / 临床肝胆病杂志

Epithelial-mesenchymal transition (EMT),which means the transformation of epithelial cells into mesenchymal cells under the influence of cytokines,leading to pathological changes in tissues.According to recent research findings,EMT plays an important role in or-gan fibrosis.Various types of EMT in the fibrosis of hepatobiliary system,as well as the characteristics of each stage and the disease progres-sion,are described,which is of great significance for understanding the development,termination,and even reversion of EMT and fibrosis of hepatic and biliary epithelial cells.

Diagnostic Usefulness of Basic Hematologic Tests for the Detection of Bacteremia in Febrile Patients with Neutrophilia

BACKGROUND: Alterations in blood cell count are well recognized features of bacteremia. The study objective was to determine the hematologic changes predictive of bacteremia. METHODS: We retrospectively studied febrile adult patients with neutrophilia and included patients were either bacteriologically proven cases or those who had clinically suspected bacterial infections. Hematologic findings derived from basic hematologic tests were compared between patients with and those without bacteremia. RESULTS: Of the 624 patients, 143 (22.9%) had significant bacteremia. The following items were significantly different between patients with and those without bacteremia by univariate analysis: absolute neutrophil count, neutrophil differential, absolute lymphocyte count, lymphocyte differential, platelet count and band-associated parameters such as absolute band neutrophil count (ABC). Multivariate analysis revealed platelet count, lymphocyte differential and ABC as independent predictors (P<0.0001, each). Platelet count, the most potent predictor of bacteremia, showed area under the curve (AUC) of 0.685. Analysis according to the primary diagnosis indicated that the most potent predictors of bacteremia in patients with respiratory tract, urinary tract and hepatobiliary system infections were platelet count (P=0.002, AUC=0.697), ABC (P=0.002, AUC=0.681) and neutrophil differential (P=0.0001, AUC=0.822), respectively. CONCLUSIONS: Simple variables obtained from basic hematologic tests were associated with bacteremia even in febrile patients with neutrophilia. In particular, very high neutrophil differential was highly predictive of bacteremia in patients with hepatobiliary system infections and its clinical usefulness needs to be elucidated in a prospective study.

Hepatobiliary Interventions

Hepatobiliary interventional procedures are most important and commonly practiced procedures in Korea. These procedures comprise about 60~80% of procedures in interventional radiology. We can do percutaneous transhepatic biliary drainage(PTBD), percutaneous cholecystostomy in patients with bile duct and cystic duct obstruction. These procedures prevent high-risk operation and are performed on an emergency basis in some patients with bile infection. A residual biliary stone after operation can be removed with basket and shock wave without reoperation and multiple intrahepatic stones also can be removed through the PTBD tract without operation. Transarterial chemoembolization is a very effective method and has the widest range of indications in treatment of hepatocellular carcinoma(HCC). Also we can treat HCC percutaneously with local injection of absolute ethanol and radiofrequency ablation. Transjugular intrahepatic portosystemic shunt(TIPS) has replaced surgical shunt operation in variceal bleeding in liver cirrhosis. Resection of a large volume of liver is a very safe method after portal vein embolization of a lobe to be resected due to hypertrophy of the remaining lobes of the liver. Metallic stenting of kinking vessels always shows excellent results and we can employ this technique for hepatic vein and portal vein kinking after living-donor liver transplantation.

CLINICAL AND EXPERIMENTAL STUDY ON EFFECT OF HEPATOCHOLANGIOLITHIASIS ON HEPATOBILLARY SYSTEM / 中国普通外科杂志

In order to explore the effect of hepatocholangiolithiasis on hepatobiiiary system, 160 patients with gallstone were observed by using choledochofiberscope, microscope and electnonic microscope. Damage of bile ducts was found in 84 cases(52.5%) and damage of the liver in 40 cases (25% ) with naked eyes. However, denaturation of hepatocytes occured in nearly all of the cases under microscope. To testify the clinical finding, animal experiments were made in 60 rabbits including infusion of gallstone or silt into bile ducts in groupl, 2, and subacute toxiologic experiment was made by direct injection of gallstone or silt into liver tissue(group3, 4). The results showed that under same condition damage of liver and bile duct caused by gallstone is more severe than that caused by silt. The authers suggest that hepatocholangiolithiasis can damage the hepatobiiiary system no matter whether there is obstruction or not. The harmful substance of gallstones can damage liver tissue directly. So effective therapy should be given as early as possible when the dis-gnosis of hepatocholangiolithiasis is made.