肝病学和胰腺科学

Pancreatic tumor resection remains a challenge in laparoscopic procedures. Several cases must be assisted, or conversion to laparotomy. it's probably pancreas encompasses a specific tissues structure and unique. But, the foremost frequent are due to the fault of designing and fault to place the trokkar itself. A 26 year old female had an intra-abdominal mass on left hypochondrium since four years ago. General condition was almost normal, and had no other complain. She couldn't have normal eating. CT abdominal study found a tumor 12x9x7 cm subcostal region, suspicious from the parenchymal of the tail of pancreas, capsulated, and isolated from the adjacent organs. Laboratory study showed almost normal with HB=11.2 mg/dl. Amylase and lipase of pancreas were normal, LFT normal and specific blood study result was normal. Laparoscopic procedures were performed with 11 mm umbilical port, 11 mm port LMC, 5 mm port two cm below os, and 5 mm port 1 cm left from the left rectus sheath. Maneuver of the tumor isolated from adjacent organs will be easily identified, with the position of the trokkars. Evacuation of the tumor through the bikini incision was done on the request of patient itself. Postoperative study of the histopathology report was neoplasm, originated from the tail of pancreatic bodies. No mitotic and no proof of malignancy tumor was found. Patient was discharged on day two and no antibiotic was administered for ambulatoire. Day seven after surgery was evaluated, no port-site and bikini incision inflammatory and infection was observed. Activity of daily living at day 8 was observed. Totally laparoscopic pancreatic resection are often performed by every surgeons and depend upon the knowledge of topography anatomica and port placement accuracy.

Background: Several studies have suggested a link between microbiota imbalance and a few gastrointestinal, inflammatory and neoplastic diseases. However, the role in pancreatic diseases remains unclear. to guage the available evidence for pancreatic diseases, we undertook a scientific review. Methods: OVID Medline (1946 to 2017), EMBASE (1980 to 2017) and therefore the Cochrane Central Register of Controlled Trials (CENTRAL Issue 3, 2017) were explore for studies on microbiota in pancreatic disease. We also searched the reference lists of retrieved papers and conference proceedings. We excluded animal studies, reviews, and case reports. Results: a complete of two,833 articles were retrieved. After screening and applying the exclusion criteria, 10 studies were included. Three studies showed lower levels of Bifidobacterium or Lactobacillus and better levels of Enterobacteriaceae in chronic pancreatitis. Two of those studies were uncontrolled, and also the third (controlled) study which compared patients with endocrine and exocrine insufficiency, reported that Bacteroidetes levels were lower in those patients without diabetes, while Bifidobacteria levels were higher in those without exocrine insufficiency. only 1 study investigated acute pancreatitis, showing higher levels of Enterococcus and lower levels of Bifidobacterium versus healthy participants. There was an overall association between carcinoma and lower levels of Neisseria elongate, Streptococcus mitis and better levels of Porphyromonas gingivalis and Granulicatella adiacens. Conclusions: Current evidence suggests a possible link between microbiota imbalance and carcinoma. Regarding acute and chronic pancreatitis, data are scarce, dysbiosis appears to be present in both conditions. However, further investigation is required to substantiate these findings and to explore therapeutic possibilities.

Objectives: to work out the efficacy of (Sofosbuvir/ledipasvir) in treating children with HCV infection. Patients and methods: Patients with positive HCV PCR, aged 7 to 18 years were enrolled. History and clinical examinations and investigations were conducted. HCV genotyping was done (if affordable). Sofosbuvir was given to all or any patients once daily. Ribavirin was added for INF-experienced patients or with established cirrhosis. Follow up with liver function and renal function and PCR was done at 12 weeks (end of treatment); then after 12 weeks post treatment (SVR12). Total duration of therapy was 12 weeks. Extended to 24 in cases with established cirrhosis. trojan horse SPSS version 20 was used for data analysis. Results: the quantity of patients were 22, with mean age of 12.5 years, 14 boys (63.6%), and eight girls (36.4%). Genotype 1 was the dominant type (75%). SVR 12 was achieved in 20 patients (90.9%), the remaining 2 (9.1%) had partial virological response. HBV co-infection was found in 5 cases; they were kept on Entecavir during the course of treatment. All achieved SVR12 for HCV and reduce titter for HBV. Even INF-experienced patients (7 patients 31.8%) were responsive with SVR12. The treatment was well tolerated. Conclusion: Sofosbuvir/ledipasvir is effective in treating HCV in children, and is well tolerated. Key word: Direct acting antivirals, hepatitis C virus, Sofosbuvir/ledipasvir, Pediatrics, children.

Introduction: Several markers are proposed along the time to assess the severity and therefore the progression of inflammatory bowel disease (UC) but they're expensive and a few of them not specific for intestinal inflammation. Thus, new simpler and cheaper tools are required to guage the severity of the disease. The aim of our study was to judge the contribution of the neutrophil/ lymphocyte ratio (NLR) for assessing the severity of UC. Patients and Methods: We performed a retrospective study over a 5 year period (January 2012- December 2016), including 68 UC patients, from ambulatory or hospitalized, divided into two groups: the primary group of 23 patients (33.8%) with active disease and also the second group of 45 patients (66.2%) of inactive UC. Disease activity was assessed using the Mayo score and therefore the data was statistically analyzed using SPSS20. Results: Mean age of patients was 39 years (19-78 yrs). Female-male ratio was 0.78 and therefore the average disease duration was 8 years. Seven cases (10.3%) were diagnosed with pancolitis. Of the 23 patients with active UC, 14 patients had mild to moderate disease and 9 patients had a severe form. In patients with inactive disease, average NLR was 2.36 (0.79 to 10.84), while in patients with active UC average NLR was 4.28 (2.18 to 11.59) with a major difference (p <0.01). No significant NLR variations were observed between the patients with mild to moderate disease and people with severe forms. Conclusion: In our study, NLR was significantly higher within the cases of active UC. this will be a useful marker within the assessing and follow from the UC activity, without giving information on the disease severity. Key words: inflammatory bowel disease, neutrophils/lymphocytes.

Pancreatic surgery is related to a comparatively high morbidity and mortality compared with other abdominal surgeries. this is often a results of the complex nature of the organ, the difficult access as a results of the retroperitoneal position and also the number of technically challenging anastomoses required. Nevertheless, the past 20 years have witnessed a gentle improvement in morbidity and a decrease in mortality achieved through alterations of technique (particularly regarding the pancreatic anastomoses) along with hormonal manipulation to decrease pancreatic secretions. Recently minimally invasive or laparoscopic pancreatic surgery is now being performed in specialized HPB units round the world with results resembling open surgery and lesser morbidity. While practically all pancreatic surgeries is done laparoscopically, the foremost common procedure performed may be a laparoscopic distal pancreatectomy, thanks to the more straightforward nature of the resection and therefore the lack of a pancreatic ductal anastomosis. Laparoscopic distal pancreatectomy is sometimes performed for tumors within the distal body and tail of thepancreas. Laparoscopic lateral pancreaticojejunostomy is additionally commonly finished patients with chronic pancreatitis with a dilated main epithelial duct. Laparoscopic pancreatoduodenectomy or Whipple???s procedure is additionally possible in experienced centers in selected group of patients with periampullary tumors. The results are equivalent or better than those related to a conventional approach. one among the areas where the minimally invasive approach has been found to be exceptionally useful is in patients with necrotizing pancreatitis who require necrosectomy. A laparoscopic approach for necrosectomy is far safer and carries far less morbidity that the standard open necrosectomy. The procedure may be done multiple times to clear the necrotic areas and drain the infection. this method has also been shown to cut back surgery related mortality during this group of patients. The talk will target the present evidence base for increasing the utilization of laparoscopic pancreatic resection and can highlights challenges and other aspects that has got to be considered before adapting to the present technique.