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High field MR scanners can resolve a metabolite resonating at 2.06 ppm in the in vivo proton-decoupled liver 31P MR spectrum. Traditionally this peak has been assigned to phosphoenolpyruvate (PEP), the key metabolite for gluconeogenesis. However, recent evidence supported the assignment to biliary phosphatidylcholine (PtdCh), which is produced in the liver and stored in the gall bladder. To elucidate the respective contributions of PtdCh and PEP to the in vivo resonance at 2.06 ppm (PEP-PtdCh), we made phantom measurements that confirmed that both biliary PtdCh and PEP resonate approximately at 2 ppm. The absolute quantification of PEP-PtdCh yielded concentrations ranging from 0.6 to 2.0 mmol/l, with mean coefficients of variation of 4.8% for intraday and 7.2% for interday reproducibility in healthy volunteers. The T1 relaxation time of PEP-PtdCh was 0.97 ± 0.30 s in the liver and 0.44 ± 0.11 s in the gallbladder. Ingestion of a mixed meal decreased the concentration of PtdCh-PEP by approximately 12%. In the retrospective analysis, PEP-PtdCh was 68% higher in the liver of subjects with gallbladder infiltration of the volume of interest (VOI) compared with those without gallbladder infiltration. PEP-PtdCh was also significantly higher in the liver of cholecystectomy patients compared with volunteers without gallbladder infiltration, which suggests increased intrahepatic bile fluid as a compensation for gall bladder removal. These results show that liver PtdCh is the major component of the resonance at 2.06 ppm and that careful VOI positioning is mandatory to avoid interference from the gallbladder. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Gallbladder cancer is a high-mortality cancer with a wide range of incidence worldwide. Some indigenous populations are known to have a higher incidence of gallbladder cancer. Commonly, it is incidentally discovered during routine gallbladder surgery. The primary aim was to determine the incidence and characteristics of gallbladder cancer in a New Zealand population. The secondary aim was to determine if inequalities in gallbladder cancer rates between Māori and non-Māori have decreased. Methods A retrospective cohort study utilizing an online database was conducted to identify all patients with gallbladder malignancy treated in the Waitemata District Health Board from 2003 to 2013. The outcomes measured were staging of cancer, histology, ethnicity, incidental finding and survival rates. Results The age-standardized incidence ( ASI) rate of gallbladder carcinoma is 0.60/100 000. The gender-specific ASI rates were 0.21/100 000 (men) and 0.76/100 000 (women). The incidence for Māori was 0.96/100 000 (men) and 1.37/100 000 (women). Gallbladder carcinoma was found incidentally in 0.44% of cholecystectomies, which made up 46.2% of all cases. Right upper quadrant pain was the most common presenting symptom (74.4%). Surgery was the most common treatment modality (66.7%). Mean survival across all patients was 12.24 months. Conclusion Our study found that the ASI of gallbladder carcinoma when compared with the Koea et al. study has decreased for men from New Zealand, but appears to have increased slightly for women from New Zealand. The raw incidence for Māori men and women appears to have decreased, but inequality in gallbladder cancer incidence between Māori and non- Māori remains. [ABSTRACT FROM AUTHOR]

The mouse gastro-intestinal and biliary tract mucosal epithelia harbor choline acetyltransferase (ChAT)-positive brush cells with taste cell-like traits. With the aid of two transgenic mouse lines that express green fluorescent protein (EGFP) under the control of the ChAT promoter (EGFPChAT) and by using in situ hybridization and immunohistochemistry we found that EGFPChAT cells were clustered in the epithelium lining the gastric groove. EGFPChAT cells were numerous in the gall bladder and bile duct, and found scattered as solitary cells along the small and large intestine. While all EGFPChAT cells were also ChAT-positive, expression of the high-affinity choline transporter (ChT1) was never detected. Except for the proximal colon, EGFPChAT cells also lacked detectable expression of the vesicular acetylcholine transporter (VAChT). EGFPChAT cells were found to be separate from enteroendocrine cells, however they were all immunoreactive for cytokeratin 18 (CK18), transient receptor potential melastatin-like subtype 5 channel (TRPM5), and for cyclooxygenases 1 (COX1) and 2 (COX2). The ex vivo stimulation of colonic EGFPChAT cells with the bitter substance denatonium resulted in a strong increase in intracellular calcium, while in other epithelial cells such an increase was significantly weaker and also timely delayed. Subsequent stimulation with cycloheximide was ineffective in both cell populations. Given their chemical coding and chemosensory properties, EGFPChAT brush cells thus may have integrative functions and participate in induction of protective reflexes and inflammatory events by utilizing ACh and prostaglandins for paracrine signaling. [ABSTRACT FROM AUTHOR]

Carcinoma of gall bladder is the most common malignancy of the biliary tract worldwide and is usually associated with poor prognosis. In this era of laparoscopic cholecystectomy, there has been increase in detection of early stage incidental gall bladder carcinoma in cholecystectomy specimens. A retrospective study was carried out in tertiary care hospital in central India. A total of 2990 patients underwent laparoscopic cholecystectomy during the year 2001-2013. Hospital records and histopathology reports of these patients were studied in detail. Twenty three cases of gall bladder carcinoma were detected incidentally accounting for an incidence of 0.76 %. It was more common in females with an M: F ratio of 1:1.9. Mean age of presentation was 57.8 years. Gall stones were present in 22 cases and one patient presented with features of acute cholecystitis. Three patients had associated xanthogranulomatous inflammation and 10 had associated intestinal metaplasia. It is not uncommon to encounter incidental malignancies of gall bladder in laparoscopic cholecystectomy specimens sent to histopathology for presumably benign disease. Histopathology reports must include comments on extent of infiltration, perineural invasion, tumor differentiation and nodal involvement for oncologist information and subsequent management of patients. [ABSTRACT FROM AUTHOR]

Objectives Candida albicans is an important fungal pathogen that can cause life-threatening disseminated infections. To determine the efficacy of therapy in murine models, a determination of renal fungal burden as cfu is commonly used. However, this approach provides only a snapshot of the current situation in an individual animal and cryptic sites of infection may easily be missed. Thus, we aimed to develop real-time non-invasive imaging to monitor infection in vivo. Methods Bioluminescent C. albicans reporter strains were developed based on a bioinformatical approach for codon optimization. The reporter strains were analysed in vitro and in vivo in the murine model of systemic candidiasis. Results Reporter strains allowed the in vivo monitoring of infection and a determination of fungal burden, with a high correlation between bioluminescence and cfu count. We confirmed the kidney as the main target organ but additionally observed the translocation of C. albicans to the urinary bladder. The treatment of infected mice with caspofungin and fluconazole significantly improved the clinical outcome and clearance of C. albicans from the kidneys; however, unexpectedly, viable fungal cells persisted in the gall bladder. Fungi were secreted with bile and detected in the faeces, implicating the gall bladder as a reservoir for colonization by C. albicans after antifungal therapy. Bile extracts significantly decreased the susceptibility of C. albicans to various antifungals in vitro, thereby probably contributing to its persistence. Conclusions Using in vivo imaging, we identified cryptic sites of infection and persistence of C. albicans in the gall bladder during otherwise effective antifungal treatment. Bile appears to directly interfere with antifungal activity. [ABSTRACT FROM PUBLISHER]

Opioid analgesics are widely believed to cause spasm of the bile duct sphincter and so impede bile flow. Thienorphine is a partial opioid agonist that is a good candidate for the treatment of opioid dependence; however, to date, no studies have reported the effects of thienorphine on the function of the biliary tract. This study examined the in vivo effects of thienorphine on the guinea pig isolated sphincter of Oddi, choledochus and gall bladder and on bile flow. The area under the curve (AUC) of isolated sphincter of Oddi was not influenced by thienorphine or buprenorphine, whereas morphine increased the AUC of the isolated sphincter of Oddi in a concentration-dependent manner. Thienorphine and buprenorphine concentration-dependently decreased the AUC of isolated choledochus, while morphine increased the AUC of isolated choledochus. Thienorphine had no effect on the contractile amplitude or basal tension of isolated gall bladder muscle strips. In contrast, buprenorphine and morphine increased the contractile basal tension of isolated gall bladder muscle strips in a concentration-dependent manner. Thienorphine (0.01–1.0mg/kg) had no significant inhibitory effect on bile flow. However, morphine (1.0–10mg/kg) and buprenorphine (1.0mg/kg) significantly inhibited bile flow. The maximum inhibition of bile flow by buprenorphine was 63.9±12.9% and by morphine was 74.1±11.3%. In summary, thienorphine has little influence on the guinea pig isolated sphincter of Oddi, choledochus and gall bladder or on bile flow, which may result in a lack of adverse biliary colic effects. [ABSTRACT FROM AUTHOR]

We report a 63-year-old male patient who presented with eosinophilic granulomatous vasculitis of the gall bladder secondary to carbamazepine drug therapy. Following commencement of carbamazepine for treatment of partial seizures, the patient developed an allergic cutaneous drug rash. He continued to take carbamazepine postdischarge despite cessation by the treating team. He represented 7 weeks later with acute pancreatitis and cholecystis. Gall bladder histopathology showed a granulomatous vasculitis. [ABSTRACT FROM AUTHOR]

Peritonitis secondary to spontaneous rupture/perforation of the gall bladder is a rare condition overall and is even less common in the forensic population. We report the case of a middle-aged man who died from generalized peritonitis from gall bladder perforation due to acute acalculous cholecystitis. This condition usually occurs in critical patients with systemic illness, and although the exact pathogenesis remains unclear, the development of acalculous cholecystitis appears to be multifactorial. Antemortem diagnosis is reliant upon clinical presentation, laboratory data, and radiologic studies. Surgery and appropriate antibiotics are mainstays of treatment; however, there is an emerging role for minimally invasive procedures. Histopathologic features show significant overlap with the calculous type. Although increasing numbers of acalculous cholecystitis have been diagnosed in the critically ill, the fatal presentation of a perforated gall bladder following an undiagnosed case of acute acalculous cholecystitis is unusual in a nonhospitalized and ambulatory man. [ABSTRACT FROM AUTHOR]

78 non-pathological Gall Bladders and Livers were studied morphometrically .The length and breadth of GB was compared with that of the respective liver. The measurements were taken by measuring Tape. Morphologically Normal (Pyriform) GBs were 53.2%, cylindrical 11.4%, oval shaped 11.4%, partially intra hepatic 5.1 %, intra hepatic 3.8%, hour glass 6.3%, phrygian cap 3.8%, double GB 1.3%, left sided 2.5%. Metrically length and breadth of GB was highly significant (p<0.01). Correlative coefficient values between length of GB and length of Liver was +0.356 and p value was highly significant (p<0.01). Similarly breadth of GB and breadth of Liver correlative coefficient was +0.242 and p value was significant (p<0.05). By these values of GB we can explore the length and breadth of liver. Hence physiological liver can be differentiated from pathological liver (hepatomegaly) especially during the liver transplantation. This study will certainly help anatomists, anthropologists and medico legal experts to compare the south Indian GB and Liver with that of other parts of the country and abroad. Moreover to radiologists and laparoscopic surgeons during cholecystectomy and liver transplantation. [ABSTRACT FROM AUTHOR]

The aim of the current study was to determine the localisation and number of NADPH-d mast cells in the normal domestic pig gall bladder. The gall bladders of 6 male and 6 female pigs were examined by using light microscopic enzymohistochemical and immunohistochemical techniques. Enzymohistochemistry was performed to display NADPH diaphorase activity. Then, the avidin-biotin-peroxidase complex technique for detection of mast cell tryptase expression was performed in order to confirm that NADPH-d positive cells, observed in the studied organ, are actually mast cells. Light microscopy showed strong to medium NADPH-d reactivity in the mast cells granules. Mast cells number was the highest in the propria of gall bladder fundus, body and neck as well as in the same layer of the cystic duct Ductus cysticus, followed by fibromuscular layer. The smallest density of mast cells was observed in the subserosal layer. However, statistically significant difference between the number of these cells in the muscular layer and the tela subserosa of gall bladder fundus was not detected. The density and localisation of observed tryptase positive mast cells were the same. In conclusion, the results of this study gave us a reason to presume that NADPH-d positive cells observed in the wall of porcine gall bladder and its excretory duct possess metabolic pathway for nitric oxide synthesis. Based on obtained data it is suggested that NADPH-d positive mast cells are most probably involved in the regulation of the function of epithelium, smooth muscle layer and blood vessels of the organ. [ABSTRACT FROM AUTHOR]

The objective of this investigation was to study the histological structure of the gall bladder in the common quail (Coturnix coturnix). Samples were obtained from six male and six female healthy adult common quail. Tissue sections were stained with haematoxylin and eosin. Histological results showed that the overall histology of the gall bladder of the common quail is similar to that in the chukar partridge except for the goblet cells. No significant sex-based differences were found. The gall bladder was composed of tunica mucosa, tunica muscularis and tunica serosa or tunica adventitia. The tunica mucosa was mainly lined with simple columnar epithelium which was covered by a continuous striated border of microvilli. Goblet cells were observed among the epithelial cells. The tunica mucosa formed some folds which appeared to be regularly distributed over the whole gall bladder luminal surface and were mostly isometric. Deep invaginations of the surface epithelium were observed to have grown down into the underlying mesenchyme, showing a tubular gland-like appearance. The muscularis mucosa was absent. The thin lamina propria-submucosa contained loose connective tissue which consisted of numerous diffuse lymphatic tissues, but no glands were observed. The tunica muscularis consisted of a thin circular layer of smooth muscle fibres. The loose connective tissue of the tunica serosa or adventitia was made up of adipose tissues and blood vessels. It is concluded that the histological structures of the gall bladder of the common quail are similar to those of the chukar partridge except for the presence of goblet cells among the epithelial cells of the tunica mucosa. [ABSTRACT FROM AUTHOR]

The knowledge of variations in the origin and course of cystic artery is important for the surgeons as uncontrolled bleeding from the cystic artery and its branches can be fatal during cholecystectomy that increases the risk of intraoperative lesions to vital vascular and biliary structures. The present study was undertaken on 100 human liver specimens with intact gallbladder and extrahepatic duct system, obtained from the Department of Anatomy and the Department of Forensic Medicine, Mysore Medical College and Research Institute, Mysore. The cystic artery was studied with regard to variations in the origin, length and diameter. It was observed that the origin of the cystic artery was normal in 92% of cases and variations were seen in rest 8% of cases. Most common source of origin of the cystic artery was the right hepatic artery (92%). The mean length of the cystic artery in the present study was 17.60 mm and ranged between 3.7 mm to 42 mm. Mean length in males was 17.40 mm and in females 17.88 mm. Mean external diameter of the cystic artery was 2.20 mm and ranged between 1.1 mm and 3.2 mm. No change in the external diameter of the cystic artery was noted through the entire course of the artery. Mean external diameter in males was 2.20 mm and in females 2.19 mm. No significant difference was observed in the external diameter between different age groups. [ABSTRACT FROM AUTHOR]

Researchers nowadays have devoted extra attention to the different biomedical applications of indocyanine green (ICG), a US Food and Drug Administration-approved fluorescent compound in the fields such as drug delivery, medical imaging and disease diagnosis. In addition, hepatic function evaluation could be conducted by using ICG before surgical procedures and angiographic assessment of blood. Therefore, ICG will be expected to be excellent imaging and targeting agent in various preclinical and clinical model systems. However, whether ICG possesses the potential for the gall bladder's intraoperative imaging guidance needs to be further explored in vivo animal experiments. Herein, near-infrared fluorophores ICG can display the specific uptake by the gall bladder cells and tissues. The dynamic process of biodistribution and the clearance of ICG in vivo in mice are clearly shown in real-time live-body imaging. Furthermore, ICG was rapidly excreted into the bile and lately biodistributed to the stomach after treatment in mice. Meanwhile, the signal-to-background ratio of the gall bladder demonstrated a tremendously higher level compared to other organs (stomach, heart, liver, lung, pancreas, spleen, intestine and duodenum). In conclusion, fluorescence navigation using ICG fluorescence imaging will provide good visualization and detection of the target lesions (gall bladder) in clinics such as diagnostic medical imaging and intraoperative navigation., (© 2022 Wiley-VCH GmbH.)

The epidemiology of parasite infection in local and imported breeds is quite an essential topic in the meat industry and human health. This study aims to determine the prevalence of Dicrocoelium dendriticum in local sheep breeds (Naemi, Najdi, and Harri) and imported breeds from Romania (Romani breed) and the epidemiology of the infection in Saudi Arabia. Morphological description, the relationship between dicrocoeliasis and sex, age, and histological changes were also presented. A total of 6845 slaughtered sheep at Riyadh Automated slaughterhouse were investigated and followed up for 4 months between 2020-2021. It included 4,680 local breeds and 2,165 imported Romanian breeds. Fecal samples and livers and gallbladders from slaughtered animals were examined for apparent pathological lesions. The results indicated that the infection rate in slaughtered animals was 10.6% in imported Romani sheep and 0.9% in the local Naeimi breed. After identifying the parasite morphologically, negative results were obtained from examining feces, gallbladders, and livers of Najdi and Harry sheep breeds. The mean number of eggs per 20 µL/gallbladder was low (72.78 ± 17.8: 76.11 ± 5.07), medium (334.59 ± 90.6: 292.91 ± 26.63), and high (1113.2 ± 22.3: 1004 ± 143.4) in imported and Naeime sheep, respectively. Significant differences were found between gender and age (males and females were 3.67% and 6.31%; > 2 years 4.39%, 1-2 years 4.22%, and 1 year 3.53%) respectively. Histopathological lesions in the liver were more pronounced. Our survey confirmed the presence of D. dendriticum in imported Romani and local Naeimi sheep, and the potential role of imported sheep in the epidemiology of dicrocoeliasis in Saudi Arabia., Competing Interests: No potential conflict of interest relevant to this article was reported., (© Copyright 2022 Korean Society of Animal Science and Technology.)

Abdominal tuberculosis is one of the common extra pulmonary tuberculosis with diverse clinical manifestations. It has high disease burden in endemic countries like India leading to significant morbidity and mortality when left untreated. It is of vital importance to treat to prevent significant disease related mortality. We report 4 patients of abdominal tuberculosis who presented with atypical presentations. The aim of our case series is to know the uncommon presentations of a common disease., Competing Interests: Conflicts of interest All authors have none to declare., (Copyright © 2021 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Gall bladder tuberculosis (GB TB) is a very rare disease and scarce data is available on exact incidence and clinicopathogenesis even in endemic areas. The aim is to provide an insight into epidemiology, pathophysiology and management for better understanding of gall bladder tuberculosis. We collected data available from the literature on all histologically proven gall bladder tuberculosis. Case reports with either no article or only abstracts were available excluded from the study. Fifty two case reports and series with total 73 patients were included in this study. Mean age of patients was 48 years (Range 8-86 years) with male: female ratio of 1:1.7. 53 (73%) patient had isolated disease and 18 (24%) had associated abdominal tuberculosis. 3 (4%) of patients had concomitant and 7 (9%) had past history of pulmonary tuberculosis. 39 patients presented as cholecystitis and 25 as gall bladder mass. 44 (60%) patients had gall stones and majority of them (56%) are multiple. Granuloma and caseous necrosis was found in 80% & 60% of patients respectively. In conclusion, Gall bladder tuberculosis is a very uncommon presentation of abdominal tuberculosis. Pre-operative diagnosis is not possible due to lack of specific diagnostic test so increase in awareness and a high index of suspicious is required., Competing Interests: Conflicts of interest The authors have none to declare., (Copyright © 2021 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Mucosal Schwann cell hamartoma (M-SCH) of the intestinal mucosa is a rare entity and incidental finding in histological examination. Histological characteristics are Schwannonian cell proliferation in lamina propria with S100-positivity. M-SCH-like lesion in the gall bladder is even rarer and is a recently reported entity. We report this extremely rare lesion in a cholecystectomy specimen of a 4-year-old boy, which makes it the youngest patient to be having M-SCH-like lesion in the gall bladder. [ABSTRACT FROM AUTHOR]

Adenomas of the extrahepatic biliary tuce are rare and common bile duct adenomas are rare too. They may be pessile or pedunculated our patient was a 60 years old lady who presented with RUQ pain and jaundice so with impression of cholangitic under weat laparotomy, cholecystectomy, CBD explouation and choledochoduodestomy. During CBD exploration a 0.5×0.5 cm of CBD identified that excised. Histopathology confirmed the diagnosis of CBD adenoma and the patient discharged 6 days later with no complication.

A case of cystic mucinous hyperplasia is described in 5 years old, female, German Shepherd dog. Macroscopically the gall bladder was distended. There were multiple 0.1-0.3 cm size cystic papillary structures in many areas of gall bladder. In addition a 16 cm diameter paraovarian cyst containing serous fluid was detected in the cranial aspect of left ovary. Tissues were processed routinely and stained with haematoxylin-eosin (H&E) and Periodic Acid Shiff (PAS) stains. The gall bladder cysts contained a mucinous secretion and were lined with cuboidal epithelium. Immunohistochemically, TGF- β1, HER2 and Cx43 markers were mildly positive in cytoplasm of the gall bladder epithelial cells although there were no positive reactions with Ki67 and CEA markers. [ABSTRACT FROM AUTHOR]

A new Myxosporea, Zschokkella soleae sp. n., was found in the gall bladder and the bile of common sole, Solea solea ( L.), from Ghar El Melh Lagoon in north-east Tunisia. This is the first record for the presence of Zschokkella species in Tunisian waters. The parasite's plasmodia are polysporic with variable size and shape. Some plasmodia appeared attached to the gall bladder epithelium while others were found free in bile. Mature spores are ellipsoidal in frontal view 13.8 ± 0.38 μm long and 10.86 ± 0.40 μm wide with two equal size spherical polar capsules 3.6 ± 0.43 μm in size. The prevalence of infection seems to correlate with host size and changes over the year with maximum percentage in summer. Based on the 18S rDNA sequence data, Z. soleae sp. n. is readily distinguishable from other myxozoan DNA sequences in GenBank. Phylogenetically, the new species is placed in the freshwater Myxidium clade including several Zschokkella spp. infecting the gall bladder. Morphology, histology as well as DNA sequence analysis indicate that the examined species differs from all previously described Zschokkella species. [ABSTRACT FROM AUTHOR]

Liver is the largest gland in the body and rarely shows variations in its lobes and fissures. We studied 55 Formalinfixed livers for occurrence of abnormal shape, lobes, fissures and position of gall bladder. In 60% of cases the liver was normal. 40% livers showed one or the other variations. Additional lobes were found in 9.09% of cases. Additional fissure was found in 1.81% of cases. Presence of dumbbell shaped caudate lobe and presence of large papillary process was noted in 1.81% cases each. In 1.81% cases the fissure for ligamentum teres was absent or situated on the anterior surface of the liver. In 1.81% of cases each the liver was either extremely long or extremely flat. In 18.18% of the cases, the gall bladder was short and its fundus did not project beyond the inferior border of the liver. These findings may be useful for surgeons and radiologists. [ABSTRACT FROM AUTHOR]

Background: Approximately 40 species of Sphaeromyxa have been described, all of which are coelozoic parasites from gall bladders of marine fish. They are unique amongst the myxosporeans as they have polar filaments that are flat and folded instead of being tubular and spirally wound. This unusual feature was used as a subordinal character to erect the suborder Sphaeromyxina, which contains one family, the Sphaeromyxidae, and a single genus Sphaeromyxa. Methods: In the present study, we examine eelpout from the genus Lycodes from Iceland for the presence of myxosporean parasites in the gall bladder and perform morphological and DNA studies. Results: A novel myxosporean, Sphaeromyxa lycodi n. sp., was identified in the gall bladders of five of the six species of Lycodes examined, with a prevalence ranging from 29 - 100%. The coelozoic plasmodia are large, polysporous and contain disporic pansporoblasts and mature spores which are arcuate. The pyriform polar capsules encase long and irregularly folded ribbon-like polar filaments. Each spore valve has two distinct ends and an almost 180° twist along the relatively indistinct suture line. The single sporoplasm is granular with two nuclei. Sphaeromyxa lycodi is phylogenetically related to other arcuate sphaeromyxids and is reproducibly placed with all known sphaeromyxids and forms part of a robustly supported clade of numerous myxosporean genera which infect the hepatic biliary systems of a wide range of hosts. Conclusions: Sphaeromyxa lycodi is a common gall bladder myxosporean in eelpout of the genus Lycodes from Northern Iceland. It has characteristics typical of the genus and develops arcuate spores. Molecular phylogenetic analyses confirm that sphaeromyxids form a monophyletic group, subdivided into straight and arcuate spore forms, within the hepatic biliary clade that infect a wide range of freshwater associated animals. The ancestral spore form for the hepatic biliary clade was probably a Chloromyxum morphotype; however, sphaeromyxids have more recently evolved from an ancestor with a spindle-shaped Myxidium spore form. We recommend that the suborder Sphaeromyxina is suppressed; however, we retain the family Sphaeromyxidae and place it in the suborder Variisporina. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy has almost replaced the open cholecystectomy in patients in which removal of gallbladder is required. Objective:Toassesstheclinical out-come of laparoscopic Cholecystectomy for management of acute cholecystitis and to evaluate its safety and frequency of complications. Study Design: Prospective observational study Study Setting: Liaquat University Hospital and Private Medical setup. Methodology:All patients had routine investigations, Liver function tests and ultrasound abdomen. The patients who underwent laparoscopic cholecystectomy were included in this study. The procedure was carried out by standard four port technique. Clinical examination, investigations, postoperative complications were recorded on proforma and results were drawn. Results:Total study population was 63 patients with female preponderance and male to female ratio of 1:3.2 Mean age was 44.21 years ± 13.43. Main per-operative complications observed were spilled stones 7.93% and hemorrhage in 6.34% cases, bile duct injury in 4.76% cases and gallbladder perforation in 4.76% patients. Post-operative complication included wound infection in 9.52%, Ilues and post-cholecystectomy syndrome in 6.34%, bile leakage in 4.76% and CBD stricture in 1.5% cases. Conclusion:Laparoscopic early cholecystectomyis reliable and safe modality cost effective, and timely surgery with modern conception in the management of acute cholecystitis, because of accelerated recovery, negligible wound infection or related complication, and less postoperative pain. [ABSTRACT FROM AUTHOR]

Abstract: Background: Carcinoma of the gall bladder is the fifth most common malignancy of the gastrointestinal tract after colorectal, pancreatic, gastric and esophageal carcinomas. Aim of the work: To study the role of multidetector computed tomography in the diagnosis and staging of gall bladder carcinoma. Subjects and methods: This study included twenty-five patients presented to us during the period from June 2011 till May 2012 and were diagnosed radiologically by multidetector computed tomography as carcinoma of the gall bladder and the diagnosis was confirmed histopathologically. All the patients were subjected to ultrasonography followed by multidetector computed tomographic imaging using triphasic examination technique. Results: Among the twenty-five patients included in this study there were fifteen females and ten males. Their ages ranged from 50 to 70years old (average 60years). All the patients were radiologically diagnosed as gall bladder carcinoma based on the multidetector computed tomographic findings. Infiltrating masses were detected in fifteen patients (60%), Intraluminal polypoidal masses were detected in nine patients (36%) while one patient (4%) presented with mural thickening of the gall bladder wall. Conclusion: We conclude that multidetector CT is the diagnostic tool of choice in the detection and staging of gall bladder carcinoma. [Copyright &y& Elsevier]

Introduction: Radical resection to achieve R0 status remains the only potential curative option in patients with gall bladder cancer (GBC). This study was aimed to evaluate the efficacy of an extended criterion of radical resection to achieve R0 status in GBC. Methods: A triple-phase CT with 3D reconstruction was done in all patients. A standard resectability criterion was followed in all patients. A minimum of liver segment 4B + 5 resection and radical lymphadenectomy including the para-aortic areas were undertaken in all patients. Adjacent organectomy was added as required. Results: Between November 2008 and April 2011, 59 patients with GBC underwent operation and 40 (resectability, 68 %) underwent resection. The resectional procedures performed were segmentectomy 4B + 5 in 31 (78 %), median sectorectomy in 2 (5 %), extended right hepatectomy in 3 (8 %), and hepatopancreaticoduodenectomy in 4 (10 %) patients. Postoperative complications occurred in 24 (60 %) patients. Two patients died postoperatively. A total of 829 lymph nodes were harvested and the median lymph node count was 18 (4-77). Twenty-three (58 %) patients had lymph node metastases. Twenty-eight of 40 (70 %) had disease limited till N1 nodes. Metastases up to N2 lymph nodes were seen in 12 (30 %). American Joint Committee on Cancer seventh edition stages were I-2 (5 %) patients, II-5 (13 %), III-19 (48 %), and IV-14 (35 %). R0 resection was achieved in 33 (83 %) patients. Four patients had recurrence and one died of recurrence. All other patients are alive till the last follow-up. Conclusions: Assessment with triple-phase CT with 3D reconstruction can produce high resectability rate in GBC. Extended criterion of radical resection results in R0 status in more than 80 % of patients with GBC. [ABSTRACT FROM AUTHOR]

Background: In the setting of difficult dissection of Calot's triangle during laparoscopic cholecystectomy, conversion is commonly advocated. An alternative approach aimed at preventing bile duct injury is laparoscopic partial cholecystectomy (LPC). The safety and efficacy of this procedure are unclear. Methods: A systematic review of the literature was performed independently by three researchers. The outcomes were conversion rate, hospital length of stay (LOS), bile duct injury, bile leak, symptomatic gallstones in the remnant gallbladder, need for reoperation, postoperative endoscopic retrograde cholangiopancreaticography (ERCP), percutaneous intervention, and mortality. Results: The review included 15 publications, which reported on 625 patients. Four different operative techniques could be distinguished. Conversion to open (partial) cholecystectomy was performed in 10.4 % of the cases. The median LOS was 4.5 days (range, 0-48 days). The most common complication was postoperative bile leak, which occurred in 66 patients (10.6 %). One case of bile duct injury occurred. During the follow-up period, 2.2 % of the patients experienced recurrent symptoms of gallstones. Eight patients (2.7 %) underwent reoperation. Postoperative ERCP was performed for 26 (7.5 %) of 349 patients. A percutaneous intervention was performed for 5 (1.4 %) of 353 patients. Three deaths were described in the reviewed series (1 of pulmonary sepsis and 2 of myocardial infarctions). A rough comparison showed that fewer bile leaks, less need for ERCP, and less recurrent symptoms of gallstones seemed to occur when the cystic duct and gallbladder remnant were closed. Conclusions: Literature concerning LPC is scarce. Four different LPC techniques can be distinguished. When a difficult gallbladder is encountered during LC, LPC seems to be a safe and feasible alternative to conversion. Closing of the cystic duct, gallbladder remnant, or both seems to be preferable. [ABSTRACT FROM AUTHOR]

Background: Gall bladder carcinoma accounts for 98% of all the gall bladder malignancies and it is the sixth most common malignancy of the gastrointestinal tract worldwide. The incidence of incidental gall bladder carcinoma which is diagnosed during or after a laparoscopic cholecystectomy is reported to be around 0.19-3.3% in the literature. Aim: This study was aimed at detecting the incidence of gall bladder carcinomas which were diagnosed incidentally during or after laparoscopic cholecystectomies which were done for gall stone disease and cholecystitis. Materials and Methods: We analyzed the medical records of patients with symptomatic gallstone disease and acute or chronic cholecystitis, who underwent laparoscopic cholecystectomies at the Hakeem Abdul Hameed Centenary Hospital during the period from January 2007 to June 2012. Results: A total of 622 laparoscopic cholecystectomies were performed at our institute during the study period of five and a half years. In 6 (0.96%) cases, incidental carcinomas of the gallbladder were discovered. Conclusion: A laparoscopic cholecystectomy which is performed for benign gall bladder disease rarely results in a diagnosis of unexpected gallbladder cancer. The microscopic examination of the specimens, with special attention to the depth of invasion, range of the mucosal spread and the lymphovascular involvement, is critical in diagnosing the incidental malignancies as well as for the subsequent management of the cases. [ABSTRACT FROM AUTHOR]

Background: Although laparoscopic cholecystectomy has become the gold standard for removing the Gall Bladder (GB) for operable benign diseases, many open cholecystectomies are still performed in developing countries. We present our experiences with all cholecystectomies done in a secondary health care hospital, in north-central Nigeria., Patients and Methods: All patients who had open and laparoscopic cholecystectomies over a 20year period between January 2000 and December 2019 at the general surgery unit of Asokoro District Hospital, Abuja, Nigeria were reviewed with a focus on demography, indications for surgery, type of operation, complications, and outcomes. The diagnosis of benign gall bladder diseases was by findings on patients' presentation, clinical examination, trans-abdominal ultrasound scan, and histological examination of all specimens. All open cholecystectomies were via the Kocher's incision approach while the laparoscopic cholecystectomies were via the 4-port incisions approach., Results: A total of 120 cholecystectomies comprising 74 open cholecystectomies and 46 laparoscopic cholecystectomies were performed. There were 27(22.5%) males and 93(77.5%) females giving a male to female ratio of 1:3.4. The age range was 19 to 80years and the peak age was in the 41-50years range. The commonest indication for surgery was calculous cholecystitis in 107(89.2%) patients while the commonest post-operative complication was surgical site infection in 4(3.33%) patients. Majority (80%) were cholesterol stones. All the gall bladders were benign and there was no mortality recorded., Conclusion: Open and laparoscopic cholecystectomies are safe in Asokoro District Hospital, Abuja Nigeria and the outcomes are comparable to results from other centres in the region., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2022 by West African Journal of Medicine.)

Gall bladder is known for many congenital anomalies such as duplication, intrahepatic position, floating position etc. Most of its anomalies can be detected in ultrasound examination and radiography. We report an extremely rare congenital anomaly of gall bladder as observed in a male cadaver during dissection classes. The gall bladder was totally enclosed in the right free margin of the lesser omentum, in front of the usual contents of the right free margin of lesser omentum. The size, shape and blood supply of the gall bladder were normal. Though this anomaly might not cause any functional disturbances, it might result in complications during laparoscopic cholecystectomy., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: Tuberculosis is still a killer disease and a nightmare in developing countries. Post-tubercular hydrocephalus remains one of the most severe complications, with many diversion procedure methods. How common is the occurrence of co-morbid post tubercular hydrocephalus with tubercular peritonitis is still not known. This is a frustrating cause of repeated shunt complications and revisions. Methods: We discuss the management of two cases that were the cause of nearly 50 % of our shunt revisions due to the comorbidities of post-tubercular hydrocephalus and tubercular adhesive peritonitis. We performed the ventriculocholecysto (VC) shunt. This procedure diverts CSF from the ventricular system to the gall bladder. Results: The two children are disease free and did not require a revision in the 3.4-year follow-up period. Conclusion: The VC shunt is a simple procedure. It improved the quality of life of these children who otherwise would have had a very morbid period during shunt revisions and the active disease. These children did not require further revisions and can grow normally. [ABSTRACT FROM AUTHOR]

Objectives: Salmonella typhi forms biofilm on the surface of gallstones promoting colonization and carrier state. The aims are to detect its frequency in chronic calcular cholecystitis patients, to find out their antibiotic resistance pattern, and also to examine biofilm on the surface of gallstones and detect its correlation to antibiotic susceptibility pattern. Materials and methods: The study group included 257 patients with chronic calcular cholecystitis. S. typhi was isolated from gall bladder specimens. Antibiotics susceptibility tests of the isolates were done. Biofilm on surface of gallstones were visualized using scanning electron microscopy. Virulence (Vi) antibodies against S. typhi were studied in sera of 257 healthy controls. Results: 10.9% of patients were chronic typhoid carriers compared to only 3.5% of the controls (OR=3.37, p=0.002). Multidrug resistance was detected in 35.7% of isolates. S. typhi biofilms on the surface of the 21/28 (75%) gallstones were detected. Ninety percent of the strains that produced maximum amount of biofilm were multidrug-resistant. Conclusion: Chronic calcular cholecystitis patients are more prone to typhoid carriage due to biofilm formation of S. typhi on the surface of gallstones. [ABSTRACT FROM AUTHOR]

Background: Recent studies have documented that chronic liver disease is strongly associated with development of gallstone. Our study aims to document the frequency of gallstones in different CTP classes of cirrhotic patients and study related radiological features. Methodology: 913 patients of cirrhosis of liver presenting at Hepatology Clinic of CMC, Larkana during January 2011 to December 2011 were enrolled for study. Ultrasound of all cases was performed to detect gallstones and study the related radiological features. The data was analyzed using SPSS version 19. Results: Majority (n = 646, 70.8%) were male. Gallstones were detected in 269 (29.5%) and of these 136 (14.9%) were multiple. Patients having gallstones were older with mean age of 49.92 ± 17.35 years as compared to 41.42 ± 15.08 years having no stones. Female were more likely to have gallstones (p < 0.002) and more frequently detected in patients aging 65 - 74 years (p < 0.001) with odds of 3.43 (95% CI: 2.35 - 4.99). Patients with gallstones had advanced liver disease and were more likely to be in CTP class C (p < 0.001) with odds of 5.17 (95% CI: 3.79 - 7.04). Patients with gallstones had statistically significant thickened gall bladder wall (p < 0.001) with odds of 4.48 (95% CI: 3.30 - 6.08). Conclusion: Gallstones are common in cirrhosis with more than 50% are multiple. They are more frequency seen in advanced liver disease i.e. CTP class C, increasing age and females. [ABSTRACT FROM AUTHOR]

Abstract: Background: A minority of patients of acute hepatitis may exhibit edematous GB walls with no visible lumen despite fasting and may also exhibit paradoxical GB response in the post-prandial state. Methods: Patients of acute hepatitis underwent routine upper abdominal sonography after overnight fasting. Patients who demonstrated contracted GB with edematous and coapted walls without any visible lumen despite overnight fasting were studied in the post-prandial phase after having breakfast. Serial ultrasonography was carried out at 10–15 min interval for an hour and changes in GB morphology was noted at each stage. Results: A total of 77 patients of acute hepatitis underwent USG of hepatobiliary system between Sept 2008 and Aug 2009. Contracted gall bladder with edematous and coapted walls without any visible lumen despite overnight fasting was noted in 11 patients and were studied in the post-prandial phase. Post-prandial paradoxical filling of GB was observed in all such cases. Serial post-prandial ultrasonography demonstrated onset of filling of GB as early as 10–15 min post-prandial. Maximal GB distension was observed between 30 and 60 min. USG at 60 min post-prandial showed slight reduction in GB volume. As the GB distended in the post-prandial state, the lumen became increasingly visible with marginal reduction in wall thickening. Conclusion: We have observed transient paradoxical filling of GB on serial USG in early post-prandial state, in a subset of patients of acute viral hepatitis who had contracted GB with coapted walls in the initial USG after overnight fasting. [Copyright &y& Elsevier]

Abstract: Carcinogenic potential of argemone oil (AO) and butter yellow (BY), the adulterants encountered in edible oil, in gall bladder of Swiss albino mice was undertaken to investigate the potential aetiological factors of gall bladder carcinoma (GBC) in the Indo-Gangetic basin. Twice weekly intraperitoneal (ip) administration of AO (5ml/kg body wt) and BY (25mg/kg body wt) to Swiss albino male and female mice for 30 and 60days indicated that females were more vulnerable to these adulterants in terms of responses to inflammatory markers. Subsequent experiments with dietary exposure of AO (1%) and BY (0.06%) for 6months in female mice showed symptoms related to cachexia, jaundice and anaemia. High levels of total cholesterol, low density lipoprotein (LDL), TG, bilirubin and low level of high density lipoprotein (HDL) as well as gallstone formation was shown by AO exposure only, leading to the development of adenocarcinoma. BY exposure resulted in adenoma and hyperplasia without stone formation. The cyclooxygenase (COX-2) overexpression was found to be related to prostaglandin E2 (PGE2) production in AO treated mice but not in BY exposed animals, thereby indicating a differential pathway specific carcinogenicity. PGE2 stimulates the secretion of secreted mucins (MUC5AC), which is involved in stone formation following AO exposure. Enhanced secretion of membrane bound mucins (MUC4) in BY and AO exposed mice resulted in the activation of ErbB2 and downstream signalling such as p-AKT, p-ERK and p-JNK, which ultimately affects the target proteins, p53 and p21 leading to adenoma and adenocarcinoma, respectively. The study suggests that AO and BY are responsible for producing GBC in mice along with stone formation in the AO exposed animals. [Copyright &y& Elsevier]