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Hepatic grooves:An observational study at laparoscopic surgery

World Journal of Experimental Medicine 2024年第2期14卷 97-102页

作者： Shamir O Cawich dexter a thomas.fawwaz mohammed Michael T Gardner Marlene Craigie Shaneeta Johnson Ramnanand S Kedambady Department of Surgery University of the West IndiesSt Augustine 000000Trinidad and Tobago Department of Surgery Port of Spain General HospitalPort of Spain 000000Trinidad and Tobago Section of Anatomy Basic Medical SciencesUniversity of the West IndiesKingston 000000Jamaica Department of Radiology University of the West IndiesKingston 000000Jamaica Department of Surgery Morehouse School of MedicineAtlantaGA 30310United States Section of Anatomy Department of Basic Medical SciencesUniversity of the West IndiesKingston KIN7Jamaica

BACKGROUND In traditional descriptions,the upper surface of the liver is smooth and convex,but deep depressions are variants that are present in 5%-40%of *** sought to determine the relationship between surface depressions and the *** To use exploratory laparoscopy to determine the relationship between surface depressions and the *** An observational study was performed in all patients undergoing laparoscopic upper gastro-intestinal operations between January 1,2023 and January 20,2024.A thirty-degree laparoscope was used to inspect the liver and *** surface depressions were present,we recorded patient demographics,presence of diaphragmatic bands,rib protrusions and/or any other source of compression during *** Of 394 patients,343 had normal surface anatomy,and 51(12.9%)had prominent surface depressions on the *** was no significant relationship between the presence of surface depressions and gender nor the presence of rib ***,there was significant association between the presence of surface depressions and diaphragmatic muscular bands(P<0.001).CONCLUSION With these data,the diaphragmatic-band theory has gained increased importance over other theories for surface *** studies are warranted using cross sectional imaging to confirm relationships with intersectional planes as well as beta-catenin assays in the affected liver parenchyma.

关键词： Liver Variant Vein Hepatic Surgery

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Rescue from complications after pancreaticoduodenectomies at a low-volume Caribbean center:Value of tailored peri-pancreatectomy protocols

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World Journal of Gastrointestinal Surgery 2024年第3期16卷 681-688页

作者： Shamir O Cawich Elijah Dixon Parul J Shukla Shailesh V Shrikhande Rahul R Deshpande fawwaz mohammed Neil W Pearce Wesley Francis Shaneeta Johnson Johann Bujhawan Department of Surgery University of the West IndiesSt Augustine 000000Trinidad and Tobago Department of Surgery Faculty of MedicineUniversity of CalgaryCalgaryAlberta T2N2T9Canada Department of Surgery Weill Cornell Medical CollegeNew YorkNY 10065United States Department of Surgical Oncology Tata Memorial CenterHomi Bhabha National UniversityMumbai 400012India Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom University Surgical Unit Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery University of the West IndiesNassau N-1184Bahamas Department of Surgery Morehouse School of MedicineAtlantaGA 30310United States Department of Surgery General Hospital in Port of SpainPort of Spain 000000Trinidad and Tobago

BACKGROUND Pancreaticoduodenectomy(PD)is a technically complex operation,with a re-latively high risk for *** ability to rescue patients from post-PD complications is as a recognized quality *** protocols were instituted at our low volume facility in the year *** To document the rate of rescue from post-PD complications with tailored protocols in place as a measure of *** A retrospective audit was performed to collect data from patients who experienced major post-PD complications at a low volume pancreatic surgery unit in Trinidad and Tobago between January 1,2013 and June 30,***-dardized definitions from the International Study Group of Pancreatic Surgery were used to define post-PD complications,and the modified Clavien-Dindo classification was used to classify post-PD *** Over the study period,113 patients at a mean age of 57.5 years(standard deviation[SD]±9.23;range:30-90;median:56)underwent PDs at this *** complications were recorded in 33(29.2%)patients at a mean age of 53.8 years(SD:±7.9).Twenty-nine(87.9%)patients who experienced major morbidity were salvaged after aggre-ssive treatment of their ***(3.5%)died from bleeding pseudoaneurysm(1),septic shock secondary to a bile leak(1),anastomotic leak(1),and myocardial infarction(1).There was a significantly greater salvage rate in patients with American Society of Anesthesiologists scores≤2(93.3%vs 25%;P=0.0024).CONCLUSION This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring *** low volumes at our facility,we demonstrated that 87.9%of patients were rescued from major *** attributed this to several factors including development of rescue protocols,the competence of the pancreatic surgery teams and continuous,and adaptive learning by the entire institution,cul-minating in the development of tailored peri-pancreatectomy protoc

关键词： Pancreas Complication Rescue Failure Morbidity Mortality Pancreaticoduodenectomy

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Review of minimally invasive pancreas surgery and opinion on its incorporation into low volume and resource poor centres

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World Journal of Gastrointestinal Surgery 2021年第10期13卷 1122-1135页

作者： Shamir O Cawich Michael D Kluger Wesley Francis Rahul R Deshpande fawwaz mohammed Kimon O Bonadie dexter A thomas Neil W Pearce Beth A Schrope Clinical Surgical Sciences University of the West IndiesTunapuna 331333Trinidad and Tobago Department of Surgery New York Presbyterian Hospital/Columbia University Medical CenterNew YorkNY 10032United States Department of Surgery University of the West IndiesNassau N-1184Bahamas Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom Department of Clinical Surgical Sciences University of the West IndiesTunapuna 331333Trinidad and Tobago Department of Surgery Health Service AuthorityGeorgetown 915 GTCayman Islands Department of Surgery Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery Columbia University College of Physicians and SurgeonsNew YorkNY 10032United States

Pancreatic surgery has been one of the last areas for the application of minimally invasive surgery(MIS)because there are many factors that make laparoscopic pancreas resections *** concept of service centralization has also limited expertise to a small cadre of high-volume centres in resource rich ***,this is not the environment that many surgeons in developing countries work *** patients often do not have the opportunity to travel to high volume centres for ***,we sought to review the existing data on MIS for the pancreas and to *** this paper,we review the evolution of MIS on the pancreas and discuss the incorporation of this service into low-volume and resource-poor countries,such as those in the *** paper has two ***,we performed a literature review evaluating all studies published on laparoscopic and robotic surgery of the *** data in the Caribbean is examined and we discuss tips for incorporating this operation into resource poor hospital *** pancreatic case volume in the Caribbean,and financial barriers to MIS in general,laparoscopic distal pancreatectomy,enucleation and cystogastrostomy are feasible operations to integrate in to a resource-limited healthcare *** is because they can be performed with minimal to no consumables and require an intermediate MIS skillset to complement an open pancreatic surgeon’s peri-operative experience.

关键词： Pancreas Surgery Laparoscopic Minimally invasive Pancreatectomy Whipple’s Pancreaticoduidenectomy

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Transcriptome changes in stages of non-alcoholic fatty liver disease

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World Journal of Hepatology 2022年第7期14卷 1382-1397页

作者： Jihad Aljabban Michael Rohr Saad Syed Kamal Khorfan Vincent Borkowski Hisham Aljabban Michael Segal Mohamed Mukhtar mohammed mohammed Maryam Panahiazar dexter Hadley Ryan Spengler Erin Spengler Department of Medicine University of Wisconsin Hospital and ClinicsMadisonWI 53792United States Department of Medicine University of Central Florida College of MedicineOrlandoFL 32827United States Department of Medicine Northwestern Memorial HospitalChicagoIL 60611United States Department of Gastroenterology and Hepatology University of California San Francisco-FresnoFresnoCA 93701United States Department of Medicine Barry UniversityMiamiFL 33161United States Department of Medicine Michigan State University College of Human MedicineEast LansingMI 49503United States Department of Medicine Windsor University School of MedicineSaint Kitts 1621CayonSaint Kitts and Nevis Department of Surgery University of California San FranciscoSan FranciscoCA 94305United States Department of Artificial Intelligence PathologyUniversity of Central Florida College of MedicineOrlandoFL 32827United States Department of Gastroenterology and Hepatology University of Wisconsin Hospital and ClinicsMadisonWI 53792United States

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the most common chronic liver disease in the United States and *** currently understood model of pathogenesis consists of a‘multiple hit’hypothesis in which environmental and genetic factors contribute to hepatic inflammation and *** To examine the genetic expression of NAFLD and non-alcoholic steatohepatitis(NASH)tissue samples to identify common pathways that contribute to NAFLD and NASH *** We employed the Search Tag Analyze Resource for Gene Expression Omnibus platform to search the The National Center for Biotechnology Information Gene Expression Omnibus to elucidate NAFLD and NASH *** NAFLD,we conducted meta-analysis of data from 58 NAFLD liver biopsies and 60 healthy liver biopsies;for NASH,we analyzed 187 NASH liver biopsies and 154 healthy liver *** Our results from the NAFLD analysis reinforce the role of altered metabolism,inflammation,and cell survival in pathogenesis and support recently described contributors to disease activity,such as altered androgen and long non-coding RNA *** top upstream regulator was found to be sterol regulatory element binding transcription factor 1(SREBF1),a transcription factor involved in lipid *** of SREBF1,we observed upregulation in CXCL10,HMGCR,HMGCS1,fatty acid binding protein 5,paternally expressed imprinted gene 10,and downregulation of sex hormone-binding globulin and insulin-like growth factor *** molecular changes reflect low-grade inflammation secondary to accumulation of fatty acids in the *** results from the NASH analysis emphasized the role of cholesterol in *** canonical pathways,disease networks,and disease functions were related to cholesterol synthesis,lipid metabolism,adipogenesis,and metabolic *** upstream regulators included proinflammatory cytokines tumor necrosis factor and IL1B,PDGF BB,and *** of beta-estradiol

关键词： Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Bioinformatics AKT inhibitor Therapy

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Dissecting novel mechanisms of hepatitis B virus related hepatocellular carcinoma using meta-analysis of public data

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World Journal of Gastrointestinal Oncology 2022年第9期14卷 1856-1873页

作者： Jihad Aljabban Michael Rohr Saad Syed Eli Cohen Naima Hashi Sharjeel Syed Kamal Khorfan Hisham Aljabban Vincent Borkowski Michael Segal Mohamed Mukhtar mohammed mohammed Emmanuel Boateng Mary Nemer Maryam Panahiazar dexter Hadley Sajid Jalil Khalid Mumtaz Department of Medicine University of Wisconsin Hospital and ClinicsMadisonWI 53792United States Department of Medicine University of Central Florida College of MedicineOrlandoFL 32827United States Department of Medicine Northwestern Memorial HospitalChicagoIL 60611United States Department of Medicine Vanderbilt Medical CenterNashvilleTN 37232United States Department of Medicine Mayo ClinicRochesterMN 55905United States Department of Medicine University of Chicago HospitalsChicagoIL 60637United States Department of Gastroenterology and Hepatology University of California San Francisco-FresnoFresnoCA 93701United States Department of Medicine Barry UniversityMiamiFL 33161United States Department of Medicine Michigan State University College of Human MedicineLansingMI 49503United States Department of Medicine Windsor University School of MedicineFrankfortIL 60423United States Department of Surgery University of California San FranciscoSan FranciscoCA 94143United States Department of Pathology University of Central Florida College of MedicineOrlandoFL 32827United States Department of Gastroenterology and Hepatology Ohio State University Wexner Medical CenterColumbusOH 43210United States

BACKGROUND Hepatitis B virus(HBV) is a cause of hepatocellular carcinoma(HCC). Interestingly, this process is not necessarily mediated through cirrhosis and may in fact involve oncogenic processes. Prior studies have suggested specific oncogenic gene expression pathways were affected by viral regulatory proteins. Thus, identifying these genes and associated pathways could highlight predictive factors for HCC transformation and has implications in early diagnosis and *** To elucidate HBV oncogenesis in HCC and identify potential therapeutic *** We employed our Search, Tag, Analyze, Resource platform to conduct a meta-analysis of public data from National Center for Biotechnology Information’s Gene Expression Omnibus. We performed meta-analysis consisting of 155 tumor samples compared against 185 adjacent nontumor samples and analyzed results with ingenuity pathway *** Our analysis revealed liver X receptors/retinoid X receptor(RXR) activation and farnesoid X receptor/RXR activation as top canonical pathways amongst others. Top upstream regulators identified included the Ras family gene rab-like protein 6(RABL6). The role of RABL6 in oncogenesis is beginning to unfold but its specific role in HBV-related HCC remains undefined. Our causal analysis suggests RABL6 mediates pathogenesis of HBV-related HCC through promotion of genes related to cell division, epigenetic regulation, and Akt signaling. We conducted survival analysis that demonstrated increased mortality with higher RABL6 expression. Additionally, homeobox A10(HOXA10) was a top upstream regulator and was strongly upregulated in our analysis. HOXA10 has recently been demonstrated to contribute to HCC pathogenesis in vitro. Our causal analysis suggests an in vivo role through downregulation of tumor suppressors and other *** This meta-analysis describes possible roles of RABL6 and HOXA10 in the pathogenesis of HBV-related HCC. RABL6 and HOXA10 represent potent

关键词： Hepatitis B virus Hepatocellular carcinoma Genomics Meta-analysis

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Surgical relevance of anatomic variations of the right hepatic vein

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World Journal of Transplantation 2021年第6期11卷 231-243页

作者： Shamir O Cawich Vijay Naraynsingh Neil W Pearce Rahul R Deshpande Robbie Rampersad Michael T Gardner fawwaz mohammed Roma Dindial Tanzilah Afzal Barrow Department of Surgery University of the West IndiesSt Augustine 000000Trinidad and Tobago Department of Surgery Port of Spain General HospitalPort of Spain 000000Trinidad and Tobago University Surgical Unit Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom Department of Radiology University of the West IndiesSt.Augustine 000000Trinidad and Tobago Department of Radiology Port of Spain General HospitalPort of Spain 000000Trinidad and Tobago Section of Anatomy Basic Medical SciencesUniversity of the West IndiesKingston 000000Jamaica Department of Radiology University of the West IndiesSt Augustine 000000Trinidad and Tobago

BACKGROUND Variations in the anatomy of hepatic veins are of interest to transplant surgeons,interventional radiologists,and other medical practitioners who treat liver *** drainage patterns of the right hepatic veins(RHVs)are particularly relevant to transplantation *** The aim was to identify variations of the patterns of venous drainage from the right side of the *** the best of our knowledge,there have been no reports on RHV variations in in a Caribbean *** Two radiologists independently reviewed 230 contrast-enhanced computed tomography scans performed in 1 year at a hepatobiliary referral *** outflow patterns were observed and RHV variants were described as:(1)Tributaries of the RHV;(2)Variations at the hepatocaval junction(HCJ);and(3)Accessory *** A total of 118 scans met the inclusion *** 39%of the scans found conventional anatomy of the main hepatic *** RHVs were present 49.2%and included a well-defined inferior RHV draining segment VI(45%)and a middle RHV(4%).At the HCJ,83 of the 118(70.3%)had a superior RHV that received no tributaries within 1 cm of the junction(Nakamura and Tsuzuki type I).In 35 individuals(29.7%)there was a short superior RHV with at least one variant *** to the Nakamura and Tsuzuki classification,there were 24 type II variants(20.3%),six type III variants(5.1%)and,five type IV variants(4.2%).CONCLUSION There was significant variation in RHV patterns in this population,each with important relevance to liver *** radiologists and hepatobiliary surgeons practicing in the Caribbean must be cognizant of these differences in order to minimize morbidity during invasive procedures.

关键词： Liver Variant Hepatic Vein Anomaly Venous,Drainage,Vena cava

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