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Cancer of the uncinate process of the pancreas:surgical anatomy and clinicopathological features

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Hepatobiliary & Pancreatic Diseases International 2009年第6期8卷 569-574页

作者： Adrian W. O'Sullivan Nigel Heaton mohamed rela Institute of Liver Studies King's College Hospital National Health Service(NHS) Foundation Trust

BACKGROUND:The clinicopathological features of uncinate process pancreatic cancer(UPPC) are poorly *** the anatomy of the uncinate process and its division during surgery are central to pancreaticoduodenectomy for *** set out to describe the embryology and anatomy of the uncinate process and the clinicopathological features of *** SOURCES:All published case series of UPPC were reviewed and included in this ***:The true incidence of UPPC is difficult to quantify,with the reported incidence ranging from 2.5% to 10.7% of pancreatic *** are 5 published series of UPPC including 117 patients,72 males and 45 females,aged from 45-53 years to 61-84 *** median survival was 5 or 5.5 months in 3 of the series,12.1 months in another based only on potentially resectable lesions and 17 months in another based only on resected ***:The number of reported series of UPPC is limited,with vague symptoms as the predominant presenting features of the *** prognosis is poor with synchronous venous resection demonstrating a survival advantage.

关键词： pancreatic neoplasms uncinate process anatomy embryology surgery

Long-term liver allograft fibrosis:A review with emphasis on idiopathic post-transplant hepatitis and chronic antibody mediated rejection

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World Journal of Hepatology 2022年第8期14卷 1541-1549页

作者： Mukul Vij Ashwin Rammohan mohamed rela Department of Pathology Dr.Rela Institute and Medical CenterChennai 600044Tamil NaduIndia Institute of Liver disease and Transplantation Dr.Rela Institute and Medical CenterChennai 600044Tamil NaduIndia

Liver transplantation(LT)is a life-saving surgical procedure and the current standard of care for most patients with end stage liver *** improvements in organ preservation techniques,perioperative care,and immunosuppression,there is better patient and graft survival following LT,and assessment of the liver allograft in long-term survivors is becoming increasingly *** or de novo viral or autoimmune injury remains the most common causes of chronic hepatitis and fibrosis following liver transplantation in ***,no obvious cause can be identified in many adults with controlled recurrent disease and the majority of pediatric LT recipients,as they have been transplanted for non-recurrent liver *** surveillance liver biopsies post LT have been evaluated in several adult and pediatric centers to identify long-term pathological *** findings are frequently present in liver biopsies obtained after a year post *** significance of these findings is uncertain as many of these are seen in protocol liver biopsies from patients with clinically good allograft function and normal liver chemistry *** narrative review summaries the factors predisposing to long-term liver allograft fibrosis,highlighting the putative role of idiopathic post-LT hepatitis and chronic antibody mediated rejection in its pathogenesis.

关键词： Liver allograft fibrosis Long term Idiopathic hepatitis Chronic antibody mediated rejection

Current perspectives on the role of liver transplantation for Langerhans cell histiocytosis:A narrative review

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World Journal of Gastroenterology 2022年第30期28卷 4044-4052页

作者： Jagadeesh Menon Ashwin Rammohan Mukul Vij Naresh Shanmugam mohamed rela Institute of Liver Disease&Transplantation Dr.Rela Institute&Medical CentreBharath Institute of Higher Education&ResearchChennai 600044India

Langerhans cell histiocytosis(LCH)is a malignant disease of the histiocytes involving various organ *** spectrum of liver involvement in LCH ranges from mild transaminitis to end-stage liver *** hallmark of hepatic LCH is secondary sclerosing cholangitis,which manifests due to a progressive destruction of the biliary tree by malignant *** remains the mainstay of treatment for active *** recognition,diagnosis and a systematic approach to the management of LCH can ameliorate the disease ***,the liver involvement in these patients may progress despite the LCH being in *** transplantation(LT)remains central in the management of such *** facets of the management of LCH,especially those with liver involvement remain ***,aspects of LT in LCH with regards to the indication,timing and post-LT management,including immunosuppression and adjuvant therapy,remain *** review summarises the current evidence and discusses the practical aspects of the role of LT in the management of LCH.

关键词： Langerhans cell histiocytosis Liver transplantation Outcomes Management Chemotherapy Ethics

Cystic dystrophy in heterotopic pancreas:a rare indication for pancreaticoduodenectomy

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Hepatobiliary & Pancreatic Diseases International 2009年第2期8卷 215-217页

作者： Harun Thomas Paul Marriott Bernard Portmann Nigel Heaton mohamed rela Institute of Liver Studies Kings College School of Medicine at Denmark Hill

BACKGROUND:Cystic dystrophy in heterotopic pancreas (CDHP)is a rare benign condition characterized by the presence of cysts in the wall of the digestive tract associated with inflammation and fibrosis,intermingled with heterotopic pancreatic *** options for CDHP are poorly defined. METHOD:We report a case of CDHP,and review the literature focusing on the diagnosis and management. RESULTS:CDHP is mainly encountered in men in the fifth decade of life in association with chronic pancreatitis secondary to alcohol *** and mechanical obstruction of heterotopic pancreatic ducts have been implicated in its *** presentation is varied and current imaging provides the diagnosis. Treatment options include somatostatin analogue injections, endoscopic cyst fenestration and surgical resection (pancreaticoduodenectomy or gastrointestinal bypass). CONCLUSION:CDHP is rare and presents a diagnostic and therapeutic *** long term efficacy and indications for different treatment options need to be refined.

关键词： pancreas diseases duodenum cysts heterotopia

Clinical features and treatment of sump syndrome following hepaticojejunostomy

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Hepatobiliary & Pancreatic Diseases International 2011年第3期10卷 261-264页

作者： Gabriele Marangoni Amir Ali Walid Faraj Nigel Heaton mohamed rela King's College London School of Medicine at King's College Hospital Institute of Liver StudiesDenmark Hill

BACKGROUND:Cholangitis after Roux-en-Y hepaticojejunostomy is usually caused by anastomotic stricture.A small number of cases present without evidence of obstruction and are ascribed to reflux of gastro-intestinal content into the biliary tree above the anastomosis (sump syndrome).Despite prophylactic rotating antibiotic therapy,the cholangitic episode may be severe and ***:From 2001 to 2006,six patients who had undergone an end-to-side hepaticojejunostomy presented to our institution with recurrent episodes of biliary *** stricture was excluded by liver MRI/MRCP and percutaneous transhepatic cholangiogram (PTC).Barium meal showed reflux of contrast into the biliary tree in all *** patients had a short jejunal Roux limb (less than 50 cm) on pre-operative ***:Five patients underwent surgery and two of them had two *** patient had a Tsuchida antireflux valve and subsequently underwent lengthening of the Roux *** patients had lengthening of the Roux loop;one underwent re-do hepaticojejunostomy and one had concomitant revision of the hepaticojejunostomy and lengthening of the Roux *** latter underwent further lengthening of the Roux *** patients are cholangitis-free 6,36 and 60 months after surgery;two still experience mild episodes of ***:An adequate length of the Roux loop is important to prevent ***,Roux loop lengthening to 70 cm or more does not always resolve the problem and cholangitis,although generally less frequent and severe,may recur despite appropriate reconstructive or antireflux *** these cases,life-long rotating antibiotics is the only available measure.

关键词： biliary tract surgical procedures biliary tract disease septicemia

Non-functioning well-differentiated neuroendocrine tumor of the extrahepatic bile duct:an unusual suspect?

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Hepatobiliary & Pancreatic Diseases International 2007年第5期6卷 549-552页

作者： Harsheet Sethi Mansoor Madanur Parthi Srinivasan Bernard Portmann Nigel Heaton mohamed rela Department of Hepatobiliary and Transplant Surgery Kings College HospitalDenmark HillLondon SE5 9RSUK Department of Histopathology Kings College HospitalDenmark HillLondon SE5 9RSUK

BACKGROUND:Neuroendocrine tumors(NETs)arising in the biliary tree are extremely rare,and 37 cases were identified in the English literature. METHODS:A well-differentiated NET was found arising from the junction of the cystic and common hepatic ducts, in a 51-year-old male presenting with pedal edema and weight loss with abnormal liver enzymes and a normal serum bilirubin *** mass was seen on radiological imaging and biopsy of the liver was suggestive of an early cholangiopathy.A bile leak complicating the liver biopsy led to an ERCP that demonstrated a filling defect suggestive of a mass in the common bile duct(CBD). RESULTS:He underwent a successful excision of the tumor with a Roux-en-Y *** diagnosis of NET was made on histological and immunohistochemical analysis of the resected *** remains well and disease free 22 months after surgery. CONCLUSIONS:Recognition of biliary NET continues to be a challenge and an increased awareness of these tumors in rare sites will result in optimal management of these tumors.

关键词： carcinoid neuroendocrine tumor biliary common bile duct

Matching donor to recipient in liver transplantation: Relevance in clinical practice

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World Journal of Hepatology 2013年第11期5卷 603-611页

作者： Mettu Srinivas Reddy Joy Varghese Jayanthi Venkataraman mohamed rela Institute of Liver Diseases and Transplantation Global Hospital and Health City Department of Hepatology and Transplantation Institute of Liver Diseases and Transplantation Global Hospital and Health City

Achieving optimum outcomes after liver transplantation requires an understanding of the interaction between donor,graft and recipient *** the cohort of patients waiting for a transplant,better matching of the donor organ to the recipient will improve transplant outcomes and benefit the overall waiting list by minimizing graft failure and need for re-transplantation.A PubMed search was conducted to identify published literature investigating the effects of donor factors such as age,gender,ethnicity,viral serology;graft factors such as size and quality,recipient factors such as age,size,gender and transplant factors such as major or minor blood group incompatibility and immunological *** also report technical and therapeutic modifications that can be used to manage donor-recipient mismatch identified from literature and the authors’clinical *** donor and recipient factors impact graft survival after liver *** matching based on donor-organ-recipient variables,modification of surgical technique and innovative peri-transplant strategies can increase the donor pool by utilizing grafts from marginal donors that are traditionally turned down.

关键词： Liver transplantation Donor-recipient mismatch Immunological mismatch Viral serology mismatch

Critical Update on the Diagnosis and Management of COVID-19 in Advanced Cirrhosis and Liver Transplant Recipients

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Journal of Clinical and Translational Hepatology 2021年第6期9卷 947-959页

作者： Cyriac Abby Philips mohamed rela Arvinder Singh Soin Subhash Gupta Sudhindran Surendran Philip Augustine Department of Clinical and Translational Hepatology and The Monarch Liver Laboratory The Liver InstituteCenter of Ex-cellence in Gastrointestinal SciencesRajagiri HospitalAluvaKeralaIndia Institute of Liver Disease and Liver Trans-plantation Dr.Rela Institute&Medical CentreBharath Institute of Higher Education and ResearchChennaiIndia In-stitute of Liver Transplantation and Regenerative Medicine MedantaThe MedicityGurgaonIndia Max Centre for Liver and Biliary Sciences Max Saket HospitalNew DelhiIndia Gastrointestinal Surgery and Solid Organ Transplantation Amrita Institute of Medical Sciences and Research CentreAmrita Vishwa VidyapeethamKochiKeralaIndia Gastroen-terology and Advanced GI Endoscopy Center of Excellence in Gastrointestinal SciencesRajagiri HospitalAluvaKeralaIndia

The novel coronavirus disease 2019(COVID-19)pandemic has impacted health care worldwide,with specific patient populations,such as those with diabetes,cardiovascular disease,and chronic lung disease,at higher risk of infection and others at higher risk of disease *** with decompensated cirrhosis fall into the latter category and are a unique group that require specific treatment and management decisions because they can develop acute-on-chronic liver *** liver transplant recipients,the atypical immunity profile due to immunosuppression protects against downstream inflammatory responses triggered by *** exhaustive review discusses the outcomes associated with COVID-19 in patients with advanced cirrhosis and in liver transplant *** focus on the immunopathogenesis of COVID-19,its correlation with the pathogenesis of advanced liver disease,and the effect of immunosuppression in liver transplant recipients to provide insight into the outcomes of this unique patient population.

关键词： Coronavirus Cirrhosis Portal hypertension Acute-on-chronic liver failure Sepsis Hepatic encephalopathy Multiple-organ failure Critical care

Combined hepatocellular cholangiocarcinoma: A clinicopathological update

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World Journal of Hepatology 2024年第5期16卷 766-775页

作者： Mukul Vij Fadl H Veerankutty Ashwin Rammohan mohamed rela Department of Pathology Institute of Liver Disease and TransplantationChennai 600044India Comprehensive Liver Care Institute VPS LakeshoreCochin 682040India Institute of Liver Disease and Transplantation Dr.Rela Institute and Medical CentreChennai 600044India

Combined hepatocellular-cholangiocarcinoma(cHCC-CCA)is a rare primary liver cancer associated with an appalling *** diagnosis and manage-ment of this entity have been challenging to physicians,radiologists,surgeons,pathologists,and oncologists *** diagnostic and prognostic value of biomarkers such as the immunohistochemical expression of nestin,a progenitor cell marker,have been explored *** a better understanding of biology and the clinical course of cHCC-CCA,newer treatment modalities like immune checkpoint inhibitors are being tried to improve the survival of patients with this rare *** this review,we give an account of the recent developments in the pathology,diagnostic approach,and management of cHCC-CCA.

关键词： Combined hepatocellular-cholangiocarcinoma Immunotherapy Nestin Hepatocellular carcinoma Cholangiocarcinoma Liver cancer Biomarker Immune checkpoint inhibitors Pathology Genomic landscape