The celiac artery (CA), gastroduodenal artery (GDA) and right gastroepiploic artery (RGEA) are also shown. Deforolimus purchase During the surgical procedure of pancreaticoduodenectomy, the IPDA is usually ligated and cut. However, with the above anatomy, we were concerned about the possibility of significant hepatic ischemia. Because of this, the operation was planned with a view to preserve the IPDA. At laparotomy, intraoperative ultrasound was used to confirm that the LHA and IPDA were not closely applied to the pancreatic tumor. After dividing the pancreas above the portal vein, the LHA and IPDA were taped and clamped and the pancreas was transected along the vessels without cutting the pancreas tumor.
The GDA and small arterial branches were ligated after which clamps on the IPDA and LHA were released (Figure 2). She was discharged from hospital 2-weeks after surgery without any complication. When operating on tumors in the head of the pancreas, it is important to recognize aberrant hepatic arteries. Relatively common anomalies are an hepatic artery or RHA that arises from the SMA. These anomalous arteries usually run laterally to the portal vein behind the head of the pancreas and enter the right side of the hepatoduodenal ligament, find more posterolateral to the common bile duct. In the above patient, there was not only an anomalous RHA but also a LHA
that arose from the IPDA within the pancreatic parenchyma. This may be the first report of successful pancreatoduodenectomy without injury to these arteries. Pre-operative 3-dimensional CT arteriography is helpful in demonstrating aberrant blood vessels that may alter operative procedures and perhaps reduce operative morbidity and mortality. Contributed by “
“To the Editor: We read with great interest the article recently published in this most journal by Dr. Guy et al.1 The authors show a direct correlation between liver damage and deregulated Hedgehog (HH)-pathway in liver biopsies from a
cohort of 90 nonalcoholic fatty liver disease (NAFLD) patients. They demonstrate the association between HH-producing/responsive target cells and fibrosis stage. Shh and Gli2-expressing cells have been positively correlated with portal inflammation, ballooning, and fibrosis stage. Furthermore, they reported a pivotal role of the HH-pathway in both hepatic and extrahepatic tissue, highlighted by the colocalization of Gli2 with vimentin or α-smooth muscle actin. Guy et al. hypothesize the possibility to control the HH signaling pathway through specific inhibitors as a useful tool to hamper the progression of NAFLD. In this regard we wish to report our preliminary data. We treated Huh7.5.1 cells with a combination of fatty acids (FAs), palmitic and oleic acid (1 mM), for 14 hours to mimic the intrahepatic fat accumulation typical of NAFLD.