Polymer nanocomposites exhibiting magnetically tunable microwave properties

Polymer nanocomposites (PNCs) have been synthesized using Rogers polymer and CoFe₂O₄ nanoparticles (CFO NPs). X-ray diffraction (XRD) confirms the inverse spinel crystal structure of CFO NPs and transmission electron microscopy (TEM) images show the uniform dispersion of nanoparticles (10 nm ± 1) into the polymer matrix. Magnetic measurements indicate superparamagnetic response near room temperature for all PNCs. A blocking temperature T(B)~298 K was observed and does not vary for different loading fractions of CFO NPs for the PNCs. The saturation magnetization (M(s)) was found to be 11 emu g⁻¹ for 30 wt% CFO, increasing to 32 emu g⁻¹ for the 80 wt% CFO loaded PNC. A large value of coercivity (H(c) = 19 kOe) is also observed at 10 K and is not affected by varying CFO loading. Microwave measurements show significant absorption in the 80 wt% CFO loading PNC and the quality factor shows a strong enhancement with applied magnetic field.

Histopathological effects and EROD induction in common carp exposed to dietary heavy oil

Common carp, Cyprinus carpio, was exposed to 1% and 5% dietary heavy oil for 2 weeks. Higher polyaromatic hydrocarbons (PAHs) accumulation induced higher hepatic EROD activity in exposure groups compared with the control group. Significant histological alternations were observed in the liver such as nuclear and cellular hypertrophy, accumulation of eosinophilic granules in cytoplasm, nuclear degeneration and fibrillar inclusion in cytoplasm. Severe damage of the kidney was indicated by nuclear and cellular degeneration, and ultimately necrosis in the tubular epithelium cells. In addition, dilated glomerulus with hemorrhage was found in the renal capsule. The mean assessment value (MAV) and degree of tissue changes (DTC), as semi-quantitative analyses, were significantly increased with concentration and duration of exposure. Likewise, frequencies of pathological lesions in both liver and kidney were also increased with concentration and duration of exposure.

Centrality dependence of the charged-particle multiplicity density at midrapidity in Pb-Pb collisions at sqrt[s(NN)] = 2.76 TeV

The centrality dependence of the charged-particle multiplicity density at midrapidity in Pb-Pb collisions at sqrt[s_{NN}]=2.76  TeV is presented. The charged-particle density normalized per participating nucleon pair increases by about a factor of 2 from peripheral (70%-80%) to central (0%-5%) collisions. The centrality dependence is found to be similar to that observed at lower collision energies. The data are compared with models based on different mechanisms for particle production in nuclear collisions.

Elliptic flow of charged particles in Pb-Pb collisions at sqrt[S(NN)] = 2.76 TeV

We report the first measurement of charged particle elliptic flow in Pb-Pb collisions at sqrt[S(NN)] =2.76 TeV with the ALICE detector at the CERN Large Hadron Collider. The measurement is performed in the central pseudorapidity region (|η|<0.8) and transverse momentum range 0.2<p t<5.0 GeV/c. The elliptic flow signal v₂, measured using the 4-particle correlation method, averaged over transverse momentum and pseudorapidity is 0.087 ± 0.002(stat) ± 0.003(syst) in the 40%-50% centrality class. The differential elliptic flow v₂ p t reaches a maximum of 0.2 near p t =3 GeV/c. Compared to RHIC Au-Au collisions at sqrt[S(NN)] 200 GeV, the elliptic flow increases by about 30%. Some hydrodynamic model predictions which include viscous corrections are in agreement with the observed increase.

Charged-particle multiplicity density at midrapidity in central Pb-Pb collisions at sqrt[S(NN)] = 2.76 TeV

The first measurement of the charged-particle multiplicity density at midrapidity in Pb-Pb collisions at a center-of-mass energy per nucleon pair √ S NN = 2.76 TeV is presented. For an event sample corresponding to the most central 5% of the hadronic cross section, the pseudorapidity density of primary charged particles at midrapidity is 1584 ± 4(stat) ± 76(syst), which corresponds to 8.3 ± 0.4(syst) per participating nucleon pair. This represents an increase of about a factor 1.9 relative to pp collisions at similar collision energies, and about a factor 2.2 to central Au-Au collisions at √ S NN = 2.76 TeV. This measurement provides the first experimental constraint for models of nucleus-nucleus collisions at LHC energies.

Midrapidity antiproton-to-proton ratio in pp collisons at sqrt[s]=0.9 and 7 TeV measured by the ALICE experiment

The ratio of the yields of antiprotons to protons in pp collisions has been measured by the ALICE experiment at sqrt[s]=0.9 and 7 TeV during the initial running periods of the Large Hadron Collider. The measurement covers the transverse momentum interval 0.45<p_{t}<1.05  GeV/c and rapidity |y|<0.5. The ratio is measured to be R_{|y|<0.5}=0.957±0.006(stat)±0.014(syst) at 0.9 TeV and R_{|y|<0.5}=0.991±0.005(stat)±0.014(syst) at 7 TeV and it is independent of both rapidity and transverse momentum. The results are consistent with the conventional model of baryon-number transport and set stringent limits on any additional contributions to baryon-number transfer over very large rapidity intervals in pp collisions.

Co-purified gelatinases alter the stability and biological activities of human plasma fibronectin preparations

BACKGROUND AND OBJECTIVE

Fibronectin (FN) is an important cell adhesion molecule that is used widely to characterize cell behavior. Preparations of FN purified from human plasma by gelatin-Sepharose affinity chromatography typically also contain gelatin-binding gelatinases that may cleave FN, reduce its stability and alter its biological activities. Available methods for separating gelatinases from FN are resource demanding. Therefore, our objective was to devise a time- and cost-efficient protocol for purification of gelatinase-free FN.

MATERIAL AND METHODS

Experiments tested the elution profiles for FN and gelatinases from gelatin-Sepharose using a concentration range (1-7%) of dimethyl sulfoxide (DMSO) and 4 m urea as eluants. Subsequently, we explored the sequential application of those eluants for differential elution of gelatinases and FN using a single affinity column. Finally, experiments characterized the stability of purified FN with or without contaminating gelatinases, as well as the effects of FN degradation on cell attachment and migration.

RESULTS

Assay optimization demonstrated that pre-elution with 3% DMSO efficiently eliminated gelatinases but not FN from gelatin-Sepharose, whereas subsequent elution with 4 m urea released FN. Sequential elutions with DMSO and urea produced gelatinase-free FN, which was more stable than FN eluted by urea only. Fibronectin degradation did not affect human gingival fibroblast attachment, but increased cell migration significantly.

CONCLUSION

The present experiments devised a time- and cost-efficient protocol for eliminating gelatinases during purification of human plasma FN. Gelatinase-free FN preparations had greater stability, which may be essential for experiments because FN fragments have altered biological activities compared with intact FN.

Bioleaching of low-grade uranium ore using Acidithiobacillus ferrooxidans

Bioleaching of uranium was carried out with Turamdih ore sample procured from Uranium Corporation of India Limited, Jaduguda. The bacterial strain that was used in the leaching experiments was isolated from the Jaduguda mine water sample. Efficiency of bioleaching was studied by varying parameters like pulp density and initial ferrous concentration as source of energy. It is observed that the efficiency of bioleaching was 49% at 10% pulp density (w/v) and initial pH 2.0. Addition of external has no effect on efficiency of bioleaching showing domination of direct leaching mechanism over indirect.

Improvement in time to treatment following establishment of a dedicated medical admissions unit

The importance of medical admissions units (MAU) has been emphasised by the royal colleges and the Society for Acute Medicine. This study looked at the time to treatment of four common medical conditions before and after the establishment of a dedicated MAU. Before the development of the MAU, treatment given in the emergency department (ED; median 111 minutes) was significantly quicker than on the admitting general medical ward (median 262 minutes, p<0.001). Following the establishment of the MAU, treatment given in the ED (median 70 minutes) remained significantly quicker than on the MAU (median 180 minutes, p<0.05). Treatment was given significantly quicker on the MAU compared with the antecedent admitting medical wards (p<0.05). In addition, more patients were treated within protocol-driven time guidelines. In summary, the establishment of a MAU significantly improved time to treatment, compared with admitting directly to general medical wards. This has implications for patients who are boarded directly to medical wards when the MAU is at full capacity.

Impact on outcome of the route of conduit transposition after transhiatal oesophagectomy: A randomized controlled trial

AIM

To assess the influence of the route of conduit transposition after transhiatal oesophagectomy on the postoperative morbidity and mortality and late outcome at 6 months.

METHODS

Patients with oesophageal carcinoma, undergoing transhiatal oesophagectomy (gastric conduit), were randomized to either anterior or posterior route of conduit transposition. Patients with advanced tumour, distant metastasis, extensive invasion of the stomach, previous gastric surgery, any anterior mediastinal abnormality detected on preoperative imaging, ASA grade III/IV and poor preoperative pulmonary function were excluded. Intraoperative complications, postoperative morbidity and mortality and late outcomes were compared.

RESULTS

Of the 49 patients (34 men), 24 patients were randomized to the anterior mediastinal route and 25 to the posterior. The mean duration of the operative procedure (anterior: 235min; posterior: 225min) and the mean blood loss (anterior: 531ml; posterior: 538ml) were not statistically different. The most common complications were pulmonary and cardiac and comparable in both groups. Four patients died postoperatively. At 6-month follow-up the incidence of dysphagia, anastomotic stricture, anastomotic recurrence, aspiration and reflux symptoms and weight gain were similar.

CONCLUSIONS

The route of conduit transposition did not affect the outcome. However, an individualized approach depending upon the operative findings, radicality of the procedure, and perceived need for postoperative adjuvant therapy may be useful.

Coverage of ante-natal care in a block of West Bengal using lot quality assurance sampling

A cross-sectional study using lot quality technique was undertaken among a sample of 198 women in 18 sub-centers (lots) of Bankura-I Community Development Block who had delivered in last 12 months preceding the survey to find out the sub-center(s) with 'acceptable' coverage (> or = 50%) and overall coverage of 'appropriate' antenatal care of the block. Registration before 12 weeks, three antenatal check-ups with checking of BP, weight, edema and abdominal examination, distribution of 100 IFA tablets and adequate tetanus prophylaxis were taken collectively as a measure of'appropriate' antenatal care. Out of 18 sub-centers, only one had 'acceptable' coverage of appropriate antenatal care. The overall coverage of 'appropriate' antenatal care was 29.1% in the study Block.

Chromosomal abnormalities and reproductive outcome in Malaysian couples with miscarriages

INTRODUCTION

This study was done to determine the prevalence of chromosomal abnormalities and the subsequent reproductive outcome in couples who had two or more miscarriages.

METHODS

56 couples with a history of at least two previous miscarriages were evaluated for prevalence and types of chromosomal abnormalities from their karyotype records. The study was a retrospective one, and subsequent reproductive outcome after a period of 12-24 months from the time of karyotyping was obtained by telephone interviews and scrutiny of the case records. The comparison of reproductive outcome was done by chi-square statistics.

RESULTS

Five couples (8.9 percent) had a chromosomal abnormality in one partner. Three cases of reciprocal translocations t(5;11), t(9;14), dup(9q); one Robertsonian D/D translocation 13/14; and one mosaic Down syndrome male karyotype were found. Among the 32 couples available for follow-up, there was a lower incidence of subsequent live healthy births among chromosomally-normal couples (35.7 percent) compared to chromosomally-abnormal ones (25 percent). However, the difference was not statistically significant (p-value is 1.0). There was a lower incidence of subsequent abortions in chromosomally-normal couples (42.8 percent) compared to chromosomally-abnormal ones (50 percent), but the difference was also not statistically significant (p-value is 1.0).

CONCLUSION

Chromosomal abnormalities were seen in 8.9 percent of the couples, and translocations were the commonest abnormality found. The frequencies of subsequent live healthy births and subsequent abortions showed no significant difference between couples having normal karyotypes and those having chromosomal abnormality in one partner.

mTOR-understanding the clinical effects

The target of rapamycin (TOR) is a highly conserved serine/threonine kinase that controls cell growth and metabolism in response to nutrients, growth factors, cellular energy, and stress. The TOR kinase, which was originally discovered in yeast, is also expressed in human cells as mammalian TOR (mTOR). In this review, we focus on how mTOR-inducible signals function in cell protection and cell survival of effector and regulatory T cells as well as its role in endothelial cell biology. We evaluate how signaling is important for vascular endothelial cell growth, survival, and proliferation; and we consider how the function of mTOR in endothelial cells may be clinically important in the rejection process. Understanding the biology of mTOR allows clinicians to use mTOR inhibitors optimally as therapeutics following solid organ transplantation.

A randomized controlled trial (RCT) comparing best supportive care (BSC), 5-FU plus folinic acid (FUFA) and, gemcitabine plus oxaliplatin (Gem-Ox) in management of unresectable gallbladder cancer (GBC)

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Background: GBC is common in females residing in the northern part of India. Surgery is the only curative treatment. Unfortunately most patients present in advance and unresectable stage (median survival 3–4 months). Chemotherapy regimens for GBC are not yet standardized. Studies are few and mostly retrospective with small sample size and usually combine heterogeneous malignancies. Adequately powered RCT are not available. This was rationale to undertake study. Methods: It was single center, open label, three armed RCT. Ethical clearance was taken. Planned sample size was 81 to have type I & type II error probabilities of 0.05 & 0.2 respectively. Primary end point was to compare OS in unresectable GBC between BSC vs. FUFA vs. Gem-Ox arms. Secondary end points were to compare PFS in three arms and toxicity analysis of chemotherapy arms. Inclusion criteria were: proven unresectable GBC, performance state ≤2, adequate bone marrow reserve and normal biochemical profile (bilirubin≤3 mg % & liver enzymes within 5 times of upper limit). Patients in BSC group received symptomatic treatment without anticancer therapy. In FUFA group, weekly bolus doses of 5-FU (425mg/m2) plus Folinic acid (20 mg/m2) were given for a maximum of 30 weeks. In Gem-Ox group patients received gemcitabine (900 mg/m2) plus oxaliplatin (80 mg/m2) days 1 and 8 q3 weekly till maximum of 6 cycles. Results: Eighty one patients were randomized (BSC=27, FUFA=28, Gem-Ox=26). Median OS in BSC, FUFA and gem- Ox arms was 4.5 (CI 0.2–8.8), 5.3 (CI 3–6.2) and 9.3 (CI 5–14) months respectively (p= 0.039)). Median PFS was 2.8 (CI 1.8–3.8), 3.5 (CI 3.2–3.8) and 8.5 (CI 5.7–11.3) months in BSC, FUFA and Gem-Ox arm respectively (p= 0.0001). Chemotherapy arms were generally well tolerated. There was no difference in grade 3/4 toxicities in FUFA and Gem-Ox arm except for deranged liver function test, which was more in Gem-Ox arm (p=0.04). There was no toxic death. Conclusions: Probably this is the first RCT confirming efficacy of chemotherapy (Gem-Ox) compared to BSC in improving OS and PFS in unresectable GBC. Both chemotherapy arms were well tolerated.

No significant financial relationships to disclose.

Influence of arm and wrist support on forearm and back muscle activity in computer keyboard operation

The effects of forearm and wrist supports on the upper extremity postures in computer keying tasks and associated EMG activity of arm and back muscles were examined (N = 8). Four positions were forearms unsupported (floating) and supported, wrists supported by bead packed (WR1) and gel-filled (WR2) wrist rest. The right and left elbow extensions were 65 degrees and 68 degrees , respectively, in unsupported forearms. Bilateral elbow extension increased with the forearm/wrist supports and mostly, the elbow was maintained at around 90 degrees or greater. The wrist extension decreased with forearm/wrist supports over the unsupported condition. The forearm support significantly reduced the activity of forearm extensor digitorum, i.e., right (F((1, 47)) = 12.19, p < 0.01) and left (F((1, 47)) = 5.38, p < 0.05) and upper trapezius muscles over the floating posture. Wrist rests, however, increased load on the upper trapezius; the activities of flexor digitorum superficialis and erector spinae were close to the resting EMG activity for both forearm and/or wrist support. The type of wrist rests was a concern and this study indicated that the gel filled wrist rest was advantageous in reducing the forearm muscle load, in comparison to the bead packed cushions.

Biomechanical Analysis of CT Scan-based Hip Prosthesis With an Optimal Hip Ball by Using Finite Element Analysis

Bone loss around the femoral stems during the insertion of a standard prosthesis is a major problem in hip arthroplasty. Moreover, long periods of use of the standard metallic prosthesis often lead to revision surgery because of disuse osteoporosis (stress shielding). The main factor behind this problem is the material-stiffness mismatch of the bone and implant, with the latter consisting of metals such as stainless steel, Co-Cr-Mo alloy, or Ti6Al4V alloy. Our study aimed to decrease the factor of geometric mismatch by designing and making customized hip prostheses from computed tomography scan data and finite element analysis. Therefore, the inner medullar cavity of the femur would match exactly with the prosthesis. Our results showed that the desired stress-strain values were close to the physiological level. We observed that the maximum Von Mises stresses for the bone and implant were 41.8 MPa and 197 MPa, respectively. An optimization analysis of the taper angle of the prosthesis hip ball for fixation with the stem has also been performed, in which the angle was found to be approximately 2 deg. The taper angle plays an important role in load transfer and safe levels of stress-strain using various ball materials.

Phenotypic heterogeneity and genetic modification of P102L inherited prion disease in an international series

The largest kindred with inherited prion disease P102L, historically Gerstmann-Sträussler-Scheinker syndrome, originates from central England, with émigrés now resident in various parts of the English-speaking world. We have collected data from 84 patients in the large UK kindred and numerous small unrelated pedigrees to investigate phenotypic heterogeneity and modifying factors. This collection represents by far the largest series of P102L patients so far reported. Microsatellite and genealogical analyses of eight separate European kindreds support multiple distinct mutational events at a cytosine-phosphate diester-guanidine dinucleotide mutation hot spot. All of the smaller P102L kindreds were linked to polymorphic human prion protein gene codon 129M and were not connected by genealogy or microsatellite haplotype background to the large kindred or each other. While many present with classical Gerstmann-Sträussler-Scheinker syndrome, a slowly progressive cerebellar ataxia with later onset cognitive impairment, there is remarkable heterogeneity. A subset of patients present with prominent cognitive and psychiatric features and some have met diagnostic criteria for sporadic Creutzfeldt-Jakob disease. We show that polymorphic human prion protein gene codon 129 modifies age at onset: the earliest eight clinical onsets were all MM homozygotes and overall age at onset was 7 years earlier for MM compared with MV heterozygotes (P = 0.02). Unexpectedly, apolipoprotein E4 carriers have a delayed age of onset by 10 years (P = 0.02). We found a preponderance of female patients compared with males (54 females versus 30 males, P = 0.01), which probably relates to ascertainment bias. However, these modifiers had no impact on a semi-quantitative pathological phenotype in 10 autopsied patients. These data allow an appreciation of the range of clinical phenotype, modern imaging and molecular investigation and should inform genetic counselling of at-risk individuals, with the identification of two genetic modifiers.

A multilayer self-organizing model for convex-hull computation

A self-organizing neural-network model is proposed for computation of the convex-hull of a given set of planar points. The network evolves in such a manner that it adapts itself to the hull-vertices of the convex-hull. The proposed network consists of three layers of processors. The bottom layer computes some angles which are passed to the middle layer. The middle layer is used for computation of the minimum angle (winner selection). These information are passed to the topmost layer as well as fed back to the bottom layer. The network in the topmost layer self-organizes by labeling the hull-processors in an orderly fashion so that the final convex-hull is obtained from the topmost layer. Time complexity of the proposed model is analyzed and is compared with existing models of similar nature.

Pulmonary manifestations in systemic lupus erythematosus (SLE) with special reference to HR CT

AIMS AND OBJECTIVES

1. To evaluate whether CT helps in the early diagnosis of pulmonary manifestations in SLE. 2. To study the pulmonary involvement and determine the incidence and type of pulmonary involvement.

MATERIALS AND METHODS

Thirty eight patients fulfilling ACR classification criteria for SLE were studied. Chest X-ray, pulmonary function tests (PFT), HRCT scan thorax were done. Investigations were done to detect other organ involvement. Patients with known interstitial lung disease (occupational hazard) or pregnant females were excluded.

RESULTS

Clinical signs and symptoms referable to pulmonary involvement were present in 9 patients (23.68%). HRCT thorax detected abnormalities in 21 patients (55.26%); pulmonary function abnormalities were present in 11 patients (28.95%) and plain X-ray chest abnormalities were present in 7 patients (18.42%). Out of 38 patients pulmonary involvement was present in 22 (57.89%) cases and HRCT thorax findings were present in 21 (95.45%) of them.

CONCLUSION

Pulmonary involvement is present in a significant number of SLE patients, who are often asymptomatic, with normal chest X-ray or normal PFT. HRCT scan thorax could diagnose the pulmonary involvement in asymptomatic patients with normal chest X-ray and uncertain PFT.

Dissecting obesogenic behaviours: the development and application of a test battery for targeting prescription for weight loss

There are limited practical tools to help clinicians or public health workers manage obesity in their patients. We have previously developed a scanning technique for diagnosing environments leading to obesity (Analysis Grid for Environments/Elements Leading to Obesity). Here we describe the development of a tool for identifying behaviours in an individual most likely to lead to obesity. A questionnaire battery of five tests called the DAB-Q (Diet, Activity and Behaviour Questionnaire) was developed, piloted and internally validated with overweight women from a commercial weight loss programme. Outcome from the tests, which are available free on the Internet, provides clinicians with a simple, effective and time-saving tool for ranking foods, drinks and activities likely to be most effectively targeted for weight loss in an individual. This is based on total scores derived from measures of frequency, potential for change and potency of each item as a potential contributor to overweight.

Correlation of structural, magnetic and transport properties with the tolerance factor in a low-doped La(0.875)Sr(0.125-x)Ca(x)MnO(3), (0 ≤x≤0.125) system: cross-over from Mott to Shklovskii-Efros variable range hopping conduction

Samples of the low-doped manganite La(0.875)Sr(0.125-x)Ca(x)MnO(3) (0≤x≤0.125) have been synthesized and the effect on the structural, magnetic and transport properties of decreasing the tolerance factor by replacing larger Sr(2+) ions with smaller Ca(2+) ions are reported. For samples with x≥0.0625, a concentration (x) dependent structural transition (rhombohedral ([Formula: see text]) to orthorhombic (Pnma)) has been detected at room temperature and the Curie temperature T(C) is found to decrease with increased Ca doping level. For samples with x≤0.0625, a narrow metallic region exists and the corresponding insulator to metal transition temperature T(MI) decreases with increasing Ca content, i.e. decreasing tolerance factor. In the paramagnetic region, x dependent crossover from Mott variable range hopping (Mott-VRH) to Shklovskii-Efros variable range hopping (SE-VRH) occurs as the Ca content increases. The thermoelectric power (TEP) of the samples increases substantially, varying inversely with the tolerance factor. These results are analysed from the consideration of increased bending of the Mn-O-Mn bond with the decrease of the average ionic radius of the A-site element [Formula: see text] and the tolerance factor t, which causes narrowing of the bandwidth, decrease of mobility of e(g) electrons and weakening of the double exchange (DE) interaction associated with the substitution of Ca.

Role of toxin and nutrient for the occurrence and termination of plankton bloom—Results drawn from field observations and a mathematical model

The termination of harmful algal blooms (HABs) and coexistence of phytoplankton-zooplankton populations are of great importance to human health, ecosystem, environment, tourism and fisheries. In this paper we propose a three-component model consisting of dissolved limiting nutrients (N) supplied at constant rate and partially recycled after the death of plankton by bacterial decomposition, phytoplankton (P) and zooplankton (Z), where the growth of zooplankton species reduce due to toxic chemicals released by phytoplankton species. Our analysis leads to different thresholds which are expressible in terms of model parameters and determine the existence and stability of various states of the system. We observe that phytoplankton-zooplankton persist if the maximal zooplankton ingestion rate exceeds a lower threshold value. It is shown that the coexistence equilibrium loses its stability when the dilution rate of the nutrient concentration passes through a critical value and Hopf bifurcation occurs that induces oscillations of the population. Our results indicate that the occurrence of bloom increases when the nutrient concentration is very high, and in that case toxin produced by the phytoplankton plays a very crucial role towards the termination of the planktonic bloom.

Two cases of isochromosome 18q syndrome

Patients with isochromosome 18q, a rare cytogenetic abnormality, also reported as Edwards syndrome, is the second most common autosomal trisomy. However, the phenotypic features and survival of these patients are not uniform and depend upon the portion of chromosomes getting duplicated or deleted. The survival of these children may be longer, hence a good cytogenetic diagnosis is a must. Morphological characteristics of isochromosome 18q are not yet fully delineated because of the rarity of the cases and as most cases are aborted medically or terminate spontaneously. We report two cases of isochromosome 18q, one male aged two years old and the other a male aged eight months old, and review the literature on this rare syndrome.

Transcatheter arterial embolization in the management of hemobilia

BACKGROUND

This retrospective analysis evaluated the clinical and radiologic results of transcatheter arterial embolization (TAE) in the treatment of significant hemobilia. The imaging findings, embolization technique, complications, and efficacy are described.

METHODS

Thirty-two consecutive patients (21 male, 11 female, age range 8-61 years) who were referred to the radiology department for severe or recurrent hemobilia were treated by TAE. Causes of hemobilia were liver trauma (n = 19; iatrogenic in six and road traffic accident in 13), vasculitis (n = 6), vascular malformations (n = 2), and hepatobiliary tumors (n = 5). Iatrogenic liver trauma was secondary to cholecystectomy in those six patients. Four of five hepatobiliary tumors were inoperable malignant tumors and one was a giant cavernous hemangioma. Arterial embolization was done after placing appropriate catheters as close as possible to the bleeding site. Embolizing materials used were Gelfoam, polyvinyl alcohol particles or steel coils, alone or in combination. Postembolization angiography was performed in all cases to confirm adequacy of embolization. Follow-up color Doppler ultrasound and contrast-enhanced computed tomography was done in all patients.

RESULTS

Ultrasonic, computed tomographic, and angiographic appearances of significant hemobilia were assessed. Angiogram showed the cause of bleeding in all cases. Three patients with liver trauma due to accidents required repeat embolization. Eight patients required surgery due to failed embolization (continuous or repeat bleeding in four patients, involvement of the large extrahepatic portion of hepatic artery in two, and coexisting solid organ injuries in two). Severity of hemobilia did not correlate with grade of liver injury. All 13 patients with blunt hepatic trauma showed the cause of hemobilia in the right lobe. No patient with traumatic hemobilia showed an identifiable cause in the left lobe. There were no clinically significant side effects or complications associated with TAE except one gallbladder infarction, which was noted at surgery, and cholecystectomy was performed with excision of the hepatic artery aneurysm.

CONCLUSION

TAE is a safe and effective interventional radiologic procedure in the nonoperative management of patients who have significant hemobilia.