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Nan X, Chan E, Wong KSC, Ng J, Izwan S, Cooper M, Damodaran R. Laparoscopic Cholecystectomy in Pregnancy: A Seven-Year Retrospective Study From an Australian Tertiary Center. Cureus 2023; 15:e50034. [PMID: 38186520 PMCID: PMC10768355 DOI: 10.7759/cureus.50034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 01/09/2024] Open
Abstract
Background Cholecystectomy is the second most common non-obstetric indication for surgery during pregnancy; however, there is little recent literature specifically exploring perioperative care approaches, and a paucity of Australian data exists. This study investigates the incidence of laparoscopic cholecystectomy (LC) during pregnancy, peri-operative management, and post-operative outcomes in a single Australian tertiary center. Methods A retrospective analysis of LCs performed on pregnant patients between the ages of 16 and 50 years at a tertiary hospital between 2016 and 2023 was completed. Results Twenty-three patients underwent LC. The median gestational age was 17+4 weeks (4+3-30+6). Cases were performed in all three trimesters, with the majority in the second trimester (n=12, 52.2%). Surgery indications were recurrent biliary colic (n=11, 47.8%), acute cholecystitis (n=8, 34.8%), and gallstone pancreatitis (n=4, 17.4%). Obstetrics and Gynecology (O&G) consultations occurred in 56.5% (n=13) of cases. Fetal heart rate (FHR) was recorded perioperatively in 82.6% (n=19) of cases. Preoperative steroids were given to 40% of eligible patients. An intraoperative cholangiogram was performed in 12 (52.2%) cases, of which eight (66.7%) utilized abdominal shielding. There was no perioperative maternal mortality nor fetal loss. Surgical morbidities were pancreatitis (n=1), bile leak (n=1), and intraoperatively recognized bile duct injury (n=1). Two threatened preterm labors and five (26.3%) preterm deliveries occurred. Conclusion Performing LC in pregnancy does carry a risk of major morbidity; however, there was no mortality or fetal loss across all trimesters. The decision to perform abdominal shielding during an intraoperative cholangiogram should be approached sensitively in a case-by-case manner, given recent paradigm shifts in radiology. A multidisciplinary approach with standardized local perioperative care policies regarding procedures such as O&G consultation, perioperative steroid use, and FHR monitoring is strongly recommended.
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Affiliation(s)
- Xinyi Nan
- General Surgery, Gold Coast Hospital and Health Service, Gold Coast, AUS
- School of Medicine and Dentistry, Griffith University, Gold Coast, AUS
| | - Erick Chan
- General Surgery, Gold Coast Hospital and Health Service, Gold Coast, AUS
- School of Medicine and Dentistry, Griffith University, Gold Coast, AUS
| | - Kok Sum Chloe Wong
- General Surgery, Gold Coast Hospital and Health Service, Gold Coast, AUS
| | - Justin Ng
- General Surgery, Gold Coast Hospital and Health Service, Gold Coast, AUS
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, AUS
| | - Sara Izwan
- General Surgery, Gold Coast Hospital and Health Service, Gold Coast, AUS
- School of Medicine and Dentistry, Griffith University, Gold Coast, AUS
| | - Michelle Cooper
- General Surgery, Gold Coast Hospital and Health Service, Gold Coast, AUS
| | - Ramesh Damodaran
- General Surgery, Gold Coast Hospital and Health Service, Gold Coast, AUS
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Abdelmohsen SM, Zidan MM, Fahmy SSE, Baghdady AS. Post-cesarean section laparoscopic cholecystectomy: a case report. BMC Pregnancy Childbirth 2023; 23:452. [PMID: 37330492 DOI: 10.1186/s12884-023-05767-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/08/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy at the time of cesarean section is novel in medicine. It is safe, feasible, and cost-effective. CASE PRESENTATION A 29-year-old G3P2 + 0 woman had two previous cesarean sections. She was pregnant at 32 weeks. The fetus had anencephaly. She had acute cholecystitis. Laparoscopic cholecystectomy done at the time of termination of pregnancy by cesarean section. CONCLUSIONS In a critical period, such as acute cholecystitis, the combination of laparoscopic cholecystectomy immediately post cesarean section is effective if the surgeon is highly qualified and experienced.
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Affiliation(s)
- Sarah Magdy Abdelmohsen
- Department of Pediatric Surgery, Aswan University Hospital, Aswan University, Aswan City, Egypt.
| | - Mohamed Mahmoud Zidan
- Department of General Surgery, Aswan University Hospital, Aswan university, Aswan City, Egypt
| | - Sherif Salah Eldeen Fahmy
- Department of Obstetrics and Gynecology, Aswan University Hospital, Aswan University, Aswan City, Egypt
| | - Ahmed Saleh Baghdady
- Department of General Surgery, Aswan University Hospital, Aswan university, Aswan City, Egypt
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Lopez-Lopez V, Navaratne L, Ferreras D, Gil PJ, Bansal VK, Mattila A, Parra-Membrives P, Marco TG, Ruiz-Manzanera JJ, Nassar AHM, Sánchez-Bueno F, Robles-Campos R, Martinez-Isla A. Laparoscopic bile duct exploration during pregnancy: a multi-center case series and literature review. Langenbecks Arch Surg 2023; 408:45. [PMID: 36662260 DOI: 10.1007/s00423-023-02793-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/02/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND The physiological changes of pregnancy increase the risk of gallstone formation and choledocholithiasis. Traditionally, endoscopic retrograde cholangiopancreatography (ERCP) has been the main approach for managing choledocholithiasis during pregnancy, but recent progress in laparoscopic bile duct exploration (LBDE) has demonstrated this technique as a safe and effective alternative option. METHODS A retrospective multicenter study of all patients who underwent LBDE during pregnancy from five centers with proven experience in LBDE between January 2010 and June 2020 was performed. The primary endpoint was to analyze the role of LBDE during pregnancy and to further characterize its position as a safe and effective alternative for the management of choledocholithiasis. A systematic review of the published literature relating to LBDE during pregnancy until February 2022 was also performed. RESULTS Five institutions reported performing LBDE during pregnancy in 8 patients. Median surgical time was 75 min (range: 60-140 min). The bile duct was cleared successfully in all patients, and the median hospital stay was 2 days (range: 1-3 days). The literature review identified a total of 7 patients with a successful CBD clearance rate of 86%. There were no major maternal, fetal, or pregnancy-related complications in any of the total 15 patients included. The symptomatic common bile duct lithiasis with deranged liver function tests was the most frequent indication (n=7). CONCLUSION LBDE during pregnancy appears to be safe and effective. More evidence reporting outcomes of LBDE during pregnancy is needed before any strong recommendations can be made.
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Affiliation(s)
- Víctor Lopez-Lopez
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain.
| | - Lalin Navaratne
- Department of Upper GI Surgery, Northwick Park & St Mark's Hospitals, London North West University Healthcare NHS Trust, London, UK
| | - David Ferreras
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Pedro Jose Gil
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Virinder K Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Anne Mattila
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Pablo Parra-Membrives
- Hepatobiliary and Pancreatic Surgery Unit, Valme University Hospital, Sevilla, Spain
| | - Tania Gaspar Marco
- Department of Gynecology and Obstetrics, Vega Baja Hospital, Alicante, Spain
| | - Juan Jose Ruiz-Manzanera
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Ahmad H M Nassar
- University Hospital Monklands, Lanarkshire, and University of Glasgow, Scotland, UK
| | - Francisco Sánchez-Bueno
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Ricardo Robles-Campos
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Alberto Martinez-Isla
- Department of Upper GI Surgery, Northwick Park & St Mark's Hospitals, London North West University Healthcare NHS Trust, London, UK
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Emergency laparoscopic cholecystectomy after cesarean section in pregnant women at 38 weeks: A clinical case. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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5
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Saglam A, Derwig I, Sezik M, Tuncer SC, Ozcil MD, Kasap B, Misirlioglu M, Alkan E, Ozkan N. The incidence of biliary sludge in first trimester pregnancies with hyperemesis gravidarum and its effect on the course of hyperemesis gravidarum. J OBSTET GYNAECOL 2022; 42:1775-1781. [PMID: 35297719 DOI: 10.1080/01443615.2022.2038106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pregnancy is one of the risk factors for biliary sludge (BS) formation. In this cross-sectional study, a total of 959 pregnant women were included. Serum aspartate aminotransferase, alanine aminotransferase, sodium, potassium, triglycerides, cholesterol levels and the presence of ketones in urine were determined. The presence of BS was investigated using maternal abdominal ultrasound. The incidence of BS in pregnancies complicated by hyperemesis gravidarum (HG) was 14%. The degree of ketonuria and low birth weight were statistically higher in pregnancies with maternal BS than women without sludge. Total weight gain during pregnancies with BS was statistically lower than controls. The incidence of BS in pregnancies with HG does not appear to increase due to HG-related complications, such as dehydration, starvation and weight loss. However, the severity of HG may be worse when HG is associated with sludge.Impact StatementWhat is already known on this subject? The incidence of biliary sludge (BS) in pregnant women ranges between 10.9% and 36%. Some clinical conditions, such as pregnancy, prolonged fasting, total parenteral nutrition, rapid weight loss and ceftriaxone treatment can play a role in the formation of gallbladder sludge.What do the results of this study add? This is the first study to investigate the incidence of BS in hyperemesis gravidarum (HG) pregnancies. Results show that HG may transiently be associated with BS. HG is more likely to cause a transient increase in new sludge formation. The symptoms and complications related to HG may be more severe when HG is associated with BS.What are the implications of these findings for clinical practice and/or further research? Our study showed that BS can be found in HG patients, and HG can be a predisposing factor for new sludge formation, although this association is generally driven by advanced maternal age and increased baseline serum lipid and alanine aminotransferase levels. BS may also be independently associated with an increased risk of subsequent preterm delivery in women with HG.
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Affiliation(s)
- Aylin Saglam
- Department of Obstetrics and Gynaecology, Aksaray University School of Medicine, Aksaray, Turkey
| | - Iris Derwig
- Chelsea Westminster Hospital NHS Foundation Trust, London, UK
| | - Mekin Sezik
- Department of Obstetrics and Gynaecology, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Sibel Cigdem Tuncer
- Department of Biochemistry, Aksaray University School of Medicine, Aksaray, Turkey
| | - Mustafa D Ozcil
- Department of Obstetrics and Gynaecology, Hatay Mustafa Kemal University, Antakya, Turkey
| | - Burcu Kasap
- Department of Obstetrics and Gynaecology, Mugla Sitki Kocman University, Mugla, Turkey
| | - Mesut Misirlioglu
- Department of Obstetrics and Gynaecology, Hatay State Hospital, Antakya, Turkey
| | - Ender Alkan
- Department of Radiology, Aksaray University School of Medicine, Aksaray, Turkey
| | - Namık Ozkan
- Department of General Surgery, Gaziosmanpasa University School of Medicine, Tokat, Turkey
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Belal S, Hamed HM, Kamal A, Al-Sayed MAW, Hamid HMAE. Risk Factors Associated with Cholelithiasis during Pregnancy and Postpartum. OPEN JOURNAL OF OBSTETRICS AND GYNECOLOGY 2022; 12:1166-1175. [DOI: 10.4236/ojog.2022.1211101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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7
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Varlas VN, Bohîlțea R, Gheorghe G, Bostan G, Angelescu GA, Penes ON, Bors RG, Cloțea E, Bacalbasa N, Diaconu CC. State of the Art in Hepatic Dysfunction in Pregnancy. Healthcare (Basel) 2021; 9:1481. [PMID: 34828527 PMCID: PMC8618725 DOI: 10.3390/healthcare9111481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 12/21/2022] Open
Abstract
Hepatic dysfunction in pregnant women is always challenging for the obstetrician, as the spectrum of hepatic abnormalities can be very large and have various implications, both for mother and fetus. There is a diagnostic and therapeutic polymorphism of hepatic dysfunction in pregnancy and insufficient knowledge related to the etiopathogenesis and epidemiology of this disease. The clinical forms of hepatic dysfunction encountered in pregnancy can vary from liver diseases related to pregnancy (e.g., HELLP syndrome, intrahepatic cholestasis, hyperemesis gravidarum, or acute fatty liver of pregnancy) to de novo ones occurring in pregnancy, and pre-existing liver disease (cholelithiasis, Budd-Chiari syndrome, and cirrhosis). We performed a systematic literature search over 10 years. The review protocol assumed a search of two databases (PubMed®/MEDLINE and Web of Science Core Collection). The strategy regarding the management of these diseases involves multidisciplinary teams composed of different specialists (obstetricians, gastroenterologists and anesthetists) from specialized tertiary centers. Despite the improving prognosis of pregnant women with liver diseases, the risk of maternal-fetal complications remains very high. Therefore, it is necessary to ensure careful monitoring by a multidisciplinary team and to inform the patients of the potential risks.
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Affiliation(s)
- Valentin Nicolae Varlas
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (V.N.V.); (R.G.B.); (E.C.)
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.A.A.); (O.N.P.); (N.B.)
| | - Roxana Bohîlțea
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (V.N.V.); (R.G.B.); (E.C.)
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.A.A.); (O.N.P.); (N.B.)
| | - Gina Gheorghe
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Georgiana Bostan
- Department of Obstetrics and Gynecology, County Emergency Hospital “St. John the New”, 720034 Suceava, Romania;
| | - Gabriela Anca Angelescu
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.A.A.); (O.N.P.); (N.B.)
- Department of Internal Medicine, County Emergency Hospital Ilfov, 022115 Bucharest, Romania
| | - Ovidiu Nicolae Penes
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.A.A.); (O.N.P.); (N.B.)
- Department of Anesthesiology and Intensive Care, University Clinical Hospital, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Roxana Georgiana Bors
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (V.N.V.); (R.G.B.); (E.C.)
| | - Eliza Cloțea
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (V.N.V.); (R.G.B.); (E.C.)
| | - Nicolae Bacalbasa
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.A.A.); (O.N.P.); (N.B.)
- Department of Visceral Surgery, “Fundeni” Clinical Institute, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Camelia Cristina Diaconu
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
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Abstract
Gallstone disease is the most common gastrointestinal disease in developed countries and is present in up to 15% of the population. Owing to the increased risk factors for gallstones in pregnancy, it is the second most common non-obstetric emergency, affecting up to 12% of pregnant women with a risk of recurrence. Up to 3% of pregnant women in America require a cholecystectomy in the first year after delivery. Gallstone disease has a high risk of developing associated complications, and maternal mortality can be up to 37% if the patient develops gallstone pancreatitis. Endoscopic retrograde cholangiopancreatography and cholecystectomy can be performed safely in the second trimester when benefits outweigh the risks. However, if the patient is able to be managed conservatively, then a cholecystectomy should be performed in the postnatal period to avoid further recurrences and complications. Despite this, there is currently no national UK guidance on how to manage gallstones and related diseases during pregnancy.
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Affiliation(s)
- Ecf Hess
- Department of Obstetrics & Gynaecology, Stoke Mandeville Hospital, Buckinghamshire NHS Foundation Trust, Aylesbury, UK
| | - R P Thumbadoo
- Department of General Surgery, Stoke Mandeville Hospital, Buckinghamshire NHS Foundation Trust, Aylesbury, UK
| | - Ecp Thorne
- Department of Emergency Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - K McNamee
- Department of Obstetrics & Gynaecology, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
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9
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Considering delay of cholecystectomy in the third trimester of pregnancy. Surg Endosc 2020; 35:4673-4680. [PMID: 32875420 DOI: 10.1007/s00464-020-07910-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/17/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Current guidelines support laparoscopic cholecystectomy as the treatment of choice for pregnant women with symptomatic gallbladder disease, regardless of the trimester. Early intervention has remained the standard of care, but recent evidence has challenged this practice in pregnant women. We sought to compare surgical and maternal-fetal outcomes of antepartum versus postpartum cholecystectomy in New York State. METHODS Between 2005 and 2014, the New York Statewide Planning and Research Cooperative System (SPARCS) database was queried for patients who underwent cholecystectomy within 3 months before (antepartum cholecystectomy, APCCY: n = 82) and after (postpartum cholecystectomy, PPCCY: n = 5040) childbirth to approximate third-trimester operations. All patients who underwent cholecystectomy during pregnancy (n = 971) were extracted to evaluate inter-trimester differences. Subgroup analysis compared APCCY patients who were not hospitalized within 1 year before APCCY (n = 80) and PPCCY patients who were hospitalized within 1 year before childbirth (n = 29) for symptomatic biliary disease. Multivariable generalized linear regression models were used to characterize the association between timing of cholecystectomy and several primary outcomes: length of stay (LOS), 30-day non-pregnancy, non-delivery readmission (NPND), bile duct injury (BDI), composite maternal outcome (antepartum hemorrhage, preterm delivery, cesarean section), any complications, and fetal demise. RESULTS Third-trimester APCCY women had longer LOS (Ratio: 1.44, 95% CI [1.26-1.66], p < 0.0001) and greater incidence of preterm delivery (OR 2.54, 95% CI [1.37-4.43], p = 0.0019). Cholecystectomy timing was not independently associated with differences in composite maternal outcome (p = 0.1480), BDI (p = 0.2578), 30-day NPND readmission (p = 0.7579), any complications (p = 0.2506), and fetal demise (2.44% versus 0.44%, p = 0.0545). Subgroup analysis revealed no differences in any of the seven outcomes. CONCLUSIONS New York Statewide data suggest that although laparoscopic cholecystectomy is safe in pregnancy, delay of cholecystectomy should be discussed in the third trimester due to an increased risk for preterm delivery.
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10
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Abstract
Diseases of the gallbladder and biliary tract are extremely common in developed nations. Because of the physiology of pregnancy, their incidence increases during gestation. This article represents a review of the existing literature on the entire spectrum of biliary disease. The physiology, clinical presentation, and diagnostic evaluation of a variety of conditions are reviewed. Historical and contemporary data regarding pregnancy implications and treatment options are discussed.
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11
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Abdullah SB, Dietz KR, Holm TL. Fetal MRI: incidental findings in the mother. Pediatr Radiol 2016; 46:1736-1743. [PMID: 27554368 DOI: 10.1007/s00247-016-3680-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 06/23/2016] [Accepted: 07/26/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fetal magnetic resonance imaging (MRI) is a routinely used tool in prenatal diagnosis; however, there is a lack of studies evaluating incidental findings observed in the mother. OBJECTIVE This study describes and quantifies incidental findings observed in the mother during fetal MRI. MATERIALS AND METHODS We reviewed all fetal MRI studies at the University of Minnesota Medical Center from February 2008 to September 2014. Two pediatric radiologists retrospectively conducted a consensus evaluation. The maternal findings were categorized into neurologic, gynecologic, urinary, gastrointestinal and musculoskeletal. Hydronephrosis consistent with the stage of pregnancy was recorded but was not included as an abnormal finding. Abnormal findings were classified into three groups, depending on their clinical significance: level I (low), level II (medium) and level III (high). RESULTS We evaluated 332 pregnant patients with a mean age of 29.3 years and a mean gestational age of 29 weeks. Of these, 55.4% had at least 1 incidental finding, for a total of 262 incidental maternal findings. Of the 262 abnormalities, 113 (43.1%) were neurologic, 69 were gynecologic (26.3%), 36 (13.7%) urinary, 24 (9.2%) gastrointestinal and 20 (7.6%) musculoskeletal. Of the 262 incidental findings, 237 (90.5%) were level I, 24 (9.2%) were level II and 1 (0.4%) was level III. CONCLUSION Our results suggest that although the vast majority of incidental maternal findings are benign, more significant findings are still encountered and should be expected.
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Affiliation(s)
- Selwan B Abdullah
- Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
- Medical School, University of Minnesota, Minneapolis, MN, USA.
| | - Kelly R Dietz
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Tara L Holm
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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Baheti AD, Nicola R, Bennett GL, Bordia R, Moshiri M, Katz DS, Bhargava P. Magnetic Resonance Imaging of Abdominal and Pelvic Pain in the Pregnant Patient. Magn Reson Imaging Clin N Am 2016; 24:403-17. [PMID: 27150326 DOI: 10.1016/j.mric.2015.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The utility of MR imaging in evaluating abdominal and pelvic pain in the pregnant patient is discussed. Details regarding the indications, technical aspects, and imaging findings of various common abdominal and pelvic abnormalities in pregnancy are reviewed.
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Affiliation(s)
- Akshay D Baheti
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Room BB308, Box 357115, Seattle, WA 98195, USA.
| | - Refky Nicola
- Department of Radiology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 648, Rochester, NY 14642, USA
| | - Genevieve L Bennett
- Department of Radiology, New York University School of Medicine, 660 First Avenue, New York, NY 10016, USA
| | - Ritu Bordia
- Section of Neuroradiology, Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501, USA
| | - Mariam Moshiri
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Room BB308, Box 357115, Seattle, WA 98195, USA
| | - Douglas S Katz
- Section of Neuroradiology, Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501, USA
| | - Puneet Bhargava
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Room BB308, Box 357115, Seattle, WA 98195, USA
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Goktas SB, Manukyan M, Selimen D. Evaluation of Factors Affecting the Type of Gallstone. Indian J Surg 2015; 78:20-6. [PMID: 27186035 DOI: 10.1007/s12262-015-1313-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/19/2015] [Indexed: 11/29/2022] Open
Abstract
The aim of this study is to determine the factors affecting the formation of the gallstone types of cholesterol and pigment stones. This descriptive and retrospective study comprised 164 patients who underwent cholecystectomy. Research data were obtained using a data collection form with 34 questions developed by the researchers based on the relevant literature. Statistical analysis of the data was made on SPSS 15.0 software using the percentage assessment method and chi-square test. Advanced statistical analysis of the data was performed using multivariate logistic regression. Cholesterol stone was found to form in individuals with anemia, those going through the menopause, and those consuming liquid oil and not undertaking exercise. The risk of pigment stone formation was found to be higher in the obese and those with liver disease and who do not consume milk. From the results of the study, it was determined that the dietary habits, chronic diseases, and lifestyle behaviors of individuals could be effective factors in the formation of cholesterol and/or pigment stone.
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Affiliation(s)
| | - Manuk Manukyan
- Faculty of Medicine Hospital, Maltepe University, Istanbul, Turkey
| | - Deniz Selimen
- School of Health, European University of Lefke, Lefke, Cyprus
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Ellington SR, Flowers L, Legardy-Williams JK, Jamieson DJ, Kourtis AP. Recent trends in hepatic diseases during pregnancy in the United States, 2002-2010. Am J Obstet Gynecol 2015; 212:524.e1-7. [PMID: 25448511 DOI: 10.1016/j.ajog.2014.10.1093] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/03/2014] [Accepted: 10/28/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE While pregnancy-related severe liver disorders are rare, when they occur morbidity and mortality rates are increased for mothers and infants. The objective of this study was to examine the prevalence and trends of hepatic diseases during pregnancy hospitalizations from 2002 through 2010 in the United States. STUDY DESIGN Hospital discharge data were obtained from the Nationwide Inpatient Sample, the largest all-payer hospital inpatient care database in the United States that provides nationally representative estimates. Pregnancy hospitalizations with the following diagnoses were identified: hepatitis B, hepatitis C, gallbladder disease/cholelithiasis, liver disorders of pregnancy, chronic/alcohol-related liver disease, biliary tract disease, and HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome. Age, insurance status, hospital location, and hospital region were compared among women with and without hepatic diseases using a χ(2) test. Trends in rates of pregnancy hospitalizations and mean charges were analyzed using multivariable logistic and linear regression, respectively. RESULTS From 2002 through 2010 there were an estimated 41,479,358 pregnancy hospitalizations in the United States. Gallbladder disease and liver disorders of pregnancy were the most common hepatic diseases (rates = 7.18 and 4.65/1000 pregnancy hospitalizations, respectively). Adjusted rates and mean charges significantly increased for all hepatic diseases during pregnancy over the study period. All hepatic diseases were associated with significantly higher charges compared to all pregnancy hospitalizations. HELLP syndrome was associated with the highest mean charges. CONCLUSION This large study among a representative sample of the US population provides valuable information that can aid policy planning and management of these hepatic diseases during pregnancy in the United States.
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de Bari O, Wang TY, Liu M, Paik CN, Portincasa P, Wang DQH. Cholesterol cholelithiasis in pregnant women: pathogenesis, prevention and treatment. Ann Hepatol 2014. [PMID: 25332259 DOI: 10.1016/s1665-2681(19)30975-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Epidemiological and clinical studies have found that gallstone prevalence is twice as high in women as in men at all ages in every population studied. Hormonal changes occurring during pregnancy put women at higher risk. The incidence rates of biliary sludge (a precursor to gallstones) and gallstones are up to 30 and 12%, respectively, during pregnancy and postpartum, and 1-3% of pregnant women undergo cholecystectomy due to clinical symptoms or complications within the first year postpartum. Increased estrogen levels during pregnancy induce significant metabolic changes in the hepatobiliary system, including the formation of cholesterol-supersaturated bile and sluggish gallbladder motility, two factors enhancing cholelithogenesis. The therapeutic approaches are conservative during pregnancy because of the controversial frequency of biliary disorders. In the majority of pregnant women, biliary sludge and gallstones tend to dissolve spontaneously after parturition. In some situations, however, the conditions persist and require costly therapeutic interventions. When necessary, invasive procedures such as laparoscopic cholecystectomy are relatively well tolerated, preferably during the second trimester of pregnancy or postpartum. Although laparoscopic operation is recommended for its safety, the use of drugs such as ursodeoxycholic acid (UDCA) and the novel lipid-lowering compound, ezetimibe would also be considered. In this paper, we systematically review the incidence and natural history of pregnancy-related biliary sludge and gallstone formation and carefully discuss the molecular mechanisms underlying the lithogenic effect of estrogen on gallstone formation during pregnancy. We also summarize recent progress in the necessary strategies recommended for the prevention and the treatment of gallstones in pregnant women.
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Affiliation(s)
- Ornella de Bari
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, USA
| | - Tony Y Wang
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, USA; Department of Biomedical Engineering, Washington University, St. Louis, USA
| | - Min Liu
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Chang-Nyol Paik
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, USA
| | - Piero Portincasa
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - David Q-H Wang
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, USA
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Juárez A, Rivera A, Alarcón I, Durán M, Islas L, Téllez S. Colecistectomía durante la resolución obstétrica, evento simultáneo. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2014. [DOI: 10.1016/j.gine.2010.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Veerappan A, Gawron AJ, Soper NJ, Keswani RN. Delaying cholecystectomy for complicated gallstone disease in pregnancy is associated with recurrent postpartum symptoms. J Gastrointest Surg 2013; 17:1953-9. [PMID: 24002766 DOI: 10.1007/s11605-013-2330-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 08/20/2013] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Pregnancy is a risk factor for gallstone disease; in some patients, cholecystectomy may be delayed to the postpartum period. Our aim was to examine the effect of antepartum interventions on postpartum outcomes in complicated gallstone disease (CGD) during pregnancy. MATERIAL AND METHODS Retrospective analysis of patients seeking medical care for CGD (cholecystitis, choledocholithiasis, or gallstone pancreatitis) during pregnancy at a single tertiary care institution over a 10-year period (2002-2012). Patients were contacted via standardized telephone survey to account for outside hospitalizations. RESULTS AND DISCUSSION We identified 56 patients with CGD during pregnancy, 42.9 % initially presenting during the second trimester. Choledocholithiasis was the most common diagnosis (n = 30). Antepartum cholecystectomy was performed in 17.9 %. Seventeen patients did not follow up postpartum and did not complete telephone survey. Of the remaining 29 patients, 58.6 % had recurrent postpartum symptoms, 35.3 % recurred within 1 month, and 82.4 % within 3 months of delivery. Antepartum ERCP with biliary sphincterotomy decreased postpartum symptom recurrence (38.5 vs. 75.0 %, p = 0.07). CONCLUSIONS The majority of patients with CGD who do not undergo antepartum cholecystectomy have recurrent postpartum symptoms often within 3 months postpartum. When appropriate, physicians should advocate for antepartum or early postpartum cholecystectomy to minimize symptom recurrence and unplanned hospitalizations.
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Affiliation(s)
- Annapoorani Veerappan
- Department of Medicine, Division of Gastroenterology & Hepatology, Feinberg School of Medicine, NMH/Arkes Family Pavilion Suite 1400, 676 N Saint Clair, Chicago, IL, 60611, USA
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Imaging of pregnant and lactating patients: part 2, evidence-based review and recommendations. AJR Am J Roentgenol 2012; 198:785-92. [PMID: 22451542 DOI: 10.2214/ajr.11.8223] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objectives of this article are to discuss the current evidence-based recommendations regarding the use of diagnostic imaging in the evaluation of pulmonary embolism, appendicitis, urolithiasis, and cholelithiasis during pregnancy. CONCLUSION Diagnostic imaging should be performed during pregnancy only with an understanding of the maternal and fetal risks and benefits, the comparative advantages of different modalities, and the unique anatomic and physiologic issues associated with pregnancy.
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Abstract
Changes in the liver biochemical profile are normal in pregnancy. However, up to 3% to 5% of all pregnancies are complicated by liver dysfunction. It is important that liver disease during pregnancy is recognized because early diagnosis may improve maternal and fetal outcomes, with resultant decreased morbidity and mortality. Liver diseases that occur in pregnancy can be divided into 3 different groups: liver diseases that are unique to pregnancy, liver diseases that are not unique to pregnancy but can be revealed or exacerbated by pregnancy, and liver diseases that are unrelated to but occur coincidentally during pregnancy.
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Affiliation(s)
- Arjmand R Mufti
- Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medical Center, IL 60637, USA
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Abstract
Severe liver disease in pregnancy is rare. Pregnancy-related liver disease is the most frequent cause of liver dysfunction in pregnancy and provides a real threat to fetal and maternal survival. A rapid diagnosis differentiating between liver disease related and unrelated to pregnancy is required in women who present with liver dysfunction during pregnancy. Research has improved our understanding of the pathogenesis of pregnancy-related liver disease, which has translated into improved maternal and fetal outcomes. Here, we provide an overview of liver diseases that occur in pregnancy, an update on the key mechanisms involved in their pathogenesis, and assessment of available treatment options.
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Affiliation(s)
- Deepak Joshi
- Institute of Liver Studies, King's College Hospital, London, UK
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Tseng JY, Yang MJ, Yang CC, Chao KC, Li HY. Acute Cholecystitis During Pregnancy: What is the Best Approach? Taiwan J Obstet Gynecol 2009; 48:305-7. [PMID: 19797027 DOI: 10.1016/s1028-4559(09)60311-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Abstract
BACKGROUND Although rare, pancreaticobiliary disease during pregnancy can pose a serious risk to both the mother and fetus. Data regarding the relative safety of endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy are sparse. METHODS We performed a retrospective review of 17 ERCP procedures performed at a single tertiary care referral center between January 2005 and April 2009. Records were reviewed for ERCP indication, endoscopic interventions, use and extent of fluoroscopy, postprocedure complications, and pregnancy outcomes including Apgar scores. RESULTS All procedures were performed without any maternal adverse events immediately or on follow-up. There were no signs of fetal distress during any of these cases, and there were no fetal complications noted upon delivery or at 30-day follow-up per chart review. CONCLUSION Therapeutic ERCP during pregnancy appears to be safe when performed in experienced hands and with judicious use of fluoroscopy.
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Affiliation(s)
- Adel Y Daas
- Drs. Daas and Agha are also affiliated with the University of South Florida College of Medicine
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Slingluff JL, Williams JT, Blau L, Blau A, Dick EJ, Hubbard GB. Spontaneous gallbladder pathology in baboons. J Med Primatol 2009; 39:92-6. [PMID: 19793177 DOI: 10.1111/j.1600-0684.2009.00387.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gallbladder pathology (GBP) is a relatively uncommon, naturally occurring morbidity in both baboons and humans. METHODS A retrospective analysis was performed on 7776 necropsy reports over a 20 year period to determine the prevalence of baboon GBP. RESULTS Ninety-seven cases of GBP were identified, yielding a 20 year population prevalence of 1.25%. GBP is more common in adult female baboons, occurring with a female to male ratio of nearly 2:1. Among gallbladder pathologies, cholecystitis (35.1%) and cholelithiasis (29.9%) were the most prevalent abnormalities, followed by hyperplasia (16.5%), edema (15.5%), amyloidosis (5.2%), fibrosis (4.1%), necrosis (4.1%), and hemorrhage (1.0%). CONCLUSION Many epidemiologic similarities exist between GBP in baboons and humans suggesting that the baboon may serve as a reliable animal model system for investigating GBP in humans.
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Affiliation(s)
- J L Slingluff
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA, USA
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Resende V, Petroianu A, Alves MSD, Alberti LR. Influência da icterícia obstrutiva na capacidade reprodutiva, desenvolvimento fetal e morfologia ovariana em ratas. Rev Col Bras Cir 2009; 36:339-46. [DOI: 10.1590/s0100-69912009000400012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 01/08/2009] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Estudar a influência da icterícia obstrutiva sobre a capacidade reprodutiva e desenvolvimento fetal em ratas. MÉTODOS: Foram utilizadas 60 ratas sexualmente maduras e sabidamente férteis distribuídas em dois grupos: grupo 1 (n=30)- submetidas a ligadura do ducto biliopancreático e grupo 2 (n=30) -controles. A partir do 23? dia pós-operatório, as ratas foram acasaladas e seus ciclos estrais avaliados diariamente por meio de esfregaços vaginais, que permitiram determinar o dia da cópula e a idade gestacional em que foram mortas. Realizou-se estudo histológico dos corpos lúteos nos ovários de todas as ratas e analisou-se macroscopicamente a morfologia externa dos fetos. RESULTADOS: Observou-se que 23 ratas controle (92%) e 11 ratas ictéricas (39,3%) desenvolveram prenhez (p=0,0002). As 17 ratas com hiperbilirrubinemia e sem prenhez (60,7%) apresentaram somente corpos lúteos com aspecto involutivo em seus ovários e sofreram modificações em seus ciclos estrais, permanecendo vários dias em proestro ou estro. As ratas prenhes com hiperbilirrubinemia não apresentaram alterações em seus corpos lúteos, porém os seus fetos eram anormais. CONCLUSÃO: Em presença de hiperbilirrubinemia, a fertilização é viável, a capacidade reprodutiva é muito reduzida, os ciclos estrais tornam-se irregulares, o epitélio vaginal permanece cornificado, os corpos lúteos ovarianos regridem, os corpos lúteos gravídicos não são alterados aumentando progressivamente durante a prenhez e o desenvolvimento fetal é gravemente alterado.
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Keller J, Frederking D, Layer P. The spectrum and treatment of gastrointestinal disorders during pregnancy. ACTA ACUST UNITED AC 2008; 5:430-43. [DOI: 10.1038/ncpgasthep1197] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 05/29/2008] [Indexed: 02/08/2023]
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