Prepartum behaviors as early indicators for postpartum energy associated biomarkers status in Holstein dairy cows.

Our main aim was to investigate the predictive value of prepartum behaviors such as total daily rumination (TDR), total daily activity (TDA) and dry matter intake (DMI) as early indicators to detect cows at risk for hyperketonemia (HYK), hypoglycemia (HYG) or high non-esterified fatty acid (NEFA) status in the first (wk1) and second week (wk2) postpartum. In a case control study, 64 Holstein cows were enrolled 3 weeks before the expected time of calving and monitored until 15 days in milk (DIM). Postpartum blood samples were taken at D3 and D6 for wk1 and at D12 and D15 for wk2 to measure beta-hydroxybutyrate, NEFA and glucose concentration. Ear-mounted accelerometers were used to measure TDR and TDA. DMI and milk yield were obtained from farm records. Relationships between the average daily rate of change in prepartum TDR (ΔTDR), TDA (ΔTDA), and DMI (ΔDMI) with postpartum HYK, HYG and NEFA status in wk1 and wk2 post-partum were evaluated using linear regression models. Models were adjusted for potential confounding variables, and covariates retained in the final models were determined by backward selection. No evidence was found to support the premise that prepartum ΔTDR, ΔTDA or ΔDMI predicted postpartum HYK, HYG or NEFA status in wk1 or in wk2. Overall, prepartum ΔTDR, ΔTDA and ΔDMI were not effective predictors of HYK, HYG or NEFA status in the first 2 weeks postpartum.

Re-opening Sudan: the Balance Between Maintaining Daily Living and Avoiding the Next Peak of COVID-19.

PURPOSE OF THE REVIEW: To describe the intersectionality of healthcare and economy, and potential solutions to prevent the next peak of COVID-19 in Sudan. RECENT FINDINGS: Sudan has recently emerged from a 30-year dictatorship to face the COVID-19 pandemic in the midst of the worst economic crisis. Disease control measures that have been used in developed countries have been difficult to implement in Sudan due to economic, social, and structural challenges. There is a need for integration of data into the disease response plan and for community engagement to help with mitigation efforts. Youth-led community organizations were critical in the success of the Sudanese revolution. Their formal involvement in contact tracing and community awareness campaigns can be beneficial. SUMMARY: The COVID-19 pandemic has brought to the surface many of the challenges facing the healthcare system in Sudan. Culturally tailored interventions are needed to prevent the next peak of COVID-19 in the country.

Group & save sampling in lumbar decompression: A review into current practice.

The risks, benefits and technical aspects of surgery require careful consideration. One element of this is the requirement of postoperative blood transfusion. Patients who undergo elective lumbar decompression are at a low risk of requiring a postoperative transfusion yet undergo multiple preoperative group & save tests. For those who are at a low risk of bleeding, a single group & save sample may be adequate. This review analysed the postoperative blood loss and transfusion rate associated with lumbar decompression surgery without fusion in one institution. A subsequent cost analysis and review of the literature was performed. The aim was to assess whether single group & save sampling, within the context of lumbar decompression, was cost effective and amenable to the patient without impacting patient care. Average blood loss was estimated as a drop in Hb of 12.3g/dl. Six patients (14%) had Hb loss of over 20g/dl. No patients underwent a blood transfusion. Through examination of medical records, we found that 65% of patients (35) were suitable for single group & save sampling, estimating a saving of £2415.95 (53%). Selective group & save testing holds economic potential and safeguards patients from undergoing unnecessary testing. The next step after this review would be a prospective multi-centre study.

Role of TGF-ß1 and C-Kit Mutations in the Development of Hepatocellular Carcinoma in Hepatitis C Virus-Infected Patients: in vitro Study.

Transforming growth factor beta (TGF-ß) acts as a tumor-suppressing cytokine in healthy tissues and non-malignant tumors. Yet, in malignancy, TGF-ß can exert the opposite effects that can promote proliferation of cancer cells. C-Kit plays a prominent role in stem cell activation and liver regeneration after injury. However, little is known about the cross-talk between TGF-ß and C-Kit and its role in the progression of hepatocellular carcinoma (HCC). Here, we studied the effect of increasing doses of TGF-ß1 on CD44+CD90+ liver stem cells (LSCs) and C-Kit gene expression in malignant and adjacent non-malignant liver tissues excised from 32 HCC patients. The percentage of LSCs in malignant tumors was two times higher compared to their counterparts from the non-malignant tissues. When treated with increasing doses of TGF-ß1, proliferation of both malignant and non-malignant LSCs was progressively suppressed, but low TGF-ß1 dose failed to suppress the growth of malignant LSCs. Moreover, C-Kit exons 9 and 11 were expressed in malignant LSCs, but not in their non-malignant counterparts. Analysis of C-Kit detected mutations in exon 9 (but not in exon 11) in some malignant liver cells resulting in the changes in the amino acid sequence and dysregulation of protein structure and function. Interestingly, in malignant liver cells, mutations in exon 9 were associated with high-viremia hepatitis C virus (HCV), and expression of this exon was not suppressed by the TGF-ß1 treatment at all doses. To our knowledge, this is the first report that mutations in the C-Kit gene in HCC patients are associated with high- viremia HCV. Our study emphasizes the need for investigation of the TGF-ß1 level and C-Kit mutations in patients with chronic HCV for HCC prevention and better therapy management.

Clinical and ultrasonographic investigations of 30 water buffaloes (Bubalus bubalis) with hepatomegaly.

BACKGROUND AND AIM: Knowledge of normal ultrasonographic dimensions of the liver and associated vascular structures is an important indicator for the diagnosis of hepatic diseases. Enlargement of the liver beyond its normal dimensions is the term of hepatomegaly and ultrasonography is the primary and the suitable diagnostic technique for this condition. Therefore, this study aimed to describe the clinical and ultrasonographic findings of liver diseases causing hepatomegaly in 30 buffaloes as well as to provide a range of liver dimensions and its blood vessel measurements in normal and diseased buffaloes. MATERIALS AND METHODS: The study population included 30 buffaloes that were admitted to the clinic of the Faculty of Veterinary Medicine - Zagazig University for investigation of clinical signs associated with gastrointestinal diseases such as anorexia, chronic weight loss, and variable degrees of diarrhea or constipation. The animals were subjected to thorough clinical and ultrasonographic investigations. In addition, 10 healthy buffaloes were investigated ultrasonographically and post-slaughtering for comparison of liver dimensions and physical appearance. RESULTS: Three conditions causing hepatomegaly were identified in this study as multiple focal hepatic lesions, diffuse fatty liver, and hepatic congestion. Clinically, it was difficult to differentiate between each condition while ultrasonography was the ideal tool for diagnosis after comparing with necropsy as a gold standard tool. Hepatomegaly was recorded in all affected animals with a significant decrease in the size of the portal vein (PV) and caudal vena cava (CVC) in animals affected with multiple focal hepatic lesions and fatty liver disease while the size of the PV and CVC was significantly increased in buffaloes with hepatic congestion. CONCLUSION: Ultrasonography can aid to accurately identify buffaloes with hepatomegaly and differentiate between different lesions involved.

Effect of Commonly Consumed Beverages on Color Stability of Polymethyl Methacrylate Denture Base Material.

Color change of prosthodontic materials may result in patient dissatisfaction and additional expenses for replacement. This study aimed to determine the effect of daily-consumed beverages (tea, coffee, and Pepsi®) on the color stability of two types of heat-cured acrylic resin denture base materials (Hiflex-H and DPI® Heat Cure). A total of 136 disc samples were prepared as per manufacturer instructions and divided into two main groups of 68 discs of each type (20 mm ± 0.1 mm in diameter and 3 mm ± 0.1 mm in thickness), according to the acrylic resins, and stored in distilled water for 24 hours. Each group was subdivided into four groups according to the three beverages types and distilled water (as a control). Specimens were scanned (computer analysis) three times after consumption of the beverage: 0 day (T0), 15 days (T1), and 30 days (T2). The International Commission on Illumination was used to determine the mean color change (ΔE). The most color change was apparent with tea after 30 days (ΔE = 39.21) when compared to specimens stored in distilled water (ΔE = 1.43). DPI Heat Cure acrylic resin showed more color change compared to Hiflex-H acrylic resin. When computing color change (ΔE) to NBS (National Bureau of Standards), appreciable to very much change in color was apparent with the three staining beverages compared to slight and noticeable color change with distilled water. By increasing the time of the experiment, significant increase in the mean color was observed. Tea immersion showed the greatest color changes (very much change in color, per NBS), followed by Pepsi and coffee. Increasing the immersion period increased the staining result.

Colic in a working horse population in Egypt: Prevalence and risk factors.

REASONS FOR PERFORMING STUDY: Colic is an important health problem in managed horse populations. Currently, there is limited information about colic prevalence and risk factors for colic in working horse populations. OBJECTIVES: To determine the prevalence of, and risk factors for, colic in a working horse population in Egypt and to describe management practices in this working horse population. STUDY DESIGN: Cross-sectional survey. METHODS: Owners of 350 working horses were interviewed. Data about their horses, management and colic episodes in the preceding 12 months were collected. Dental examination was conducted on 342 horses and blood samples (n = 100) were collected for immunodiagnosis of tapeworm (Anoplocephala perfoliata) infection. Multivariable logistic regression analysis was used to identify risk factors for a history of colic in the preceding 12 months. RESULTS: The 12-month prevalence of colic was 54.6%. Severe and moderate tapeworm infection intensity was identified in 3% and 26% of horses tested, respectively. Horses that had severe dental disease (odds ratio [OR] 6.8, 95% confidence interval [CI] 1.9-24.3, P<0.001), that displayed stereotypic behaviour (OR 2.0, 95% CI 1.15-3.5, P = 0.013), were fed ground corn during the 'dry season' (OR 1.65, 95% CI 1.03-2.6, P = 0.035) or that had received an anthelmintic in the previous 6 months (OR 2.1, 95% CI 1.3-3.3, P = 0.003) were more likely to have a history of colic in the preceding 12 months. Horses fed on rice bran during the 'green season' (OR 0.47, 95% CI 0.26-0.9, P = 0.015) and that displayed geophagia/coprophagia (OR 0.19, 95% CI 0.05-0.73, P = 0.001) were less likely to have a history of colic. CONCLUSIONS: Colic is common in this working horse population and this study has identified factors associated with altered likelihood of colic. The study provides important information that may be used to inform future prospective studies investigating colic in working horse populations and to assist development of preventive healthcare strategies. The Summary is available in Chinese - see Supporting information.

Role of laparoscopic peritoneal biopsy in the diagnosis of peritoneal tuberculosis. A seven-year experience.

The diagnosis of asymptomatic abdominal tuberculosis,without characteristic laboratory and radiologic findings, is difficult. We therefore investigated the role of diagnostic laparoscopy in patients with suspected peritoneal tuberculosis(PTB). Patients admitted to Hamad General Hospital, Qatar,who underwent laparoscopic peritoneal biopsy for suspected PTB from January 2004 to December 2010 were retrospectively analysed. Factors assessed included patient age, sex, symptoms,clinical signs, CT scan findings, laparoscopic findings andhistopathological diagnosis. A total of 41 patients, 33 males(80.5%) and 8 females (19.5%), of mean age 31 years, underwent laparoscopic peritoneal biopsy for suspected PTB duringthe study period. Abdominal pain was the most common presenting symptom, observed in 33 (80.5%) patients.Computerized tomography (CT) of the abdomen showed as citesin 37 patients (90%), bowel nodules in 22 (54%), peritoneal thickening and nodules in 37 (90%) and enlarged mesenteric lymph nodes in 11 (27%). The classical gross laparoscopic appearance of peritoneal tuberculosis was observed in 38 patients (93%), whereas laparoscopic findings were normal in 3 patients (7%). Histopathological results confirmed granulomatous inflammation in 38 patients (93%). The sensitivity and specificity of gross laparoscopic appearance in diagnosing peritoneal TB were both 100%. Two patients experienced complications from laparoscopy (5%), but there were nolaparoscopy-related deaths. Laparoscopic peritoneal biopsy isa rapid and safe method of accurately diagnosing PTB.

Infection complications and pattern of bacterial resistance in living-donor liver transplantation: a multicenter epidemiologic study in Egypt.

INTRODUCTION: Data on the prevalence and pattern of infection after living-donor liver transplantation (LDLT) are scarce in Egypt. We therefore conducted this study to quantify the incidence, risk factors, and pattern of bacterial resistance post-LDLT in 3 hospitals in Egypt. PATIENTS AND METHODS: We conducted a retrospective, multicenter study of the medical records of 246 patients who underwent LDLT between January 2006 and April 2011 at 3 transplant centers in Egypt. RESULTS: Of 246 patients enrolled in this study, 127 (52%) developed infectious complications after LDLT, with 416 episodes of infection occurring within 3 months of transplantation. Biliary tract infection was the most common, occurring in 169 (40.6%) patients. The rate of infection with Gram-negative bacteria was higher than that of infection with Gram-positive bacteria (310 [74%] vs 87 [21%]; P < .001). Overall, 75% of Gram-negative isolates were multidrug resistant. Significant independent risk factors for infection were portal vein thrombosis (odds ratio, 2.4; P = .037) and biliary complications (odds ratio, 5.4; P < .001). CONCLUSIONS: Our data showed a high-resistance pattern of bacterial infection after LDLT in Egypt. Early biliary complications were an independent risk factor for bacterial infection.

Optimizing outcome of recurrent hepatitis C virus genotype 4 after living donor liver transplantation: moving forward by looking back.

PURPOSE: Recurrence of HCV after LDLT is almost universal. Different factors affect response to treatment. Few data are available regarding outcome of recurrent HCV genotype 4. The purpose of this study is to improve outcome of recurrent HCV genotype 4 after LDLT. METHODS: An IRB approved chart review of 243 patients transplanted for ESLD, HCV genotype 4 over 4 years were reviewed. Protocol liver biopsies were taken 6 months after transplant. Patients received pegylated interferon and ribavirin in case of histological recurrence. Five patients had FCH were excluded. RESULTS: Thirty-seven patients were included. Sustained Virological Response (SVR) was achieved in 29 (78.3%). Patients with Metavir fibrosis stage (F0) and (F1) had SVR in 5/5 (100%) and 20/24 (83.3%). Two patients with F1 had to stop treatment because of thrombocytopenia and 2 were non responders. Three out of 6 patients (50%) with (F2) had SVR, 2 were non responders and one had to discontinue treatment because of severe depression. One of 2 patients (50%) with F3 had SVR and the other patient decompensated within 4 months before treatment and died. CONCLUSION: Protocol biopsies allow early detection of inflammatory changes in the graft before fibrosis occurs. Early treatment of recurrent HCV genotype 4 after LDLT results in better response.

Hydatid disease of the liver: laparoscopic approach, initial result in Egypt.

This prospective study assessed the laparoscopic approach for treatment of HHC in Ain Shams University Hospitals from January 2010 to April 2012. Laparoscopic partial cystectomy was performed in all patients; no conversion to open technique or anaphylaxis was recorded. The mean operative time was 60 minutes with no perioperative mortality, while postoperative morbidity was recorded in 4 patients (36%). The mean length of hospital stay was 4.5 days. Radiological and serological tests showed no recurrences at a median follow up period of 18 months. Laparoscopic management of HHC is feasible gaining all the benefits of laparoscopy with no added morbidities or increased risk of recurrence. Careful patient selection is madrdatory to achieve successful results.

A novel mutation of the ornithine transcarbamylase gene leading to fatal hyperammonemia in a liver transplant recipient.

Ornithine transcarbamylase (OTC) deficiency (OTCD) is an X-linked urea cycle disorder. Being an X-linked disease, the onset and severity of the disease may vary among female carriers. Some of them start to develop the disease early in life, whereas others remain asymptomatic throughout their lives. Our patient was a 42-year-old man who developed severe hyperammonemia and fatal brain edema after receiving a right lobe graft from an asymptomatic female living donor with unrecognized OTCD. The donor developed hyperammonemia and disturbed level of consciousness that was managed successfully by hemodialysis. Molecular testing of the OTC gene in the donor revealed a heterozygous nonsense mutation (c.429T>A) in exon 5.

Cavernous antioxidant effect of green tea, epigallocatechin-3-gallate with/without sildenafil citrate intake in aged diabetic rats.

This study aimed to assess the cavernous antioxidant effect of green tea (GT), epigallocatechin-3-gallate (EGCG) with/without sildenafil citrate intake in aged diabetic rats. One hundred and four aged male white albino rat were divided into controls that received ordinary chow, streptozotocin (STZ)-induced aged diabetic rats, STZ-induced diabetic rats on infused green tea, induced diabetic rats on epigallocatechin-3-gallate and STZ-induced diabetic rats on sildenafil citrate added to EGCG. After 8 weeks, dissected cavernous tissues were assessed for gene expression of eNOS, cavernous malondialdehyde (MDA), glutathione peroxidase (GPx), cyclic guanosine monophosphate (cGMP), and serum testosterone (T). STZ-induced diabetic rats on GT demonstrated significant increase in cavernous eNOS, cGMP, GPx and significant decrease in cavernous MDA compared with diabetic rats. Diabetic rats on EGCG demonstrated significant increase in cavernous eNOS, cGMP, GPx and significant decrease in cavernous MDA compared with diabetic rats or diabetic rats on GT. Diabetic rats on EGCG added to sildenafil showed significant increase in cavernous eNOS, cGMP and significant decrease in cavernous MDA compared with other groups. Serum T demonstrated nonsignificant difference between the investigated groups. It is concluded that GT and EGCG have significant cavernous antioxidant effects that are increased if sildenafil is added.

Efficacy of two fungus-based biopesticide against the honeybee ectoparasitic mite, Varroa destructor.

The varroa mite, Varroa destructor (Anderson and Trueman) (Acari: Varroidae), is known as the most serious ectoparasitic mite on honeybee, Apis mellifera (Hymenoptera: Apidae) in the world. Based on the spores of entomopathogenic fungi, two commercial preparations; Bioranza (Metarhizium anisopliae) and Biovar (Beauveria bassiana) were evaluated through application into the hives against varroa mite. Data showed significant differences between treatments with Bioranza and Biovar, the results were significant after 7 and 14 days post-treatment. Mean a daily fallen mite individual was significantly different between the hives before and after the applications of the two biopesticides and wheat flour. Also, mites' mortality was, significantly, different between the hives before and after treatments. There were significant differences between treatments with the two biopesticides in worker's body weight. Bioranza and Biovar did not infect the honeybee in larval, prepupal, pupal and adult stages. Scanning and transmission electron microscopy images showed spores and hyphae penetration through stigma and wounds on varroa. The results suggest that Bioranza and Biovar are potentially are effective biopesticides against V. destructor in honeybee colonies.

Application of Yang-Monti Principle in Ileal Ureter Substitution: Is It a beneficial Modification?

Ureteric substitution using the Yang-Monti principle was reported as a modification of simple ileal ureter replacement. In this study, we evaluate its safety, surgical outcome and impact on renal function.

Sixteen patients underwent ileal ureter replacement using the Yang-Monti principle to overcome long ureteric defects. Exclusion criteria included patients with elevated serum creatinine > 1.8 mg/dL, inflammatory bowel syndrome or irradiated bowel. Antireflux implantation into the bladder was performed in 12 patients while 4 patients with intact healthy lower ureters underwent distal ileal-ureteral anastomosis. Follow-up protocol was carried out for up to 3 years in 9 patients.

No intra-operative or postoperative mortality or significant complications occurred. There were minor complications in the form of urinary leakage that necessitated prolonged ureteric stenting in one patient, superficial wound infection in another one and 3 patients developed treatable urinary tract infection without late harmful effects. During follow up, no excess mucus production or metabolic abnormalities were encountered. All patients had preserved renal function (improved in 13 patients and stabilized in 3) without any evidence of urinary obstruction.

The reconfigured ileal segment for ureteric substitution is a safe technique with an excellent outcome. It uses short ileal segments for reconstruction of an ileal tube of adequate length and optimal caliber that permits easy antireflux implantation into the bladder so it is not associated with excess mucus production or metabolic abnormalities and offers a durable preservation of renal function without urinary obstruction. .

Application of Yang-Monti principle in ileal ureter substitution: is it a beneficial modification?

PURPOSE: Ureteric substitution using the Yang-Monti principle was reported as a modification of simple ileal ureter replacement. In this study, we evaluate its safety, surgical outcome and impact on renal function. MATERIALS AND METHODS: Sixteen patients underwent ileal ureter replacement using the Yang-Monti principle to overcome long ureteric defects. Exclusion criteria included patients with elevated serum creatinine > 1.8 mg/dL, inflammatory bowel syndrome or irradiated bowel. Antireflux implantation into the bladder was performed in 12 patients while 4 patients with intact healthy lower ureters underwent distal ileal-ureteral anastomosis. Follow-up protocol was carried out for up to 3 years in 9 patients. RESULTS: No intra-operative or postoperative mortality or significant complications occurred. There were minor complications in the form of urinary leakage that necessitated prolonged ureteric stenting in one patient, superficial wound infection in another one and 3 patients developed treatable urinary tract infection without late harmful effects. During follow-up, no excess mucus production or metabolic abnormalities were encountered. All patients had preserved renal function (improved in 13 patients and stabilized in 3) without any evidence of urinary obstruction. CONCLUSIONS: The reconfigured ileal segment for ureteric substitution is a safe technique with an excellent outcome. It uses short ileal segments for reconstruction of an ileal tube of adequate length and optimal caliber that permits easy antireflux implantation into the bladder so it is not associated with excess mucus production or metabolic abnormalities and offers a durable preservation of renal function without urinary obstruction.

Anatomy of the right liver lobe: a surgical analysis in 124 consecutive living donors.

BACKGROUND: Understanding anatomic variations of the right lobe is fundamental in adult to adult living donor liver transplantation. METHODS: We analysed anatomy in 124 right liver (RL) donors. RESULTS: Portal vein: normal anatomy was found in 85.5% donors. In 14.5% the main right portal vein (PV) was absent. Hepatic artery: single arterial inflow of the RL was identified in 96% of donors. In 4% two arterial stumps were found. Bile duct: classic anatomy was identified in 50.8% of donors; 9.7% had a trifurcation of the common bile duct; in 7.2% the right anterior and in 15.3% the right posterior bile duct opened into the left bile duct; one segmental bile duct opened directly into the common bile duct in 12.1% and two segmental bile ducts in 4.8%. Hepatic veins (HV): in 74.3% the right HV was the single outflow; in 24.2% significant accessory HV (>5 mm) were preserved, in 2.4% the middle HV was harvested. We found that patients with PV variations had high incidence of multiple bile ducts (88.9%) while patients with single right PV had lower incidence (42.4%) (p = 0.00026). CONCLUSION: While anatomic variations in the RL donor were common, no contraindication to RL harvesting was noted in this study.

Assessment of the correlation between two defining criteria for bidirectional isthmic block in the ablation of typical atrial flutter.

BACKGROUND: A complete, bidirectional conduction block in the cavotricuspid isthmus (CTI) represents the end-point of the typical atrial flutter ablation. We investigated the correlation between two criteria for successful ablation, one based on the atrial bipolar electrogram morphology before and after complete CTI conduction block, compared to the standard criteria of differential pacing and reversal in the right atrial depolarization sequence during coronary sinus (CS) pacing. METHOD: We conducted a retrospective study in 111 patients (81 males, average age 62±10 years) who underwent an atrial flutter ablation during September 2007 - July 2009 in the Cardiology - Rehabilitation Hospital, UMF Cluj-Napoca. We assessed the presence of a bidirectional block at the end of the procedure using the standard criteria. We then analyzed the morphology of the bipolar atrial electrograms adjacent to the ablation line, before and after CTI conduction block. RESULTS: A change from a qRs morphology to a rSr' morphology when pacing from the coronary sinus and from a rsr' morphology to a QRS morphology when pacing from the low-lateral right atrium was associated with a CTI conduction block. Sensitivity (Se), specificity(Sp), positive predictive value (PPV), negative predictive value (NPV) were 96%, 89%, 99% and 67% respectively. CONCLUSION: Our study suggests that the analysis of the atrial bipolar electrogram next to the ablation line before and after CTI ablation may be used as a reliable criterion to validate CTI conduction block due to its high sensitivity, specificity and positive predictive value.

Extra-anatomical hepatic artery reconstruction following post-embolization iatrogenic dissection and arterial anastomotic rupture in two liver transplant recipients.

When hepatic artery reconstruction is required during hepatic transplantation, this is generally performed with donor vessels. We describe two cases requiring a prosthesis. The first case was a 58-year-old man transplanted for cirrhosis complicated by hepatocellular carcinoma. During transplantation, dissection of the celiac trunk occurred due to arterial embolization and the use of the patient's vessels was impossible. An extra-anatomical bypass between the infra-renal aorta and the donor hepatic artery was performed via the interposition of a graft tube. The second case was a 52-year-old man transplanted for cirrhosis complicated by hepatocellular carcinoma. On day 16, a ruptured anastomosis was suspected and the patient underwent emergency revision laparotomy. Arterial revascularisation was performed with an aortohepatic bypass using a synthetic GoreTex((R)) graft. Patient follow-up was uneventful.