Comparison of post-operative short-term and long-term outcomes between occult and frank biliary rupture of hydatid disease.

BACKGROUND/AIMS: Intrabiliary rupture (IBR) is the most common and serious complication of hepatic hydatid cyst (HHC). The aim of this retrospective study was to evaluate postoperative short-term and long-term outcome of patients treated surgically for complicated liver hydatid cysts. METHODOLOGY: A total of 168 cases with biliary communication of hydatid cyst were analyzed retrospectively, 92 of which had biliary communication with an occult rupture while 76 (45.23%) had Frank biliary rupture. Preoperative demography, ultrasonic cyst features, postoperative short-term complications, postoperative follow-up (long-term) complications and hospital stay were recorded and analyzed. RESULTS: There were no differences in the demographic characteristics and preoperative cyst features in Frank and occult group. Compared with the Frank group 9.34 +/- 1.25 (days), the postoperative stay in occult 6.97 +/- 1.62 (days) were relatively shorter. The incidence of overall postoperative short-term complications and long-term complications were insignificantly lower in occult group (22.82%) than Frank group (30.26%) with P = 0.275. Incidence of postoperative biliary leakage 8 (8.69%) and abscess 5 (5.43%) in occult group was insignificantly more common than Frank rupture with biliary leakage 5 (6.5%) and abscess 2 (2.63%) with P value was 0.609 and 0.365 respectively while long-term biliary stricture is significantly greater in Frank group (10.52%) then occult group (0%) with P = 0.01. CONCLUSIONS: Frequency of occurrence of postoperative short-term complications biliary fistula and abscess is relatively more common in occult rupture with transcystic drain due to its indolent course, inability to find and suture the rupture orifice, and incomplete decompression while biliary stricture is significantly more common in Frank group due to its involvement of major bile ducts.

Randomized comparison of postoperative short-term and mid-term complications between T-tube and primary closure after CBD exploration.

OBJECTIVE: To compare the postoperative short-term and mid-term complications in patients who underwent CBD exploration and closure by using T-tube or primary closure. STUDY DESIGN: Prospective randomized clinical trial. PLACE AND DURATION OF STUDY: Hepatobiliary Department of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China, from August 2009 to March 2013. METHODOLOGY: A total of 148 consecutive patients with Common Bile Duct Stones (CBDS) and CBD dilation were enrolled in this randomized study to undergo open cholecystectomy with CBD exploration. Pre-operative findings, postoperative short-term complications, postoperative follow-up (mid-term), and hospital stay were recorded and analyzed. RESULTS: A T-tube was inserted in 76 (51.35%) patients and the primary closure was done in 72 (48.64%) patients. There were no differences in the demographic characteristics and clinical presentations between the two groups. Compared with the T-tube group 8.97 ± 1.629 days, the postoperative stay in primary closure 5.34 ± 1.25 days was significantly shorter (p < 0.01). The incidence of overall postoperative short-term complications and mid-term complications were statistically but not significantly lower in the primary closure group (9.7%) than that in T-tube group (17.10%, p=0.189). CONCLUSION: Complications in the primary closure group were lower than that in T-tube group but there was no significant statistical difference. So during open surgery for CBD stones, primary closure of CBD appeared safe and effective with shorter hospital stays and less complications.

Lepidium sativum but not Nigella sativa affects carbamazepine disposition in an animal model.

Efficacy and safety profile of a drug may be affected when concomitantly used with herbal medicines. The present study was conducted to investigate the effects of some commonly used herbal products viz. Nigella sativa (Black seed) and Lepidium sativum (Garden cress) on the pharmacokinetics of carbamazepine (CBZ), a narrow therapeutic index drug, in an animal model. In a control group, five rabbits received 40 mg/kg of CBZ orally and blood samples were withdrawn at different time intervals (0, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12 and 24 hrs) from a marginal ear vein. After a suitable washout period, an aqueous saline suspension of Nigella sativa (200 mg/kg) or Lepidium sativum (150 mg/kg) was given orally for eight days to the rabbits. On day eight, CBZ (40 mg/kg) was re-administrated orally and blood samples were collected using the same sampling scheme. Drug levels in plasma were determined by liquid chromatography and pharmacokinetic parameters were calculated using non-compartmental analysis. No significant difference was observed in the maximum concentration (Cmax), area under concentration curve (AUC), half-life (T1/2), clearance (Cl/F) and volume of distribution (Vz/F) of CBZ following Nigella sativa treatment. Whereas, increased Cmax, absorption rate measured by the time to Cmax (Tmax), and prolongation of the terminal elimination half-life (T1/2) were observed after the co-administration with Lepidium sativum. Findings of the present study suggest that concurrent use of Lepidium sativum alters the pharmacokinetics of CBZ in an animal model. Further confirmation of these results in humans will warrant changes in CBZ dose and/or frequency before co-administration with these herbal medicines.

Effects of Nigella sativa and Lepidium sativum on cyclosporine pharmacokinetics.

The present study was conducted to investigate the effects of Nigella sativa and Lepidium sativum on the pharmacokinetics of cyclosporine in rabbits. Two groups of animals were treated separately with Nigella sativa (200 mg/kg p.o.) or Lepidium sativum (150 mg/kg p.o.) for eight consecutive days. On the 8th day, cyclosporine (30 mg/kg p.o.) was administered to each group one hour after herbal treatment. Blood samples were withdrawn at different time intervals (0.0, 0.5, 1.0, 1.5, 2.0, 3.0, 4.0, 6.0, 8.0, 12, and 24 hrs) from marginal ear vein. Cyclosporine was analyzed using UPLC/MS method. The coadministration of Nigella sativa significantly decreased the C(max) and AUC(0-∞) of cyclosporine; the change was observed by 35.5% and 55.9%, respectively (P ≤ 0.05). Lepidium sativum did not produce any significant change in C(max) of cyclosporine, although its absorption was significantly delayed compared with control group. A remarkable change was observed in T(max) and AUC(0-t) of Lepidium sativum treated group. Our findings suggest that concurrent consumption of Nigella sativa and Lepidium sativum could alter the pharmacokinetics of cyclosporine at various levels.