Safety of a thickened extensive casein hydrolysate formula.

OBJECTIVES: Cow's milk allergy (CMA) is treated in formula-fed infants with an extensive protein hydrolysate. This study aimed to evaluate the nutritional safety of a non-thickened and thickened extensively casein hydrolyzed protein formula (NT- and T-eCHF) in infants with CMA. METHODS: Infants younger than 6 mo old with a positive cow milk challenge test, positive IgE, or skin prick test for cow milk were selected. Weight and length were followed during the 6 mo intervention with the NT-eCHF and T-eCHF. RESULTS: A challenge was performed in 50/71 infants with suspected CMA and was positive in 34/50. All children with confirmed CMA tolerated the eCHF. The T-eCHF leads to a significant improvement of the stool consistency in the whole population and in the subpopulation of infants with proven CMA. Height and weight evolution was satisfactory throughout the 6 mo study. CONCLUSIONS: The eCHF fulfills the criteria of a hypoallergenic formula and the NT- and T-eCHF reduced CMA symptoms. Growth was within normal range.

Left hepatic duct anatomy: implications.

A review of the findings of a 10-year experience with biliary interventional procedures in 838 patients led to consideration of the anatomy of the left hepatic duct. To better illustrate the findings, 15 normal human livers obtained at autopsy were fixed and dissected. Fifty-five percent of the patients had a single left hepatic duct that was formed by the intrahepatic union of ducts draining segments II and III (segmental nomenclature follows Couinaud) lateral to the falciform ligament. Central to this ligament, the left duct became extrahepatic and was joined by ducts from segments I and IV. The real and theoretical implications of the unpredictable variability of biliary anatomy, the frequency of right lateral duct drainage into the left hepatic duct, and the extrahepatic contiguous relationship between the left hepatic duct and the left portal vein are discussed.