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Accurate knowledge of the anatomy of the bile ducts is critical for successfully hepato-biliary surgery. We describe the anatomical variations of the confluence of the bile ducts, their branches patterns, frequency and classification. From 1996 to 2011, we have collected data of the bile duct confluence. 2,032 and 1,014 anatomical variations of right and left bile ducts, respectively, were reviewed and classified according to the branching pattern. The frequencies of each type of the right hepatic duct (RHD) were as follows: Type A1-1,247 (61.3%); Type A2-296 (14.5%); Type A3-272 (13.3%); Type A4-124 (6.1%); Type A5-21 (1%) and others-72 (3.5%) and, for the left hepatic duct (LHD) was as follows: Type B1-773 (76.2%); Type B2-153 (15%); Type B3-38 (3.7%); Type B4-9 (0.8%); Type B5-29 (2.8%) and others-12 (1.1%). Atypical branching patterns of both the right and left hepatic ducts were found in 14 and 8%, respectively. The two most common variations of the RHD were right anterior and posterior hepatic ducts join together to form the RHD and trifurcation where the RHD is absent and right anterior and posterior hepatic ducts join directly to the confluence with the LHD to form the common hepatic duct. The two most common variations in the LHD were segment IV drainage to the left and right hepatic ducts.

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ObjectiveTo review studies performed in animal models that evaluated therapeutic interventions to inflammatory response and microcirculatory changes after cardiopulmonary bypass.MethodsIt was used the search strategy ("Cardiopulmonary Bypass" (MeSH)) and ("Microcirculation" (MeSH) or "Inflammation" (MeSH) or "Inflammation Mediators" (MeSH)). Repeated results, human studies, non-English language articles, reviews and studies without control were excluded.ResultsBlood filters, system miniaturization, specific primers regional perfusion, adequate flow and temperature and pharmacological therapies with anticoagulants, vasoactive drugs and anti-inflammatories reduced changes in microcirculation and inflammatory response.ConclusionDemonstrated efficacy in animal models establishes a perspective for evaluating these interventions in clinical practice.

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Background: Acute graft-versus-host disease (GVHD) usually occurs by 8 weeks after liver transplantation (LT) usually is an uncommon complication but has both high mortality and major diagnostic challenge in addition most of them are associated with resistance to steroid therapy. Objective: Discuss the pathogenesis, treatment and long-term results of Acute Graft versus Host Disease after Liver Transplantation. Methods: A PubMed search was performed to identify all reported cases of GVHD following LT. The medical subject heading GVHD disease was used in combination with LT, including adults (19 + years) and children. The bibliographies of the articles found though PubMed were then searched for further reports of GVHD. Results: We reviewed 102 cases of acute GVHD, 96 (94.1%) adults and 6 (5.8%) children. After treatment 24 (25%) adults and 3 (50%) children were alive only. As far as the treatment of GVHD is concern the therapy used in adults and in children patients was respectively : anti-thymocyte globulin + prednisolone -19 (19.5%); interleukin-2 receptor blocker -17 (17.5%); OKT3 -12 (12.3%); cyclosporine -9 (9,2% ); others -39 (40.2%) and in children anti-thymocyte globulin -1 (20%); anti-thymocyte globulin + prednisolone -1 (20%); prednisolone -1 (20%); anti-thymocyte globulin + prednisolone + interleukin-2 receptor blocker-1 (20%); not mentioned -1.There was no standard treatment of acute GVHD for both children and adults. Conclusion: Although acute GVHD following LT is rare complication and mortality is still very high, there is no consensus for the treatment of steroid-refractory forms. Further researches are needed to provide new approach for treating effectively such condition.