Portal biliopathy was reversed in 38 of 43 patients by either portosystemic shunting or splenectomy-devascularization. In five patients, direct biliary decompressive procedures were required because of shunt blockage or a non-reversible biliary stricture.

Purely laparoscopic MH is feasible and safe. Simultaneous RFA and bilobar resection should probably be avoided.

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Mucormycosis of the gastrointestinal tract is a rare infection that usually occurs in patients who are immunocompromised and carries a high mortality. We report four cases of gastrointestinal mucormycosis seen over a one year period with different presentations, risk factors and different anatomical sites of involvement. A preoperative diagnosis was made only in one patient. All underwent surgery, three survived and one died postoperatively from multiorgan failure.

Though tuberculosis of the biliary tract is rare, it needs to be considered in the differential diagnosis of patients with biliary obstruction especially in countries where the disease is endemic.

Background. The Pringle maneuver is widely used in liver surgery to reduce intraoperative blood loss.1 However, total vascular inflow occlusion is frequently associated with ischemia reperfusion injury leading to postoperative liver dysfunction and impaired recovery. 2-4We describe herein an original procedure of modified Pringle maneuver (MPM) during laparoscopic liver resection with selective clamping of hepatic arterial inflow. Methods. Of 183 laparoscopic major hepatectomies performed at the Institute Mutualiste Montsouris between January 1998 and March 2014, 19 patients required vascular clamping, and MPM was used in 6 patients. The video showed this procedure in a 58-year-old woman with multiple colorectal liver metastases planned for laparoscopic right trisectionectomy. After the division of the right hepatic artery and the right portal vein, the parenchymal transection was performed with 12 mm Hg of pneumoperitoneum pressure using MPM in order to control the bleeding. Results. The total operative time was 187 min and estimated blood loss was 70 ml. A right trisectionectomy were performed successfully with a purely laparoscopic procedure. After an uneventful postoperative recovery, the patient was discharged on the fifth postoperative day. Among 6 patients in whom this technique was applied, only one patient experienced grade II postoperative liver failure according to Clavien-Dindo classification. Conclusions. Selective clamping of hepatic arterial inflow may be a preferred surgical strategy for high-risk patients, with elective application of this maneuver preemptively in all cases where excessive bleeding is anticipated. Electronic supplementary material The online version of this article CONFLICT OF INTEREST

This paper deals with detection of macro-level crack type damage in rectangular E-Glass fiber/Epoxy resin (LY556) laminated composite plates using modal analysis. Composite plate-like structures are widely found in aerospace and automotive structural applications which are susceptible to damages. The formation of cracks in a structure that undergoes vibration may lead to catastrophic events such as structural failure, thus detection of such occurrences is considered necessary. In this research, a novel technique called as node-releasing technique in Finite Element Analysis (FEA), which was not attempted by the earlier researchers, is used to model the perpendicular cracks (the type of damage mostly considered in all the pioneering research works) and also slant cracks (a new type of damage considered in the present work) of various depths and lengths for Unidirectional Laminate (UDL) ([0]S and [45]S) composite layered configurations using commercial FE code Ansys, thus simulating the actual damage scenario. Another novelty of the present work is that the crack is modeled with partial depth along the thickness of the plate, instead of the through the thickness crack which has been of major focus in the literature so far, in order to include the possibility of existence of the crack up to certain layers in the laminated composite structures. The experimental modal analysis is carried out to validate the numerical model. Using central difference approximation method, the modal curvature is determined from the displacement mode shapes which are obtained via finite element analysis. The damage indicators investigated in this paper are Normalized Curvature Damage Factor (NCDF) and modal strain energy-based methods such as Strain Energy Difference (SED) and Damage Index (DI). It is concluded that, all the three damage detection algorithms detect the transverse crack clearly. In addition, the damage indicator NCDF seems to be more effective than the other two, particularly when the detection is for damage inclined to the longitudinal axis of the plate. The proposed method will provide the base data for implementing online structural health monitoring of structures using technologies such as Machine Learning, Artificial Intelligence, etc.

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