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Our purpose was to determine if the presence of duodenal diverticula predisposes to the development of pancreaticobiliary disease. Between May 1999 and February 2001, 381 patients were examined by endoscopic retrograde cholangiopancreaticography. Of these patients, 51 had periampullary diverticula. In 27 patients the papilla was located inside the diverticulum (Group I), in 19 patients it was located at the edge of the diverticulum (Group II), and 5 patients it was located at a distance closer than 3 cm to the diverticulum (Group III). Seventeen patients in group I and 11 patients in group II had had a previous cholecystectomy. The overall incidence of biliary system stone disease was 22.2% in group I, 36.8% in group II, and 100% in group III. All patients were treated with endoscopic sphincterotomy and three (two in group I and one in group II) developed biliary system disease (cholangitis or pancreatitis). We think that sphincterotomy should be applied regardless of the presence of stone if the papilla is located inside or at the edge of the diverticulum. If the papilla is located 3 cm or more far for diverticulum, it should be considered within the frame of general sphincterotomy indications in the absence of stone disease.

Hepatic ischaemia-reperfusion injury is a serious problem that occurs during various surgical operations such as liver transplantation, surgical revascularization, and partial organ resection. Different pharmacological agents have been used for the protection of organ function and for extending the tolerable ischaemic interval after the ischaemic insult. We aimed to determine the presence of 8-hydroxydeoxyguanosine (8-OHdG) in the DNA from liver undergoing ischaemia-reperfusion, and also to evaluate the protective effects of N-acetylcysteine (NAC) and EGb761 (Ginkgo biloba extract) against hepatic oxidative DNA damage. A total of 40 rats were divided into four groups of 10 animals each (sham-operation group, control group, NAC group, and EGb761 group). Oxidative damage to DNA was evaluated by measuring the increase in 8-OHdG formation in liver tissue and also the effects of NAC and EGb761 pretreatment. Hepatic ischaemia for 90 min followed by reperfusion caused a marked increase in tissue levels of 8-OHdG, thiobarbituric acid-reactive substance, serum ALT, AST and LDH activities compared to sham-operated group. Pretreatment with both NAC and EGb761 clearly diminished 8-OHdG formation and lipid peroxidation. These findings suggest that antioxidant molecules such as NAC and EGb761 may be useful in preventing postischaemic reperfusion injury in hepatic tissue.

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