The risk of ischemia of segment IV after split liver resection is high. This anatomical study was done to identify the arterial blood supply and the intrahepatic distribution of liver segment IV. The anatomy of segment IV was studied in 29 livers from adult cadavers. To identify the arterial blood supply of segment IV, water and ink were injected into the various branches of the hepatic artery and the outflow through segment IV and discoloration of the liver parenchyma were observed. In 23 of the 29 livers (79.3%), the arterial perfusion of segment IV was separated by a line drawn from the left side of the inferior vena cava at the top of and lateral to the falciform ligament to the medial point of the gallbladder bed. The area lateral to this line was supplied mainly by the right hepatic artery, and the area medial to it was supplied mainly by the left hepatic artery. In addition to the classification system of Couinaud, we describe here a new division of liver segment IV based on arterial blood supply. These anatomical findings may be useful in defining the resection line for split liver to prevent necrosis of segment IV.
Background: Vaginal delivery is a physiological process that holds multiple complications. Perineal trauma and vaginal laceration is considered a common complication associated with vaginal delivery. Well established risk factors, recognized by the Royal College of Obstetricians and Gynecologists, are ethnicity, birth weight over 4 kg, persistent occipital posterior position, nulliparity, induction of labor, shoulder dystocia, instrumental delivery. There are other risk factors that were suggested in the literature but data are conflicting, such as Prolonged second stage of labor, episiotomy and obesity Objectives: This study aimed to evaluate third and fourth degree tears rates and the impact of related risk factors on perineal tears in a single Saudi center. Study Design: A retrospective observational cohort study. Methods: This retrospective cohort study analyzed all vaginal deliveries from January 2011 to December 2015 in Security Forces Hospital, Riyadh, Saudi Arabia. The Hospital has around 6000 deliveries per year. Data were extracted from dedicated database software for antenatal care through Hospital System (Medical Record Viewer-MRV) and from Midwife Head Nurse daily record system. Results: During the period of interest 28325 records were identified. Caesarean section was performed in 7322 of them (25.8%). Of the remaining 21003 records, 20300 were included in the study according to the inclusion criteria mentioned above. 56 patients (0.28%) had a severe perineal tear because of delivery and were included in group A (Study Group). Group B (Control Group) consisted of remaining 20244 patients. Univariate analysis indicated the following as risk factors for severe perineal tears: gestational age >40 weeks, nulliparity, moderate/ severe obesity, instrumental delivery, shoulder dystocia, pushing stage >90 min, birth weight >4 kg, head circumference at birth >34 cm and length at birth >50 cm. Risk factors still significant in the final multivariate model were moderate/severe obesity (OR=2.8, CI=1.3-6.1), instrumental delivery (OR=2.6, CI=1.2-5.6) and birth weight (OR=1.1/hg, CI=1.1-1.2). Conclusions: Moderate/severe obesity, vacuum delivery and fetal weight resulted as independent risk factors for severe obstetrical tears.
Power lines or underground power cables generate electromagnetic interaction with other objects near to them. This study evaluates the magnetic field emitted by underground extra high voltage cables. The presented work aims to show a numerical simulation of the magnetic field of a buried 400 kV underground power line, which is used as a novel prototype in several countries at a short distance. The underground power cable study, in the presence of the current harmonics at different positions, with time variation by finite element resolution, using Comsol Multiphysics with Matlab software in two dimensions. The simulation results illustrate the magnetic flux density variation-in terms of amplitude and distribution as a function of different actual harmonics rates. The underground cable performance and magnetic field have affected by the harmonics effects. The maximum magnetic induction levels generated by significant harmonics are superior to the limits recommended by the international standard norms. In this paper, shielding has been used as an appropriate remedy to attenuate the magnetic field.
BackgroundBariatric surgery is one of the most effective interventions for morbid obesity. Despite its benefits, unwanted consequences such as dumping syndrome (DS) have been reported following the procedure. This study aims to estimate the prevalence of DS and identify the factors associated with it in Saudi Arabia. MethodologyThis cross-sectional study collected data from patients who underwent bariatric surgery at King Fahad General Hospital, Jeddah, Saudi Arabia, in 2019-2020. A validated questionnaire was used to collect the data. The questionnaire included demographic items such as age and sex and items relating to DS such as nausea, vomiting, and palpitations. A modified version of the Sigstad diagnostic scoring system was used to confirm the diagnosis. ResultsOf the 240 investigated cases, two-thirds (67.5%) were females. The most reported symptoms were nausea (37.9%), vomiting (36.7%), desire to lie down (25.5%), restlessness (25.5%), and abdominal fullness (23.7%). Based on the modified Sigstad diagnostic scoring system, 75 (31.4%) patients met the criteria for DS. The bivariate analysis showed the prevalence was significantly higher in females (36.4%), those with university qualifications (40.3%), and those with high monthly income (62.5%) (p<0.05). Also, dietary behaviors in terms of frequency, size of meals, and drinking liquids with meals were significantly associated with the prevalence of DS, where the lowest prevalence was recorded among those who ate more than one small meal (10.9%), while the highest prevalence was found in those who ate more than one large meal (81.8%); also, the prevalence was significantly higher in patients who drank liquids with meals (40.8%) than those who drank liquids between meals (26.8%) (p<0.05). ConclusionIn this single institutional study, we report a 31.4% prevalence of DS among our cohort. The predictors of the syndrome include gender, education level, monthly income, eating more than one large meal per day, and drinking liquids with meals. In the future, these predictors will be explained to patients before and after bariatric surgery to reduce the prevalence of such inconvenient syndromes.
Aim of the study: Liver regeneration after hemi-hepatectomy may be affected by several growth factors and cytokines. The aim is to evaluate the importance of interleukin 6 (IL-6) in the induction of liver cell regeneration and find correlations with other parameters such as liver enzymes, and DNA analysis by flow cytometric studies. Material and methods: 80 adult male Sprague-Dawley rats were obtained and divided into two equal groups (n = 40 rats) to undergo 70% partial hepatectomy: group 1 -untreated (control) group; 40 rats not treated; and group 2 -treated group, 40 rats treated with IL-6 35 µg/100 gm body weight according to a lethality study for a period of 4 days, then hepatic resection was carried out according to the steps of Higgins and Anderson. Assessment of liver enzymes and bilirubin level was done. Flow cytometric study was done using a flow cytometer (FACSCalibur; Becton Dickinson) and DNA content was estimated with CellQuest software (Becton Dickinson). Results: The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were significantly higher in the untreated group of rats with liver resection. A higher value of bilirubin was observed in the treated group. Rat weight at sacrification was significantly lower in the group of rats treated with IL-6 than those without treatment, p < 0.001. Liver weight at sacrification was significantly higher in the group of rats treated with IL-6 (p < 0.001). The percentage of apoptotic cells with hypodiploid DNA content was determined from DNA histograms. Untreated rat resected liver showed a peak pattern that represented liver damage with high damage of 73.4%. Conclusions: Interleukin 6 is of value in induction of liver cell regeneration after seventy percent hemi-hepatectomy as evident by increased liver cell mass, liver enzymes and flow cytometric analysis.
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