Dilatation of the cystic duct appears to be rare but was demonstrated in the patient illustrated below. A 36-year-old man was investigated because of upper abdominal symptoms including abdominal pain. Blood tests revealed a minor elevation of bilirubin (1.7 mg/dl, 29 μmol/l) and a mild elevation of alanine aminotransferase and gamma-glutamyl transpeptidase. An ultrasound study showed a dilated bile duct, mild dilatation of intrahepatic ducts and minor thickening of the wall of the gallbladder. MRCP revealed a dilated lower bile duct and marked dilatation of the portion of the cystic duct that entered the bile duct (Figure 1).
Other images showed that the junction of the cystic duct and bile duct was widely patent. Tipifarnib in vitro Figure 2 demonstrates a narrow distal bile duct (short arrow), the main pancreatic duct (long arrows) and a long common channel (thick arrow). As the cyst appeared to spare at least some of the common hepatic duct, it was classified as type IB with atypical involvement of a portion of the cystic LDK378 duct. He was treated by cyst excision, cholecystectomy and Roux-en-Y hepaticojejunostomy to correct the extrahepatic obstruction and to minimize the risk of malignant change within the cyst wall. “
“A national viral hepatitis therapy program was launched in
Taiwan in October 2003. This study aimed to assess the impact of the program on reduction of end-stage liver disease burden. Profiles of national registries of households, cancers and death certificates were used to derive incidence and mortality MCE of end-stage liver diseases from 2000 to 2011. The age-gender-adjusted incidence and mortality rates of hepatocellular carcinoma (HCC) and chronic liver diseases and cirrhosis of adults aged 30-69 years were compared before and after launching the program using Poisson regression models. A total of 157,570 and 61,823 patients (15-25% of the eligible for reimbursed treatment) received therapy for chronic hepatitis B and C, respectively,
by 2011. There were 42,526 chronic liver diseases and cirrhosis deaths, 47,392 HCC deaths, and 74,832 incident HCC cases occurred in 140,814,448 person-years from 2000 to 2011. Male gender and elder age were associated with a significantly increased risk of chronic liver diseases and cirrhosis and HCC. The mortality and incidence rates of the end-stage liver diseases decreased continuously from 2000-2003 (before therapy program) through 2004-2007 to 2008-2011 in all age and gender groups. The age-gender-adjusted rate ratio (95% confidence interval, p-value) in 2008-2011 was 0.78 (0.76-0.80, p<0.001) for chronic liver diseases and cirrhosis mortality, 0.76 (0.75-0.78, p<0.005) for HCC mortality, and 0.86 (0.85-0.88, p<0.