ObjectiveTo evaluate the effectiveness of noradrenaline for the treatment of hepatorenal syndrome (HRS).BackgroundHRS represents the development of renal failure in cirrhotic patients. The standard treatment for HRS is terlipressin, which, as opposed to noradrenaline, is more expensive and less accessible in most tertiary care centers.Patients and methodsThirty consecutive patients with HRS type 1 received noradrenaline (1–4.0 mg/hour) and albumin for 14 days. The parameters recorded were: serum creatinine levels, creatinine clearance, mean arterial pressure (MAP), urine output, and serum sodium levels evaluated at baseline and on treatment days 1, 3, 7, and 14.ResultsMost patients achieved serum creatinine levels <1.5 mg/dL and were considered responders (22/30, 73%), whereas eight patients (27%) were nonresponders. At baseline, responders and nonresponders differed only regarding initial bilirubin levels and international normalized ratio values. Treatment duration was 7.5±3.2 days. Responders experienced a significant (p<0.05) decrease in serum creatinine levels (from 3.26±0.48 to 1.28±0.14 mg/dL), as well as a significant increase (p<0.05) in creatinine clearance (from 21±4.1 to 67.7±12.1 mL/min), urine output (from 583±41.1 to 1163±105 mL/day), MAP (from 79.2±2.94 to 93.9±2.34 mmHg), and serum sodium levels (from 125±2.01 to 132.3±1.39 mEq/L). In nonresponders, the MAP increased, but serum creatinine levels also increased, reflecting a decrease in creatinine clearance and urine output, with no significant change in serum sodium levels over the duration of the treatment.ConclusionIn most patients, noradrenaline treatment induced systemic vasoconstriction resulting in HRS reversal, with acceptable safety, in agreement with previously reported outcomes of terlipressin treatment.

Water is the most vital source and one of the precious natural resources of this planet. Due to industrialization and urbanization ground water quality is adversely affected. According to WHO, nearly 80% of all the diseases in human beings are caused by water. Many of the people of Mangalam, near Tirupathi, Andhra Pradesh, India are affected by pollution of drinking water. In the present study an attempt was made to assess the quality of ground water and its suitability for drinking purpose. EXPERIMENTAL Water samples and chemicalsFor the analysis of physicochemical parameters, 8 areas were selected located in and around Mangalam, near Tirupathi, India. The ground water samples were collected in clean and dry

INTRODUCTIONThe common hepatic artery originates from coeliac trunk, a branch of abdominal aorta, along with splenic and left gastric arteries. After its origin, it gives a gastroduodenal branch which heads downwards posterior to the pyloric part of stomach and the first part of duodenum. The hepatic artery proper arises from the common hepatic artery as one of the terminal branches and reaches the porta hepatis through the right free margin of the lesser omentum where it lies anterior to the portal vein and to the left of bile duct. The right gastric artery usually arises from hepatic artery proper. Hepatic artery proper then divides into right and left branches which supply the right and left lobes of the liver respectively. The gall bladder is supplied by a cystic branch from the right hepatic artery. Although variations of the branching pattern and distribution of the common hepatic artery are common, variations in its origin and course are relatively rare and are important in surgical and radiological point of view. One of the rare origins of the hepatic artery is from the superior mesenteric artery. With the advent of new diagnostic, therapeutic and operative techniques within the abdominal cavity, a sound knowledge of the variant courses of the abdominal vessels become important for dealing clinicians, surgeons and interventional radiologists. Surgeons undertaking hepatobiliary and gastric surgery must be acquainted with the anatomy of common hepatic artery and should be able to recognize its multiple anatomical variants to avoid subsequent thrombosis leading to ischaemia of the liver or bile duct and stomach with distressing consequences. The present study was carried out to document the normal anatomy and different variations of the common hepatic artery and to evaluate the possible clinical implications. Methods: A total of 36 properly embalmed and formalin fixed cadavers were dissected in the abdominal region and viscera were mobilized to expose the origin of important branches of the common hepatic artery. Results: Classical branching pattern of common hepatic artery was seen in 91.66% cases. Origin of right hepatic artery from superior mesenteric artery and accessory cystic artery from gastroduodenal artery was seen in 2.77% cases. In 5.55% cases, right gastric artery originated from left hepatic artery. Conclusions: Knowledge of such variations will play a significant role in avoiding technical difficulties during infusion therapy and chemoembolization of neoplasm in the liver. It is also valuable in carrying out surgical intervention safely in the abdomen and also in the interpretation of angiographic reports.

No abstract

No abstract