Day 1 :
Keynote Forum
Dr. Hendrick Reynaert
Vrije University, Belgium
Keynote: Management of NAFLD in patients with DMT2
Time : 9:20 - 10:00
Biography:
H Reynaert, MD, PhD is a Professor of Physiology and Pathophysiology at the Vrije Universiteit Brussel. He is Head of the Hepatology unit at the University Hospital Brussels (UZ Brussel) and Senior Researcher in the Liver Cell Biology lab at the Vrije Universiteit Brussel. He is the past President of the Belgian Association for Study of the Liver (BASL) and current President of the Flemish Society of Gastroenterology (VVGE). He is the member of many national and international societies, including AASLD, EASL, and AGA. He is interested in many aspects of liver disease, including cirrhosis and its complications, viral hepatitis and Non-Alcoholic Liver Disease (NAFLD).
Abstract:
Non-Alcoholic Fatty Liver Disease (NAFLD) is defined by the presence of steatosis in >5% of hepatocytes. It comprises the spectrum of simple steatosis (Non-Alcoholic Fatty Liver or NAFL), and a progressive form, Non-Alcoholic Steatohepatitis (NASH), in which steatosis is accompanied by inflammation, fibrosis or even cirrhosis and hepatocellular carcinoma. NAFLD is associated with insulin resistance and its prevalence is increasing rapidly, paralleling the prevalence of metabolic syndrome. It is estimated that in some countries 30% of the population has NAFLD, but the prevalence in patients with diabetes mellitus type 2 (DMT2) is much higher. Moreover, in DMT2 patients, NASH is more prevalent. Therefore, it is imperative to screen patients with DMT2. In recent years, non-invasive methods to identify patients at risk have been developed. These include imaging techniques and several scoring systems consisting of clinical and biological data. In high risk patients, liver biopsy, which remains the gold standard for diagnosing and grading disease severity, should be performed. Patients at risk should be treated and strict follow-up to detect complications early is essential. We suggest an algorithm as depicted in Figure 1. Treatment of NASH is difficult and unsatisfactory. Weight loss by diet and life style changes (exercise) remains the cornerstone of treatment. It has been shown that ≥7% weight loss resulted in histological improvement. Weight loss is however problematic in this patient group: bariatric surgery improves all histological lesions in NASH including fibrosis. Up to now, no drug treatment has been shown to unequivocally improve NASH. PPAR-gamma agonists, vitamin E, FXR agonists, GLP-1 agonists and PPAR-alpha/delta agonists have shown favorable effects, but large phase 3 trials are lacking. A multitude of new drugs, targeting different metabolic pathways are being developed and tested. Hopefully, we will be able to treat patients with NASH more optimally in the near future.
Keynote Forum
Ali Ghannam
CGMH Kaohsiung, Taiwan
Keynote: Microscopic hepatico biliary anastomosis in staged adult living liver transplant is a safe and accessible choice
Time : 10:00-10:40
Biography:
Ali Ghannam has analyzed and studied surgical technique by microscope in liver transplant surgery. He did special comparison between microscopic duct to duct and enteric hepatico biliary anastomosis of the different cases of adult split liver transplant. He has experience as Hapatico Biliary Pancreatic Laparoscopic Surgeon from Al Bashir Hospital in Amman, Jordan. He joined Liver Transplant Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan as a Researcher and Clinical Fellow in Liver Surgery and Liver Transplant for one year. He established and organized the data for future study in the Field of Microscopic Biliary Drainage Split Liver Transplant. This analysis made the surgical practice in split liver transplant updated and evidenced by clinical based medicine.
Abstract:
Statement of Problem: Staged liver transplant is a solving problem for cases of transplant associated with portal hypertension and massive bleeding from the raw surfaces due to previous liver resection and retransplant. Usually biliary reconstruction is postponed 24-48 hours till coagulopathy and circulatory stability improved. There is a known complication of biliary drainage including stricture and leak which is not only a serious morbidity but also associated with increased mortality.
Purpose: The purpose of the study is to focus on hepatico biliary anastomosis and biliary drainage as a choice in staged liver transplant, defined in the previous study. In our experience, we preferred to do enteric drainage and we find it accessible by microscopic surgery.
Methodology & Theoretical Orientation: Long term study of the whole cases of liver transplant in our center has been studied. Total number of 40 cases of staged adult living liver transplant has been grouped in to two groups. Group A of staged biliary duct to duct (12 cases) and group B enteric hepaticobiliary (28) anastomosis has been compared in our study.
Findings: Microscopic technique in staged split liver living adult transplant enteric biliary drainage is a choice practiced in our center with acceptable complication.
Conclusion & Significance: The operative plan for staged living liver transplant can include enteric drainage of biliary system. Era of microscopic surgery in hepatico biliary drainage can be applied in challenging cases of portal hypertension, high child’s grade and intraoperative massive blood loss.
Recommendation & Treatment: Microscopic surgery is applied in vascular surgery and now it is also applied for biliary drainage procedure. Complicated cases of living split liver adult transplant biliary drainage by duct to duct anastomosis and classic Roux-en-Y hepatic jejunal anastomosis is carrying the same results.
Keynote Forum
Hani Oweira
Hirslanden Hospital, Switzerland Group Photo 11:
Keynote: Surgery of the Liver and intraoperative interventional Therapies What is possible today?
Biography:
Praxis Dr. Hani Oweira is a Partner of the Surgical Center Zurich. He was affiliated doctor at the Andreas Clinic Cham train
Abstract:
Liver resections are performed to manage Benign and Malignant focal lesions in the liver, and the post-operative outcome was improved over time due to improvement of surgical techniques which get benefit from understanding the liver anatomy and segmentation with improvement of hemostasis techniques. Anatomy wise liver is divided to 2 lobes (Right and left) ant into 8 segments classified by Couinaud based on vascular inflow and outflow. There are many techniques for liver parenchymal transection started with clamp –crush technique and developed to ultrasonic vibration (harmonic shear), Cavitron Ultrasound Surgical Aspirator CUSA), hydro jet, radiofrequency dissector and recently staplers. There are numerous types of resection could be divided to major (>2 segments) and minor (<2 segments) and could be divided into anatomical (right and left hepatectomy, right anterior and posterior sectionectomy and left lateral sectionectomy), non-anatomical resection and individual segmentectomy. There are many other interventional procedures can be done during surgery for hepatic focal lesions rather than surgery as radiofrequency ablation (RFA), cryoablation or irreversible electroporation (IRE) which usually kept as combined intervention with surgery in deep parenchymal lesions which difficult to be removed without injuring or scarifying a major hepatic structure. Also one of the elegant technique in management of hepatic focal lesions especially Malignant one is adjuvant or pre operatiove angio-embolization or chemo/ radio embolization which deprive the lesion from its blood supply and supplying it with chemo or radiotherapy which may decrease the size of lesion and make it easier and accessible to be removed. In addition to that, systemic chemotherapy could have benefit in malignant lesions as it may decrease the size of the lesions and minimize the liver parenchyma needed to be resected to remove the whole lesion, and sometimes it
changes non resectable liver lesions to resectable one.
Keynote Forum
Dr. Amin El-Gohary,
Burjeel Hospital, UAE
Keynote: Vomiting of Surgical Significance
Time : 09:30-10:10
Biography:
Prof. Dr. Amin El-Gohary completed his MBBCh in 1972 and his Diploma in General Surgery in 1975 at Cairo University, Egypt. He became the Chief and Head of the Department of Pediatric Surgery of a large government hospital. He also held post as the Clinical Dean of Gulf Medical College, Ajman for 3 years. Prof. Dr. Amin is well known in Abu Dhabi for his extensive interest and involvement in scientific activities. He was the President of the Pediatric Surgical Association of UAE. Prof. Amin is a member of several associations in Paediatric surgery: Executive Member of the International Society of Intersex and Hypospadias Disorder (ISHID), British Association of Pediatric Surgery, Egyptian Association of Pediatric Surgeons, Asian Association of Pediatric Surgeons, and Pan African Association of Pediatric Surgery. He is also the founder and member of the Arab Association of Pediatric Surgeons.
Abstract:
Vomiting is common symptoms among neonates, infants and children and the majority are managed by pediatrician or pediatric gastroenterologist. However there are types of vomiting that should be referred and managed by pediatric surgeons. These include the following:
1- Bilious vomiting however small or intermittent
2- Projectile vomiting
3- Frothy neonates
The cardinal signs and symptoms of bowel obstruction are : vomiting, abdominal distension , abdominal pain and constipation. Of which bilious vomiting is considered the most important sign. Any Baby who vomits bile should be considered as having an underling intestinal obstruction until proved otherwise
Mal-rotation in particular carries a high mortality rate if associated with volvulus , despite its minimal symptoms in the form of intermittent bilious vomiting.
The presentation highlights the different pathological condition associated with vomiting, and their clinical, radiological and surgical management.
- Liver Fibrosis|Liver Cancer|Liver Inflammation and Immunology
Location: 1
Chair
Hendrick Reynaert
Vrije University, Belgium
Co-Chair
Hani Oweira,
Hirslanden Hospital, Switzerland
Session Introduction
Maridi Aerts
University Hospital in Brussels, Belgium
Title: High prevalence of advanced NAFLD in patients with DMT2
Biography:
M Aerts is currently working at the University Hospital in Brussels, UZ-Brussel. She is a staff member of the Gastroenterology/Hepatology Department since 2012.
Abstract:
Background: NAFLD is a multifactorial disease with an enormous increase in prevalence worldwide. It is known that patients with diabetes mellitus type 2 (DMT2) are at higher risk of developing NAFLD and are more likely to progress to more severe disease.
Methods: Patients with DMT2 presenting at the diabetes liver clinic were evaluated with abdominal ultrasound (US). If steatosis was present, they underwent a Fibroscan® or elastography (ARFI) and a blood test. Risk scores, (NAFLD fibrosis score and Antwerp NASH score) were calculated to estimate the presence of NASH and/or advanced fibrosis.
Results: 112 patients underwent US, of which 90 (55 male, 35 female) had steatosis (80%). Mean age was 57.2 yrs (range 40 - 78). All patients with steatosis on US underwent Fibroscan® (11) or elastography (75) or both (4). 22 patients (24%) had ≥F2 fibrosis (Fibroscan® > 7.2 kPa or elastography >1.32m/s). 7 patients (8%) had F4 fibrosis, (Fibroscan® >14.5 kPa, or ARFI>1.87. The NAFLD fibrosis score was calculated in 90 patients. In 19 patients (21%) the NAFLD fibrosis score was > 0.676, suggestive for ≥F3 fibrosis; only in 10 patients (11%) the score was < -1.455, excluding significant fibrosis. The remainder (68%) had an intermediate score. The Antwerp NASH score was calculated in 86 patients. In 31 patients (36%) the score was > 1.34,
suggestive for NASH; in 9 patients (10.5%) this score was < -1.34, excluding NASH.
Conclusions: Our results confirm that NAFLD is very common in DMT2 patients. Moreover, many patients are at risk for developing NASH and/or advanced fibrosis. These patients should be followed-up closely to detect complications early. Awareness of this progressive disease among diabetologists and hepatologists is vital to identify patients who need close followup and hopefully specific treatment in the near future.
Reju George Thomas
Chonnam National University Hwasun Hospital, South Korea
Title: Chitosan bilirubin nanoparticles loaded with losartan as nanomedicine for Liver Fibrosis therapy
Biography:
Reju George Thomas has completed his MTech in Nanotechnology from Amrita Institute of Nanosciences and Molecular Medicine (ACNSMM), India during 2010- 2012 and PhD from Chonnam National University (Feb 2016). Currently, he is doing Post-doctoral research under Prof. Yong Yeong Jeong developing theranostic nanoparticles and conducting pre-clinical testing at Clinical Vaccine R&D Centre of Chonnam National University Hwasun Hospital.
Abstract:
Bilirubin is hydrophobic in nature and glycol chitosan was covalently attached to this compound via a stable amide bond resulting in chitosan bilirubin (ChiBil). ChiBil is found to have ability to undergo a solubility switch from hydrophobic to hydrophilic in response to intrinsic ROS. Advanced liver fibrosis is a condition characterized by ROS stress and metabolical effects in hepatocytes. In our study, we use ChiBil as a ROS quenching, anti-inflammatory agent which also have ability to load hydrophobic or hydrophilic drug against progression of fibrosis. Therefore, we have loaded losartan, a hyperthensive drug which is proven to have anti-fibrosis effect also, inside ChiBil. We have developed liver fibrosis model in C3H/HeN mice by administering thioacetamide and ethanol. ChiBil-losartan was injected through intravenous route in 3 dosages for a period of 9 days. Finally, we analyzed hepatic histopathology and biochemical estimation, respectively. We observed a dosage dependent improvement of hepatic fibrosis and biochemical examination (AST/ALT ratio) in the ChiBil-losartan treated group. ChiBillosartan micelles might be useful in reduction of mice hepatic fibrosis model.
Ahmed S. Ibraheem
Sohag University, Egypt
Title: Single or combined cadmium and aluminum intoxication of mice liver and kidney with possible effect of zinc
Biography:
Ahmed S Ibraheem has obtsined his PhD from Virginia Common Wealth University in 2004 and then moved to Sohag University Egypt. Later, he temporaryly started working at Hail University, KSA. The field of specialization for him is Immunology with special focus on Autoimmunity.
Abstract:
In this study, we planned to test toxic effects of cadmium, aluminum either alone or combined with each other on sensitive organs as kidney and liver. The cadmium alone decreased the animal’s body weight. Meanwhile, aluminum did not affect the changes in body weight of cadmium treated animals; adding the zinc significantly reduced the loss of body weight. Serum creatinine and urea were significantly lower in treated group than in control group. Cadmium and aluminum or combination of them resulted in a significant increase in serum GPT and GOT activity. Zinc did not prevent the changes caused by aluminum, however, the changes resulted by cadmium intoxication were almost healed or ameliorated by zinc. Treating with Zn alone resulted in drastic effects on kidney tissues more than either cadmium or aluminum. Treating with cadmium or aluminum resulted in infiltration of the liver parenchyma with lymphocytes, fibrosis, micro vesicular steatosis of the hepatocytes for both and appearance of many phagocytic cells, pyknotic cells and vacuolation for cadmium. Combined cadmium and aluminum treatment resulted in less damage than cadmium alone with exception of fatty degeneration. Unexpectedly, zinc induced acute cells exibited vacuolation and steatosis. Cadmium and aluminum combined together did not worsen the situation as expected but was less damaging than cadmium alone, which suggests a possible synergistic effect of combination. Meanwhile, zinc failed to protect kidney from aluminumintoxication, which strengthens the suggestion of two different pathways of cadmium and aluminum intoxication. This finding meant that cadmium is more hepatotoxic than aluminum.
Abdel Rahman Abdulla Al Manasra
Jordan University of Science and Technology, Jordan
Title: Correlation between ultrasound and histologic findings of fatty liver changes among morbidly Obese Patients
Biography:
Abdel Rahman Abdulla Al Manasra, MD, has completed his graduation in 2005 from Jordan University of Science and Technology, Irbid, Jordan with Bachelor’s in Medicine and Surgery. Later, he obtained a higher specialization degree in General Surgery from same university after 5 years of residency training at King Abdullah University Hospital. In 2013, he graduated from the Medical University of South Carolina and became an American Society of Transplant Surgeons’(ASTS) Certified Abdominal Multi Organ Transplant Surgeon. This was followed by a one year of specialized fellowship training in pediatric abdominal transplant surgery. Since 2014, he has been working as a Consultant Abdominal Transplant and Hepatobiliary Surgeon at King Abdullah University Hospital, as well as an Assistant Professor of Surgery at Faculty of Medicine, Jordan University of Science and Technology.
Abstract:
Background & Aim: Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in obese patients and the commonest cause of liver disease in western countries. Although liver biopsy is essential for diagnosis, ultrasound may predict its presence. We aim to evaluate sensitivity, specificity and predictive value of ultrasound in diagnosing NAFLD’s patterns among morbidly obese patients.
Methods: 45 morbidly obese patients submitted to sleeve gastrectomy were prospectively studied. They underwent true cut liver biopsy during the surgery. Classification of histological patterns was based on the NIH-sponsored NASH Clinical Research Network NAFLD Activity Score (NAS). Prior to surgery, patients had an assessment for fatty liver changes by ultrasound (5 grades). The findings from histology (being the gold standard test) and ultrasound (being the test in question) were compared.
Results: 71% of patients were females (32/45). The mean age was 35 (range: 17-58) and the mean BMI was 43 (range: 35-52). The prevalence of NAFLD histologically was 91.8%. 19/45 patients (39%) had non-alcoholic steatohepatitis (NASH) on histology. Ultrasound’s sensitivity, specificity and positive predictive value in diagnosing either NAFLD or NAS were 50%, 85% and 25%; respectively. While its sensitivity, specificity and positive predictive value in diagnosing NASH were 28%, 100% and 100%; respectively. There was significant correlation between ultrasound grades and each of steatosis histologic grades (P<0.001), NAS (score) (P<0.001) and the presence of NASH (P<0.001).
Conclusion: NAFLD has a very high prevalence among morbidly obese patients. Assessment by ultrasound showed an absolute positive predictive value (100%) for NASH. This supports its routine use as a low-cost, non-invasive diagnostic tool for this co-morbidity in morbidly obese patients. The frequently reported low sensitivity of ultrasound may be attributed to technical difficulties inherited by the body habitus of morbidly obese patients. Liver ultrasound may contribute to identify obese patient’s candidate for bariatric surgery.
Mohammad Firoz Alam
Jazan University, Kingdom of Saudi Arabia
Title: Therapeutic Action Mechanism Of Zingerone Against CCl4 Induced Liver Mitochondrial Toxicity in Swiss Albino Mice
Biography:
Mohammad Firoz Alam is working as an Assistant Professor (Toxicology) in the Department of Pharmacology and Toxicology, College of Pharmacy, Jaan University, Jazan since 2010. He has specialisation in Neurotoxicology. Presently, he is engaged in toxicity evaluation of drugs and chemicals on animal models (rat/mice) and its protection management by using phytomedicine or drug. He has more than 11 years of experience in teaching and research at different universities. He is experienced in planning, development and execution of high impact research. He has 5 approved projects from Jazan University. He has successfully finished two projects and three are under progress. He has published 21 articles in peer reviewed journals with ISI Thomson Reuter. He has supervised six Pharm D students in Scientific Research Deanship Student Projects, Jazan University, Jazan, KSA.
Abstract:
Mitochondria are well known for energy source in hepatocytes and play an important role in extensive oxidative metabolism and normal function of the liver. Another important role of mitochondria is it helps in signalling pathways that mediatehepatocyte injury, because impaired mitochondrial function contribute to several chronic liver diseases such as alcohol induced liver diseases, non-alcoholic fatty liver diseases, viral hepatitis, cholestasis and Wilson’s diseases etc. Impairment of the electron transport chain or oxidative phosphorylation causes to decrease oxidative metabolism, decrease ATP synthesis, and also reduce hepatocyte tolerance towards free radical insults. Several drugs, toxins and herbs have been reported to cause liver injury and drugs itself account for 20-40% of all instances of rapid development of hepatic injury. Swiss Albino mice were divided into 5 groups; group 1 was control. Group 2 received CCl4 as (1.5 mg/kg) in oil i.p, twice a week for 15 days. Groups 3 and 4 were pretreated with zingerone 50 and 100 mg/kg b.wt respectively once daily for 15 days. Group 5 was treated with 100 mg zingerone only. The animals were sacrificed on day 16 and livers were taken out to isolate the mitochondria. Results indicated that the content of lipid peroxidation (LPO) was increased significantly and the content of glutathione and activities of antioxidant enzymes; glutathione peroxidase (GPx) glutathione reductase (GR), glutathione-S-transferase (GST), superoxide dismutase (SOD) and catalase (CAT) were decreased significantly in the liver mitochondria of CCl4 treated group as compared to the liver mitochondria of control group. This impairment of mitochondrial changes was protected significantly and dose dependently with the treatment of zingerone in Group 3 and Group 4. Thus the present study indicates that the zingerone which is a part of our daily diet may be used as the best therapeutic potential tool for the prevention of liver injury.
Ahmed S. Ibraheem
Sohag University, Egypt
Title: Establishment of hepatitis model in rat liver induced by injecting extracted DNA: Histopathological study
Biography:
Ahmed S Ibraheem has obtained his PhD from Virginia Common Wealth University in 2004 and then moved to Sohag University Egypt. Later, he temporarily started working at Hail University, KSA. The field of specialization for him is Immunology with special focus on Autoimmunity.
Abstract:
Chronic inflammatory liver diseases can be induced by viral infections, toxic-metabolic factors and/or autoimmune mechanisms. Inflammation or viral infection results in hepatocyte damage or cell lyses which cause DNA or other cell nuclear materials to be released by hepatocytes to serve as auto-antigens that participate in auto-immune hepatitis. Those released cellular materials will be exposed to the immune system before phagocytosis by Kupffer cells. In this study, injecting rats with extracted DNA combined with CFA resulted in hepatitis cellular symptoms. Plasma globulin was increased and liver function enzymes were higher in plasma and lower in liver tissues compared to CFA and control groups. The inflammation was indicated histologically bythe presence of active Kupffer cells, it led to irregularly shaped hepatic lobule, pyknotic cells, vacuolated nucleus and infiltration of liver parenchyma with lymphocytes. Vacuolation of the cells with fatty degeneration and necrotic hepatocytes also, was recorded. It is clear that using cell nuclear materials can induce inflammation that has some hepatitis identity.
Hossein Kargar Jahromi
Jahrom University of Medical Sciences, Iran
Title: Effects of Orchid Root Extract on Hepatic Toxicity Caused by Isoniazid in Rats
Biography:
Hossein Kargar Jahromi has a PhD in Comparative Histology. He is a member of Research Center for Noncommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran and Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom, Iran.
Abstract:
Statement of the Problem: In addition to metabolism of different compounds, detoxification of drugs, environmental pollutants and, in general, of various toxins is one of the important functions of the liver (1). In most cases, during the detoxification process, metabolic activation by cytochrome P450 enzymes in liver microsomes causes production of toxic and active metabolites that can damage various tissues including the liver (2). Isoniazid also, despite its effectiveness in treating tuberculosis, causes acute complications for hepatic cells through the production of free radicals (3, 4). Hepatic toxicity caused by isoniazid can appear as cellular necrosis, steatosis (accumulation of fats), or both. Metabolites of this drug also have toxic effects on liver cells (5) Hydrazine is one of the most important metabolites of isoniazid. Plants have always been considered one of the main options for treating poisoned livers because they are available natural sources of antioxidants. orchid or Dactylorhiza lancibracteata (C. Koch) Renz, formerly named Orchis maculate L., belongs to the family Orchidaceae, has various species, and grows almost everywhere in the world. Its root nodules, which can usually be harvested in early summer, keep their medicinal properties for up to two years (6, 7). Therefore, considering the presence of antioxidant compounds in orchid, and given its protective effect against hepatic toxicity, this research was conducted to study the effects of aqueous extract of this plant against liver poisoning caused by isoniazid in rats.
Methodology & Theoretical Orientation: Rats were randomly place in the 7 eight-member groups of the control, the sham (receiving distilled water), the isoniazid group ( that was given this medicine at 50 mg/kg), and the experimental groups 1, 2, 3, and 4 that received isoniazid at 50 mg/kg together with 40, 80, 160, and 320 mg/kg of the extract. The rats were injected intraperitoneally for 28 days, SPSS was employed to analyze the data, and one-way ANOVA and Duncan’s test were used to compare the groups.
Findings: The groups treated with isoniazid and various doses of the extract significant reductions in serum levels of hepatic enzymes. Comparison of the various doses of the extract indicated the 320 mg/kg dose had the maximum therapeutic effect against hepatic injury caused by isoniazid.
Conclusion & Significance: Orchid extract, probably because of its antioxidant properties, could improve the destructive effects of isoniazid on the liver.