Different modalities of hepatic resection in liver diseases

Blood loss and bile leak remain major issues during liver resection. We aimed to compare the efficacy of two commonly used transaction techniques; the ultrasonic-dissector [UD] and ultrasonic-coagulation-shears [UCS]. 143 consecutive patients were enrolled into a prospective, observational, non-randomized, comparative study, performed from the March 2008 till end of May 2009, in Liver Unit, Queen Elizabeth Hospital, University of Birmingham, UK. Outcomes looked at are blood-loos, speed of transaction and morbidity. Study groups are comparable except that there are more major resections in the UD than in the UCS, [86.9 and 42.4% respectively, p=0.04]. There is no statistically significant difference [SSD] in the mean surface areas of resected liver specimens between the two groups [114 [ +/- 11] versus 94 [ +/- 9] cm[2] [p=0.06]. there is no SSD in the amount of lost blood, amount of blood loss per square centimeters of resection surface area, amount of blood transfused or the percentages of patients, who required blood transfusion, intra- or post-operatively, between the groups. There are no SSD in the mean transaction time, haemostatsis times, mean transaction and haemostasis speeds. The overall "identification of landmarks" score is 4/5 for UD and 3/4 for UCS which is not SSD. The Pringle manoeuvre was resorted to in significantly more patients in the UD than in the UCS [17 [20.2%] and 5 [8.5%] respectively, p=0.03], with mean ischaemic time significantly more in the UD [17 +/- 3] versus 4 [ +/- 4] minutes respectively, p=0.02]. There is no SSD in the magnitude of post-operative liver cell injury reflected by the mean of ALT, AST, bilirubin and INR peak values. There is also no SSD among the two groups regarding postoperative minor [grade 1 and 2] or major [grade 3, 4, and 5] complications, median ICU and hospital stays. This study confirms that both instruments of transaction can be used safely in elective liver resection and it is not possible to recommend any of these two instruments over the other

P300 auditory event related potential in children with attention deficit hyperactivity disorder [ADHD]

The overall purpose of this research was to evaluate children with attention deficit hyperactivity disorder [ADHD], investigate P300 auditory evoked potentials in those children and to compare between medicated and non-medicated children. The study included twenty children aged between 7 and 12 years, with primary diagnosis of ADHD, who participated in this study. All subjects had normal hearing, and they were divided into two groups: non medicated group [10 subjects], and medicated group [10 subjects] under methylphenidate treatment [10mg/day]. They underwent detailed history, psychometric assessment, Otoscopic examination, and basic audiological evaluation and P300 evaluation. The twenty children who participated in the study were free from any gross neurological signs. Majority of the children [14 children - 70%] have had normal age appropriate psychomotor development Sixty per cent came from consanguineous families. Seventy five per cent have had smooth past medical history. Half of the included children have had normal scholastic achievement. The mean general intelligence quotient [IQ] among the studied children was 85.35 [S. 0. 9.65]. The mean percentage score of ADHD was 90.95 [5. D. 10.74]. Among 40 ears [20 right and 20 left] 60% of the subjects did not have any P300, 20% from the medicated group and 40% from non-medicated group. From meditated group 8 ears out of 20 ears [40%] did not show P300, right ears [37.5%] and left ear [62.5%]. For non medicated group 16 ears out of 20 ears [80%] did not showed P300, right ears [44%] and left ear [56%]. There were significantly reduced in P300 latency and increased amplitude in medicated group compared with non-medicated. Multivariate analysis between different variables revealed the following statistically significant correlations: verbal reasoning and P300 latency in medicated group, quantitative reasoning and P300 latency in medicated group, general IQ and P300 latency in non-medicated group and quantitative reasoning and P300 latency in non-medicated group. Children with ADHD need to have thorough and comprehensive psychometric assessment because on general psychological examinations, they may function normally. Also, the medicated subjects have more persistence of P300, which showed reduced latency and increased amplitude than non - medicated group. So, auditory cognitive evoked potential [P300] topography may be able to predict robust response to the stimulant medications in children with ADHD

Role of MR chlangiopancreatography in biliary obstruction- A clinico-radiologic and opreative study

Thirty-five patients with obstructive jaundice suspected clinically [19 males and 16 females, their ages ranged from 5 to 81 years] were included in this study. All patients were subjected to complete medical history, full clinical examination, biochemical study [liver function tests and hepatitis markers], abdominal US and magnetic resonance cholangiopancreatography [MRCP]. Twenty-three patients were operated upon. ERCP was done in nine patients as well as percutaneous transhepatic cholangiography [PTC] and drainage transhepatic cholangiography [PTD] in two patients. One patient was diagnosed by ultrasound [US] and MRCP to have primary sclerosing cholangitis. MRCP images revealed extrahepatic biliary obstruction in 34 cases with good quality images. It demonstrated the levels of obstruction in all patients but diagnosed their causes in 33 only [16 were malignant, 11 calcular, one primary sclerosing cholangitis, 3 post-cholecystectomy stricture of CBD, one papillary stenosis and one chronic pancreatitis]. In two patients, there was a distal obstruction of undetermined origin by MRCP and one patient had calcular obstruction by ERCP [false -ve]

Is the postoperative hypocalcemia after subtotal thyroidectomy for thyrotoxicosis considered a surgical complication?

This study included sixty patients who had subtotal thyroidectomy for thyrotoxicosis. Serum calcium was calculated for every patient preoperatively and on the second postoperative day. PTH level was also measured for every patient on the second postoperative day. Fourteen patients developed postoperative biochemical hypocalcemia and five patients had manifest tetany. PTH and postoperative serum calcium showed insignificant relation. There was no permanent hypocalcemia in this series. The results suggested that the postoperative serum calcium in patients subjected to subtotal thyroidectomy for thyrotoxicosis is directly related to the period of preparation of thyrotoxic patient [the shortest the period the more liability for postoperative hypocalcemia], the level of preoperative serum calcium [the more hypercalcemia, which was due to severe thyrotoxic osteodystrophy, the more liability for postoperative hypocalcemia]. There is no clear evidence for a radical change in surgical teaching from the lateral ligation of the inferior thyroid arteries to protect the recurrent laryngeal nerve

Human fascioliasis in Assiut suburb, Upper Egypt

During this study, a case of human fascioliasis was recorded for the first time from Upper Egypt. Two mature flukes were released from the bile duct of 29-year old female patient. The encountered worms were washed, flattened, fixed, carmine stained, mounted and photographed for morphological studies. Clinically, the patient was presented with a history of abdominal pain and tenderness in the right hypochondrium and epigastrium five months ago. The pain was frequently repeated and was accompanied by vomiting and relieved by antispasmodics. Radiologically, there was intrahepatic biliary dilation and the gall bladder was of irregular wall, enlarged and contained muddy bile. Laboratory investigations revealed anemia, bilirubinemia and eosinophilia. The patient was operated on with the possible diagnosis of choledocholithiasis and parasites were incidentally discovered at the operation. Examination of bile and stool were negative for Fasciola eggs which means that the eggs were excreted at irregular intervals from the adult fluke; for this reason, diagnosis of human fascioliasis based on the detection of the parasite eggs in the stool is often unreliable

Evaluation of the efficacy and toxicity of epirubicin and cisplatin with cyclic continuous infusion of 5-fluorouracil in advanced breast cancer

Nineteen evaluable patients with advanced breast cancer were included in this study. Fourteen patients received no previous chemotherapy and five patients received previous chemotherapy [CMF] and two of them received [CAF] as well. Age of patients ranged between 25 and 55 years, the median was 38 years. There were five postmenopausal and fourteen permenopause. The most common site of metastasis was the lymph nodes [supraclavicular or contralateral axillary] which was reported in 12 patients. All patients received the cyclic continuous infusion 5- FU for seven days plus epirubicin in day one and cisplatin in day three only. There were four complete responders, partial response was recorded in eleven patients with an overall response rate 79.1%. The failure free survival for untreated patients was 71.4% after a median follow up of 19 months. In previously treated patients, the failure free survival was 20% after a median follow up period of 13 months with median response period of 9.7 months

Puberty in renal transplant girls

Evaluation of puberty parameters in renal transplant girls who receiving a combination of immunosuppressive treatment including cyclosporine A, prednisolone and azathiopnne 18 living related donor renal transplant girls were evaluated initially and followed for 2 years post transplant. All underwent measurement of Tanner stage, height, bone age,and endocrinologic evaluation. Our results showed that at initial evaluation retarded sexual maturation was observed in 22.2% of girls and height SDS in 38.9% of girls were greater than 2 SD below the mean for age. Serum estradiol level was significantly correlated with height,bone age, and Tanner stage. The height increment was significantly correlated inversely with the duration of immunosuppresion. Dialysis duration was significantly longer in girls with good physical growth followed transplantation. Our data indicate that diminished renal function and predinsolone treatment appear to be additive in delaying maturation in some girls after kidney transplantation. Moreover, renal transplant girls maintained on triple immunosupperssive treatment showed acceptable puberty parameters in the majority of patients

Environmental stress and genetic damage in aquatic organisms

This work was planned to investigate the effect of pollution upon the genetic material of aquatic organisms. In order to achieve such a purpose, Tilapia nilotica and Tilapia zillii were chosen and caught from two regions varying in their environmental stress; the first is River Nile and the second is a closed drain which receives domestic sewage. Mitotic activity, chromosomal aberrations and in vivo induction of sister chromatid exchanges were examined in gills as well as in kidneys. The results obtained revealed that the environmental stress was proven to be capable of causing inhibition of cell proliferation; clastogenic effect and primary DNA damage in gills and kidneys of both species with differential effect

Parotid silaometry: standardization of the technique

Clinical investigations of the parotid gland are currently sialography, C.T. scanning, MR scanning, scintigraphy, excision biopsy, aspiration biopsy and sialometry. The practical application of sialometry in the evaluation of parotid functions has been halted by the wide inter subject and intra subject variations in the parotid secretory rate, pattern and composition. In this study, several basic experiments were undertaken, in order to determine the technique for obtaining the most consistent salivary composition under various secretory flow rates and duration of stimulation. The results of these experiments, the proposed standard technique and its clinical application are presented and discussed

Doppler wave analysis of prostaglandin-induced erection

Doppler wave length analysis was used to assess penile blood flow in 50 important patients both in the flaccid state and after induction of erection with 25 ug/ml prostaglandin E1, intracavernous injection. Nine volunteers served as controls. Maximum velocity was slightly lower in patients in the flaccid state but was not different from controls after induction of erection. Prostaglandin E1, induced good erection which lasted for an average of 2.6 hours in 100% of controls and 80% of patients. In 9 patients whose main complain was rapid loss and weakness of erection, the end diastolic velocity was above the zero base line, after prostaglandin injection they developed tumescence without rigidity and the end diastolic velocity increased to more then 5 cm/sec. Cavernosography proved venous leak in 8 of those patients [88.8%]. There was a good correlation between a normal Doppler analysis and a positive response to prostaglandin injection. Elevated end diastolic velocity especially after prostaglandin was predictive of venous leak. No complications resulted from the use of prostaglandin E1 injections. The combined use of Doppler and prostaglandin E1 intracavernous injection enhanced the diagnostic yield of both of them and allowed selection of candidates for cavernosography

Study of serum angiotensin converting enzyme activity in end stage renal failure

Serum angiotensin converting enzyme [s.ACE] activity was measured in 30 patients with end stage renal failure [15 newly discovered and 15 on regular hemodialysis] and 15 matched controls. This study revealed significant decrease in s.ACE activity in undialysed uremic subjects as compared with control group and a significant increase in s.ACE in dialysed group in relation to undialysed group, while there was no significant difference in this respect between dialysed uremic subjects and control group. On the other hand there was no significant correlation betueen s.ACE activity and each of the : systolic diastolic, mean blood pressure, age of subjects, serum urea and creatinine in all studied groups, and no correlation was found between duration of dialysis and s.ACE activity in dialysed group. We conclude that chronic renal failure patients not on haemodialysis tend to be associated with lower levels of s.ACE activity and tend to be normalized by hemodialysis irrespective to the duration of dialysis

Study of plasma lipids, lipoproteins and lecithin cholesterol acyl transferase activity in nephrotic syndrome

Thirty subjects were included in this study and divided into 2 groups, control [n = 10] and nephrotic [n = 20] group, which further subdivided into 2 subgroups, severe [n = 8, serum albumin below 2 g/dl] and less severe [n = 12, serum albumin above 2 g/dl] nephrotic subgroup. The estimation of plasma level of high density lipoprotein-cholesterol [HDL-C], low density lipoprotein-cholesterol [LDL-C], triglycerides; total cholesterol [TC], free cholesterol [FC], esterified cholesterol [EC], Lecithin cholestero acyl transferase [LCAT] activity, Apolipoprotein-A[1] [APo-A[1]] and other routine investigation were done for all subjects. This study aimed at elucidating the possible changes in LCAT activity, associated with nephrotic syndrome and to find out its relation with plasma lipid and lipoprotein abnormalities in a trial to identify which type of patients are more liable to atherosclerosis. A significant decrease in plasma LCAT activity, APo-A, HDL-C and EC/TC ratio were detected in nephrotic as compared with control group and in severe as compared with less severe nephrotic subgroup. Also, plasma TC, FC, Triglycerides and LDL-C in nephrotic group were significantly higher than control group and FC/TC ratio was higher in severe as compared with less severe nephrotic subgroup. We conclude that low HDL-C and its APo-A[1] level along with. low LCAT activity may uncover the protection of nephrotic patients against enhanced atherogenesis and the low serum albumin level as well as the higher FC/TC ratio may predict the patients more prone to atherogenesis