Ureteroscopy versus extracorporeal shock wave lithotripsy in the management of distal ureteral calculi

To compare, ureteroscopy [URS] and extracorporeal shock wave lithotripsy [ESWL] in the management of distal ureteral calculi. Between January 2000 and May 2001, 120 patients with distal ureteral calculi had been prospectively randomized between extracorporeal shock wave lithortipsy and retrograde ureteroscopy in the urology department of Cairo University hospitals and Suez Canal University Hospital. Our patients were divided into two groups, 60 patients each. The first group was treated with extracorporeal shock wave lithotripsy [ESWL] and the second group with rigid ureteroscopy. The patients were evaluated by history taking, clinical examination, laboratory investigations and radiological investigations including plain X ray film for kidney, ureter and bladder [KUB] and intravenous urography [IVU]. All patients of URS required spinal or general anaesthesia, URS was found to be significantly less time consuming than ESWL with a mean time of 40 +/- 9.25 and 60 +/- 10.68 minutes respectively.The mean fluoroscopy time was 3.9 +/- 1.45 minutes and 7.2 +/- 2.04 minutes in URS and ESWL group respectively. No ureteric stens were inserted pre or postoperatively in ESWL group but in URS group ureteric stents were inserted in all successful cases.The overall success rates in URS and ESWL groups were 95% and 90% respectively.The hospital stay of ureteroscopy is significantly longer than that of ESWL [P < .05]. Postoperative IVU revealed significant improvement in the state of upper urinary tract in URS and ESWL groups. There was no statistical significant difference in the overall complication rate of URS and ESWL. In our study we found that ESWL is a valid and effective alternative for treatment of distal ureteral calculi, however the patients must be informed about the possibility of colic during passage of fragments, retreatment and the need for close follow up to monitor the passage of stone fragments until they were stone free.We concluded that URS should be the procedure of choice for lower ureteral calculi, as it has advantages of, high immediate success rate [95%], low retreatment rate, short operative time, short fluoroscopy time in addition to immediate and reliable technique to relieve the obstruction of upper urinary tract

Increasing of probiotic and therapeutic action in karish cheese using tolue balsam extract

Enrichment of a probiotic Karish cheese culture with Tolue balsam [Myroxylon balsamum] extract [0.4%v/v] serves a dual purpose. Not only does it have therapeutic and carminative properties, but initiates growth of Bifidobacterium in Karish cheese. Marked increases in acetaldehyde content, total organic acids and viable counts of Bifidobacterium ssp. were detected. Furthermore, Bifidus-Karish cheese enhanced by Tolue balsam extract had higher sensory scores than conventional Karish and probiotic Karish cheese

value of laparoscopic cholecystectomy in acute cholecystitis

This study is aiming to assess the value of laparoscopic cholecystectomy in acute calcular cholecystitis. Twelve patients with acute calcular cholecystitis, diagnosed by clinical examination and radiological and laboratory investigations were operated upon by laparoscopic cholecystectomy. There were 1 gangrenous, 2 empyema, 4 mucocele and 5 edematous cholecystitis. 4 out of the 12 patients were converted to open cholecystectomy due to intraoperative diffuculties. These included one gangrenous, one empyema, one with mucocele and one with edematous cholecystitis. The complications included 1 case of common bile duct injury managed by T-tube after laparotomy, 1 case of bile leak due to a missed stone of the common bile duct which was extracted later by ERCP and 2 cases of wound infection in the converted group. This study confirmed the belief that cases of acute calcular cholecystitis might be assessed laparoscopically with the intention of proceeding to laparoscopic cholecystectomy. On initial dissection, an empyema or gangrenous cholecystitis are found and satisfactory progress of the dissection is not possible, conversion to open cholecystectomy should be considered early

Hepatic parenchymal injury A retrospective study of 150 cases

A retrospective study was carried out on 150 cases, 80% were males and 20% were females. 62% of cases were due to blunt trauma and 38% were due to penetrating injuries. Diagnostic peritoneal lavage and abdominal ultrasonography proved to be excellent tools for diagnosis of hepatic injuries, while the value of CT scan was not proved due to the small number of cases [3 cases]. 70% of cases were treated with simple technique of hemostasis while, 30% needed advanced technique. Hepatic packing was used in 20% of cases with omental packing in 18% and peri-hepatic packing in only 2% of cases. 6 of patients in this work developed intraabdominal abscesses and needed drainage with corrugated rubber drains. Another 6 patients needed reoperation for closure of wound dehiscence. The mortality rate was 10%; a relatively low figure due to exclusion of major hepatic vascular injuries from this study, also due to death of patients with severe hepatic injuries during transport to hospital