Evaluation of primary repair of common bile duct in common bile duct stones

Background: Despite advancements in gallbladder surgery with the introduction of endoscopic and laparoscopic techniques, many surgeons, especially in the developing world, still perform open cholecystectomy with common bile duct [CBD] exploration for choledocholithiasis

Aim of the study: The purpose of the study was to report the outcomes of open CBD exploration without theuse of Tetubes

Materials and methods: A prospective study of open CBD exploration and primary closure was performed without Tetube drainage. Preoperative investigations, the surgical techniques, and perioperative outcomes were recorded

Results: Fifty patients had CBD exploration. In 45 patients this was performed by means of asupraduodenal choledochotomy, and in five of these patients free passage into the duodenum could not be achieved using catheters, irrigation, and dilators. These were completed with acholedochoduodenostomy

Conclusion: In a limited resource setting, there is still a role for open CBD exploration and primary closure without the necessity of Tetubes and stents as evidenced by a good perioperative patient outcome

Nutritional Status of Under-Five Children in Libya : a National Population-Based Survey

Aim: To describe the nutritional status of children under-five years of age in Libya. Population and methods: A secondary analysis of data of 5348 children taken from a national representative; two-stage; cluster-sample survey that was performed in 1995. Results: Prevalence rates of underweight; wasting; stunting; and overweight were determined using standard definitions in reference to newly established WHO growth charts. The study revealed that 4.3of children were underweight; 3.7wasted; 20.7stunted; and 16.2overweight. Seventy percent of children had normal weight. Undernutrition was more likely to be found in males; in rural areas; and in under- privileged groups. Overweight was more likely found in urban; privileged groups. Wasting was more common in arid regions; stunting was more common in mountainous regions of Al- Akhdar; Al-Gharbi; and in Sirt. Al-Akhdar had the highest prevalence of overweight. Conclusion: The country had a low prevalence of underweight and wasting; moderate prevalence of stunting; and high prevalence of overweight. The country is in the early stages of transition with evidence of dual-burden in some regions. Similar surveys are needed to verify secular trends of these nutritional problems; particularly overweight

Nutritional Status of Under-five Children in Libya: a National Population-based Survey

Aim: To describe the nutritional status of children under-five years of age in Libya. Population and methods: A secondary analysis of data of 5348 children taken from a national representative; two-stage; cluster-sample survey that was performed in 1995. Results: Prevalence rates of underweight; wasting; stunting; and overweight were determined using standard definitions in reference to newly established WHO growth charts. The study revealed that 4.3of children were underweight; 3.7wasted; 20.7stunted; and 16.2overweight. Seventy percent of children had normal weight. Undernutrition was more likely to be found in males; in rural areas; and in underprivileged groups. Overweight was more likely found in urban; privileged groups. Wasting was more common in arid regions; stunting was more common in mountainous regions of Al-Akhdar; Al-Gharbi; and in Sirt. Al-Akhdar had the highest prevalence of overweight.Conclusion: The country had a low prevalence of underweight and wasting; moderate prevalence of stunting; and high prevalence of overweight. The country is in the early stages of transition with evidence of dual-burden in some regions. Similar surveys are needed to verify secular trends of these nutritional problems; particularly overweight

Total intravenous anesthesia versus inhalational anesthesia in patients undergoing laparoscopic cholecystectomy. A comparative study of postoperative subclinical hepatic dysfunction

Inhalational anesthetics are reported to cause mild liver dysfunction in some cases. This dysfunction reflected as asymptomatic transient elevation in liver enzyme. On the other hand no reports have indicated that total intravenous anesthetics [TIVA] cause liver or other organ dysfunction. In addition the use of TIVA become popular due to the availability of new drugs which have short acting effects and TIVA technique produce less air pollution. 40 patients undergoing laparoscopic cholecystectomy were randomized into two equal groups. The first group received inhalational anesthesia. Anesthesia induced with fentanyl 2 microg/kg, atracurium 0.5 mg/kg, propofol 2.5mg/kg and was maintained using sevoflurane 2-3%, nitrous oxide 66% in oxygen with atracurium infusion at rate of 0.5 mg/kg/hr. The second group received TIVA. Anesthesia was induced with fentanyl 2 microg /kg and atracurium 0.5 mg/kg and propofol 2.5 mg/kg. and anesthesia was maintained using propofol infusion using a syringe pump at a rate of 10 mg/kg/hr for 10 mm then 8 mg/kg for the next 10 mm and finally maintained at 6mg/kg/hr with nitrous oxide 66% in oxygen and muscle relaxation was maintained with infusion of atracurium in rate of 0.5 mg/kg/h. Liver enzymes were measured preoperative, at the end of operation, 3h, 6h, and 24 hours postoperative and compared to the preoperative values. There were transient significant increase in the values of AD, GST, and AST in inhalational group and ALT significantly increased in both groups. There were insignificant changes in hemodynamic parameters. TIVA technique is superior to inhalational technique during laparoscopic cholecystectomy as regards its effect on the liver enzymes

Morphological study of the anteromedial region of the ankle [anatomical snuffbox of the ankle!]

The purpose of the present study was to describe the morphological aspects of the antero-medial side of the ankle region, that was similar to the anatomical snuffbox on the lateral side of the dorsum of the wrist. Dissection of this region was performed on twenty-two adult human cadaveric specimens of the ankles in both sexes. This region appeared as triangular skin depression on full extension of the big toe and inversion of the foot. Its base was formed by the anteroinferior end of the medial malleolus and bounded by the tendons of tibial muscles; tibialis anterior anterosuperiorly and tibialis posterior postero-inferiorly. The roof was formed by the skin and fasciae. Great saphenous vein and saphenous nerve were found in the superficial fascia, crossing the triangle medial and superficial to tibialis anterior. The floor was formed by the deltoid ligament of the ankle joint. This ligament appeared strong. However, the most thickened band was that attached to the sustentaculum tali. The presented anatomy provides a basis for a relatively safe area for a needle puncture or surgical approach of the ankle joint

Inferior extensor retinaculum of the human ankle; its medial and lateral attachments and arrangement of structures deep to it

The attachments and arrangement of the inferior extensor retinaculum were studied through surface anatomy and radiological examinations for ten adult healthy persons in addition to dissection of its region in fourteen human lower limbs, obtained from anatomy department, Zagazig university. The results were correlated together and analyzed. It was shown that the retinaculum was Y shaped. Its stem was attached to the antero-superior aspect of the calcaneus. while its two limbs extended medially. The upper limb was attached to the medial malleolus, while the lower one was attached to the medial cuneiform in addition to its continuation with the plantar aponeurosis. The long muscle tendons in front of the ankle were found to split the retinaculum into superficial and deep layers, except that of tibialis anterior that passed superficial to the main fibers of the retinaculum. The neuro-vascular bundle [represented by the anterior tibial vessels and nerve] was found to pass in a special compartment deep to the retinaculum; lying at a deeper level than that of the surrounding tendons. This compartment was roofed by the retinaculum while its floor was formed by the fascia overlying the talus. The relations between the present morphological findings and the previous results were discussed and also correlated with some clinical conditions

Light and electron microscopic study of the ovarian surface epithelium [OSE] of the adult albino rat

Twenty adult female albino rats were used in this study. They were divided into two groups. The first group included ten adult non-pregnant animals, while the second group included ten pregnant ones, that terminated at the middle of pregnancy [tenth day of gestation]. These animals were sacrificed after being anaesthetized. Then, the ovaries were extracted and prepared for light and electron microscopic examinations. The results revealed that the ovary of the non - pregnant group was covered with a single flat epithelial layer. The nuclei were found to lie in the larger portions of the cells that sent cytoplasmic attenuations, containing many vacuoles and covering the underlying tunica albuginea. This tunica was well-formed, containing many extra-cellular collagen fibrils .The fibroblasts were arranged into two or more layers, parallel to the surface epithelium. The cortical stroma showed many graafian follicles in different stages of development. The developing follicles were mostly bulging through the ovarian surface epithelium [OSE]. The ovary of the pregnant group showed OSE with some proliferative changes. These changes included proliferation of the cells of OSE and the underlying tunica albuginea, The OSE was formed of a single layer of flat epithelial cells but with more nuclei and nuclear irregularity and folding. Also, there was increased thickness of the tunica albuginea with increased vascularity and collagen fibrils,Examination of the cortical stroma showed general similarity between the pregnant and non-pregnant groups, regarding the presence of different stages of developing graafian follicles. However, these follicles were mostly not bulging through the OSE during pregnancy, despite the presence of mature graafian follicle. Also there were increased atretic follicles. This might be an indication of gradual disappearance of mature graafian follicles without rupture through OSE [without ovulation]. The changes occurring during pregnancy in OSE and underlying tunica albuginea might have a role in prevention of ovulation

Open versus laparoscopic anterior highly selective and posterior truncal vagotomy in the treatment of chronic duodenal ulcer

Vagotomy has almost replaced gastric resection in the treatment of chronic duodenal ulcer in most of surgical centers, and the highly selective type is a logical step in the direction of more conservatism. In the present study, open versus laparoscopic anterior highly selective vagotomy [HSV] and posterior truncal vagotomy [TV], were used for the treatment of chronic duodenal ulcer [CDU] and the results were evaluated. Anterior HSV and posterior TV were used to treat 38 patients with CDU. Twenty patients were managed by open surgery [group I], and 18 by laparoscopic surgery [group II]. Laparoscopic surgery was performed successfully in 15 patients [83%], while it failed in 3 patients [17%] and converted into open surgery. The mean operative time was 90 minutes in the open surgery group [OSG], and 150 minutes in the laparoscopic surgery group [LSG]. The mean postoperative hospital stay was 12 days in the OSG, while it was 3 days in the LSG. The basal acid output [BAO] and the maximal acid output [MAO] reduced significantly in both the OSG and LSG groups [P<0.01]. By assessment using the Visick scale, in the OSG, 14 patients [70%] were Visick grade I, 4 patients [20%] were Visick grade II, and 2 patients [10%] were Visick grade III, Using the same scale in the LSG. 12 patients [80%] were Visick grade I. one patient [7%] was Visick grade II, and 2 patients [13%] were Visick grade IV. Recurrence occurred in 2 patients [10%] of the OSG, and in one patient [7%] of the LSG. We concluded that although both open and laparoscopic surgery offers satisfactory results in the treatment of CDU, the later could be considered as a reasonable alternative. It is a minimally invasive technique with minimal operative and postoperative morbidity and short hospital stay

Prosthetic versus non-prosthetic rectopexy with temporary anal circulage through posterior sagittal approach in the treatment of adult complete rectal prolapse

Twenty-four adult patients with complete rectal prolapse [CRP] were admitted to the Surgical Department, Tanta University Hospital. The patients were divided, with random selection, into two equal groups; group I, in whom prosthetic rectopexy [PRP] were performed and group II, in whom non-prosthetic rectopexy [NPRP] were performed, using the posterior sagittal approach [PSA] with temporary anal circulage. The mean age of patients was 35 years and the follow-up period ranged from 6-36 months. Complete cure of the prolapse occurred in all patients, and only 2 anterior mucosal prolapse [16.7%] were observed in group II patients and treated by simple mucosal excision 2 months later. Incontinence to flatus was present in 4 patients [33.3%] of group I and in 3 patients [25%] of group II. Incontinence to loose stool was present in 3 patients [25%] of group I and in 2 patients [16.7%] of group II. Incontinence to flatus and loose stool improved within one month postoperatively in both groups. Superficial wound infection occurred in 3 patients [25%] of group I and in 2 patients [16.7%] of group II and resolved within 3 weeks postoperatively. No recurrence was observed during the period of follow-up. The management of adult CRP, by rectopexy through PSA, either by using polypropylene mesh [PRP] or without using mesh [NPRP], with temporary anal circulage, is a safe and easy procedure with good mobilization and fixation of the rectum and an easy access to the repair of pelvic floor muscles

Laporoscopic assisted orchiopexy for impalpable undescended tests

Multiple approaches exist for the management of impalpable undescended testicle. With the use of diagnostic laparoscopy widely accepted in the setting of the non-palpable testis, laparoscopic orchiopexy seemed to be a logical extension. We report our experience with laparoscopic orchiopexy in treating 36 impalpable testis in 32 children at Tanta University Hospital, three of them had undergone a negative groin exploration at other centers, Twelve children had an absent testis at the side under investigation [33.3%]. Twenty children with 24 intra-abdominal testes underwent laparoscopic assisted orchiopexy. Eighteen of them were submitted to a single - stage standard subdartos orchiopexy, and two-stage orchiopexy for the remaining six with a success rate reaching 87.5%. There were no technical failures or laparoscopy-related complications in all of these children. We concluded that laparoscopic assisted orchiopexy is a satisfactory and reliable technique which has the advantage of being accurate diagnostic and proper therapeutic in one setting

Thrombosis and cavernomatous transformation of the portal vein among hepatic diseases and hepatic arterial buffer response

Portal vein thrombosis [PVT] and cavernomatous portal vein [CPV] are rare conditions that may affect both children and adults. In this study the incidence of PVT and CPV among different liver conditions were recorded and the results were evaluated. From January 1993 to December 1999, 353 patients with different liver conditions were evaluated, regarding the clinical presentation, the liver pathology and the ultrasonographic findings in the portal system and hepatic artery. Of the 353 patients, 224 were males [63.5%] and 129 were females [36.5], with a mean age of 36 years [range 9 to 58 years]. The early clinical presentation was abdominal pain and vomiting and/or fever, while the late presentations were that due to portal hypertension such as variceal bleeding. The liver pathology was periportal fibrosis [PPF] in 124 cases [35.1%], cirrhosis in 48 cases [13.6%], mixed cirrhosis and PPF in 163 cases [46.2%], hepatocellular carcinoma [HCCa] in 16 cases [4.5%] and post-splenectomy acute PVT in 2 cases [0.6%]. By ultrasonography, PVT was found in 22/353 patients [6.2%] with the different liver conditions. CPV transformation was found in 4/353 of such cases [1.1%]. By studying the hepatic arterial buffer response, the resistive index [RI] was found to be as low as 0.558 in cirrhosis and HCCa patients with PVT and as low as 0.490 in postsplenectomy patients with acute PVT. We concluded that Early diagnosis of PVT or CPV transformation, in patients with risk factors, by their clinical presentation and a meticulous technique of duplex scanning of the portal system, is very important to avoid early bowel ischaemia or late variceal hemorrhage

Nasal ketamine versus nasal midazolam for pediatric premedication

Ninety patients A.S.A.I and 11 their age ranging from one to six years were undergoing general and urological surgeries. The patients were divided randomly into three groups, each of thirty patients. Group A, Group B and Group C. Group A received nasal ketamine in a dose of 5 mg/kg, Group B received nasal midazolam in a dose of 0.15 mg/kg [Control group] received IM midazolam in a dose of 0.1 mg/kg and Mepridine 1 mg/kg IM. Sedation was started as excellent in 19 children and as adequate in 6 children in the ketamine group [Group A] compared with 16 and 7 children in midazolam [Group B]. In Group C [control group], sedation was started as excellent in 9 children and adequate in 7 children

Immunohistochemical demonstration of toxoplasma antigen in the placenta of cases of abortion

The sera of 65 women presenting with abortion and 30 women with normal obstetric history were examined for Toxoplasma antibodies using IHAT. The level of Toxoplasma antibodies was significantly higher in cases of abortion than in normal control. Sixteen formalin fixed paraffin- embedded placenta [representing negative and positive cases for toxoplasmosis] were examined by immunoperoxidase procedure to detect Toxoplasma antigen in tissues. They were also examined histopathologically [by HX and E.]. Toxoplasma antigen could be detected in the placenta of all cases with high titer. In all sero- negative cases, Toxoplasma antigen could not be detected. Out of six cases with low or moderate titer, one case only showed Toxoplasma antigen in the placenta. The histopathological studies of seropositive cases revealed a picture of villitis in the form of slight villous oedema with scattered mononuclear cellular infiltration mainly of lymphocytes and plasma cells. The data proved the usefulness of immunoperoxidase procedure as a specific and sensitive test to confirm the diagnosis of serologically positive toxoplasmosis in high titer