Port-site non-tuberculous mycobacterial infection after laparoscopic cholecystectomy: a case series study

Port-site infection by mycobacterial organism is an unusual complication. This article aims to report the occurrence of port-site mycobacterial infection after laparoscopic cholecystectomy and to describe the diagnostic and therapeutic tools of this unusual complication. This case series study included 7 cases presented by port-site unhealed sinuses after laparoscopic cholecystectomy in Al-Azhar University hospital, Cairo, Egypt. Two methods were used to confirm the diagnosis; the bacteriological diagnosis by culture of pus collected from the port-site and histopathological examination of specimens after resection of port-site unhealed sinuses. Bacteriological and histopathological examinations showed the presence of mycobacterial infection in 4 cases [57,1%]. There was a special characteristic picture on sinogram and during surgical excision of the sinuses. All cases cured by meticulous surgery followed by anti-mycobacterial medications. Mycobacterial infection may be one of the causes of port-site delayed wound healing and the treatment should mainly depend on good meticulous surgical excision

relationship of plasma visfatin and retinol binding protein-4 to fat composition assessed by ultrasound, obesity, and type 2 diabetes mellitus

Adipose tissue is responsible for releasing various adipokines which have been related to insulin resistance. Understanding the relationship of these adipokines to insulin resistance may foster the development of new treatments for diabetes. The primary objective of this study was to determine the possible association between visfatin and retinol binding protein-4 [RBP-4] in type 2 diabetes and obesity. The role of ultrasound measurements was to determine which of the adipose tissue depot most closely relates to visfatin and RBP-4 levels. According to the body mass index [BMI], 40 type 2 diabetes patients were divided into two equal groups, the 1[st] was non-obese diabetic patients with BMI <25Kg/m[2] and the other was obese diabetic patients with BMI >25Kg/m[2]. There were 40 healthy persons in the control group; also, divided into two equal groups according to the BMI. Anthropometric and biochemical measurements were done by using standardized techniques. Fasting plasma visfatin, retinol binding protein-4 and insulin levels were measured by enzyme-linked immunosorbent assay. Insulin resistance index was calculated by the homeostasis model assessment [HOMA[IR]]. Visceral fat in multiple sites, subcutaneous fat and fat deposition in the liver were measured by ultrasonography. The levels of plasma visfatin were increased significantly in diabetics compared to control group; moreover, visfatin concentration in diabetics was significantly higher compared to control subjects with similar BMI values. The levels of plasma RBP-4 were significantly higher in diabetic patients compared to control group. Furthermore, the levels of RBP-4 were significantly higher in diabetics in comparison to non-diabetics with similar BMI values. Plasma visfatin was positively correlated with RBP-4, BMI, waist/hip ratio [WHR], insulin, insulin resistance index and visceral fat area in diabetic patients, while it was negatively correlated with systolic blood pressure. On the other hand, plasma RBP-4 correlated positively with visfatin, BMI, WHR, blood glucose, insulin and insulin resistance index, and fatty liver detected by ultrasound in diabetic patients. Stepwise regression analysis revealed that plasma visfatin levels remained positively associated with visceral fat and WHR; while plasma RBP-4 levels remained positively correlated with BMI, fatty liver and insulin in diabetic patients. Plasma visfatin levels are significantly higher in diabetics than control subjects and positively correlated with visceral fat area but not with subcutaneous fat. The correlation between visfatin and visceral fat measurement confirm that visceral fat measurement by ultrasound is effective and reproducible. Although visfatin levels are increased in type 2 diabetes mellitus, the association seems to be primarily through obesity. Moreover, plasma RBP-4 levels are increased significantly in type 2 diabetes mellitus and obesity. However, circulating RBP4 is not correlated with the amount of visceral or subcutaneous fat, but, it correlates positively with liver fat. Furthermore, metabolic parameters support the close relationship between circulating RBP-4 with liver fat and insulin resistance