Effect of pan-retinal laser photocoagulation on plasma VEGF endothelin-1 and nitric oxide in PDR / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To study plasma levels of vascular endothelial growth factor (VEGF), endothelin-1(ET-1) and nitric oxide (NO) in patients with proliferative diabetic retino-pathy (PDR) before and after pan-retinal photocoagula-tion (PRP).·METHODS: In this prospective study, forty patients (23 females and 17 males, mean age 48.5±12.2) with PDR without previous PRP therapy were studied. Blood samples were obtained before and 3 months after the last PRP session. Baseline (prelaser) plasma levels of VEGF, ET-1 and NO were compared with their levels in 30 healthy age- and sex- matched controls and also with plasma levels 3 months post-PRP. ·RESULTS: Patients with PDR had significantly raised plasma VEGF (375±89ng/L), ET-1(20±5ng/L) and NO (135±53μmol/L) when compared with healthy control group (P<0.01). After PRP, there was a significant re-duction in plasma VEGF (179±66ng/L), ET-1 (11±5ng/L) and NO (91±49μmol/L) levels at 3 months' follow-up but still significantly higher than healthy controls.·CONCLUSION: Patients with PDR demonstrate elevated VEGF, ET-1 and NO, which decreased after successful laser treatment.

Nodal status, C-ERBB-2 expression combined with lymphovascular invasion creates a more powerful tool for predicting outcome in breast cancer

To evaluate the prognostic role of peritumoral vascular invasion [PVI] and its association with axillary nodal status and c-erbB-2 expression. Seventy five patients with stage I and II breast carcinoma who underwent conservative breast surgery or modified radical mastectomy were assessed clinically and pathologically for tumor size, grade, axillary lymph node status and peritumoral vascular invasion [PVI]. The immunophenotype of the tumor was determined as: the expression of oestrogen [ER] and progesterone [PgR] receptors, and c-erbB2. Thirty eight patients [50.7%] showed PVI. It was found that extensive PVI was significantly more likely to be associated with nodal positivity, higher tumor grade and c-erbB-2 over-expression. - 52/75 [69.3%] patients showed positive nodal status. The analysis showed that nodal positivity was significantly associated with tumor size, higher grade, presence of PVI and c-erbB-2 overexpression. - PVI and nodal positivity showed no significant association with receptor status. These data suggest that assessment of PVI together with axillary nodal status and c-erbB-2 expression creates a more powerful tool for predicting outcome in patients with breast cancer

Comparative study between using harmonic scalpel and electrocautery in modified radical mastectomy

The harmonic scalpel is a recent surgical instrument that allows intra-operative cutting and coagulation at the same time. The aim of this study was to compare between the usage of harmonic scalpel or electrocautery in modified radical mastectomy operation. This study included fourty patients with operable breast cancer. They were randomized into two equal groups to do modified radical mastectomy either using harmonic scalpel [group A] or using conventional electrocautery [group B]. The total operative time, the time of axillary dissection, the time for raising the flaps and the time of breast dissection were calculated. The days of drainage and the total drainage volume were also recorded. Calculating the time needed for axillary dissection revealed a significantly shorter time in patients operated on by harmonic scalpel. [p = 0.004]. The mean total draining volume in group [A] was lower than in group [B]. The difference was statistically significant. [p=0.02]. 15% of cases in group [A] and 25% of cases in group [B] suffered from postoperative seroma, the difference was statistically insignificant [p=o.677]. The use of harmonic scalpel in MRM shortening the axillary dissection time and decrease drainage volume, drainage day and hospital stay

role of CT guided fine needle aspiration biopsy in the management of intra-abdominal masses

The evaluation of deep non-palpable abdominal masses or focal lesion is often difficult. Distinction between malignant and non-malignant lesions and particularly inflammatory lesions is vital for patient management, and is often suspected from imaging techniques; the diagnosis requires confirmation by biopsy. Fine needle aspiration cytology [FNAC] is a well established diagnostic technique. This study aimed at evaluation of CT guided FNAB in diagnosis of intra-abdominal masses and its impact on treatment planning. The study was conducted on thirty patients with intra-abdominal masses [clinically or radiologically diagnosed] admitted to the Department of Surgery, Faculty of Medicine, the Main University Hospital. FNAs were performed at the Radiology unit in the Main University Hospital with the pathologists assistance. Patients were subjected to surgical exploration according to the findings, aiming at resection of the mass. The impacts of CT and FNAB on the surgical decision were recorded The pathological findings of FNAB were compared with the final histo-pathological findings of the specimen. The study was carried but on 30 patients who had abdominal mass or masses. Each patient was subjected to CT guided FNAC. The age of the patients ranged between 18-70 years, with a mean of 48.57 +/- 13.69 years. with a male to female ratio 1:1. The Sensitivity for CT was 76% and for FNAB was 89%. Specificity for CT was 100% and for ENAB was 100%. Positive predictive value for CT was 90% while it was 95% for FNAB. Negative predictive value was 18% for CT and 40% for FNAB. CT guided FNAB is a relatively painless procedure. It is a safe method for obtaining a pathologic diagnosis. The overall accuracy of the CT guided FNA in intra-abdominal masses was 73.3%. CT guided FNAB helped in avoiding surgery in patients with metastatic or irresectable tumors. The accuracy was 100% in hepatic, pancreatic and pelvic masses. while it was less accurate in retroperitoneal and gastrointestinal masses. This accuracy increased with adenocarcinomas and benign tumors, but decreased with lymphomas, smooth muscle tumors, inflammatory and fibrotic lesions

Evaluation of combined graded compression ultrasonography with alvarado score in the diagnosis of acute appendicitis

Decision making in cases of acute appendicitis may be difficult specially for junior surgeons. Radiological investigations do not appear to be helpful. In some studies, the Alvarado scoring system was helpful in minimizing unnecessary appendicectomies. The aim of this study was to evaluate Alvarado score and its combined use with graded compression ultrasonography in the diagnosis of cases suspected to have acute appendicitis. All patients who were admitted with a provisional diagnosis of acute appendicitis between [first of May 2004 to the last of April 2005], in Surgical Emergency Department Alexandria Main University Hospital were prospectively entered into this study. The study included 377patients between the ages of 10 and 76 years. They were prospectively evaluated on admission using the Alvarado Score to determine whether or not they had acute appendicitis all equivocal cases were subjected to graded compression ultrasonogra

Guided wire localization of non-palpable breast lesions

The wide use of screening mammography had resulted in the discovery of an increasing number of suspicious non-palpable breast lesions for which surgical excision after guided wire localization is the diagnostic gold standard. This study had included 32 patients with non-palpable breast lesions, wire localization was done guided by U.S in 22 patients and by mammography in the remaining ten. This was followed by operative excision of the lesion around the guide wire tip. Specimen radiography was done for 25 of excised specimens. Complete excision was achieved in 22 patients [88%]. Histopathological examination yielded the final pathological diagnosis, malignant lesions were found in 7 occasions [21.87%]. U.S proved to be a simple technique allowing guidance in different sites of the breast through the shortest possible route thus obviating excessive breast dissection

Primary hyperparathyroidism: clinical presentation and management

Nineteen patients with primary hyperparathyroidism were operated upon in the period from January 1994 till December 1998. Thirteen patients were females and six were males. The maximum age incidence occurred in the fourth decade. Bony lesions were the frequent presentation. They were in the form of localized pain and bone swelling [38.8%], pathological fracture [26.3%] and generalized bone ache [10.5%]. The diagnosis of primary hyperparathyroidism was established on basis of elevated levels of ionized calcium, 24-hours urinary caclium and PTH together with decreased levelof serum phosphorus. Preoperative ultrasonography correctly localized the parathyroid pathology in 73.7%. Bilateral exporation of the neck revealed a sizable solitary parathyroid adenoma in 18 patients. In a single case the adenoma was intra thyroid in location. A concomitant partial throidectomy was performed in 7 patients. The postoperative complications were trivial; 11 patients suffered from transient hypercalcaemia. The determined postoperative serum calcium and PTH were normalized although both attained a different pattern to do this after operation. Among the 15 patients presenting with bone cysts, only two were treated surgically. The majority responded to conservative treatment adopting rest and immobilization after parathyroid adenectomy. Moreover, the pathological fractures healed well conservatively after the adenectomy. Internal fixation was resorted to in only 2 cases having pathological fractures of the femur

Renaissance of small diameter partial portacaval shunt: experience, outcome and survival in Egyptian schistosomal portal hypertensive bleeders

The objective of this work was to evaluate specifically the surgical experience, portal haemodynamics, clinical outcome and survival in Egyptian schistosomal portal hypertensive bleeders after the small diameter partial portacaval shunts [SDPPCS]. This prospective study included fifty-six patients out of two hundred and fifty-four patients with schistosomal hepatic fibrosis, portal hypertension, and splenomegaly and complicated by bleeding oesophageal varices. All patients belonged to class A or B of Pugh modification of Child-Turcotte classification of cirrhosis. All patients were studied preoperatively with endoscopy and color duplex. All patients showed a preoperative haemodynamics pattern with hepatopedal flow. The fifty-six patients were prepared for elective small diameter partial portacaval shunt, SDPPCS, using the 8 mm, non-compressible polytetrafluoroethylene [PTFE] graft, Gore-Tex, W. L. Gore and Associates, Inc., Elkton, Md.].Postoperative duplex study was repeated one month, six months, and one year after operation. The portal flow cephalad and caudal to shunt site were measured, shunt patency was directly visualized, and flow in IVC cephalic to shunt in the intrahepatic portion was measured. Postoperative endoscopic evaluation, every three months during the first year, then every six months afterwards, to assess the downgrading of varices. One-three years of follow-up were the time allowed before reporting the final results. The episodes of variceal bleeding, ascites and encephalopathy were recorded for all patients. Twenty-one cases [37.5%] belonged to child s class A, and thirty-five cases [62.5%] were class B. SDPPCS was abandoned in 5/56 [8.9%]. Causes of operative failure in graft replacement were: adhesions due to previous cholecystectomy in 1/56 [1.8%], very thin walled PV in 1/56 [1.8%], very small PV < 10 mm in 3/56 [5.35%], extensive collaterals around the PV in 2/56 [3.58%], and medially displaced PV with inability to dissect a sufficient segment in 1/56 [1.8%]. Complications: were in the form of PV thrombosis in 1/56 [1.8%], IVC thrombosis in 1/56 [1.8%], shunt thrombosis in 2/56 [3.58%], and transected CBD in 1/56 [1.8%]. SDPPCS permitted sufficient volume of prograde flow of portal blood to the liver leading to maintenance of liver functions and low incidence of encephalopathy. SDPPCS resulted in progressive diminution of the size and grade of esophageal and gastric varices, as well as, disappearance of risk signs, thus guarding against rebleeding. There was statistically significant difference in downgrading of esophageal and gastric varices and improvement of gastropathy. SDPPCS resulted in improvement in hematological abnormalities with significant increase of blood elements, especially for thrombocytopenia. SDPPCS resulted in significant decrease in splenic size and splenic congestion. There was no operative mortality. Survival after SDPPCS was 91.07%. Shunt was patent in 49/51 patients [96%]. Three patients [5.357%] complained of mild encephalopathy after SDPPCS. Small diameter partial portacaval shunt [SDPPCS], using 8 mm PTFE graft, is feasible technically and is effective in controlling bleeding esophageal bleeding with preservation of a prograde hepatic portal flow, that preclude encephalopathy, in Egyptian schistosomal portal hypertensive bleeders. It could be considered as an alternative to difficult cases meant for DSRS, or shunt procedures in splenectomized patients

surgical experience with ovthotopic liver transplation in the rat

A surgical experience with 45 Orthotopic Liver Transplantation [OLT] in synergenic rats has been reviewed with technical details. Perioperative mortality was 11%. The mean time for donor operation was 29min [range; 24-35], Bench surgery 12 min [range; 10-18], Anhepatic phase 18 min [range; 15-25] and recipient operation 47min [range; 35-64 min]. OLT in the rat are relatively inexpensive and generally accepted as an excellent model for the analysis of pathological, physiological and immunological aspects related to organ transplantation. OLT in the rat is an excellent model for microvascular training and the Cuff technique [sutureless anastomosis] has simplified the vascular anastomosis and it may open the door for clinical application

Distal hypospadias repair using modification of the tubularized incised plate urethroplasty snodgrass operation: New concepts

There is no single, universally applicable technique for hypospadias repair. The Snodgrass tubularized entirely incised urethral plate [TIP] urethroplasty is a recent contribution, which becomes a popular technique for repair of distal [anterior] hypospadias. It simplifies the decision-making algorithms in hypospadias surgery with achieving good functional and cosmetic results. Eighteen boys with distal hypospadias have been subjected to Snodgrass repair with new concepts in modifications to avoid postoperative external meatal stenosis and the need for regular postoperative dilatations. No single recurrence, meatal stenosis, skin loss or penile torsion occurred in this work. Only one [5.6%] case with minimal fistula occurred due to mild infection treated conservatively. All patients had a vertically oriented slit-like normal positioned external meatus. These modifications could add more functional and cosmetic results to the Snodgrass repair