Cardiac surgery in Assiut University Hospital; ten years experience

Patients with cardiac lesions admitted for cardiac operations [closed or open] were retrospectively included in this study. The patients were diagnosed and fully investigated for elective surgery. There was a progressive increase in the number of patients with open surgery from 1990 [22 patients] to 1999 [122 patients], but the reverse was with closed valvular surgery from 1990 [24 patients] to 1999 [none]; the difference was significant. There was also an increase in the number and types of patients with congenital cardiac lesions subjected to surgery. There was also an improvement in the morbidity and mortality [early and late]; the difference was highly significant

Open heart surgery in Assiut University Hospital: evaluation of our experience in 77 cases

Two decades ago, the approach regarding the cardiac operations in Assiut University Hospital was restricted to closed heart technique for management of rheumatic mitral valve stenosis, pericardial and some extracardiac lesions. After advent of open heart surgery the practice was expanded to involve different types of valvular deformities in 73 patients and non-valvular intracardiac lesions in 4 patients. Regarding the valvular lesions, 51 of them were subjected to valve replacement [AVR n = 29, MVR n = 17, AMVR n = 5] utilizing Sorin tilting disc valve in 37 and St Jude in 14 patients. Open mitral commissurotomy with or without commissural sutures was performed in 19 patients and capentier Edward ring was implanted in another patient. The remaining 2 cases of valvular lesions had congenital pulmonary stenosis managed by commissurotomy. The nonvalvular lesions [4 cases] were managed by closure of ASD [2 cases] and excision of atrial myxoma and subaortic membrane, one patient each. The overall early [<30 days] mortality was 14%. The mortalities were attributed to compromised left ventricular function [4 cases], myocardial failure and/or arrythmia [3 cases], coagulopathy [2 cases], respiratory failure and prosthetic valve malfunction [2 patients]. No mortality was attributed to technical error

Closed versus open mitral commissurotomy: NYHA class and echocardiographic studies before and after the operation

This study included 45 patients [27 males and 18 females] with isolated rheumatic mitral valve stenosis with a mitral valve area < 1.5 cm2. They were managed and followed up for a mean period of 19 months. They were classified into 2 groups. Group I [GI], 26 patients underwent closed mitral commissurotomy [CMC] and group II [GII], 19 patients who were subjected to open mitral commissurotomy [OMC]. Follow up revealed improvement of the functional class in both groups [P < 0.03]. The improvement was better in GII, but the difference between the two groups insignificant. Based on the results, mitral commissurotomy either closed or open, provides marked symptomatic and hemodynamic improvement in most patients with better results in open commissurotomy

Nissen fundoplication for the treatment of chronic asthmatic patients

This study was applied on 30 adult patients [21 males and 9 females] presented by chronic bronchial asthma and symptoms of GERD who were refractory to conservative anti-asthma medical lines. Clinical assessment, X-ray chest, esophagography, pulmonary function tests before and after bronchodilators, tests to confirm GERD and upper GI endoscopic examination including lower esophageal multiple biopsies were done to all cases. Six out of 30 patients underwent Nissen fundoplication as a selected surgical anti-reflux technique. Esophagitis was detected in 96.6% of cases, endoscopic evidence of GERD was shown in 63.3%, anti-reflux treatment together with bronchodilators have caused clinical reversibility of airway obstruction by 20% or more as proved by pulmonary function parameters tested. Anti-reflux conservative treatment has achieved good response in 24 patients. Regarding the 6 patients who were subjected to surgery, 5 of them showed marked clinical and pulmonary functions improvement with decreased frequency of exacerbations, reduction of bronchodilator dose and disappearance of reflux symptoms. One patient failed to show clinical response

Three years follow-up of prosthetic heart valve implantation in Assiut University hospital

Three-year follow up of 51 hospital survivors who underwent isolated aortic valve replacement [AVR, n = 29], mitral valve replacement [MVR, n = 17] or both aortic and mitral valve replacement [AMVR, n = 5] showed a decrease in the actuarial survival rate at the end of the 1st year to 94% compared with 86% survival rate at the end of the 3rd year. Considering the valve site, the actuarial survival rate after AVR at the end of the 3rd year was 79% compared with 72% after MVR. Valve-related complications occurred in 11 patients. Prosthetic valve endocarditis was fatal in 5 cases, anticoagulant-related hemorrhage was encountered in 5 cases with a fatal event in one patient. Valve thrombosis was a lethal cause in one patient. Cardiac non-valvular complication in the form of coronary ischemia was encountered in one case, 3 years after AVR. Noncardiac non-valvular complications were false thoracic aortic aneurysm in one case and epigastric hernia in another case. At the end of the 3 years of follow-up, 72.5% of the patients were free from morbidity

Medical antireflux treatment for asthma associated with gastroesophageal reflux

Thirty patients with non-allergic bronchial asthma associated with gastroesophageal reflux [GER], were studied before and after 9 weeks of antireflux medical therapy [ranitidine HCl]. All patients were subjected to full clinical history and examination, chest roentgenogram, ventilatory function tests, and tests to confirm GER [Bernstein test, Tuttle test, upper gastroesophageal endoscopy including taking biopsy from lower esophageal mucosa for histopathological examination]. Esophageal and pulmonary symptoms scores were recorded weekly. Endoscopic evidence of GER was shown in 63% of cases, while histopathologically esophagitis was proved in 96%. 9-week antireflux medical treatment was associated with rapid and dramatic response of reflux symptoms in 80% of cases and with more delayed and less dramatic improvement in pulmonary symptoms in 87% of case, evidenced subjectively by decline of both esophageal and pulmonary symptoms scores. Objectively esophageal erosions were diagnosed endoscopically in 16 out of 19 patients and healed completely. Ventilatory function tests also significantly improved [P <0.01]. It was concluded that there is a subset of patients in whom bronchoconstriction is triggered by GER. Treatment of the reflux in such patients improved their asthma

Comparative study between the spectrum and drug sensitivity of pathogens causing empyema thoracis in the period of 1974-1977 and 1991-1993 in upper Egypt

159 cases of post-pneumonic empyema thoracic were included in this study. They were divided into 2 groups. Comparative study between both groups revealed no difference as regard aged and sex predilection. Bacteriologically, positive cultures of pus collected from group I for aerobic bacteria were obtained in 80.6% of cases. Staph. aureus played a major role in causing empyema thoracic [43.5%]. Other isolates were: Pneumoccoci [syn. strept. pneumoniae] [25.8%], Pseudomonas sp. [14.5%], Klebsiella sp. [12.9%], Strept. pyogenes and Proteus [8% for each] and Diptheroid [4%]. Nothing recorded about anaerobic bacteria. In group II, positive cultures of pus for aerobic and anaerobic bacteria were obtained in 43.3 and 42.1%, respectively. Although Staphylococcus aureus headed the aerobic bacterial list yet, its frequency decreased to 23.7%. Other isolates were Klebsiella sp. [11.3%], Strept, pyogenes [7.2%], Strept. pneumoniae [6.2%], E. coli [5.1%], Proteus sp. [4.1%] and Pseudomonas sp. [2.1%]. Contrary to group I, Strept. pneumoniae and Pseudomonas sp. played minor roles. As regard anaerobic bacteria, the commonest was Bacteroids sp. [18.4%], followed by Peptostreptococcus [10.5%], Peptococcus [7.9%] and Fusobacterium was the least common [5.3%]. Results of sensitivity tests showed that the different isolated pathogens were sensitive to different antimicrobial drugs, so, the choice of antibiotic must usually be determined by the results of culture and sensitivity testing

Foreign body inhalation in patients with persistant cough

596 patients persistent cough were collected from the Pediatrics, Chest and Cardiothoracic Surgery departments of Assiut and Menia University Hospitals. The patients were classified into four groups. Group A [39] had a definite history of foreign body inhalation. Group B [18] had a suggestive history. Group C [27] had clinical and/or radiological features suggestive of respiratory obstruction. Group D [512] had neither a history of foreign body inhalation nor features of respiratory obstruction. All patients in groups A, B and C and 4 from group D, were subjected to bronchoscopy at the Cardiothoracic Surgery Unit of Assiut University Hospital. Foreign bodies were found in 9.7% of patients studied. They were present in 90%, 61%, 30% and 0.8% of groups A, B, C and D, respectively. Right thoracotomy was performed in one case because the foreign body penetrated the bronchial tree. History taking was found to be the most important factor in diagnosis. Some unusual cases were discussed

Cell-type diagnosis of advanced central bronchogenic carcinoma without restoring to major thoracotomy

Seventy-three patients [forty-five males and twenty-eight males] who had central bronchogenic carcinoma were diagnosed. The methods utilized in the diagnosis were revised to decide a rapid diagnostic approach without restoring to major thoracotomy. According to the radiologic features, they were classified into total lung atelectasis [six patients], para- cardiac shadow [thirty patients], hilar and para-hilar shadows [sixteen patients], para-tracheal shadow [sixteen patients] and more than of the mentioned features [five patients]. Bronchoscopically, they were classified into those with visualized lesions [22 patients] and non-visualized lesions [51 patients]. Palpable scalene lymph gland was positive in all specimens [100%] regardless of the radiologic or the bronchoscopic classification. This is in contrast to non-palpable node which produced negative diagnosis in all specimens. Bronchoscopic biopsy was positive in all cases with visualized lesions, while blind biopsy was positive in 9% of non-visualized lesions. The patients with non- visualized growth and non-palpable scalene node could be diagnosed safely by anterior mediastinotomy without restoring to major thoracotomy. This procedure has many advantages

Primary lung cancer in patients below the age of 40 years in upper Egypt

Thirty-two patients aged from 18 to 39 years were managed for bronchogenic carcinoma in Menia and Assiut University Hospitals in the period from July 1988 to December 1993. All patients were symptomatic at time of diagnosis. Initial clinical examination, radiologic features and bronchoscopic findings that indicated advanced disease tumor were found in 27 patients. Yielded positive results of exfoliative cytology were low [sputum 13%, bronchial wash 28% and pleural fluid 9%]. Adenocarcinoma was found in 46.8% of the patients, small cell carcinoma in 28.1%, alveolar cell carcinoma in 9.4%, mixed adenosquamous and large cell carcinomas in 6.3% for each and lastly, squamous cell carcinoma in 3.1%. According to TNM definition in new international staging for lung cancer [1986], none had stage II or IIIa, but nine patients had stage IIIb and twenty-two had stage IV, while one patient only had stage I tumor disease. Resectability rate was 3%

Cancer esophagus: 7 years experience in Assiut University Hospitals

This work represents our experience in 139 patients with proved cancer Esophagus. They were classified into two groups: Group [I] : Including 74patients who were managed in the period from April 1984 to December 1986. This period represented our early experience in dealing with such cases. Esophageal resection and Esophagogastric anastomosis were performed in 46 patients and Esophagogastric by pass operation in 4 cases. The anastomosis was done manually in 24 patients and by stapler in 26 patients. Two stapling devices were used [EEA in 12 and ILS in 14]. Leakage was a complication in 36% of the manual anastomosis and 15% of stapler type. Palliative procedures done for the inoperable cases were either esophageal intubation [14 patients] or gastrostomy in 3 patients. Group [II] : Included 65 patients who were managed in the peroid from January 1987 to October 1991, During this period we modified our technique in anastomosis to avoid the anastomotic leakage and gastric perforation that were encountered in the first group. Esophageal resection and Esophago gastric anastomosis were performed in 31 patients and esophageal resecetion with total gastrectomy was undertaken in other 2 cases. The anastomosis was sewn manually in 29 patients and using ILS device in the remaining 4 cases. The incidence of leakage has been decreased markedly in this group but still there is substantial mortality attributed to other causes than leakage. Palliative procedures were resorted to in 30 patients, palliative intubation was used in 18 cases and substernal gastric pedicle tube by pass in 12 cases. The other 2 cases who had an upper 1/3 carcinoma were refered to deep x-ray therapy

Why surgery is preferable in management of solitary pulmonary nodules?

This study included 108 patients who had solitary pulmonary nodules. 65 had malignant lesions [Group I] and 43 had nonmalignant nodules [Group II]. Bronchogenic carcinoma headed the list of malignant lesions [91%], while granulomas either specific or nonspecific headed the list of nonmalignant nodules [60%]. After thoracotomy, it was proved that the clinical, radiological, laboratory and bronchoscopic studies achieved the following In group I [GI] correct preoperative diagnosis in 3%, false negative diagnosis in 12% and the remaining 85% their lesions were suggestive of malignancy but without definite proof. In group II [GII] correct preoperative diagnosis was achieved in 20 nodules [granuloma [18], hamartoma [one] and pulmonary arteriovenous fistula [one]]. The preoperative diagnosis was different from post operative diagnosis in 6 cases. False diagnosis as bronchogenic carcinoma was reported in one case. The remaining lesions [16], their benign nature was established after thoracotomy. Surgery is the line of choice in dealing with such cases to explore, identify and resect the lesion whenever possible

Identification of cardiovascular abnormalities in children with empyema thoracis by two-Dimensional and doppler echocardiography

Echocardiographic assessment of children with empyema has not previously been reported in the literature. Two-dimensional and Doppler echocardiography were performed in 47 children with acute [n=23] and chronic [n=24] empyema and 34 control subjects. Echocardiography demonstrated pericardial effusion in 11/47 patients [23%]. Those with acute empyema had significantly thicker pericardium [p < 0.009] than control subjects. tricuspid regurgitation was present in 21/47 patients [45%]. The mean right ventricular internal dimension in diastole [RVID] was significantly larger in acute [p < 0.006] empyema than that of control subjects. the mean tricuspid pressure gradients indicated on elevated mean right ventricular systolic pressure with increased calculated mean pulmonary arterial systolic pressures of children with acute empyema [38.5 +/- 6.4 mmHg] and chronic [39.8 +/- 5.6 mmHg] empyema than the normal mean [20 +/- 4 mmHg] reported by Krovetz and Goldblom. Children with chronic empyema had significantly less mean left ventricular internal dimension in diastole [LVID] [p < 0.005] and in systole [LVIS] [p < 0.02] than control subjects. strikingly, their mean left ventricular mass was also significantly less [p < 0.05] than that of either acute empyema or control subjects. these results provide base line data for follow up of children with acute and chonic empyema

Bronchial carcinoma in Assiut University Hospital

The data of 106 patients [82 males and 24 females] with proved bronchogenic carcinoma were analysed. Seventy-three% of them were found inoperable after clinical and/or radiological examination. Another 7% were excluded from surgery after bronchoscopic examination. Twenty% were submitted to surgical treatment, while the rest once diagnosed were beyond the territory of the surgeon. Ten% were found to be resectable after thoracotomy. Delay, partly caused by the patient and the treating doctor and by the nature of the disease are behind the low operability and resectability rates here