Study of endocrinal, biochemical and radiological changes after roux-en Y gastric bypass in patients with clinically severe obesity

Study of endocrinal, biochemical and radiological changes after Roux-en Y gastric bypass in patients with clinically severe obesity. Our study included 30 patients with clinically severe obesity, RYGB was done for all patients. Daily postoperative oral supplementation with 1000 mg of calcium and 800 IU of vitamin D was done for each patient. Body weight, BMI, also Total body fat, Total lean tissue mass, Bone Mineral content [BMD], Bone Mineral density [BMD], Total bone area [TBA] [using DEXA], also, serum calcium, parathyroid hormone [PTH], 25-OH vitamin D, 24 hours urinary calcium and bone specific Alkaline phosphatase [BSAP] were assessed preoperatively and one year after surgery. In our study: females comprised 73% of cases. The mean age was 35 +/- 8.8 years. One year after RYGB: Body weight [BW] decreased significantly from 132.8 +/- 26.5 to 90.3 +/- 17.3 kg [p = 0.000]. Body Mass Index [BMI] decreased significantly from 48 +/- 7.3 to 32.6 +/- 4.1 kg/m[2] [p= 0.000]. Also, parameters of skeletal health changes were determined after one year. BMC decreased significantly from 2968.6 +/- 71.4 to 2700.8 +/- 45.4 gm [p = 0.000] BMD decreased significantly from 1.2600 + 0.03 to 1.2197 +/- 0.015 gm/cm[2] [p= 0.000]. TBA decreased significantly from 2356.2 +/- 35.4 to 2216.3 +/- 43.5 cm[2] [p= 0.000]. Serum calcium, 24 hours urinary calcium and BSAP were non significantly decreased while OH-vitamin D and PTH were non significantly increased after surgery. From this study, RYGB gives very good results as regards reduction of body weight. Postoperative supplementation with calcium and vitamin D partially correct osteoporosis. Further studies are needed to determine the exact dose of calcium and vitamin D that may abort bone resorption. From this study, it is shown that Roux-en-Y gastric bypass operation gives very good results as regards reduction of body weight in morbidly obese patients. Postoperative supplementation with calcium and vitamin D partially correct osteoporosis. So, These patients need periodic follow up for Bone Mineral Density [BMD], PTH, calcium, serum vitamin D and markers of bone resorption and formation specially postmenopausal female

Effect of parathyroidectomy on patients with tertiary hyperparathyroidism [retrospective study]

The aim of this work was to study the effect of parathyroidectomy on patients with tertiary hyperparathyroidism. A total number of 10 patients with tertiary hyperparathyroidism manifestations underwent parathyroidctomy, where the patients with adenoma of parathyroid gland underwent excision of adenoma or multiple adenoma, and patients with hyperplasia of parathyroid gland underwent total parathyroidectomy and implantation of a part of one parathyroid gland into the sternomastoid muscle. There were significant changes in clinical and labortatory values between pre- and post-operative measures in both types of patients [adenoma and hyperplasia] where there were significant decrease in serum cacium, serum alkaline phosphatase and parathyroid hormone [P.T.H] and great changes in preoperative manifestations. From this study we can concluded that the optimal treatment of tertiay hyperparathyroidism is surgical excision of edenoma or adenomas, or total parathyroidectomy and transplantation of a part of one gland into the sternomastoid muscle in case of hyperplasia of parathyroid gland

Prognostic value of sentinel lymph node and local thyroid lymphocyte infiltration in differentiated thyroid carcinoma

The aim of this work is to investigate the prevalence, significance and prognostic value of lymphocytic infiltration and SLN associated to differentiated thyroid carcinoma. Our study included 50 patients with preoperative diagnosis of differentiated thyroid carcinoma by FNAC and Trucut needle biopsy, there age ranged from 17 to 55 years with mean age [36 year]. They were 35 females and 15 males. Absence of clinically palpable draining cervical lymph node was the main exclusion criterion in selection of our patients.Our patients were subjected to peroperative injection of patent blue dye intra tumoral, detection and resection of SLN and stained lymphatic channels, resection of samples from jugular lymph nodes [non stained] as NSLNs. Then total thyroidectomy was done. In our study, SLNs staining occurred in 37/50 patients with DTC [74%], 28 of which in patients with PTC 28/33 [84.8%], 5 in patients with FTC 5/13 [38.4%] and 4 in patients with follicular variants of PTC 4/4 [100%] mapping failure occurred in 13/50 patients [26%].22 patients revealed the SLN biopsy from which 18 patients show -ve NSLN and 4 patients with +ve NSLNs [false +ve]. 15 patients revealed -ve SLN biopsy from them 10 patients show -ve NSLNs and 5 patients show +ve NSLN [false -ve SLNI. The accuracy of SLN biopsy needs further investigation before it can be recommended in the routine management of the thyroid neoplasia. The onus must fall on the endocrine surgeon to define clearly the direct therapeutic relevance of occult nodal disease if SLN biopsy is to become a standard of care in thyroid cancer

Evaluation of different treatment modalities of neurovascular compression in thoracic outlet syndrome

Objective: The aim of this study is to evaluate the results of different modalities of treatment of neurovascular compression manifestations of thoracic outlet syndrome [TOS]

Patients and methods: This prospective study included 50 patients with neuro and / or vascular compression manifestations at thoracic outlet area. They were admitted to the Vascular Surgery Unit, Mansoura, University Hospital, Mansoura, Egypt, during the period from January 2000 to May 2003. Patients were classified into two main groups. Group I [Neurogenic TOS, 35 patients with 40 limbs]: included patients presenting mainly with neurogenic manifestations. Scalenectomy +/- cx. rib excision was done in 22 limbs and combined Scalenectomy + cx. rib in addition to 1St rib excision was done in 18 limb. Group IIA [arterial TOS, 9 patients with 10 limbs]: This group included patients presenting mainly with arterial manifestations. They were subjected to surgical decompression, various methods of arterial reconstruction +/- sympathectomy. Group IIB [venous TOS, 6 patients]: This group included patients presenting mainly with arterial manifestations. They were subjected to surgical decompression, various methods of arterial reconstruction +/- sympathectomy

Results: For neurogenic group: The outcome for patients treated by scalenectomy +/- cervical rib excision was excellent in 14 limbs, good in 6 limbs and fair in 2 limbs. However, the outcome for patients treated by combined scalenectomy + cervical rib excision in addition to first rib excision was excellent in 11 limbs, good in 4 limbs and fair in 3 limbs. For arterial group: The come was excellent in 8 limbs and good in 2 limbs. For venous group: Surgical decompression in the form of scalenectomy, venolysis and 1St rib excision was done for 2 patients and the outcome was good. Conservative treatment and also P.T.A. showed failure in two patients [out of the five thrombotic patients [40%]]

Conclusion: In patients with TOS scalenectomy +/- cervical rib excision is as effective as combined scalenectomy and first rib excision ,however ,first rib excision is still indicated where there is tight costoclavicular space after scalenctomy, and also is indicated in patients with vascular manifestations

Patients and methods: This prospective study included 50 patients with neuro and / or vascular compression manifestations at thoracic outlet area. They were admitted to the Vascular Surgery Unit, Mansoura, University Hospital, Mansoura, Egypt, during the period from January 2000 to May 2003. Patients were classified into two main groups. Group I [Neurogenic TOS, 35 patients with 40 limbs]: included patients presenting mainly with neurogenic manifestations. Scalenectomy +/- cx. rib excision was done in 22 limbs and combined Scalenectomy + cx. rib in addition to 1St rib excision was done in 18 limb. Group IIA [arterial TOS, 9 patients with 10 limbs]: This group included patients presenting mainly with arterial manifestations. They were subjected to surgical decompression, various methods of arterial reconstruction +/- sympathectomy. Group IIB [venous TOS, 6 patients]: This group included patients presenting mainly with arterial manifestations. They were subjected to surgical decompression, various methods of arterial reconstruction +/- sympathectomy

Results: For neurogenic group: The outcome for patients treated by scalenectomy +/- cervical rib excision was excellent in 14 limbs, good in 6 limbs and fair in 2 limbs. However, the outcome for patients treated by combined scalenectomy + cervical rib excision in addition to first rib excision was excellent in 11 limbs, good in 4 limbs and fair in 3 limbs. For arterial group: The come was excellent in 8 limbs and good in 2 limbs. For venous group: Surgical decompression in the form of scalenectomy, venolysis and 1St rib excision was done for 2 patients and the outcome was good. Conservative treatment and also P.T.A. showed failure in two patients [out of the five thrombotic patients [40%]]

Conclusion: In patients with TOS scalenectomy +/- cervical rib excision is as effective as combined scalenectomy and first rib excision ,however ,first rib excision is still indicated where there is tight costoclavicular space after scalenctomy, and also is indicated in patients with vascular manifestations

Parathyroidectomy for patients with tertiary hyperparathyroidism [Mansoura experiences]

Objective: The aim of this work was to study the effect of parathyroidectomy on patients with tertiary hyperparathyroidism, and to determine whether patients with tertiary hyperparathyroidism due to single- or two- gland disease undergoing limited resection have similar outcomes compared with patients with hyperplasia undergoing subtotal parathyroidectomy

Patients and Methods: A total number of 15 patients with manifestations of tertiary hyperparathyroidism underwent parathyroidectomy, where patients with adenoma[s] of parathyroid gland underwent excision of only the adenoma[s], and patients with hyperplasia of parathyroid gland underwent subtotal parathyroidectomy

Results: There were significant changes in both clinical and laboratory values between pre- and post operative measures in both types of patients [adenoma and hyperplasia]. This was proved by the significant decrease in serum calcium, serum alkaline phosphatase and parathyroid hormone as well as the great clinical improvement in the preoperative manifestations

Conclusion: From this study we can conclude that the optimal treatment of tertiary hyperparathyroidism is surgical excision of adenoma[s] in patients with parathyroid adenoma[s] or subtotal parathyroidectomy in patients with hyperplasia of parathyroid gland

strategy of wide local excision followed by postoperative radiotherapy in adult rhabdomyosarcoma: is it worthwhile?

This study was done on 20 patients with adult rhabdomyosarcoma of lower extremities. They were subjected to careful history taking, general and local examination. Investigations were done to confirm the diagnosis and to be sure that there was no distant metastasis. They included biopsy [Tru-Cut, incision and excision], plain X-ray chest, computed tomography [CT] chest, bone scan and magnetic resonance imaging [MRI] on the tumor area. The preoperative investigations included complete blood picture, liver functions, serum creatinine, blood sugar and ECG. Operation was done in the form of wide local excision [conservative surgery or limb salvage technique]. Radiotherapy was applied at the tumor area after surgery in the form of 6000 rad divided on six doses over six weeks. A long-term follow up for two years was done regarding local recurrence, distant metastasis and other complications

Special tactics in repair of epigastric hernia

This study included 30 patients presented with epigastric hernias of different sizes. Careful clinical examination and preoperative investigations were done to evaluate the general conditions of the patients and to treat any correctable medical disease. After assuring that there was no contraindication to surgery, the elective surgically correction of the hernia was done by a special technique in all patients using three-layer repair [vest-over pants repair, gel foam packing and prolene mesh [hernioplasty]. A follow up of the patients was done for one year. The results were very satisfactory with no recurrence

Study of risk factors and different modalities of treatment in lower extremity vascular injuries

This study included 88 patients with lower extremity vascular injuries. They were assessed on presentation and resuscitation protocols were initiated if signs of shock were present. Arterial injuries were repaired by primary repair, resection and anastomosis, interposition graft, artery ligation, temporary shunts and extra- anatomical bypass. Venous injuries were repaired by the same techniques, but when the repair would be complex or the patient is hemodynamically unstable, simple ligation was done. Primary amputation was done for patients where limb salvage was impossible clinically. MESS score was applied on the cases to obtain a score, which predicted the eventual need for amputation

Laparoscoplciversus conventional mesh repair of inguinal hernia; comparative randomized trial

This prospective randomized study was undertaken to compare laparoscopic transabdominal mesh repair versus open preperitoneal mesh repair and anterior tension free mesh repair in the treatment of inguinal hernia. between August 1997 and August 1999, a total number of 140/175 patients with nyhus type2, 3A, and 3B and type4 passed the exclusion criteria and agreed randomization. Laparoscopic inguinal mesh repair was carried out in 45 patients [mean age 39.2 years], open preperitoneal mesh repair was performed in 47 patients [mean age 43.2 years] and anterior tension free mesh repair was performed in 48 patients [mean age 43.9 years]. The mean follow up period was 29.1 months in laparoscopic group, 28.3 months in the open preperitoneal group and 29.2 months in the anterior group laparoscopic group showed a significant longer operative time [75.1 +/- 10.2 mm] than the open preperitoneal group [25.8 +/- 7.1 rain] and the anterior group [40.1 +/- 9.4]. On the other hand, hospital stay was significantly shorter in laparoscopic and open preperitoneal group [1.1 +/- 0.3. and 1.2+0.6 days respectively] than the anterior group [2.4+0.5 days]. The mean time to return to the normal activity was significantly less in laparoscopic group and open preperitoneal groups [6.7 and 8.6 days respectively] compared with the anterior group [13.7 days]. Postoperative morbidity was in the form of nerve injury and hydrocele, which were significantly more in the anterior group and pneumoscrotum that was most frequently encountered in laparoscopic surgery. Recurrence rate was more common in the anterior group [8.3%]. compared with both the open preperitoneal and laparoscopic groups [2.1%, and 4.3% respectively]. We can conclude that both laparoscopic mesh repair and open preperitoneal mesh repair have less postoperative pain, short hospital stay, early pain free return to work and normal activity, low complication and recurrence rates. However, the open preperitoneal mesh repair has the advantage of a shorter operative time and low operative charges

Effect of varicocelectomy on sperm count, motility and morphology: comparative randomized study of different approaches

This prospective study was undertaken to estimate the effect of varicocelectomy on the count, motility and sperm morphology and how the morphological criteria predict outcome in patient population. Also, to estimate which approach can improve this outcome in a comparative randomized study. Between June 1996 and June 2000, a total number of 346/425 patients suffering from varicocele with primary infertility passed the exclusion criteria and agreed randomization. Their mean age was 33.4 years. All patients were clinically examined and fully investigated using semen analyses, testicular ultrasound and color doppler flow imaging. Bilateral high ligation, bilateral laparoscopic approach and subinguinal varicocelectomy with 5.5X magnification were carried out in 119, 112 and 115 patients respectively. Postoperatively, patients were followed up at 1, 3, 6 and 12 months intervals. Surgical correction of varicocele was associated with significant overall improvement in sperm count and motility in all-surgical groups. According to WHO classification, the percentage of sperms with normal morphology was significantly increased with a significant decrease in percentage of amorphous forms. Also, according to Kruger classification, there was a significant improvement in the overall percentage of normal forms after varicocelectomy. Moreover, the pregnancy rate was significantly higher in the subinguinal approach with magnification [53%] when compared with high ligation and laparoscopic groups [21.8% and 29.4% respectively]. On the other hand, postoperative hydrocele formation occurred more frequently in the high ligation approach [24.3%] when compared with laparoscopic [5.3%] and subinguinal [0%] approaches. Also the postoperative recurrence was significantly higher in the high ligation group [23.5%] when compared with the laparoscopic [14.2%] and the sabinguinal with magnification groups [0.8%]. From this study, we conclude that varicocelectomy has a positive effect on sperm count, motility and morphology and the subinguinal varicocelectomy with magnification is a safe, and a minimal invasive approach to varicocelectomy that lessens the incidence of hydrocele formation and varicocele recurrence, and assures preservation of testicular artery. Moreover, it has a higher positive effect on the sperm motility and morphology, which are the predictors of pregnancy