ABSTRACT
The evidence based data of hydatid liver disease indicate that the level of evidence was too low to help decide between radical or conservative surgeries [level IV evidence, grade C recommendation]. So, there is a need for accurately designed randomized trials with precise goals to compare pericystes-tomy versus a specific modified endocystectomy technique for the treatment of hepatic hydatid cysts 8 cm or less in diameter in Egyptian patients, regarding the operative time, intra-opera-tive blood loss, complications and long term recurrence and to test the role of anti-hydatid IgG4 in diagnosis and detection of early recurrence. 60Patients with 131 liver cysts of E. granu-losus fulfilling the study criteria were randomly divided to two groups. G1: 32 patients with 69custs treated by modified endo-cystectomy and GII: 28 patients with 62cysts treated by closed total pericystectomy. GIa included 40cysts >5cm in diameter [mean 6.86, SD +/- 0.809] and GIb29cysts5cm in diame-ter [mean 7.01 SD +/- 0.79] and GIIb25cysts >/-cm in diameter [mean 4.04 SD +/- 0.93]. Preoperative evaluation inclyded histo-ry taking, clinical examination, blood tests, specific anti-hydat-id IgG4, abdominal sonography and CT scan. The operative time for dealing with each cyst was in minutes. Operative blood loss and need for blood trancfusion were estimated for each patient. Specific anti-hydatid IgG4 by ELISA was used to diagnose and to detect early rasurrence. Patients were followed up clinically and by ultrasonography every 3 months and for anti-hydatid IgG4 every 6 months for 24-90 months. The mean maximum operative time was in GIIa followed by GIa, GIb, then GIIb. The operative time was significantly lower in GIIb than Ib and in GIa than IIa. Seven patients [GII] had blood transfusion. The intraoperative bleeding in GI was <500ml/patient, and 18patients [GII] each bled >500ml. No intra-peritoneal seedling during the follow up. Five of 55patients [9%] were serologically suspected of relapse or incomplete cure. One [GII] showed early recurrence at 3 months. High IgG4 antibodies were detected in patients which decreased gradually after surgery and normal after 18 months post-operation.
Subject(s)
Humans , Male , Female , Cystectomy , Ultrasonography , Tomography, X-Ray Computed , Postoperative Complications , Recurrence , Immunoglobulin G , Randomized Controlled Trials as TopicABSTRACT
To initially evaluate the possibility of electively repairing groin hernias in ascitic liver patients, to test the feasibility of the use of mesh in these patients and to evaluate mesh repair versus herniorraphy, 30 patients' [3 females and 27 males] with liver ascites and uncomplicated groin hernias were treated operatively for their hernias. They were divided into two groups: group I [Gp I]: 14 patients [9 indirect, 3 direct and 2 femoral] treated by herniorraphy and group II [Gp II]: 16 patients [10 indirect, 3 direct, 3 femoral] treated by polypropylene mesh placement with or without plug. All operations were performed under local anesthesia with preoperative prophylactic antibiotic cover. 23 patients were followed up: 11 in Gp I [4 to 24 months mean = 14.82 SD, 6.08] and 12 in group II [7 to 28 months mean = 14.42 SD, 5 98] Seventeen ascitic fluid samples were taken intra-operatively for bacteriological study. There was no operative mortality. Post operative complications included : temporary increase in ascites which occurred in 25 patients [12 in group [I], 13 group[II]]. In 21 cases. It responded to medical treatment and in three it required paracentesis. There was no deep wound infection. There were three cases of superficial wound infection [2 in group I and one in group II]. Scrotal hematoma and/or seroma occurred in four cases. A major attack of variceal bleeding occurred in a patient in the mesh group and was treated successfully. There was no spontaneous bacterial peritonitis. There were three recurrences: two in Gp I and one in Gp II. two of the recurrences were attributed to technical mistakes. Five [29.41%] of the bacteriological samples showed mono-microbial organisms i.e. bacterascites. Three were gram-ve two of them were E coli and one Pantoea spp. and two were Gram +ve Staph aureus [one was methicillin resistant] Findings indicate that elective groin hernia repair in liver patients with ascites is feasible even without prior peritoneovenous shunting with no mortality and an acceptable overall rate of complication. The use of mesh seems justified in -those patients with comparable of not superior, results to herniorraphy. Mesh placement was not associated with any increase in the rate of complications or wound infection .Although no spontaneous bacterial peritonitis occurred in this .study, caution should be taken and long antibiotic cover is probably important to avoid this fatal complication because bacterascites was found in 29 41% of the patients
Subject(s)
Humans , Male , Female , Hernia, Femoral/surgery , Surgical Mesh , Postoperative Complications , Wound Infection , Recurrence , Liver Diseases , AscitesABSTRACT
P53 is a tumour suppressor gene on chromosome 17 P. Alterations [deletion or mutation] within the coding sequences of the gene are among the most frequent genetic changes detected in human neoplasm. The use of gene therapy in some tumours is a new trend nowadays which carries many hopes for the future treatment of these tumors. This modality of treatment utilizes transfer vectors [plasmid, virus,] for delivering certain genes into malignant cells to induce tumour suppression. Injection of P53 intratumoral [I.T] in Hepatocellular Carcinoma [H.C.C.] is an example of this therapy. The aim of this study is to compare the effect of intratumoral injection of P 53 to that achieved with alcohol injection in cases of H.C.C. In a prospective study, eleven consecutive patients, diagnosed as H.C.C., were subjected to I.T injection of alcohol [Group I] and another eleven patients were subjected to I.T P 53 injection [Group II]. The results show that alcohol injection has superior results in treating H.C.C. over P 53 injection