Management of common bile duct stones in the laparoscopic era: an alternative pathway

The aim of this study was to evaluate a modified pathway of management of stones in the common bile duct. Twenty-five patients with gallstone disease were included in this study. All had clinical and/or chemical evidence of bile duct obstruction. For each patient, an abdominal ultrasound was done, followed by magnetic resonance cholangiography. The results were compared. Then, endoscopic retrograde cholangiography was performed, essentially for the removal of bile duct stones. Ultrasound revealed bile duct stones in 11 patients; while, in the rest of the patients, it was inconclusive. Magnetic resonance examination was normal in four patients [i.e. no obstruction found]; while it confirmed the presence of biliary obstruction in 21 patients; 17 due to stones and 2 due to other causes and in 2 patients, there was no obvious cause of obstruction. Endoscopic retrograde cholangiography was attempted in 23 patients. It was possible to insert endoscopic stents in two patients with malignant obstruction who needed no further surgery. The stones were endoscopically removed in 18 patients. Laparoscopic cholecystectomy was successfully performed in 20 patients. Open cholecystectomy and bile duct exploration were done in three patients

Investigating different health implications due to occupational exposure to vinyl chloride in an Egyptian PVC production facility

The present study aims at investigating possible health hazards due to occupational exposure to vinyl chloride monomer [VCM] and polyvinyl chloride [PVC]. Relevant haematological, liver and renal functions, tumour markers, roentegenograms of the chest and peripheral [distal] ends of the short- long bones [of hands and wrists], ultrasonographic parameters of the liver and abdominal organs as well as chromosomal aberrations are evaluated for 182 workers, chosen on simple random basis, from different sections at an Egyptian facility manufacturing VCM and PVC. Air measurements were taken at the breathing level at different sections. The highest VC levels were detected at the liquid waste treatment, VCM emergency scrubber tower, direct chlorination sections, the reactors' areas. Clinically, more than 80% of the studied workers have one or more symptoms and / or signs affecting their respiratory, digestive, circulatory, liver, renal, or musculoskeletal system. The onset of the majority of the elicited manifestations proved to be after the start of their work at the VCM / PVC manufacturing plant. About 44% of the studied workers had one or more abnormal ultrasonographic findings; 39.3% had abnormal liver [as regard the size or pattern], 20% had abnormal spleen, 5.8% had abnormal renal pattern. Eight workers had positive chest x- rays for interstitial pulmonary fibrosis or emphysema, and eight workers had osteolytic bony lesions affecting the peripheral areas of their distal phalanges in both hands. Positive antinuclear antibodies [ANA] was elicited in sera of 28 workers [15.4%]. All, except four workers have chromosomal aberrations in various forms: gaps, breaks, deletins. isogaps, isobreaks, dicentrics, centromere separation, as well as polyploidy. The study pointed out the presence of serious exposure to vinyl chloride, higher than the recommended TLV, in different locations. The clinical study revealed many adverse health effects which strongly suggest the relation with either acute, chronic, and / or delayed consequences of the occupational VCM/PVC exposure. Adopting preplacement and periodic medical examinations as well as provision of suitable protective clothing and equipment for workers at VCM / PVC manufacturing sections. Addition of "VCM / PVC Exposure and Consequent Effects" to the Egyptian List of Occupational Diseases. Good training is important for improving the working behaviour. Continuous monitoring of VC and related compounds should be a routine procedure