Hydatid Liver Disease: Long Term Results of a Surgical Management

To review the experience of the surgical management of liver hydatid cystic disease between 1973 and 1999. We retrospectively analyzed the files of 169 patients with liver hydatid cyst that were managed surgically between 1973 and 1999 with emphasis on the surgical treatment and its results. There were 112 females and 57 males with a mean age of 39.2 +/- 17.9 years [range: 5-85 years]. Most patients were symptomatic, 29.5% presented with abdominal pain, 27% with jaundice or gave a history of jaundice and 6% with weight loss. Hepatomegaly and palpable abdominal mass were the commonest physical signs. The right liver was affected more than the left 68% and 21.8%, respectively. In 13.6%, the cysts were >/= 10 cm in diameter. Pre-operative complications were common in our series [37.8%] and the commonest preoperative complication was intra-biliary rupture [34%]. The surgical procedures performed were variable, external drainage and omentoplasty were the commonest procedures performed. The mortality, morbidity and recurrence rates were high, 6.5%, 53.8% and 7%, respectively. The surgical management of liver hydatid disease is still carrying a high morbidity, mortality and recurrence rates, radical surgery when feasible, is associated with better results regarding length of hospital stay, morbidity and mortality than conservative surgery. The best surgical procedure to be employed is yet to be determined. The surgical option should be tailored to the case and according to the surgeon's experience and setup

Serum alkaline phosphatase, its isoenzymes and sialic acid in breast cancer patients

Serum samples from 86 patients with breast cancer were assayed for sialic acid concentration. Total alkaline phosphalatse [ALP] and ALP isonzymes by EDTA inhibition and heat inactivation, in order to evaluate their utility and behaviour in these patients. Serum samples from 76 healthy control subjects were assayed and compared with breast cancer cases. The results from this study suggest that serum total ALP and sialic acid concentrations were increased significantly in breast cancer patients and the increase was more in patients with metastases. The diagnostic usefulness of sialic acid in this study was quite comparable, with 91.86% [79 of 86] of breast caner patients showing elevated level. ALP inactivation by heat was more marked than inhibition of ALP by EDTA. The use of these isoenzymes as a diagnostic tool in breast cancer patients could help together with increased sialic acid level and ALP, especially in patients with metastases

Abnormalities in liver function tests in a group of patients with breast and gall bladder carcinoma

This study was conducted to investigate the clinical usefulness of liver function tests particulary gamma glutamyl-transferase enzyme [GGT EC 2.3.2.2.], total alkaline phosphatase enzyme [ALP EC 3,1,2,1] and 5-nucleotidase enzyme [5NT EC 3.1.3.5] as indicators of liver metastases in 44 breast cancer patients and 6 gall baldder cancer patients. The results of the activity of the three enzymes in 50 healthy controls were also compared. Preoperative imaging investigations when carried were also compared with enzymes values. The result from this study suggest that GGT is the most sensitive [90.9%] and specific [82.35%] enzyme in the diagnosis of liver involvement. While ALP is less sensitive [84.37%] and less specific [70,58%]. 5-Nucleotidase was not as good as GGT or ALP. We can conclude that an increase of GGT in patients known to have breast or gall bladder cancer would raise a high index of suspescion of liver metastases. This may lead to more cost effective use of further confirmatory tests i.e. imaging or laparoscopic guided biopsy to establish the diagnosis and the extent of the disease