Experimental induction of Klebsiella rhinoscleromatis infection in albino rats. [a histopathologicaland bacteriological study]

Scleroma, the chronic specific granuloma of the nose and upper respiratory tract is endemic in Egypt and many other countries. The exact pathogenesis of the disease as regards the etiologic role of Klebsiella rhinoscleromatis is contradictory. This work investigated the effect of experimental intravenous injection of Klebsiella rhinoscleromatis bacilli in albino rats to demonstrate that the organism can fulfill Koch's postulates. Organisms were isolated from biopsy specimens taken form nasal lesions of ten patients in the granulomatous stage of scleroma. Specimens were subjected to bacteriological and histopathological examinations to confirm the diagnosis. One hundred micro of freshly prepared bacterial inoculum containing 10[8] CFU/ml was injected weekly in the tail vein of each of thirty albino rats and repeated for 5 consecutive weeks. Biopsy specimens were taken form sacrificed animals and subjected to bacteriological and histopathological examinations. Positive histopathological diagnosis of scleroma was reported in the nose of 66.7% of rats, the larynx of 46.7%, the lungs of 26.7% and liver of 20% of rats. Bacteriological techniques were successful in revealing Klebsiella rhinoscleromatis form the nose of 36.7% of rats, the larynx of 30% and the lungs of 20% of rats. Various techniques were carried out to demonstrate the organisms in tissue sections. Two histochemical stains were employed including silver and periodic acid Schiff [PAS] stains. Immunoperoxidase technique using Klebsiella capsular type 3 antiserum was Care applied It gave positive results in 66.7% or the 6 stained liver sections inspite of negative bacteriological cultures. The histiocytic nature of the Mikulicz cells was confirmed using alpha-1 antitrypsin, an immunohistochemical marker of histiocytes, and by studying the ultrastructural features of Mikulicz cells using the transmission electron microscope

Video-coelioscopic anatomy of the cystic artery

Arterial bleeding is a serious problem in laparoscopic cholecystectomy, therefore careful identification of the cystic artery and its anomalies as seen through the video-laparoscope could be of significant help in avoiding one of the greatest problems of biliary surgery, namely iatrogenic injury of the bile ducts. So, we reviewed the anatomy of the cystic artery during 80 laparoscopic cholecystectomies. A normal cystic artery was found in [76.2%] of patients, doubling of the artery in [17.5%] and an artery inferior to the cystic duct in [6.2%]. Dissection of the porta is avoided until the lateral edge of the cystic duct is identified after that identification of the cystic artery is attempted. Cautery and sharp dissection of the tissues in the portal area should be done cautiously to identify any arterial anomalies

value of video-laparoscopy in the management of the impalpable testes

The management of a boy presenting with unilateral or bilateral impalpable testes presents a diagnostic and therapeutic challenge. This work describes the technique of video-laparoscopy in the diagnosis and management of such testes in 20 patients [24 testes]. The testis was absent or atrophic in 5 patients [20.8%]; it was in the inguinal canal in 12 patients [50%]; just canalicular in 5 patients [20.8%] and abdominal in 2 patients [8.3%]. We also found that the laparoscope can be used therapeutically in straightening the course of gonadal vessels and vas deferens in 3 cases and in performing fowler-stephens long loop vas orchidopexy in 2 cases. We recommended the use of video laparoscope as a routine in cases of clinically impalpable testes