Role of MR chlangiopancreatography in biliary obstruction- A clinico-radiologic and opreative study

Thirty-five patients with obstructive jaundice suspected clinically [19 males and 16 females, their ages ranged from 5 to 81 years] were included in this study. All patients were subjected to complete medical history, full clinical examination, biochemical study [liver function tests and hepatitis markers], abdominal US and magnetic resonance cholangiopancreatography [MRCP]. Twenty-three patients were operated upon. ERCP was done in nine patients as well as percutaneous transhepatic cholangiography [PTC] and drainage transhepatic cholangiography [PTD] in two patients. One patient was diagnosed by ultrasound [US] and MRCP to have primary sclerosing cholangitis. MRCP images revealed extrahepatic biliary obstruction in 34 cases with good quality images. It demonstrated the levels of obstruction in all patients but diagnosed their causes in 33 only [16 were malignant, 11 calcular, one primary sclerosing cholangitis, 3 post-cholecystectomy stricture of CBD, one papillary stenosis and one chronic pancreatitis]. In two patients, there was a distal obstruction of undetermined origin by MRCP and one patient had calcular obstruction by ERCP [false -ve]

Is the postoperative hypocalcemia after subtotal thyroidectomy for thyrotoxicosis considered a surgical complication?

This study included sixty patients who had subtotal thyroidectomy for thyrotoxicosis. Serum calcium was calculated for every patient preoperatively and on the second postoperative day. PTH level was also measured for every patient on the second postoperative day. Fourteen patients developed postoperative biochemical hypocalcemia and five patients had manifest tetany. PTH and postoperative serum calcium showed insignificant relation. There was no permanent hypocalcemia in this series. The results suggested that the postoperative serum calcium in patients subjected to subtotal thyroidectomy for thyrotoxicosis is directly related to the period of preparation of thyrotoxic patient [the shortest the period the more liability for postoperative hypocalcemia], the level of preoperative serum calcium [the more hypercalcemia, which was due to severe thyrotoxic osteodystrophy, the more liability for postoperative hypocalcemia]. There is no clear evidence for a radical change in surgical teaching from the lateral ligation of the inferior thyroid arteries to protect the recurrent laryngeal nerve

Human fascioliasis in Assiut suburb, Upper Egypt

During this study, a case of human fascioliasis was recorded for the first time from Upper Egypt. Two mature flukes were released from the bile duct of 29-year old female patient. The encountered worms were washed, flattened, fixed, carmine stained, mounted and photographed for morphological studies. Clinically, the patient was presented with a history of abdominal pain and tenderness in the right hypochondrium and epigastrium five months ago. The pain was frequently repeated and was accompanied by vomiting and relieved by antispasmodics. Radiologically, there was intrahepatic biliary dilation and the gall bladder was of irregular wall, enlarged and contained muddy bile. Laboratory investigations revealed anemia, bilirubinemia and eosinophilia. The patient was operated on with the possible diagnosis of choledocholithiasis and parasites were incidentally discovered at the operation. Examination of bile and stool were negative for Fasciola eggs which means that the eggs were excreted at irregular intervals from the adult fluke; for this reason, diagnosis of human fascioliasis based on the detection of the parasite eggs in the stool is often unreliable

Evaluation of the efficacy and toxicity of epirubicin and cisplatin with cyclic continuous infusion of 5-fluorouracil in advanced breast cancer

Nineteen evaluable patients with advanced breast cancer were included in this study. Fourteen patients received no previous chemotherapy and five patients received previous chemotherapy [CMF] and two of them received [CAF] as well. Age of patients ranged between 25 and 55 years, the median was 38 years. There were five postmenopausal and fourteen permenopause. The most common site of metastasis was the lymph nodes [supraclavicular or contralateral axillary] which was reported in 12 patients. All patients received the cyclic continuous infusion 5- FU for seven days plus epirubicin in day one and cisplatin in day three only. There were four complete responders, partial response was recorded in eleven patients with an overall response rate 79.1%. The failure free survival for untreated patients was 71.4% after a median follow up of 19 months. In previously treated patients, the failure free survival was 20% after a median follow up period of 13 months with median response period of 9.7 months