Laparoscopic heller cardiomyotomy for esophageal achalasia. Initial results

Laparoscopic Heller cardiomyotomy is replacing open surgery for esophageal achalasia. The aim of the present study was to evaluate the initial results of laparoscopic Heller cardiomyotomy. Sixteen patients [9 women and 7 men, mean age of 45 +/- 11.3 years and mean duration of symptoms of 5.2 +/- 4.5 years], who fulfilled the clinical, radiographic, endoscopic and manometric criteria for a diagnosis of esophageal achalasia, underwent laparoscopic myotomy with Dor fundoplication. Follow up to one year was complete in 14 patients. Laparoscopic Heller myotomy with Dor fundoplication is a highly effective and safe treatment for achalasia and preventing simultaneous gastroesophageal reflux. The outcome of the procedure is related to the preoperative stage of the disease on the esophagogram

Laparoscopic versus open repair for perforated peptic ulcer, a randomized study

Between June 1998 and June 2002, 23 patients with a clinical diagnosis of perforated peptic ulcer were randomly allocated to open repair [group 1] or laparoscopic repair [group 2], in El Minia University Hospitals. Open repair was performed in 14 patients [9 men and 5 women, with a mean age of 45.2 +/- 14.1 years]. Laparoscopic repair was performed in 9 patients [6 men and 3 women, with a mean age of 46.1 +/- 15.1 years]. The risk factors were similar in both groups. Laparoscopic repair had a significantly longer operative time than open repair [group 2, 115.6 +/- 45.3 versus 58.6 +/- 43.2 minutes in group 1, but the amount of analgesic required after laparoscopic repair was significantly less than in open surgery [median 3 doses versus 6 doses. There was no significant difference in the two groups of patients in terms of duration of nasogastric aspiration, hospital stay, time to return to normal activities, morbidity and mortality rates

Timing and method of reversal of Hartmann's procedure

The objective of this study was to evaluate the reversal of Hartmanns colostomy by comparing the complications of surgery with the time interval from formation to reversal as well as with the technique of anastomosis. Between March 1998 and March 2002, 32 patients with Hartmann's colostomy [18 men and 14 women with a mean age +/- SD 60.1 +/- 8.1 years] were included in this prospective study in El- Minia University Hospitals. All patients received complete clinical examination and routine investigations and the mean follow up period was 12 +/- 3.2 months. The study concluded that the late reversal [after four months] of Hartmanns procedure is more safer than the early reversal [before four months]. The reversal by stapled anastomosis is associated with a low incidence of major anastomotic complications and permanent colostomies

Genetic determinants of essential hypertension

This study aimed at determining the role of genetic and environmental risk factors in the development of essential hypertension in Alexandria, Egypt. A case-control-study was conducted in the Main Health Insurance Hospital [MHI] Alexandria, Egypt, whereby cases previously diagnosed as hypertensive were included in the study. A hospital-based control group visiting the hospital for other unrelated conditions and randomly selected in the same day as cases was also included in the study. Both cases and controls were subjected to a semi-structured questionnaire including information concerning socio-demographic data and risk factors for hypertension. Only cases were subjected to segregation analysis. This study included 165 cases with history of essential hypertension and 196 controls. Multivariate analysis of potential risk factors showed that the following factors are independently associated with an increased risk of essential hypertension; age over 40 years, elevated BMI, workers, ever smoker and stress. Education less than 6 years remained in the model as an independent protective effect. Segregation analysis proved that the disease is not inherited as single gene mode of inheritance. On the other hand, the heritability for 1st 2nd and 3rd degree relative was 28.2%, 28.7% and 20.0%. These figures provide evidence to multifactorial mode of inheritance in essential hypertension

Diagnosis and management of luteinized unruptured follicle [LUF] syndrome

A diagnosis of LUF syndrome in 490 women of unexplained infertility was made sonographically by failure to demonstrate a minimum of 5 mm reduction in follicular diameter with a change in the follicular and endometrial echogenecities within 48 hours after LH surge in urine. Fifty patients with LUF were categorized into three groups: 10 patients received only hCG for rupture of follicle, 30 patients were given clomiphene citrate therapy, then received hCG and 10 women having LUF syndrome did not receive any ovulation inducing drugs as a control group. The study concluded that the use of clomiphene citrate in LUF women increased the chance of ovulation by using 10,000 IU hCG with an increased chance of pregnancy

Endoscopic and laparoscopic treatment of mirizzi syndrome

Endoscopic followed by laparoscopic treatment of Mirizzi syndrome has been shown to be safe and effective. This technique was applied in 15 patients with Mirizzi syndrome. Ten patients had a single large stone and five had multiple stones impacted in the cystic duct. Nasobiliary drainage tube [NBDT] or stent was applied in patients for preoperative drainage of biliary tree and to prevent acute cholangitis by endoscopic retrograde cholangiopancreatography [ERCP]. Laparoscopic cholecystectomy was tried in all patients within 3 days after endoscopic intervention. In 6 cases, conversion was done from laparoscopic to open cholecystectomy. Conversion was due to fistula in three cases, injury to common bile duct in two cases and bleeding from slipped cystic artery in one case. Mortality was zero. Preoperative endoscopic drainage has many advantages including abortion of endotoxaemia in acute cholangitis, lowering the elevated serum bilirubin, improving the clinical condition of the patient, allowing easy identification of the anatomy of the bile ducts intraoperatively and immediate detection of any injury to bile ducts. The presence of stented bile duct allows for primary closure of the injury

Electrochemical behaviour of some arylidene derivatives of carbohydrazide at mercury electrode in aqueous ethanolic buffer solutions

The electrochemical behavior of some arylidene derivatives of carbohydrazides was investigated by dc-polarography, de-polarography, cyclic voltammetry, and controlled potential coulometry techniques, at a mercury electrode in 50% ethanolic Britton-Robinson buffer solutions of pH 2-10. In acidic media [pH <4], the reduction occurs along a single irreversible 8-electron wave corresponding to the cleavage of the 2 N-N bonds and saturation of the 2 C=N centers, while at 6 /7] the total limiting current decreases on increasing the pH, this decrease is accompanied with the formation of a polarographic minimum till the wave disappears completely at pH's >10. The kinetic parameters, nature of the waves, the effect of pH on the limiting current and half-wave potentials as well as the reduction mechanism are discussed

Endoscopic and histomorphometeric study of gastro-duodenal mucosa in portal hypertension

In 40 patients with that follow or complicate portal hypertension gastropathy [PHG] and duodenopathy [PHD] of hepatic etiology, histomorphometric measurement of mucosal vascular bed area through estimation of nuclear ploidy and proliferative index of epithelial mucosal cells showed that the incidence. [PHG and PHD] were 55% and 30% respectively. These incidences were significantly higher than that of 10 non portal hypertension controls and also significantly related to the degree of oesophageal varices [grade Ill and IV] and incidence of gastropathy, but not to the Child score of liver affection. It is concluded that portal hypertension was reflected more on gastric than duodenal mucosa. PHG and PHD predisposes to gastritis and ulceration and significantly raised the proliferative activity of gastric and duodenal mucosa. Congestion, inflammation and ulceration of gastro-duodenal mucosa following portal hypertension are contributing factors enhancing mucosal proliferation

Clinical, sonographic, histopatholgical and DNA study of predictors for malignancy in chronic calcular cholecystitis

In 31 patients with dyspepsia sonographic examination showed thick wall gallbladder in 26 [83.9%], multiple stones in 21 [67.7%] and single stone in 10 cases [32.2%]. Mucosal chronic inflammatory infiltration and mucosal ulceration were the most common lesions [87.1% and 67.7% respectively]. Dysplasia was found in 3 gallbladders [9.7%], with DNA changes showing aneuploid histogram pattern and higher values of S phase percent of cellular population. Hyperplasia was associated with increased percentage of cells occupying the S phase and increased values of 2C-deviation index and 5C exceeding rate percentage. The DNA changes were more associated with multiple stones with significant differences in S phase percentage cellular population between multiple and single stones. Thus, it is concluded that multiple gallstones is an indicator for preference of cholecystectomy to avoid development difficulty predicting malignancy of gallbladder

Maternal venous concentration of atrial natriuretic peptide at vaginal delivery from pre-eclampsia pregnancies

To investigate the influence of vaginal delivery in preeclamptic women on atrial natriuretic peptide [ANP], its concentration was quantified by radio-immunoassay technique in 30 preeclamptic nulliparous women and 10 comparable normotensive pregnant controls. Plasma ANP levels were increased from 228.56 +/- 20.7 pg/ml during late pregnancy, to 237.46 +/- 22.9 pg/ml during labor and 271.45 +/- 40.3 pg/ml immediately after delivery in preeclamptic women. ANP rose sharply, immediately after delivery [p <0.001]. A positive correlation was found between ANP and mean arterial pressure

Effect of calcium supplementation during pregnancy on blood pressure in normal Egyptian pregnant women

In this study, about 88 young healthy nulliparous women in their 2nd trimester between 20 and 35 years of age with normal singlet one pregnancy were enrolled in a double-blind randomized controlled clinical trial. From 24-weeks till delivery, a dose of 2 gm/day was given to one group [n=30], while a dose of only 1 gm/day was given to another group [n=30]. A third group [n=28] of controls received no calcium supplementation. The incidence of pregnancy-induced hypertension [PIH] was found to reach 10.7% in control group compared to an incidence of 6.67% in 1-gm supplementation group and to an increase of 3.3% in the 2-gm supplementation group. Treatment was associated with a decreased level of diastolic blood pressure in late pregnancy in the high-dose supplementation group. In addition, a significant reduction of the mean level of serum parathyroid hormone [parathormone, PTH] and a significant rise of the mean level of total serum calcium was found in those receiving 2-gm calcium daily