Clinical and lymphanglographic studies of early postoperative oedema following stripping operation of the long saphenous vein

In order to investigate the possibility of lymphatic disruption occuring during varicose vein surgery, this study was carried out on 20 patients presented with primary varicosity of the long saphenous vein. All of them were candidates for ligation and stripping operation. Lymphangiography for the affected limbs were performed before and after operative interference. All patients were males with a mean age 32 years. Oedema was more than 2 cm in 4 patients and less than 2 cm in 16 patients. Oedema subsided completely by the 4th week postoperatively. Postoperative lymphangiography showed much disruption in 4 patients in whom oedema was moderate and mild disruption in 10 patients, it also showed insignificant changes in 4 patients and the procedure failed in 2 patients, Lymphatic disruption was more around the knee joint. Two patients developed haematoma formation. Sepsis complicated a wound of one patient. It was concluded that lymphatic disruption attending varicose vein removal contributes to post operative leg oedema

Serum proteins and immunoglobulins in patients with carcinoma of the bilharzial bladder

The sera of 25 patients suffering from advanced stages [T3 and T4] of carcinoma of the bilharzial urinary bladder were examined for serum proteins and immunoglobulin levels. In addition, sera of 16 bilharzial cystitis patients and of 16 normal healthy individuals were included in the study. While there was a reduction in the albumin level and an increase in alpha-1, alpha-2, and gamma globulin levels in the sera of the 25 cancer patients, the beta globulins remained apparently unchanged and the alpha-2/beta ratio had therefore inverted values [1.5] as compared to normal controls [0.9]. A definite increase in IgG, IgA, IgM and IgE fractions in bilharzial bladder cancer patients was found. The immunoglobulin levels were higher in patients with T3 than with T4 lesions. On the other hand, there was a marked decrease in the non-immunoglobulin component[s] in sera of the cancer patients. This decrease was noted more in patients with T4 than in those with T3 lesions. Serum proteins and immunoglobulins in the bilharzial cystitis patients had intermediate values more or less midway between the bladder cancer patients and the normal controls

Australia antigen and anti-australia antibody in lymphomas, leukemias and breast cancer

The sera of 90 lymphoma and 60 leukemic patients were studied for the presence of either HBsAg or anti-HBs using counter-electrophoresis. In addition, the study included 40 breast cancer patients and 20 normal healthy subjects as controls. The findings indicated a close and specific association between hepatitis B infection and leukemia. The frequency of exposure in leukemia patients was 17% compared to 5% in the other groups. Acute leukemia cases with positive HBsAg or anti-HBs reactions indicated a group with very bad prognosis. The causal relationship of hepatitis B virus to certain types of leukemias was discussed

New concept of the pathogenesis and treatment of anterior abdominal wall herniae based on anatomical and biomechanical studies. Part I- tensile properties of human anterior abdominal wall tissues concerned in herniology

The preference of various tissues used for surgical repair of hernia depends largely on clinical experience and observations. It was suggested that the criteria of preference may be put on more stable basis by actual testing of the tensile properties of these tissues. Accordingly we started by a trial to test some specimens of abdominal wall layers using some textile testing instruments with standardization of the dimensions of specimens and conditions of the test. The preliminary results indicated that the fascia transversalis was superior in its tensile properties. Peritoneum was less variable in its characteristics. A trial to use the ball burst test was conducted but according to lack of standardization it was not possible to represent the results in a com prehensive form. However this last test should be subjected to a more extensive work in the future

Part II - anatomical peculiarities of the anterior abdominal wall in the view of study of 200 halves of cadavers of still and newborns with operative observations in 300 cases of inguinal hernias and 103 cases of ventral hernias

This study was based on dissection of cadavers of still borns and newborns died shortly after birth and from observations during operations on inguinal and ventral herniae. Certain anatomical peculiarities were reported and their relation to the etiology of hernia were discussed. The presence of an accessory internal oblique muscle between the internal oblique and the transverse stratum was confirmed in many cases. It was observed that the lowermost fibres of the transversus abdominis were distributed in such a way to pull on and strengthen the fascia transversalis in the inguino-hypogastric region. In a good number of cases some of the fibres turn around the internal ring acting as a sphincter preventing the descent of intestines in a patient processus vaginalis when this latter is present. Adipose hernia can be a very important factor in many cases of herniae at all sites, ventral or inguinal. Understanding of these anatomical points concerned in the etiology of hernia helped us to decide the line of treatment. The operative techniques described in part III of this work were mainly based on the appreciation of the importance of the fascia transversalis as an efficient support for the posterior wall of the inguinal region

Part III - operative repair for inguinal hernia in adults

It was clear from the previous operative observations, that defects in the fascia transversalis was an important finding in all types of inguinal herniae. The role of excess properitoneal fat in the production of direct hernia or in increasing the defect in oblique hernia, was also emphasized. The efficiency of the fascia transversalis and peritoneum as materials for repair of the posterior wall of the inguinal canal was proved from biochemical studies and anatomical studies in parts I and II of this work on the herniae of the anterior abdominal wall. Accordingly 2 techniques were described for the repair of 300 cases of inguinal herniae [oblique + direct + combined] using fascia transversalis alone for the oblique and together with peritoneum for the other two types. Evaluation of these techniques in comparison with other conventional procedures was discussed

Part IV - spontaneous ventral hernias study of the etiology and treatment in the view of certain anatomical, clinical and operative observations in 104 cases

One hundred cases of herniae of the linea alba [midline spontaneous ventral herniae] were studied. Out of these we had 32 cases of paraumbilical hernlae which we regarded as defects in the lhiea alba nearest to the umbilicus. We believe that these herniae were due to protrusions of the extraperitoneal-fat through vascular lacunae. Vertical repair with imblication of the linea alba in its extent above the umbilicus was done using stainless steel wire. This technique proved very efficient in almost all cases. Two cases of spigelian herniae were presented and described. We had one more case of spontaneous lateral ventral hernia, due to congenital muscular deficiency