Review on Metformin Effect on Male Reproductive System

Male infertility and issues of impaired fecundity have been currently a global problem. Diabetes mellitus caninfluence male fertility either directly or indirectly due to abnormal spermatogenesis, which results in reducedsperm quality. Most reported cases of diabetes are of type 2 DM cases, frequently treated with oral anti-diabeticdrugs. Metformin is considered first-line therapy for the treatment of T2DM. This drug is an oral insulinsensitizing agent that can elevate insulin sensitivity and reduce plasma fasting insulin. The main metabolic actionof metformin target the liver. However, it was indicated that metformin acts on many organs of the body whichinclude the male reproductive system. With the increasing numbers of diabetic individuals among younger people,there is an enhancement in the utilizaton of metformin in individuals of this age group. Therefore, it is critical torecognize the role of metformin in male fertility. In this review, we are presented with the most recent dataaccessible regarding the investigation of the influences of metformin on the male reproductive system. Togetherwith the discussion of these influences, their importance to male fertility is also argued.

the bispectral index a sensitive monitor for survival after living donor liver transplantation?

Bispectral index [BIS] monitoring has been established as a standard monitoring method for the assessment of the depth of anesthesia during living donor liver transplantation [LDLT]. We tested the sensitivity and specificity of BIS readings during LDLT in predicting the postoperative 3-month survival. After receiving ethical approval, 42 patients who had undergone LDLT under sevoflurane-fentanyl-rocuronium anesthesia were studied. Correlations between BIS readings and extubation time, postoperative liver function tests, intensive care unit stay, and 3-month mortality were tested. Receiver operating characteristic curves were generated to determine the sensitivity and specificity of the BIS readings during different phases of surgery in predicting the survival outcome. The extubation time, liver function tests, coagulation factors V and VII, and intensive care unit stay were not statistically correlated with the BIS values. Receiver operating characteristic curve analyses showed reasonable sensitivity and specificity of mean BIS values during hepatic resection and neohepatic periods for predicting the 3-month mortality, with an unweighted accuracy of 76 and 73%, respectively. The nonsurvivors had significantly higher mean BIS values during the neohepatic phase [P<0.05]. The researchers concluded that the BIS monitoring during hepatic resection and neohepatic phases seems to be a suitable noninvasive monitoring tool with reasonable sensitivity and specificity for predicting the 3-month mortality after LDLT under sevoflurane-fentanyl anesthesia

framework to protect urban districts from the traffic noise in Elkhoms city, Libya

Similar to several cities all over the world, the urban districts of Elkhoms city, Libya, suffer from traffic noise, which results mainly from the rapid urbanization and extension towards the highways. The influence of this noise affects negatively different activities and uses within the city structure: residential, educational and health. This paper aims to propose a framework to address the traffic noise problems in Elkhoms city. To attain this aim, the paper, firstly, discusses the nature of traffic problems and noise levels in Elkhoms city. Afterwards, the researcher demonstrates the procedures of the traffic noise mitigation, which can be applied at two levels: planning and architectural. At planning level, the attenuation takes place at the noise sources such as urban and arterial roads. The applications at the architectural levels focus on the noise receiver; buildings in this case which represent the last protected line from noise. Later, the researcher carries out several measures to evaluate the influence of planning and architectural applications to reduce the noise levels in Elkhoms city. The paper ends with a number of planning and architectural criteria which should be taken into account to reduce the influence of traffic noise

relationship between children's attitude, family support and glycemic control in type-1 diabetes mellitus of school children in Alexandria city

The diagnosis of a chronic condition of any child places this family at risk, the physical health and emotional well-being of all members of the family are disturbed so, a family physician scope of service is to cope with chronic disease in children biopsychosocially. [1] To determine attitude of type -1diabetic children. [2] To study the effect of family support on glycemic control. [3] To study the effect of family support on compliance of diabetic children. [4] To study relationship between children's attitude, patient compliance and glycemic control. This study is a descriptive [cross-sectional] study which was carried out on diabetic students who were attending out patient clinic sporting health insurance hospital of students in Alexandria. The representative sample [100] was selected by simple randomization from type -1 diabetic students. The out come of study was achieved by a modified questionnaire which was applied during the period of April 2008 up to April 2009.The results illustrated that there was a significant relationship between childern's atttitude, family support, diabetic control and adherence of diabetic children at diabetic clinic of sporting student hospital. This study showed that there were different attitudes of diabetic children towards the disease. We conclude that the improvement of the quality of family support which introduced to diabetic children and the quality of diabetic care by the physician and the family leading to good metabolic control and lowering of HbA1c

Early results of percutaneous plate fixation of unstable fractures of the dorsolumbar spine

Standard techniques for lumbar pedicle screw fixation involve open exposures and extensive muscle dissection that is associated with extensive blood loss, lengthy hospital stays, and significant cost. Mini-invasive techniques are widely accepted as being the less aggressive procedure in any kind of surgery. Further attempts of development of percutaneous techniques in spinal surgery were reported, but little among them with a real success. The aim of the present study is to evaluate the early results of treatment of unstable fractures of the dorsolumbar spine using the WSH [world spine holding] percutaneous spine fixation system. From March 2005 to March 2006, fourteen patients aged 18 - 58 years with unstable fractures of the dorsolumbar spine without neurological impairment were treated in Mansoura Emergency Hospital with the WSH percutaneous spine fixation system. The range of follow-up of the patients was 6-18 months. The mean operative time was around one hour and blood loss was negligible. The mean hospital stay was two days. According to the modified Macnab criteria, excellent results are 78.6%, good results are 14.3% and fair results are 7.1%. Complications included only one patient with subcutaneous hematoma and the need for screw reposition in one case. No septic problem was encountered. We conclude that preliminary results of the percutaneous fixation of the dorsolumbar fracture were promising allowing the surgeon to perform biomechanically sound internal spinal fixation with minimal tissue trauma to minimize approach related morbidity while achieving the same result as more traditional, invasive approaches

Serum aflatoxin level as a predictor of hepatocarcinogenesis in HCV-infected Egyptians

Egypt has a very high prevalence of Hepatitis virus type C [HCV] infection and an increasing incidence of hepatocellular carcinoma [HCC] in a younger age group. As alcoholism is rare in Egypt, the main risk factor for carcinogenesis in HCV infected patients is supposed to be mutation induced by aflatoxin or its metabolites in hepatocytes. The environmental exposure to aflatoxins in foods or feeds may be reflected on the level of circulating aflatoxin [AFB1] in blood. The levels of albumin-abducted AFB1 were measured using a quantitative ELISA test in the sera of 80 Egyptian patients diagnosed as HCC, 40 HCV infected non malignant subjects and 40 healthy control individuals. The mean value of albumin-abducted AFB1 in the sera of HCC patients was significantly higher than the control groups [P< 0.05]. Farmers coming from rural areas had significant rise in the AFB1 compared to other patients coming from urban areas or having other jobs [P< 0.01]. The level of AFB1 was noticed to be significantly higher in patients having multiple lesions and also in patients presenting with tumor sizes more than 5 cm [P< 0.05]. HCV antibody and/or RNA were detected in all examined HCC patients. Exposure to environmental aflatoxin seems to be a major risk factor for HCC in HCV-infected Egyptians. HCV chronic hepatitis could render the liver less capable of intoxication and removal of AFB1 from the body. Then the accumulated AFB1 may induce mutation in p53 paving the way for HCV to induce HCC

Treatment of subtrochanteric fractures of the femur in elderly patients with gamma locking nail

A prospective study included 23 elderly patients with Subtrochanteric fractures. Long Gamma locking nail was used for fixation of fractures. Closed technique was used in all patients except 3 patients in whom open reduction was done to overcome difficulty in closed reduction. All the patients were followed up for at least 1 year. The average time to union was 14 weeks. Only one case had a delayed union. Varus malunion occurred in one patient. Limb length shortening of 1.5 cm occurred in one patient. External rotation malunion of approximately 15° was noted in 2 patients. Functional outcome using Harris hip score was 90 [range 79-99]. From this study, use of long Gamma nail for fixation of Subtrochanteric fractures is a safe method for elderly patients provided that the surgeon is aware of technique and complications which may occur during nail insertion

Percutaneous ablation [radiofrequency and ethanol injection] versus hepatic resection in treatment of HCC in Egypt

Hepatocellular carcinoma [HCC] is common in Egypt due to the high prevalence of HCV infection and the intermediate prevalence of HBV infection. There is no unequivocal evidence to establish the first line treatment in patients with HCC and compensated cirrhosis and thus studies comparing the different options are needed. Is to compare the effectiveness of percutaneous ablation [PEI, RFA] versus hepatic resection in treatment of HCC patients. This study included 45 HCC patients subjected to medical history, clinical assessment and complete investigations. They were distributed randomly between 3 lines of therapy; Group [1]: 14 patients who underwent RFA, Group [2]: 15 patients who underwent PEI and Group [3]: 16 patients who underwent surgery. Follow up was done for 12 months. The mean age of the patients was 53.19 +/- 4.08 years, 34 [75.6%] were males and 11 [24.4%] were females. All patients came from slum or rural areas in Egypt with low socioeconomic status and 85.1% were smokers. Thirty six [80%] were HCV Ab positive, 5 [11.11%] HBs Ag positive and 4 [8.89%] negative for both markers. Rectal biopsy for Bilharzial ova was positive in 20 [44.44%] patients; 57.6% had cirrhosis, 29.2% had chronic hepatitis and 13.2% had normal liver parenchyma. The tumor was a solitary nodule in 41 [091.11%] patients, two or three nodules in 2 [4.45%] patients. A tumor with a diameter <3cms was found in 28 [62.2%] patients and between 3 and 5cm in 17 [37.8%] patients. The tumor was located in the right lobe in 33 [73.3%] patients and in the left lobe in 12 [26.7%] patients. Child's class A was found in 41 [90.9%] patients and 4 [9.1%] were Child's class B. The response rate between the three modalities of therapy [resection, RF or PEI] showed no statistical significance. There were minimal changes of liver function tests with no statistically significant difference between pre and post percutaneous ablation therapy [PEI, RFA]. The deterioration of liver function [increase in liver transaminases and decrease of serum albumin] and complications were statistically significantly higher in the surgically managed group compared to PEI and RFA groups. PEI showed lower complications than RFA or surgery. Both percutaneous ablation and surgical resection did not significantly differ in terms of efficacy, however, percutaneous ablation therapy showed no mortality and low rate of complications. The choice between either forms of percutaneous ablation should be individualized to every case according to the cost, tumor site and the availability of the therapeutic modality. Surgical resection should not he chosen as a therapy for HCC unless functional hepatic reserve allows it. More studies on large number of cases and follow up for at least five years are needed

Preradiation chemotherapy versus radiotherapy in the treatment of adult meduloblastoma

To determine whether preradiotherapy [RT] chemotherapy would improve outcome for medulloblastoma when compared with RI alone. Chemotherapy comprised vincristine 1.5 mg/m2 days], 7 and 14, etaposide 100 mg/m2 days1.2. and 3 and carboplatin 500 mg/m2 days] and 2. Patients age ranged between 16 and 45 years inclusive were randomly assigned to receive 35 Gy craniospinal RT with a 19 Gyposteriorfossa boost, or chemotherapy followed by RT. Ls 0i5[i paienzs randomly assigned to treatment, 25 were treated with RT alone and the other 25 patients were treated with chemotherapy and Irradiation. There was a statistically significant difference in overall survival at 3 years between both arms 58% and 75% respectively. Acute toxicity was limited to alopecia, nausea and hematological toxicities. High grade nausea and vomiting was reported in 4 patients and neuropathy in two patient. Grade 3 or 4 [anemia, neutropenia and thrombocytopenia were recorded in group B, this is attributed to chemotherapy. Improved EFS and OS for chemotherapy group patients compared with RT alone were noticed. Chemotherapy was well tolerated. It is anticipated that this regimen could reduce atotaxicity and nephrotoxicity compared with cisplatin-containing schedule

Steroid sparing using safer drugs in the management of children and adolescents with chronic asthma

This study included forty five [19 males and 26 females] children and adolescent patients [mean age 11.2 +/- 3.4 years] suffering from chronic bronchial asthma, in whom oral and/or inhaled steroids were necessaary to control their symptoms. They were selected from patients attending outpatient clinics of Pediatrics and Chest Departments of Tanta University Hospital. They were assigned randomly into 3 treatment groups [15 cases each]; Lidocaine group receiving nebulized lidocaine 1 mg/kg/dose twice daily, Montelukast group receiving oral montelukast 5 mg once daily, and control group who continued on their traditional drugs [bronchodilators and steroids]. History and clinical examination were performed and the following investigations were done to all study cases as a base line and after 2 weeks of treatment: PEFR, FEV1, FEF[25.75%], Induced sputum was collected and utilized to do sputum eosinophil count, sputum eosinophilic cationic protein [ECP] and sputum nitric oxide [NO] metabolites [nitrites and nitrates]. PEFR increased significantly 20 minutes after lidocaine inhatation, indicating bronchodilating effect of lidocaine. Studied pulmonary function parameters [PEFR, FEV1 and FEF[25-75%], significantly increased, while induced sputum analysis data [sputum eosinophil count % and sputum ECP] significantly decreased after treatment in Iidocaine and montelukast groups as compared to base line values and control group. However, the difference between the two groups after treatment was not significant. Sputum total nitriteslnitrafes did not change significantly after treatment in both groups and in controls due to pretreatment of ail study cases with steroids. Successful steroid withdrawal was obtained in 86% of lidocaine group and 73% of montelukast group along of 2 weeks. The difference between success rates in the two groups was statistically insignificant [p0.05]

Conclusion: the present study suggests that both nebulized lidocaine and oral montelukast could be reasonable steroid sparing agents allowing maintained asthma control with no or reduced dose of steroids. Lidocaine is cheap while montelukast is easily administered in children. Both agents exhibited comparable steroid sparing actions without significant side effects. However, lidocaine inhalation works as asthma reliever as well, due to its bronchodilating action

Results of treatment of ununited fractures of scaphoid bone by iliac bone graft and Kirschener wire fixation

Fractures of the scaphoid comprise 70% to 80% of injuries to carpal bone. Studies suggest that only 5% to 110% of these fractures proceed to non-union. This risk of delayed healing or non-union have been attributed to delay in beginning treatment, inadequate immobilization, displacement of the fragments, instability due to ligamentous injury or inadequate blood supply of the proximal fragment. Non-union of the scaphoid usually causes pain and weakness, which interfere with work and sport, also non-union would most probably result in carpal osteoarthritis. Sixteen patients with symptomatic non-union of the scaphoid had been treated by iliac bone graft and Kirschener wire fixation in Mansoura University Hospital. The patients presented with pain, limited range of wrist motion and weak grip strength. The average age was 27.6 years. The average time of delay before the operation was 32 months [3 months - 60 months]. The average duration of follow up period was 9 months. Union was achieved in 15 patients [93. 75%] at an average period of 20 weeks [16-28 weeks]. According to weightington wrist scoring system: 13 patients [81 .25%] had excellent results, 2 patients [12.5%] had good results, one patient [6.25%] had poor results, and no fair results. Iliac bone graft and Kirschner wire fixation is an effective procedure for management of scaphoid non-union. It is simple, economic procedure that does not need special equipments and fixation does not add much to the operative time

Sacrospinalis muscle pedicle bone graft in posterolateral fusion for spondylolisthesis

This prospective study was conducted to evaluate the results of sacrospinalis muscle pedicle bone graft as a method to improve the quality of fusion mass after posterolateral fusion for lumbar sporidylolisthesis. This study included twenty patients with lumbar spondylolisthesis [7 Grade I. 10 Grade II and 3 Grade III]. All patients had low back pain and associated radicular pain was present in 12. All patients failed to respond to adequate conservative treatment. There were 13 females and 7 males. The patients were aged between 25 and 55 years with an average of 37.5 years. Posterolateral spinal fusion with sacrospinalis muscle pedicle bone graft on the left side and autogenous iliac bone chips on the right side with the use of transpedicular internal fixation system, was done in all patients. In 12 patients with radicular pain, laminectomy and discectomy was done in addition. The period of follow up ranged from 8 months to 18 months. Satisfactory osseus fusion was obtained in [85%] of patients on the left side where muscle pedicle bone graft was used while satisfactory osseus fusion was obtained in [70%] of patients on the right side where iliac bone chips were used. Functional improvement was obtained in 90% of patients with excellent to good result. No scoliosis or weakness of the extensor muscles of the back developed after reanchorage of the sacrospinalis muscle to the lumbosacral spines. We recommend the use of sacrospinalis muscle pedicle bone graft to improve the quality of fusion mass obtained in posterolateral fusion for treatment of spondylolisthesis

Unstable lower cervical spine injuries results of posterior lateral mass plate fixation

Thirty patients with unstable lower cervical spine injuries were treated from January 1998 to December 2001 using posterior lateral mass plating and autogenous iliac hone graft. There were 25 males and 5 females, the average patient age was 37.73 years [range 18-60 years]. The average duration of follow-up was 15.18 months [range 6 to 43 months]. The cause of trauma was motor vehicle accidents in 18 patients, a fall from height in 9 patients and diving into a shallow water in 3 cases. Eight patients had associated injuries, three of them suffered head injuries, 2 cases had pelvic fractures. 2 cases had femoral shaft fractures and one patient had forearm fracture. Thirty patients met the criteria for posterior cervical plating and fusion having cervical instability. Eleven patients had unilateral facet dislocation at one level, four patients had bilateral facet dislocation at one level, 13 patients had fracture dislocations either at one or two levels, and Two patients had burst fracture at one Level. Neurologically, 10 patients were neurologically free complaining of neck pain only, 8 patients had a one level root injury, 4 patients had anterior cord syndrome. 3 patients had Brown Sequard syndrome, and 5 patients had complete cord injury. The final functional results were assessed using Bohlman and Anderson criteria. No patient's neurological function deteriorated after surgery. All the patients with radicular symptoms relieved and all incomplete spinal cord injuries improved at least one ASIA Level. All the patients had solid fusion and good alignment based on flexion and extension radiographs at follow-up. Although one patient had implant failure in the form of backing out of the screws, non had an increased deformity and all progressed to sound fusion. Extension of the fusion mass beyond the instrumented levels was evident in 12 patients. There were no neurologic or vascular complications related to screws fixation. Posterior Cervical plating with lateral mass fixation and bone grafting offers a reliable method of achieving fusion, with minimal bracing and more rapid functional recovery in the treatment of fractures and dislocations of the lower cervical spine

correlation between magnetic resonance imaging and the operative and clinical findings after lumbar discectomy

Forty two patient were admitted to Mansoura University Hospital for treatment of lumbar disc prolapse. They were studied prospectively with magnetic resonance imaging before they had open discectomy, and the findings were correlated with clinical symptoms before and after operation and with the operative findings. There were 26 males and 16 females. The patients aged between 25 and 60 years with an average of 37.5 years. MRI studies showed, a sequestrated fragment in 59% of patients, a subligamentous disc sequestration in 25% and a disc protrusion in 16%. In twenty five patients the operated level was [L4-L5], while in 16 patients the operated level was [L5-S1], and only in one patient, the operated level was L3-L4. The diameter of the protrusion was 4 mm to 13 mm for the craniocaudal extension, and 5 mm to 18 mm for the anteroposterior extension. No correlation could be found between the neurological deficit and the size of the disc prolapse. There was significant correlation between obstruction of the spinal canal and the type of the disc lesion, either extrusion, subligamentous disc sequestration, and free sequestration. Magnetic resonance imaging is a helpful pre-operative diagnostic investigation which shows structural changes in the disc and the correct localisation and size of the disc sequestration, but there was no correlation between the imaging findings and the clinical symptoms

Extensile lateral approach in comminuted supracondylar intercondylar fractures of the femur

This study was conducted to evaluate the results of the operative treatment of the comminuted supra condylar intercondylar fractures of the distal end of the femur through the extensile lateral approach. This study included twenty two patients with a mean age of 39.8 years, presented to Mansoura Emergency hospital with simple fracture of the distal end of the femur treated operatively through extensile lateral approach through which the extensor mechanism of the knee was elevated with a block of bone removed from the tibial tuberosity. There were 8 female and 14 male. After an average follow up of 13.5 months the results were excellent or good in 81.8% of the patients and it were fair to poor in 18.2% of the patients. There were no delayed union nor non union in our study. There were 4 cases with malunion of varus or valgus deformity measuring less than 5°. As regard the range of motion, 14 patients [64%] had shown knee flexion up to 70°, 6 patients [27%] had knee flexion up to 95o, while 2 patients [9%] had knee flexion more than 125°. Out of the 22 patients, 20 patients had full knee extension, while the remaining 2 patients had extension lag of about 5°. We found the extensile lateral approach is a useful and a safe one to facilitate the operative treatment of severely comminuted intra-articular fractures of the distal end of the femur. Close attention to the surgical details is necessary to avoid the potential complication of this approach

Three weeks external fixation followed by hip spica cast for femoral shaft fractures in older children and adolescents

There has been a recent resurgence of interest in operative stabilization of pediatric femoral shaft fractures in older juveniles and adolescents. External fixation has many advantages especially in polytraumatized patient and in open fractures. Some authors criticize external fixation if used till full union as it may cause nonunion, delayed union, and refracture after its removal. The aim of this study is to evaluate the results of three weeks external fixation for pediatric femoral shaft fractures [6-16 years] followed by hip spica till complete union. Twenty eight femoral shaft fractures in 25 patients were the material of this study. The mean age was 9 years [range 6 - 16 years], with 19 boys and 6 girls. Three patients had bilateral fractures and 3 fractures were open. Eight patients were polytraumatised, and most of fractures were diaphyseal [25 cases]. On admission immediate skin traction was applied over Thomas splint and the patients were referred for radiological examination. All the patients were listed for external fixation next morning except in three cases with open fractures where immediate external fixation was done after thorough debridment and irrigation. The orthopaedic table with traction piece was used in all patients after general anesthesia. A closed reduction or assisted closed reduction using Joy-Stick technique under image intensifier was done. A uniplanar double bar AO tubuIar external fixator with at least two pins proximal and distal to the fracture avoiding the physes was used. Post operative meticulous pin-site care, immediate active hip and knee range of motion were advised, followed by assisted crutch weight-bearing as tolerated. The average length of hospital stay was 5.6 days [range 2-16 days]. Three weeks later a hip spica was applied after removal of the fixator, and radiographs were done every 21 days till complete union. The average time for union was 9 weeks [range 6-15 weeks], with an average follow up period of 18 months [range 3-36 months]. The following complications were reported: pin-tract infection [4 cases], angulation >10 degrees in AP view [1 case] angulation >10 degrees in lateral view [3 cases], genu varum [1 case], translation [4 cases], limb-length discrepancy [6 cases], partial loss of reduction [2 cases], and residual knee fiexion deformity about 5 degrees [1 case]. In conclusion applying external fixation for a short period just enough to get the fracture stabilized by soft tissue callus give the patient all its advantages with minimal complications. Also it shortened the period of hospital stay and the cost of treatment

Post-gastrojejunostomy entero-gastric reflux: is it always Symptomatic?

Evaluation of the problem of enterogastric reflux in duodenal ulcer patients managed by anterior and posterior truncal vagotomy and simple loop gastrojejunostorny. Between September 1976 and May 1996, 709 duodenal ulcer patients were managed by different surgical techniques. Anterior and posterior truncal vagotomy with simple loop gastrojejunostomy were done for 372 patients [52.5%]. Of the last group, 75 random patients were studied for enterogastric reflux. The mean postoperative period was 6.5 years, the mean age was 43 years, 64 were men and 11 were women. Careful clinical examination, barium meal study and esophagogastroscopy with histological examination of multiple gastric biopsies were done for all patients. Dual channel simultaneous esophageal and gastric 24h pH monitoring was done for 28 patients. Patients were classified into 2 groups, group 1 included 44 patients [58.7%] free of symptoms and group 2 included 30 patients [40%] who complained of one or more symptom of gastritis, however, the classic symptoms of alkaline refiux gastritis were found only in 8 patients [10.7%]. One patient [1.3%] was excluded due to proved ulcer recurrence. Endoscopic evidence of gastritis was found in 50% in group I versus 73.3% in group 2 [P<0.05]. Histopathologic evidence of gastritis was found in 77.3% in group 1 versus 46.7% in group 2 [P=0.007]. PH monitoring revealed alkaline gastric reflux in 50% in group I versus 75% in group 2 [P>0.05] alkaline esophageal reflux in 33.3% in group 1 versus 50% in group 2 [P<0.05] and mixed esophageal reflux [i.e alkaline and acidic] in 16.7% in group 1 versus 18.8% in group 2 [P> 0.05]. Enterogastric refiux is not an infrequent problem after trurcal vagotomy and loop gas trogejunostory. Pathologic alkaline gastric reflux should be proved by endoscopy, histopathology and pH metry before deciding remedial surgery

value of pulmonary function tests before and after different thoracic and abdominal operations

This study included seventy-one patients classified according to the type of surgery into two groups. Thoracic group including thirty-nine patients subjected to thoracic surgery, their age ranged from 9 to 60 years with the mean of 37.31 +/- 15.29. Abdominal group including thirty-two patients subjected to upper abdominal operation, their age ranged from 17 to 70 years with the mean age of 49.4 +/- 17.95. Full clinical and radiological assessment and also changes in pulmonary function tests [PFTs] and arterial blood gases were done for all the patients pre and postoperatively. The results revealed an acute restrictive pattern, following thoracic and upper abdominal surgery persisting for two weeks and was being more in the first days with gradual improvement in the following days. This reduction in PFTs was marked among patients with preexisting pulmonary disease [COPD], heavy smokers and who underwent resectional thoracic surgery. A significant hypoxemia was observed in the first two days following thoracic and abdominal operation. The incidence of postoperative complications increased in patients with previous lung disease and increased also with abnormal preoperative pulmonary function < 60% for VC, FVC, FEV1, PEFR, MVV and < 75% for FEV1/FVC%. Resectional thoracic operations were followed by a higher incidence of postoperative pulmonary complication than non- resectional surgery

Laparoscopic cholecystectomy: a recent experience

A long the period from October 1992 to July 1993, 162 consecutive patients with gall stones were considered for laparoscopic cholecystectomy in the Gastroenterology Center of Mansoura. 106 females and 56 males, their ages ranged from 23 to 65 years. All the patients underwent ultrasonic abdominal examination, complete laboratory, chest and cardiac assessment. E.R.C.P., papillotomy and stone extraction when needed was done in cases with history [or] of jaundice before the procedure. Cardiac and hypertensive patients were excluded from the study. Laparoscopic cholecystectomy was successful in 135 out of the 262 cases [83.3%]. 27 cases failed to be completed by laparoscopy [16.7%], 5 cases were due to uncontrollable bleeding, 3 from injured cystic artery and 2 from cirrhotic liver. The other failures were due to marked dense adhesions with acutely inflammed gall bladder in 9 cases, injury of common bile duct in 2 cases, injury of gall bladder with escape of multiple small stones intra-abdominally in 2 cases, 5 cases gall bladder masses, failure to grasp or manipulate thick walled gall bladders that were packed with multiple small stones in 2 cases, presence of cholecysto-duodenal fistula in one case and injury of the right common iliac vessels by the trochar in one case. There were no deathes, but post-operative major complications occured in 4 cases that needed laparotomy, 2 cases of internal haemorrhage and 2 cases of biliary peritonitis. There were 6 minor complications, 3 surgical emphysema, and 3 small collections in gall bladder bed, that all passed conservatively. The shortest time of the procedure was 20 minutes and the longest was 3 hours. The median post-operative stay was 2 days and all the patients could start oral diet in the morning of the second day. In Conclusion, from this recent experience and results. We could suggest what are the possible difficulties and complications that could be met with laparoscopic cholecystectomy and we suggest that it should tried in most of patients who require elective or urgent cholecystectomy specially if radiological and endoscopic support are available

Parietal cell vagotomy [P.C.V.] 15 years experience

Along 15 years, 106 patients had elective parietal cell vagotomy for duodenal ulceration. Ninty nine patients have complete follow up from 12 months to 15 years. Of those, 42 patients had surgery over 10 years ago and 35 patients survived for more than 10 years. There was no hospital mortality. Gastric stasis recorded early in 3 cases [3%] and 2 of them required reoperation in 2 patients splenectomy was required as a result of operative trauma. Mild dumping occured in 2 cases [2%] and mild diarrhea in other 2 cases, 40 cases suffered from early mild and transient [40.4%] dysphagia. From 2-10 years after surgery, thirty patients [30%] have had recurrent ulceration. In seven [7%] of these cases the recurrence was asymptomatic. The overall clinical results by using modified Vi-sick's were excellent and very good in 66.4% of cases and unsatisfaction in 33.6%