Leak after laparoscopic cholecystectomy; incidence and management

Background: laparoscopic cholecystectomy is currently the procedure of choice for symptomatic gallstones. It has evolved from an innovative, but time-consuming, novelty to a routine day-case procedure over the last 20 years

Purpose: to estimate the incidence and management options of post laparoscopic cholecystectomy biliary leaks. Also, it is a trial to advocate a minimally invasive structured management protocol to treat patients with bile leak

Patients and Methods: this study was a case series of 100 patients who underwent laparoscopic cholecsystectomy. We didn’t include patients who had: Biliary leak post Laparoscopic converted to open cholecystectomy. Biliary leak due to other procedures. Biliary leaks managed by open surgery. Biliary injuries discovered and definitively managed intra-operatively. The included patients presented to the General Surgery Department at Manshyt El Bakry General Hospital. Patients’ age ranged from 12 to 65 years and patients’ sex was distributed as 78 females and 22 males

Results: in our cases there were two out of the 100 patients suffered from biliary leak ,one of the two cases that were presented with biliary leak after surgery was due to direct injury to accessory duct of Luschka and the other one was due to a slipped clips

Conclusion: cholecystectomy is the most frequently performed abdominal operation in the United States, with currently over 700,000 cases occurring per year. Bile leak as a result of cholecystectomy is uncommon. The frequency in large series is less than 2% and in our study it was exactly 2%. And the treatment of that leak varies from conservative treatment to ERCP and stent insertion like we did

Increased cryo-survival rate in ejaculated human sperm from infertile men following pre-freeze in vitro myo-inositol supplementation / 대한생식의학회지

OBJECTIVE: To investigate the effects of in vitro myo-inositol (Myo-Ins) supplementation of cryopreserved human semen on the cryo-survival rate (CSR). METHODS: Semen samples were obtained from 41 infertile men. Following routine semen analysis, each sample was divided into two equal aliquots (0.5 mL each). One aliquot was treated with 1 mg of Myo-Ins dissolved in 10 µL of sperm preparation medium. The second aliquot was treated with 10 µL of the same medium (control). Both aliquots were incubated for 20 minutes prior to freezing to slow the freezing process. The frozen samples were examined for post-thaw percentages of total motility (TM), progressive motility (PM), and the CSR, defined as the percentage of post-thaw TM divided by the percentage of pre-freeze TM and multiplied in 100. The results were expressed as median and interquartile range (25th and 75th percentiles). RESULTS: The pre-freeze TM (50% [30%–50%]) and PM (35% [20%–35%]) were significantly higher than the post-thaw TM and PM in the Myo-Ins group (15% [10%–35%] and 10% [5%–20%]; p < 0.001 and p < 0.001, respectively) and the control group (10% [6%–30%] and 5% [3%–15%]; p < 0.001 and p < 0.001, respectively). The CSR of the 41 semen aliquots supplemented with Myo-Ins (40% [25%–70%]) was significantly higher than that of the control samples (30% [13%–58%], p=0.041). The CSR of the 26 abnormal semen samples that were supplemented with Myo-Ins (38% [20%–50%]) was significantly higher than that of the control samples (23% [12%–30%], p=0.031). CONCLUSION: In vitro Myo-Ins supplementation of ejaculated human sperm from infertile men resulted in a significant increase in the CSR in samples with abnormal pre-freeze sperm parameters.

Sedative and muscle relaxant activities of diterpenoids from Phlomidoschema parviflorum

Abstract Phlomidoschema parviflorum (Benth.) Vved. (Basionym: Stachys parviflora Benth.) Lamiaceae, have significance medicinal importance as it is used in number of health disorders including diarrhea, fever, sore mouth and throat, internal bleeding, weaknesses of the liver and heart genital tumors, sclerosis of the spleen, inflammatory tumors and cancerous ulcers. The present contribution deals with the sedative and muscle relaxant like effects of diterpenoids trivially named stachysrosane and stachysrosane, isolated from the ethyl acetate soluble fraction of P. parviflorum. Both compounds (at 5, 10 and 15 mg/kg, i.p) were assessed for their in vivo sedative and muscle relaxant activity in open field and inclined plane test, respectively. The geometries of both compounds were optimized with density functional theory. The molecular docking of both compounds were performed with receptor gamma aminobutyric acid. Both compounds showed marked activity in a dose dependent manner. The docking studies showed that both compounds interact strongly with important residues in receptor gamma aminobutyric acid. The reported data demonstrate that both compounds exhibited significant sedative and muscle relaxant-like effects in animal models, which opens a door for novel therapeutic applications.

Impact of dietary oils and fats on lipid peroxidation in liver and blood of albino rats

<p><b>OBJECTIVE</b>To investigate the effects of different dietary fat and oils (differing in their degree of saturation and unsaturation) on lipid peroxidation in liver and blood of rats.</p><p><b>METHODS</b>The study was conducted on 50 albino rats that were randomly divided into 5 groups of 10 animals. The groups were fed on dietary butter (Group I), margarine (Group II), olive oil (Group III), sunflower oil (Group IV) and corn oil (Group V) for 7 weeks. After 12 h of diet removal, livers were excised and blood was collected to measure malondialdehyde (MDA) levels in the supernatant of liver homogenate and in blood. Blood superoxide dismutase activity (SOD), glutathione peroxidase activity (GPx), serum vitamin E and total antioxidant capacity (TAC) levels were also measured to determine the effects of fats and oils on lipid peroxidation.</p><p><b>RESULTS</b>The results indicated that no significant differences were observed in SOD activity, vitamin E and TAC levels between the five groups. However, there was significant decrease of GPx activity in groups IV and V when compared with other groups. The results indicated that feeding corn oil caused significant increases in liver and blood MDA levels as compared with other oils and fats. There were positive correlations between SOD and GPx, vitamin E and TAC as well as between GPx and TAC (r: 0.743; P<0.001) and between blood MDA and liver MDA (r: 0.897; P<0.001). The results showed also negative correlations between blood MDA on one hand and SOD, GPx, vitamin E and TAC on the other hand.</p><p><b>CONCLUSIONS</b>The results demonstrated that feeding oils rich in polyunsaturated fatty acids (PUFA) increases lipid peroxidation significantly and may raise the susceptibility of tissues to free radical oxidative damage.</p>

Carcinoma of periampullary region; histopathological study and correlation with prognosis

Periampullary malignancies are aggressive neoplasms with low survival rates. The factors favoring long-term survival for periampullary neoplasm are related to histopathologic features, site, stage, resection margins and lymph node metastases. To study some clinical and histopathological parameters of cancer head of pancreas and periampullary region. Statistical study of the impact of these parameters on the outcome of malignancy in this region. This study was carried out on 144 cases of penampullary cancers. The clinical data including, pathological data are revised. Special stains and immunohistochemistry are used when necessary. The most common malignant tumor of peniampullary region is carcinoma of ampulla of vater, then cancer head pancreas, then bile duct carcinoma and lastly duodenal carcinoma [43.7%, 40%, 10% and 6.3% respectively]. We found that the median survival of periampullary cancer is 15 months. The prognosis of these malignant tumors is related to site [P=0.0054], size of the tumor [P=0.0005], grade [P=0.0000], lymph node metastasis [P=0.0123] and tumor stage [P=0.0084]. Other parameters including age and sex, local extension and cut margins are statistically of no significant effects on the prognosis. Periampullary carcinomas are aggressive neoplasm with short survival. It seems that our locality shows epidemiologic factors that leads to that the age of patients at time of presentation and prognosis differ from literatures

ccLack of evidence for the role of BK and JC polyoma viruses in non-hodgkin's lymphoma

Background: Human polyomaviruses JCV and BKV can cause several clinical manifestations in immunocompromised hosts, including progressive multifocal leukoencephalopathy [PML] and hemorrhagic cystitis. The association of these viruses with clinical tumors and their possible roles in the etiology of nonhodgkin's lymphoma are not clear. So, the purpose of this study was to screen for the presence of JCV, and BKV DNA sequences in NHL, where immunocompromised individuals are known to be at risk of development of virus-mediated neoplasm

Materials and Methods: Fresh tumor samples from 66 Egyptian patients with Non-Hodgkin's lymphoma and 34 control groups were examined by polymerase chain reaction [PCR] for detection of JCV DNA and BKV DNA sequences

Results: Our results have shown that JCV DNA sequences were found in the tumor tissues of 40/66 [60%] NHL patients compared to 14/34 [41.1%] of the control group, whereas BKV DNA sequences were found in 23/66 [34.8%] of NHL patients compared to 7/34 [20.5%] of the control group. There was no statistically significant difference between the presence of virus in cases and controls [p > 0.05]. For overall survival [OS] on univariate analysis, negative JCV DNA patients had not a different time to survive compared with positive JCV DNA patients [Log Rank test = 1.62; p = 0.20]. Also, Presence of JCV DNA sequences in NHL patients did not affect the response of those patients to chemotherapy [Log Rank test = 0.74; p = 0.40]. The same findings were found with BKV infection where BKV had not any effect on the survival [Log Rank test=015; p = 0.70] and the response of those patients [Log rank test = 0.39; p = 0.53]

Conclusion: The present study has shown that presence of both BKV DNA and JCV DNA sequences in NHL patients had not any effect on overall survival [OS] or the response to chemotherapy in those patients

Ain Shams experience with total inter-vertebral DISC prosthesis with 30 months follow up

Degeneration of the intervertebral disc is the most common cause of low back pain. Continuous researches for an alternative option to surgical fusion have been successfully run over the last two decades. That resulted in total intervertebral disc prosthesis for treatment of disc degeneration with motion segment preservation. The aim of this study is evaluation of the short term results of lumbar intervertebral disc prosthesis in treatment of degenerative lumbar disc disease in selected cases. This prospective study was carried out at Ain Shams University hospital in the period between August 2000 and March 2005.on 16 patients with disabling low back pain due to degenerative disc disease. Seven of them have also sciatica. The patients were selected according to 1- the age between 22 -48 years 2-chronic disc disease presented by severe low back pain with or without sciatica 3- good bone quality 4-all had moderate to severe degrees of disability according to the modified Stauffer and Coventry Scoring system which have not improved by medical treatment and physiotherapy. All patients have been treated by total disc replacement [SB Charite] after complete clinical, radiological investigation that included stress X-ray films and MRI study. One level replacement was done in 12 patients and double levels replacement were done in four patients'.The total number of the disc prostheses used in this study were twenty prostheses. The operation was done through an anterior retroperitoneal approach in 15 cases and through transperitoneal approach in 1 case. The patients were followed up for an average period of 30 months [range 7-60 months]. The results were evaluated according to modified Stauffer and Coventerey. The patients were satisfied with the results. All have resumed the pre-disease activities and duties although two patients had low back pain that needs mild anti-inflammatory medications in low doses. Two patients have a displaced prosthesis [off-position from the mid-line in antero-posterior view only while the saggital view position was perfect in these patients like others]. No major complications were recorded in relation to the surgical approach or to the prosthesis during surgery or immediately after; also no complications were reported in relation to the position of the prosthesis or its integrity and stability, and no ossification in the surgical bed, were detected in the follow up period up to 60 months in the early inserted prosthesis. Although the number of cases in this study is limited and the follow up period is short, the maximum follow up period is five years the results are satisfactory to the surgeons and to the patients. Comparing this results in relation to the activities and duties before surgery and in relation to the results and complications after spinal fusion surgery with its passive effect on the discs above and blow the fused segment. So the articulating disc prosthesis can be a successful solution for treatment of degenerative and prolapsed disc in well selected patients

Effect of peritoneal dialysis and hemodialysis on oxidation end products in end stage renal disease patients

Chronic renal failure [CRF] is a worldwide public health problem. It is a progressive disease characterized by gradual and persistant impairment of both glomrerular filtration and tubular functions, so the kidneys are no longer able to keep normal internal environment. Oxidative and carbonyl stresses are considered among the mechanisms involved in the pathogenesis of CRF. Oxidative stress is known as imbalance between reactive oxygen species and antioxidants in favour of the former, while carbonyl stress is characterized as an overload of reactive carbonyl compounds [RCOs]. Both oxidative stress and carbonyl stress can cause damage to important biological structures e.g. proteins, carbohydrates, lipids, and nucleic acids resulting in the generation of new compounds and modified structures which can serve as markers of these mechanisms such as advanced glycation end products [AGEs] and advanced oxidation protein products [AOPPs]. AOPPs are proteins, predominantly albumin and its aggregates, that are damaged by oxidative stress. The present work aimed to study the effects of two different renal replacement modalities, peritoneal dialysis [PD] and hemodialysis [HD], on oxidation products of glucose, lipids, and proteins in patients with end stage renal disease [ESRD.] It also aimed at studying the effects of these therapies on the antioxidant defenses of these patients. The present study was conducted on 20 patients with ESRD. Patients were divided into two groups; group I consisted of 10 patients maintained on continuous intermittent peritoneal dialysis [PD] thrice weekly, and group II consisted of 10 patients maintained on bicarbonate hemodialysis [HD] thrice weekly. 10 healthy volunteers of matched age and sex served as a control group. All patients and control subjects were subjected to the following investigations; serum malondialdehyde [MDA] serum AOPPs, blood glutathione [GSH], erythrocyte glutathione peroxidase [GPx] and superoxide dismutase [SOD] activities, plasma vitamins A and C, serum vitamin E and beta carotene. For all patients, these markers were measured before the start of dialysis and 4 weeks after the first dialysis session. For control volunteers, these markers were measured only once. There was significant increase in the predialysis values of MDA and AOPPs when all ESRD patients were compared with the control group. There was also significant decrease in the predialysis values of GSH, GPx, SOD, vitamins A, E, and C, and beta carotene when all ESRD patients were compared with the control group. There was significant increase in the postdialysis values of MDA and AOPPs and significant decrease in the postdialysis values of GSH, GPx, SOD, vitamins A, E, and C, and beta carotene compared to their corresponding predialysis values in both PD and HD groups. There was no significant percentage change in all studied markers between PD and HD except GPx and vitamin C where the percentage change was significant. This study also revealed significant positive correlation between serum levels of MDA and AOPPs and significant negative correlation between each of them in one hand and all the antioxidant markers except for vitamin E in the post dialysis phase in the other hand. It is concluded that both PD and HD therapies, as practiced currently, are associated with increased oxidative stress. AOPPs are new uremic toxins that appear to be important components in the complex pathophysiology of oxidative stress and inflammation and therefore should be taken as a potential target to interrupt the vicious circle of oxidation and inflammation in uremia. AOPPs can be also used as a marker of oxidative stress. Prevention of oxidative stress in dialysis patients might focus on improving the biocompatibility of the dialysis system and supplementation of deficient patients with antioxidants

effect of intraoperative repair of mild-to-moderate and moderate ischemic mitral valve regurgitation on the postoperative results of coronary artery bypass graft surgery

Patients undergoing bypass grafting [CABG] often present with mitral regurgitation [MR]. While surgical strategy for patients with either trace or severe MR is well established, the need for a valve procedure with mild-to-moderate and moderate mitral regurgitation is still controversial. This study aims at evaluating the impact of intraoperative repair of mild-to-moderate or moderate ischemic mitral valve regurgitation on the early postoperative results of Coronary Artery Bypass Graft Surgery. Our prospective comparative study was done in the Department of Cardiothoracic Surgery of Kasr El Aini University French Teaching Hospitals as well as private hospitals after approval of the local ethical committee. The study included 60 consecutive CABG patients: 13 women [21.6%] and 47 men [78.3%] with a mean age of 59 +/- 3.5 years [range 39-66 years] which were operated upon between 2004 and 2006. Patients were divided into two adequately-matched groups: group A [no 30] included patients who carried out mitral repair concomitant with CABG; and group B [no 30] which included patients who were submitted to CABG only. Data was collected prospectively in the 1st. group patients and retrospectively in the 2nd. group patients. Preoperative patient characteristics, as well as the general operative techniques used, were comparable between patients of both groups. Preoperative Clinical and Echocardiographic examination in all patients proved the presence of mild to moderate or moderate ischemic mitral regurgitation [NYHA Clinical grades 1-2 or grade 2]. Similar Comorbidity conditions were present in both groups. Follow-up was done by clinical and echocardiographic examination for 1st. postoperative year to assess early and short-term results and identify independent predictors for early and short-term postoperative risk. A single patient [3.3%] died in group A patients; versus 4 patients [13.3%] in group B. [p< 0.01]. Better clinical improvement [NYHA step-up for milder sypmtoms]; and functional results [earlier return to work]; together with more echocardiographic improvement [LVEDD, LVESD, LA diameter, LVEF%, and surface area of the MR jet] occurred in group A versus group B patients. Morbidity occurred more in 6 [20%] of group B patients; versus 4 patients [13.3%] in group A with no statistical significance. Independent predictors of poor postoperative outcome of CABG surgery were: female sex; preoperative LVEF dysfunction, frequent preoperative infarctions, poor NYHA Class; prior cerebrovascular accident and incomplete revascularization. We found that intraoperative repair of mild-to-moderate or moderate ischemic MR during coronary artery bypass graft surgery led to a better intraoperative and postoperative outcome compared to those in whom CABG surgery was done alone. Being associated with acceptably-less mortality and morbidity complications in the immediate and early postoperative periods we justify its safe use in this context

Urinary N-acetyl-beta-D-glucosaminidase: as a marker for early detection of renal tubular disturbance in patients with IDDM [type 1]

Clinical diabetic nephropathy represents one of the major forms of microangiopathy complications of diabetes. This condition is associated with renal tubular as well as glomeruiar damage. The aim of this study is to N-acetyl-Beta-D glucosaminidase [NAG] and glomeruiar integrity was evaluate the level of NAG in IDDM patients [type1] and its relation to microalbuminuria, duration of diabetes and diabetic control. Tubular cell structural integrity was evaluated by measuring urinary measured by evaluating the level of microalbuminuria. in addition serum creatinine was evaluated as a common test for renal function. Moreover, the level of serum fructosamine and blood HbA1c were measured to assess the degree of the control of blood glucose along a short and long periods respectively. The study was done on three groups of male diabetic patients, type 1 [IDDM] according to disease duration. They were selected with aging up to 30 years old and of the same socioeconomic levels. In addition, age-matched healthy male persons were taken as controls. In conclusion, this study indicates that urinary NAG measurement is a sensitive, non-invasive test for early detection of diabetic patients at risk of developing diabetic nephropathy and as a good marker for long term period glycemic control in IDDM patients

Some histochemical stromal characterizations in colorectal epithelial tumors

Stroml changes may play an important role in progression, invasion and prognosis of colorectal tumors. Biopsy specimens of colorectal tumors were evaluated for stromal char- acterizations. Section stained with Haematoxyline and eosin [HandE] were examined as regard the presence of tumor infiltrating lymphocytes [TILs] and tumor associated eosinophilic infiltrate [TE]. The number of TILs were larger in earliest stages of colorectal cancers and decreased with the presence of metastasis. The prognosis of carcinomas was better for those with higher eosinophilic infiltration Expression of gelatinase A type of Matrix Metalloproteinases [MMP2] was assessed histochemical in both adenomas and carcinomas. Cytoplasmic expression of MMP-2 is significantly high in colorectal carcinomas [56%] compared to adenomas [20%]. [p=0.006]. A positive relation- ship between MMP-2 expression and tumor grade, Dukes' stage and nodal status was reported. The staining in density of MMP-2 in adenomas was either moderate [50%] or weak [50%]. On the other hand, 28.6% of carcinomas were strongly stained, 39.3% were moderately stained and 32.1% were weakly stained

Clinical and laboratory studies of DDB in treatment of chronic hepatitis C 4. Combination therapy with amantadine hydrochloride, a pilot study in Egypt

The aim of this pilot study was to evaluate the efficacy and safety of Dimethyl Dimethoxy Biphenyl Dicarboxylate [DDB] and amantadine hydrochloride [amantadine] in treatment of patients with chronic hepatitis C virus infection [HCV]. For this objective, 80 patients with chronic HCV were selected and divided randomly into four equal groups: Group I treated with DDB, Group 2 treated with amantadine, Group 3 treated with DDB and amantadine while Group 4 treated with silymarine and acted as control group. Follow up of those patients 12 months after initiation of therapy, revealed dramatic clinical improvement of the main symptoms in patients treated with DDB and DDB-amantadine combined therapy, sustained normalization of the mean serum ALT level in 100% of DDB and DDB-amantadine combined therapy group versus 45% of patients treated with amantadine only. On the other hand there was statistically significant decrease in the mean serum AST and bilirubin level in patients treated with DDB and amantadine in comparison with the control group. Estimation of the mean serum albumin revealed statistically significant increase in DDB and DDB-amantadine treated groups, while estimation of the serum alpha-fetoprotein showed statistically significant decrease in DDB and DDB-amantadine treated groups in comparison with amantadine and control groups. Follow up of DDB and amantadine treated patients [Groups 1, 2 and 3] 6 months after therapy revealed sustained normalization of the mean serum ALT levels in 85% of patients treated with DDB-amantadine combination versus 75% of patients treated with DDB and 30% of patients treated with amantadine. Also there was statistically significant sustained decrease in the mean serum AST, bilirubin and alpha- fetoprotein levels. Serum HCV RNA detected by PCR 12 months after initiation of therapy become negative in 40% of case treated by DDB and amantadine combination, versus 15% in both DDB and amantadine treated patients and 0% in control group. Six months after cessation of therapy serum HCV RNA detected by PCR remained negative in 35% of DDB and amantadine combination treated patients versus 10% and 15% in DDB and amantadine treated patients respectively. It could be concluded that the additive value of DDB-amantadine combined therapy in chronic hepatitis C patients is a beneficial strategy which needs further studies [This is the 4[th] study in this field, Montasser, 1999, Montasser, 2000 and Montasser et al. 2000, This study was presented in Ain Shams Clinical and Scientific Society Symposium: Chronic Hepatitis C Up date 1[st] November 2000]

clinical and laboratory study of DDB in treatment of chronic hepatitis C [2] comparative studies

The aim of this study was to evaluate the role of Dimethyl Dimethoxy Biphenyl Dicarboxylate [DDB], a Chinese drug, in treatment of patients with chronic hepatitis C infection [HCV]. This is the second study in this field, in the first one, which was a pilot or preliminary study in Egypt, it was con-eluded that DDB is beneficial in treatment of patients with HCV because it improves dramatically the main symptoms and induces sustained biochemical improvement without undesirable side effects. In this study 100 patients with HCV were selected and treated with DDB. Follow up of those patients for 12 months revealed sustained clinical improvement, normalization of serum ALT, statistically significant decrease in serum AST when compared with the control group and serum HCV RNA, detected by polymerase chain reaction [PCR], became negative in 10.66% of cases [The first part of this study was presented in Ain Shams Clinical and Scientific Society Symposium: Chronic Hepatitis up to date, April 1999]

Histopathological changes in vocal folds of female rabbits after injection of anabolic steroids

In this experimental research, a study group of ten unmarried female rabbits was injected with anabolic steroids and their vocal folds were examined histopathologically and compared with those of a control group of five rabbits. There were no differences in the epithelial, elastic or muscular tissues between both groups. However, there was some increase in the density of subepithelial collagen fibers of the vocal fold ligament in three rabbits of the study group, which may be attributed to the individual sensitivity of the rabbits. This increase may explain the irreversible virilization of voice in human females