Multi-center study of wilms tumors treated by different therapeutic strategies in two different countries

According to the treatment of Wilims' tumours', two different therapeutic strategies were established in the 2[nd] half of the last century. Both NWTS and SIOP have helped to improve the clinical management and outcome of Wilms' tumour's patients. In this study we compared the 3 groups of Wilms' tumour patients with different racial backgrounds and therapeutic strategies. Clinicopathological review was performed for 40 patients treated at Kyushu University [KU] hospital in Japan from 1960 to 2006 according to NWTS and JWiTS [Japanese Wilms' tumour Study] protocols, and 79 patients treated at South Egypt Cancer Institute [SECI] from 2002 to 2009 according to SIOP protocol. Retrospective study of 33 patients treated at pediatric surgery department of Assiut University hospital, from 2000 to 2009 according to NWTS protocol In KU group, a favourable histology [FH] was diagnosed in 82.5% and an unfavourable histology [UH] in 17.5%. Distribution of the clinical stage: I = 40%, II = 22.5%, III = 22.5%, IV = 7.5%, V = 7.5%. Five year overall survival was 82.5% and 5 year stage related survival was as follows; I 93.7%, II 83.3%, III 62.5%, IV 33.3% and V 100%. In SECI group, FH was diagnosed in 89.9%, UH in 8.8% and benign disease in 1.3%. Distribution of the clinical stage [pre and post chemotherapy] was as follows: I = 25.3% 50%, II =19% 20%, III = 35.4 15%, IV = 12.5% 5%, V =7.6% 7.6%. No case of intra-operative tumour rupture was recorded. The overall 5 year survival rate 80% with 5 year stage related survival was as follows; 195%, 11 93%, III 75%, IV 50% and V 83%. In AU group a favourable histology [FH] was diagnosed in 79% and an unfavourable histology [UH] in 9%. Distribution of the clinical stage: I = 39.4%, II = 21.2%, III = 21.2%, IV = 12%, V = 6%. The overall 5 years survival rate was 78.8% and 5 year stage related survival was as follows; 192%, 11 86%, III 71%, IV 50% and V 50%. The KU and AU group results proved the advantages of primary surgery in which accurate staging information and unmodified tumour histology helped subsequent treatment by proper chemotherapy dose. The SECI group results proved that preoperative chemotherapy increased the rate of stage I disease and decreasing the incidence of intraoperative tumour rupture. However, there was a possibility that chemotherapy administered to benign disease or an inappropriately low dose led to unfavourable histology

Comparative study between open anterior approaches using the prolene patch and open posterior [pre-peritoneal] using a configured prolene mesh in treatment of recurrent inguinal hernia

Recurrence of inguinal hernia is not an infrequent problem seen by the surgeon. Usually repair of such hernia is technically more demanding than a primary repair, with a potential for new recurrence and a high risk of complications. The objective of this study is to compare between the anterior approach using the prolene patch and a pre-peritoneal approach with prolene mesh configuration. A comparative study was done from June2004 to December 2006, at Assiut university hospital on thirty patients with recurrent inguinal hernia selected for this prospective comparative study. The studied patients were allocated into two groups: group A [anterior approach n=15 patients] and group B [posterior approach n= 15 patients]. Thirty patients with recurrent inguinal hernia were operated. All of them were males. Incidence of cord injury in group A was 6.6%, while no injury of the occurred in group B. the incidence of haematoma [6.6%], scrotal oedema [20%] and testicular atrophy [6.6%] were encountered in group A while no reported cases were seen in group B. Although both anterior and posterior approachs are effective treatment modalities for treatment of recurrent inguinal hernias, yet the open pre-peritoneal approach is technically easier, safer, cheaper, is followed by minimal morbidity and has a low re-recurrence rate

Acute limb ischemia: delayed presentation and outcome

Acute limb ischemia still represents an important dangerous situation in vascular surgery. Delayed presentation of acute ischemia usually leads to catastrophic outcome. Late ischemia represented 20.4% of all cases of acute limb ischemia admitted to our hospital during one year period. We were aiming to evaluate such cases with acute prolonged limb ischemia identifying causes of delayed presentation and its imprint on patients limb and life. Forty-five patients [45 limbs] were included in this study. There were 25 females and 20 males with ages ranged between 20 and 85 years [mean; 58 years]. The lower limbs were affected in 91.1% of cases while the upper limbs were involved in 8.9%. Sixty percent of cases had embolic ischemia while 40% suffered from thrombotic ischemia. The average ischemic interval was 6.8 days. Methods of treatment included medical and/or surgical intervention. Doctors of other specialties were responsible for delayed presentation in 62.2% of cases because of wrong diagnosis or treatment. Patients themselves were blamed in 31.1% of cases due to ignorance or low socioeconomic level. Long distance from the nearest specialty hospital was the cause of delay in 6.7% cases. Overall, a good outcome was recorded in 11.1% patients. Major amputation was ultimately required in 71.1% patients. Death occurred in 4.5% patients. Treatment of acute prolonged limb ischemia is difficult and results in high morbidity. Proper management of acute limb ischemia requires educational programs for genior doctors, patients and community to realize its causes, manifestations, methods of diagnosis, and importance of time factor and its imprint on patient's limb and life

Enoxaparin versus heparin for the prophylaxis of post-operative deep vein thrombosis in general surgery

Patients undergoing surgery with a prolonged general anesthesia or a period of a limited postoperative mobility, or both, face a high risk of thromboembolism. Surgical procedure is considered as the third most common risk factor for thromb oembolism after old age and obesity. To asses the value of enoxaparin in the prophylaxis of venous thromboembolism and the possible complications in comparison to heparin in high risk patients undergoing general surgery. In the period between March 2003 and May 2005, 200 patients admitted for different surgical procedures were randomized into 2 equal groups: [1] Group A where unfractionated heparin was used as a prophylactic anticoagulant drug, and [2] Group B where enoxaparin was utilized. Patients were obese with one or more risk factors for deep vein thrombosis. Clinical and laboratory assessment in addition to venous duplex scanning of the lower limbs were performed. The ages of the patients ranged from 40 to 82 years with a mean of 61 years. A mean preoperative hospitalization period of 6.1 days and a mean operative duration of 95 minutes was recorded. Postoperative deep venous thrombosis [DVT] occurred in 10 [5%] patients, 8 of them were asymptomatic [4 in each group] and diagnosed by duplex ultrasound. The 2 remaining patients had symptomatic DVT, both were in group A. Bleeding complications occurred in 30% and 16% patients of group A and group B, respectively. Low molecular weight heparin [enoxaparin] is more effective and safer than unfractionated heparin, but with higher costs in the prophylaxis of postoperative deep venous thrombosis

Role of sonography in diagnosis of anorectal malformations

Anorecral malformations comprise a spectrum of diseases; some of these defects are minor and easily treated with an excellent functional prognosis. Others are complex and difficult to manage, their functional prognosis is poor, and frequently, they are associated with other defects. The management of a newborn infant with an anorectal malformation is critical, because it will determine the immediate future of the child [Pen A, 1992]. The aim is to evaluate the various modalities of diagnosis of congenital malformation; both clinical and radiological modalities [invertography, lateral prone cross-table radiography, perineal ultrasonography]. Our prospective study consists of 47 children with anorectal malformation admitted to the Pediatric Surgery Unit. Department of General Surgery. Assiut University Hospital from April 2004 to February 2005. They were subjected to clinical evaluation in the form of history consanguinity, pregnancy, date of presentation color of urine and suggestive of other congenital anomalies. General examination [general condition; body weight, vital signs, systemic examination; head and neck.; chest and heart, spine and extremities, nervous system, genitalia]. Strict perineal examination, meticulous perineal inspection for any fistulous opening probing of the fistula, looking for meconium coming from the urethra. And lastly, radiological evaluation, in the form invertogram, cross-table lateral prone radiogram and ultrasonography of the distal rectal pouch were done. Our study included 47 cases with anorectal malformation, 25 males and 21 females, their ages ranged form 1-day to 5 years. Associated anomalies beside the anorectal anomaly were found in 18 babies. All cases were submitted to clinical evaluation, and the type of defect was obvious in 31 cases [66%]. the remaining 16 cases [43%] need radiological evaluation to detect the type of anomaly. Clinical methods were more sensitive in the diagnosis of females, 18 of 21 female [85%] were diagnosed clinically three females need radiological study [15%]. From 26 males, 13 cases were diagnosed clinically [50%] and 13 cases need radiological evaluations to detect type of the anomaly. Imperforate anus is a common congenital anomaly that requires rapid evaluation and possible early surgical decompression. Appropriate surgical intervention depends upon the position of the distal rectal pouch and -its relation to puborectalis. radiological evaluations are needed to diagnose the level of the anomaly, and ultrasound of the rectal pouch was the most accurate method in the diagnosis of such anomaly

Transanal pull through operation for Hirschsprung's disease, preliminary results

This study was done on 32 patients [30 males and 2 females] who were diagnosed to have Hirschsprung's disease for them transanal pull through operation was done. There was no operative or early post operative complications. Late post operative stricture of the anastamosis occurred in one patient who responded well to dilatation There was frequency of defecation up to 10 times per day in most patients which improved gradually over few weeks. We concluded that trasanal pull through operation for Hirschsprung's disease is safe and feasible in selected patients

Dysmorphogenesis, clinical study

Dysmorphology describes the study of human congenital defects or abnormalities of body structure that originate before birth, dysmorphic anomalies can occur in any part of the body and most arise during the first 3 months of intrauterine life. Some of these anomalies are negligible or have only cosmetic significance, but about 3% of all children are burn with a serious structural defect that interferes with normal body function and can lead to lifelong handicap or even early death. To evaluate the prevalence, pattern of clinically detectable congenital anomalies among neonates, infants and children admitted to Assiut University Hospital. During a period of one and half years from January 2003 to June 2004, a total 9700 cases were admitted to AUH, 620 of them have a congenital malformation. They are segregated into 222 neonates, 269 infants and 129 children: 119 babies have GIT anomalies, 129 have cardiac anomalies, and 75 have CNS anomalies and 86 with urogenital anomalies. The results spotlight that the incidence of dysmorphogenesis is high with father's age less than 40 years old age. The incidence of dysmorphogenesis is increased directly with number of pregnancies. The prematurity doesn't have adverse effect on the incidence of congenital anomalies. The incidence increased among babies came from rural area. Directly related to the maternal age showing low incidence with age

Vascular cell adhesion molecule-1, E-selectin and von willebrand factor: Role as surrogate markers of angiogenesis in breast cancer

Angiogenesis, the development of new blood vessels from pre-existing vasculature, is a prerequisite for tumor growth and metastasis in breast cancer. Surrogate markers for angiogenesis would be useful for studying the effectiveness of antiangiogenesis drugs. We examined the potential of three glycoproteins: vascular cell adhesion molecule-1 [VCAM-1], endothelial selectin [E-Selectin], and von Will brand factor [vWF], to serve as markers for angiogenesis. Serum levels of VCAM-1, E-selectin and plasma vWF levels were measured by enzyme-linked immunosorbent assay in 54 women with different stages [1-IV] of breast cancer [12 women in stage 1, 16 in stage 11, I4 in stage III and 12 in stage IV]. Their ages ranged from 25-70 years. To investigate whether the concentration of these activated endothelial cell molecules are associated with breast cancer, the serum levels of soluble VCAM-1, E-selectin and plasma levels of vWF in women with breast cancer were compared with those of22 healthy age-matched control women, we also examined whether levels of VCAM-1, E-selectin or vWF are associated with tumor progression and stage of breast cancer [early and advanced breast cancer]. The results revealed that levels of VCAM-1, E-selectin and vWF are elevated in breast cancer women, even in early stages when compared with control women. Although plasma vWF and serum VCAM-1 levels were significantly elevated in advanced stages than early stages of breast cancer with a positive correlation with disease stage, E-selectin did not show a statistical difference between different stages of breast cancer. vWF, which is released by all endothelial cells, would be a pan-endothelial marker that would not accurately report angiogenesis and Serum soluble VCAM-1 can, be considered as an accurate marker of tumor angiogenesis in breast cancer

value of Hetastarch in prophylaxis against renal impairment in cirrhotic patients with spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis [SBP] is an ominous complication of the late stage liver disease. Renal impairment in the course of SBP is a frequent event and constitutes the most important predictor of hospital mortality in these patients. Administration of intravenous albumin was applied for prevention of SBP related renal impairment and it reduced the incidence of renal impairment and mortality in comparison with treatment with antibiotic alone. Because albumin is expensive and not available in some settings, we worked to assess the possible use of Hetastarch and assess its beneficial effects in prevention of SBP related renal impairment. The present study was conducted on 60 patients with liver cirrhosis, ascites and SBP. The patients were divided into two groups: Group [1]: 30 subjects who received empirical antibiotic plus plasma expander for treatment of SBP and Group [2]: 30 subjects who received empirical antibiotic alone. The plasma expander chosen was Hetastarch [the colloidal solution hydroxyethyl starch [Haes-steril] in a dose of 500 cc every 8 hours/5 days [20 ml/kg B. wt/day] due to its relative less side effects on coagulation process. It was found that the administration of Hetastarch as a artificial plasma expander decreased renal impairment in patients with liver cirrhosis and spontaneous bacterial peritonitis. The incidence of renal impairment was significantly lower among patients treated with antibiotic therapy plus plasma expander [13.3%] than those treated with antibiotic alone [36.6%]. Patients received Hetastarch showed maintenance of renal function allover the follow up period, higher urine output, better renal profile than other group not treated by Hetastarch. We concluded that treatment with Hetastarch was safe and effective and it can be considered as an alternative to albumin in prophylaxis against renal impairment in cirrhotic patients with SBP

new method for non operative treatment of giant omphalocele

The incidence of omphalocele is approximately, 1 in 500 live born. More than 50% have other serious defects. Ideal treatment would be primary closure which is not always possible. When the defect is large [> 10 cm], the infant has a small abdominal cavity or in cases of suspected chromosomal anomalies, non operative management using topical application of escharotic agent is a reasonable choice of treatment. Thirty Five patients were treated for omphalocele at Assiut University hospital, Pediatric surgery unit between years 1998 and 2004, using topical application of paste of Acacia Nilotica mixed with gentian violet to the intact sac twice daily for variable periods. The sac changes to a very tough structure without any infection or any other local or systemic complications and the skin creeps under it and it takes off gradually leaving a ventral hernia for later repair. Non operative management of large omphalocele with Acacia Nilotica is a good initial treatment

Ultrasonographic diagnosis of pre-term versus term infantile hypertrophic pyloric stenosis

To evaluate the determinants of ultrasonographic measurements of pyloric length and muscle thickness in pre-term versus term infants with hypertrophic pyloric stenosis [HPS]. fifty infants 920 pre-term and 30 term] were operated upon for hps at Assiut University Hospital over 2-year period. Ultrasonographic measurements of pyloric length and muscle thickness were related to age, history of prematurely, weight, sex and family history of H.P.S. Pyloric length in infants with HPS was significantly greater at those born at term compared to those born prematurely [18.4mm SD 2-1 vs 17.1 mm SD 3], P = 0.042, this was explained by body weight and length increasing by 1.1mm [SD 0.34] per 0.042, this was explained by body weight and length increasing by 1.1mm [SD 0.34] per kilogram [P = 0.002]. There was no significant relationship with measured muscle thickness. Ultrasonograhic measurement of pyloric length is strongly correlated with the weight of the infant irrespective of other factors. The relationship of length and weight may be useful in confirming the presence of HPS in small and pre-term infants

study of histopathologic changes in soft tissues associated with asymptomatic impacted mandibular third molar

Forty eight patients participated in the present study. They were divided according to the width of non-pathological radiographic pericoronal radiolucency into group one with pericoronal radiolucencies having width of less than 1mm, and group two with pericoronal radiolucency less than 2.5 mm but more than 1 mm. The present study was designed to find out firstly; the possible incidence of histopathological changes in the soft tissues adjacent to impacted mandibular third molar that were asymptomatic and not associated with pathological pericoronal radiographic radiolucency. Secondly, to examine if the pathological changes, in the soft tissue around the asymptomatic impacted third molars; parallel those noted in the radiographic radiolucency. The pericoronal soft tissue were removed after the extraction of teeth, fixed in 10% formaline. and processed to be submitted for the histological study. The examination revealed firstly; mild variable tissue changes in the different tissue specimens which dose not encourage the prophylactic removal of impacted third molars because the histological changes were not conclusive for cystic degeneration. Secondly; no significant histopathological differences had been recorded between the two groups of different radiolucencies

Propofol versus thiopentone as a sole anaesthetic agent in children: a comparative study

In a comparative study, 40 children were included in 2 equal groups to study the characteristics of either propofol or thiopentone as a sole anaesthetic agent in minor day-stay surgical procedures. Propofol was given in a dose of 2.5 mg.Kg[-1], while thiopentone was given in a dose of 4-5 mg.Kg[-1]. It was found that respiratory rate, systolic, diatolic and mean arterial blood pressures decreased significantly from the preinduction values [P< 0.05]. The heart rate decreased significantly after propofol, while it showed a significant increase after thiopentone administration. The incidence of pain on injection was significantly more in propofol than in thiopentone injection. Airway obstruction was seen in 25% of propofol group, while it was manifested in 40% of thiopentone group. Mild laryngeal spasm was manifested in 5% of propofol group patients, while it was seen in 15% of thiopentone group patients. Apnoea occurred in 25% of propofol group children and in 10% of thiopentone group children. It was of longer duration in the former group. Propofol was associated with significantly rapid and clear recovery from anaesthia than thiopentone, otherwise it offers no advantage over thiopentone as a short-acting anaesthetic agent

Effect of exposure of the gastric mucosa of albino rats to a mild irritant on the development of stress ulcer

Fifty adult male albino rats were used to study the effect of orogastric administration of a mild irritant; 0.3 NHcl on the development of stress ulcer induced by restraint, cold-restraint and water immersion as compared to a control nonstressed group. All forms of stress produced a significant decrease in volume, total acid output and pepsin output with no significant change in acid or in pepsin concentrations of gastric juice. A significant decrease in gastric mucosal PGE2 was also observed and would account for the gross mucosal lesions found in the stomachs of the stressed groups. Orogastric administration of 0.3 NHcl had no effect on the gastric juice changes produced by the stressors. However, it reduced markedly the various scores of the ulcer lesions probably secondary to preservation of gastric mucosal PGE2, and adaptive cytoprotection

Effect of insulin and/or oral hypoglycaemic drugs on the serum glucose level and lipid profile in streptozotocin induced diabetes

Eighty adult male albino rats of local strain with average weight of 220 gm were used to investigate the effect of insulin and/or oral hypoglycaemic drugs on serum glucose, total triglycerides, total cholesterol, high density lipoptotein cholesterol [HDL-chol], and low density lipoprotein cholesterol [LDL-chol] levels. The animals became diabetic by intraperitoneal injection of a lonely dose of streptozotocin. Except the control normal and control diabetic non-treated groups, all other six groups were subjected to different lines of treatment of oral sulfonylurea hypoglycaemic agent [glibenclamide], biguanide hypoglycaemic agent [metformin] and subcutaneous protamine zinc insulin. It was found that diabetic non-treated group showed higher serum glucose, triglycerides, total cholesterol and [LDL-chol] levels. On the other hand, [HDL-chol] level was lower as compared with the control group. Treatment with the above mentioned hypoglycaemics, alone and in combination, reduced serum glucose, triglycerides, total cholesterol, and LDL-chol, while HDL-chol increased to some extent. This effect may be explained by the fact that streptozotocin destroys the pancreatic beta cells, so glibenclamide loses its main action on beta cells completely and acts only by its peripheral mechanism. On the other hand, metformin caused significant reduction in serum glucose and lipid profile possibly because its main action is insulin independent. It was found that the addition of either glibenclamide or metformin to insulin treatment improved and prolonged its effect on these criteria

Effect of insulin and/or oral hypoglycemic drugs on the oxygen consumption of brain in diabetic rats

Eighty adult male albino rats of local strains with average weight of 220 gm were used to investigate the effect of insulin and /or oral hypoglycemic drugs on the O2 consumption of brain in diabetic rats. It was found that glibenclamide and insulin, alone and in combination, improved the brain O2 consumption. On the other h and, Metformin decreased the O2 consumption of the brain and decreased the increasing O2 consumption caused by both glibenclamide and insulin possibly by stimulating the anaerobic glycolysis of the cells