Effect of bilateral Truncal ligation of the inferior thyroid artery on serum calcium levels after subtotal thyroidectomy

Hypocalcaemia is a well recognized complication of thyroid surgery. We have compared the prevalence of hypocalcaemia in our patients following ligation and non-ligation of the inferior thyroid artery after thyroid surgery. A prospective study was done from January 2004 to December 2007, at Assiut University Hospital. All patients [110 patients] undergoing subtotal thyroidectomy were placed in two groups at random. Group I [55 patients] had inferior thyroid arteries ligated whereas in Group II [55 patients], inferior thyroid arteries were not ligated Serum calcium levels were measured before and after surgery. 110 patients were operated [90 females and 20 males], 55 patients in Group I and similar number in Group II Transient hypocalcaemia was observed in 2 [3.63%] patients in Group I and in one [1.81%] patient in Group II. Permanent hypocalcaemia was observed in one [1.81%] patient in Group I and no permanent hypocalcaemia recorded in Group II. Results were statistically insignificant. There is no significant difference in post-operative hypocalcaemia whether or not the inferior thyroid arteries were ligated

Role of systemic inflammatory response in prognosis and survival after curative resection of colorectal cancer

Some studies have shown that the presence of a systemic inflammatory response, as evidenced by raised circulating concentrations of C. reactive protein [CRP] predicted recurrence and overall survival in patients with colorectal cancer. The aim of this study was to examine the relationship between the inflammatory response and prognosis and survival in patients undergoing potentially curative resection for colorectal cancer. 90 patients considered to have undergone curative resection were studied. Circulating CRP concentration was measured before and after operation. The majority of patients were aged 65 years or more, had colonic tumours and Dukes stage B lesions. 23 patients had raised preoperative value, 11 [47.8%] of them, had raised concentration after operation. 67 patients with a normal preoperative value, 60 [89.5%] of them had normal postoperative value. During follow up, 17 [18.8%] patients developed recurrence and 25 [27. 7%] died. In patients who have undergone potentially curative resection for colorectal cancer the presence of a systemic inflammatory response predicts a poor outcome

Mesh plug repair for paraumbilical hernia

The standard method of repair of paraumbilical hernia [PUH] is by Mayo's technique, using a double breasted flap of the rectus sheath. The present study describes and evaluates the application of prolene mesh plug in the repair of PUH. The use of a mesh plug in hernia repair is not a new concept with previous investigators yielding consistently excellent results in the repair of femoral and inguinal hernia. Twenty patients with paraumbilical hernia [PUH] admitted to Assiut University Hospital, General Surgery Departments between April 2004 and April 2006. There were twelve [12] female [60%] and eight [8] male [40%] with median age group 53 years [range 34-86 years]. Whenever local anaesthic was used. This technique included 3-4cm incision either supra or infraumbilically, the sac was dissected from the surrounding tissues till the margin of the hernial ring, the content of the sac reduced followed by reduction of the sac in the abdomen. Cigarettes stub was done from prolene mesh sheet [2.5cm x10cm]. The stub inserted into the defect with its external margin flush with the hernial ring and fixed to it with prolene 3/0 suture. Then suction was inserted subcutaneously and the wound closed with subcuticular suture. Follow up was done for 18 month. Patients with local anaesthesia discharged from the hospital within 24 hours and those with general anaesthesia discharged within 48 hours without anaesthetic complications and post-operative pain controlled with non narcotic analgesia. The post-operative complications were two cases [10%] of wound infection. The patients return to normal activity after 7 days [range from 4-12 days]. Seventeen patients [85%] satisfied the procedure and recurrence occurred in one case only [5%]. Mesh plug repair can be performed with minimal post-operative complications, low recurrence rate, minimal post-operative pain and achieving excellent patient satisfaction. Prosthetic mesh plug repair under local anaesthetic could become the standered treatment for PUH in adults

Total cystopericystectomy versus traditional cyst evacuation for treatment of hydatid cysts of the liver

Echinococcosis is a zoonotic disease that occurs throughout the world. Surgery is the recommended treatment for hepatic hydatid cysts. The purpose of this study is to evaluate the technique of cystopericystectomy for treatment of hydatid cysts of the liver comparing it with the traditional surgical technique of cyst evacuation. Twenty six patients [26] admitted with hydatid disease of the liver in Assiut University Hospital from January 2004 to April 2007. All patients were randomized into two groups, group I [13 patients] were managed by total cystopericystestomy and group II [13 patients] managed by conservative technique of cyst evacuation. History, clinical examination chest X-ray abdominal ultrasonography and computed tomography were performed. All patients were treated with oral albendazole dose for two months after surgery. Blood transfusion hospital stay, post-operative complications, and any evidence of hydatid recurrence were recorded. Surgery was performed on 26 patients with liver hydatid disease [14 men and 12 women] with a mean age of 40.2 years [range 21-73 years]. The mean diameter of the cyst was 6.6cm [range 5-11cm]. Blood transfusion was required in 5 patients in the group of cystopericystectomy and in 2 patients of traditional technique of cyst evacuation. The mean hospital stay was 6.1 days in cystopericystectomy group and 8.2 days in the traditional technique of cyst evacuation. During the follow up period which extended up two years postoperatively, no mortality was verified, the incidence of postoperative complications was 7.6% in the group randomized to cystopericystectomy and it was 23.07% in the group randomized to cyst evacuation. Recurrence of hydatid disease was observed in one patient 7.6% in the group treated by cyst evacuation, but no recurrence was observed in cystopericystectomy group. Surgical treatment of hepatic hydatid disease by total cystopericystectomy combined with medical therapy with albendazole is a valuable alternative to the more conservative technique of cyst evacuation with a lower incidence of morbidity and recurrence