Perioperative acute phase response and outcome of hepatic resection, an experimental study

Identification of patients at risk of postoperative complications could have an impact on the indications for a procedure as well as permitting modifications of treatment to reduce the surgical risk. This experimental study evaluated the correlation between peri-operative acute phase response and outcome of hepatic resection. The study was conducted on sixty healthy golden hamsters, which underwent partial hepatectomy. They were arranged in 3 groups [20 per each]. One day prior to resection, fracture of the left hind leg was done in group I [GI] and wound infection had been created in group II [GII]; while nothing done in group III [GIII] that acted as a control. Blood samples to estimate SGPT and serum albumin [as basic investigations for hamsters liver function] and serum IL-6 and CRP [as acute phase reactants] were taken preoperatively, immediately after resection and for the consecutive 3 days post operatively. The mean serum level of both acute phase reactants increased in GI and GII preoperatively and continues to rise immediately after resection. Post-operatively; among the three groups, the mean serum level of both reactants was higher in GI than in GII that was in turn higher than in GIII except when the postoperative complications were more severe than the other group, then this relation changed

Human papilloma virus DNA and p53 protein expression among Egyptian patients with urinary bladder cancer in relation to schistosomiasis and clinicopathologic outcome

Several studies have demonstrated an association between human papilloma virus [HPV] infection and urological malignancies. Inactivation of p53 tumor suppressor gene is a common genetic change in human cancers. Since proper understanding of the natural history of bladder cancer and significant prognostic factors is critical for management of this disease, we aimed to study the role of HPV16, 18 types and p53 protein expression among 72 Egyptian patients with bladder cancer in relation to schistosomiasis and clinicopathological parameters. Polymerase Chain Reaction assay [PCR] was used for detection and typing of HPV-DNA in bladder tissue biopsies where as p53 protein over expression was detected by immunohistochemistry. Results revealed that 36.1% of bladder tumors were schistosomiasis-associated, while 69.4% and 78.6% were significantly related to transitional cell carcinoma [TCC] and low grade tumor respectively. HPV16, 18 DNA types were detected in 41.7%, the majority of which [66.6%] was of type-16. p53 protein expression and its coexistence with HPV DNA-types was detected in 66.7% and 38.9% of tumors respectively. Although p53 protein expression had no statistically significant relation to schistosomiasis, the presence of HPV DNA or its coexistence with p53 showed statistically significant relation. In pre-malignant lesions, positive HPV DNA incorporation and p53 expression were detected in 20% and 12.5% respectively. Fair correlation was recorded between the presence of HPV DNA-types and p53 expression [kappa coefficient = 0.421]. Significant marked expression of p53 was detected in 92.9% of HPV DNA positive cases. There was no significant association between tumor recurrence and HPV DNA positivity. It is worth mentioning that marked expression of p53 was significantly associated with recurrent tumors [85.7%]. In conclusion, both HPV infection and p53 protein expression could contribute to schistosomal bladder carcinogenesis in an independent way. Over expression of p53 could play a role as an indication for high risk HPV infection or for tumor recurrence tendency. We suggest screening of patients with schistosomiasis for high risk HPV-16 and HPV-18, as they will need more strict treatment modalities and follow up besides, monitoring of their response to therapy. Further data are needed to study the relation between HPV and the reduction in cancer-specific survival, which is the ultimate goal of screening

Assessement of peritoneal adhesions due to starch granules of surgical glove powder an experimental study

Introduction of foreign material into abdominal cavity during surgery causes irritation of peritoneum leading to postoperative [P0] adhesions. To assess and prevent P0 adhesions, an experimental study was done to assess the caused by starch granules of the surgical glove powder and to avoid complications using the effect of normal saline and low molecular weight heparin [LMWH]. Thirty Wister Albino male rats were subjected to laparotomy and ileocaecal abrasions were done mechanically to induce postoperative peritoneal adhesions. Rats were divided into 3 groups, 10 animals each. The sterile starch powdered gloves were used in the laparotomy procedure. The basic procedure performed in the three groups was serosal abrasions at the ileocaecal region and using the 2-layer technique in the closure of the abdominal cavity. In GI no further management was performed than the basic procedure. In GIl and G III before closure normal saline and [LMWH] was spilled into the peritoneal cavity respectively. The results showed that in GI, there were severe firm intraperitoneal adhesions especially at the site of the ileocaecal abrasions. This was proved macroscopically and histologically. The reactions detected in biopsies of GIl and GIll were lesser in intensity compared to GI. Morphometric assessment of collagen deposition in the intra-peritoneal adhesions revealed a significant decrease in GIl and GIll compared to GI