Evaluation of the mesh-bridged posterior partial fundoplication-a new technique in treatment of gastroesophageal reflux disease

Disruption of the wrap and slipping are the most frequent causes of deficient reflux control after anti-reflux surgery. Isolauri et al. [1997], after an experimental study, suggested that if scarring could be induced between the fundal wrap and the esophagus, it could probably help to prevent slippage and disruption of the fundoplication wrap. This study was randomly conducted in the Gastrointestinal Surgery Unit, General Surgery Department, Tanta University Hospital on 60 patients suffering from GERD during the period from May 2003 to June 2005. They were randomly classified into two groups; group I comprised 30 patients for whom posterior partial fundoplication [modified Toupet technique] was performed and group II comprised 30 patients for whom mesh-bridged posterior partial fundoplication was performed. At 24 months postoperatively, 4 out of the 30 patients belonged to group I developed recurrence of GERD while none of the 30 patients belonging to group II developed recurrence. The difference in the recurrence rate between the two groups was found to be statistically significant. [P<0.0412]. The mesh-bridged posterior partial fundoplication proved to be effective in achieving the advantages and avoiding the disadvantages of both total and partial fundoplication in short term and mid-term follow-up; good reflux control and low incidence of mechanical complications. Moreover, did not significantly prolong the operation time and did not add to the patients' morbidity

Assessment of the surgical option esophagogastrectomy with and with out feeding jejunostomy in management of cancer lower two thirds oesophageus

The outcome of the surgical management of 39 consecutive patients with carcinoma of the distal two thirds of the oesophagus over a 5-years period is reviewed. Lewis Tanner oesophagectomy was performed for resectable cases. Patients were classified into two groups [A and B], according to the adopted method of pre and postoperative nutritional support. Primary surgery was carried out in 15 patients group A [parenteral nutrition] and in 24 patients group B [T-tube feeding jejunostomy]. Resectability rates of both groups were 80 and 83 percent respectively. Tumour staging was assessed intraoperative and compared with preoperative categorization. Three patients group A [20 percent], and 4 patients group B [17 percent] were found having irresecrable tumours during exploration [stage IV]. Hospital mortality rate was 25 percent, all belonged to group A cases. Incidence of late postoperative complications and survival data were recorded in both groups. Resection of the oesophageal tumours has led to effective palliation of the patient symptoms. Only 7 percent [2/12] of group A patients were living at [3-5 years], both initially had stage I disease and squamous cell tumours, while 35 percent [7/20] of group B patients were living at [3-34 months], all initially had stage I and II disease, 5 had squamous cell tumour and 2 had adenocarcinoma. It is clear that late presentation is a limiting factor in improving results. The value of T-tube feeding jejunostomy was predicted by reduction of early postoperative morbidity in group B cases

Assessment of emergency endoscopic control of massive gastric variceal bleeding

During emergency endoscopic examination of 282 patients admitted for massive bleeding gastroesophageal varices, 44 patients [15.6 percent] were found having bleeding from a point distal to squamocolumnar junction. Active bleeding was encountered in 29/44 patients [66 percent], while the accused site of bleeding could be detected in 15/44 patients [34 percent]. Endoscopic injection of diluted tissue adhesive enbucrilate had led to successful control of bleeding in 42/44 patients [95 percent]. Massive bleeding during emergency endoscopy was encountered in 12/44 patients [27 percent], it was massive and uncontrollable in 2 patients, both succumbed of intraprocedural cardiac arrest [5 percent]. Endoscopic injection of large volume of enbucrilate to control massive bleeding in the remaining 10 patients had led to embolic obliteration of the main portal vein in one patient [2 percent] without detectable changes in the clinical course of the patient. Four patients out of 42 survivors developed hepatic coma in the early postinjection period, 3 of them died. Early recurrent bleeding was encountered in 5/42 patients [12 percent], all were controlled by endoscopic reinfection of enbucrilate. Endoscopic sclerotherapy of the associated oesophageal varices had led to complete dysphagia in one patient due to accumulation of huge submucous haematoma that involved the distal two-thirds of the oesophagus, it was successfully evacuated endoscopically. Endoscopic injection of tissue adhesive enbucrilate, is a life saving successful procedure in achieving haemostasis of massive gastric variceal bleeding with accepted low morbidity rates

Evaluation of silver[AgNOR] technique as a rapid method for histopathological diagnosis on whole cell preparations in some fresh operative specimens

The silver [AgNOR] staining technique for nucleolar organizer regions was applied to both whole cell preparations [cell imprint and needle aspiration smear] and to paraffin wax sections of 24 fresh operative specimens [6 reactive, lymph nodes, 6 lymph node metastasis, 6 cancer breast, 6 cancer colon]. The mean [AgNOR] count per nucleus was higher in whole cell preparations than in paraffin wax sections for each specimens. Furthermore, AgNOR dots were much more easily distinguished and enumerated in the whole cell preparation than in sections. The mean [AgNOR] count was significantly higher in malignant [7.6] than in reactive lesions [1.3] [P <0.001]. Also, the mean AgNOR count was significantly higher in lymph node metastasis [mean 4.4] than in reactive lymph node lesions [mean 1.3] [P <0.001]. So, the silver [AgNOR] staining technique appears to be the method of choice. It is simple, rapid and can readily be performed to differentiate between benign, reactive and malignant lesions on whole cell preparation either by cell imprinting or by aspiration smear