ABSTRACT
Introduction: In decompensated liver diseases with umbilical hernia [U.H.], when the ascites is refractory, the abdomen becomes very tense, that may lead to rupture of the U.H. After repair of the ruptured U.H., the ascitic fluid accumulates very rapidly, clue to salt and water retention produced by metabolic response to surgery added to the original pathology of portal hypertension and prolonged use of diuretics that lead to severe salt depletion, which in turn leads to low response to diuretic therapy. In the post-operative period the patient feels much discomfort, with the possibility of early disruption of the hernial repair
Aim of the Work: To assess the impact of insertion of abdominal drain after repair of ruptured umbilical hernia in ascitic patients
Materials and Methods: Twenty patients with chronic decompensated liver disease presented with ruptured U.H., were divided randomly into two groups tell each: Group 1: Repair of the hernia and insertion of tube drain in the peritoneal cavity for one week. Group 2: Repair of the hernia without abdominal drain
Results: Male to female ratio was 4:1. All the studied cases were of Child grade C, all of them had hypoalbuminaemia [mean value= 1.97 G/%]. The mean platelets count was 64,350 /cu mm., and the mean total leucocytic count was 10,735/cu mm. In the drained group the amount of ascitic fluid drained was decreasing with its lowest value just before the removal of the drain and before the start of the diuretic therapy. The mean hospital slay in the drained group was 10.7 days, and in the non-drained group was 5 days. Three patients developed wound infection one in the drained group and 2 in the non-drained group. Follow up for 12 months revealed recurrence of the U.H. in two cases from the non-drained group, with no recurrence in the draied group
Conclusion: insertion of a drain after repair of rupture U.H. relieves most of the post-operative abdominal discomfort, gives some rest to the already exhausted kidneys, minimize the possibility of wound infection and minimizes the possibility of early hernial recurrence
ABSTRACT
Background: The liver is the main site where most of glucose metabolic processes take place. It is suspected that partial hepatectomy will alter the glucose homeostasis, so it is mandatory to study the effect of partial hepatectomy on the glucose metabolism. Introduction: the liver exerts multiple complex metabolic functions. Partial hepatectomy, reduces the functioning liver cell mass. The body responds to surgery both locally and generally. The general one includes endocrinal and metabolic response
Aim of the Work: To determine the effect of partial hepatectomy on the glucose metabolism, by performing Glucose tolerance curve
Materials and Methods: 32 rats were included in this work, divided into 4 groups, 8 rats per each [5 were subjected to actual resection and 3 were subjected to sham operation]. First group: glucose tolerance curve [GTC] was done 24 hours after hepatectomy, 2[nd] group the GTC was done 48 hours after hepatectomy, 3[rd] group the GTC was done 72 hours after hepatectomy, and 4[th] group the GTC was done 96 hours after hepatectomy. Two blood samples were taken, pre-operative and post-operative, for determination of blood sugar and liver enzymes. For determination of the GTC, blood glucose was determined 4 times: at [0] time fasting sample, then [1/2 an hour] after an oral glucose meal then at [1 1/2 hours] and at [2 1/2 hours]
Results: There was weight loss in the post-operative period in various groups, that was minimal [8 grams] in the 1[st] group, and maximal [13 grams] in the 4[th] group. The resected segments varied from 30% to 60% of the whole liver mass. The mean liver weight was 3.67% of the whole body weight. In the P.O. period there was elevation of the ALT and AST, which was greater in the 1[st] group and least in the 4[th] group. There was low grade hyperglycemia, and the blood glucose level failed to return to baseline, 2 1/2 hours after the oral meal, in all groups. There were slight changes in the level of the B. sugar between various groups and between the individuals of each group, but not to the significant level
Conclusion: There was postoperative glucose intolerance manifested by low grade hyperglycemia in the early postoperative period with mild diabetic curve despite the reduced functional liver cell mass
ABSTRACT
Introduction: Ischemia and reperfusion [I/R] injury is a common complex inflammatory phenomenon encountered in medical practices. The initial site of abnormality in ischemia has recently emphasized on the cellular mitochondria. The damage is dramatically magnified by large number of events, such as oxygen free radical formation, release of iron storage, damage of the microvasculature of [I/R] organs, inflammatory cytokines, complement activation and neutrophil infiltration of the site of injury
Aim of the Work: To determine which is more injurious to liver tissue, ischemia or reperfusion? and to investigate the protective effect of ascorbic acid, DDB* and Silymarin preconditioning on [l/R] injury in a rat model
Materials and Methods: eighty rats were exposed to different periods of [l/R] injury with total time of 60 minutes, They were divided equally into 4 groups. One of them was used as a control group while the others were exposed to 10; 20 and 30 minutes ischemia respectively. Each group was subdivided into 4 subgroups which were preconditioned with either no medication, Ascorbic acid, DDB or Silymarin respectively. Blood samples were taken twice, after the periods of ischemia and reperfusion where serum levels of malondialdehyde [MDA], ALT, AST and LDH were determined. Liver biopsy also, was taken twice, after ischemia and after reperfusion, for histopathological study
Results: The pathological results showed that [I/R] injury was time related. In short periods of ischemia [10 min and 20 min] the pathological changes improved during the reperfusion periods while in longer duration of ischemia [30 min] the pathological changes were irreversible and even worsen during the reperfusion period. Preconditioning with Ascorbic acid, DDB and Silymarin minimize the pathological changes in all periods of ischemia when compared with the corresponding non-treated groups. The best results were detected with Ascorbic acid subgroup then DDB. The laboratory results showed that serum levels of MDA. ALT, AST and LDH were greater in the post reperfusion samples than that of the post-ischemic samples and were time-related. Preconditioning decreased the serum levels of MDA, ALT. AST and LDH in all groups after exposure to [I/R] as compared with non-treated group, but not to the significant level. The best results were detected with Ascorbic acid subgroup then DDB
Conclusion: The reperfusion plays the main rule in hepatic [I/R] injury. Preconditioning with Ascorbic acid, DDB or Silymarin attenuated the hepatic [I/H] injury. However, Ascorbic acid showed the best results, then DDB while Silymarin was the last. *DDB. Chinese herbal therapy used as a hepato-protective
ABSTRACT
Background: Pancreas is a deeply seated organ and difficult to investigate. Many studies have appeared comparing Endoscopic Ultrasonography [EUS] with various other pancreatic imaging techniques, and proved that [EUS] has emerged as the most accurate single test for imaging pancreatic disease
Introduction: Many investigators proved that EUS was superior to other investigation modalities, and could be used both as conventional and interventional modality. EUS is capable of evaluating and integrating: mucosal, vascular, ductal and parenchymal abnormalities caused by disease. To obtain information about these 4 types of abnormalities; 4 separate tests are often required: endoscopy for mucosa, venogram or arteriogram for veins and arteries. ERCP for ducts: and CT scan or standard US for parenchyma and lymph nodes
Aim of the Work: To evaluate the value of EUS in pre-operative assessment of pancreatic lesions
Patients and Methods: Thirty patients were included in this study, all of them were diagnostically problematic. All had symptoms related to pancreato-biliary disease, but had either no diagnosis after conventional studies, or probable malignancy with uncertain tumor stage or resection status. All of them were subjected to EUS examination in addition to full clinical examination, laboratory investigations and other imaging modalities [U/S, spiral CT and ERCP]. The imaging findings were compared with both operative and histopathological findings for tumor status and vascular involvement
Results: male to female ratio was 3:2, with high frequency in the age group of 65- years. In diagnosis of pancreatic cancer EUS was able to detect mass that coincide with operative findings and histopathology in 80% of the cases, as compared with US [28 %] and CT [48 %]. In pancreatic cysts, EUS was as sensitive as both US and CT., while in chronic pancreatitis, EUS was more sensitive [100%] than both CT [66%] and US [0%]. EUS was superior to spiral CT in diagnosis of vascular invasion [8 versus 4 respectively], while CT was superior in detecting lymph node involvement [4 versus 8 respectively]
Conclusion: EUS is a good partially invasive modality, more sensitive than other imaging modalities in diagnosis of pancreatic lesions particularly those less than 3 cm in diameter. It can detect chronic pancreatitis in patients where other tests have not shown diagnostic findings. It can predict the unresectable cases and then preclude unnecessary exploration, and so prevent the morbidity and the cost of an unnecessary surgical procedure
ABSTRACT
Introduction: Hyaluronic acid [HA] is produced mainly in fibroblasts specially in synovial tissue, and part of the produced HA enters the general circulation via the lymphatic system and is rapidly cleared and degraded almost exclusively in the liver, by a very efficient and specific receptor mechanism in sinusoidal endothelial cells [SEC]. The serum level of HA increases if its production is increased [inflammation of synovial membranes] or its clearance is decreased [impaired liver function]
Aim of the work: To determine the value of serum level of Hyaluronic acid in assessment of chronic liver diseases and Hepatocellular carcinoma
Patients and Methods: This study included 90 patients, divided into 3 groups: - Group 1: 60 patients had chronic liver diseases with various etiology with no malignancy. -Group 2: 20 patients had HCC. -Group 3: 10 patients with no liver disease as a control group. The group of chronic liver disease was subdivided into 3 subgroups, according to Child-Pugh [CP] classification, [A, B, and C]. Serum Hyaluronic acid [HA] was determined for all the studied cases at the time of examination and once more for HCC group, 2 weeks after surgical resection or tumor ablation
Results: Serum[S]. hyaluronic acid was significantly higher in the group of chronic liver disease and its subgroups [Child-Pugh A, B and C subgroups] than in the control group. There was direct proportion between the serum level of HA and the severity of the chronic liver disease. Pre-operatively, the serum level of HA in HCC cases was increased significantly, as compared to the control group. Postoperatively, the s. level of HA was decreased but insignificantly
Conclusion: The serum Hyaluronic acid [HA] concentration reflects the extent of liver fibrosis and severity of cirrhosis. HA could be used as a non-invasive marker for assessment of chronic liver disease, where its serum level was seen to correlate positively with the advancement of the liver disease. Its value in HCC cases was insignificant, where it has no diagnostic or prognostic value, and the serum level of HA in these cases reflects the underlying liver disease