Prolonged total parenteral nutrition to tunnel or not?

The effects of subcutaneous catheter tunneling on the incidence of catheter sepsis and catheter life-span was studied in 30 patients who received prolonged total parenteral nutrition [TPN] and long-term chemotherapy. The effects of catheter tunneling were compared with conventional venous catheters inserted in 120 surgical patients. The total number of catheters inserted was 235. Catheter life span range was 30-180 days in tunneling group and 8-15 days in the non-tunneling one. Catheter sepsis occurred in 39 cases in the non-tunneling group, while it was suspected in only one case in the tunneling one. It was concluded that tunneling should be considered in chronic venous access because it increases catheter life span and diminishes the incidence of catheter-related sepsis, especially in critical surgical patients where nursing care is suboptimal

Anaesthetic and surgical considerations of hepatotoxic effects of organophosphorous pesticides pollution on human and rabbit's liver

This work included clinical and experimental study to clarify the toxic effects of organophosphorous compounds [OPC]. The clinical work was done on 20 adult male patients known to be in contact with OPC passively or actively and scheduled for elective cholecystectomy under general anesthesia. Preoperative, operative and postoperative serum hepatic transaminase, alkaline phosphates, bilirubin and liver biopsy were studied. The experimental work included 24 rabbits allowed to inhale airline, rosepher and their mixture for five hours daily for seven successive days. Serum liver transaminase, alkaline phosphatase, bilirubin and liver biopsy were studied to clarify the histopathologic effects of OPC. This study proved that serum hepatic transaminase and alkaline phosphatase showed higher level than base level after anesthesia and postoperatively in clinical work. Liver biopsy revealed mild to moderate histopathologic changes in the form of fatty infiltration associated with focal steatosis. However, the experimental study showed marked and significant higher levels of serum hepatic transaminase and reduction of alkaline phosphatase level. Liver biopsy showed marked ballooning degenerative massive venous congestion and marked lymphatic infiltration

role of ultrasound and computerized tomography in the diagnosis of thyroid swellings

This work aimed to assess the value of ultrasonography and computerized tomography as guidance to the management of different thyroid disease. In this study, 36 cases of suspected thyroid swellings were evaluated by ultrasound [US] and computed tomograph [CT] and the value of these techniques was discussed. Ultrasonography is generally a safe method of examination which permits an excellent visualization of the thyroid parenchyma and anatomy. It is widely used for evaluation of thyroid nodules and detection of small nodules. It also can define the exact number and the nature of focal lesions whether solid or cystic. Computed tomography offers excellent resolution of the thyroid relative to other soft tissue structures in the lower neck. It can demonstrate the entire neck and chest and readily show retrosternal extension of a goiter, airway compression and displacement of the trachea. Lymph node enlargement and infiltration of the surrounding structures in cases of malignant tumors can be also detected

Testicular swellings simulating malignancy. Clinical pitfalls, sonographic and histopathological correlation

The final diagnosis of twenty-eight consecutive male patients presented with unilateral testicular swelling, underwent inguinal orchiectomy due to suspected testicular malignancy was correlated with the results of the clinical and sonographic examinations. A high index of suspicion arose primarily from the patients history, clinical examination of the swelling and its appearance on scrotal ultrasonography. Histopathological examination proved the existence of testicular malignancy in 2 cases [7.1%]. The final diagnosis of the remaining 26 cases, based on histopathological examination, was tuberculosis in one case [3.6%], testicular infarction in 2 cases [7.1%], neglected torsion in 6 cases [21.4%], filariasis in one case [3.6%], chronic nonspecific orchitis in 9 cases [32.1%] and granulomatous orchitis in 7 cases [25%]. All were found to simulate malignant tumors either in their clinical presentation, local examination or ultrasonographic appearance. Benign testicular swellings simulating malignancy are not rare and hence differential diagnosis of testicular tumors should be expanded to include chronic and granulomatous orchitis, testicular infarction, neglected torsion as well as tuberculosis and filariasis. The decision of orchiectomy should be properly judged in view of the under-estimated incidence of benign swellings simulating malignancy

Primary tension - free epigastric hernioplasty: procedure and outcome

Between January 1992 and May 1998, we operated upon 110 patients with large epigastric hernias [3cms or more] performing a primary pure prosthetic tension-free repair using the onlay polypropylene mesh graft technique, aiming to reduce the expected high recurrence rate after other repairs [1,4]. This group is retrospectively reviewed. There were 77.3% females and 22.7% males. Only elective repairs were included. All recurrent cases, the pediatric age group and those with ascites were not included. 7 patients [6.4%] has other types of hernia while 13 [11.8%] had more than one epigastric hernia. 8 patients [7.3%] presented with diastases [divarication] of recti in addition to their hernias. No perioperative mortality. Removal of the mesh, mesh extrusion or deep mesh infection did not occur in any case. Recurrence rate was 2.7% [3 cases] and was attributed either to emergence of a new hernia [in 2 cases] or to a correctable technical error [in one case]. Total complication rate was 18% while, complication rate related to mesh application was 10.7%. All complications were not serious and easily controlled as they necessitated minor surgical reintervention in only 4.5% of cases. It is to be concluded that the results are gratifying and the technique used is simple, durable and has a few and easily treatable complications. So, we recommend this repair as the primary repair of all epigastric hernias 3 cm or more to reduce the high recurrence rates noticed with other repairs

Laparoscopic vagotomy in treatment of chronic duodenal ulcer [Posterior truncal vagotomy associated with anterior highly selective vagotomy]

To evaluate the safety of laparoscopic vagotomy this study included 20 patients with chronic duodenal ulcer, admitted in Al-Zahraa university hospital in the period between 1994-1997. Preoperatively, full history, clinical examination upper gastrointestinal endoscopy, abdominal ultrasonography and barium meal were done to all patients. Laparoscopic posterior truncal vagotomy associated with anterior highly selective vagotomy was done to all patients and any operative or postoperative complications were recorded. Postoperatively clinical evaluation and endoscopy were repeated to compare with the preoperative data and to assess ulcer healing. 90 to 180 minutes [mean 135 mm.]. Intraoperatively there was minimal bleeding in 2 cases and was controlled by diathermy and clips, two cases of arrthymia and one case of hypercapnoea improved spontaneously after temporal desufflation of co2. Postoperatively scapular pain, diffuse abdominal pain and mild fever were noticed in 6,2 and 2 patients respectively. Postoperative stay in the hospital was ranged from one to 5 days [mean 3 days]. Two patients were still complaining of dyspepsia and were improved by medical treatment. Six months follow up by endoscopy revealed that 19 cases were completely free and one case still had an ulcer which also was improved by medical treatment. One patient developed a very small hernia at the site of laparoscopic port above the umbilicus. However laparoscopic vagotomy is a new promising, minimally invasive technique. Its simplicity, safety, efficacy, minimal scarring and early mobilization support its wider use, but it will be necessary to validate this initial experience with a large number of patients and adequate long term follow up. So we concluded that laparoscopic vagotomy should not be developed so as to avoid or be contrary to the established principles of open surgery, but rather it should be designed as a continuation of classical surgery with new and different techniques

role of colour doppler sonography in the differential diagnosis of breast lesions [in correlation with Mammography, conventional ultrasonography and histopathology]

To evalute the role of colour doppler sonography [CDS] in the differential diagnosis of breast lesions prospective study of 104 patients who underwent breast imaging diagnostic techniques from January 1995 to December 1997 was done. A good history and clinical examination were conducted to all patients. Mammography and conventional ultrasonography were done firstly as a preliminary test, then colour doppler sonography was done to all patients for examination of all lesions detected by mammography and/or ultrasonography and completed by examination of the whole diseased breast and the contralateral breast especially the corrosponding area to the lesion as a control. All the detected breast lesions were excised surgically and their pathological results were obtained and proved that 38 lesions were benign while 66 ones were malignant. Mammography showed an accuracy of 84.2% for benign and 83.4 for malignant lesions with a 6% false positive and 3% false negative. Ultrasonography showed an accuracy of 78.9% for benign and 74.2% for malignant lesions with a 7.6% false positive and 10.5% false negative. Colour doppler sonography showed an accuracy of 76.3 for benign and 77.3% for malignant lesions with a 3% false positive and 5.3% fasle negative. Malignant lesions were characteristically more vascular than the benign ones because they stimulate the growth of new blood vessels by secreting angiogenesis factors. Most malignant lesions had more than 3 blood vessels either within the lesion or at its periphery while the benign ones even the largest had no more than 3 vessels. Malignant vessels are usually tortuous, larger, and occur away from the site of normal vessels. The maximum velocity of blood flow was much higher in malignant lesions [mean 31.2 cm/sec] than benign ones [mean 18.9 cm/sec]. Systolic/diastolic [S/D] ratio and resistance index [RI] of the flowing blood were estimated for all lesions and were non specific in all values. We concluded that colour doppler sonography is a new promising technique, non invasive, fast, easy and safe. Its of great value in differential diagnosis of breast lesions and helps in diagnosis of their local and distant extention to lymph nodes. A triple imaging technique [combined use of mammography, conventional ultrasonography and colour doppler sonography is considered an ideal pathway in differential diagnosis of breast lesions, with an accuracy nearly to 100%, helps to avoid the false positive and negative results and reduces the number of unnecessary biopsies. It can be used as a routin procedure in the programs of screening, early detection and diagnosis of breast lesions

Is it worthy to do CT to diagnose acute appendicitis

20 patients have been evaluated by CT, if they have appendicitis either proximal or distal. the changed occurred in CT has been documented by many radiologist. Our purpose is to find, is it worthy to do CT to diagnose appendicitis in Egypt. Appendicitis historically has been diagnosed clinically, with only occastional use of diagnostic imaging. Reported rates of negative findings at diagnostic laparotomy in patients diagnosed clinically range between 6.5% and 45% [average, 20%] [1-3]. Reported clinical false - negative ranges between 7% and 33% [average, 20%] [4.5] when clinical impression alone was relied on for diagnosis, a normal appendix was removed in approximately every fifth patient who underwent appendecetomy and the diagnosis was over looked in every fifth patient who actually has appendicitis but was clinically evaluated and sent home

Diagnostic value of CT in pancreatic carcinoma a retrospective study

Abdominal CT scans for 15 patients proved to have carcinoma of the pancreas were revised. The main primary CT features were, the presence of a mass lesion and assocaited dilated common bile duct and/or pancreatic ducts. Secondary features of malignancy were surface irregularity, organ invasion, lymph node enlargement and liver deposits. CT is valuable in diagnosis of the presence of the tumour, its site and size and staging of pancreatic carcinoma. Also CT helps in tumour resection after demonstrating its size

Diagnostic aspects of renal masses a retrospective study

Imaging diagnostic modalities as ultrasonography and computed tomography beside the conventional urographic procedures were used to study 15 different mass lesions. The value of those different diagnostic modalities was determined with their accuracy and relative merits