Laparoscopic heller cardiomyotomy for esophageal achalasia. Initial results

Laparoscopic Heller cardiomyotomy is replacing open surgery for esophageal achalasia. The aim of the present study was to evaluate the initial results of laparoscopic Heller cardiomyotomy. Sixteen patients [9 women and 7 men, mean age of 45 +/- 11.3 years and mean duration of symptoms of 5.2 +/- 4.5 years], who fulfilled the clinical, radiographic, endoscopic and manometric criteria for a diagnosis of esophageal achalasia, underwent laparoscopic myotomy with Dor fundoplication. Follow up to one year was complete in 14 patients. Laparoscopic Heller myotomy with Dor fundoplication is a highly effective and safe treatment for achalasia and preventing simultaneous gastroesophageal reflux. The outcome of the procedure is related to the preoperative stage of the disease on the esophagogram

Surgical and pathological study of infantile hypertrophic pyloric stenosis in our locality

This study has included 80 newborns and infants [62 males and 18 females] suffering from infantile hypertrophic pyloric stenosis [IHPS]. The main presentation was repeated resistant vomiting, loss of weight, constipation or epigastric distention and the age of presentation was one week to five months. Fifty-eight out of 80 infants with IHPS [45 males and 13 females] were subjected to full history, thorough clinical examination and investigation in the form of pediatric endoscopy and gastrografin. From all patients, biopsy was taken from the hypertrophic layer of the pyloric antrum. The pattern of labeling in the myenteric nerve plexus layer is normal. Histochemical study revealed a marked reduction in fibers expressing nitric oxide synthase in the hypertrophic circular muscle, however, nitric oxide synthase was present in the myenteric plexus. The results have shown that the percentage of newborn with IHPS to live birth in the studied locality was 3/1000. In this study, 90% of patients had nitric oxide synthase loss in their histochemical studies of pyloric circular muscle. The management of such patients with surgical myotomy was file best procedure, while, laparoscopic or endoscopic dilatations are sill unsatisfactory to be the procedure of choice

Comparative study of non surgical treatment of hemorrhoids

This study included 90 patients [34 males and 56 females], their ages ranged from 18 to 50 years [with a mean age of 37 years] and were selected from patients complaining of hemorrhoids examined with first degree piles [46 patients] and second degree piles [44 patients]. All of them were subjected to full history, clinical examination and investigation in the form of laboratory study and anoscope. They were classified into three groups: In group A [n = 30], 19 with first degree piles and 11 with second degree piles whom were treated by laser coagulation. Their results were satisfactory in 26 patients [19 patients with first degree and 7 patients with second degree piles]. In group B [n = 30], 9 patients with first degree and 21 with second degree piles. The results showed that non-surgical treatment of hemorrhoids was simple and safe. The optimal method depends upon the degree of piles. As regards first degree hemorrhoids, laser coagulation was the optimal method, followed by sclerotherapy, while for the second degree, the method of choice was rubber b and s ligation of hemorrhoids

Surgical and computed tomography evaluation of soft tissur sarcomas

The current trend towards limb-sparing surgery in patients with soft tissue sarcomas increased the need for accurate preoperative assessment of the primary tumor. Tumor site, extent and relationship to the adjacent bone and neurovascular structures were evaluated to determine whether adequate radical surgery is feasible or more limited excision as a part of multimodality treatment is appropriate. Preoperative computed tomography [CT] was compared with operative findings in 18 patients with soft tissue sarcomas. CT prediction of muscle group involvement by the tumor was correct in 88.9% and that of major artery or vein invasion was correct in 83.3% and 94%, respectively. Assessment of the tumor relationship to major peripheral nerve was accurate for thigh sarcomas but was not possible in upper limb tumors. Although CT confirmed frank bony involvement in two patients, it failed to distinguish between tumors closely adjacent to periosteal and those with periosteal invasion. Detection of residual or recurrent tumor nodules by CT is less reliable. CT is the most useful and accurate method before surgical intervention

Retrospective study of breast abscess in our hospital

This study was carried out on 100 children with idiopathic steroid insensitive nephrotic syndrome aged 3 to 16 years. They were 61 males and 39 females. Cases with the secondary forms of nephrotic syndrome and those who were steroid sensitive were excluded from the study. After a thorough history and clinical examination, all cases were subjected to laboratory investigations including complete urine analysis, 24 hr urinary protein estimation, serum creatinine. Plasma proteins, serum albumin, total serum cholesterol, C3, C4, and ultrasound - guided renal biopsy where kidney tissues were examined using light and immunofluorescence microscopy. Our results showed the presence of the minimal change nephrotic syndrome in 62 percent of cases [36 patients with nil disease and 26 patients with other minimal change variants], focal segmental glomerulosclerosis [FSGS] in 25 percent, diffuse mesangial proliferation in 5 percent, membranous nephropathy in 4 percent and membranoproliferative glomerulonephritis in 4 percent of cases. Patients with MCNS had significantly younger age of onset, less frequent hypertension, and lower level of serum creatinine compared to those with other renal histopathology [P < 0.01, < 0.05 and < 0.01, respectively]. Steroid resistance was significantly more frequent than steroid dependence among children with renal histopathology other than MCNS. Patients with steroid resistant nephrotic syndrome had significantly older age of onset, significantly higher frequency of hypertension, significantly higher serum creatinine, and significantly more frequent heavy proteinuria when compared with those having frequently relapsing steroid dependent nephrotic syndrome [P < 0.05, < 0.01, < 0.01, and < 0.05, respectively]

Surgical and epidemiological study of intussusception in first and second decade life

Twenty cases of intussusception in children between the ages of 5 and 15 years were compared with intussusception in infancy and early childhood. They accounted for 18.5 percent of all 108 children treated for intussusception in El Minia University hospitals from 1992 to 1996. Diagnosis of intussusception was delayed, probably due to an unusual presentation. Fifty-five per cent had a definite predisposing factor precipitating the intussusception and 45 percent had a small bowel intussusception, which warranted early surgical intervention. In the absence of contraindications no child should be disqualified from an attempt at hydrostatic reduction. After hydrostatic reduction careful follow-up is required to exclude an organic lesion, possibly by a small bowel follow-through meal. Surgery is indicated after hydrostatic reduction in case of chronically recurrent abdominal complaints

Study of the hemostatic effects of ethanolamineoleate in the injection selero therapy for esophageal varices

Changes in coagulation and fibrinolysis were investigated in 20 patients with esophageal varices, who underwent endoscopic injection sclerotherapy [EIS] with 5 percent ethanolamine oleate [EO], by means of serial determination of plasma fibrinopepite A [FPA] and fibrinopepite B beta 15 - 42 [B beta 15 - 42]. One hour after the completion of EIS, the value of FPA was significantly increased to 38.1 +/- 11.1 ng/ml [mean +/- s.e.m.] from a pre-EIS value of 7.1 +/- 1.4 ng/ml [P < 0.01] and it gradually returned to normal range by 48 h after EIS. A very similar change was observed in the value of B beta 15- 42 [P < 0.01]. These observations indicated that EIS provokes transient activation of coagulation and fibrinolysis. In vitro studies, however, revealed that EO inhibits fibrin clot formation because of the Ca[2+] chelating ability of its constituent ethanolamine, although oleate or benzyl alcohol exhibited procoagulant activity in FPA formation in vitro. Nevertheless, an external application of EO or oleate over decapsulized kidney of rat resulted in a significant accumulation of [125]1 labeled fibrin [ogen]. From these results it was suggested that intravascular injection of EO, which exerts an inhibitory effect on coagulation in vitro, activates the local coagulation system. The activation may be accelerated by an acute inflammatory process provoked by oleate, which is supported by such clinical manifestations as mild fever, retrosternal pain leukocytosis and an increase in plasma fibrinogen level which was observed in all during that period

Surgical and pathological study of hirschsprugn's disease treatment by modified Duhamel operation in one stag versus two stages procedure

This work included 19 patients [17 males, 2 females], whose age ranged from 2 to 6 years, selected from Surgical and Pediatric Outpatient Clinics of El-Menia University Hospital in the period from January 1991 to December 1992. The aim of this work was to appraise the modified Duhammel operation which was used in the study with or without preoperative colostomy in patients complaining of Hirschsprung's disease with mild abdominal distention. The postoperative results were promising. Follow up of the patients ranged from 6 to 24 months. This procedure without colostomy shortened the surgical management of such patients and minimized the postoperative period of illness

Sclerotherapy rather than surgery for less rebleeding in cirrhotic patients with variceal bleeding

In the two years period from January 1991 to December 1992, 45 cirrhotic patients [32 males-13 females] with acute variceal bleeding underwent either surgical treatment in the form of non shunting produces [15 patients] or endoscopic injection sclerotherapy [30 patients] at surgical and tropical department of El Minia and El Mansoura University hospitals. We analyzed the clinical records of these patients. The two groups were 1and 2 comparable in regard to clinical condition and liver function, except for the higher rate of child[s] C patients in the sclerotherapy group than in the surgical group. Control of variceal bleeding was attained in 10 of the 15 surgical patients [66.6 percent] and in 26 of 30 [86.6 percent] sclerotherapy patients. Bleeding-recurred in 9 patients of 15 [60 percent] in surgical group and in 6 patients of 30 [20 percent] in the sclerotherapy group. Mortality rate at 30 days and 6 months were 1/15 [6.6 percent], 3/15 [20 percent] in surgical patients and no mortality in the first 30 days and 1/30 [3.3 percent] at 6 months of the sclerotherapy group. Therefore in our patients sclerotherapy led to a fewer rebleeding as compared to other patients who underwent surgical treatment

Diabetic Foot: Surgical and bacteriological study

This work included 42 patients [30 males - 12 females] who came to surgical outpatient clinic in El-Minia and El-Mansoura University Hospitals from March 1991 to Jan. 1993. All patients were complaining of diabetic foot infection. Every patient was recommended for full history, clinical examination and laboratory study including a swab for bacteriological study and antibiotic sensitivity test. Preoperative stabilization of assessment for every patient by controlling of diabetes by insulin administration according to the blood and urine sugar test every 6 hours. We classified our patients into four groups: group [A] included 18 patients [42.8 percent] presented with mild diabetic foot infection for whom we did surgical drainage with good results in 12 patients out of 18 patients [66.6 percent], group [B] were 13 patients [30.9 percent] with suppurative foot infection and tissue destruction, we performed surgical debridement and repeated dressing with halting of infection and healing in 11 patients out of 13 [84.6 percent], group [C] with pripheral vascular affection, we did surgical debridement associated with lumber sympathectomy which gave the best response in our work with good healing in 6 patients out of 7 patients [85.7 percent],group[D] their number were 4 patients [9.7 percent] presented with diabetic gangrene of the foot we performed amputation according to the popliteal pulsation and doplar examination with healing in all patients. The bacteriological results proved poly-microbial infection which necessiatated administration of multi- antimicrobial chemotherapies which supported the different surgical maneuvers. Diabetic foot is one of the difficult cases in its treatment but from our study we found that the early presentation of the diabetic foot infection with good preoperative assessment by controlling the diabetes mellitus and starting the proper antibiotic early with performing multi- surgical maneuvers according to the local presentation and the pripheral vasculature and repeated dressing carried the best outcome with good healing in a short period of time