Tibial corticotomy and periosteal elevation for chronic critical lower limb ischaemia

Estimating procedure's safety, efficiency, efficacy and cost/benefit. Thirty six patients were enrolled. Preoperative demographic data, ankle systolic pressure, and magnetic resonance angiography were obtained. Early results [1st month] included skin perfusion and pain, late results involved wound healing, pain, Kelker score, procedure morbidity, patient satisfaction and quality of life. Mean age SD was 68.03 5.5, males were 23[63.9%], twenty [55.6%] patients had ankle systolic pressure 50 mmHg and 29 [80.5%] with infrainguinal disease. Within the 1st month; skin perfusion and rest pain improved in 91.7%, 86.1%, patients respectively. Magnetic resonance angiography at the 2nd month declared vascular response for all patients. By the end of 1st year 34 [94.4%] patients achieved complete wound healing, also rest pain and claudication relief occurred in 86.1% and 55.6% patients, with 20 [55.6%] patients had excellent score. Procedure morbidity was [17.7%]. Satisfaction measures at six and twelfth months were "mean SD" 7.1, 1.3, 8.7, 1.7 respectively. Twelfth month quality of life improved [overall score P = 0.05, mental health scale < 0.05 and pain/anxiety domain P < 0.001]. The procedure represents an invaluable tool to be evaluated in randomized study

Rubber band ligation for 550 patients of symptomatic haemorrhoids out of 2200 patients retrospective study

This retrospective study was conducted to elucidate the results of the treatment for symptomatic haemorrhoids using rubber band ligation [RBL] method. Method: a retrospective study for 550 patients who came to the colorectal unit from June 1998 to June 2006, data was retrieved from archived files. Forty four patients with haemorrhoid had liver cirrhosis.RBL was performed using the Mc Gown applicator on an outpatients basis. The patients were asked to return to out-patient clinic for follow up at 2 week, 1, 6, months and through telephone call every 6 month for 2 years]. After RBL 496 patients [90.18%] were cured with no difference in outcome for first, second or third degree haemorrhoids [P value = 0.31]. symptomatic recurrence was detected in 16.03% after 2 years then repeated RBL or surgery were done for them. A total of 88 patients [16%] had 155 complications from RBL which required no hospitalization. Complications were registered; pain in 10.37%, rectal bleeding in 8.36% and vaso-vagal symptoms in 7.81%. RBL is a safe and successful method for treating symptomatic haemorrhoids, even in cirrhotic patients

Bacterial tranlocation in an experimental intestinal obstruction model. C-reactive protein reliability?

Bacterial translocation occurs in preseptic conditions such as intestinal obstruction. CRP is a marker of ischaemia. 45 albino male rats were divided into 3 groups [15 each]]. GI control;, GII simple intestinal-obstruction and GIII strangulated obstruction. Outcome measures were: [1] bacteriologic count and typing for intestinal contents, intestinal wall, liver, mesenteric lymph nodes and blood [cardiac and portal] [2] histopathologic: mucosal injury score, inflammatory cell infiltrate in the wall, MLN, liver, [3] biochemical: serum CRP, IL-10, mucosal stress pattern [glutathione peroxidase malonyldialdhyde tissue level]. [1] Intestinal obstruction associates BT precursors [bact-overgrowth, with mucosal-acidosis, immuno-incomptence], [2] bacterial translocation [frequency and density] was found higher in strangulated I.O that was mainly enteric [aerobic and anaerobic] and mostly E.coli, [3] the pathogen commonality supports the gut origin hypothesis but the systemic inflammatory response goes with the cytokine generating one. [4] The CRP median values for GI, II, III were 0.5, 6.9, 8.5 mg/L, for BT+ve 8 mg/L and 0.75 mg/L for BT-ve rats. Bacterial translocation occurs bi-directional [systemic-portal] in intestinal obstruction and the resultant inflammatory response pathogenesis is mostly 3 hit models. CRP is a reliable marker of BT, BT density and vascular compromise during I.O

Randomized, clinical trial of ligasure haemorhoidectomy versus conventional "ferguson" haemorhoidectomy

To compare outcome of Ligasure and Ferguson" haemorhoidectomy. Eighty patients with grade III and IV haemorhoids were prospectively randomized and underwent either Ligasureor "Ferguson" haemorhoidectomy. We documented preoperative data, perioperative, [operative time and blood loss], postoperative, [pain score, analgesia, morbidity, hospital stay, healing time, anorectal manometery and patient satisfaction over 6 months]. Ligasure group achieved a significant reduction in operative time, blood loss [each, P=0.001], pain score, analgesics at 1st, 3rd, 7th day, 2nd week [all, P<0.05], hospital stay and healing time [each, P<0.05]. Postoperative morbidity between both groups was significant. Manometeric changes [postoperative versus preoperative] were insignificant in Ligasure group [P>0.05], but in conventional group postoperative pressures were lower, resting [P,0.0001], squeeze [P,0.001]. Also better 3rd month satisfaction was noticed in Ligasure group, p, 0.03. Ligasure haemorhoidectomy is superior to conventional haemorhoidectomy. Ligasure patients gain short term benefits: Reduced postoperative pain, wound healing time and better satisfaction. Cost remains the most important point against LVSS

Role of octreotide in control of lymphorrhea after axillary node dissection in mastectomy operations - a randomized controlled study

Aim: Lymphorrhea and seroma formation are disabling and serious complications of axillary lymphadenectomy. The role of octreotide in control of post axillary dissection lymphorrhea will be assessed in this study

Methods: Fifty female patients with cancer breast of different stages were subjected for modified radical mastectomy and divided into two groups; the first group was given octreotide [Sandostatin, Novartis Pharma AG, Basie, Switzerland] 0.1 mg subcutaneous 18 hours for 7 days, the other group was the control group. Both groups were evaluated for amount and duration of lymphorrhea as well as infection and hematoma formation

Results: A significant difference in the amount and duration of lymphorrhea between the two groups was observed [P = 0.0003]. In the first 8 days, the mean amount of lymphorrhea was 145.0 +/- 45.8 cc per day and mean duration of drainage was 27.0 +/- 7.59 days in control group. In the treatment group, the mean amount of lymphorrhea was 104.0 +/- 29 cc per day and the mean duration of drainage was 12.7 +/- 6.74 days

Conclusion: Octreotide could be used successfully for control of post-axillary lymphadenectomy lymphorrhea and this may lower the incidence of lymphedema and lymphosarcoma

Evolution of colorectal cancer in schistosomiasis

Aim: To define the clinico-pathologic character of schistosomiasis mansoni associated colorectal cancer [S.CRC] and the possible carcinogenic relation of Schistosoma mansoni [S.M]

Methods: This study included 176 patients with colorectal cancer associated with S.M. Their clinical database and surgical pathology sheets were documented with the detection of S.M on stool analysis, serologic tests, pathologic associated lesions and tumor P53 protein expression using immuno-cytochemical assay

Results: Sixty eight patients [40%] with S.CRC were below 40 years with male predominance [1.8 - 1], distal CRC predominance in 109 patients [62%], mucinous type in 58 patients [33%], higher grades II, III in patients [79%], with significant angio-invasion in 50 patients [30%], lymph vessels invasion in 50 patients [35%] and perineural invasion in 17 patients [10%], associates with poor immune response in 8 patients [5%], preceded with schistosomal lesions especially in patients with schistosomal colitis >/= 10 years, associates with TP53 in 114 cases [65%] and presented at advanced stages in 99 cases [56%] with only hepatic metastasis in 28 cases [90%]

Conclusion: S.CRC is a special clinical entity that has all pathologic pattern, bad biologic behavior and the SM is implicated in SCRC progression

Early jejunal tube feeding after repair of congenital tracheo-esophageal fistula

The role of postoperative enteral feeding has been well documented. The objective of this study was to assess the benefits of early feeding via a transgastric jejunal tube after primary repair of congenital esophageal atresia [EA] with tracheo-esophageal fistula [TEF]. Thirty patients were treated at Mansoura University Children's Hospital during the period from July 2002 and January 2005. Following thoracotomy and primary esophageal anastomosis, Stamm's gastrostomy was constructed, through which a jejunal tube was passed. Twenty four patients survived, six cases died. Four patients developed esophageal leaks, which were treated conservatively, one of them developed anastomotic stricture later and another developed a recurrent fistula. We observed improved infant's weight profile and increases IL-12 levels. Diminished glutathione peroxidase levels were detected postoperatively. Early enteral feeding improves the survival, decreases the morbidity, maintains the body weight and the hydroelectrolytic equilibrium and builds up the immunologic response

Utility of preoperative serum carcinoemberyonic antigen in colorectal cancer patients

Background and Aim: the usefulness of preoperative Carcinoembryonic antigen [CEA] in colorectal cancer [CRC] remains unsettled as regards its role in management and follow up of CRC patients. Efficacy of basal CEA in the diagnosis, prognosis, follow up and therapy of CRC patients will be assessed in this study

Patients and Methods: 200 CRC patients and 100 persons as a healthy control were included in the study. Basal CEA was done before resection. Postoperative Dukes' staging was adopted. Routine follow up and CEA estimation were done

Results: the mean CEA in CRC patients [17.3 ng% +/- 1.67] was significantly higher than control [3.41 ng% +/- 1.1]. A significant association between mean basal CEA and Dukes' classes was evident [it was 7.8, 12.7, 25.8 ng% for Dukes' A, B, C]. The validity of basal CEA in primary CRC diagnosis was highly positive, with higher efficacy in advanced disease detection and negative exclusion power for DFS prediction. Basal CEA was a discriminant factor in prognosis. DFT and DFS were higher in patients with CEA

Conclusion: the preoperative CEA identifies subsets with favourable, indolent and uneven biological behaviour [ 15 ng %]. With conventional staging, it forms strong prognostic tool that supplies practice guideline for follow up and therapy