First record of schistosoma intercalatum in upper Egypt; an abnormal locality and presentation simulating lymphoma

Schistosomiasis due to Schistosoma intercalatum is highly restricted to the Western regions of equatorial Africa. Its main clinical manifestation is rectal bleeding. A case is described of a 14 year old boy living in Upper Egypt who was presented to General Surgery Department, Sohag University Hospital, South Valley University, complaining of vague abdominal pain, rectal bleeding, multiple abdominal masses and splenomegaly. Laparotomy revealed moderate splenomegaly, multiple hepatic focal lesions, mesenteric and paracolic lymphadenopathy, and multiple nonobstructing colonic masses. Splenectomy was done, multiple lymph node biopsies and wedge liver biopsy were taken. Endoscopic rectal biopsy was also done. The primary diagnosis was abdominal lymphoma with hepatic and splenic involvement. Histopathological examinations of these biopsies revealed congested spleen and multiple bilharzial granulomata effacing the whole lymph nodal architecture, infiterating the portal tracts of the liver, and surrounding terminally spined-eggs of the rectal wall. Staining of the rectal specimen by Modified Ziehl-Neelsen showed red coloration of the egg-shell characteristic of S. intercalatum. We here announce the first record of S. intercalatum in Upper Egypt, Sohag Governorate and also report all interesting unusual presentation of S. intercalatum schistosomiasis by abdominal lymph node enlargement simulating lymphoma

Outcome of parathyroidectomy for primary hyperparathyroidism in Sohag university hospital in 5 years: retrospective study

Primary hyperparathyroidism [PHPT] is a common endocrine disease treated very effectively by surgery. It is the commonest cause of hypercalcaemia. The majority of cases are caused by adenoma [80% to 85%], whereas approximately 15% have diffuse hyperplasia of all four parathyroidglands. Rarely [1%], parathyroid carcinoma is the cause of hyperparathyroidism. Parathyroid diseases has not been investigated in our community before. This study had been conducted to analyze the outcome of surgical treatment of [PHPT], as regard the success rate, complications and recurrence. Between May 1999 and July 2004, 14 consecutive patients with [PHPT], who had been submitted to surgery in Sohag University Hospital were enrolled in this study. Analysis of clinical presentations, laboratory and imaging studies, surgical approach, intraoperative findings, and outcome assessment m terms of success rate, complications had been done. A total number of 14 patients diagnosed as PHPT, 10 were women and 4 were men. Their age ranged from 25-51 years, with a mean age of 41.2 +/- 6.9 years. Bone affection was the dominant presenting feature [79%]. All cases showed high level of serum calcium [mean 3.13 +/- 0.42 mmol/L] and parathormone hormone [mean 787.4 +/- 256.6 pg/mL]. Accuracy of ultratsound scanning of the neck was 71% in localization of parathyroid lesions, while that of CT and Sestamibi scan were 85% and 87.5% respectively. A single parathyroid adenoma was the commonest lesion [86%]. All patients, but two, had been followed up from 6 months to 18 months with a mean of 11 +/- 4 months. The success rate was achieved in all but one [92.9%], who had been found to be an ectopic parathyroid adenoma in the superior mediastinum. There was one case who died due to the morbid general medical condition. Postoperative temporary hypocalcaemia was observed in two cases. No permanent injury to RLN was reported in our cases. Parathyroid disease is not uncommon problem in our locality. Surgery of PHPT is a very successful operation with minimal morbidity. Early discovery of PHPT gives the best chance of cure and avoid disastrous complications of this disease

Diverticular disease; is it an underestimated problem in our locality?

Background: Colonic diverticular disease is common in Western countries. It is often asymptomatic; only 10-26% of patients will progress to diverticulitis with symptoms ranging from minor complaints to life threatening sequelae

Objectives: To recognize the pattern of presentation, diagnosis, treatment and. outcome of diverticular disease in our community

Methods: From January 1996 to June 2004, 19 patients with diverticular disease were retrospectively studied

Results: Twelve patients were males and 7 females. Mean age was 5912.9 [range 47.5-71] years. Fifteen patients [90%] presented with left lower quadrant pain, bleeding per rectum in 5 patients [26.3%], tender left lower quadrant mass in 3 patients [15.8%] and acute abdomen in 3 patients [15.8%]. Diagnosis was done using ultrasonography, colonoscopy enema and CT. Conservative treatment was successful in 12 patients [63.2%]. Seven patients [36.8%] required surgery Hartmann’s procedure was done in 5 patients [71.4%], and one-stage colonic resection was done in 2 patients [28.6%]Postoperative complications were encountered in 2 patients [28.6%]. No reported mortality

Conclusion: Diverticular disease is not uncommon in our locality, and requires high index of suspicion and multidisciplinary approach for proper diagnosis and management. The majority of cases are treated conservatively but surgery remains safe in some patients. Resection and primary anastomosis has an acceptable morbidity and mortality. For high-risk patientsr Hartmann's procedure remains a gold standard

Management of gastroesophgeal reflux induced bronchial asthma

Gastroesophageal reflux disease [GERD] induced asthma is a common clinical disorder. The aim of this study was to evaluate the effect of both medical and surgical therapy of GERD in the management of GERD induced asthma. Forty patients who had a diagnosis of chronic asthma as well as symptoms suggestive of GERD, were subjected to pulmonary function tests and tests for GERD. They were first given medical therapy for both bronchial asthma and GERD. Twenty-two patients, who continued medical treatment, showed good response to medical therapy in the form of decreased symptom and frequency of asthma and reflux symptoms as well as improvement in the pulmonary function tests [p<0.05]. Fourteen of the remaining 18 patients who refused to continue medical treatment were subjected to surgical correction of GERD in the form of Nissen floppy fundoplication. The other 4 patients refused surgery. Ten patients showed marked clinical improvement in the asthma and GERD symptoms as well as significant improvement in the pulmonary function tests after surgery [p <0.05]. Four patients failed to show improvement of their asthma after surgery. Postoperative complications in the form of chest infection, wound sepsis, burst abdomen were reported in 8 of the patients who have had surgery. Over correction of incompetent cardia was seen in 4 patients and responded well to balloon dilatations. Death attributed to surgical interference was not recorded in this series. This study showed that control of GERD in patients with GERD induced asthma is mandatory and also highlighted that surgical treatment of GERD substantially improves patients with GERD induced asthma when medical therapy could not be maintained and should be considered in patients with GERD induced asthma

Closed hemorrhoidecetomy for treatment of hemorrhoids [with special emphasis on the Jack Knife position]

Many procedures have been devised for the treatment of hemorrhoids. Most of them remove the hemorrhoidal tissue, non deal with the raw area left after removal of the hemorrhoidal tissue leaving it exposed to fecal matter, sweat, friction, causing severe pain and discomfort. Closed hemorrhoidectomy has been advocated by Ferguson and Heaton in 1959 is a trouble free operation. Closed hemorrhoidectomy was done for 50 patients with different degrees of piles except first degree. Another 50 patients operated upon by the classical hemorrhoidectomy described by Millican and Morgan in 1937, leaving the wound open after excision of the hemorrhoidal tissue. This work was done in Sohag University hospital. In the closed group complete closure of the wound with full restoration of the anorectal mucosa and skin was done. The closed hemorrhoidectomy operation provided a significant reduction in the number and severity of the previously known typical postoperative complications of open hemorrhoidectomy operation [pain after surgery and defecation, edema of perianal tissue, bleeding at postoperative period, blood discharge at defecation, urinary retention and dysuria, etc.]. Complete closure of the wound showed healing by primary intention in most patients. Still more impressive is the decrease in the number of cases of bleeding in the first consequent defecation. Follow up of these patients was done post operatively al 1 and 2 weeks and 1 and 2 months. Late complications [anal stenosis, long periods of healing, anal fissure or skin tags] were not recorded in the closed group. This study showed that closed hemorrhoidectomy is an effective and safe operation and has great advantages over the open method, and is suitable for routine hemorrhoidectomy

Sonographic guidance of percutaneous drainage of abscesses and fluid collections as an alternative to surgery

Availability and advances in ultrasound instrumentation have improved the ability of ultrasonic guidance of interventional procedures. In this article we describe our technique of puncture and aspiration followed by percutaneous catheter drainage for 124 cases with 137 abscesses and fluid collections; discovered on abdominal sonographic examination. Defervescence was attributed to reduction of bacterial flora and institution of proper antibiotic treatment based on culturing of the aspirate and sensitivity of the organism; as well as on providing a mean for continuous drainage of the abscess through a catheter Daignostic puncture and aspiration was successful in all cases [100%]. Catheter drainage was curative in 92 of the total number of abscesses and fluid collections [74.1%]. Partial success followed by surgery occured in 19 cases [15.3%]. The technique failed to cure the abseess or the fluid collection in the rest of cases [13 cases-10.4%].Complications occured in 20 cases; 7 majors and 13 minors. The method is recommended for the initial management of abdominal abscesses and fluid collections