Conversion of laparoscopic to open cholecystectomy: identification of preoperative risk factors

Introduction: Laparoscopic cholecystectomy has become the standard operative prodedure for cholelithiasis; however, approximately 5% to 15% of patients require conversation to open surgery for various reasons. The issue of this conversion remains unsettled. Conversion exerts adverse effects on operating time, postoperative morbidity, and hospital costs. We aimed in this current study to identify the risk factors that may predict conversion of laparoscopic cholecystectomy to open surgery

Patients and methods: A retrospective analysis of medical records of 143 patients who underwent laparoscopic cholecytectomy, including demographic, ultrasonographic, and operative and postoperative data. Preoperative risk factors affecting conversion to open surgery were identified with statistical analysis

Results: Increased risk of conversion with statistical significance was found in advanced age[OR=12.16], male gender [OR=6.86], obesity [OR=5.22], diabetes [OR=31.5], previous abdominal surgery [OR=8.20], emergency laparoscopic cholecystectomy for acute cholecystitis [OR=9.75] and thickened gallbladder wall on ultrasonographic scanning [OR=7.27]. No significant relation was found between the likelihood of conversion and any of the following: concomitant diseases [cardiovascular diseases or cirrhosis], preoperative ERCP, and preoperative abnormal liver function test results

Conclusion: knowledge of these factors will help the surgeon to counsel and select the patient, arrange the operating schedule, and plane of the duration of convalescence but they were not contraindication for the operating schedule, and plane of the duration of convalescence but they were not contraindication for laparoscopic cholecystectomy

Study of the role of C reactive protein measurement in reducing the rate of negative explorations for acute appendicitis

Appendicectomy for suspected acute appendicitis is a common procedure. The rate of normal appendices unnecessarily removed remains high [15-30%] despite several techniques and investigations used to improue our diagnostic accuracy. Many studies investigated the role of raised C-reactive protein in improving the diagnosis of acute appendicitis with con-jlicting results. This study emphasizes the impact of a normal [rather than raised] serum C-reactive protein in reducing the rate of negative explorations. In a double blind study, blood for the measurement of serum C-reactive protein [CRP] was collected pre-operatively from 156 patients just before going to the operating room for appendicectomy. The histopathology of the 156 appendices were grouped into positive [acute appendicitis] and negative [normal appendix]. White blood count [WBC], CRP and the histopathology findings were correlated. In patients with histopathologically proven acute appendicitis both the WBC count and serum CRP level were significantly raised [P=0.025 and P<0.0001 respectively]. Serum CRP level was normal in 26 out of 30 negative explorations [normal appendix on histopathology]. The specificity and sensitivity of serum CRP was 86.6% and 93.6% respectively. A normal preoperative serum CRP measurement in patients with suspected acute appendicitis is most likely associated with a normal appendix Deferring surgery in this group of patients would probably reduce the rate of unnecessary appendicectomies

Study of the deleterious effect of varicocele on both testicular volume and consistency matched with spermiogram and FSH

Male subfertility is a very common health problem facing urologist, dermatologist and general surgeons every now and then. In addition to its importance as a health problem, it presents also a big social problem hence the great deal for early detection and treatment. Varicocele is a common treatable cause of male subfertility. It is more frequent and larger in taller men and usually first appear at the time of puberty [1]. Testes associated with large varicoceles are smaller and may be soft with more severe disturbances of spermatogenesis [2]. Men with varicoceles have poorer semen quality than those without varicoceles indicating adverse effects of varicocele on testis [3]. In this study we investigate 32 infertile patients with different grades of varicocele for evaluation of the effect of varicocele on testicular volume, consistency and seminogram the results showed epsilateral reduction of testicular volume and consistency plus poor seminogram parameters. Another 10 normal fertile volunteers were subjected to the same investigation and showed significant difference between both groups as regards to testicular volume, consistency and seminogram variables

Two-step eragile X-screening programme in mentally retarded males

The goal of the present two-step screening program [clinical selection followed by cytogenetic and molecular studies] is to identify affected males without adding too much load on the cytogenetic laboratory, and to inform their families about the diagnosis so that female relatives at risk can consider this information in their family planning and reproductive options. A total of 306 adult instituted males with mental retardation of unknown aetiology were screened for 10 clinical traits associated with the fragile X [fra[X]]syndrome, including physical features, behaviour and family history of mental retardation. Sixty-one [19.9%] males with a clinical score of > 5 were selected for cytogenetic and molecular analyses, thereby reducing the workload on the laboratory by 81.1%. Eleven patients [18%] were positive cytogenetically and confirmed by Southern blotting, so giving a 3.6% overall incidence of the fra[X] syndrome among the instituted males with mental retardation. The high clinical score increased the likelihood of a positive diagnosis [15% of the fragile X cases had a clinical score of 5-7, and 66% had a score of 8-10]. The expression of the fragile site at Xq27.3 ranged between 7%-34%, with a mean of 19.5%. Two patients had constitutional chromosomal abnormalities. This two-step screening program is cost effective and suitable for screening a large population at risk, with the advantage of reducing the workload on the laboratory without apparently impairing the ability to find patients with the fra[X] syndrome

Antibiotic sensitivity of isolates of Pseudomonas aeruginosa in Buraidah, Saudi Arabia.

A study was carried out to determine the pattern of in vitro antibiotic sensitivity of a cross section of the isolates of Pseudomonas aeruginosa recovered from diverse clinical sources during a one year period. One hundred and eighty-six isolates were investigated by disc diffusion method employing multidiscs. Majority of the isolates were sensitive to amikacin (89.7%), tobramycin (75.81%), norfloxacin (68.48%), piperacillin (68.25%), and ceftazidime (58.81%). Other antibiotics were effective for a lesser number of isolates. A few isolates were simultaneously resistant to several antibiotics, viz. gentamicin, carbenicillin, tobramycin, ceftazidime and augmentin. The significance of the findings is discussed.

Maxillary sinus radiographs in children with respiratory symptoms

The present study was conducted on 100 children [51 boys and 49 girls] aged from 1-11 years presenting with upper respiratory tract complications at the outpatient clinic of Alexandria University Children's Hospital. Complete opacity of the sinuses was found in 67% of children, moderate opacity in 15%, mild opacity in 8% and concentrin membrane thickening in 6%. Only 13% of children had their maxillary sinus radiograms clear

Biochemical study of children with grand mal epilepsy treated with either carbamazepine or valproate sodium

The present study was conducted on 40 children with grand mal epilepsy attending the Pediatric Neurology Clinic of El-Shatby Children's Hospital [Alexandria]. They were divided into two groups Group [A]: those patients receiving valproate sodium as the sole drug therapy and Group [B]: those patients receiving carbamazepine as the sole drug therapy. Twenty patients from each group were investigated at three stages: Before starting treatment, after four weeks of treatment and after control of the attacks. Twenty healthy, age-matched children were studied as controls. Serum and CSF electrolytes,liver transaminases, alkaline phosphatase and lactic dehydrogenase were studied

Histopathological and histochemical studies on jejunal mucosa in diarrheal disease in infancy and early childhood

The jejunal mucosa of 90% of well nourished children with enteral diarrhea [30 patients] showed definite histopathological changes which varied from mild to severe. The severity of mucosal changes was neither related to the causative organism or degree of dehydration. The jejunal mucosa of 13 marasmic children with enteral diarrhea showed moderate to severe changes while all kwashiorkor patients [7] with diarrhea showed severe changes. Lactase activity as well as fat absorption were positively correlated with the severity of the mucosal changes. Recovery of histopathological changes was slower in malnourished patients

Management of recent tongue type calcaneal fractures by axial fixation

Intra-articular fractures of the os-calcis comprise 75% of all calcaneal fractures. Different methods for the treatment of such fractures have been described, but the prognosis remained guarded. Axial fixation as described by Essex-Lopresti in the hands of experienced orthopaedic surgeons yields encouraging results. Results of treatment have been found to be inversely influenced by the delay in the start of treatment and the comminution present at the fracture site. The degree of restoration of the tuber joint angle affected the end result favourably

Hodgkin's disease: cytochemical studies of deoxyribonucleic acid [DNA] and glucose 6-phosphate dehydrogenase [C6PD] after cyclopho-sphamide [endoxan] treatment

Deoxyribonucleic acid [DNA] and glucose 6- phosphate dehydrcgenase [G6PD] enzyme were studied in human normal lymph node and Hodgk in's disease cells. It has been observed that DNA was present in chromatin materials, whereas [G6P D] was present as granules distributed uniformaly in the cytoplasm. Under the effect of endoxan, a decreased activity of DNA and G6PD has been noticed. This could be explained on the basis that alkylation of phosphate groups was the main point of attack on the DNA which result in the breakdown of the DNA molecule

Cytochemistry of ribonucleic acid [RNA] in murine liver cells infected with schistosoma mansoni

The changes in the concentration of ribonucleic acid [RNA] were studied in liver cells of mouse after infestation with the cercariae of Schistosoma mansoni. It was found, that there is a fluctuation in the intensity of basophilia in parenchymal cells depending on the interval of schistosomal infection. Using the methyl green-pyronin stain, it was found that RNA is localized in the nucleolus and cytoplasm of both normal and infected hepatic cells of mouse. Pronnounced changes in the concentration of RNA were observed in hepatic cells after 50, 75, and 100 days from the beginning of schistosomal infestation, These changes include a decrease in the intensity of basophilia in 50 days post infection and its increase in 75 and 100 days of infection respectively