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

Comparative study between biofeedback retraining and botulinum neurotoxin in treatment of anismus patients

Anismus is a significant cause of chronic constipation. This study came to revive the results of biofeedback BFB retraining and botulinum toxin A BTX- A injection in treatment of anismus patients. Forty eight patients with history of constipation underwent anorectal manometry, balloon expulsion, defecography, and electromyography. All patients had a non relaxing puoborectalis muscle. The patients were randomized into 2 groups. Group I patients receive biofeedback, two times per week for one month. Group II patients were injected with BTX- A. Follow up was conducted weekly in the first month then monthly for one year. In BFB training group 3 patients quite before the end of sessions with no improvement, initial improvement was recorded in 12 patients [50%] while long term success was recorded in 6 patients [25%]. In BTX-A group, initial improvement recorded in 17 patients [70.83%] with long term improvement in 8 patients [33.3%] There is a significant difference between BTX-A group and BFB group as regarding the initial success, but this significant difference disappeared at the end of follow up. Biofeedback retraining has therapeutic effect on patients suffering from anismus also, BTX-A injection is successful for temporary treatment of anismus and need repeated injection. Initial improvement is better after BTX-A injection

Proximally based versus distally based gluteus muscle flap in treatment of end stage fecal incontinence

To compare proximally based versus distally based gluteus maximus muscle flap transposition in patients with end stage fecal incontinence. Between August 2005 and August 2007, this prospective randomized study was performed on twenty patients with an end stage anal incontinence. They were sixteen men and four women with an age ranging from 7 to 31 years. A proximally based gluteus maximus flap [group III] was carried out in ten patients while, a distally based flap [group I] was done in the other ten. Patients were followed up for 6 - 18 months both subjectively and objectively with evaluation of their incontinence score, anorectal manometry, saline enema test and magnetic resonance imaging [MRI]. Overall, 6/10 patients [60%] in group I and 8/10 patients [80%] in group II were clinically improved with down staging of their incontinence scores from C3 to 0 [P 0.003 and 0.0001 respectively]. This was confirmed by the significant changes in anorectal manometry and saline enema test. MRI done one month postoperatively showed disruption in three patients. Proximally based gluteoplasty appears to be an excellent encirclement procedure that restores voluntary squeeze pressure as well as rectal sensation when compared with unilateral distally based gluteoplasty

Fournier's gangrene: clinical, biochemical, bacteriologic, immunologic study and treatment outcome

Identify Fournier's disease associations, outcome and survival factors. Fournier's gangrene patients [34] were treated between 2003 to 2006. Data were collected about medical history, physical findings, metabolic test, bacteriologic typing, immunologic screening for T cell function, serum IL-2, ICAM-I and gamma IFN with their management. The disease had age range 3-67 years, polymicrobial nature, and low serum albumin [3.3 +/- 0.6mg/dl]. Inadequate T-cell function [18255.3 +/- 1641 CPM] and high ICAM-I, IL-2, gamma IFN [10.5 +/- 0.7, 93.3 +/- 1.6, 131 +/- 2 pg/ml] were detected in Fournier's disease but serum IL-2 was relevant to outcome [P=0.0001]. The survival factors were patients' age [P=0.0001], presentation timing [P=0.001], both disease extent [P=0.0001], septic shock [P=0.01], severe SIRS [P=0.001], serum albumin [P=0.0001] and IL-2. Fournier's disease is consistent with deviated metabolic status and immunologic dissonance, inciting local gangrenous process, these parameters are significant for disease outcome

Concentration of total matrix metalloproteinase-2 in the serum of patients with colorectal cancer

The processes of basement membrane degradation and remodeling of extracellular matrix [ECM] involves proteolytlc enzymes called metalloproteinases. Among the numerous metalloproteinases enzymes of this group the key role is played by matrix metalloproteinase-2 [MMP-2]. The purpose of this study was to evaluate the concentration of soluble MMP-2 in serum of patients with colorectal cancer and the effect of surgical treatment on this parameter in the postoperative period as well as assessment whether MMP-2 serum concentration correlate with clinicopathological variables. We measured, prior to primary surgery and 4 weeks after surgery, the concentrations of MMP-2 in serum samples of 40 patients with colorectal cancer. Also the serum concentration of MMP-2 of 10 healthy volunteers was measured. The measurements were performed with enzyme linked immunosorbent assays [ELISA]. MMP-2 concentrations are higher in cancer patients than control [P < 0.001]. The levels of soluble MMP-2 in serum [median of the control cut-off limit] correlated with Dukes' stage [P = 0.03], grade P=0-04], and lymph node metastasis [P = 0.02]. No statistically significant correlation was found between the circulating MMP-2 and the other clinicopathological factors. Comparing the blood serum concentration of MMP-2 before and after operation reveals a significant decrease after radical surgery. Plasma concentration MMP-2 was correlated with clinical staging in colorectal cancer, and falling to the normal range following curative surgery

Role of MRI with endorectal coil in management of perianal fistula

Aim: the management of fistula in-ano has been based on digital examination and operative findings. This study was conducted to asses the diagnostic accuracy of magnetic resonance imaging [MRI] with endorectal coil in perianal fistula

Patients and Methods: twenty patients with anal fistula were classified into two groups. The first one included those who had primary fistula [10 patients] and the second included those with recurrent fistula [10 patients]. All patients underwent preoperative MR imaging using endorectal coil. The findings were compared to examination under anesthesia [ELIA] and final surgical findings

Results: comparing MRI with operative data [EUA and final surgical results]; in the first group with simple fistula, MR imaging showed additional information than examination under anesthesia in only one patient [10%] and did not diagnose one fistulous tract at all. 111 the second group, MRI detected 8 internal openings correctly and one opening was missed. MRI added information than EUA in 6 patients, its fallacies was noted in 2 patients

Conclusion: MRI with endorectal coil could be very useful and reliable in defining fistula anatomy, assessing relationship with anal sphincter, identifying secondary extensions [particularly horseshoe tracts] and planning surgical strategy

Antibiotic prophylaxis in elective laparoscopic cholecystectomy: a prospective study

Aim: laparoscopic cholecystectomy gives rise to a very complicated issue concerning the use of antimicrobial prophylaxis. The role of antibiotic prophylaxis in elective laparoscopic cholecystectomy and the relation between post-operative septic complication and bile microbiology will be assessed in this study

Patients and methods: 64 patients were included in the study and divided into two groups; group A: [29 patients] received antibiotic prophylaxis [cefotaxime] and group B [35 patients] received 100m1 isotonic saline [placebo]. Bile sampling and culture was taken for all cases and the patients' were followed up for incidence of sepsis where the wounds were swapped and cultured

Results: bile sampling and culture revealed no growth in 41 cases [64.1%] [19 in-group A and 22 in-group B]. Postoperative infection developed in two cases of group A and in three cases of group, B. Incidence of wound infection was significantly related to incidence of GB perforation [p < 0.0001]. Swabbing of infected wounds and collections revealed infecting organisms other than that detected in bile culture except in one case of group B

Conclusion: there is no relation between bile microbiology and postoperative infection, so, antibiotic prophylaxis is to be used in high-risk patients and in patients suspected to have difficult operation and GB perforation

Association of serum vascular endothelial growth factor level with estrogen receptors status in breast cancer patients

Aim: angiogenesis is essential for tumour growth and metastasis. Vascular endothelial growth factor [VEGF] has been suggested as the major angiogenic factor in breast carcinoma. The aim of the present study was to analyze the relationship between the serum of vascular endothelial growth factor [VEGF] in breast cancer patients and its relationship to various prognostic indices and estrogen receptor status

Methods: VEGF levels was determined in 45 breast cancer patients a d 15 healthy women, using enzyme-linked immunoassay technique

Results: serum vascular endothelial growth factor [VEGF] levels were detected in 45 patients with breast cancer before surgery and at 3 weeks after surgery. The serum VEGF levels of the cancer patients as a group were significantly elevated compared with those of the controls [P < 0.0005]. VEGF levels were elevated in patients with invasive cancer of duct carcinoma, and estrogen receptor [ER]-positive tumors. Post-operatively, VEGF level decreased significantly

Conclusions: preoperative senln2 VEGF detects breast cancer with a sensitivity of 62.2%. The relationship to cancer type and EX status may have future therapeutic implications which deserves more extensive study

Timing of drain removal after modified radical mastectomy; a prospectne randomized study

Background: Axillary lymph node dissection [ALND] is a standard procedure in the treatment of breast cancer. Current practice following ALND involves several days of drainage of the axilla to reduce the formation of seroma. The aim of this study is to compare 5 days to 8 days drainage after modified radical mastectomy [MRM]

Study Design: A prosrpective randomized trial was performed comparing 5 days drain; Age to 8 days drainage. The primary dutcome measure was duration Qt Hospital stay. Formation of seroma had wound related complications jam secondary outcome measure

Result: Thirty patients were randomized to the 5 days drainage group [A]. 30 patients to 8 days drainage group [B]. Seroma aspiration was required in 46.7% [14 patients] after 5 days drainage and in 33.3% [10 patients] after 8 days drainage [P= 0.07]. Infectious complications were seen in 4 patients after. 8 days drainage versus 1 after 5 days drainage [P = 0.0001]

Conclusion: Five days drainage following ALND is feasible and facilitates early hospital discharge. Furthermore, 5 days drainage is not associated with excess wound related complications compared to long-term drainage

DNA flow cytometry in colorictal carcinomas: experiences in tumors from Egypt

Colorectal carcinoma occurs at a much lower frequency in Egypt than in western countries. In this study of forty colorectal carcinomas we investigated the prognostic value of flow cytometric ploidy and S- phase measurements together with various morphological characteristics of the tumors. Repeated measurements of 324 paraffin - embedded or fresh samples from the 40 tumors demonstrated the high reproducibility of ploidy and S- phase analysis [r=0.97 and r= 0.89 respectively]. Tumor heterogeneity showing diploid and aneuploid cell population or aneuploid cell populations with various ploidy values by measuring a mean of 4.6 samples /tumor was found in 40%, while the proportion of aneuploid tumors increased significantly with grade but not with stage of the tumors. The% S-phase cells correlated with grade but not with the stage. After a follow up of 24 months, in the Kaplan Meire univariate Analysis, the following factors had a prognostic value, staging [P=0.005]. ploidy level [P=0.0018],% S-phase [P=0.0006], histopathological types [P=0.01], grading [P=0.05]. Multivariate Analysis using Cox's proportional Hazanl model revealed independent prognostic value for Dukes' stage [P=0.02], and ploidy level [P=0.05]

Study of intratumoral and intravenous administration of recombinant of human TNF in patients with advanced cancers

Twenty-eight patients with advanced cancers resistant to standard cytoreductive therapy were enrolled in this study [eight cases of lymphoma, four cases of melanoma, four cases of renal cell carcinoma, four cases of ovarian carcinoma, cases of pancreatic malignancies and four cases of breast cancer]. The study found that the mean TNF level in cancer patients = 57.09 +/- 11 pgm/ml [0.120 U/ml]. The study also found that the maximal plasma level of TNF is higher [60 U/ml] after intratumoral injection than after 24 hours infusion [5 U/ml]. The necrotizing effects of TNF on the tumor were observed in twelve patients after intratumoral administration and only in eight patients after continuous infusion. The side effects after 24 hours infusion were fever, chills, tachycardia, severe hypotension, nausea, vomiting diarrhea, fluid retention due to capillary leak syndrome, general prostration and CNS affection. These side effects after 24 hours infusion were more severe and took more time for resolution than after intratumoral injection in which the only side effects were fever, chill, tachycardia and change in blood pressure. So, it was concluded that intratumoral application of rHuTNF is better tolerated and more efficient than continuous 24 hours infusion