Autologous Stem Cells Transplantation in Egyptian Patients with Liver Cirrhosis on Top of Hepatitis C Virus

BACKGROUND AND OBJECTIVES: Use of pluripotent stem cells is an ideal solution for liver insufficiencies. This work aims is to evaluate the safety and feasibility of autologous stem cells transplantation (SCT) in Egyptian patients of liver cirrhosis on top of hepatitis C virus (HCV). SUBJECTS AND RESULTS: 20 patients with HCV induced liver cirrhosis were divided into 2 groups. Group I: included 10 patients with liver cirrhosis Child score > or =9, for whom autologous stem cell transplantation was done using granulocyte colony stimulating factor (G-CSF) for stem cells mobilization. Separation and collection of the peripheral blood stem cells was done by leukapheresis. G-CSF mobilized peripheral blood mononuclear cells (G-CSF PB-MNCs) were counted by flow cytometry. Stem cell injection into the hepatic artery was done. Group II: included 10 patients with HCV induced liver cirrhosis as a control group. Follow up and comparison between both groups were done over a follow up period of 6 months. The procedure was well tolerated. Mobilization was successful and the total number of G-CSF PB-MNCs in the harvests ranged from 25x106 to 191x106. There was improvement in the quality of life, serum albumin, total bilirubin, liver enzymes and the Child-Pugh score of group I over the first two-three months after the procedure. CONCLUSION: SCT in HCV induced liver cirrhosis is a safe procedure. It can improve the quality of life and hepatic functions transiently with no effect on the life expectancy or the fate of the liver cirrhosis.

Towards an Egyptian guideline from screening to treatment of hepatocellular carcinoma [part I]

These recommendations provide a data-supported and based-evidenced approach to the screening, diagnosis, staging and treatment of Egyptian patients with hepatocellular carcinoma [HCC] in which we tried to construct an Egyptian algorithm for our Egyptian HCC patients in terms of type and timing of surveillance, readily available diagnostic tools that suit our means and the proper and efficient timely treatment that suits our resources. They are based on the experience of the authors in the specified topic and the AASLD Policy on the Development and Use of Practice Guidelines. These recommendations suggest preferred approaches to screening [for early detection of cases with hepatic nodule and/or elevated AFP], diagnosis [for accurate diagnosis of HCC cases], staging [for detection of specific category of treatment according the patient's general condition] and treatment [selection of the most suitable treatment option for the patient after his proper evaluation]. In an attempt to characterize the quality of evidence supported recommendations, the Egyptian Guidelines requires a category to be assigned and reported with each recommendation [Table I]

Towards an Egyptian guideline from screening to treatment of hepatocelhilar carcinoma [part II]

These recommendations provide a data-supported and evidence based approach to the screening, diagnosis, staging and treatment of Egyptian patients with hepatocellular carcinoma [HCC] in which we tried to construct an Egyptian algorithm for our Egyptian HCC patients in terms of type and timing of surveillance, readily available diagnostic tools that suits our means and the proper and efficient timely treatment that suits our resources. They are based on the experience of the authors in the specified topic and the AASLD Policy on the Development and Use of Practice Guidelines. These recommendations suggest preferred approaches to screening [for early detection of cases with hepatic nodule and/or elevated AFP], diagnosis [for accurate diagnosis of HCC cases], staging [for detection of specific category of treatment according the patient's general condition] and treatment [selection of the most suitable treatment option for the patient after his proper evaluation]. In an attempt to characterize the quality of evidence supported recommendations, the Egyptian Guidelines requires a category to be assigned and reported with each recommendation [Table 1]

Delayed reconstruction of the biliary tract after postcholecystectomy bile duct injury

Bile duct injury is one of the most serious complications of cholecystectomy. Proper diagnosis and appropriate treatment of bile duct injury are paramount in preventing life-threatening complications of cholangitis, biliary cirrhosis, portal hypertension, end stage liver disease and death. Sixty patients with postcholecystectomy bile duct injury were managed in Ain- Shams University Hospitals during the period from April 2003 till January 2007. The age of the patients ranged from 28 to 65 years [average 35 years]. The patients were assessed clinically, then by full laboratory investigations. Abdominal ultrasonography was performed as the first radiological investigation to diagnose biliary leakage and/or intrahepatic biliary radicle dilatation. Then MRCP was done to identify the nature and the type of the lesion. The initial goal of the treatment was to control sepsis by broad spectrum antibiotics, to aspirate bile by U/S or CT guided drainage, and to decompress the biliary tree by ERCP and stent insertion [in patients with distal bile duct or minor bile duct leaks: 30 patients = 50%] or by PTC and stenting [in patients with proximal bile duct leaks or total occlusion of the major bile ducts: 30 patients = 50%]. Patients with cystic duct or minor bile duct leaks [10 patients = 16.7%] were adequately treated by the above mentioned protocol without further complications. While patients with major bile ducts leaks or occlusion [50 patients = 83.3%] required delayed reconstruction by Roux-en-y hepaticojejunostomy after 6-8 weeks. These patients were followed up for 6-36 months [average 18 months]. 47 patients [94%] showed favorable postoperative results with no further complications. Three patients [6%] showed postoperative stricture of the anastomosis which responded to PTC pneumatic balloon dilatation. The control of sepsis and the ongoing bile leak is the primary goal of the initial management of bile duct injury. A delayed elective reconstruction of major biliary injuries following cholecystectomy, is associated with less complications compared to acute repair under suboptimal circumstances

Chemoembolisation of hepatocellular carcinoma

Transcatheter oily chemoembolisation was done to 36 patients with hepatocellular carcinoma. 9 patients had underwent the procedure followed by injection of gel foam particles. Surgery was done to 7 patients following the procedure by one to two months. All patients were followed up by Alphaf feto-protein level after 7 - 10 days and by CT after one mouth of the procedure. Alpha feto-protein level dropped in 27 cases to less than 50% compared with the pre-chemoembolisation level and to a level between 50% to 75% of the previous level in 6 cases while no significant changes occured in 3 cases. C.T. showed marked decrease in the tumour size in 5 cases, slight decrease in the tumour size in 23 patients while no change in size occured in 8 cases

Cholelithiasis in infancy and childhood: spectrum and current management

The advances of imaging studies have led to the recognition of cholelithiasis in infancy and childhood with increasing frequency. This study included 28 children with cholelithiasis managed at the Surgical Departments of Ain-Shams University Hospital, Cairo and Arabian Oil Company Hospital, Saudi Arabia over the past 4 years. Their ages ranged from 1 to 12 years. Twelve children suffered from predisposing disorders, 8 had gall stones in association with hereditary spherocytosis and underwent cholecystectomy during the course of splenectomy while 4 premature babies were treated with total parenteral nutrition [TPN] prior to the diagnosis of cholelithiasis and showed stone resolution within 1 year. Sixteen children had idiopathic gall stones, 12 of them underwent open cholecystectomy [in addition to cyctogastrostomy for pancreatic pseudocyst in one of them], while 4 had laparoscopic cholecystectomy [LC]. Follow-up period ranged from 3 months to 4 years. The importance of nonoperative treatment of childhood cholelithiasis, in selected patients aiming at spontaneous stone resolution and the advantages of applying laparoscopic cholecystectomy [LC] in children, was highlighted

Ureteropelvic junction obstruction: an objective approach to diagnosis and treatment

Favorable outcome of the management of ure-teropelvic junction [UPJ] obstruction depends upon early recognition of the disease and the proper selection of patients for operative or non operative treatment. Over the last 4 years, eighteen patients with confirmed or suspicious diagnosis of UPJ obstruction were referred for management at the pediatric Surgical Units in Ain Shams University, Cairo and the Arabian Oil Hospital Saudi Arabia. The first group [Group A] included twelve neonates with confirmed antenatal diagnosis of UPJ obstruction in 8 and suspected in 4, while the second group [Group B] included six children [aged 4 months to 6 years], 5 of whom were referred for evaluation of their urinary act infection and the sixth had pelvicalyceal dilatation on US done for his blunt abdominal trauma. According to the results of confirmatory US and diuretic renogram, obstructed kidneys were found in 15 patients, for whom Anderson-Hynes dismembered pyeloplasty was performed. The other 3 patients showed equivocal results, and were managed conservatively. All patients were followed up for 6 months to 4 years. Following surgery, neonates had better improvement of their renal functions than children. Conservative treatment yielded good results in 2 patients, while the third [a neonate] had pyeloplasty 6 months later.Our data emphasize the importance of antenatal diagnosis of UPJ obstruction to initiate prompt postnatal diagnosis of UPJ obstruction to initiate prompt postnatal work up and the significance of diagnosing the obstruction objectively, so as to select the patients for operative or non operative treatment

Cholelithiasis in infancy and child hood: spectrum and current management

The advances of imaging studies have led to the recognition of cholelithiasis in infancy ad childhood with increasing frequency. This study includes twenty eight children with cholelithiasis managed at the surgical departments of Ains Shams University Hospital, cairo and Arabian Oil Company Hospital, Saudi Arabia over the past 4 years. Their ages ranged from 1 to 12 years. Twelve children suffered from predisposing disorders: eight had gall stones in association with hearditary spherocytosis and underwent cholecystetomy during the course of splenectomy while four premature babies were treated with total parenteral nutrition [TPN] prior to the diagnosis of cholelithiasis and showed spontaneous stone resolution within 1 year. sixteen children had idiopathic gall stones: twelve of them underwent open cholecystectomy [in addition to cystogastrostomy for pancreatic pseudocyst in one of them], while four had laparoscopic cholecystectomy [LC]. Follow up period ranged from 3 months to 4 years. We highlight the importance of nonoperative treatment of childhood cholelithiasis in elected patients aiming at spontaneous stone resolution and the advantages of applying laparoscopic cholecystectomy [LC] in children

one year-trial of low fat, high carbohydrate diet in subjects with mammographic dysplasia

Although evidence is increasing about the influence of dietary fat on breast cancer risk, little information exists about the effects of dietary fat on the human breast. In this study the effect of dietary fat reduction on mammographic dysplasia [Nodular or sheet-like areas of radiological density] was elicited. Women with mammographic dysplasia were randomely allocated to a control group, with the advice of maintaining a balanced diet [38% of calories as fat], or an intervention group, in which they were taught to reduce dietary fat to a target of 15% of calories. A total of 54 patients participated in this study. Nearly 25% of both the intervention group and the control group failed to provide data after 1 year and dropped out of the study. Food records and chemical analysis of duplicate meals, and serum cholesterol measurements were assessed for the rest. Comparison of mammograms before and after one year of dietary fat reduction showed significant influence on the extent and density of mammographic dysplasia. Surgical biopsies performed at the end of the study showed six cancers in the control group and one in the intervention group which constitute four times the number expected. This study confirms the relationship between dietary fat, mammographic dysplasia and the potential risk of breast cancer

Neonatal intestinal obstruction: antenatal diagnosis and postnatal management

The increased use of ultrasonography in the evaluation of pregnancy has provided a unique opportunity to diagnose fetal abnormalities in utero. This study includes 24 neonates referred over the past 3 years for management of their antenatally diagnosed intestinal obstruction. The postnatal work up included immediate resuscitation, confirmation of the diagnosis and timely intervention. One infant died soon after birth due to associated malformations. In the remaining 23 patients, surgical interventions yielded favorable results. The value of antenatal diagnosis of intestinal obstruction is emphasized for alerting the obstetrician, the pediatrician and the pediatric surgeon to avoid delayed diagnosis and management and decreasing the neonatal morbidity and mortality rates

role of aspiration cytology in the diagnosis of solitary throid nodules

Solitary thyroid nodules represent a challenge to the physician as to decide the probability of its malignant character. Fine needle aspiration cytology is a nontraditional approach with many advantages. It reduces expenses, with prompt reassuring results that are accurate [percentage of accuracy 99%]. With 85 patients, 6 proved to have malignant nodules. Postoperative histopathological examination has shown one false negative result

Management of common bile duct stones after cholecystectomy

Non-surgical management was attempted as the first line of treatment in 39 patients presenting with stone [s] in the common bile duct after cholecystectomy. Of these, 12 patients presented with a T-tube. Endoscopic sphincterotomy was successful in 31 patients [79.5%] to achieve clearance of the common bile duct. In patients with the T-tube still in place, and in whom endoscopic sphincterotomy has failed, attempts at removal of the stones via the T-tube tract were successful in 3 out of 4 patients. Surgical intervention was indicated in only 6 cases [15%]: 5 patients after failure of non-surgical management and the sixth patient was operated upon to deal with bleeding after sphincterotomy