Leak after laparoscopic cholecystectomy; incidence and management

Background: laparoscopic cholecystectomy is currently the procedure of choice for symptomatic gallstones. It has evolved from an innovative, but time-consuming, novelty to a routine day-case procedure over the last 20 years

Purpose: to estimate the incidence and management options of post laparoscopic cholecystectomy biliary leaks. Also, it is a trial to advocate a minimally invasive structured management protocol to treat patients with bile leak

Patients and Methods: this study was a case series of 100 patients who underwent laparoscopic cholecsystectomy. We didn’t include patients who had: Biliary leak post Laparoscopic converted to open cholecystectomy. Biliary leak due to other procedures. Biliary leaks managed by open surgery. Biliary injuries discovered and definitively managed intra-operatively. The included patients presented to the General Surgery Department at Manshyt El Bakry General Hospital. Patients’ age ranged from 12 to 65 years and patients’ sex was distributed as 78 females and 22 males

Results: in our cases there were two out of the 100 patients suffered from biliary leak ,one of the two cases that were presented with biliary leak after surgery was due to direct injury to accessory duct of Luschka and the other one was due to a slipped clips

Conclusion: cholecystectomy is the most frequently performed abdominal operation in the United States, with currently over 700,000 cases occurring per year. Bile leak as a result of cholecystectomy is uncommon. The frequency in large series is less than 2% and in our study it was exactly 2%. And the treatment of that leak varies from conservative treatment to ERCP and stent insertion like we did

Single-center experience with cyclosporine for treatment of idiopathic minimal change nephrotic syndrome in children

Cyclosporine A is used in the treatment of idiopathic nephrotic syndrome. We conducted this study to evaluate the effect of cyclosporine and its combination with ketoconazole in Egyptian nephrotic children with steroid-resistant and steroid-dependant minimal change. Forty-eight children with minimal change lesions who received cyclosporine with or without ketoconazole were studied. Their mean age was 5.17 +/- 1.59 years, and they were 31 boys and 17 girls. The mean duration of the disease was 6.22 +/- 3.16 years. Thirty-one of the children were steroid dependent and 17 were steroid resistant. Cyclosporine treatment was commenced after remission was attained and adjusted to a target trough level of 100 nanogram/mL. The mean cyclosporine therapy at a dose of 2.07 +/- 0.91 mg/kg was administered for a mean of 25.75 +/- 1.95 months. Thirty-three patients received adjunctive ketoconazole therapy. Thirty-eight patients [79.2%] responded well to cyclosporine. Steroid therapy could be discontinued in 43 patients [89.6%], but 9 experienced relapse. Ten patients [20.8%] were resistant to cyclosporine therapy. Fifteen patients received cyclosporine alone, while 33 received concomitant cyclosporine and ketoconazole. The response to cyclosporine was significantly better in those on ketoconazole. The economic effect of ketoconazole therapy was a reduction in the costs of cyclosporine treatment by 47.4% at 1 year of treatment. Cyclosporine treatment in children with minimal change nephrotic syndrome is effective in preventing relapse and decreasing steroid toxicity. Its combination with low-dose ketoconazole is safe, reduces treatment costs, and improves the response to cyclosporine

Relation between thyroid hormone concentration and serum levels of interleukin-6 and interleukin-10 in patients with nonthyroidal illness including chronic kidney disease

We evaluated relations between interleukins [IL] IL-6 and IL-10 and euthyroid sick syndrome [ESS] in patients with nonthyroidal illness [NTI]. Sixty patients and 20 healthy volunteers were recruited. The patients had either chronic kidney disease [CKD], congestive heart failure [CHF], or acute myocardial infarction [MI], distributed equally in 3 subgroups. Serum levels of IL-6 and IL-10, thyroid stimulating hormone [TSH], total T4, and T3 were determined. In the 60 patients with NTI, we detected a significantly lower T3 and T4 levels compared to controls, while TSH level was within the reference range. Also, IL-6 level was substantially higher than that in controls [P < .001] and correlated with T3 [r = -0.620, P < .001] and T4 [r = -0.267, P < .001]. Similarly was IL-10 level [P < .001] that correlated with T3 [r = -0.512, P < .001], but not with T4. The ILs correlated positively with each other [r = 0.770, P < .001]. Only IL-6 was a predictor of low T3 [P = .001]. The proportion of patients with subnormal T3, T4, and TSH levels was highest in those with MI along with greatest IL-6 and IL-10 levels compared to patients with CHF and CKD. Patients with CKD showed the least disturbance in IL-6 and IL-10 despite the lower levels of T3, T4, and TSH in a higher proportion of them compared to patients with CHF. The high frequency of ESS in patients with NTI may be linked to IL-6 and IL-10 alterations. Perturbation of IL-6, and not IL-10, might be involved in the pathogenesis of ESS along with other key players as suggested by our findings in CKD

Protenuria after kidney transplantation its relation to hepatitis C virus and graft outcome

Chronic Hepatitis C Virus [HCV] infection has been associated with glomerular disease in native and transplanted kidneys. We evaluated the presence of HCV infection at the time of transplantation and occurrence of proteinuria in Egyptian kidney transplant patients and their link with graft survival. This retrospective study was done on 273 patients with end-stage renal disease transplanted in Mansoura Urology and Nephrology Center Between 1993 and 1996. Their sera were routinely assayed for anti-HCV antibodies at the time of transplantation. The relationship between the HCV and the development of posttransplantation proteinuria was evaluated, along with the possible effects of proteinuria on long-term graft survival. A total of 169 kidney recipients [61.9%] were positive for anti-HCV antibodies. The mean durations of post-transplant follow-ups were 87.73 +/- 26.79 months [range, 19 to 123 months] and 84.29 +/- 28.55 months [range, 11 to 123 months] for the patients with and without anti-HCV antibodies, respectively. The patients in these groups were comparable regarding the incidence of proteinuria [33% and 32%, respectively] and its quantity [median, 0.6 g/d and 0.4 g/d, respectively]. Irrespective of the HCV infection, patients with nephrotic-range proteinuria showed a worse graft survival [P < .001] and a higher frequency of chronic allograft nephropathy [P = .03] compared with nonproteinuric patients. There is a high prevalence of HCV infection in our patients with end-stage renal disease awaiting kidney transplantation. The incidence and quantity of proteinuria do not increase by HCV infection, and nephrotic-range proteinuria is independently associated with chronic allograft nephropathy and a poorer graft outcome

Impact of uraemia on the shear bond strength between composite resin and tooth structure: sem evaluation

Objectives: This study was aimed to investigate the influence of uraemia on enamel and dentin bond strength to resin composite using a total-etch adhesive system. The micromorphological appearance of resin-tooth interfaces was also investigated

Methods: The adhesive system and the composite resin used in this study were Excite and Tetric EvoCeram [lvoclar/ Vivadent] according to manufacturers' recommendations. Thirty six human molars were used for this study, 28 molar for shear bond test and 8 molars for micromorphological study. The teeth were divided into two groups, A and B, and then each group was subdivided into two subgroups. Teeth of group A were extracted from normal individuals while group B were extracted from uraemic patients. Enamel bonding sites were prepared in the buccal surfaces of subgroups A[1] and B[1] while dentin bonding sites were prepared in occlusal surfaces of subgroups A[2] and B[2] using 600 grits SiC abrasive paper. For shear bond test specimens were etched with 37% phosphoric acid gel and composite rods were bonded with the adhesive resin. Shear bond strengths were determined using a Universal Testing Machine at a cross-head speed of 2mm/min until failure occurred. Fracture modes were examined at 16x magnifications with stereomicroscope. The other 8 specimens were prepared with the adhesive resin only and examined with SEM

Results: Bond strengths to normal enamel were significantly higher compared to normal dentin, uraemic enamel and uraemic dentin. SEM observations revealed shallower etch pattern for uraemic enamel and poor infiltration of resin into dentinal tubules for uraemic dentin compared to normal specimens

Significane: Uraemia had impact on the bond strength of composite resin to tooth structure

role of parenteral iron therapy in treating the chronic hemodialysis associated anemia, a comparative study between iron saccharate and gluconate

Anemia in hemodialysis patients is a complex syndrome and many factors other than absolute or relative erythropoietin [EPO] deficiency may contribute to it. The most important factor is the presence of iron depletion. The impetus of this study was to assess the safety and efficacy of iron saccharate complex [ISC] and sodium ferric gluconate complex [SFGC] as relatively new parenteral iron preparations in treating anemia in hemodialysis patients. Forty-eight adult anemic patients of both genders [33 males and 15 females] who had an adequate level of both hemodialysis and nutrition status and received neither EPO nor parenteral iron therapy during the preceding 6 months were randomized into two groups. The first group, comprised 22 patients who were treated with parenteral ISC, 100 mg twice weekly for two months and once weekly thereafter. The second group included 26 patients who received SFGC, 62.5 mg twice weekly for two months and once weekly thereafter. The patients were followed up for 6 months. Our results showed that iron stores had been adequately repleted by the use of both parenteral iron formulas. Repletion of iron stores was associated with a significant rise of both hemoglobin and hematocrit% in both groups at the end of follow up period in comparison to their initial values at the start of the study [P < 0.001]. Both parenteral iron therapy preparations were tolerated and comparable with no statistical difference between both groups. Parenteral iron saccharate and gluconate are effective and sale treatment of anemia associated with chronic hemodialysis patients provided that they had an adequate level of both dialysis and nutrition