Laparoscopic adjustable gastric banding for morbid obesity: radiographic management and imaging of postoperative complications

We present the results of our experience in 150 individuals underwent laparoscopic adjustable gastric banding [LAGB] to assess its efficacy in terms of weight loss and safety as well as to validate the role of radiographic assessment in determining the range of early and late possible postoperative complications. 150 consecutive [105 women, 45 men] morbidly obese patients with BMI of >40 kg/m[2] or BMI of >35 kg/m[2] with one obesity related disease who underwent LAGB were included in this study. Water soluble upper gastrointestinal study was done on the second postoperative day to ensure adequate position of the band, check the device components, and exclude perforation. 4 weeks after surgery stoma size adjustment was performed. Additional sessions were scheduled depending on the patient's ability to eat, weight loss curve, or manifestation of complications. Patients were followed up to 36 months. The% mean excess weight loss [EWL] at 1 year, 2 years, and 3 years was 44.4% [ +/- 17.8], 51.8% [ +/- 20.9], and 52.0% [ +/- 19.6], respectively. Complications relating to the gastric band occurred in 10 patients [6.5%]. Acute Gastric Perforation occurred in 2 patients [1.3%], band erosion in 4 patients [2.6%], slippage of the gastric band with gastric strangulation in 4 patients [2.6%]. Tube-related complications were detected in 15 patients [10%] and included port site discomfort in 3 patients [2%], port infections in 5 patients [3.3%], tube disconnection in 3 patients [2%] and tube leak in 4 patients [2.7%]. The LAGB procedure is a minimally invasive, totally reversible laparoscopic alternative in the treatment of morbid obesity. Various complications may be detected on follow-up imaging studies. The radiologist should be aware of these possible complications and their radiologic appearances

Spectrophotometric and spectrofluorimetric determination of certain diuretics in pure forms and in their pharmaceutical formulations

Three Simple and selective spectrophotometric and spectrofluorimetric methods were developed for the quantitative determination of certain diuretics [bendroflumethiazide, benzthiazide, chlorthalidone, clopamide, hydrochlorothiazide, hydroflumethiazide, indapamide and xipamide] in pure forms as well as in their pharmaceutical formulations through their hydroxamate formation and subsequent complexation with iron [method I], reaction with potassium ferricyanide [method II] and reaction with 4-chloro-7-nitrobenzofurazan [method III]. The conditions for different reactions were studied and optimized. The methods have been validated and successfully applied to the analysis of bulk drugs and their tablets with good recoveries ranging from 97.93 [ +/- 1.46] to 100.6 [ +/- 1.75] for method I. 98.49 [ +/- 1.43] to 99.86 [ +/- 0.87] for method II, and 98.98 [ +/- 1.11] to 99.90 [ +/- 0.86] for method III. No interference was observed from common pharmaceutical adjuvants. The results obtained compare well with those of reported methods

Selective spectrophotometric determination of atorvastatin

Four simple, accurate, sensitive, selective and economic spectroscopic methods were developed for determination of atorvastatin in bulk and dosage form. Procedures I and II determined the drug in presence of other three statins [lovastatin, pravastatin and simvastatin] as well. Procedure I is based on formation of a highly colored ion-pair complex with methylene blue dye that was extractable in chloroform. The absorbance of the complex was measured at 654 nm against a blank. Procedure II was based on the reaction of the drug with N-bromosuccinimide [NBS] in slightly acidic media producing a yellow colored product measured at 347 nm. Procedure III depended on formation of chloroform extractable salt with silver and copper cations, while procedure IV depended on AAS measurement of copper in the chloroform extractable salt formed between the drug and copper cation. Beer's law was obeyed in the ranges of 1-12, 3-84, 10-65, 12-80 and 40-200 micro g ml[-1] for procedures I, II, Ilia, Illb and IV respectively with correlation coefficient not less than 0.9991. The four methods hold well accuracy and precision when applied to the analysis of the drug in its dosage form with percentage recoveries ranged from 99.2 +/- 0.634 to 100.53 +/- 0.227

Assessment of the outcome after popliteal distal bypass for limb salvage

Twenty four patients with limb threatening ischaemia due to occlusion of the popliteal artery were included in this prospective study. The patients were considered potential for surgery due to presence of ischaemic ulcer or gangrene in 15 patients and ischaemic rest pain alone in 9 patients. The inclusion criteria for popliteal distal bypass was short segment occlusive diseases of the popliteal artery and its trifurcation. Patients with diffuse disease of the superficial femoral artery were excluded from this study. Popliteal artery bypasses were performed electively in all patients. Autogenous vein as a conduit was utilized in all of them. Translocated saphenous vein was the most frequent conduit used in 12 patients [50%]. In situ saphenous vein was utilized in 9 patients [37.5%] where as reversed saphenous vein was used in 3 patients [12.5%]. The inflow vessels were below knee popliteal artery in 14 patients [58.3%] and above knee popliteal artery in 10 patients [41.7%]. The outflow were posterior tibial artery in 12 patients [50%], peroneal artery in 4 patients [16.6%] anterior tibial artery in 6 patients [25%] and dorsalis pedis artery in 2 patients [8.4%]. In the early and late postoperative periods, the survival rates were 95.83% and 87.50%, the primary patency rates were 91.30% and 80.95%, the secondary patency rates were 91.30% and 85.7% and limb salvage rates were 91.97% and 87.50% respectively which compare favorably with other reports of popliteal distal bypass. The same is true regarding reports for femorodistal bypass. At the end of the follow up period 16 [66.6%] out of 24 patients had a functioning limb used for ambulation and transfer. In conclusion, popliteal distal bypass is a safe and efficient procedure with favorable outcome. However, the results are poor in patients with renal impairment

impact of early diagnosis and associated injuries on the outcome of patients with traumatic diaphragmatic rupture

Thirty-eight patients with surgically confirmed diagnosis of traumatic diaphragmatic rupture were included in this prospective study. They were classified into two age and sex matched groups: Group A included 22 patients where the diaphragmatic rupture was the prime indication for surgical intervention and group B included 16 patients where associated thoraco-abdominal injuries mandated an urgent surgical intervention. In conclusion, a high index of suspicion and awareness of the mechanism of injury are required for the early diagnosis of diaphragmatic rupture. The initial plain chest X-ray is reliable in detecting the diaphragmatic tear, especially in the presence of herniated hollow viscera. Ultrasonography and CT scan are useful auxiliary investigations which improve dramatically the early preoperative diagnosis of diaphragmatic rupture. Due to the severity of trauma required to rupture the diaphragm, associated injuries are common. However, no specific associated injury proved to be a sensitive index for diaphragmatic rupture. During exploratory laparotomy for abdominal trauma, a thorough examination of both hemidiaphragms is mandatory. Postoperative morbidity and mortality could be attributed to the severity of trauma indices and associated injuries but not to the diaphragmatic tear itself

efficacy and safety of angioembolization in the surgical management of blunt liver injuries

Twenty-one patients sustaining complex liver injuries due to blunt abdominal trauma were included in this study; all of them were hemodynamically unstable. They were classified into two groups: The first included fourteen patients where perihepatic packing was utilized to control bleeding from complex liver injuries and the second group included seven patients where angiographic embolization of the hepatic artery was performed after perihepatic packing. Demographic data, severity of injury, hemodynamic status, metabolic response, grading of the liver injuries associated injuries, resuscitation measures as well as complications and outcome were collected and compared in both groups. The study concluded that perihepatic packing evolved as the most significant therapeutic modality in the reduction of mortality after severe liver injury. When surgery is indicated, the policy of minimal intervention is recommended. The aim of surgery should be hemorrhage control

Management and imaging strategies in vertebral artery injuries due to penetrating neck trauma

Eleven patients with vertebral artery injury due to penetrating trauma were included in this prospective study. They were classified according to the clinical evidence of vascular injury into two groups: Group A included six patients showing hard signs suggestive of vascular injury and group B included five patients who were showing soft signs suspicious of vascular injury. Patients from group A who were vitally unstable [four patients] were taken immediately to the operation theater, while the other stable patients [two patients] did angiography to locate the site of injury and plan surgical approach. Proximal and distal ligation to the injured vertebral artery was done in three patients. Proximal ligation and packing with hemostatic agent were mandatory in two patients. A damage control was utilized in one patient. Patients from group B were subjected to MRA which was reliable to detect the site and type of injury; conservative treatment was adopted in all of them. The mortality rate was 9%. Massive blood transfusion, chylous fistula and pneumonia were the main postoperative complications. In spite of the ligation of the vertebral artery, none of the patients developed a neurological deficit. Patients who were managed conservatively and those who had proximal ligation and packing by hemostatic agents did not develop any late complications during the follow up period

role of non invasive imaging in the surgical management of the patients with mesenteric venous thrombosis

Twenty-one patients of surgically confirmed diagnosis of mesenteric venous thrombosis were included in this study. A detailed history was taken and thorough clinical examination was performed. The patients were divided into two groups: Group A included eight patients who showed an evidence of localized or generalized peritonitis and group B included 13 patients who showed nonspecific clinical findings. The duration of symptoms was significantly longer in patients from group A than group B. All patients were subjected to ultrasonographic abdominal examination with color flow Doppler scanning. It could suspect the diagnosis of mesenteric venous thrombosis in 62.5% and 76.9% of the patients in group A and B, respectively. Immediate surgical exploration was performed in all patients from group A without any further investigations. Contrast enhanced spiral CT was done in 11 patients from group B, while contrast enhanced MRI was done in the other 2 patients. A surgical exploration was done in all of them

Diagnostic peritoneal lavage [DPL]: accuracy in predicting necessary laparotomy following both blunt and penetrating trauma

Management of abdominal trauma requires more than the detection of injury. Accurate assessment of the need for operative repair is important for successful outcome. Diagnostic peritoneal lavage [DPL] is now established as investigation of choice in patients with blunt and penetrating abdominal trauma in whom clinical findings are equivocal. This study included 80 cases of abdominal injuries. DPL was done for them, the open technique was used which is more safe. Various criteria for evaluation of DPL fluid were studied

Preventable trauma deaths in Kasr El Aini and one general hospital

The preventable death rate is defined as the proportion of all deaths judged to have been preventable if optimal care had been delivered. Trauma death studies act as a medical audit quality of trauma care provided to the public and serve the purpose of analyzing how trauma system is functioning. This study is a trial to identify errors and how much they affect the mortality rate hoping to avoid them, hoping to diminish the mortality rate of severely injured trauma patient. In 6 months study done in two hospital Kasr El-Aini University Hospital and El-Fayoum General Hospital for 55 multiple and severely injured trauma patients, using the clinical method for detection of preventable trauma death, 17 preventable trauma deaths were accurately analyzed and the errors were classified into prehospital [31%] immediate resuscitative [23.5%] management [operative [45%] and criteria care phase errors [18.5%]

Typhoid ileal perforation

25 cases of perforated typhoid ulcers of the ileum are reported. 12 cases were diagnosed preoperatively as perforated typhoid ulcers, either being referred by physicians or from hospitals. The remaining cases were diagnosed as peritonitis with perforated typhoid as differential diagnosis in 5 cases. A case of peritonitis after mild closed abdominal trauma proved to have 2 perforated typhoid ulcers. A technique of serosal patch using a loop of jejunum to reinforce the suture line and to protect incipient ulcers was practiced in 10 cases with favorable results

Bilharzial stricture ureter in Egypt: surgico-pathological study

Although bilharzial ureteric strictures were the subject of intensive studies in Egypt since the days of Makar [1955], their exact clinicopathological features and proper management were adequately established rather quite recently. This study based on twenty cases [nineteen males and one female aged between twenty and sixty years]. They were presented by renal aching, ureteric colic or symptoms of complications which proved to be due to ureteric strictures by IVU, cystoscopy and sometimes ultrasonography.Most strictures involved the terminal ureter, 50% being intramural, 15% juxtavesical and 15% combined; while pelviureteric and supravesical were rare [5% for each] and multiple strictures were present in 10% of cases.The techniques used in the surgical treatment of these patients depended on the site and extent ofthestricture. Theyincluded ureterocystostomy[ten cases], resection anastomosis [four cases], boari flap ureteroplasty[three cases], pyeloplasty [one case], coloureteroplasty[onecase], ileoureteroplasty [one case] and anderson-hynes pyeloplasty [one case].The relation between the anatomicopathological features of the stricture and the type of surgery adopted was illustrative enough to deserve presentation in this paper