Surgical management of hydatid liver cysts; inra-operative pair, cysto-pericystectomy and omentoplasty

Liver hydatid cysts caused by Echinococcus granulosus presents medical, veterinary and economic problems worldwide. In an attempt to eradicate liver hydatid cysts by eliminating the parasite, disappearance of the residual cavity, preventing complications and recurrence, the present study was done in Theodore Bilharz Research Institute on 36 patients. They were 11 females and 25 males with age ranging between 18-55 years old. All patients were sub to a full history taking and clinical examination, a full battery of hematological, biochemical, immunological and radiological investigations. Intra-operative Puncture Aspiration Injection and Re-aspiration [PAIR] was performed to all cysts before surgical intervention. Total cysto-pericystectomy [CPC] was done in 25 patients with both open and closed technique. Partial cysto-pericystectomy was done in 11 patients due to firm adherence of the cyst to the liver structures. Omentoplasty [OP] was performed to fill all cavities accompanied with external open system drainage tube. There were no mortalities in this study. Post operative complications were found in 7 patients. Cystectomy and omentoplasty related complication were found in 3 patients, General surgical complications were found in 1 patient. Biliary related complications occurred in 3 patients in the form of biliary leak in 2 patients and biliary fistulae in 1 patients. All these complications responded well to conservative management. A combination of different radical and conservative surgical modalities in the same sitting in the form of intra-operative Puncture Aspiration Injection and Re-aspiration, cystopericystectomy and omentoplasty could be considered the surgical method of choice with no mortality

Zinc variation during liver regeneration following partial hepatectomy in schistosomiasis [experimental study]

This study aimed to estimate the serum level and hepatic content of zinc in experimental schistosomiasis as well as their alteration during liver regeneration following partial hepatectomy. The included animals were divided into two groups, schistosomal [40 hamsters] and non-schistosomal [33 hamsters]. The hamsters, either infested or not, were subjected to 35% partial hepatectomy [left lateral lobe hepatectomy]. Scarification of animals, collection of blood samples and regenerating liver tissue were done at two days, one, two and three weeks after hepatectomy. The serum level and hepatic content of zinc were estimated biochemically. The rate of hepatic regeneration was studied by histopathological examination and measurement of DNA content in the liver remnant. Hypozincemia with decreased hepatic zinc content was reported in schistosomal group preoperatively. Their DNA content [175.8 ug/g] had significant lower level when compared with the non-schistosomal group [335.75 ug/g]. During liver regeneration, serum zinc declined sharply; however the highest hepatic concentration and peaked DNA content were recorded in the first 48 hours following partial hepatectomy in schistosomal group. The mean liver weight reached a maximum of only 72.3% of its preoperative weight

possible role of helicobacter like species in the aetiology of chronic cholecystitis in patients with positive gastric helicobacter infection

The aim of this study was to correlate between the helicobacter species identified in gall bladder specimens and those in upper GI biopsies. In this study, out of 60 gastric biopsies, 32 were +ve for H. pylori. The H. pylori like organisms were detected in 5 gall bladder specimens. The 5 positive gall bladder specimens were only found among the 32 cases with gastric biopsies +ve for H. pylori. This study suggested that there was no apparent association between colonization of the gall bladder with Hp in relation to chronic calcular cholecystitis. However, wider scale studies with multicentre-controlled investigations may help to establish a more consistent role of helicobacter species in the aetiology of cholecystitis

Prognostic factors in acute mesenteric ischemia

Between 1996 and 1999, 43 patients were operated upon for acute mesenteric ischaemia, in Kasr El-Aini hospital and Theodor Bilharz research institute. They included 17 patients [39.5%] with acute embolic mesenteric ischaemia, 9 patients [20.9%] with mesenteric thrombosis, 3 patients [7%] with non occlusive mesenteric ischaemia and 14 patients [32.6%] with mesenteric venous occlusion. 53.5% of the patients presented with classical clinical picture of mesenteric ischaemia Management plan was revascularization of the intestine whenever possible and resection of frank necrotic intestine. A second look operation was the rule when a revascularization procedure was done or when doubtful loop of intestine was left. The overall mortality was 30.2%

Biochemical assessment of liver cell regeneration in normal versus bilharzial livers after partial hepatectomy

The liver exhibits a remarkable regenerative capacity after major resection provided it is normal. It is commonly assumed that a normal liver tolerates 70-80% resection safely. On the other hand, the capacity for regeneration after partial hepatectomy in chronic liver disease such as produced by schistosomiasis mansoni, is still unknown. The aim of this work is to assess DNA, thymidine kinase activity and liver function tests after partial hepatectomy in normal hamsters compared to those infected with schistosoma mansoni, this is to show the effect of schistosomal infestation on the regenerative ability of the liver. In the bilharzial groups there was a significant increase in the liver DNA level [P<0.005]. In the nonbilharzial group there was a highly significant increase in the liver DNA level [P<0.005]. In the bilharzial groups there was a significant increase in the liver thymidine kinase activity [P<0.005], in the non-bilharzial group there was a highly significant increase in the liver thymidine kinase activity [P<0.005]. In the bilharzial group there was a marked rise in the serum enzyme during the first three days after partial hepatectomy [P<0.005] and still high even after three weeks. In the non-bilharzial group there was a significant rise in time AST observed during the first three days after surgery [P<0.005] and returned to the preoperative mean value by the second post-operative week. .in the bilharzial group, total proteins showed a significant decrease [P<0.05] in relation to the pre-operative baseline value, and still after three weeks post-heptectomy [P<0.005] didn't recover to the pre-operative mean value. In the bilirarzial group there was a significant rise in sermon total bilirubin during the first three days after partial hepatectomy [P<0.005] which continued up to the third week post hepatectomy. In th non-bilirarzial group there was a significant increase observed up to three days after the operation [P<0.005] and started to drop after the first week posthepatectomy. The bilharzial group showed a significant rise in Serun Alkaline Phosphatase [P<0.05] during the first three days after the operation and returned to the baseline value after the first week after the operation. The non bilharzial group didn't show any changes throughout the whole periods after the operation