Comparative study between laparoscopic assisted versus open left sided hemicolectomy and sigmoidectomy for cancer colon

Background: Traditionally, open procedure through exploratory incisions remains the gold standard approach for treating colorectal [CRC]. Laparoscopic colectomy was proved to be a better alternative to the open approach. Though in some studies, it was found that the length of the operation tends to be somehow longer. However, in experienced hands it has comparable oncologic outcomes. Moreover, the laparoscopic approach is associated with less postoperative pain, faster return of bowel activity, earlier resumption of oral intake and lesser hospital stay

Aim of the Study: to study and evaluate the effectiveness of laparoscopic left hemicolectomy and sigmoidectomy compared to the open left sided colectomy and sigmoidectomy for malignancy regarding operative time, length of hospital stay, return of bowel function, resumption of oral intake, postoperative pain perception, general postoperative complications, surgical site infections and early recurrence

Patients and methods: This comparative study has been conducted in El-Demerdash hospital, Ain Shams University - Cairo, Egypt and has included 60 patients where half of the patients underwent open left hemicolectomy or sigmoidectomy and the other half underwent laparoscopic left hemicolectomy or simoidectomy. We performed both procedures during the period between 1[st] of January 2016 and 1[st] of January 2017 with 12 months of follow up post-operatively

Results: In our study, the laparoscopic operation was associated with less hospital stay, earlier return of bowel activity, earlier resumption of oral intake without the use of the regular anti-emetics with better pain control and perception postoperatively. Moreover, it was associated with less surgical site infections and general complications including the respiratory ones than the open operation. We had similar anastomotic leak rates and early recurrence rate between both operations. Finally, the laparoscopic operation was associated with more operative time compared to the open operation

Conclusion: Laparoscopic left hemicolectomy and sigmoidectomy are oncologically sound when compared to the open left hemicolectomy and sigmoidectomy for treating left sided and sigmoid cancers. Moreover the laparoscopic approach yielded better outcomes regarding the postoperative recovery compared to the open approach

Recommendation: A further high volume study is needed to assess the long term effects of both procedures in our hospital

role of fine needle aspiration cytology and imprint cytology in cervical lymphadenopathy

To determine the diagnostic accuracy of cervical lymphadenopathy by fine needle aspiration [FNAC] and imprint cytology [IC]. This study included 94 patients with cervical lymphadenopathy. They were subjected to clinical examination and FNAC of one of the enlarged lymph nodes. This was followed by IC and histological examination of this lymph node after its excision. Clinical examination was correct in 78% of the cases. The overall accuracy of fine needle aspiration was 93%. It was accurate on all cases of reactive hyperplasia, 93% of tuberculosis Iymphadenitis, 90% in Hodgkin's lymphoma. 86% in non-Hodgkin's lymphoma, and 91% of metastasis lymphadenopathy. On the other hand, the overall accuracy of IC was higher than that of fine needle aspiration, being 97%. It diagnosed all cases of reactive hyperplasia and non-Hodgkin's lymphoma, 97% in tuberculosis lymphadenitis, 90% in Hodgkin's lymphoma and 95% in metastasis lymphadenopathy. These techniques proved to be reliable, rapid, and inexpensive procedures in diagnosis of lymphadenopathy. They can differentiate well between inflammatory and neoplastic lesions, in cases of lymphoma, cytological diagnosis should be followed by histological diagnosis for accurate classification and grading

Surgical management of post endoscopic retrograde cholangiopancreatography [ERCP] duodenal perforation

Traditionally post ERCP duodenal perforations have been managed surgically; however, in the last decade, management has shifted toward a more selective approach. Those who favor a selective approach have not elaborated distinct management guidelines. To evaluate the authors experiences in management of post ERCP duodenal perforations to define the criteria for operative management and a systematic management approach. A retrospective review of consecutive cases of ERCP related perforation [from May 2000 to May 2004] was carried out. Seventy-four out of 3050 ERCP performed [2.4%] were complicated by duodenal perforations and were included in the study. Forty-two perforations [56.8%] were discovered at ERCP while 32 cases [43.2%] required additional radiological assistance. Twenty-nine patients [39.2%] were operated early within 6 hours whereas 45 patients [60.8%] were initially treated conservatively. Fifteen patients had surgery after failure of medical treatment. Four cases [8.9%] died under conservative treatment and 14 cases [31.8%] died after surgical intervention. Pyloric exclusion procedure [PE] was done for 33 patients [75%]. Early diagnosis is important but difficult especially for retroperitoneal perforations. Clinical and radiographic features of ERCP - related duodenal perforations can be used to stratify patients into surgical or non-surgical cohorts. A selective management scheme is proposed based on the features of each type. Pyloric exclusion procedure is the operation of choice when the diagnosis is delayed and when the perforation is not detected or can't be repaired

In vitro effect of mirazid on schistosoma mansoni worms

Measuring mirazid ability for contracting the worm muscle and its effect on the worm surface ultrastructure can be used to monitor the in vitro effect of any drug. This study aimed to investigate the actual effect of mirazid [a new schistosomicide, purified oleo-resin extract of myrrh, derived from Commiphora molmol plant] on S. Mansoni worms by detecting its in vitro effect. Three groups of white albino mice [five mice in each group] were infected by 100 cercariae for each mouse. The 3rd group served as a control group. Seven weeks post- infection, the mice were sacrificed, perfused and worms were collected. Muscle tension of the worms collected from the first group of mice was assayed in response to mirazid in rising concentrations of 100, 200, 300 and 400 nM. The in vitro effect of mirazid on the muscle tension of single S. Mansoni worm was determined using a special device to determine the percentage of change in work length [% shortening]