Study of gall bladder contractility and prevalence of gallstones in Egyptian patients with liver cirrhosis

Gall bladder stones are considered a public health problem allover the world. Many factors have been proposed to explain the increased incidence of gallstones in liver cirrhosis as alcoholism, changes in total bile acid pool, decreased cholesterol secretion, hemolysis secondary to hypersplenism, increased oestrogen levels and changes in gall bladder and sphincter of Oddi motility, but the exact mechanism has not been yet elicited. Our objective was to study gall bladder contractility and prevalence of gallstones in patients with liver cirrhosis in addition to analysis of the effect of portal hypertension on these two parameters. Eighty patients with chronic liver disease were enrolled [60 patients with liver cirrhosis and 20 patients with pure hepatosplenic schistosomiasis]. Ultrasonographic diagnosis of gallstones with evaluation of gall bladder contractility and portal hypertension were done. An increase in the number of subjects with gallstones with an increase of gall bladder fasting volume and residual volume with a decrease in gall bladder ejection fraction in the patients than the controls. Also there was an increase in the percentage of patients with gallstones among those with higher grades of portal hypertension. Patients with liver cirrhosis have higher frequency of gallstones with diminished gall bladder contractility and higher measures of portal hypertension

Intraoperative evaluation of graft patency in off-pump coronary artery bypass grafting

The accuracy of the anastomosis in off-pump coronary artery bypass [OPCAB] is sometimes questionable due to incomplete stability of the anastomotic site and wet field. Transit time flowmetry is a new technology used to evaluate the immediate graft patency intraoperatively. This is a prospective study to evaluate the benefit of this new technology in detecting silent technical errors leading to early graft stenosis or occlusion. In a period of 22 months, a prospective study of 112 patients underwent OPCAB with total number of 308 anastomoses. All grafts were tested by transit time flowmetry. The pulsatility index [PI] and the flow pattern wave were used to evaluate the patency of the grafts. These parameters were acceptable in all but 4 grafts [1.2%]. The cause was a technical error in all 4 grafts which were revised. None of these cases required revision on the pump. ECG and hemodynamics were normal in all 4 cases. We concluded that transit time flowmetry is an effective and reliable method in detecting early anastomotic problems in the operating room. Surgeons should be encouraged to use it routinely in the operating room in off- and on- pump technique