Association of serum level of vitamin D and VDR polymorphism Fok1 with the risk or survival of pancreatic cancer in Egyptian population

BACKGROUND AND AIMS: Pancreatic cancer (PC) is the fourth most common cause of death from cancer in Egypt. Few studies have been conducted to assess the relationship between vitamin D serum level and vitamin D receptor (VDR) polymorphisms with the survival of PC patients. This is the first study in Egypt to investigate the association of the status of vitamin D serum level and genotypic distribution of single nucleotide polymorphisms (SNP) Fok1 with the risk of developing PC and whether they could detect survival or not. PATIENTS AND METHODS: The study included a total of 47 PC cases that were histopathologically proven to have PC, and 37 controls that were attending at the same time for investigation but proved that they were all PC free. Pre-diagnostic concentrations of vitamin D and VDR polymorphism Fok1 were assessed from all participants in the study. RESULTS: There was a 1.5-fold increase in the serum level of vitamin D in PC patients when compared to non-PC subjects. Regarding VDR Fok1, polymorphism distribution in PC was CC (Wild Type) 26 (55.3%), CT 16 (34%), and TT 5 patients (10.7%). For the control group, CC was found in 24 (64.8%), CT in 12 (32.4%), and TT genotype was found only in one individual 1 (2.8%) with no statistically significant difference between the two studied groups (P 0.72). CONCLUSION: Low serum vitamin D or VDR-SNP is not a risk factor for PC in Egyptian patients. Recommendations to increase vitamin D concentrations in healthy persons for the prevention of cancer and improving overall survival should be carefully considered.

Detection of Helicobacter antigen in stool samples and its relation to H. Pylori positive cholecystitis in Egyptian patients with chronic calcular cholecystitis

Evidences supporting the association between H. pylori infection and chronic cholecystitis could be found by using direct culture or staining of H. pylori in gallbladder tissues as well as indirect techniques. Stool antigen test has been widely used due to its non-invasive nature. Various stool antigen tests were developed to detect H. pylori using an enzyme immunoassay [EIA] based on monoclonal or polyclonal antibodies This study evaluated the frequency of H. pylori antigen in stool samples of patients with chronic calcular cholecystitis as regard gall bladder histopathological changes. -Fifty patients were included presented with symptomatic cholecystolithiasis recruited from the outpatient clinic of National Hepatology and Tropical Medicine Research Institute during 2014-2015. Full history and clinical examination and abdominal ultrasonography were performed. Stool samples were collected, prepared and examined for detection of H. pylori antigen. Cholecystectomy was done for all patients; 45 patients [90%] by laparoscopic Cholecystectomy and 5 patients [10%] by open surgery and removed gallbladders were submitted to pathology department for detection of H. pylori in tissue under microscope using Giemsa stain. The results showed that [82%] were females with mean age [42.6+1years]. The mean BMI was [29+7.2] H. pylori-specific antigen in stool samples was detected in 40% of patients and38% were detected in patients; tissue, with significant correlation between H. pylori-specific antigen in stool and in tissue. Histopathological pictures infection in tissue were 68.4% mucosal erosions, 63.2% mucosal atrophy, 57.9% mucosal hyperplasia, 26.3% metaplasia, 42.1% musculosa hypertrophy, 26.3% fibrosis, but lymphoid aggregates were in 42.1% of cases

Value of prophylactic drainage after cholecystectomy: a retrospective study

Detection of the value of prophylactic drainage after cholecystectomy. A retrospective study which was carried on 98 patients to whom cholecystectomies were done in NHTMRI between January 2008 and October 2010. The patients were divided into two groups concerning the surgical technique whether open or laparoscopic; further subdivision into two groups where prophylactic drain was fixed or not was done. During the period of the study, 98 cholecystectomies were done, 56 cases were done laparoscopically [prophylactic drains were fixed in 12 cases and the remaining 44 without drains]. The other 42 cases were done by open surgical technique [40 cases with drains and 2 without]. Post-operative follow up revealed faster return to normal gastrointestinal activity and earlier hospital discharge in the no drain group. Prophylactic drain placement cannot be advocated following simple cholecystectomy either laparoscopic or open

Laparoscopic cholecystectomy as a day surgery procedure: is it safe?-an Egyptian experience

Major surgery performed as a day surgery procedure is not uncommon. The aim of this study is to evaluate the feasibility of day surgery procedures in laparoscopic cholecystectomy [LC]. A total of 210 patients scheduled for elective LC between 2006 and 2008 were included in our study. The mean age was 40.63 years [range, 25 - 70 years]. The indication for surgery was symptomatic cholelithiasis confirmed by ultrasonography without clinical or radiological evidence of acute cholecystitis. All patients were informed about the same-day discharge policy and received the postoperative instruction form on discharge. Preoperative work-up included history taking and physical examination in addition to standard laboratory and radiological tests. Patients above 35 years of age had an ECG done. All patients were examined in the outpatient clinic by a consultant anesthesiologist the night before surgery. Operative time, hospital stay, and complications were recorded. Telephonic feedback, on the morning after surgery was routinely done as an early follow-up. Out of the total number of patients, 140 patients were ASA [I] and 70 were ASA [II] [40 patients were controlled hypertensives and 30 were controlled diabetics]. Conversion rate was 1.4%. The mean hospital stay was 6.7 hours [range, 6-8 hours]. The mean operative time was 31.2 minutes [range, 20 - 60 minutes]. None of the patients required an abdominal drain. No morbidities or mortalities were reported in this series. LC may be done as a day surgery procedure with optimal patient satisfaction and without complications

Laparoscopic cholecystectomy in liver cirrhosis patients: an Egyptian experience

Cirrhosis represents a common histologic pathway for a wide variety of chronic liver diseases. Hepatitis C virus [HCV] is the most important cause of liver cirrhosis in Egypt. Although cirrhosis has been regarded as a relative contraindication for laparoscopic cholecystectomy [LC] due to bleeding complications and subsequent liver failure, several reports support the safety of LC in selected patients. A prospective study to evaluate the efficacy and safety of laparoscopic cholecystectomy in cirrhotic patients. 177 hepatitis C positive patients with chronic calculus cholecystitis, scheduled for cholecystectomy, were included in this study between Jan. 2009 and Mar. 2010 where laparoscopic cholecystectomy was performed to them after fulfilling the inclusion criteria. Two risk stratifications schemes have been used to estimate the perioperative risk of patients with cirrhosis; the Child-Turcotte-Pugh [CTP] score and the Model for End-stage Liver Disease [MELD] score. 177 liver cirrhosis patients with chronic calcular cholecystitis scheduled for LC represented the population of this study. All patients were HCV positive patients with Child A class cirrhosis and MELD score < 9. Mean surgical time: 55 minutes, surgical difficulty varied between average in 64%, moderate in 28% and extensive in 8% where 3.4% needed conversion to open cholecystectomy. Postoperative follow up of all cases was multidisciplinary approached by both surgeons and hepatologists. All cases showed sound recovery confirmed by abdominal sonar to exclude intra-abdominal collections and application of both CTP and MELD scores, where all cases kept class A Child score and MELD score < 9. Laparoscopic cholecystectomy is a safe procedure for hepatitis C positive cirrhotic patients when established risk stratifications systems such as CTP and MELD scores are used for evaluation

Detection of helicobacter pylori in hepatic tissue of patients with chronic hepatitis c and hepatocellular carcinoma: [immunohistochemical study]

Recent studies have suggested that bacterial coinfection with Helicobacter species in patients already infected with hepatitis C virus [HCV] could be involved in the development of cirrhosis and hepatocellular carcinoma [HCC]. A retrospective study was performed in order to explore the association between Helicobacter pylori and HCV in hepatic tissue of Egyptian patients with chronic hepatitis C and hepatocellular carcinoma. The presence of Helicobacter pylori was tested by immunohistochemistry on liver samples from two groups of patients; chronic hepatitis C [group I, n = 45] and hepatocellular carcinoma [group II, n = 15]. Group I [chronic hepatitis C] involved 31 males and 14 females [male/female, 2.2:1]. Their age ranged from 27 to 58 years with a mean of 45.8 +/- 7.0 years and HCC group involved 11 males and 4 females [male/female, 2.8:1]. Their age ranged from 48 to 78 years with a mean of 60.2 +/- 10.0 years. Immunostaining revealed H. pylori microorganisms in 33/45 biopsies [73.3%] of chronic hepatitis C group and 5/15 [33.3%] of HCC group [p = 0.005]. H. pylori organisms were present in liver tissues of HCV and HCC patients with significantly higher proportion in the former. Further studies are needed to ascertain its possible role, if ever, in the pathogenesis of cirrhosis and hepatic malignancy in Egyptian patients

Etretinate in the management of harlequin siblings.

Harlequin fetus is the severe form of congenital ichthyosis. There are very few reports of babies with this condition surviving the first few weeks of life. We treated two siblings who lived for 22 months and six weeks respectively. We started treatment with oral etretinate every early in their lives and achieved good improvement in the skin condition of these babies.