Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy for carcinoma of the head of the pancreas, randomized study

Pancreaticoduodenectomy is the primary means of treating cancer head of the pancreas. Associated mortality rates have dropped dramatically in the past decade, but morbidity rates remain high. Patients were divided randomly into two groups:- 1- The first group includes 49 patients have undergone pancreaticogastrostomy. 2- The second group includes 55 patients have undergone pancreaticojejunostomy. The patients were followed for the presence of complications especially pancreatic leak. The study included 104 patients divided randomizly into two groups the first group included 49 patients who had undergone pancreaticogastrostomy and the other group includes 55 patients who had undergone pancreaticojejunostomy. 70% were males, 30% were females, age 74 +/- 13 years. Comparing the complication observed after the two procedures, Multiple complications occurred in 30.6% in patients who undergone pancreaticogastrostomy and 38.18% in patients who undergone pancreaticojejunostomy. With no statistically significant difference between the 2 procedures. No reported mortality in the two groups had been observed. The most common complication observed in the pancreaticogastrostomy group was pancreatic fistula [14.28%] followed by intra-abdominal fluid [8.16%], biliary fistula, bleeding, reoperation [4.08%] each. For the pancreaticojejunostomy group the most common complication observed were pancreatic fistula [20%] followed by intra-abdominal fluid and reoperation [9.09%] each, biliary fistula [5.45%], no bleeding reported. pancreaticogastrostomy is associated with a lower frequency of multiple surgical complications which is not statistically significant and higher incidence of pancreatic fistula in the pancreaticojejunostomy arm

Vascular endothelial growth factor and insulin-like growth factor 1 in malignant and non malignant thyroid

Angiogenesis has been postulated to play an important role in the development of malignant tumors. One of the important proangiogenic factors involved in the growth of normal and neoplastic tissues is vascular endothelial growth factor [VEGF]. VEGF is expressed in normal thyroid as well as in thyroid pathologies such as Graves' disease, thyroiditis, and thyroid cancer. IGF-I is one of the most important growth factors and is needed for the proliferation and development of thyroid cells. To investigate the role of IGF-1 and VEGF in malignant and non malignant Thyroid. Serum and tissue levels of IGF-1 and VEGF were determined by ELISA in 10 Patients with toxic goiter, 10 patients with benign thyroid tumors, 10 patients with thyroid carcinoma and 10 healthy control individuals. There was no significant difference in mean serum levels of VEGF in healthy controls when compared to other groups of the study. However, there was a significant difference in the mean tissue levels of VEGF in patients with thyroid carcinoma, patients with benign thyroid tumors or toxic goiter when compared to those of healthy controls. Moreover, the mean tissue levels of VEGF was significantly higher in patients with toxic goiter compared to those of controls [P<0.05].Using a cutoff value of 3941.10 pg/g for tissue VEGF resulted in sensitivity and specificity of 90%, 100%, respectively for benign thyroid tumors and thyroid carcinoma. Mean serum levels of IGF-1 was significantly higher in patients with thyroid carcinoma when compared to either those of healthy controls or those of patients with toxic goiter. In addition, the mean serum levels IGF-1 was significantly higher in patients with benign thyroid when compared to either those of healthy controls or patients with toxic goiter. While, there was no significant difference in mean serum levels IGF-1 in patients with thyroid carcinoma versus those of patients with benign thyroid. There was no significant difference in mean serum levels IGF-1 in patients with toxic goiter versus those of healthy controls. By using a cutoff value of 360.4 ng /g, the sensitivity, specificity of tissue IGF-1 for toxic goiter were 90%, 100% respectively. Using the same cutoff value the sensitivity and specificity were 100% for both benign thyroid tumors and thyroid carcinoma. Tissue levels of VEGF increased in patients with thyroid carcinoma, patients with benign thyroid tumors and in patients with toxic goiter than in healthy controls. Tissue and serum levels of IGF-1 were increased in patients with thyroid carcinoma, patients with benign thyroid tumors. The risk of cancer is higher among people with raised concentrations of insulin-like growth factor. Ongoing clinical trials will answer if therapy directed towards angiogenesis may be an alternative way to improve outcome in those patients

Primary resection anastomosis of obstructed left colon with intraoperative irrigation in comparison to multi-staged treatment

This study included 30 patients presented with obstructed left colon. The patients were divided into two groups: Group A included 15 patients to whom multistaged procedure was done and group B included 15 patients were subjected to primary resection anastomosis with intraoperative irrigation. It was found that the total mortality was high in the first group [five patients] compared with the second group [three patients]. Apart from the occurrence of the fistula in four cases, the complications were less in group B. The psychic trauma of colostomy and colostomy complications [stenosis, prolapse, retraction and para colostomy hernia] were avoided in group B as well as the stay in hospital was short compared with group A