Initial experience of surgical microwave f issue precoagulation in liver resection for hepatocellular carcinoma in cirrhotic liver

Surgical hepatic resection has been considered as the first-line treatment which is most effective and radical treatment for HCC, however, HCC is usually associated with poor liver function owing to chronic hepatitis or liver cirrhosis. Techniques that can eradicate the tumor and also preserve liver function are needed. Moreover, hepatic resection, in the presence of cirrhosis, raises special problem of high risk as hemorrhage and liver failure, thus, good clinical results can only be achieved by minimizing operative blood loss, time of the intervention as well as the hepatic reserve. The tremendous progress in microwave technology has recently attracted considerable attention. This study evaluated the feasibility of this new liver transection technique demonstrating the high performance of this procedure, the accuracy in terms of squeeze effect on veins and portal branch and in terms of reducing the intra operative blood loss, and minimizing the operative time for safe hepatectomy.Twenty-six consecutive patients a first-time diagnosis of hepatocellular carcinoma [HCC] on top of liver cirrhosis were recruited for the study, from August 2011 to January 2013.A11 patients were subjected to full clinical examination, laboratory investigations, abdomen ultrasound [U/S], triphasic computed tomographic liver scan [CT] and dynamic magnetic resonance imaging [MRI] in some doubtful cases. Inclusion requirements were presence of resec-table disease without vascular invasion or extrahepatic spread at imaging, Child-Pugh class A and B [Score 7] liver cirrhosis, [INR]< 1.6or platelet count >60 000/mm3 with no previous treatment. Patients were treated by applying pre-coagulation of the liver transection lines using microwave probe positioned in parallel to the line of resection by open approach after intra-operative U/S assessment for localization of the tumor and line of resection.The procedures were performed under general anesthesia. Mobilization of the liver was not necessary to be done in all cases. Intra-operative ultrasound [Aloka, Tokyo, Japan] was used to exclude lesions not detected pre-operatively [operative surprise], to define the location, number and size of the tumor and to identify large intra-hepatic large vascular and biliary structures, and guide insertion of the microwave applicator. Intraoperative ultrasound was used again, to assess that the line of resection was done. Primary endpoints documented were total operative time, time for liver parenchyma transection, intraoperative blood loss and blood transfusion requirements. Secondary endpoints included postoperative complications, mortality and intensive care unit [ICU] together with hospital stay

Dry vesicostomy in the management of urinary incontinence and bladder dysfunction in children

Experience in using a vesicostomy technique in the management of urinary incontinence and bladder dysfunction in children and adolescent is presented. The operation creates a permanent, dry, catheterizable cutaneous vesicostomy. Clean intermittent catheterization [C.I.C.] via the vesicostomy stoma keeps the intra- vesical pressure below the urethral closing pressure and prevents urinary leakage. Sixteen patients with incontinence and lower urinary tract dysfunction were operated. Dryness was achieved in nine patients and compliance in using catheterization perstoma was excellent in 13 out of 16. The operation described when performed in selected patients proved to be simple with low morbidity and good functional result

Studies of leukocytic enzymes in vitamin A deficiency

A study was carried out on 300 rats to reveal the effect of vitamin A deficiency on total protein, alkaline phosphatase [ALP], acid phosphatase, and lactic acid dchydroggenase [LDH] in the leukocytes extraction. It was found that serum level of retinol was significantly reduced in vitamin A deficient rats. Hypovitaminosis A was accompanied by significant reduction in total protein in leukocytes extract in deprived rats as compared t control ones. Vitamin A deficiency also had an effect on lcukocytes enzymatic activity as the ALP, ACP ACP and LHD enzymes in WBC[s] extract were significantly decreased in deficient rats as compared to control ones

Effect of vitamin A deficiency on lymphocytes and immunity

This study was done on 300 rats of 3 weeks age, divided into 2 groups: 200 rats were maintained on vitamin A deficient diet. Vitamin A levels in both serum and liver of deficient rats were greatly reduced as compared to control ones. Vitamin A was found to have an effect on growth where the body weight and organs weight in deficient rats were significantly decreased as compared to control groups. Vitamin A deficiency is accompanied by changes in protein synthesis with a significant reduction in total protein in serum and liver in deprived rats as compared to control ones. The change in protein in turn affects antibody production. Vitamin A has a role in protection againts infection, where severe vitamin A deficiency leads to increased susceptibility to infection. This is due to the mucous membranes beeing damaged by the vitamin A deficiency to the extent that natural barriers is weakened which is partly attributable to the decrease in lymphocytic tissue function and number where there is a marked leukopenia and decrease in the percentage of lymphocytes in deprived rats as compared to control ones. Hypovitaminosis A not only affects the number of the cell [leukopenia] but also it affects the capacity and function of these cells to respond E. coli polysaccharide antigen in vitamin A deficient rats indicating lack of cell mediated immune response. Vitamin A plays a role in biosynthesis of gamma- globulins where the immunoglobulins [IgG, IgM and IgA] were decreased significantly in deprived rats as compared to controls i.e. vitamin A deficiency impaired humoral immunity

Splenic artery ligation and vasoligation in the management of bleeding oesophageal varices

The effects of splenic artery ligation combined with vasoligation of the short gastric, left gastric vessels and veins around the abdominal esophagus were studied in 20 patients with bleeding esophageal varices. Follow-up period varied between 18-24 months. The liver pathology was bilharzial fibrosis in 17 [85%], mixed in 2 [10%] and post-hepatic cirrhosis in one [5%]. The patients were classified according to the modified Child's Risk Grading into grade A [20%], B [60%] and C [20%]. The drop in portal pressure varied between 23 and 5 cm/H20 [mean 8.1 cm/H20]. Recurrent bleeding after 20 months occurred in one [5%]. Postoperative ascites developed in four [20%], but was easily controlled medically. All the patients showed improvement in the peripheral blood picture. Deterioration in liver function tests occurred in one patient. None of the patients developed splenic abscess or cysts. Endoscopic follow-up showed that the varices did not disappear, but progressed. There was no operative mortality. One patient [5%] died two months postoperatively from progressive liver failure. The preliminary results of this line of treatment are encouraging, but longer follow-up is still needed

Acetylcholine esterase enzyme study of the myenteric plexus in infantile hypertrophic pyloric stenosis

Phyoric tissues from 13 infants with infantile hypertrophic pyloric stenosis and 4 normal control were studied using acetylcholine esterase enzyme apparent reduction in the number of the cholinergic ganglia in the intermuscular plexus was seen. Increased demand and compression by the hyper-atrophied muscles Lare new meatus was achieved. Only one developed a fistula. In this preliminary study the operation has proven to be technically simple with few complications

Modification of the Mathieu and Horton-Devine urethroplasty in the management of hypospadias

A one-stage urethroplasty based on the Mathieu and Horton-Devine operation is described. The operation was carried out on 10 boys with distal and mid-penile hypospadias. In all of them a terminal position for the new meatus was achieved. Only one developed a fistula. In this preliminary study the operation has proven to be technically simple with few complications

Primary reconstruction of bladder exstrophy: a report on the early results of the operation

Primary reconstruction of bladder extrophy was carried out on five children at Ismailia General Hospital. Successful repair was achieved in four of them. The details of the technique are presented. The early results are encouraging; however, final assessment of the functional results needs longer follow-up and could only be made after attempting correction of the genital aspect off the problem

Histochemical studies of alkaline phosphatase in different hamster tissues with schistosoma mansoni

Alkaline phosphatase [AP] was studied histochemically in different hamster tissues after Schistosoma mansoni infection. The results showed that the spleen AP increases in early stage after infection, suggesting immunological function for the spleen. In the liver, the AP content increased after the 5th week of infection. The site of the enzyme was shown to be around the endothelium of the blood vessels and blood sinusoids. After infection, the enzyme contents increased in the same sites as before infection, and in addition, there was deposition of the enzyme around and on the ova. In the normal intestine, AP was located in the epithelial surface, which decreased after infection and was replaced by higher content around and on the ova. Kidney AP did not show any change after infection, in quantity or site

Congenital and segmental obstructive Emphysema

Our experience with congenital obstructive emphysema is reviewed with special reference to problems in diagnosis and management. A flow chart for the diagnostic approach is presented. Two cases with segmental involvement of the emphysema are documented and the pathogenesis discussed. Treatment of congenital obstructive emphysema in the neonate or infant with respiratory distress is usually lobectomy. However for older children with mild symptoms, a conservative policy of treatment is justified

Endogenous sex hormones and basal gastric secretion

The effect of endogenous sex hormones on basal gastric secretion was studied in both male and female rats. Using female rats, the secretion was studied in non-pregnant, early pregnant, full term pregnant and pseudo-pregnant animals. No significant difference was found between males and non-pregnant females. True pregnancy resulted in progressive decrease in the volume and acidity of the basal gastric secretion. Peptic activity was significantly increased in early pregnancy and significantly decreased, below the basal level, at full term. Pseudo-pregnancy did not affect the basal gastric secretion, except for a significant decrease in free acidity