Laparoscopic gastric bypass for the treatment of morbid obesity

Many authors consider Roux-en-Y gastric bypass [RYGBP] to be the "gold standard" in surgery for morbid obesity. However, laparoscopic RYGBP is arguably the most challenging minimally invasive procedure in general surgery and its learning curve is steep and difficult. The aim of this study was to study the feasibility, safety, and effectiveness of laparoscopic Roux-en-Y gastric bypass [LRGBP] in the treatment of morbid obesity. This study included 30 consecutive morbidly obese patients that underwent attempted laparoscopic RYGBP. Only patients who had a previous open upper abdominal surgery and/or BMI> 60 kg / m[2] were excluded. A prospective analysis was performed identifying the technical success, operative times, complications, length of hospital stay, and weight loss. Open conversion was required in one patient [3.3%]. There were no leaks at the gastrojejunal anastomosis, but one patient died because of gastrointestinal leak from a traumatic perforation. The mean operative time was 215 minutes. The average hospital stay was 3.4 days. One patient required endoscopic balloon dilation for stenosis at the gastrojejunostomy. Another patient required surgery for internal hernia. Patients were followed up for a mean of 21.3 months. Average excessive weight loss was 74.8%. Laparoscopic RYGBP is feasible, but it is a very complex operation. Our data showed adequate short-term weight loss and marked correction of co-morbidities. The complication rates are acceptable in the very beginning of our experience, which includes our learning curve for the procedure

Expression and prognostic significance of P-glycoprotein [MDR-1] in infiltrating duct carcinoma of the breast

Breast cancer is a major public-health issue worldwide. It is the most common cancer in women constituting 22% of all cancer cases world wide. Until recently, breast cancer was subclassified on the basis of cellular morphology and the presence of several receptors, namely ER, PgR, and the Her2, identified by immunohistochemistry. The present study was designed aiming to determine the expression of P-glycoprotein in infiltrating ductal carcinoma [IDC] patients, to correlate the expression of P-glycoprotein with other clinical and pathological parameters and to ascertain whether pretreatment detection of P-glycoprotein in patients with breast cancer could be utilized as a reliable predictor of poor prognosis. The present study constituted thirty nine cases of IDC received at the pathology department during one year beginning at January 2004. For all studied cases, routine histopathologic diagnosis and immunodetection of P-gp, ER, PgR and Her2 were carried on. Retrospective follow up of the patients for period of 2-3 years after the mastectomy operation was carried on with statistical analysis of the results. ER positive status was encountered in 10 cases [25%]. PgR positive status was encountered in 14 cases [35.9%]. A statistically significant association was detected between both ER and PgR expression and nuclear grade [P=0.002, p=0.017]. Her 2 positive immunostaining was detected in 12 cases [30.8%]. P-gp was detected in 26 cases [66.7%]. Statistically significant association between P-gp and Her2 expression was found [p=0.027]. The present study detected that ER negativity [p=0.009], nuclear grade III [P=0.06] and triple-negative molecular subtype [P=0.017] were associated with poor local recurrence-free survival [LRFS]. Her2 positivity [P=0.06] and lymph node metastasis [P=0.08] were associated with poor distant-metastasis free survival [DMES]. Her2/neu IDC that express P-gp had the poorest DFS. Pretreatment detection of P-gp is of great value to predict the response to chemotherapy in patients with Her2 -positive and triple negative infiltrating ductal carcinomas

Non-operative management of stable patients with abdominal stab wounds: is it feasible in Egyptian patients?

Non-therapeutic laparotomy morbidity rate in patients with stab wounds is approximately 40% . Selective conservative management, rather than mandatory laparotomy, is a better approach. We studied patients with penetrating abdominal stab wounds admitted to Alexandria Main University Hospital [Referral hospital] during 5 years from January 2001 to December 2005. This study included total 308 stabs in 275 patients, mean age 33 years [range 12-75 years]; 246 [89%] male. Mean admission systolic blood pressure of negative laparotomy in was 115 mm Hg [range 60-155 mm Hg]; while for positive laparotomy it was 90 mm Hg [range 45-140 mm Hg]. 236 [85%] only had US, and 182[65%] had CT. 112 [47%] of them bad positive clinical and/or imaging results, all underwent laparotomy: 99 [88%] therapeutic, 13 [12%] negative. In patients with negative clinical as well as US and CT, only 63[35%] had successful non-operative management and 107 [65%] had laparotomy, which was unnecessary negative in 98 [95%]. CT accurately predicted laparotomy need in 1 65/1 82 [91%] patients. In patients with penetrating stab abdominal wound, hypotension was the main clinical indicator for urgent operation. In hemodynamically stable patients, abdomino-pelvic CT with contrast bad high sensitivity to predict need for laparotomy

Study of genetic predisposition in Egyptian colorectal cancer patients: role of phase II xenobiotic metabolizing genes polymorphism

The glutathione S-transferase [GST] supergene family is an important part of cellular enzyme defense against endogenous and exogenous chemicals, many of which have carcinogenic potential. The present investigation was conducted to evaluate the possible association between genetic polymorphisms of glutathione S-transferase M1 and T1 [GSTM1 and GSTT1], and susceptibility to colorectal cancer and the interaction with environmental factors. A case-control study of 50 patients and 50 healthy controls was conducted to investigate the role of GSTM1 and GSTT1 polymorphisms in colorectal cancer. Genotypes of GSTM1 and GSTT1 polymorphisms were analyzed by multiplex polymerase chain reaction [PCR]. The frequencies of GSTM1 null and GSTT1 null genotypes in controls were 42% and 16%, respectively. The GSTM1 polymorphism was associated with an increased risk of developing colorectal cancer [p=0.002; OR=3.9, 95% CI 1.68- 9.15]. There was no significant association between GSTT1 null genotype and colorectal cancer risk. The GSTT1 deletions was associated with an increased risk of developing distal tumour [OR =5.25, 95% CI: 1.6-16.7, p=0.006]. GSTM1 null genotype was significantly more common in patients who were diagnosed before the age of 40 years than in those who were diagnosed at an older age. This suggests that the GSTM1 genotype might influence the age of onset of colorectal cancer. In conclusion, the results of the present study suggest that GSTM1 null genotype and combined GSTM1/T1 null genotypes may confer a genetic susceptibility to colorectal cancer. In addition, other environmental factors such as smoking may also have a contributing role

Scoring of acute pancreatitis and its impact on consequent treatment

Acute pancreatitis is a serious disease in surgical practice which may have fatal outcome. The aim of this study was to evaluate the benefits of assessing the severity of acute pancreatitis using various scoring systems and to determine their impact on consequent treatment and prognosis. Nineteen patients were studied in a series. The Ranson's, APACHE II, Multiple organ system failure [MOSF] and abdominal CT scoring systems were used. Seventeen patients [89.4%] had Ranson's score <3, APACHE II score 1-4, CT scoring 0-2 and MOSF score 0. They had clinically mild acute pancreatitis and recovered without mortality. Another 2 patients [10.6%] had Ranson 's score 4 and 6 respectively, APACHE II score 14 and 15, CT scoring 2 in early stage and 3 in late stage; and MOSF score 0 in early stage and 3 in late stage. These two patients developed clinically severe disease with pancreatic necrosis and abscess. Both developed multiorgan failure and died inspite of intensive medical therapy and surgical intervention. Scoring of acute pancreatitis allowed prompt identification of patients with severe disease in need of intensive care unit referral and allowed following up of the course of the disease. Simultaneous scoring by different scoring systems gave better evaluation especially by scores that can be repeated as APACHE II and CT scores. Multiorgan failure was associated with mortality. Endoscopic sphincterotomy was guided by the present pathology rather than the scoring. Infected pancreatic necrosis was an indication for surgical intervention but it still has bad prognosis in spite of early scoring, intensive therapy and surgical intervention

Haptoglobin gene polymorphism in type 2 diabetic patients with and without nephropathy

The development and progression of diabetic microvascular complications including nephropathy are related to the degree of glycemic control and oxidative stress and may be influenced by genetic factors. The aim of the present study has been to investigate the association between haptoglobin [Hp] gene polymorphism and the occurrence of diabetic nephropathy in patients with type 2 diabetes mellitus and to find a possible link between haptoglobin phenotypes and inflammatory parameters; serum C - reactive protein [CRP], interleukin- 6 [IL - 6] and haptoglobin. The study included 60 normotensive type 2 diabetic patients of more than 5 years duration categorized in 3 equal groups according to urinary albumin excretion [UAE] into normo, micro and macroalbuminuric. In addition, 20 individuals of matched age and sex were selected to serve as a control group. Serum CRP, IL - 6 and haptoglobin concentrations were measured and haptoglobin phenotyping was conducted using polyacrylamide gel electrophoresis. The frequency of haptoglobin phenotype 1- 1 [Hp 1 - 1] in diabetic patients with normoalbuminuria was 7 of 20 [35%] as compared with diabetics with macroalbuminuria, 1 of 20 [5%] [p = 0.02] however, the frequency of Hp 2-2 was greater in diabetics with macroalbuminuria, 12 of 20 [60%] as compared with those with normoalbuminuria or controls, 5 of 20 [25%] [p= 0.03]. Patients with diabetic nephropathy [micro- or macroalbuminuria] had higher levels of serum CRP IL-6 and haptoglobin than those without nephropathy [normoalbuminuria]. Serum haptoglobin levels in type 2 diabetics were higher in Hp phenotype 2-2 as compared with Hp 1-1 however, serum CRP and IL - 6 levels did not differ significantly between haptoglobin phenotype groups. Moreover, there was significant positive correlations between urinary albumin excretion and serum levels of CRP, lL-6 and haptoglobin in diabetic patients. From this study, it could be concluded that haptoglobin phenotype 2-2 is considered as a major susceptibility gene for the development of nephropathy in type 2 diabetic patients. In addition, the significant association between inflammatory parameters and UAE indicates that inflammation may be a pathogenic mechanism of renal injury in type 2 diabetics. Moreover, serum interleukin - 6 and haptoglobin may be good prognostic factors for the development of nephropathy in the course of diabetes mellitus

effect of cimetidine on portal hypertension due to schistosomal hepatic fibrosis

The effect of cimetidine on portal hypertension due to schistosomal hepatic fibrosis was studied. The portal pressure was measured during laparotomy in 10 patients before and after intravenous administration of 400 mg cimetidine, no significant drop of portal pressure occurred. It is therefore unlikely that cimetidine would be of use in the treatment of portal hypertension due to schistosomal hepatic fibrosis

Fiberoptic esophagoscopy versus oesophagography in the diagnosis of oesophagial varices

Comparing the diagnostic yield of oesophageal varices by oesophagoscopy and oesophagography in 100 patients with schistosomal hepatic fibrosis. Endoscopy showed varices in 79 patients while only 51 patients showed varices by oesophagography. In 20 patients with positive findings on endoscopy and a negative conventional oesophagography, varices could be detected in nineteen patients by hypotonic oesophagography

value of fibre endoscopy in the diagnosis of gastro-duodenal dyspepsia

150 patients with gastroduodenal dyspepsia were examined endoscopically, the additional information obtained by endoscopy in patients already examined by barium studies was assessed. In duodenal ulcers 73% were diagnosed by barium studies, the accuracy of endoscopy was 98%. Most cases of advanced carcinoma of the stomach were diagnosed radiologically. However, endoscopy yielded two patients with early mucosal carcinoma. Endoscopy was essential in the diagnosis of chronic gastritis. A large percent [22%] of patients had negative radiological and endoscopic findings inspite of persistent dyspepsia

Effect of gastro-oes ophageal decognestion "Hassab's operation" on liver functions in patients with hepatic schistosomiasis and ascites

A battery of liver function tests including estimations of serum bilirubin, turbidity tests, serum protein, prothrombin activity, serum alkaline phosphatase and transaminase, was done before and after Hassab's decongestion operation in twelve male hepatic schistosomiasis patients with resistant ascites. Decrease of zinc sulphate turbidity, serum enzymes, total globulins together with increase of serum albumin and prothrombin activity was recorded after operation. Improvement of hepatic and intestinal blood flow, splenectomy, amelioration of hepatic functions and renal haemodynamics are supposed to be underlying factors