protective effect of insulin against isoflurane and sevoflurane induced hepatocellular apoptosis

Several studies deducted that inhalational anesthetics induce apoptosis in human cells. Insulin is believed to have an antiapoptotic action so it is widely used as cardioprotective agent against ischemic reperfusion injuries. This study compared the apoptotic effect of inhalational anesthetics and figuring out the antiapoptotic effect of insulin against perioperative induced hepatocellular apoptosis using immune histochemical study of liver biopsy. Eighty [ASA I] patients scheduled for laparoscopic cholecystectomy were randomly allocated into 4 groups [20 patients each]. Two groups were anesthetized using isoflurane and the other two were anesthetized using sevoflurane. The control groups [IC, SC] received normal saline and the insulin groups [II, SI] received glucose, insulin and potassium [GIK] infusion. Infusions were given 2 hours before induction of anesthesia. Liver biopsy was taken before the umbilical port closure. In liver biopsy Caspase 3, 7, 9 and Akt activity were evaluated. Liver function tests were estimated before infusion and one day after surgery. Serum K and blood glucose levels were closely monitored all through the study. The results showed that in the isoflurane groups, the percentage of caspase 3 and 7 positive cases decreased while Akt positive cases increased significantly in II compared to IC respectively [p < 0.05]. In the sevoflurane groups, the percentage of caspase 3 positive cases decreased significantly in SI compared to SC group [p < 0.05]

Comparison between the efficacy of transureteral lithotripsy and extracorporeal shock wave lithotripsy in the treatment of distal ureteral stone

Objective: To compare the efficacy, cost effect and safety of extracorporeal shock wave lithotripsy [ESWL] and ureteroscopy [URS] for distal ureteric calculi by evaluating stone-free rates, retreatment rates, need for auxiliary procedures, associated complications and technical consideration with respect to patient satisfaction

Patient and method: 70 patients with single unilateral radiopaque distal ureteric stone ranges from 0.8 cm to 1.2 cm in diameter and >/=1.5 cm in length were enrolled in a prospective randomized trial. Patients were randomized to undergo URS [35] or ESWL [35]. The electromagnetic Dornier lithotripter S was used for ESWL and a semi-rigid Olympus ureteroscope, 7[degree sign] direction of view, angled ocular,8.6/9.8 Fr. x 43 cm, 6.4 Fr. channel was used for URS. Patient and stone characteristics, treatment parameters, clinical outcomes, and patient satisfaction were assessed for each group

Results: Patients in the ESWL group achieved a 77.1% overall stone-free rate [SFR] with a 74.3% retreatment rate and no auxiliary procedure was done. Complications occurred in 11.4% of patients treated with ESWL. Patients in the URS group achieved a 97.1% overall SFR with a retreatment rate of 8.6% and an auxiliary procedure rate of 100%. Complications occurred in 31.4% of patients treated with URS. Patient satisfaction was high for both groups, including 94.3% for URS and 77.1% for ESWL. ESWL were already at outpatient clinic so there were no admission or hospital stay. While in URS group patients admitted with mean hospital stay 1.6+/-0.5 day

Conclusions: In the treatment of large distal ureteral calculi >/= 1.5 cm, both URS and ESWL modalities are comparable but URS is recommended as a first option as it is more effective than ESWL regarding stone-free rate and it provides immediate stone clearance with lower retreatment rates and higher patient satisfaction

Non-invasive assessment of liver fibrosis in patients with hepatitis C: shear wave elastography and colour Doppler velocity profile technique versus liver biopsy

Background and study aims: Determination of the presence and degree of liver fibrosis is essential for the prognosis and treatment of patients with chronic hepatitis C. Non-invasive methods of assessing fibrosis have been developed to reduce the need for biopsy. We determined the efficacy of shear wave elastography [SWE] and colour Doppler velocity as non-invasive methods for the assessment of liver fibrosis compared to liver biopsy among patients with chronic hepatitis C virus [HCV] infection

Patients and methods: In total, 117 patients with chronic HCV infection and 50 healthy age- and sexmatched control subjects were included. For each patient and control, abdominal ultrasonography, Doppler ultrasonography of the right portal vein [PV], and SWE were performed, whereas liver biopsy was performed for patients

Results: The mean value of the right PV maximum velocity was lower in patients with different stages of fibrosis than in controls [p < 0.001]. The mean value of liver stiffness determined by SWE was significantly higher in patients with different stages of fibrosis than in controls. Cutoff values for liver stiffness determined by SWE for assessing fibrosis stages were F2 >/= 4.815, F3 >/= 6.335, and F4 = 7.540 with a sensitivity of 84.6%, 96.2%, and 100.0%; specificity of 88.5%, 93.8%, and 100.0%; positive predictive value [PPV] of 93.6%, 98.0%, and 100.0%; negative predictive value [NPV] of 74.2%, 88.2%, and 100.0%; and overall accuracy of 85.9%, 95.6%, and 100.0% [area under the ROC curve [AUC]: 0.89, 0.96, and 1.0], respectively. Cutoff values for the right PV maximum velocity for assessing fibrosis stages were F2 < 23.4, F3 < 21, and F4 < 20 with a sensitivity of 65.0%, 57.4%, and 57.1%; specificity of 59.8%, 76.4%, and 75.5%; PPV of 33.8%, 58.3%, and 32.0%; NPV of 84.4%, 75.7%, and 89.7%; and overall accuracy of 61.1%, 69.5%, and 72.5% [AUC: 0.614, 0.696, and 0.625], respectively

Conclusion: SWE is effective for the non-invasive assessment of liver fibrosis in patients with HCV infection. SWE provides a more accurate correlation with liver fibrosis stage than colour Doppler velocity profile for the assessment of liver fibrosis, especially in advanced stages [F3 and F4]

One-stage percutaneous triple procedure for treatment of endoscopically unmanageable patients with malignant biliary obstruction and marked ascites

Background and study aims: To assess the feasibility, safety and efficacy of one-stage percutaneous triple procedure including; ascites drainage, primary metallic biliary stenting, and tract embolisation with N-butyl 2-cyanoacrylate [NBCA], in treatment of patients with malignant biliary obstruction and marked ascites

Patients and methods: This study involved 25 patients with malignant biliary obstruction and marked ascites [age range, 46-78 y; mean age +/- SD, 65 y +/- 5] for whom endoscopic treatment failed or was unsuitable. Ascites drainage, percutaneous primary metallic biliary stenting, and tract embolisation with lipiodol/NBCA mixture were performed in a one-stage procedure. The mean +/- SD follow up period was 26 +/- 2 weeks

Results: The technical and clinical success rates were 96% and 88% respectively. No procedure related deaths or major complications were observed. The reported minor complications included; moderate pain and vomiting during and after balloon dilation, postprocedural cholangitis, and bile leakage in 44%, 16%, and 8% of the patients respectively. Primary stent patency was achieved in 96%. The 30-days mortality was 8%. The stent obstruction occurred in 3 [13%] of the 23 patients who survived more than 30-days

Conclusions: Percutaneous drainage of ascites followed immediately by primary biliary stenting, together with tract embolisation with NBCA is technically feasible, safe, and effective alternative palliative treatment for endoscopically unmanageable patients with malignant biliary obstruction and marked ascites

Correlation between hepatitis B surface antigen titers and HBV DNA levels

To assess the correlation between serum HBsAg titers and hepatitis B virus [HBV] DNA levels in patients with hepatitis B envelop antigen-negative [HBeAg -ve] HBV genotype-D [HBV/D] infection. A total of 106 treatment- na‹ve, HBeAg -ve HBV/D patients were included; 78 in the inactive carrier [IC] state and 28 in the active hepatitis [AH] stage. HBV DNA load and HBsAg titers were tested using TaqMan real-time polymerase chain reaction [PCR] and automated chemiluminescent microparticle immunoassay, respectively. The median [range] log10 HbsAg titer was significantly lower in the IC group compared with AH group, 3.09 [-1 to -4.4] versus 3.68 [-0.77 to 5.09] IU/mL, respectively; P < 0.001. The suggested cutoff value of HBsAg titer to differentiate between the two groups was 3.79 log10 IU/mL. In addition, there was a significant positive correlation between HBsAg and HBV DNA levels in the whole cohort, AH, and IC groups [r = 0.6, P < 0.0001; r = 0.591, P = 0.001; and r = 0.243, P = 0.032, respectively]. Serum HBsAg titers may correlate with HBV DNA in treatment-na‹ve HBeAg -ve HBV/D patients, and supports the use of HBsAg levels in clinical practice as a predictor of serum HBV DNA levels.

Inflammatory bowel disease in Saudi Arabia: a hospital-based clinical study of 312 patients

The epidemiology, clinical characteristics, and natural course of inflammatory bowel disease [IBD] in Saudi Arabia are still largely unknown. Hence, we decided to conduct a large retrospective, cohort study to determine these features of the disease. Retrospective study conducted in a tertiary care hospital in Riyadh from January 1970 to December 2008. We reviewed all the cases of IBD diagnosed and collected all data pertaining to patients with IBD. A total of 312 patients with IBD were included for this analysis, including 197 [63%] patients with Crohn disease [CD] and 115 [37%] patients with ulcerative colitis [UC]. The mean age [standard deviation] of patients with IBD was 25.5 [10.6] years; 152 [48.7%] were males and 160 females. The referral rate in the past 10 years was 72.1% compared with preceding 20 years, and 56% [n=178] of patients with IBD were from the central region of Saudi Arabia. The patients were followed up for a mean duration of 9.5 years; during their follow-up, 206 patients [66%] required hospital admission and 9 patients [2.9%] with UC developed colon cancer. A total of 6 patients died during the follow-up. Fifty-three percent [n=104] of the patients with CD underwent surgeries as part of their treatment, whereas only 20% [n=23] of the patients with UC underwent colectomy. The incidence of IBD has been gradually increasing in Saudi Arabia over the years. Clinical features and morbidity in patients are not different from patients with IBD seen in the West

Wilson disease in 71 patients followed for over two decades in a tertiary center in Saudi Arabia: a retrospective review.

Wilson disease [WD] is a rare autosomal recessive disease. Our objective was to describe the diverse patterns, therapies, and outcomes of this disease. A retrospective study over two decades on WD patients in a tertiary care center in Saudi Arabia. Clinical and laboratory findings of 71 patients with WD were retrieved from their charts, referral notes and our hospital electronic records and were analyzed. The mean age and standard deviation was 16.8 [10.7] years and 56.5% were males. The main manifestations of WD were hepatic, neurological, and mixed in 39 [54.9%], 12 [16.9%], and 20 [28.2%] patients, respectively, and 11 [15.5%] were asymptomatic cases detected by family screening. A family history of WD was positive in 41 [57.7%] patients, and consanguinity of parents was found in 26 [36.6%] patients. The mean [SD] follow-up period was 92.2 [72.9] [range, 1-320] months. Ten [14.1%] patients died during follow up, while 45 [63.4%] and 16 [22.5%] were still on or lost from follow-up, respectively. The mean [SD] age at the end of follow-up was 25.3 [12] [range, 4-62] years. Hepatoma was discovered in 5 [7.0%] patients. Penicillamine therapy was used by 58 [81.7%] patients, while zinc and trientine were given to 32 [45.1%] and 11 [15.5%] patients, respectively. Sixteen [22.5%] patients underwent liver transplantation and one died [1.4%] on the waiting list. The liver condition remained stable or improved in 35 [49.3%], and the neurological status showed improvement in 11 [34.4%] of the 32 patients who had neurological involvement. This is the biggest cohort to be reported from the Middle East. WD presentation and outcome of WD are very diverse, and its diagnosis still depends on clinical, laboratory, and radiological evidence of abnormal copper metabolism. WD should be considered in patients of any age with obscure hepatic and/or neurological abnormalities.

Insulin resistance, steatosis, and fibrosis in Egyptian patients with chronic hepatitis C virus infection

Both nonalcoholic fatty liver disease [NAFLD] and chronic hepatitis C virus [HCV] infection are common in Egypt, and their coexistence is expected. There is controversy regarding the influence of NAFLD on chronic HCV disease progression. This study evaluates the effect of NAFLD on the severity of chronic hepatitis C [CHC] [necroinflammation and fibrosis] and assesses the relative contribution of insulin resistance syndrome to the occurrence of NAFLD in patients with chronic HCV infection. Untreated consecutive adults with chronic HCV infection admitted for liver biopsy were included in this study. Before liver biopsy, a questionnaire for risk factors was completed prospectively, and a blood sample was obtained for laboratory analysis. Our study included 92 male patients. Their mean +/- SD age and aspartate aminotransferase [AST] level were 42 +/- 7.7 years [range 20-56] and 68 +/- 41.7 U/L [range 16-214], respectively. The mean insulin level and insulin resistance index were 15.6 +/- 18.3 mlU/mL [range 5.1-137.4] and 5.9 +/- 15.2 [range 0.9-136.2], respectively. Fifty four percent of patients had steatosis and 65% had fibrosis. In multivariate analyses, steatosis was associated with insulin resistance and fibrosis was associated with high AST level, age >40 years, and steatosis. Steatosis is a histopathologic feature in >50% of patients with chronic HCV infection. Insulin resistance has an important role in the pathogenesis of steatosis, which represents a significant determinant of fibrosis together with high serum AST level and older age

Predictors of sustained virological response to a 48-week course of pegylated interferon alfa-2a and ribavirin in patients infected with hepatitis C virus genotype 4

Knowledge of the predictors of sustained viral response [SVR] to pegylated interferon [PEG-INF] alfa-2a and ribavirin [RBV] therapy in patients with hepatitis C genotype-4 [HCV-4] is crucial for selecting patients who would benefit most from therapy. We assessed the predictors of SVR to this combination therapy in Saudi patients with chronic HCV-4 infection. This retrospective study included 148 patients with HCV-4 infection who underwwent clinical, biochemical and virological assessments before treatment and at 12, 24, 48 and 72 weeks posttreatment. Of the 148 patients, 90 [60.8%] were males. Mean [SD] for age was 48.5 [12.7] years and BMI was 27.9 [7.5] kg/m[2]. Seventy-nine of 148 [60.1%] patients were treatment naive and 110 [74.3%] underwent pre-treatment liver biopsy. Eighteen [12.2%] patients did not complete therapy because of side effects or they were lost to follow up. Early virological response was achieved in 84 of 91 [92.3%] patients. In the 130 [87.8%] patients who completed therapy, 34 [26.2%] were non-responders and 96 [63.8%] achieved end-of-treatment virological response [ETVR]. SVR and virological relapse [24 weeks after ETVR] occurred in 66/130 [50.7%] and 30/130 [31.2%] patients, resspectively. Compared to relapsers, sustained responders were significantly younger [P = .005], non-diabetic [P = .005], had higher serum albumin [P = .028], lower alpha-fetoprotein level [P = .026], lower aspartate aminotransferase [AST] [P = .04] levels, and were treatment-naive [P = .008]. In a multivariate regression analysis, the independent predictors of SVR were younger age [P = .016], lower serum AST [P = .012], and being treatment na‹ve [P = .021]. Approximately half of HCV-4 patients who complete the course of combination therapy achieve an SVR, especially if they are young, treatment naive and have lower AST levels

Recurrence of hepatitis C virus genotype-4 infection following orthotopic liver transplantation: natural history and predictors of outcome

There are few reports on hepatitis C virus genotype 4 [HCV-4] recurrences after orthotopic liver transplantation [OLT]. Therefore, we undertook a study to determine the epidemiological, clinical and virological characteristics of patients with biopsy-proven recurrent HCV infection and analyzed the factors that influence recurrent disease severity. We also compared disease recurrence and outcomes between HCV-4 and other genotypes. All patients who underwent OLT [locally or abroad] for HCV related hepatic cir-rhosis from 1991 to 2006 and had recurrent HCV infection were identified. Clinical, laboratory and pathological data before and after OLT were collected and analyzed. Of 116 patients who underwent OLT for hepatitis C, 46 [39.7%] patients satisfied the criteria of recur-rent hepatitis C. Twenty-nine [63%] patients were infected with HCV genotype 4. Mean [SD] for age was 54.9 [10.9] years. Nineteen of the HCV genotype 4 patients [65.5%] were males, 21 [72.4%] received deceased donor grafts, and 7 [24.1%] developed >1 acute rejection episodes. Pathologically, 7 [24.1%] and 4 [13.8%] patients had inflammation grade 3-4 and fibrosis stage 3-4, respectively. Follow-up biopsy in 9 [31%] HCV genotype 4 patients showed stable, worse and improved fibrosis stage in 5, 2 and 2 patients, respectively. Of the 7 patients in the recurrent HCV group who died, 6 were infected with genotype 4 and 4 of them died of HCV-related disease. This analysis suggests that HCV recurrence following OLT in HCV-4 patients is not significantly different from its recurrence for other genotypes

Management protocol for different thumb injury

Treatment of ligament injuries of the thumb depends on the presence or absence of fracture fragments and on the degree of joint stability

Leukocyte apheresis in the management of ulcerative colitis

Ulcerative colitis is a chronic inflammatory disease that affects the colon and rectum. Its pathogenesis is probably multifactorial including the influx of certain cytokines into the colonic mucosa, causing disease activity and relapse. The hypothesis of removing such cytokines from the circulation by leukocytapheresis was implemented to reduce disease activity, maintain remission, and prevent relapse. Many recent reports not only in Japan, but also in the West, have highlighted its beneficial effects in both adult and pediatric patients. Large placebo-controlled studies are needed to confirm the available data in this regard. In this article, we shed some light on the use of leukocyte apheresis in the management of autoimmune diseases, especially ulcerative colitis

Chemical and biochemical studies on the effect of heat on some nuts: i. Phenolic content and it's antioxidant activities

Polar extracts of walnut, hazelnut and almond, with a significant antioxidant and antiradical activities, were found to contain phenolic acids and tannins with remarkable amount in walnut extract but it is less poor phenolic and flavonoid contents in hazelnut and almond extracts. Tannins content are hydrolysable tannins which are derivatives of gallic acid, hexahydroxydiphenic acid and ellagitannis, while the flavonoids content are very poor and mainly flavonols, which were determined by comparative chromatographic analysis with authentic samples of flavonoids to be glycosides of kaempferol, quercetin isorhamnetin with their aglycones and the flavanones catechin and epicatechin. A significant increasing of inhibition percentage effect with raising the temperature due to the increasing of the concentration of phenolic contents and not due to the change of the structure of the phenolic contents

Experience with 122 consecutive liver transplant procedures at king Faisal specialist hospital and research center

Saudi Arabia is a leading country in the Middle East in the field of deceased-donor liver transplantation [DDLT] and living-donor liver transplantation [LDLT]. We present out experience with DDLT and LDLT at King Faisal Specialist Hospital and Research Center [KFSHRC] for the period from April 2001 to January 2007. We performed 122 LT procedures [77 DDLTs and 45 LDLTs] in 118 patients [4 re-transplants] during this period of time. The number of adult and pediatric procedures was 107 and 11, respectively. The overall male/female ratio was 66/52 and the median age of patients was 43 years [range, 2-63 years]. In the DDLT group, the median operating time was 8 hours [range, 4-19], the median blood transfusion was 6 units [range, 0-40], and the median hospital stay was 13 days [range, 6-183]. In the DDLT group, after a mean follow-up period of 760 days [range, 2-2085], the overall patient and graft survival rate was 86%. In the LDLT group, the median opera ting time was 11 hours [range, 7-17], the median blood transfusion was 4 units [range, 0-65], and the median hospital stay was 15 days [range, 7-127]. In the LDLT group, and after a mean follow-up period of 685 days [range, 26-1540], the overall patient and graft survival rates were 90% and 80%, respectively with no significant difference in patient and graft survivals between groups. Biliary complications were significantly higher in LDLT compared to DOLT [P<0.05]. Vascular complications were also significantly higher in LDLT compared DDLT [P<0. 05]. Both DDLT and LDLT are being successfully performed at KFSHRC with early experience indicating a higher rate of biliary and vascular complications in the LDLT group

Study of the prevalence of osteopenia in Saudi patients with chronic liver disease awaiting liver transplantation

Osteoporosis is an important complication in chronic liver disease patients. This study assessed bone mineral density [BMD] in Saudi pre-transplant cirrhotic patients compared to healthy controls, evaluated its relation to gender, disease etiology and severity. We included 91 patients and 56 healthy controls [mean +/- SD age 46.1 +/- 14.8 and 55.6 +/- 12.9 years; with 45[49.5%] and 13[24.1%] were males respectively. BMD [g/cm2], Z-score [a SD from measure related to age and sex], and T-score [a SD related to peak bone mass for a young adult] of the lumbar vertebrae [L] and the femoral neck [F] were obtained using dual-photon absorptiometry. Osteoporosis was defined as a T-score of <-2.5 and osteopenia as a T- score between -1 and -2.5. Patients were significantly younger and included more males than controls p<0.001 and P<0.01 respectively. Despite that, the osteopenia calculated index was significantly higher in patients than controls [2.39 +/- 2.23 versus 1.04 +/- 1.53 respectively; p<0.01]. The mean lumbar BMD, Z-score and T-score in patients and controls were [0.91 +/- 1.6 g/cm2, -1.44 +/- 1.20 and -1.48 +/- 1.5] and [1.03 +/- 1.7, -0.24 +/- 1.1 and -0.72 +/- 1.2] respectively; p<0.001 for all. However, patients and controls had comparable femoral BMD and femoral T-score [0.84 +/- 0.1 6 g/cm2 and -1.18 +/- 1.2] and [0.85 +/- 0.13 g/cm2 and -0.88 +/- 1.1]; p= 0.51 and 0.14 respectively, but the femoral Z-score was significantly lower in patients' group [-0.73 +/- 1.1 and -0.25 +/- 1.0 for patients and controls respectively; p<0.01]. The mean MELD and Child-Pugh scores in patients were 15.1 +/- 6.4 and 9.4 +/- 2.2 respectively. Depending on the Z-score, lumbar and femoral osteopenia +/- osteoporosis in patients and controls were detected in 43[53.1%] and 24[29.3%] and 9 [16.7%] and 4[7.4%] [p<0.001 and p<0.01] respectively. Within patients, BMD was significantly less in females and in those with viral etiology compared to males and non-viral etiology [p<0.01 for both]. No correlation was detected between either the MELD score or the Child-Pugh score and lumbar or femoral BMD, T-score or Z-score. Low BMD is very common in cirrhotic patients awaiting liver transplantation irrespective of disease severity. Lower BMD is more severe in female patients and those with viral etiology. These findings necessitate early detection, proper treatment, avoidance of post-transplant steroid induction in these patients

Soluble P-and E- selectins and ultrastructural evaluation of canine liver after reperfusion with methylprednisolone and prostaglandin E 1

Ischemia reperfusion injury [IRI] is a multifactorial process that may be the main underlying factor in critical phases faced during and after liver transplantation. This work evaluates the effect of methylprednisolone [MP] and prostaglandin El [PGE1] on IRI of the liver of dogs at the ultrastructural level together with the assessment of soluble P-and E- selectin levels. Three groups of dogs [9 each] were subjected to 60 min ischemia followed by 30 min reperfusion with the appropriate solution according to the group. Group I, the control untreated group was flushed with Ringer's solution, group II was administered 10 mg/kg MP 24 hours before the procedure and with induction of anaesthesia, and group III was flushed with PGE1 in Ringer's solution at a rate of 0.02 microg/kg/min. Liver specimens were collected before ischemia, after ischemia and after reperfusion and were processed for the preparation of ultrathin sections for electron microscopic examination. Corresponding venous blood samples were harvested, centrifuged and serum was processed for the estimation of soluble P-and E- selectins by enzyme immunoassay, together with alanine and aspartate aminotransferases. Electron microscopic [EM] examination of liver ultrathin sections revealed that the morphological structure of hepatocytes and endothelial lining of hepatic sinusoids were well preserved in the group treated with PGE1. Hepatic ultrastructure was much altered in MP treated group showing necrotic and degenerative changes. The control untreated group disclosed bleb formation of hepatocytic membrane with increased leukocyte infiltration. Soluble P-and E- selectin levels were significantly elevated in the control group, near to pre-ischemic level in PGE1 group and showed a persistent elevation in MP group. Serum transaminases [AST and ALT] were significantly elevated in both control and MP groups as compared to their corresponding pre-ischemic levels. Yet, in PGE1 group, their values were comparable to the pre-ischemic ones. This work confirms the hepatoprotective effect of PGE1 in IR injury. The PGE1 impact on preserving the subcellular structure of hepatic sinusoids is crucial and may be mainly attributed to its biological properties. We presume that P-and E- selectins are greatly implicated in the mechanism of IR and may be an important therapeutic target by specific monoclonal antibodies

Bleeding per rectum: aetiological factors and a study of loss of heterogenisity [LOH] of NF1 gene in cases of colorectal cancer

This prospective study was designed to identify etiological factors of lower gastrointestinal bleeding and study the [LOH] of NF1 gene in cases of colorectal cancer among the attendants of gastrointestinal tract [GIT] out-patient clinic in El-Minia University hospital in sex months interval. During the period between February and August 2004, [4500] patients presented to the GIT out-patient clinic, Eighty [80] patients of them were complaining of bleeding per rectum. These 80 patients subjected to history taking, clinical examination, abdominal ultrasound, stool analysis, trial of medical treatment and colonoscopy, and study of LOH of NF1 gene in cases of tumours. We found that: 30% of cases of bleeding per rectum showed internal piles, while 10% of patients showed ulcerative colitis and 13.8% showed non specific colitis and 1.3% showed solitary rectal ulcer. Colorectal polyps were found in 11.3% of cases, cancer colon was found in 10% of cases, while normal colonic mucosa was found in 10% of cases. Rectal varices represented 5% of cases, while stenotic lesions represented 1.3% of cases and angiodysplasia represented 1.3% of cases. Juvenile polyps were the commonest colorectal polyps as they were detected in 33.3% of all cases of polyps. Double colonic lesions were detected in 13.8% of cases in our study. LOH was studied in cancer cases and the polyps to detect if it is precancerous or not. Out of the 10% diagnosed as colon cancer, 7% had LOH of NF1 gene while out of 11.3% of the polyp cases only 2% showed LOH. The most common colorectal lesions were internal piles followed by colorectal polyps and inflammatory and ulcerative colonic lesions. A tumor suppressor gene which is NF1 play and important role in cancer development. Screening program for early detection of premalignant and [or] early malignant lesions are highly recommended

Modified laparoscopic appendectomy

Background: Appendectomy accounts for 1% of all surgical procedures. Laproscopic appendectomy has incited considerable controversy since its evolution. The purpose of this clinical study is to evaluate the results of some modifications added to the operation of laparoscopic appendectomy

Patients and Methods: Two groups of patients undergoing appendectomy were studied. In the first group 50 patients were subjected to open appendectomy. While the second group included another 50 patients whom were subjected to modified laparoscopic appendectomy. We compared the patients’ operative data, operative findings, postoperative complications, length of hospital stay and recovery variables

Results: Patients’ demographics, history of previous abdominal surgery and operative findings were similar in both groups. There were no intra or postoperative complications in the modified laparoscopic appendectomy group, due to the use of two 5 mm ports, ligation of the appendicular stump with ligatures, copious irrigation of the abdomen with saline and cleaning of the port sites with Povidone Iodine 10%

Conclusion: We conclude that with the new modifications added in our study, the incidence of postoperative complications were much lower than in other techniques. Also modified Iaparoscopic appendectomy offers considerable advantages primarily because of its ability for better scope of vision, good exploration, reduction of incidence of wound infection and its cost effectiveness

Mini cholecystectomy is an alternative to laparoscopic cholecystectomy

Open Cholecystectomy through a small incision is an alternative to laparoscopic Cholecystectomy. From 1 March 2003 through 1 March 2005, 263 operations upon the gallbladder in Ain Shams University hospitals [with responsibility for surgical training] were done as intended small-incision open Cholecystectomy. 179 women and 84 men with a median age of 44 [range from 25 to 63 years] underwent Cholecystectomy for symptomatic gallstone disease. Total postoperative morbidity was 12 cases. Median postoperative stay was 1.5 day and mean total [pre- and postoperative] hospital stay 3 days for minicholecystectomy. Open, minicholecystectomy for all patients is compatible with short hospital stay, evidence-based gall-bladder surgery, and training of surgical residents