Interventional bronchoscopy: ain Shams University Hospital experience

Bronchoscopy has evolved considerably in our hospital. During recent years, we implemented the concept of interventional bronchoscopy [IB] for the first time in Egypt. IB is defined as a diagnostic and invasive therapeutic interventions that extend beyond routine Flexible bronchoscopy. In this article, we will review our clinical experience with IB during the last five years as regards methodology requirements, available equipments, clinical applications and presentation of selected research outcomes. We retrospectively reviewed all available reports of therapeutic IB performed in our bronchoscopy unit to determine the indications, application sites, methods of disobliteration and complications of therapeutic IB. In addition, recent interesting research work done on endobronchial ultrasound, autofluorescence bronchoscopy, Nd: YAG laser bronchoscopy and endobronchial electrocautery was reviewed. In order to perform an interventional procedure, well-equipped facilities, trained personnel, preprocedure evaluation, and monitoring are mandatory. More than 500 invasive therapeutic interventions were performed in the past 5 years. The results and analysis of these IB were reviewed. We concluded from the presented data that IB has quickly gained recognition and drawn interest with its promising results. Much effort is needed to overcome challenges facing IB awareness, financial concerns, training and verification of competency in our country

effect of partial hepatectomy on the thymus gland and cervical lymph node of male albino rat

An increasing number of hepatic resection is being performed as potential curative surgery for both 1ry and 2ry liver tumors and could reach about 70-80% of the liver size. The study aimed to investigate the histological and the immunohistochemical effects of partial hepatectomy [PH] on the thymus gland and the cervical lymph node [LN] of male albino rat as parts of the immune system. Forty male albino rats [130-150 gm] were divided into 4 groups of 10 rats each. The first was reserved as control. The animals of the other 3 groups were subjected to 70% PH. Then, they were sacrificed at 3, 7 and 14 days after the operation. The thymus and cervical lymph nodes were dissected. One lobe of thymus and one cervical lymph node were kept for staining with HandE. The other lobe of the thymus and another cervical lymph node were processed to make single cell suspension and cytospining. Then, they were stained with immuno-peroxidase stain for anti-proliferating cell nuclear antigen [PCNA antibody]. There was depletion of lymphocytes in the thymic cortex and in the lymphoid follicles of the cervical lymph node on day 3 of PH together with significant decrease of their weight. There was a significant decrease of the number of PCNA positively stained cells, as it reached about half the control value in both thymus and cervical lymph node on the same day. Regeneration started at day 7 PH as the depleted areas decreased in addition to appearance of large lymphocytes in the cortex of both thymus and cervical lymph node. This was parallel to the significant increase of the thymic weight and return of the LN weight to its control value. The number of PCNA positively stained cells was significantly increased to exceed double the control value in both thymus and cervical lymph node. Then, these cells decreased towards the 14[th] day. It could concluded that PH decreased the immune system for few days after the operation although further studies are needed to know which type of T-cells is liable to affection by PH

Effects of profenofos on antioxidant enzymes activities and gastric mucosa in rats

Objective: In present study the effect of the organophosphorus insecticide, profenofos, on the antioxidant enzymes activities and mucosa of stomach was investigated in rats

Material and Methods: To evaluate these effects, the biochemical, histological, morphometrical, and histochemical studies on stomach were done. Animals were divided into three groups 10 animals of each. Control animals [group I] were administered vehicle. Treatment group animals [group II and III] were respectively administered oral doses of profenofos: 86.8 and 214.4 mg/kg b. wt. daily for 15 days

Results: The administration of profenofos caused a significant decrease in the levels of superoxide dismutase [SOD], glutathione peroxidase [GPx] and reduced glutathione [GSH], and an increase in the lipid peroxidation [LPO] level [p < 0.05]. The histopathological findings indicated that profenofos caused different alterations in stomach, including haemorrhagic areas in the mucosa and submucosa and degenerative changes. The histochemical examination showed noticeable reduction in polysaccharide materials of stomach; the cells of such organ displayed faint stain

Conclusion: Generally, profenofos caused extensive biochemical, histological, and histochemical injury. Such effects were relevant to the amount of dose given

Laparoscopic cholecystectomy in patients with child-pugh A and B liver cirrhosis

Laparoscopic cholecystectomy [LC] has been widely adopted in treating benign gallbladder diseases. Cirrhosis and cirrhotic portal hypertension were contraindicated for LC in its early period. In recent years, several studies have reported liberal use of LC in patients with cirrhosis. In this study, we evaluated LC in patients with Child-Pugh A and B liver cirrhosis with LC in patients without cirrhosis as regards operative time, rate and cause of conversion if occurred, morbidity, mortality and hospital stay time. During the period from January 1999 to January 2004 [5 years], at Ain shams University hospitals, 50 consecutive patients with gallstone disease and associated liver cirrhosis of Child-Pugh A and B class included 14 males and 36 females with mean age 45.6 years [range, 22-65] underwent LC [group A]. Another 50 patients with gallstone disease who were proved not to be suffering from cirrhosis included 8 males and 42 females with mean age 41.5 years old [range, 20-61] underwent LC during the same period were used as a control group [group B]. Mean operative time [min.] for group A was 74.5 and for group B 68.25, while conversion rate was 24% for A and 8% for B. Both were statistically insignificant. Total morbidity for group A was 28% and for group B 2% which is statistically significant. Bleeding was the most common complication in group A [24%], while other complications were statistically insignificant. The mean hospital stay [days] was 4.08 for group A and was 2.52 for group B which is statistically significant There was no mortality in both groups. We suggest more liberal use of laparoscopic cholecystectomy for symptomatic gallstones in selected patients with liver cirrhosis

Postoperative intestinal dysmotility in rats: role of inducible Nitric oxide

Postoperative dysmotility of the gastrointestinal tract occurs after essentially every abdominal operation and remains one of the most perplexing problems in medicine. We proposed that inducible nitric oxide [NO] plays a role in postoperative intestinal dysmotility. Rats were underwent or not surgical intestinal manipulation. Spontaneous circular muscle contractions were recorded in both experimental groups in vitro, 24 hours after surgery. Nitrite production were measured in muscularis culture of both normal control and manipulated small bowel. Histological examination for intestinal leukocytic infiltration was also done. Intestinal manipulation resulted in a significantly diminished spontaneous contractile activity of manipulated small intestine. In control rats, selective iNOS inhibition [L-NIL] did not increase spontaneous muscle activity but after manipulation, L-NIL significantly improved the spontaneous muscle contractility. Nitrite production increased significantly from cultures of intestinal muscularis obtained from rats 24 hours after manipulation. Leukocytes invaded massively the intestinal muscularis of manipulated rats but not of normal control rats. These results show that leukocyte derived inducible NO inhibits small intestinal motility after manipulation and it probably plays an essential role in the pathophysiology of postoperative dysmotility