Evaluation of fistulotomy with immediate sphincteric reconstruction in the treatment of high transsphincteric perianal fistula

Background: High perianal fistula treatment remains challenging, mainly due to the variability in success and recurrence rates as well as continence impairment risks. So far, no procedure can be considered the gold standard for surgical treatment. Yet, strong efforts to identify effective and complication-free surgical options are ongoing. Fistulotomy can be considered the best perianal fistula treatment option, providing a perfect surgical field view, allowing direct access to the source of chronic inflammation. Controversy exists concerning the risk of continence impairment associated with fistulotomy. The present study aimed to assess the outcomes of fistulotomy with immediate sphincteric reconstruction regaring fistula recurrence, incontinence, and patient satisfaction. Methods: This interventional study was performed at the General Surgery Department of Zagazig University Hospital during the period from July 2018 to December 2019 on 24 patients with a clinical diagnosis of high transsphincteric fistula-in-ano. The fistulous tract was laid open over the probe placed in the tract. After the fistula tract had been laid open, the tract was curetted and examined for secondary extensions. Then, suturing muscles to muscles, including the internal and external sphincters, by transverse mattress sutures. Results: Our study showed that 2 patients develop incontinence to flatus ~ 8.3%.and only one patient develop incontinence to loose stool, 4.2%. Complete healing was achieved in 83% and recurrence was 16.6%. Conclusion: Fistulotomy with immediate sphincteric reconstruction is considered to be an effective option in the management of high perianal fistula, with low morbidity and high healing rate with acceptable continence state. (AU)

The relation between of insulin like growth factor II and endometrial carcinoma

Background: Endometrial cancer is the most common gynecologic malignancy in the United States and the fourth most common cancer in women. The need of a soft marker that can be used with CA-125 tumor marker for early detection of endometrial cancer and to predict late stages and advanced histopathological grades and to specify the cases who will be managed by complete surgical staging including para aortic and pelvic lymphadenectomy is of great importance. The aim of the study was to evaluate the role of insulin like growth factor 2 in endometrial carcinoma and to correlate it with different histopathological grades of the disease.Methods: This study was applied on sixty patients with abnormal uterine bleeding and were divided into two groups, Group A included 30 cases of endometrial carcinoma, while Group B included 30 cases complaining of abnormal vaginal bleeding due to other causes as a control group. Serum samples were taken from all patients and estimation of IGF-2 serum levels using ElISA technique was done. Comparison of IGF-2 serum level between both groups and correlation of its levels with different histopathological grades of endometrial cancer group were done.Results: As regard comparison between both groups and ILGF2 serum level, study results demonstrated that ILGF2 levels ranged between 600.0-1440.0 ng/ml and 40.0-560.0 ng/ml with the mean of 781.33 ng/ml±196.45 and 336.0 ng/ml±212.86 for cases Group A and control Group B respectively. There was a statistically significant difference between the two studied groups regarding ILGF2 serum level (p<0.001). As regards correlation between histopathological grades and ILGF-2 serum level in cases Group A, the study revealed a strong positive correlation.Conclusions: ILGF-2 can be used as a serum marker for endometroid adenocarcinoma of the body of the uterus and to predict its higher histopathological grades.

egyptian study for standardization of myocardial t1 mapping values on a 3 tesla mri machine

Objective: of this study is to set standard values for the native T1 values in both normal and diseased myocardium on a 3 tesla MRI machine

Methodology: this study was carried out in Misr Radiology Center. 31 patients were divided into normal group [control] including 10 patients and diseased group including 21 patients

Result: The native T1 values on the healthy myocardium ranged from 1110 to 1300 msec, with ECV values ranging from 25 to 33 % with variable elevations of the native T1 and ECV values according to the pathology affecting the myocardium. We concluded that the above values are the reference values for the 3 T MRI machine

Role of pelvic lymphadenectomy in stage 1A endometrial carcinoma diagnosed preoperatively by pelvic ultrasonography and CT scan

Endometrial cancer is the commonest gynecological cancer mostly affecting women in the postmenopausal age group. There is a debate regarding the need of pelvic lymphadenectomy in managing stage 1A diagnosed preoperatively, we try to evaluate this need. To evaluate the role of pelvic lymphadenectomy in stage 1A endometrial carcinoma diagnosed preoperatively by pelvic ultrasonography and CT scan as microscopic invasion of pelvic lymph nodes will not be seen by this imaging technique. 60 Cases of endometrial carcinoma diagnosed by fractional curettage and proved to be stage 1A preoperatively by clinical examination, vaginal US and CT scan [negative myometrial invasion, ascites, LN spread and local spread] underwent total abdominal hysterectomy with salpingo-oopherectomy, peritoneal wash for cytology, omentectomy and pelvic lymphadenectomy [external iliac and obturator groups] after written informed consent. Histopathology of the uterus, tubes, ovaries, omentum and cytology of peritoneal wash were done for surgical staging, in addition histopathology of pelvic LN was done. Histopathology of the cases revealed the following: 52 cases were endometrioid adenocarcinoma distributed as follows: 10 patients were grade I, 35 patients were grade 2 and 7 patients were grade 3. Eight cases were serous papillary adenocarcinoma, 3 of them were grade I and 5 cases were grade 2. As regards myornetrial invasion 9 cases of endonietrioid carcinoma show invasion, I of grade 1.3 of grade 2 and 5 of grade 3 in comparison to 4 cases of papillary serous adenocarcinoma I of grade I and 3 of grade 2, so 13 cases have been proved by histopathology to have myometrial invasion. There is no need for lymphadenectomy in stage 1A diagnosed preoperatively using CT scan and vaginal US, preventing high risk surgical intervention in this early stage

Assessment of sanitary landfill leachate characterizations and its impact on groundwater at Alexandria

The total amount of solid waste generated in Alexandria is 2820 tons/d which increases to 3425 tons/day during summer. In the past, 77% of the collected solid wastes was open dumped. The open dumping sites did not have the minimum requirements for pollution control. Following the exacerbation of the problem, the Alexandria Governorate contracted a company to carry out the solid waste management The contracted company transferred 75% of the daily generated solid wastes to a new constructed sanitary landfill The site receives a daily average of 1910 tons. The landfilling is performed by trench method in the form of cells. The produced leachate is discharged into two lined aerated lagoons. The biogas formed from biodegradation of land filled solid wastes is burned and the produced heat is used for drying the lagoons leachate. The remaining residues are re-landfilled. The study aims at assessment of the solid waste sanitary landfill leachate characterization and its impacts on the groundwater. The analysis of the collected data confirms that leachates from the landfill are severely contaminated with organics, salts, and heavy metals. The fluctuations in concentration levels of the different parameters were attributed to aging and thickness of waste layers, stage of decomposition, and re-landfilling of the concentrated residues from the drying lagoons. The concentrations of NH4-N [600 mg/l] indicated that the process of stabilization was still in the initial stages and attributed to the compaction process. The high BOD5 results [28,833 mg/l] indicated that the process of stabilization was in the initial stages which were very slow. The high COD results [45,240 mg/l] can be attributed to the compaction of the wastes which also retards the degradation of the solid wastes. The BOD and COD values indicated clearly severe contamination. The BOD5/COD ratio measured in the current study [0.64] indicated that the leachate of the present study was biodegradable and unstabilized, and required time and favorable conditions for anaerobic biodegradation. Heavy metals were lower compared with what have been observed in other countries. Re-landfilling of the residue after drying the leachate in lagoons and the short time of biodegradation in the landfill site were factors which effected the high strength of most of the parameters concentrations of the leachate. Assessment of groundwater contamination through piezometer wells around the active cells indicated that there was no contamination from the leachate to the groundwater surrounding the site. The study recommended emphasizing the importance of adjusting the biodegradation factors, the monitoring program, the prohibition of disposing heavy metals, determination of the leachate generation rate, and treatment of leachate