value of tumour associated antigen CA 19-9 in diagnosing malignant and benign biliary strictures

The diagnosis of cholangiocarcinoma is often difficult, making management approaches problematic. A reliable serum tumor marker for cholangiocarcinoma would be a useful additional diagnostic test. Previous studies have demonstrated that elevated serum concentrations of CA 19-9, a tumor-associated antigen, have good sensitivity and specificity for cholangiocarcinoma in patients with primary sclerosing cholangitis. However, the value of this tumor marker for cholangiocarcinoma unassociated with primary sclerosing cholangitis is unclear. Thus, the aims of this study were to determine the usefulness of a serum CA 19-9 determination in the diagnosis of de novo cholangiocarcinoma. We measured serum CA 19-9 concentrations in patients with cholangiocarcinoma [n=25], nonmalignant liver disease [n=30], and benign bile duct strictures [n=15], serum CA 19-9 concentrations were measured by a direct chemiluminometric technology. The sensitivity of a CA 19-9 value > 100U/ml in diagnosing cholangiocarcinoma was 53%. When compared with the nonmalignant liver disease and the benign bile duct stricture groups, the true negative rates were 76% and 92%, respectively. Patients with unresectable cholangiocarcinoma had significantly greater mean CA 19-9 concentrations compared to patients with resectable cholangiocarcinoma. These-data suggest that the serum CA 19-9 determination is a useful addition to the available tests for the differential diagnosis of cholangiocarcinoma

Non invasive treatment of common bile duct obstrucion

The study comprises 28 patients with obstruction of the common bile duct [CBD]. Twenty patients with calcular obstruction, these included 5 patients with missed stones in the CBD following cholecystectomy, 4 patients with malignant obstructive janudice and 4 patients with benign stricture of the CBD. All patients were subjected to full clinical examination and basic investigations, and liver function tests. Serum bilirubin and alkaline phosphatase were elevated in all patients. Abdominal ultrasonography was done and diagnostic endoscopic retrograde cholangiopancreatography with side viewing endoscopy was done to all patients. By the use of the endoscopic retrograde cholangiopancreatography, the cases of calcular obstruction of CBD were extracted by papillotomy and dormia basket or with a balloon. This procedure was successful in 17 patients out of 20. In cases presenting with stricture of the CBD failure of cannulation occured in 3 patients out of 8 and in the remaining 5 patients papillotomy with fixation of endoprosthesis was performed. All failures were surgically treated. Short and long term follow up showed satisfactory results as assessed by clinical and biochemical means

report of consecutive 22 cases of limited haemorrhiodectomy with lateral internal sphincterotomy in the management of acute strangulated hemorrhoids

Between September 1988 to October 1991 twenty two patients [8 females and 14 males] with acute strangulated hemorrhoids were treated in Ain Shams University Hospitals in the acute phase by limited hemorrhoidectomy and lateral internal sphincterotomy. Pain relief was rapid. The hospital stay ranged from 3 days to 15 days. The follow up period was 12 months. This treatment was adequate in 12 patients the rest 10 patients needed injection for bleeding 2nd degree hemorrhoids in 6 patient and hemorrhoidectomy for 3rd degree hemorrhoids in 4 patient. No postoperative complication or recurrence was detected