Different modalities of hepatic resection in liver diseases

Blood loss and bile leak remain major issues during liver resection. We aimed to compare the efficacy of two commonly used transaction techniques; the ultrasonic-dissector [UD] and ultrasonic-coagulation-shears [UCS]. 143 consecutive patients were enrolled into a prospective, observational, non-randomized, comparative study, performed from the March 2008 till end of May 2009, in Liver Unit, Queen Elizabeth Hospital, University of Birmingham, UK. Outcomes looked at are blood-loos, speed of transaction and morbidity. Study groups are comparable except that there are more major resections in the UD than in the UCS, [86.9 and 42.4% respectively, p=0.04]. There is no statistically significant difference [SSD] in the mean surface areas of resected liver specimens between the two groups [114 [ +/- 11] versus 94 [ +/- 9] cm[2] [p=0.06]. there is no SSD in the amount of lost blood, amount of blood loss per square centimeters of resection surface area, amount of blood transfused or the percentages of patients, who required blood transfusion, intra- or post-operatively, between the groups. There are no SSD in the mean transaction time, haemostatsis times, mean transaction and haemostasis speeds. The overall "identification of landmarks" score is 4/5 for UD and 3/4 for UCS which is not SSD. The Pringle manoeuvre was resorted to in significantly more patients in the UD than in the UCS [17 [20.2%] and 5 [8.5%] respectively, p=0.03], with mean ischaemic time significantly more in the UD [17 +/- 3] versus 4 [ +/- 4] minutes respectively, p=0.02]. There is no SSD in the magnitude of post-operative liver cell injury reflected by the mean of ALT, AST, bilirubin and INR peak values. There is also no SSD among the two groups regarding postoperative minor [grade 1 and 2] or major [grade 3, 4, and 5] complications, median ICU and hospital stays. This study confirms that both instruments of transaction can be used safely in elective liver resection and it is not possible to recommend any of these two instruments over the other

Electrovaporization of bladder ulcer, A new approach for treatment of Bilharzial bladder ulcer

The aim of this work was to study the safety and efficacy of electrovaporization as a new modality of treatment of bilharzial bladder ulcers. Sixty-six patients with bilharzial bladder ulcers have been treated by the use of vaportrode or pencil tip electrocautery electrode at high cutting current to evaporate the ulcer bearing area, till the perivesical tissue was exposed. Indwelling urethral catheters were fixed for one week. Successful vaporization of the ulcer bearing area was recorded in 59 patients. Failure to get satisfactory vaporization was reported in seven patients due to extensive calcification in the ulcer bearing area, for whom even trial of excision was failed. The operative time ranged from 7 to 18 minutes. Some postoperative complications occurred in the form of deep hematuria in four patients, peritonism in five patients and secondary hemorrhage in two patients. Symptomatic relief was recorded in 52 patients immediately after the removal of the catheter. Persistence of symptoms was encountered in five patients and proved to be due to persistence of the ulcer, as proved by cystoscopy in two patients and incomplete healing in three patients. Vaporization of chronic bilharzial bladder ulcer is an effective, easy and safe modality of treatment without considerable complications