Distal subtotal gastric resection for prevention of delayed gastric emptying following pancreaticoduodenectomy

Delayed gastric emptying is one of the leading causes of morbidity following pancreatico-dudenectomy occurring in nearly one third of patients. Literature reports indicate that the incidence of delayed gastric emptying [DGE] is higher after Pylorus-preserving pancreaticodudenectomy [PPPD] than after conventional pancreatico-dudenectomy [CPD]. Delayed Gastric emptying is traditionally diagnosed from patient report subjective sensations. In order to improve gastric emptying, distal subtotal gastrectomy with resection of nearly 60% of the stomach converting it from a reservoir into a conduit is undertaken to prevent gastric stasis and shortens transient time. Over a period of five years from 2001-2006, a total of twenty patients with operable pancreatic lesions underwent extended gastric resection in the form of distal subtotal gastric resection concomitant with pancreaticodudenectomy. The male-female ratio was 14/6, the mean age was 55 years with 15.5 standard deviation [SD]. This group was compared prospectively with a matched control group of patients who underwent conventional pancreaticodudenectomy regarding the development of delayed gastric emptying. We sought to quantify the rates of subjective DGE [sDGE] based on patient complaint versus objective DGE [oDGE] based on gastrograffin study in the tenth post operative day post Extended distal subtotal gasric resection with pancreatico-dudenectomy group [EPD] and the control retrospective group post conventional pancreatico-dudenectomy [CPD]. For the 20 patients in the EPD group and the other 20 patients in the CPD control group sDGE and oDGE data were collected on the postoperative day 14, and 6 months postoperatively. The incidence of sDGE was higher for the CPD [42%] than for EPD [15%] at 14 days, [33%] and [6%] at 6 months. The oDGE was higher for CPD [9 1%] than for EPD [67%] at 14 days, with a 6-months incidence of [37%] in CPD and [4.7%] for EPD. The proximal gastric function detected by the Liquid phase gastric emptying test [normal control reference=23 minutes] was prolonged for the CPD group [73 minutes] compared to [38 minutes] for the ECP in the first 14 days. At 6-months interval the LGE was [48 minutes] for CPD and [12.7 minutes] for ECP. 1-The concept of DGE should distinguish between subjective and objective symptoms. 2-The loss of distal stomach mechanoreceptors in EPD reduces patient sensation of oDGE producing silent DGE. 3- The EPD contributed greatly in preventing the early delayed gastric emptying, resulting in short hospital stay and decrease cost with minimal associated surgical morbidity

simple technique for pancreatico-jejunostomy [a experimental study]

The incidence of pancreatic fistula and the patency of the anastomosis joining the pancreas to the jejunum using a simple technique was evaluated in 8 dogs. The pancreas of each dog was divided distal to the head and uncinate process while carefully preserving the pancreatic blood supple. The body and the tail were approximated with 4/0 prolene interrupted sutures to the side of the jejunum and the pancreatic duct was cannulated with number 18 G epidural catheter and was brought through the jejunum and then out through the abdominal wall. The anastomotic patency was assessed after 8 weeks by a second operation in which the loop of jejunum, including the anastomosis with the pancreas was resected. The pancreas was examined histologically for back pressure effects and whether the mucosa creeped along the he cannula to join both the pancreatic and duodenal mucosa

Transurethral resection and intravesical instillation of BCG or thiotepa for the treatment of superficial bladder tumours

This study was conducted on 45 patients with TCC of the urinary bladder treated at the NCI, Cairo University, in the period [July 1983-December 1987], 40 males and 5 females their ages ranged between 40-70 years with a mean aged of 51.9 years, 28 patients had pa tumor [confined to the mucosa] and 17 had p1 tumors [invasion of lamina propria short of muscle bed]. After complete TUR these patients were divided into 3 groups at random [15 patients each]: Group I no further treatment after TUR, group II received intravesical BCG after TUR, group III received intravesical thiotepa after TUR. There was a statistically significant difference in the incidence of tumor recurrence in the BCG and thiotepa groups compared to control group, the incidence of recurrence was 86.7%, 40% in groups I, II, and III, respectively [p=0.02]. As regards the tumor progression 1/14 patients in BCG group showed recurrence at a higher grade [7.1%], whereas thiotepa and control groups were similar 4/15 [26.7%], in each group developed tumor grade progression. This difference was statistically significant [P=0.017]. The effect on tumor invasion and/or metastasis was studied in BCG and thiotepa groups and this incidence decreased when compared to control group, it was 26.7%, 13.3% and 6.7% in groups I, II, and III respectively. The complication and side effects of intraversical instillation of BCG [120 mg] or thiotepa [30 mg] were not severe or serious

Cryosurgery for giant cell tumor of bone

Fourteen patients who had giant cell tumor of bone underwent curettage and cryosurgery with liquid nitrogen in the period between January 1978 to December 1982. In 11 patients, the peripheral long bones were the site of origin of the tumor, in two patients, the tumor arose from the bones of the skull and the mandible was the site of origin in another patient. One of the patients had a malignant giant cell tumor as proved by the development of malignant pleural effusion and rapid local recurrence. Local recurrence occurred in three patients and was treated successfully by re-curettage and cryosurgery. In one patient, cryosurgery was performed four times within three years before complete sterilization of the tumor and three times within one and half year in another patient before eradication of the tumor. Cryosurgery with liquid nitrogen resulted in sterilization of the cavity after curettage and avoided the need for amputation in most of the cases