Hydatid disease: radiological and serological studies before and after surgery

The present study aimed to evaluate indirect haemagglutination test [IHAT] together with imaging modalities ultrasonography [US] and computed tomography [CT] in the diagnosis and postoperative follow up of hepatic hydatid disease. Sixteen patients of hepatic hydatidosis were enrolled in this study. Diagnosis was established by IHAT, US and CT. Cytological examination of hydatid fluid was performed post operatively. IHAT showed a sensitivity of 75%. Imaging techniques were 100% sensitive, they demonstrated solitary cysts in eleven patients and multiple cysts in four patients, mainly affecting the right lobe. In one patient showing a hepatic cyst, an extra hepatic one was encountered in the spleen. Radical surgical procedure in the form of pericystectomy was performed in all patients in conjunction with albendazole therapy pre and post operatively. After one year follow up, there was no evidence of recurrence, IHAT became negative in all except one patient. Complete resolution of the cyst cavities was recorded in 87.5% of the patients by US and CT. It was concluded that US and CT imaging are the most reliable modalities for diagnosis and for assessment of cure in hepatic hydatidosis, IHAT was less sensitive

Splenic artery ligation during distal spleno-renal shunt [warren's operation]

Bleeding oesophageal varices as a complication of portal hypertension is the most common cause of upper gastrointestinal hemorrhage in Egypt. It is the leading cause of death in patients with schistosomal hepatic fibrosis and portal hypertension. Distal splenorenal shunt Distal splenorenal shunt [DSRS] is a surgical procedure designed to selectively and trans-splenically decompress oesophagogastric varices in patients with portal hypertension while preserving antegrade portal venous flow to the liver. The aim of this work is to study the effect of splenic artery ligation during distal splenorenal shunt [DSRS] on portal and splenic haemodynamics, splenic volume, haematological profile and oesophageal varices. Fifteen consecutive patients with portal hypertension, schistosomal hepatic fibrosis, and bleeding oesophageal varices were classified into 2 groups [A and B]. In group A, the eight patients were subjected to conventional DSRS and in group B the seven patients were subjected to splenic artery ligation during [DSRS]. The effect of DSRS on portal and splenic veins haemodynamics showed a significant decrease in Portal vein diameter [mm] [PVD], Portal vein velocity [cm/sec] [PVV] and Portal vein flow [L/min] [PVF]. Also, there was a significant increase in Splenic vein diameter [mm] [SVD], Splenic vein velocity [cm/sec] [SVV] and Splenic vein flow [L/min] [SVF] after construction of the shunt. Follow up of patients in this study revealed no significant difference between groups A and B as regards endoscopic changes, portal haemodynamics and splenic vein parameters. In group B, splenic venous thrombosis occurred in 2 patients [28.6%] who were treated medically and the shunt was patent lliree months later, while in group A the splenic venous flow was increased postoperatively with no case of shunt thrombosis. Routine comb/nation of splenic artery ligation to DSRS is not advised and it is only recommended in marked hypersplenism

Adjuvant chemotherapy in surgicallyresect able locally advanced colorectal carcinoma: fluoro-uracilbiomodulationby folinicacid versus interferon

Surgical curative resection of locally advanced colorectal cancer [stage B2 and C] is unfortunately followed by high risk of recurrent malignancies. Ultimate control requires effective adjuvant therapy. The aim of this study was to evaluate efficiency of two regimens of modulation of adjuvant 5 fluorouracil [5 FU] by folinic acid versus interferon after surgical resection of locally advanced colorectal carcinoma. 105 patients with histologically proven colorectal carcinoma [stage B2 and C only] were included in this study. Patients were subjected to surgical treatment with operative resection followed by randomization into 3 groups, each of 35 patients. Group A received 5 FU alone, group B received in addition calcium leucovarin [L V], while group C received interferon in addition to 5 FU. Patients were followed up for a median of three years. All groups were comparable as regard age, sex, histological type, stage and clinical presentation. Three years overall and disease- free survival were relatively higher in patients of group B and C, that received 5 FU modulators. Also recurrence rate was less in group B and C than in group A, but not reaching a significant level. The clinical stage of the disease was the most important prognostic factor followed by the histopathological differentiation of the tumour. Most of patients tolerated chemotherapy with transient mild to moderate degree toxicities. Hematological and gastro intestinal toxicities were comparable in the 3 groups in group C there was mild toxicities related to interferon

In situ hybrdization of epstein-barr virus encoded RNA [EBER] in aspiration samples in lymphoma

This study aimed at applying a non-isotopic in situ hybridization technique for EBV detection on fine needle aspiration [FNA] samples using the cell print instrument-blue supplied with 15 micro filter. A total of 35 selected FNA from lymph nodes, confirmed on biopsy basis, included 18 Hodgkin's disease, 12 cases of Non-Hodgkin's lymphoma and 5 cases of metastasis from nasopharyngeal carcinoma, used as control. All cases of Hodgkin's disease showed a condensed EBV positivity picked up by all mononucleated and binucleated Reed Sternberg cells, in all the subtypes; sparing other polymorphic reactive cellularity. In Non-Hodgkin's lymphoma cases, 10/12 cases were EBV negative except for insignificant occasional scattered weak positivity picked up by the resulting lymphocytes. The remaining 2 cases gave condensed EBV positivity in few scattered reticulum cells. Retrospective immunohistochemical staining by [CD [15, 20, 43]] for these 2 cases, proved to belong to Hodgkin's disease, lymphocytic predominance of B-cell type. All cases of metastatic nasopharyngeal carcinoma showed a condensed positivity in all the metastatic epithelial cells. The usefulness of applying ISH for EBV on aspirate samples on wider scale is recommended and the possible carcinogenic role of EBV in the evolution of various subtypes of Egyptian Hodgkin's disease is discussed

Retrorectal and presacral tumors a clinicopathologic study

Neoplasms in the retrorectal or presacral area are uncommon. In this work we aimed at studying the cases of retrorectal or presacral tumors admitted to our institute in the last four years by H and E stain, immunostain and electron microscopy with review of the literature. Twenty nine patients are included in this study, having variable lesions comprising 10 congenital, 2 neurogenic, 1 osseous, 4 soft tissue tumors, 5 multiple myeloma and 7 metastatic lesions. Difficult cases were studied by immunostain and / or electron microscopy. Both techniques proved to be highly specific in diagnosing equivocal cases and determining the cell of origin