Systemic effects of ethanolamine oleate: an experimental study

An experimental study for the systemic effects of 5% ethanolamine oleate was conducted on 46 rats, divided into 3 main groups. Rats in group A were subdivided into 3 subgroups of 5 animals each. They were injected once intraperitoneally with 2, 4 and 5 ml of the drug respectively. None of the animals showed any sign of acute toxicity. Histological examination was performed 24 hours after the injection to the liver, spleen, kidneys, heart, lungs, brain, blood and bone marrow and it did not reveal any abnormality. Group B included 28 rats, which were studied for the chronic effect of the drug. They were sub- divided into 4 subgroups, which were injected daily with 0.5 ml of 5% ethanolamine oleate for 2, 4, 6 and 8 weeks respectively. None of the animals died. Histopathological changes were found only in the lungs, affecting 37.5% of the injected animals. There was lymphoid hyperplasia in 20.8%. Interstitial and intraalveolar edema and hemorrhage, with vascular congestion were detected in 25%. There was no correlation between the duration of the injections and the incidence of the lung lesions. Group C included 3 rats, which were injected once in the lower esophagus through a laparotomy. They were given 0.25, 0.5 and 0.75 ml of the drug respectively. Only the rat which was injected with 0.75 ml, developed lung edema, hemorrhage and congestion, when examined 2 weeks after the administration. It can be concluded that 5% ethanolamine oleate is relatively a safe drug. Rats tolerated up to 5 ml single dose without any detectable effect. This dose is equivalent to 180 ml if given to man. However, with frequent repeated doses, there is a potential hazard of injury to the lung capillaries

Early surgical intervention in acute cholecystitis

The role of early surgical intervention in the management of acute cholecystitis is evaluated. Forty one patients were studied. Early cholecystectomy was planned to be carried out for all patients unless there was a contraindication or poor surgical risk. Real time ultrasonography proved to be very reliable in establishing the diagnosis. Three patients were managed conservatively. Thirty eight patients were explored. Cholecystectomy was successfully accomplished in 30 patients and 2 had cholecystostomy. Flexibility of the time limit for performing early operation allowed cholecystectomy to be performed up to 8 days from the onset of the acute attack. Routine operative cholangiography is recommended since it detected CBD stones in 19.4% of patients. The morbidity rate was 13.9% and there was no mortality. The mean hospital stay for the surgically treated group was 9.8 days. Early surgical intervention is a safe, effective and relatively less costly procedure in the management of acute cholecystitis

Lower oesophageal sphincter pressure changes after treatment of bleeding varices by devascularization and by sclerotherapy

This prospective controlled study included 3 groups of 20 patients each. The first group [G.A] were apparently healthy volunteers. The second and third groups [G.B and G.C] were patients with bleeding esophageal varices treated by elective splenectomy-devascularization operation and by elective, chronic, endoscopic sclerotherapy, respectively. Lower esophageal sphincter [LES] pressure and esophageal motility pattern were performed to the control group and to the two treatment groups before and 2 months after therapy. The surgery and the repeated ethanolamine oleate injections resulted in minimal changes in the esophageal manometric tracing. The LES resting and closing pressures were not affected. The mean relaxation time in both groups did not change and was comparable to that of the control group. In [G. B], incomplete relaxation was noticed in 3 patients postoperatively compared to one preoperatively. Prolonged relaxation occurred in 3 patients compared to none and incoordination occurred in 7 patients compared to 2. These changes, however, were statistically insignificant. In [G. C], 4 patients showed incomplete relaxation compared to none in the presclerotherapy assessment. 5 patients recorded incoordinated LES response compared to one. These abnormalities were also of no statistical significance. In [G. C], also sclerotherapy resulted in increased frequency of tertiary, secondary and spontaneous non-propulsive peristalsis in most patients [90%]. However, these abnormal contractions did not take a special pattern. They were not associated with dysphagia, and the upper endoscopies were free. Nevertheless, further studies by pH monitoring, esophageal radionucleotide scan and neuro-histopathology are recommended. As a side issue in this study, the LES resting and contraction pressures in esophageal varices groups were significantly lower than the control group

Outpatient treatment of pilonidal sinus by phenol sclerotherapy

The study included 28 patients with chronic post anal pilonidal sinus; 22 were males and 6 were females. The average age was 24.7 years. They were treated by full strength phenol sclerotherapy. Injection was performed in the outpatient clinic without general anesthesia. Local infiltration anesthesia was sometimes administrated. In 7 patients [25%], a sinus opening had to be sharply widened for adequate removal of hair from inside the sinus. Hair was found in a total of 10 patients [35.7%]. The 28 patients received 65 injection sessions. The procedure failed in 2 patients and recurrence occurred in another 2 patients, 2 and 4 months after apparent cure. One of the recurrent cases could be successfully treated by reinjection, resulting in 89.3% final cure rate. The follow up period after cure ranged between one to 4 years. The average was 17.5 months. The complications of the technique were all minor. Pain during the procedure was mainly due to the trials for removing hair from the pits. It was usually tolerable. Small superficial chemical burn of the skin around the sinus occurred in all patients, but it healed readily without complication. Minimal sloughing of a sinus opening developed once. It can be concluded that phenol sclerotherapy of chronic post anal sinus is a very satisfactory line of treatment. It is very simple. It can be done as outpatient procedure without general anesthesia. It does not necessitate any sick-leave or limitation of activity. It gives an excellent cure rate for such a disease notorious for recurrence, with negligible complications. It can be repeated without any inconvenience. It has a marvelous cost- effectiveness ratio

role of magnesium in the etiology of paralytic ileus

Serum magnesium, calcium, sodium, potassium and urea were studied in 60 patients comprising 3 groups of 20 patients each. The first group included patients subjected to abdominal surgery and in whom the bowel sounds were delayed for more than 72 hours, with no passage of flatus or stools. The second group were also post-abdominal operation patients, but who restored the bowel function within 3 days. The third group were rather healthy volunteers. The levels of serum magnesium were lower in both postoperative groups, comparing with the control, but the differences were statistically insignificant. Similarly, there were no significant differences in the levels of serum calcium, sodium and urea between the 3 groups. On the other hand, the serum potassium levels were significantly lower in the ileus groups, when compared with the non-ileus postoperative cases or with the control [P <0.05]

Pancreaticoduodenectomy for pancreatic and duodenal malignancy

Radical resection of malignant tumors of pancreatic head, distal common bile duct, periampullary region and duodenum was performed in 11 patients with a mean age 51.4 years. More than half of the patients had been jaundiced at the time of operation. Preoperative stenting of the CBD helped to improve the jaundice prior to resection. Formal Whipple pancreaticoduodenectomy was the standard procedure in 8 patients and pylorus-preserving pancreaticoduodenectomy was done in 3 patients. Five patients had carcinoma of the pancreatic head proper, 3 patients had periampullary carcinoma, 2 patients had carcinoma of the distal CBD, and one patient had lymphoblastic lymphoma of the second part of the duodenum. Pancreatic fistula occurred in 2 patients, one of whom died because of associated uncontrollable infection and nutritional depletion, and the other one closed spontaneously. Minor septic complications developed in 2 patients. Long-term follow up showed 5 patients who are alive and free of recurrence. Certain detailed meticulous steps in the technique of reconstruction and pancreaticojejunal anastomosis helped to improve the results. Pancreaticoduodenectomy is considered to have an acceptable morbidity and mortality and the long-term survival is possible even for patients with cancer head proper of pancreas

Primary gastrointestinal lymphomas

Nine patients with primary gastrointestinal lymphoma are presented. They were all non-Hodgkin's lymphomas: 7 lymphocytic, one immunoblastic and one lymphoblastic. The diagnosis was made preoperatively in 5 patients, doubted in one patient and missed in 3 patients. All patients were treated surgically by resection followed by chemotherapy. Six patients received postoperative radiotherapy as well. Morbidity occurred in 2 patients and 2 patients died from recurrence 10 months and 2.5 years after surgery. The longest period of follow up is 8 years. Emphasis is laid on criteria to suspect the diagnosis and prove the primary nature of gastrointestinal lymphomas. The optimum lines of management are described

Tissue reaction to different types of suture materials and techniques used for wounds closure in pregnant rabbit uterus

Cesarean section was performed on ten at term pregnant New Zealand white rabbits to compare the macroscopic and microscopic reaction to two types of suture material; polyglactine [Vicryle] and chromic catgut and two types of closure techniques; continuous and locked. In each uterine horn two incisions were made. Each incision was closed according to predetermined method by chromic catgut or Vicryle suture using either continuous or locked technique. After 40 days the animal was sacrificed. Adhesion score was given for each uterine horn. Representative sections from suture site were obtained for histologic evaluation. Microscopically chromic catgut elicited a greater degree of adhesions than Vicryle. Microscopically Vicryle, elicited a lower degree of chronic inflammatory reaction. There was no difference in tissue response betweeen continuous and locked technique. The new synthetic absorbable suture [Vicryle] is an excellent potential alternative to reduce the incidence of post-operative morbidity

effect of a single infusion dose of propranolol on the portal hypertension

This pilot study involved 1 patients, with portal hypertension, admitted for elective splenectomy and devascularization. At laparotomy 4mg propranolol in 200ml glucose 5% were infused, while monitoring the splenic vein pressure, the pulse rate, the brachial arterial pressure and the ECG. 9 of the 10 patients responded by an initial, significant increase of the portal pressure. The mean of the maximum rise was 4.2 + 2.8 ch H2O above the mean baseline, which was 40.9 + 3.67 cm H2O. On continuing the propranolol infusion there was decline of the portal pressure. In 6 patients there was reduction below the preinfusion retained levels higher than the baseline values. The ultimate mean change in the portal pressure was insignificant reduction by 2.1 + 3.14 ml H2O. This was associated, however, with a highly significant drop in the pulse rate by a mean of 24.77 + 2.76%. The blood pressure did not show appreciable changes. The results are not in favor of the use of propranolol for the treatment of portal hypertension. They are also not promising as regard the potential use of the drug for emergency control of acute variceal hemorrhage. Its significant initial portal hypertensive effect may augment bleeding, whereas its delayed insignificant hypotensive effect is unlikely to be influential

Clinical and urethral epithelium response to the estrogen therapy in postmenopausal genuine stress incontinence

The present work had studied the response of the urethral epithelium in postmenopausal women, suffered from genuine stress incontinence to local estrogen therapy and the role of such response in the mechanism of continence. A total of 27 women in postmenopausal age referred to the gynacologist with lower urinary tract symptoms including incontinence were examined and clinically evaluated to segregate cases with genuine stress incontinence. They all had [the stress after bladder filling test] to enhance the clinical identification and quantification of urine incontinence. Sixteen women were diagnosed to have postmenopausal genuine stress incontinence ranging in its degree between mild, moderate and severe degree [5, 8, 3 women respectively]. All women were treated with 2g daily of estrogen vaginal cream for 4 weeks. Urethral smears from the midurethra were taken before and after treatment for cytological subjectively and objectively by 62.5% of cases. The cytologic changes seen in the urethral smear reflected a positive maturation index of the transitional epithelium that correlated well with the clinical response to estrogen treatment [P 0.05]. Women who did not improve clinically with treatment had no significant change in urethral cytology. The results of the present study suggested that the improvement of postmenopausal genuine stress incontinence after estrogen administration is achieved by affecting the urethral softness factor. Which in return might have increased the urethral resistance and the improved the urethral closure

retrospective study of bleeding chronic peptic ulcer

During 22 consecutive months, 731 patients presented with acute upper gastrointestinal bleeding to the Casualty Unit, Kasr Al-Aini Hospital, Cairo University. Emergency endoscopy defined the cause in 660 patients [90.3%]. Bleeding chronic peptic ulcers accounted for 17.6% of the cases [116/660]. Ninety seven patients [14.17%] had bleeding duodenal ulcer, 18 patients [2.7%] gastric ulcer, and in one patient, bleeding was due to recurrent anastomotic ulcer. The mean age was 43.3 years. The male to female ratio was 6.7: 1. Past history of a diagnosed ulcer and/or dyspepsia were positive in 79.3% of the patients. Seventy eight patients [67.2%] were treated conservatively, with 11.5% mortality. Emergency and urgent surgery were needed in 38 patients [32.8%], with 18.4% mortality. The incidence of surgery was 29.9% among duodenal ulcer bleeders [29 patients] and was 50% in gastric ulcer bleeding [9 patients]. For duodenal ulcer patients, the operation was vagotomy in 24; together with pyloroplasty in 12, with gastrojejunostomy in 9, and with antrectomy in 3. Three patients had subtotal gastrectomy, and in the remaining 2 patients under-running of the bleeding ulcer alone was done. Operated upon gastric ulcer patients had partial gastrectomy, alone in 8 and together with vagotomy in one. The overall mortality of bleeding peptic ulcer was 16 out of the 116 [13.8%]. However, if aggressive diagnosis, intensive care, planned treatment and timely-decided operative intervention were followed, the mortality could have been lower

Evaluation of the different surgical techniques for treatment of chronic duodenal ulcer

In a prospective controlled clinical trial, 59 patients with chronic duodenal ulcer, in whom surgery was indicated, were randomly allocated into 3 treatment groups. The first group [21 patients] was treated by truncal vagotomy with gastrojejunostomy [TV+GJ], the second group [20 patients] was treated by proximal gastric vagotomy [PGV], and the third group was treated by truncal vagotomy and antrectomy [TV+A]. There was no mortality after any of the three operations. Significantly raped rectum of gastric emptying occurred after PGV, followed by TV+GJ and lastly TV+A. Postoperative upper GI endoscopy, done 4 weeks after surgery, showed that bile reflux and gastritis were highest after TV+GJ, followed by TV+A lastly PGV. The differences in the endoscopic findings, between TV+GJ and PGV, were significant. Biochemical assessment of the patients, 4 weeks after surgery showed significant decrease n the basal, maximum and peak gastric acid output after each of the three operation. There was no statistical difference in the reduction between TV+GJ and PGV, whereas the reduction after TV+A was significantly greater than after TV+GJ or PGV. If reduction of gastric acidity is the only concern, then TV+A, undoubtedly, stands out. Nevertheless if vagotomy is adopted [because of the high operation mortality and morbidity, and the longterm adverse effects of gastroctomy documented by other studies], then PGV is recommended as the first choice, since it gave, in this study, the same degree of acid reduction as TV+GJ, it should, presumably, results in the same cure rate. In the mean time it was associated with less shortcomings in the early postoperative assessment