Epidermal growth factor receptor [Egfr] and C-erbB-2 Expression in colorectal adenoma and adenocarcinoma

The incidence of colorectal cancer [CRC] has been rising worldwide. Discovery of new prognostic markers in CRC patients is necessary to improve the outcome of disease and to select appropriate treatment. The epidermal growth factor receptor [EGFR] is a trans- membrane glycol-protein. An abnormal expression of the EGFR has been described in many human tumors and implicated in the development and prognosis of malignancies. C-erbB-2 is a proto oncogene. Several studies have demonstrated the value of c-erbB-2 in predicting the biological behavior of tumors. Forty five patients were included in our study. Thirty were having colorectal adenocarcinoma [21 male and 9 female] and fifteen having adenoma [11 male and 4 female] with median age of 63 years. EGFR and c-erbB-2 over expression was immunohistochemically analyzed in colorectal adenoma and colorectal adenocarcinomas in order to determine whether there was a relationship between these two proteins and various histological and clinical characteristics with their respective impact on prognosis and to study their potential usage in early diagnosis of colorectal cancer. In the current study the expression of c-erbB-2 was significantly higher in preneoplastic lesions [93.3%] than colorectal cancer [60%] p<0.001. EGFR showed an inverse pattern to c-erbB-2 expression was significantly inversely associated with low grade tumor [GI] p 0.05]. As regards, tumor location only, c-erbB-2 expression was frequently expressed in rectal cancer versus colon cancer cases [p<0.05]. From this study we can conclude that c-erbB-2 can be potentially used in early diagnosis of colorectal cancer and considered as a significant predictor of the occurrence of colorectal carcinoma while EGFR expression is considered as a prognostic tool for prediction of cancer behavior and clinical outcome in CRC cases

Laparoscopic management of abdominal hydatid disease

Hydatid cysts are a common surgical problem that is encountered in many tropical countries, including Yemen. Open surgical exploration and excision had been the mainstay of treatment until the advent of laparoscppy. Laparoscopic treatment of hydatid disease produces encouraging results, though its feasibility and safety have been questioned. Thirteen patients with abdominal hydatid Cysts; 9 hepatic and 4 splenic, underwent laparoscopic surgery between July 2005 and August 2006 in Al Amal specialized hospital of Hodyedah in Yemen. Full physical examination, laboratory assessment and imaging of the cysts were performed. The main surgical maneuvers include puncture, parasite neuteralization, and complete evacuation of the cyst followed by partial cystectomy in all cases with addition of omentoplasty in seven cases. All patients received a course of albendazole for one month preoperatively and 3 months postoperatively. Twenty three Echinococal cysts in 13 patients were treated laparoscopically. The average cyst diameter was 9.2cm. Twelve cysts located in the left hepatic lobe, 5 in the right lobe, 4 in spleen and 2 in the anterior abdominal wall. Two cysts were calcified with thick wall. Laparoscopic partial cystectomy with drainage was done in 8 patients and Omentoplasty was added to 3 of them. Conversion to open surgery was performed in 5 patients. The average operative time was 118 minutes with no intraoperative complication. The length of hospital stay range from 3 to 17 days with no operative mortality. Follow-up period for 3 up to 9 months during which no recurrences were observed. Laparoscopic treatment of hydatid disease is feasible in selected patients respecting the principles of open surgery and seems beneficial concerning postoperative comfort, hospital stay and return to daily activities

Blunt abdominal trauma: conservative Vs surgical management

Blunt trauma to the abdomen is by far the most common mechanism of injury Possible investigative modalities include; Diagnostic peritoneal lavage [DPL], Focused Abdominal Sonography For Trauma [FAST], computed tomography [CT] scanning and laparoscopy. There is an increasing volume of data supporting the non-operative management of adult patients with solid organ injury from blunt abdominal trauma. Comparative study of conservative versus operative management for blunt abdominal trauma and assessment of the value of preoperative investigations in decision-making. This study included 50 patients with the clinical diagnosis of blunt abdominal trauma, admitted from October 2002 to July 2003. Haemodynamic stability of the patient is the key determinant for the choice of the appropriate investigation or management of solid organ injuries following blunt abdominal trauma. Unstable patients with positive DPL require laparotomy, while in haemodynamically stable patients; CT is the investigation of choice. Nowadays, conservative treatment in a circulatory-stable multiply injured patient is the standard modality of treatment