Carcinoma of the ampulla of vater and duodenum

The present study was carried out on 13 patients with carcinoma of the ampulla of vater and duodenum. Fiberopic duodenoscopy was the most helpful preoperative diagnostic measure. Preoperative frozen section biopsy was diagnostic in 69.2%. Most of the tumors were of the non papillary type [9 cases]. Only 3 patients were fit for curable radical excision [pancreaticoduodenectomy]. Local transduodenal resections were associated with no operative mortality but a high recurrence rate 71%. The overall operative mortality was 7.69% with a mean survival of 21 months. Patients with papillary adenocarcinoma had a longer postoperative survival period. Patients with resectable tumors of the less invasive papillary carcinoma were recommended for pancreaticoduodenectomy. Non papillary carcinoma would preferably be treated by transduodenal local excision. Advanced irresectable tumors are better managed by endoscopic biliary decompression

Bi-directional doppler assessment of primary varicoceles

Bidirectional Doppler ultrasonography was used in the present study in 40 patients with primary varicoceles and 10 control cases. It was found to be a sensitive non invasive method to diagnose the various degrees of primary varicoceles and to detect subclinical cases [4 cases]. These latter patients showed: retrograde venous reflux, abnormal spermogram but no palpable varicoceles. The grading of varicoceles, by studying the velocity wave form pattern and the identification of the group of venous plexus affected as well as the type of varicocele were all possible using Doppler ultrasonography. Post operative Doppler examination revealed the presence of persistant venous reflux in 4 cases [10%] with no palpable varicocele. Doppler ultrasonography has thus proved accurate in detecting subclinical varicoceles and in assessing the adequacy of varicocele management

Evaluation of hydrocolloid occlusive dressing in the local management of leg ulcers

The present study was carried out to clinically evaluate the use of hydrocolloid occlusive dressing [HCD] in the treatment of leg ulcers. The material of this study consisted of 27 patients with ulcerations in the lower extremities due to variable causes. Most of the ulcers [74%] healed and the mean duration from onset of treatment to healing was 46.6 days. The need for infrequent change of dressing [mean duration 4.8 days] and the ease of application and use made this type of dressing convenient to most patients. HCD provided a moist environment which is beneficial for the healing process: it does not damage newly formed epithelium during its removal. Only one patient suffered wound infection. Four of our patients had excessive wound exudate which was judged unacceptable to them. HCD could therefore be recommended in superficial, clean, rather small wounds. Modifications increasing the absorbent capacity and the size of HCD could help to overcome the limitation of its use

Postpartum Lord's procedure treatment of anal fissures and/or hemorrhoids

200 pregnant females with anal fissure and/or haemorrhoids were randomly divided into two equal groups [A] and [B]. Patients of group [A] were subjected to Lord's procedure under local anaethesia immediately after delivery while patients of group [B] were studied as controls. 90.9% of patients with anal fissure and 83.65% of patients with haemorrhoids were rendered either symptom free or experienced great improvement after dilatation. Transient faecal soiling and transient incontinence to flatus were the commonest complications seen following Lord's procedure. However, they rectified themselves spontaneously within 4 to 6 weeks. Lord's procedure is recommended as the method of choice for the treatment of anal fissures and/or haemorrhoids in pregnancy in the immediate post-partum period

Laparoscopic cholecystectomy: technical consideration and preliminary results

Laparoscopic cholecystectomy is widely gaining acceptance among surgeons. It is an effective and safe procedure which has the advantages of being minimally invasive and of decreasing the hospital stay of the patients and hence decreasing the costs incurred by the patients subjected of cholecystectomy. Attention to the minute details of the technique and acquiring the necessary training should be a must before using this procedure with its associated high technology. The present work underlines the details of the technique and presents the preliminary results of the initial 12 cases

Methylene blue infusion for the intraoperative identification of the parathyroids

The present study was carried out on 15 patients admitted for thyroidectomy to evaluate the use of preoperative methylene blue infusion for the operative identification of the parathyroid tissue. Of the identified normal parathyroid gl and s, 76.47% stained dusky blue. The technique was found safe, inexpensive, easily reproducible and is advised to be used routinely in parathyroid exploration

Does the increasing degree of ascites affect the lower oesophageal sphincter tone in schistosomal patients?

The lower esophageal sphincter [LES] pressure was measured in 20 patients with schistosomal hepatic fibrosis and different degrees of ascites and 22 patients with no ascites. No statistically significant difference in LES pressure was detected between the two groups. However, intragastric pressure was significantly higher in the ascitic group [14.3 +/- 3.5 mmHg] than those with no ascites [6.68 +/- 2.3 mmHg] and tends to increase with increasing degree of ascites. In the ascitic group, no statistically significant differences in the LES pressure could be detected between patients having mild, moderate or tense ascites. There was no reflex increase in LES pressure with the presence of ascites or its increasing degree. The prevention of gastro-esophageal reflux in these patients was probably due to the mechanical effect of increased intraabdominal pressure on the abdominal esophagus

Serum copper in patients with schistosomal hepatic fibrosis

The body contains about 100 mg copper widely distributed in various organs with the highest concentration in the liver, brain and kidney. More than 95% of serum copper is bound to protein ceruloplasmin and the rest is bound to plasma albumin. In the liver, copper absorption and excretion, synthesis, and release of ceruloplasmin take place. It was found in this work that the peripheral serum copper concentration in schistosomal cases were significantly higher than that of controls