effect of exogenous endotoxin administration on liver regeneration after partial hepatectomy in experimental animals

The influence of exogenous endotoxin pretreatment on liver regeneration after partial hepatectomy was evaluated in 390 male Albino rats divided into four groups. Rats in the first and third groups were injected with endotoxin at a dose of 33 Mg/100g subcutaneously. Animals in the second and fourth groups were injected with normal saline. 70% partial hepatectomy was performed in the first and second groups, 24 hours post injection. Sham operation was performed in the other two groups. Hepatocyte regeneration was quantified at varying intervals post-operatively by mitotic index and detection of argyrophilic nucleolar regions [AgNORs] by high-resolution image cytometry. In the meantime, systemic venous blood samples were collected and subjected to quantitative estimation of endotoxin levels. Systemic endotoxemia occurred after exogenous endotoxin administration as well as after partial hepatectomy. Hepatocyte regeneration was significantly accelerated in response to endotoxin administration 24 hours before partial hepatectomy [P<0.05]. There was no significant correlation between variables of serum endotoxin and those of mitotic index and AgNORs. It seems that the stimulatory effect of endotoxin on liver regeneration occurs through an indirect mechanism. It is concluded that systemic endotoxemia is a natural process due to partial hepatectomy which when exaggerated exogenously, resulted in significant acceleration of hepatocyte proliferation in the course of hepatic regeneration. In this situation, systemic endotoxemia may be considered as a result and an effect. Both mitotic index and AgNORs proved to be reliable quantitative histological parameters to assess hepatic regeneration. AgNORs seemed to be more sensitive and controlled technique than mitotic index

Comparative study between open cholecysectomy and laparoscopic cholecystectomy

In this study, the results of 350 patients underwent laparoscopic cholecystectomy [LC], were compared with those of 420 patients on whom open cholecystectomy [OC] was performed, in Banha University Hospital. Laparoscopic cholecystectomy patients included cases presented as symptomatic chronic calcular cholecystitis [96.3%] and acute cholecystitis [3.7%], while OC patients included cases with both chronic [74%] and acute cholecystitis [18.6%] and common bile duct stones [7.4%]. The mean operative time was significantly longer in LC. This procedure was completed in 325 out of 350 patients, while converted to open in 25 patients [7.1%], with fewer complications in 20 patients [5.7%]. The mean postoperative stay was significantly shorter in LC. No mortality was reported in both groups, while the complication rate was 5.7% in LC and 9% in OC

Supraduodenal choledoduodenostomy versus endoscopic sphincterotomy in the management of choledocholithiasis in cholecystectomized patients [a prospective trial]

This study included managing choledocholithiasis in a cholecystectomized patients by 2 different modalities in 2 different centers. Both groups were matching together according to age, sex and liver function test. Group A included 21 patients managed by supraduodenal choledochoduodenostomy. Their mean age was 39.6 +/- 3.2 years. The mean diameter of the common bile duct was 14.9 +/- 0.9 mm. The success rate was 95% and the morbidity rate was 19%. Only a single patient was reoperated upon due to retained stone causing cholangitis. Group B included 19 patients managed by ERCP. Their mean age was 37.4 +/- 4.7 years. The success rate was 89% and the morbidity rate was 31.6%. There was no mortality in both groups. This study recommend that patients with choledocholithiasis after cholecystectomy should be assessed by the surgeon and the endoscopist to get the perfect decision in their management. Also, that both methods proved to be complementary and not competitive