Laparoscopic gastric bypass for the treatment of morbid obesity

Many authors consider Roux-en-Y gastric bypass [RYGBP] to be the "gold standard" in surgery for morbid obesity. However, laparoscopic RYGBP is arguably the most challenging minimally invasive procedure in general surgery and its learning curve is steep and difficult. The aim of this study was to study the feasibility, safety, and effectiveness of laparoscopic Roux-en-Y gastric bypass [LRGBP] in the treatment of morbid obesity. This study included 30 consecutive morbidly obese patients that underwent attempted laparoscopic RYGBP. Only patients who had a previous open upper abdominal surgery and/or BMI> 60 kg / m[2] were excluded. A prospective analysis was performed identifying the technical success, operative times, complications, length of hospital stay, and weight loss. Open conversion was required in one patient [3.3%]. There were no leaks at the gastrojejunal anastomosis, but one patient died because of gastrointestinal leak from a traumatic perforation. The mean operative time was 215 minutes. The average hospital stay was 3.4 days. One patient required endoscopic balloon dilation for stenosis at the gastrojejunostomy. Another patient required surgery for internal hernia. Patients were followed up for a mean of 21.3 months. Average excessive weight loss was 74.8%. Laparoscopic RYGBP is feasible, but it is a very complex operation. Our data showed adequate short-term weight loss and marked correction of co-morbidities. The complication rates are acceptable in the very beginning of our experience, which includes our learning curve for the procedure

Expression and prognostic significance of P-glycoprotein [MDR-1] in infiltrating duct carcinoma of the breast

Breast cancer is a major public-health issue worldwide. It is the most common cancer in women constituting 22% of all cancer cases world wide. Until recently, breast cancer was subclassified on the basis of cellular morphology and the presence of several receptors, namely ER, PgR, and the Her2, identified by immunohistochemistry. The present study was designed aiming to determine the expression of P-glycoprotein in infiltrating ductal carcinoma [IDC] patients, to correlate the expression of P-glycoprotein with other clinical and pathological parameters and to ascertain whether pretreatment detection of P-glycoprotein in patients with breast cancer could be utilized as a reliable predictor of poor prognosis. The present study constituted thirty nine cases of IDC received at the pathology department during one year beginning at January 2004. For all studied cases, routine histopathologic diagnosis and immunodetection of P-gp, ER, PgR and Her2 were carried on. Retrospective follow up of the patients for period of 2-3 years after the mastectomy operation was carried on with statistical analysis of the results. ER positive status was encountered in 10 cases [25%]. PgR positive status was encountered in 14 cases [35.9%]. A statistically significant association was detected between both ER and PgR expression and nuclear grade [P=0.002, p=0.017]. Her 2 positive immunostaining was detected in 12 cases [30.8%]. P-gp was detected in 26 cases [66.7%]. Statistically significant association between P-gp and Her2 expression was found [p=0.027]. The present study detected that ER negativity [p=0.009], nuclear grade III [P=0.06] and triple-negative molecular subtype [P=0.017] were associated with poor local recurrence-free survival [LRFS]. Her2 positivity [P=0.06] and lymph node metastasis [P=0.08] were associated with poor distant-metastasis free survival [DMES]. Her2/neu IDC that express P-gp had the poorest DFS. Pretreatment detection of P-gp is of great value to predict the response to chemotherapy in patients with Her2 -positive and triple negative infiltrating ductal carcinomas

Study of genetic predisposition in Egyptian colorectal cancer patients: role of phase II xenobiotic metabolizing genes polymorphism

The glutathione S-transferase [GST] supergene family is an important part of cellular enzyme defense against endogenous and exogenous chemicals, many of which have carcinogenic potential. The present investigation was conducted to evaluate the possible association between genetic polymorphisms of glutathione S-transferase M1 and T1 [GSTM1 and GSTT1], and susceptibility to colorectal cancer and the interaction with environmental factors. A case-control study of 50 patients and 50 healthy controls was conducted to investigate the role of GSTM1 and GSTT1 polymorphisms in colorectal cancer. Genotypes of GSTM1 and GSTT1 polymorphisms were analyzed by multiplex polymerase chain reaction [PCR]. The frequencies of GSTM1 null and GSTT1 null genotypes in controls were 42% and 16%, respectively. The GSTM1 polymorphism was associated with an increased risk of developing colorectal cancer [p=0.002; OR=3.9, 95% CI 1.68- 9.15]. There was no significant association between GSTT1 null genotype and colorectal cancer risk. The GSTT1 deletions was associated with an increased risk of developing distal tumour [OR =5.25, 95% CI: 1.6-16.7, p=0.006]. GSTM1 null genotype was significantly more common in patients who were diagnosed before the age of 40 years than in those who were diagnosed at an older age. This suggests that the GSTM1 genotype might influence the age of onset of colorectal cancer. In conclusion, the results of the present study suggest that GSTM1 null genotype and combined GSTM1/T1 null genotypes may confer a genetic susceptibility to colorectal cancer. In addition, other environmental factors such as smoking may also have a contributing role

Scoring of acute pancreatitis and its impact on consequent treatment

Acute pancreatitis is a serious disease in surgical practice which may have fatal outcome. The aim of this study was to evaluate the benefits of assessing the severity of acute pancreatitis using various scoring systems and to determine their impact on consequent treatment and prognosis. Nineteen patients were studied in a series. The Ranson's, APACHE II, Multiple organ system failure [MOSF] and abdominal CT scoring systems were used. Seventeen patients [89.4%] had Ranson's score <3, APACHE II score 1-4, CT scoring 0-2 and MOSF score 0. They had clinically mild acute pancreatitis and recovered without mortality. Another 2 patients [10.6%] had Ranson 's score 4 and 6 respectively, APACHE II score 14 and 15, CT scoring 2 in early stage and 3 in late stage; and MOSF score 0 in early stage and 3 in late stage. These two patients developed clinically severe disease with pancreatic necrosis and abscess. Both developed multiorgan failure and died inspite of intensive medical therapy and surgical intervention. Scoring of acute pancreatitis allowed prompt identification of patients with severe disease in need of intensive care unit referral and allowed following up of the course of the disease. Simultaneous scoring by different scoring systems gave better evaluation especially by scores that can be repeated as APACHE II and CT scores. Multiorgan failure was associated with mortality. Endoscopic sphincterotomy was guided by the present pathology rather than the scoring. Infected pancreatic necrosis was an indication for surgical intervention but it still has bad prognosis in spite of early scoring, intensive therapy and surgical intervention