The effect of residual gastric antrum size on the outcome of laparoscopic sleeve gastrectomy: a prospective randomized trial.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is gaining popularity worldwide as a definitive bariatric procedure. However, there are still some controversial issues associated with the technique, one of which is the size of the residual antrum. OBJECTIVES: The aim of this prospective randomized trial is to study the effect of the size of the residual gastric antrum on the outcome of LSG. SETTINGS: University-affiliated hospital. METHODS: Between November 2009 and August 2013, 113 morbidly obese patients submitted for LSG were randomized into 2 groups, namely antral preserving-LSG (AP-LSG) and antral resecting-LSG (AR-LSG), depending on the distance from the pylorus at which gastric division begins. In the AP-LSG group, the distance was 6 cm from the pylorus and included 58 patients, whereas the distance was 2 cm in the AR-LSG group and included 55 patients. The follow-up period was at least 12 months. Baseline and 6 and 12 month outcomes were analyzed including assessments of the percent excess weight lost (%EWL), reduction in BMI, morbidity, mortality, reoperations, quality of life, and co-morbidities. RESULTS: Both groups were comparable regarding age, gender, body mass index (BMI), and co-morbidities. There was one 30-day mortality, and there was no significant difference in the complication rate or early reoperations between the 2 groups. Weight loss was significant in both groups at 6 and 12 months. At 12 months, weight loss was greater in the AR-LSG than in the AP-LSG group, but with was no significant difference between the 2 groups at 12 months (%EWL was 64.2% in the AP-LSG group and 67.6% in the AR-LSG group; p>.05). The resolution/improvement of co-morbidities, quality of life outcome and the overall prevalence of co-morbidities were similar. CONCLUSIONS: LSG with or without antral preservation produces significant weight loss after surgery. The 2 procedures are equally effective regarding %EWL, morbidity, quality of life, and amelioration of co-morbidities.

Apoptosis and cell proliferation: correlation with BCL-2 and P53 oncoprotein expression in human hepatocellular carcinoma.

BACKGROUND/AIM: Occurrence and biological characteristics of tumors are related not only to over-proliferation of carcinoma cells but also to decrease of apoptosis. The present study was suggested to evaluate the correlation between P53 and Bcl-2 oncoprotein expression with apoptosis and cell proliferative activity in HCC patients. METHODOLOGY: P53 and Bcl-2 protein expression were estimated in the sera and in liver tissues of 45 HCC cases using ELISA and immunohistochemistry. Apoptosis was estimated as apoptotic index (AI) and cell proliferative activity was detected using AgNORs. RESULTS: Serum p53 antigen in HCC patients (0.46±0.331ng/ml) showed significant elevation than healthy individuals (0.24±0.11ng/ml, p<0.05). P53 protein was immunostained in 41% of HCC; 37.5% of these positive cases were in diffuse pattern representing the mutant p53. Serum Bcl-2 was elevated in HCC cases (50.28±25.83u/ ml) than healthy individuals (26.65±8.63u/ml, p<0.05). Bcl-2 was immunohistochemically localized in 35.9% of HCC and the positivity was inversely proportional with the histological grade (47.4%, 25%, 25% in grade I,II,III respectively). Bcl-2 showed a positive linear correlation with p53 in the sera of carcinoma patients (p<0.05). CONCLUSION: Bcl-2 may play a role in hepatocarcinogenesis as an inhibitor of apoptosis. However, a positive linear correlation was found between bcl-2 and p53 suggesting that bcl-2/p53 co-expression pattern may be of value in the development of more effective medical therapies in HCC.

Serum P53 Abs in HCC patients with viral hepatitis - type C.

BACKGROUND/AIMS: P53 gene mutations have a higher malignant potential and often leads to the production of p53 Abs. This study was conducted to evaluate the clinical implications of p53Abs in HCV-related HCC and its diagnostic capacity as a new biomarker in HCC. METHODOLOGY: 83 patients with HCV-chronic liver disease (25 with LC and 58 with HCC) were enrolled in this study. Ten healthy individuals (HI) served as control group. The studied group was subjected to clinical examination, imaging radiology, laboratory investigation and liver biopsy. Serum p53 Abs was assessed by (ELISA). RESULTS: Serum p53 Abs in HCC (0.5567±0.227) was significantly elevated (p<0.0001) than LC (0.252±0.0099) and HI (0.214±0.068) (p=0.001). Serum P53 Abs was significantly (p=0.01) increased with the progression of child score but there was no significant difference with regard to age, sex, tumor size or serum liver profile. However, serum p53 Abs showed no significant positive correlation with AFP in HCV-related HCC (r=0.09, p value= 0.6) but serum p53 Abs in combination with AFP showed higher diagnostic sensitivity (82.2%) of HCC than either alone. CONCLUSIONS: P53 Abs could be regarded as a specific biomarker for cancer process and its use in combination with AFP may increase the diagnostic sensitivity of HCC.

Diagnosis and management of choledochal cyst: 20 years of single center experience.

We report the first case series from Africa and the Middle East on choledochal cyst, a disease which shows significant geographical distribution with high incidence in the Asian population. In this study, the epidemiological data of the patients are presented and analyzed. Attention was paid to diagnostic imaging and its accuracy in the diagnosis and classification of choledochal cyst. Most cases of choledochal cyst disease have type I and IV-A cysts according to the Todani classification system, which support the etiological theories of choledochal cyst, especially Babbitt's theory of the anomalous pancreaticobiliary duct junction, which are clearly stated. The difficulties and hazards of surgical management and methods used to avoid operative complications are clarified. Early and late postoperative complications are also included. This study should be followed by multicenter studies throughout Egypt to help assess the incidence of choledochal cysts in one of the largest populations in Africa and the Middle East.

Prognostic significance of three hepatitis markers (p53 antibodies, vascular endothelial growth factors and alpha fetoprotein) in patients with hepatocellular carcinoma.

BACKGROUND/AIM: Hepatocellular carcinoma (HCC) is the third most common cause of cancer death in the world. Of patients with HCC, the diagnostic capacity of Alpha Fetoprotein (AFP) depends on its elevation in the serum. Concentration of AFP greater than the upper reference limit indicate the presence of HCC, but values below this level are less useful because they may also occur in chronic liver disease. To improve the sensitivity of HCC detection by AFP, this work was conducted to study serum expression of p53 Antibodies (p53 Abs) and Vascular Endothelial Growth Factors (VEGF) as a biomarkers in combination with AFP in patients with HCC. METHODOLOGY: The study included 67 patients with HCC (58 males and 9 females with a mean age of 53.7 years) and 27 patients with liver cirrhosis (23 males and 4 females with a mean age of 42 years). Ten healthy volunteers served as control group. Sera of all cases were examined for p53 Abs and VEGF by Enzyme linked immunosorbent assay (ELISA) and correlate its levels with serum AFP expression. RESULTS: Serum level of p53 Abs was detected in HCC patients (0.54 +/- 23) with a significant elevation (p < 0.0001) than liver cirrhosis (0.26 +/- 0.1) and healthy individuals (0.21 = 0.068). The higher percentage of p53 Abs (73.07%) was detected in HCC patients than in liver cirrhosis (7.4%) (p < 0.0001). Serum expression of VEGF was significantly elevated (p < 0.0001) in HCC patients and in cirrhotic patients than healthy individuals (0.52 +/- 0.25, 0.55 +/- 0.25 vs 0.17 +/- 0.034) while there was no significant difference in VEGF between HCC and cirrhotic patients (p > 0.05). There was no association between either p53 Abs or VEGF and AFP concentrations. However, a greater incidence of VEGF and accumulation of p53 Abs expression was detected in positive cases for AFP where VEGF was detected in 85.3% and p53 Abs was detected in 83.3% of positive cases for AFP. Also, p53 Abs positive patients showed a significant high serum level of VEGF; so both can be used in association for screening of patients with HCC. CONCLUSION: It could be concluded that p53 Abs can be considered as an additional tumor marker to increase the diagnostic potential of AFP in HCC patients and VEGF may offer a novel diagnostic value for HCC.