One-Session Laparoscopic Management of Combined Common Bile Duct and Gallbladder Stones Versus Sequential ERCP Followed by Laparoscopic Cholecystectomy.

AIM: This study aimed to evaluate the efficacy and safety of laparoscopic management of common bile duct (CBD) stones in a single session in comparison with two-session procedures including endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC). The most popular approach to treat CBD stones that were detected before LC is with ERCP followed by LC. This two-session approach has some disadvantages, which include spontaneous passage of stones found on magnetic resonance cholangiopancreatography while awaiting ERCP, the risk for CBD stone passage between ERCP and LC or during LC due to excessive gallbladder handling, and the need for multiple anesthesia sessions and hospital admissions within a short interval. PATIENTS AND METHODS: A prospective outcome analysis was done for 150 patients with CBD stones treated either laparoscopically in a single session with either transcystic exploration (conducted in 23 cases) or CBD exploration (conducted in 46 cases) (Group I included 75 patients) or via two sessions using ERCP followed by cholecystectomy (Group II included 75 patients). RESULTS: The rate of CBD clearance in Group I was 94.7%, whereas it was 97% in Group II. Group I is superior to Group II with regard to the operative time. There were no significant differences between the two groups regarding conversion to the open procedure, hospital stay, or postoperative complications. CONCLUSIONS: The single-session laparoscopic management of CBD stones is as safe and effective as the gold standard sequential ERCP followed by LC with nearly the same rate of success, hospital stay, and complications.

Amalgamation of procalcitonin, C-reactive protein, and sequential organ failure scoring system in predicting sepsis survival.

BACKGROUND: The clinical value of inflammatory biomarkers is still questionable. AIM OF THE WORK: The aim of this study is to compare the clinical informative value of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentration in the early detection of sepsis, as well as relating these biomarkers to other scoring systems. PATIENTS AND METHODS: A total of 138 patients were enrolled in our study. All were subjected to PCT, CRP, and sequential organ failure assessment (SOFA) scores daily for 7 days (starting from admission day). Blood samples were collected before starting antibiotics, with 28 days follow-up and patients were assigned to three groups: Group I: SOFA 2-7, Group II: SOFA 8-10, and Group III: SOFA ≥11. RESULTS: Underlying clinical diagnosis revealed pneumonia in 72 patients, urinary tract infections in eight, bloodstream infection in four, and other infections in 23, while infection could not be traced in 25 patients. The mean PCT was 3 ng/ml (95% confidence interval [CI]: 1-4), 12 ng/ml (95% CI: 9.1-14), and 19 ng/ml (95% CI: 16.3-22.3) in Groups I, II, and III, respectively, with a statistically significant difference in the mean PCT level among the three groups (P < 0.0001). On the other hand, CRP mean level did not significantly differentiate between the groups (147.1 mg/L in Group II, which was even higher than the level of Group III, 138.4 mg/L). CONCLUSION: PCT seems to do better than CRP in predicting the SOFA groups, giving its patronage display over a wide spectrum of insults.

Bacterial and fungal endophthalmitis in upper Egypt: related species and risk factors.

OBJECTIVE: To study risk factors, contributing factors of bacterial and fungal endophthalmitis in Upper Egypt, test the isolated species sensitive to some therapeutic agents, and to investigate the air-borne bacteria and fungi in opthalmology operating rooms. METHODS: Thirty one cases of endophthalmitis were clinically diagnosed and microbiologically studied. Indoor air-borne bacteria and fungi inside four air-conditioned operating rooms in the Ophthalmology Department at Assiut University Hospitals were also investigated. The isolated microbes from endophthalmitis cases were tested for their ability to produce some extracellular enzymes including protease, lipase, urease, phosphatase and catalase. Also the ability of 5 fungal isolates from endophthalmitis origin to produce mycotoxins and their sensitivity to some therapeutic agents were studied. RESULTS: Results showed that bacteria and fungi were responsihle for infection in 10 and 6 cases of endophthalmitis, respectively and only 2 cases produced a mixture of bacteria and fungi. Trauma was the most prevalent risk factor of endophthalmitis where 58.1% of the 31 cases were due to trauma. In ophthalmology operating rooms, different bacterial and fungal species were isolated. 8 bacterial and 5 fungal isolates showed their ability to produce enzymes while only 3 fungal isolates were able to produce mycotoxins. Terbinafine showed the highest effect against most isolates in vitro. CONCLUSIONS: The ability of bacterial and fungal isolates to produce extracellular enzymes and mycotoxins may be aid in the invasion and destruction of eye tissues. Microbial contamination of operating rooms with air-borne bacteria and fungi in the present work may be a source of postoperative endophthalmitis.

Taxonomy and phylogeny of new wood- and soil-inhabiting Sporothrix species in the Ophiostoma stenoceras-Sporothrix schenckii complex.

Sporothrix, one of the anamorph genera of Ophiostoma, includes the important human pathogen S. schenckii and various fungi associated with insects and sap stain of wood. A survey of fungi from wood utility poles in South Africa yielded two distinct groups of Sporothrix isolates from different geographical areas. DNA sequence and morphological data derived in this study showed that isolates in these groups represent two novel species in the S. schenckii-O. stenoceras species complex. A new species isolated from pine poles and rosebush wood and phylogenetically closely related to S. pallida is described here as Sporothrix stylites. Phylogenetic analyses also confirmed the synonymy of S. albicans and S. nivea with S. pallida. Sporothrix stylites and S. pallida also are related closely to the isolates from soil, previously treated as "environmental" isolates of S. schenckii. Soil isolates are clearly distinct from human isolates of S. schenckii. We describe the former here as Sporothrix humicola. The isolates from eucalypt poles group peripheral to most other species in the S. schenckii-O. stenoceras complex and are newly described as Sporothrix lignivora. Phylogenetic analyses of sequences of isolates from soil and wood together with those of clinical isolates showed that the human-pathogenic strains form an aggregate of several cryptic species.

Retropubic repair of genitourinary fistula using a free supporting graft.

OBJECTIVE: To report the repair of genitourinary fistulae using a retropubic extraperitoneal transvesical approach using a support graft (free graft) from the anterior abdominal wall fat. PATIENTS AND METHODS: In all, 26 women with genitourinary fistulae (25 with vesicovaginal and one uterovesical) were operated using the free graft method. RESULTS: All patients had no leakage after surgery; while 15 developed urgency three had recurrent urinary tract infection and one developed a small bladder capacity. CONCLUSION: This operation has the advantages of a short operative duration, an easy technique and fewer postoperative complications with a high success rate.

Effect of two systemic fungicides on cellulose decomposing fungi of tomato plants and on some enzymatic activities.

Kocide 101 (77% cupric hydroxide) and Ridomil plus (15% metalaxyl and 35% copper oxychloride) were used in the treatment of tomato plants. The two fungicides exerted a depressive effect on the total counts and on the individual cellulose decomposing fungal species associated with the roots and shoots of tomato. When these fungicides were incorporated in the liquid culture medium specified for growth and extracellular enzyme production by some selected fungal species, there was a significant reduction in mycelial growth as well as in amylase, cellulase, lipase and protease production by the fungi tested, particularly at the higher doses (200-400 ppm). Exceptions were observed with lower doses (50 and 100 ppm) especially in case of Aspergillus flavus, Cunninghamella echinulata, Penicillium chrysogenum and Fusarium oxysporum grown for amylase or cellulase production.

Synthesis and in vitro antifungal activity of some N,N-disubstituted dithiocarbamic acid esters derived from 2-methylquinazolinones.

A series of 2-[(N,N-disubstituted thiocarbamoylthio)methyl]quinazolinones 9a-g; 10a; 10d; 11a-d and 12a were synthesized and evaluated for potential antifungal activity against a variety of fungal species. The synthesis of the target compounds was achieved by reaction of the potassium salts of disubstituted dithiocarbamic acids 8a-g and the respective 2-bromomethyl-4(3H)-quinazolinone 4 or 3-aryl-2-chloromethyl-4(3H)-quinazolinones 5-7. The dithiocarbamic acid derivatives were synthesized in a one step reaction from the appropriate amine, alcoholic potassium hydroxide solution and carbon disulfide. TLC and elemental analyses ascertained the purity of the synthesized compounds and their structures were confirmed by IR and 1H-NMR spectroscopy. 2-Methyl-4(3H)-quinazolinone 2, the precursor of the 2-bromomethyl intermediate 4, was selected as representative example for detailed spectroscopic investigations, including 300 MHz 1H- and 13C-NMR in addition to HH COSY; APT and 1H13C HETCOR spectra, with the aim of establishing correct assignment of the spectral data of related compounds. The synthesized disubstituted dithiocarbamates 9a-g; 10a,d; 11a-d and 12a as well as tolnaftate and clotrimazole, as reference drugs, were tested in vitro at 2 and 5% concentrations against 23 pathogenic fungi. The study revealed that compound 9a exhibited broad spectrum inhibitory activity that is superior or comparable to that of the reference drugs against the tested fungal isolates. Selective fungistatic activity against Candida species was elicited by compound 9e and against Microsporum species as well as Trichophyton mentagrophytes was also observed for compound 9g. As a general pattern it might be postulated that some of the synthesized dithiocarbamate derivatives showed broad spectrum antifungal activity as compared with tolnaftate, the clinically used thiocarbamate compound, and also exhibited comparable activity to clotrimazole against Candida species and F. Solani.

Effect of soil treatment with the organophosphorus insecticide Profenfos on the fungal flora and some microbial activities.

Tests were conducted to determine the effects of Profenfos [(0-(4-bromo-2-chlorophenyl) 0-ethyl S-n-propyl-phosphorothioat] on fungal populations and some activities in soil. Profenfos (at 5.4 micrograms active ingredient/g dry soil), has a significant adverse effect on the count of total fungi after 2, 4 and 6 weeks after treatment. This effect was completely alleviated after longer incubation. Incorporation of this insecticide into the agar medium inhibited the total count of soil fungi at 6.4 and 38.4 micrograms ml-1. Initial activation followed by a decrease in CO2 output occurred in soil treated with 5.4 micrograms a.i./g. The two doses of Profenfos accelerated urease activity for 6 weeks after soil treatment, but inhibited the enzyme activity after longer periods. An inhibitory effect on nitrate reductase activity was observed with some insecticide treatments in the early stages of incubation followed by an activation in certain cases.

Salmonella meningitis. [case report]

Salmonella infections in children occur mainly as gastroenteritis which is a self limiting disease. Typhoid is the next common form; where antiiotics are warranted. Rarely; localised infections can occur especially in the younger age groups. The patient in this case had salmonella meningitis which is a rare form of salmonella infection with a bad prognosis

Some ecological and physiological studies on bacteria isolated from salt-affected soils of Egypt.

Members of Bacillaceae, Rhizobiaceae, actinomycetes and others were isolated from cultivated and non-cultivated saline soils. The high population of bacteria and actinomycetes were almost coincided with the relatively high levels of organic matter whatever the degree of soil salinity. Bacillus stearothermophilus and B. subtilis were more frequently isolated than other Bacillus species. Most of Rhizobium isolates were salt tolerant being able to grow in media containing 3% and 6% NaCl. The abilities of different bacterial isolates to attack citrus pectin, soluble and insoluble forms of cellulose were also tested.

Some physiological studies on fungi isolated from poultry feedstuffs.

A total of 506 isolates of mesophilic, thermophilic and thermotolerant fungi isolated from the poultry feed ingredients included soybean meals, ground maize, cottonseed cake, wheat bran and fish meal, on glucose-Czapek's agar, Littman oxgall agar at 28 degrees C and yeast starch agar (YPSs) at 45 degrees C, were screened for their ability to produce hydrolytic protease enzyme on solid media. Most of the fungal isolates were able to produce such enzymes but with variable capabilities. The highest proteolytic activity was exhibited by some isolates of Penicillium chrysogenum, Aspergillus flavus, Thermoascus thermophilus and Rhizopus chizopodifarmis. Of all fungal isolates screened for proteolytic activity, Penicillium chrysogenum and Thermoascus thermophilus produced the highest amounts of proteases. These two isolates were used to study the effect of some environmental and nutritional factors on their proteolytic activity. It was found that the highest yield of protease by P. chrysogenum (12.5 units) was achieved 3 days after incubation at 30 degrees C. Marked reduction in protease activity was observed at 37 degrees C. The thermophilic fungus T. thermophillus exhibited maximum (18 units) proteolytic activity 6 days after incubation at 45 degrees C. The enzyme yield was reduced to 13 units at 50 degrees C. Among the seven carbon sources tested, sucrose was the most appropriate for maximum protease production by both P. chrysogenum and T. thermophilus (13.2 and 12.8 units, respectively). Of the sixteen nitrogen sources investigated, NaNO3 was the best inorganic additive nitrogenous salt which induced the highest proteolytic activity by P. chrysogenum and T. thermophilus, whereas DL-tryptophan was the most preferable organic nitrogen compound for maximum protease production by the two fungi tested.

Survey of keratinophilic and saprobic fungi in the cloven-hooves and horns of goats and sheep from Egypt.

Seventy-six species belonging to 29 genera were collected from 320 samples of cloven-hooves and horns of goats and sheep. Chrysosporium was the most common genus on the various substrates and comprehended the following species: C. asperatum, Chrysosporium anamorph of Arthroderma cuniculi, Chrysosporium anamorph of Arthroderma curreyi, C. georgii, C. indicum, C. keratinophilum, C. lobatum, C. lucknowense, C. pannicola, C. pseudomerdarium, C. queenslandicum, Chrysosporium state of Thielavia sepedonium and C. tropicum. Some interesting fungi were isolated: Myceliophthora anamorph of Arthroderma tuberculatum, Myceliophthora anamorph of Corynoascus novoguineensis, Myceliophthora anamorph of Ctenomyces serratus, Trichosporon cutaneum, Trichophyton terrestre and T. verrucosum. Also, several saprobic filamentous fungi tolerating high levels of cycloheximide were isolated of which numerous members of Acremonium, Aspergillus, Chaetomium, Fusarium, Penicillium, Scopulariopsis and several others.

Studies on the mycoflora of Aswan High Dam Lake, Egypt: monthly variations.

Fifty-one species and one variety appertaining to twenty one genera of mesophilic fungi were recovered from the monthly samples of marginal water (44 species, 1 variety and 18 genera) and submerged mud (78 species, 1 variety and 30 genera) of Aswan High Dam Lake during the period from July 1985 to December 1986. The most common species were Aspergillus fumigatus, A. flavus, A. terreus, A. niger and Penicillium funiculosum. The highest fungal populations were almost detected either in October, in December 1985 or in February 1986. Of the 12 thermophilic and thermotolerant fungal species, A. fumigatus and A. nidulans were the most common. Paecilomyces variotii, Rhizomucor pusillus, Thermomyces lanuginosus, Thermoascus thermophilus and Sporotrichum thermophilum were fairly common in one locality or more. The physico-chemical characteristics of water and mud samples were also followed.

Studies on the mycoflora of Aswan High Dam Lake, Egypt: vertical fluctuations.

The fungal population of Aswan High Dam Lake showed marked vertical variations during the period of study which extended from July 1985 to December 1986. High fungal counts were observed at the surface water which were mainly due to the high counts of Aspergillus fumigatus and A. terreus. Going deeper the fungal population decreased till 30 meters, then gradually increased to reach its maximum at the 70 meter depth (near the bottom of the lake). Such increase was basically due to the high population of Penicillium funiculosum. At each sampling time, the water temperature and the values of dissolved oxygen were always higher at the surface than near the bottom of the lake. The temperature ranged from 15 degrees to 26 degrees C and the dissolved oxygen from 1.31 to 8.98 mg 1(-1).

Mycoflora of anise and fennel seeds in Egypt.

Using four medium types (glucose-, cellulose-, 50% sucrose- and 10% NaCl-Czapek's agar), it was possible to isolate 15 fungal genera, 78 species and 6 varieties. The collective fungal spectrum varied from one medium to another where the highest number of species (57 species/1000 seeds) was obtained on glucose- and the lowest (31 species/1000 seeds) on 10% NaCl-Czapek's agar. Aspergillus, Penicillium, and sometimes Rhizopus and Chaetomium were the most common genera on the different medium types. The most common fungal species especially on glucose- and cellulose-Czapek's agar were, Aspergillus niger, A. flavus, A. ochraceus, A. fumigatus, A. flavus var. columnaris, Penicillium chrysogenum, Rhizopus stolonifer and Chaetomium globosum. Members of A. glaucus group were more frequently recovered on 10% NaCl- and 50% sucrose-Czapek's agar.

Keratinophilic fungi associated with rabbit claws in Egypt.

Using the soil plate technique, thirty one species appertaining to twenty three genera were recovered from 160 samples of rabbit claws which were collected from a rabbit farm at Assiut. Of the true keratinophilic fungi Chrysosporium tropicum was the most prevalent where it colonized 56.25% of the samples. Microsporum gypseum was rarely isolated in this study. Among the non-keratinophilic fungi Penicillium funiculosum. P. jenseni and Paccilomyces lilacinus were of low incidence (20%, 19.37% and 14.37% of the samples, respectively).

Keratinolytic fungi of wadi Qena in Egypt.

Forty-six soil samples collected from different sites of wadi Qena were examined for keratinophilic fungi using the hair baiting technique. Thirty-two species in addition to one variety of each of A. nidulans and A. flavus which belong to eighteen genera were recovered. Aspergillus, Chrysosporium, Penicillium, Microsporum and Fusarium were the most frequent genera developed from baited soils.

Cytological effects of fungal metabolites produced by fungi isolated from Egyptian poultry feedstuffs.

The cytogenetic effects of fungal metabolites produced by 113 strains belonging to 36 fungal species and isolated form 5 substrates of commercial poultry feedstuffs were tested for their effect on the growing root meristems of Allium cepa. The fungal metabolites of Paecilomyces canescens, Aspergillus fumigatus, Syncephalastrum racemosum, Aspergillus terreus and Mucor hiemalis strongly suppressed cell division. Metabolites from other strains had less effect on cell division but permitted the appearance of several abnormalities through different mitotic stages. In general, chromosomal aberrations were more obvious with metabolites of Aspergillus species, Mucor circinelloides and Cladosporium cladosporioides. The mutagenic effects produced by these fungal metabolites reflect the risk that might take place through the consumption of these contaminated feedstuffs.

Keratinophilic fungi of animal and bird pens in Egypt.

Samples were collected from 44 pens under animals and birds for the estimation of keratinophilic fungi using the hair-baiting technique. Thirty-nine species which belong to eighteen genera were recovered. Chrysosporium, Aspergillus, and Penicillium were the most frequent genera. From keratinophilic fungi, Myceliophthora anamorph of Corynascus sepedonium, Myceliophthora anamorph of Corynascus novoguinensis, Microsporum boullardii, M. gypseum, Trichophyton metagrophytes and Arthroderma sp. were recovered in different frequencies.

Keratinophilic fungi from the duck nails in Egypt.

The mycoflora of one hundred and sixty of duck nail samples, collected from the duck Farm, Faculty of Agriculture, Assiut University, were examined. Using the soil plate technique and Sabouraud's dextrose agar, thirty six species appertaining to twenty genera of keratinophilic fungi were isolated. Chrysosporium was the genus most frequently isolated (50% of the samples). Aspergillus and Penicillium occurred in low incidences (13.1 and 12.5% of total samples). Trichophyton rubrum was found to colonize few of the duck nail samples (2.5%) as well as some other fungal species previously reported as pathogenic to man and animals (Aspergillus fumigatus, Scopulariopsis brevicaulis and Paecilomyces lilacinus).