Lipoblastoma in a four-year-old African child.

A four-year old Sudanese child presented with a growing mass in the medial aspect of the right thigh. The mass appeared during the neonatal period. On clinical examination a diagnosis of lipoblastoma was entertained on the basis of the patient's age and the clinical features of the mass. The tumor was completely excised surgically. The clinical diagnosis of lipoblastoma was confirmed pathologically. Follow-up of the patient for 6 months postoperatively showed no evidence of recurrence.

Laparoscopic cholecystectomy in the Academy Medical Centre, Khartoum, Sudan.

OBJECTIVE: To highlight the results of minimum access surgery in Sudanese patients. DESIGN: Prospective audit of laparoscopic cholecystectomies. SETTING: The Academy Medical center (Yastabshiroon), Teaching University Hospital. SUBJECTS: All the patients who had this type of surgery were included in the study. Clinical and operative data were evacuated from March 2002 to March 2004. MAIN OUTCOME MEASURES: One hundred and twenty patients had laparoscopic cholecystectomy at the center. There were 97 females and 23 males; age range was 22-90 years with a mean of 52 years. Indications for surgery were repeated attacks of biliary colic in 38, chronic cholecystitis in 60, acute cholecystis in 10 and mucocele in 12 patients. RESULTS: Three patients with chronic cholecystitis had peri-portal fibrosis due to bilharzial infestations, in spite of which laparoscopic surgery was successful. Operating time was 25-120 minutes with a mean of 47 minutes. Conversion was performed in six (2%) patients because of bleeding and four for extensive dense adhesions. There was one mortality case of a 75-year-old female who had pulmonary embolus. Hospital stay was 16-24 hours with a mean of 22 hours. Two patients had port site discharge. CONCLUSION: In general, patients were satisfied with the results of surgery and this encourages us to popularise this procedure to take off in the Sudan.

Telomerase activity in bilharzial bladder cancer. Prognostic implications.

Background: Bladder cancer is a common malignancy in Egypt and other developing countries in which infection with Schistosoma haematobium is prevalent. Bladder cancer caused by bilharziasis has different clinical and biological characters than that observed in the western world. In this study, we used the TRAP technique to estimate telomerase activity in bilharzial bladder cancer specimens and we correlated the findings with other clinical and pathological findings. Patients and methods: Bladder cancer specimens were obtained from 57 patients who underwent radical cystectomy and pathological diagnosis was obtained in all patients. Tissue samples were frozen in liquid nitrogen and stored at -80 degrees C. Telomerase activity by PCR-ELISA technique was measured using TRAP technique. Results: Our patient group included 45 males and 12 females with a median age of 49 years. The majority of our patients (35/57) have squamous histology and they have proven bilharzial history shown in the pathology specimens. Stage P3b was encountered in 29/57 patients whereas thirty-five patients have grade II tumors. The majority of our patients (41/57) were negative for pelvic nodes metastases. Telomerase activity was detected in 27/57 patients (47.4%). The mean level of telomerase was 0.85+/-0.77 in positive patients and 0.029+/-0.025 in negative patients. The expression of telomerase and its mean level in patients above age of 60, in males and in those with squamous pathology, higher grade of tumors or positive node was higher than those without but the difference did not reach statistical significance (P>0.05). Alternatively, expression was significantly higher in those with stages (P1-P3a) compared with P3b-P4a disease stages (66.6% vs. 37.1, P=0.03). Conclusion: Telomerase activity is increased in bilharzial bladder cancer although to a lesser degree than that reported for TCC in the western world, which could be explained, by different biological behavior or different assay methods. Further larger studies with more number of patients are still needed to determine its potential value for early detection and possible use as a therapeutic target.

Treatment of pilonidal sinus by primary closure with a transposed rhomboid flap compared with deep suturing: a prospective randomised clinical trial.

OBJECTIVE: To assess two techniques of primary closure after excision of pilonidal sinus. DESIGN: Prospective randomised study. SETTING: University department of surgery, United Arab Emirates. SUBJECTS: 46 patients with chronic pilonidal sinus disease, 24 treated by rhomboid flap transposition, and 22 by deep suturing technique. MAIN OUTCOME: Early mobility and recurrence. RESULTS: All patients in the rhomboid flap transposition group healed their wounds primarily compared with 17 in the primary deep suturing group (77%). (P = 0.02). Five patients wounds broke down as a result of haematoma and infection (23%). The mean hospital stay for the rhomboid flap technique was 6 days compared with 9 days after deep suturing, and the mean follow up for both groups was 18 months, the rhomboid flap group returned to work a mean of nine days earlier than the deep suturing group (23 days). No recurrence has been identified yet in the rhomboid flap group, while 2 recurrences have developed in the deep suturing group (9%). CONCLUSION: Primary closure after excision of pilonidal sinus with a transposed rhomboid flap is successful in the management of pilonidal sinus and is superior to primary closure by deep suturing.

Early patient discharge following appendicectomy: safety and feasibility.

One hundred and twenty patients with non-perforated acute appendicitis were discharged within 72 h of operation; 50 left hospital within 48 h of surgery. Criteria adopted for early discharge were: stable vital signs, active bowel sounds, ambulation and ability to tolerate fluid and food without discomfort. The patient's contact address was taken and every patient was requested to report to the out-patient department on the 7th post-operative day to remove stitches and assess the wound. There were three re-admissions. Five patients, however developed wound problems, three had wound infections, one had an indurated painful wound and the last developed erythema; the latter two patients were treated on an out-patient basis. Twenty patients were not happy about early discharge. Early discharge following appendicectomy is safe and can be practiced in uncomplicated cases of acute appendicitis.

A randomized prospective study of cefoxitin versus piperacillin in appendicectomy.

A randomized prospective study of antibiotic prophylaxis using a single dose of either cefoxitin or piperacillin is presented. The trial was carried out in Al Ain Hospital in the period 1989-1992 on 250 adult patients with non-perforated appendicitis. One group (124 patients) received 2 g cefoxitin, the other group (126 patients) 2 g piperacillin. Antibiotics were administered intravenously in the operating theatre immediately before surgery. Wound infection occurred in three patients, 2.4% of the cefoxitin group and in five patients (4%) of the second group (with no significant difference). The commonest infecting organisms were Escherichia coli (5 out of 8). Mean hospital stay for patients with wound infection was 15 days (range 12-21) compared with 6 days, (range 4-8) for non-infected cases. Prophylactic cefoxitin or piperacillin were each therefore similarly effective in minimizing the rate of wound infections in patients with non-perforated appendicitis.

Diagnosis of pathologically confirmed Symmers' periportal fibrosis by ultrasonography: a prospective blinded study.

Symmers' periportal fibrosis of the liver is the major cause of morbidity and mortality in Schistosoma mansoni infection. The diagnosis is best established definitively by a wedge biopsy of the liver. The ability of abdominal ultrasonography to diagnose this condition was prospectively compared with two independent pathological examinations of wedge biopsies of the liver. Both pathologists and the ultrasonographer were unaware of the clinical diagnosis and each other's findings. Twenty-eight of 41 patients had Symmers' fibrosis by pathological examination and all were diagnosed correctly by ultrasonography prior to surgery. Symmers' fibrosis was not diagnosed by ultrasound in any of 10 patients without Symmers' fibrosis on biopsy. In 3 patients the diagnosis of Symmers' fibrosis was uncertain because the pathologists disagreed as to its presence. These results confirm the findings of previous studies and establish that ultrasonography is at least as sensitive as wedge biopsy in diagnosing Symmers' fibrosis.

A comparison of two types of vacuum drainage after cholecystectomy.

Following cholecystectomy, 50 patients were randomly allocated for suction drainage by small (2.5 mm) Redivac or large calibre (6 mm) Redivac drains. There were 25 patients in each group. Subhepatic collection was detected by ultrasonic examination in 5 patients on the seventh postoperative day. The smaller drain was used in all of these patients. Of these 5 patients, one developed pulmonary infection, a second had internal bleeding requiring laparotomy, while the remaining 3 were asymptomatic. Subhepatic fluid was not detected in any patient who had the larger drain.