Differential Expression of Glypican-3 and Insulin­Like Growth Factor-II mRNAs and Alpha-Fetoprotein and Ki-67 Markers in HCV Related Hepatocellular Carcinomas In Egyptian Patients

Background: Increasing evidence indicates that in hepatocellular carcinomas (HCCs) abnormal gene expression, for example of glypican-3 (GPC-3) and insulin-like growth factor-II (IGF-II), are associated with the occurrence and progression of HCC. The objective of this study was to evaluate the differential expression of GPC-3 and IGF-II mRNAs in HCC tissues with a background of chronic hepatitis C virus (HCV) genotype 4 cirrhosis, in relation to Ki-67 and alpha-feto protein (AFP) tissue markers. Methods: One hundred and five patients with HCCs who had undergone hepatectomy, were included, after obtaining informed consent. Total RNA was extracted from malignant and corresponding peri-malignant liver tissues, and GPC-3 and IGF-II mRNAs in addition to beta-actin mRNA as an internal control, were evaluated in all samples by reverse transcriptase-polymerase chain reactions (RT-PCR). Routine histopathological diagnosis as well as immunohistochemical (IHC) staining using monoclonal antibodies for Ki-67 and AFP were also performed. Result: Expression of GPC-3 mRNA was positive in all HCC malignant tissue, with overexpression in 86/105 (81.9%); in respect to the grade of the tumor (1-3 grades), while in peri-malignant tissue it was over expressed only in 20/105 (19%). The IGF-II mRNA was over expressed in only 10/105 (9.5%) malignant and peri-malignant samples. AFP was expressed in 33.3% of malignant samples but absent in peri-malignant tissues. Ki-67 expression was significantly increased in malignant compared to peri-malignant tissue. Conclusion: GPC-3 and IGF II mRNAs may be good molecular markers for HCC, especially with a background of cirrhosis due to chronic HCV infection. Significant correlations were noted with the pattern of AFP and Ki-67 expression.

Laparoscopic cholecystectomy as a day surgery procedure: is it safe?--an egyptian experience.

BACKGROUND/AIM: Major surgery performed as a day surgery procedure is not uncommon. The aim of this study is to evaluate the feasibility of day surgery procedures in laparoscopic cholecystectomy (LC). PATIENTS AND METHODS: A total of 210 patients scheduled for elective LC between 2006 and 2008 were included in our study. The mean age was 40.63 years (range, 25 - 70 years). The indication for surgery was symptomatic cholelithiasis confirmed by ultrasonography without clinical or radiological evidence of acute cholecystitis. All patients were informed about the same-day discharge policy and received the postoperative instruction form on discharge. Preoperative work-up included history taking and physical examination in addition to standard laboratory and radiological tests. Patients above 35 years of age had an ECG done. All patients were examined in the outpatient clinic by a consultant anesthesiologist the night before surgery. Operative time, hospital stay, and complications were recorded. Telephonic feedback, on the morning after surgery was routinely done as an early follow-up. RESULTS: Out of the total number of patients, 140 patients were ASA (I) and 70 were ASA (II) (40 patients were controlled hypertensives and 30 were controlled diabetics). Conversion rate was 1.4%. The mean hospital stay was 6.7 hours (range, 6 - 8 hours). The mean operative time was 31.2 minutes (range, 20 - 60 minutes). None of the patients required an abdominal drain. No morbidities or mortalities were reported in this series. CONCLUSION: LC may be done as a day surgery procedure with optimal patient satisfaction and without complications.

Migration of human umbilical cord blood cells into rat liver.

BACKGROUND AND OBJECTIVES: Cell therapy provides an effective strategy for the treatment of an impaired liver. Human umbilical cord blood progenitor cells have the potential to differentiate into hepatocytes. Progenitor cells transplanted into the spleen could migrate directly into the liver through portal circulation. To track migration of human umbilical cord blood progenitor cells in cirrhotic rat liver after intrasplenic transplantation and to prove the possibility similar behavior of human umbilical cord blood nucleated cells in humans. METHODS AND RESULTS: Umbilical cord blood samples from full-term deliveries will be collected after obtaining an informed consent from the mother. The collection procedure will be conducted after completion of delivery and will not interfere with the normal obstetric procedures. Adult male Sprague Dawley rats were subjected to liver cirrhosis by intraperitoneal injection of thioacetamide. Cirrhotic rats were treated with human umbilical cord blood nucleated cells by intra-splenic transplantation. Migration of intrasplenic transplanted human umbilical cord blood cells to the liver was successfully documented with Immunohistochemistry. The liver and spleen from recipient animals were removed. Histopathological and immunohistochemical analysis were performed 20 weeks after intrasplenic injection of the cells. Intrasplenically injected cells migrate to the liver of recipient animals. CONCLUSIONS: Human cord blood nucleated cells have the potential to differentiate into hepatocytes and substantially improve the histology and function of the cirrhotic liver in rats. Relocation into liver after intrasplenic transplantation could be detected by immunohistochemistry. Transdifferentiated cells could be efficiently stained with antihuman hepatocytes.

Mini-laparoscopic cholecystectomy in children under 10 years of age with sickle cell disease.

BACKGROUND: Cholelithiasis is very common in patients with sickle cell disease (SCD) and is responsible for recurrent attacks of abdominal pain. The ideal management, especially for children, remains controversial. The purpose of the present study was to evaluate the safety and outcome of mini-laparoscopic cholecystectomy (MLC) in young children under age of 10 years with SCD. METHODS: A prospective study was carried out of 75 children with SCD under 10 years of age with recurrent abdominal pains seen between August 2001 and March 2004 at Armed Forces Hospital, Khamis Mushayt, Saudi Arabia, who were screened for cholelithiasis. Twelve (16%) of the 75 children were found to have gallstones. The mean age was 7.8 years (range 4-9 years). All 12 children underwent MLC. Anaemia was corrected preoperatively in all the patients. Operative time, intraoperative complications, hospital stay, and postoperative recurrent abdominal pain were recorded. RESULTS: The mean operating time was 46.5 min (range: 35-65 min). Intraoperative cholangiogram failed in two children due to narrow cystic ducts. The mean hospital stay was 2.1 days (range: 2-4 days). No patient required intra-abdominal drain. The mean follow-up period was 13.4 months (range: 4-24 months). The only postoperative complication was deep jaundice 1 month postoperatively due to cholestasis, and this responded to medical treatment. None of the children had recurrent abdominal pain after MLC. CONCLUSION: Mini-laparoscopic cholecystectomy is a safe surgical procedure for the management of cholelithiasis in children with SCD and leads to improvement in the quality of life by decreasing the frequency of recurrent abdominal pain.

Appraisal of the modified Alvarado Score for acute appendicits in adults.

OBJECTIVE: Decision making in cases of acute appendicitis may be difficult specially for junior surgeons. Radiological investigations do not appear to be helpful. In some studies, the Modified Alvarado Scoring System (MASS) was helpful in minimizing unnecessary appendicectomies. The aim this study was to evaluate the sensitivity of MASS in the diagnosis of acute appendicitis in adults. METHODS: All adult patients aged 16-years and above who were admitted with a provisional diagnosis of acute appendicitis between January 2001 and January 2002, into the Armed Forces Hospitals, Southern Region, Khamis Mushayt, Kingdom of Saudi Arabia were prospectively entered into this study. The study included 125 patients between the ages of 16 and 76-years. They were prospectively evaluated on admission using the Modified Alvarado Score (MAS) to determine whether or not they had acute appendicitis. The MASS was correlated with the operative and histopathological findings. RESULTS: One hundred and 10 patients (88%) had appendicectomies of which 30 patients (27.3%) had normal appendices on histopathology examination. Overall the MAS system showed a sensitivity of 53.8% and a specificity of 80%. For males, the sensitivity was 56.4% and the specificity was 100%. For females, the sensitivity and specificity were 48% and 62.5%. CONCLUSION: From the results, the MASS is not sufficiently sensitive adopted as a method of diagnosing of acute appendicitis in adults in our environment. Further, requirements may be needed to improve its sensitivity and specificity.

Saphenofemoral ligation as a safe and effective alternative for the treatment of chronic venous leg ulcer.

OBJECTIVE: To evaluate the effectiveness and safety of isolated saphenofemoral junction ligation for the treatment of chronic venous leg ulcer in comparison to traditional stripping procedure. METHODS: Thirty six patients (28 men and 8 women) with mean age of 42.3 +/- 8.7, presented with a venous leg ulcer. After taking a full history, they underwent examination for presence of edema, cellulitis or local ulcer infection. The site and size of ulceration were recorded and ankle-brachial pressure index (ABPI) was measured. Venous color Doppler ultrasonography was performed and venous valvular incompetence was assessed using Valsalva test and calf compression. Patients were divided into 2 groups. Group I, (n=10) assigned for long saphenous stripping, while group II, (n=26) assigned for saphenofemoral ligation and divided combined with ligation of major tributaries under local infiltration anesthesia. Mean operative time, postoperative complications and hospital stay were recorded. The study was carried out in Benha University Hospital, Egypt and Armed Forces Hospital, Khamis Mushayt, Southern Region, Kingdom of Saudi Arabia, between January 2000 and December 2001. RESULTS: The mean operative time and the hospital stay were significantly (p<0.05) reduced in group II compared to group I. The postoperative complications were significantly (x2=7.5, p<0.05) reduced in group II. Ulcer healing started after 3 months in group II and 6 months in group I, but, by 12 months, group II had a significant (x2=6.7, p<0.05) number of healed ulcers (n=22, 84.6%), compared to group I (n=7, 70%). CONCLUSION: The isolated ligation of saphenofemoral junction is a minimally invasive, safe and effective modality for treatment of chronic leg ulcer, and being easily performed under local anesthesia and considered to be a satisfactory procedure for treatment of leg ulcer in patients who are unfit for general anesthesia.

A two-port laparoscopic placement of peritoneal dialysis catheter: a preliminary report.

Continuous ambulatory peritoneal dialysis (CAPD) is a well established modality for treating patients with end-stage renal disease (ESRD). The placement of a peritoneal dialysis catheter (PDC) is carried out either by the open method or by laparoscopy. The laparoscopic technique offers the major advantage of direct vision aiding placement of the catheter in the proper place and the additional performance of diagnostic laparoscopy. The traditional laparoscopic placement of PDC requires three ports. In this study, a two port technique for laparoscopic placement of PDC is described in nine patients. This prospective study was carried out at The Armed Forces Hospital, Khamis Mushayt, Saudi Arabia. Nine patients with ESRD underwent laparoscopic placement of the PDC between January 2001 and May 2002. There were seven females and two males, with a mean age of 52 years (range 38-75 years). The mean operating time was 41 minutes (range 30 -75 min). The mean post-operative hospital stay was 4.5 days (range 2-15 days). Two patients (22.2%) developed leakage of dialysate from the 5 mm-port and one patient (11.1%) had migration of the PDC. Our study suggests that this new modified technique appears to be safe and simple and is associated with rapid post-operative recovery.