Assessing biochar, clinoptilolite zeolite and zeo-char loaded nano-nitrogen for boosting growth performance and biochemical ingredients of peace lily (Spathiphyllum Wallisii) plant under water shortage.

BACKGROUND: Peace lily (Spathiphyllum wallisii Regel) is an ornamental indoor plant with promising cut flower market, as well as antiviral, pharmacological and ecological potentials. Water deficiency can have sound effects on the growth performance and aesthetic quality of such plant. The aim of this study was to investigate the consequences of zeolite, biochar, and zeo-char loaded nano-nitrogen application on the growth performance and biochemical components of peace lily under water shortage conditions. An experiment was conducted over two consecutive seasons (2021-2022) at the experimental nursery of Ornamental Horticulture Department, Faculty of Agriculture, Cairo University, Giza, Egypt. Soil amendments; zeolite, biochar, and zeo-char loaded nano-nitrogen were prepared and applied to soil before cultivation. RESULTS: Our results revealed that the new combination treatment (zeo-char loaded nano-N) had an exceeding significant effect on most of the studied parameters. Vegetative traits such as plant height (35.7 and 35.9%), leaf number per plant (73.3 and 52.6%), leaf area (40.2 and 36.4%), stem diameter (28.7 and 27.1%), root number (100 and 43.5%) and length (105.7 and 101.9%) per plant, and fresh weight of leaves (23.2 and 21.6%) were significantly higher than control (commercially recommended dose of NPK) with the application of zeo-char loaded nano-N during the two growing seasons, respectively. Similar significant increments were obtained for some macro- (N, P, K, Mg, Ca) and micro- (Fe, Zn, Mn) elements with the same treatment relative to control. Chlorophyll (18.4%) and total carotenoids (82.9 and 32.6%), total carbohydrates (53.3 and 37.4%), phenolics (54.4 and 86.9%), flavonoids (31.7% and 41.8%) and tannins (69.2 and 50%), in addition to the phytohormone gibberellic acid (GA3) followed the same trend with the application of zeo-char loaded nano-N, increasing significantly over control. Leaf histological parameters and anatomical structure were enhanced with the new combination treatment in comparison with control. Antioxidant enzymes (catalase and peroxidase), proline and abscisic acid (ABA) exhibited significant declines with zeo-char loaded nano-N treatment relative to control. CONCLUSION: These findings suggest that incorporating soil amendments with nano- nutrients could provide a promising approach towards improving growth performance and quality of ornamental, medicinal and aromatic species under water deficiency conditions.

Enhanced and tunable femtosecond nonlinear optical properties of pure and nickel-doped zinc oxide films.

The nonlinear optical properties of pure ZnO and Ni-doped ZnO thin films are explored using the Z-scan technique at different input laser intensities and an excitation wavelength of 750 nm by 100 fs laser pulses. The pure ZnO and Ni-doped ZnO thin films were prepared by radio frequency magnetron sputtering at room temperature. A scanning electron microscope equipped with energy-dispersive x-ray spectroscopy was used to measure the thickness and composition of the thin films, while a UV-visible spectrophotometer was used to measure the linear optical properties. The structure of the thin films was measured using x-ray diffraction. Saturable absorption (SA) was observed in the pure ZnO thin film, while Ni-doped ZnO illustrated a combination of SA and reverse SA (RSA). The nonlinear absorption coefficient (ß) and nonlinear refractive index (n2) of both pure ZnO and Ni-doped ZnO thin films were found to be input laser intensity dependent. As the input laser intensity increased, the nonlinear absorption coefficient and the nonlinear refractive index of both samples increased. An enhancement of two times in the nonlinear refractive index was observed for the Ni-doped ZnO thin film compared to the pure ZnO thin film. The optical limiting behavior of pure ZnO and Ni-doped ZnO thin films was investigated, and the data demonstrated that Ni-doped ZnO thin film is a good candidate for optical limiter applications due to the presence of strong RSA.

Pre-procedural high-pitch coronary CT angiography assessment of patients undergoing transcatheter aortic valve implantation (TAVI) without patient-specific adjustment: analysis of diagnostic performance.

AIM: To evaluate the ability to assess the coronary arteries using pre-procedural computed tomography (CT; high-pitch mode) in patients referred for transcatheter aortic valve implantation (TAVI). METHODS AND MATERIALS: CT and invasive coronary angiography (ICA) were performed pre-TAVI in 100 patients (46 women; 79 ± 5.9 years). CT was performed in prospectively ECG-triggered high-pitch mode after intravenous administration of 70 ml iodinated contrast medium. Image quality was assessed using a four-point scale (graded 0-3). Significant coronary artery stenosis (≥50% diameter) was graded as either present or absent by one observer and in one-third of patients by two observers independently. ICA was the standard of reference. Results were reported per segment and per patient. RESULTS: Twenty-two percent of patients had known coronary artery disease (CAD). In two cases, a coronary anomaly was detected. Diagnostic image quality (grade 1-3) was achieved in 30.3% of segments. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 75%, 80.5%, 16%, and 98.5%, respectively. Significant coronary stenosis could be ruled out completely in all segments in three patients. The interrater agreement per patient was excellent (kappa = 1). CONCLUSION: Relevant coronary findings can frequently be observed in high-pitch TAVI-planning CT. Despite the limitations of the technique and in patients referred to pre-TAVI evaluation (rapid heart rate, coronary calcifications, etc.), a valid evaluation of coronary arteries is possible in a considerable proportion of segments with a high NPV; however, few studies were completely free of motion artefacts to dependably exclude CAD using this technique in this challenging group of patients.

Correction to: Nuclear medicine services after COVID-19: gearing up back to normality.

The authors P. Orellana and N. El-Haj were inadvertently deleted in the original paper.

Urinary neutrophil gelatinase-associated lipocalin as a marker for disease activity in lupus nephritis.

The neutrophil gelatinase-associated lipocalin (NGAL) has been emerging as a novel biomarker of acute kidney injury while its value in lupus nephritis is uncertain. The aim of this study was to assess urinary NGAL levels as a marker for disease activity in patients with lupus nephritis.This study included 70 systemic lupus erythematosus (SLE) patients; 50 with active lupus nephritis (LN) and 20 without as well as 20 matched controls. The neutrophil gelatinase-associated lipocalin (NGAL) in both serum and urine samples was measured by enzyme-linked immunosorbent assay (ELISA). Patients with active LN received standard treatment then assessed for response as well as the value of urinary NGAL (uNGAL). Our results revealed that, The SLE patients with or without LN had an elevated urinary NGAL as compared to controls (p < 0.000) and the mean of uNGAL was (20.67 ± 5.34),(10.63 ± 3.53),(5.65 ± 2.49) respectively. Furthermore,Urinary NGAL levels in LN patients were significantly higher than those in non-LN patients (P < 0.0001). In the ROC curve analysis , the diagnostic performance of uNGAL for discriminating patients with nephritis from those without nephritis showed that the best cutoff value was 13.66 ng/ml ,sensitivity 92%,specificity 75%,area undercurve (0.959) and (P < 0.0001). Measurement of urinary NGAL levels showed an excellent diagnostic performance for discriminating patients with LN from SLE without nephritis.

Model Updating for Nam O Bridge Using Particle Swarm Optimization Algorithm and Genetic Algorithm.

Vibration-based structural health monitoring (SHM) for long-span bridges has become a dominant research topic in recent years. The Nam O Railway Bridge is a large-scale steel truss bridge located on the unique main rail track from the north to the south of Vietnam. An extensive vibration measurement campaign and model updating are extremely necessary to build a reliable model for health condition assessment and operational safety management of the bridge. The experimental measurements are carried out under ambient vibrations using piezoelectric sensors, and a finite element (FE) model is created in MATLAB to represent the physical behavior of the structure. By model updating, the discrepancies between the experimental and the numerical results are minimized. For the success of the model updating, the efficiency of the optimization algorithm is essential. Particle swarm optimization (PSO) algorithm and genetic algorithm (GA) are employed to update the unknown model parameters. The result shows that PSO not only provides a better accuracy between the numerical model and measurements, but also reduces the computational cost compared to GA. This study focuses on the stiffness conditions of typical joints of truss structures. According to the results, the assumption of semi-rigid joints (using rotational springs) can most accurately represent the dynamic characteristics of the truss bridge considered.

Correction: Mahmoud et al. Application of Silicon, Zinc, and Zeolite Nanoparticles-A Tool to Enhance Drought Stress Tolerance in Coriander Plants for Better Growth Performance and Productivity. Plants 2023, 12, 2838.

In the original publication [...].

Application of Silicon, Zinc, and Zeolite Nanoparticles-A Tool to Enhance Drought Stress Tolerance in Coriander Plants for Better Growth Performance and Productivity.

Drought stress in arid regions is a serious factor affecting yield quantity and quality of economic crops. Under drought conditions, the application of nano-elements and nano-agents of water retention improved the water use efficiency, growth performance, and yield quantity of drought-stressed plants. For this objective, two field experiments were performed and organized as randomized complete block designs with six replications. The treatments included kaolin (5 t. ha-1) bentonite (12.5 t. ha-1), perlite (1.25 t.ha-1), N-zeolite (1.3 L.ha-1), N-silicon (2.5 L.ha-1), and N-zinc (2.5 L.ha-1). The current study showed that the application of silicon, zinc, and zeolite nanoparticles only positively influenced the morphological, physiological, and biochemical properties of the drought-stressed coriander plant. Exogenous application of N-silicon, N-zinc, and N-zeolite recorded the higher growth parameters of drought-stressed plants; namely, plant fresh weight, plant dry weight, leaf area, and root length than all the other treatments in both seasons. The improvement ratio, on average for both seasons, reached 17.93, 17.93, and 18.85% for plant fresh weight, 73.46, 73.46, and 75.81% for plant dry weight, 3.65, 3.65, and 3.87% for leaf area, and 17.46, 17.46, and 17.16% for root length of drought-stressed plants treated with N-silicon, N-zinc, and N-zeolite, respectively. For physiological responses, the application of N-zeolite, N-silicon, and N-zinc significantly increased leaf chlorophyll content, photosynthetic rate, water use efficiency, chlorophyll fluorescence, and photosystem II efficiency compared with the control in both seasons, respectively. Similar results were observed in antioxidant compounds, nutrient accumulation, and phytohormones. In contrast, those treatments markedly reduced the value of transpiration rate, nonphotochemical quenching, MDA, ABA, and CAT compared to control plants. Regarding the seed and oil yield, higher seed and oil yields were recorded in drought-stressed plants treated with N-zeolite followed by N-silicon and N-zinc than all the other treatments. Application of N-zeolite, N-silicon and N-zinc could be a promising approach to improve plant growth and productivity as well as to alleviate the adverse impacts of drought stress on coriander plants in arid and semi-arid areas.

Swelling and mechanical properties of superabsorbent hydrogels based on Tara gum/acrylic acid synthesized by gamma radiation.

The main objective is to develop a new superabsorbent system especially for using in diaper applications. In this study, hydrogels based on Tara gum/acrylic acid (TG/AAc) were prepared by gamma irradiation, in the presence of N,N'-methylenebisacrylamide (MBAAm) as a crosslinking agent. The polymeric networks formed were characterized by FT-IR and evaluated by swelling studies as a function of MBAAm concentration, temperature and nature of the swelling medium. The swelling kinetics of the hydrogels was studied in terms of the diffusion exponent "n". The results showed that the water diffusion into hydrogels is a non-Fickian type. Mechanical measurements (stress-strain) curves of hydrogels were evaluated to calculate the shear modulus values and the average molecular weight between crosslinks (Mc). Moreover, the absorption under load at 37°C of water and urea aqueous solutions (as a major component of urine) by TG/AAc hydrogels was determined.

Rootstock Priming with Shikimic Acid and Streptomyces griseus for Growth, Productivity, Physio-Biochemical, and Anatomical Characterisation of Tomato Grown under Cold Stress.

With this research, we aimed to determine the impact of grafting and rootstock seed treated with Streptomyces griseus (MT210913) (S. griseus) or shikimic acid (SA) at a 60 ppm concentration on tomato (Solanum lycopersicum L.) production grown under low-temperature conditions. Two open-field trials were performed during both winter seasons of 2020 and 2021 at the Experimental Farm, Faculty of Agriculture, Cairo University, Giza, Egypt. A tomato cultivar (Peto 86) was used as a scion and two tomato phenotypes were employed as rootstocks (Solanum cheesmaniae L. (line LA 524) and GS hybrid), as well as self-grafted as a control. Effects of sub-optimal temperature on vegetative growth, yield, and fruit quality were tested. The results indicate that, under cold stress, rootstock seed priming, especially with S. griseus, enhanced plant growth, total yield, and fruit quality properties. GS hybrid rootstock was more effective than that of S. cheesmaniae rootstock in terms of mitigating the negative effect of cold stress. GS hybrid, inoculated with S. griseus, increased the total yield per plant by 10.5% and 5.7% in the first and second seasons, respectively. Higher levels of GA3 and mineral content were noticed in leaves that were grafted and treated with S. griseus compared to the control treatment. Additionally, the great enhancing effects of all anatomical features of tomato plants were recorded with GS hybrid rootstock, inoculated by S. griseus. These results prove that grafting on GS hybrid rootstock treated with S. griseus is a potential choice to alleviate the cold stress of commercial tomato varieties.

Nano-insecticides against the black cutworm Agrotis ipsilon (Lepidoptera: Noctuidae): Toxicity, development, enzyme activity, and DNA mutagenicity.

Frequent applications of synthetic insecticides might cause environmental pollution due to the high residue. In addition, increasing insecticide resistance in many insect pests requires novel pest control methods. Nanotechnology could be a promising field of modern agriculture, and is receiving considerable attention in the development of novel nano-agrochemicals, such as nanoinsectticides and nanofertilizers. This study assessed the effects of the lethal and sublethal concentrations of chlorantraniliprole, thiocyclam, and their nano-forms on the development, reproductive activity, oxidative stress enzyme activity, and DNA changes in the black cutworm, Agrotis ipsilon, at the molecular level. The results revealed that A. ipsilon larvae were more susceptible to the nano-forms than the regular forms of both nano chlorine and sulfur within the chlorantraniliprole and thiocyclam insecticides, respectively, with higher toxicities than the regular forms (ca. 3.86, and ca.2.06-fold, respectively). Significant differences in biological parameters, including developmental time and reproductive activity (fecundity and hatchability percent) were also observed. Correspondingly, increases in oxidative stress enzyme activities were observed, as were mutagenic effects on the genomic DNA of A. ipsilon after application of the LC50 of the nano-forms of both insecticides compared to the control. These promising results could represent a crucial step toward developing efficient nanoinsecticides for sustainable control of A. ipsilon.

Foliar Application of Different Iron Sources Improves Morpho-Physiological Traits and Nutritional Quality of Broad Bean Grown in Sandy Soil.

Nano-fertilizers are a new tool that can be used to address plant production challenges, and it addresses such nutrient deficiencies through smart agriculture approaches. Iron (Fe) is a vital element for several metabolic and physiological processes; however, Fe deficiency is common in poorly fertile soils (sand soil) and in arid areas. Therefore, additional research is required to select the most efficient form of iron absorbance. This research was implemented on broad bean plants (Vicia faba L. var. major Harz) to examine the impact of three iron sources: nano-iron (FeNPs, T1), iron sulfate (T2), and chelated iron (T3) as a foliar spray on the morphological properties, physiological attributes, and nutritional status of these plants compared to the untreated plants (control). The obtained results showed that foliar spraying with FeNPs, chelated iron and sulphate iron fertilizers increased plant height by 35.01%, 26.2, and 20.4%; leaf area by 38.8%, 18.3%, and 8.1%; the fresh weight of the plant by 47%, 32.8%, and 7.3%; the dry weight of the plant by 52.9%, 37.3%, and 11.2%; and the number of branches by 47%, 31.3%, and 25.6 %, respectively, compared to the control treatment (CT). Furthermore, the application of FeNPs, chelated iron, and sulphate iron fertilizers improved the number of pods by 47.9%, 24.8%, and 6.1%; the number of seeds by 32.8%, 7.9%, and 2.8%; and seed weight by 20.8%, 9.1%, and 5.4%, compared to control treatment (CT). Additionally, foliar application of FeNPs showed the highest values of photosynthesis rate (Pn), water-use efficiency (WUE), total chlorophyll, and phytohormones (IAA, GA3) compared to all the other treatments. The anatomical structure revealed an enhancement of leaf size and thickness (epidermis cells and mesophyll tissue) affected by FeNPs treatment compared to other treatments. Foliar application of FeNPs also improved the total content of carbohydrates, crude protein, element content (N, P, K, Ca, Na, Fe, Zn, Mn, and Cu), and some amino acids such as lysine, arginine, phenylalanine, isoleucine, and tyrosine in the seeds of broad beans. Based on the above results, the maximum values of all tested measurements were observed when FeNPs were used as the foliar spraying followed by chelated and sulphate iron fertilizers. Therefore, these findings suggest that using FeNPs, as a foliar treatment, could be a promising strategy for reducing the Fe deficiency in sandy soil and enhancing plant growth, pod yield, and pod quality of broad bean plants in addition to being environmentally favored in arid areas.

Incidence of perioperative adverse events in obese children undergoing elective general surgery.

BACKGROUND: A worldwide increase in the prevalence of obesity has been observed in both developed and developing countries. Few studies have addressed the anaesthetic or perioperative implications of childhood obesity. METHODS: Children aged 2-16 yr undergoing general surgery were classified using age- and sex-adjusted BMI. Patient characteristic, co-morbidity, and perioperative data were collected to ascertain the risks associated with overweight and obese children. RESULTS: We enrolled 1465 subjects in our study, of which 154 (10.5%) were classified as obese and a further 223 (15.2%) as overweight. After adjusting for age, we identified increased rates of arterial haemoglobin desaturation, difficult mask ventilation, airway obstruction, and bronchospasm in obese children. The relative risk (RR) of adverse respiratory events was higher among obese subjects than non-obese subjects and higher in younger age groups. Controlling for age, adjusted-RR (confidence interval) was 1.49 (1.2-1.86). There was a significant association between obesity and asthma with a higher odds ratio (OR) in younger age groups controlling for age: adjusted-OR=1.8 (1.15-2.82). A significant association was detected between obesity and sleep apnoea controlling for age: adjusted-OR=4.03 (2.37-6.8). CONCLUSIONS: These results suggest an increased incidence of perioperative adverse respiratory events in obese children, especially at younger ages.

Shift in parasitic infections during the Corona pandemic: a hospital-based retrospective study.

The Corona pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) calls on the Saudi government to take action to control the infection. The government closed borders, prohibited travel, limited outdoor movements, and told primary and secondary care facilities to reduce all regular non-urgent health services. It is not known whether these measures have impacted the prevalence of parasitic intestinal infections. This study has therefore been carried out to investigate this issue. Dataset of 217 stool samples submitted to the King Faisal Medical Complex (KFMC) Microbiology Laboratory in Taif, Saudi Arabia for parasitological examination during the pandemic (January-June 2020) and 649 samples submitted during the corresponding months of the previous year (January-June 2019) were extracted and analyzed. Overall, 24.1% (209/866) of samples were parasitespositives; 26.6% (173/649) before and 16.5% (36/217) during the pandemic, with 79% reduction. There was a significant difference in gender-parasitism between the two periods where the majority of parasitism were for males (p<0.001). Infections were frequent in patients aged 5- 14 years both before (84/649; 12.9%) and during (12/217; 5.5%) the pandemic, with significant difference observed between the two cohorts (p<0.002). Moreover, the majority of infected patients were non-Saudi (67.9%; 142/209), with a significant difference in nationality reported, (p=0.024). Protozoa were identified in 21.8% (189) of all samples investigated, of which, Blastocystis hominis, Entamoeba coli, Giardia lamblia, Entamoeba histolytica/dispar and Cryptosporidium species were identified in 6.1% (53), 5.4% (47), 5.0% (44), 2.8% (25), and 2.3% (20), respectively. Helminths were diagnosed in 2.3% (20/866) of samples. Eggs of hookworm, Ascaris, Taenia spp, and Hymenolepis nana were detected in 0.9% (8), 0.5% (5), 0.3% (3) and 0.4% (4), respectively. In parallel with our research hypothesis, a substantial decrease in the burden of intestinal parasitic infections was recorded with the lock-down measures taken during the Corona pandemic.

Antibacterial functionalization of cotton and cotton/polyester fabrics applying hybrid coating of copper/chitosan nanocomposites loaded polymer blends via gamma irradiation.

In the present work, copper/chitosan nanocomposites (Cu/CS) were prepared in an aqueous solution in the presence of CS as stabilizer and CuSO4·5H2O precursor. The Cu/CS NPs formation was proved through transmission electron microscopy (TEM), Dynamic light scattering (DLS), Fourier Transform infrared (FT-IR) spectroscopy and XRD diffraction. Cotton and cotton/polyester fabrics were gamma-radiation grafted by padding to pickup of 100%, in nanocomposites based on Cu/CS NPs loaded in polymer blends of poly(vinyl alcohol) (PVA) and plasticized starch (PLST). The grafted fabrics were characterized in terms of tensile mechanical, crease recovery and water absorption properties. The results showed that cotton fabrics displayed higher water absorption (%) than cotton/polyester fabrics for all PVA/PLST compositions and water absorption was found to decrease with increasing the ratio of PVA in the PVA/PLST blends. Cotton/polyester fabrics displays crease recovery angle (CRA) value of 147.6 upon treated with PVA/PLST (80/20%) and gamma irradiated to 30 kGy compared to CRA value of 125.0 for cotton fabrics treated under the same conditions. For cotton fabrics, the tensile strength was largely depends on the irradiation dose, in which the tensile strength of the treated fabric with the different formulations is higher than the untreated fabric. The antimicrobial activity of the fabrics against gram-positive bacteria (Staphylococcus aurous) and gram-negative bacteria (Escherichia coli) was investigated. In case of gram-positive bacteria cotton fabric showed the highest impact, for both 50/50 and 20/80 PVA/PLST of 14 and 14.5 mm inhibition zone, whilst, cotton/polyester fabric recorded 6 and 5 mm inhibition zone against gram-negative bacteria for 50/50 and 20/80 PVA/PLST, respectively.

Aflatoxins as a risk factor for hepatocellular carcinoma in Egypt, Mansoura Gastroenterology Center study.

BACKGROUND/AIMS: Aflatoxin B1 (AFB1) is an important food-borne mycotoxin. The co-contamination of foodstuffs with this mycotoxin is well known and has been possibly implicated in the development of hepatocellular carcinoma in high risk regions around the world. This study investigates the serum aflatoxin B1 in patients with hepatocellular carcinoma and compares it to a control group. METHODOLOGY: From January 2005 to January 2006, 80 cases with hepatocellular carcinoma diagnosed in the Gastroenterology center, Mansoura University, Egypt and 20 healthy subjects used as a control group were enrolled in the study. All patients were evaluated for age, sex, residence, occupation, history of other medical diseases, anti-bilharzial treatment, blood transfusion, viral markers, liver functions and serum level of aflatoxin B1. RESULTS: The mean age of our patients was 52.88 +/- 7.27 years versus 53.17 +/- 6.78 years for the controls, p>0.05. The serum level of AFP1 was highly significant in HCC patients compared with control (32.47 +/- 92.46 versus 7.33 +/- 5.5 P<0.0001) and it was statistically high between 51:60-years-old (P<0.05). Males represented 82.5% of the patients versus 17.5% for females. AFB1 was higher in males compared with females (P<0.05), higher in rural residents compared with urban residents (P<0.05), higher in Kafer Elchek government are versus others (P<0.01) and higher in farmers compared with those with other occupations (P<0.05). The serum level of AFB1 was high among patients with a history of anti-bilharzial treatment with tarar emetic versus oral treatment by Brazequantil (P<0.05). Hepatitis C antibody was positive in 70% of the patients. The serum level of AFB1 was statistically high in HCV-positive patients compared with HCV-negative ones (P<0.05) but showed no statistical significance in HBs-positive patients compared with HBs-negative ones (P>0.05). The serum level of AFB1 was statistically high in Child class B patients compared with class A (P<0.05), high in patients with tumor size > 5 cm compared with tumor size < 5 cm (P<0.05), high in right lobe tumor patients compared with left lobe tumor (P>0.05), high in multifocal hepatoma patients compared with single lesion patients (P<0.05). The serum level of AFB1 showed a statistically significant positive correlation with serum SGPT and alpha-fetoprotein. CONCLUSIONS: Aflatoxin B1 may play an important role in the occurrence of HCC in the north Nile delta area and especially in males, farmers, and rural residents, HCV infection, cirrhotic liver and multifocal hepatoma patients. Aflatoxin B1 in high concentration is associated with high incidence of chronic HCV, and affects hepatic parenchyma and multifocal lesions.

Surgical management of peri-ampullary tumors: a retrospective study.

BACKGROUND/AIMS: Surgical resection still remains the best treatment for patients with periampullary tumors. This study aims to present the results of surgical treatment of this disease at our center. METHODOLOGY: Between January 1995 and December 2004, 216 periampullary tumors were treated by surgical resection. The mean age was 58 years with male to female ratio 2:1. The most common symptom was jaundice (97.7%). Abdominal pain occurred in 74% of patients. Pancreaticogastrostomy was done in 183 patients and pancreaticojejunostomy in 33 patients. RESULTS: Operative mortality occurred in 7 patients (3.2%). The median survival was 22.6 months for patients with ampullary tumors and 16.6 months for patients with pancreatic head tumors. Early operative complications occurred in 33% of patients; the most common one was wound infection (11.6%), pancreatic leak (10.6%), abdominal collection (10.6%) and delayed gastric emptying (8.8%). Factors associated with increased risk of developing complications were the type of pancreatico-enteric anastomosis (pancreatic leak was more frequent with pancraticojejunostomy), soft pancreatic texture and intraoperative blood transfusion of more than 4 units. Factors associated with better survival included tumor diameter (less than 3cm), origin (ampullary), differentiation (well differentiated) and margin status (negative resection margins). CONCLUSIONS: Postoperative complications of pancreaticoduodenectomy, especially with the adoption of pancreaticogastrostomy, occur with reasonable incidence. Survival largely depends on the origin of the tumor.