The influence of surgeon volume on outcomes after pelvic exenteration for a gynecologic cancer / 부인종양

OBJECTIVE: To determine the effect of surgeon experience on intraoperative, postoperative and long-term outcomes among patients undergoing pelvic exenteration for gynecologic cancer. METHODS: This was a retrospective analysis of all women who underwent exenteration for a gynecologic malignancy at MD Anderson Cancer Center, between January 1993 and June 2013. A logistic regression was used to model the relationship between surgeon experience (measured as the number of exenteration cases performed by the surgeon prior to a given exenteration) and operative outcomes and postoperative complications. Cox proportional hazards regression was used to model survival outcomes. RESULTS: A total of 167 exenterations were performed by 19 surgeons for cervix (78, 46.7%), vaginal (43, 25.8%), uterine (24, 14.4%), vulvar (14, 8.4%) and other cancer (8, 4.7%). The most common procedure was total pelvic exenteration (69.4%), incontinent urinary diversion (63.5%) and vertical rectus abdominis musculocutaneous reconstruction (42.5%). Surgical experience was associated with decreased estimated blood loss (p < 0.001), intraoperative transfusion (p = 0.009) and a shorter length of stay (p = 0.03). No difference was noted in the postoperative complication rate (p = 0.12–0.95). More surgeon experience was not associated with overall or disease specific survival: OS (hazard ratio [HR] = 1.02; 95% confidence interval [CI] = 0.97–1.06; p = 0.46) and DSS (HR = 1.01; 95% CI = 0.97–1.04; p = 0.66), respectively. CONCLUSION: Patients undergoing exenteration by more experienced surgeons had improvement in intraoperative factors such as estimated blood loss, transfusion rates and length of stay. No difference was seen in postoperative complication rates, overall or disease specific survival.

Hypocalcemic tetany, growth failure, primary amenorrhea and iron deficiency in an adolescent girl

A 15-year-old pale and wasted prepubertal Yemeni girl presented with carpo-pedal spasms of the limbs and drowsiness after severe bilateral thigh pain and weakness for a few days. She denied any trauma or taking medications but complained of recurrent abdominal pains and distension with occasional diarrhea. Her height=119 cm and weight=19.5 kg, BMI=13.7. Her quadriceps were contracted bilaterally and there was exquisite pain on palpation of both thighs. Deep-tendon reflexes were brisk all over and Chvostek sign was positive. Abdomen appeared distended with no organomegaly. Tests showed hypocalcemia, hypophosphatemia, hypomagnesemia, high PTH and low vitamin D 25-hydroxy level, hypoalbuminemia, low B12 and low RBC folate, normal ESR with normal renal and hepatic functions. Tissue transglutaminase antibody was positive but stools negative for fat. Upper gut endoscopy revealed total villus atrophy. Bone age was nine years with osteomalacia. She was diagnosed with celiac disease plus multivitamin deficiency and was treated with vitamin D3 [600, 000 U] IM, calcium carbonate, B12 100 mcg IM, multivitamins, and Fe-sulfate. She was put on a gluten-free diet with increased calcium intake. Two months later, her weight had increased by 5 kg, height by 4 cm and her appetite improved markedly with disappearance of all abdominal symptoms and cramps. Adolescents with delayed puberty and short stature must be screened for celiac disease

Assessment of nurses knowledge and performances related to infection control in the neonatal unites at El-Minia city hospitals

The aim of this study is to assess the nurses' knowledge and performance related to infection control in the neonatal units at El-Minia City Hospitals. Correlation descriptive research design was utilized. This study was conducted in neonatal units in Suzan Moubarak University Hospital, El-Minia General Hospital, Suzan Moubarak Ministry of Health Hospital and Suzan Moubarak Health Insurance Hospital. The subjects who participated in this study included a total number of 50 nurses' who are working in the four neonatal units in the previous settings. Two tools for collecting data were used in this study; Assessment questionnaire sheet for nurses' knowledge about infection control and Observation checklist for nurses' performance about infection control. The result revealed that: total scores of nurses' knowledge and performance having Bachelor of Science in nursing were significantly higher than those who having Technical Institute of nursing Diploma, and those who having secondary nursing Diploma, [116.1 +/- 9.2, 108.8 +/- 14.0, and 97.8 +/- 16.1]; respectively. [P. 0.05].Total scores of nurses' knowledge and performance having work experience ranged from 5 to 10 years were higher than those who having work experience less than 5 years, and those who having work experiences exceeds 10 years, [108.8 +/- 15.1, 100.4 +/- 1.5, and 96.7 +/- 17.3]; respectively. Total scores of nurses' knowledge and performance who attended training courses were higher than nurse's who didn't attend. [102.7 +/- 16.5, 98.4 +/- 14.2]; respectively. The present study concluded that nurses' who were working at Souzan Mobark University Hospital [SMUH] had significantly better knowledge and performance than their colleagues who were working at the others three hospitals. This study recommended that Provision of continuing education programs on regular basis is suggested in order to refresh and update nurse's knowledge, as well as reinforce proper practice related to infection control

Heart rate and blood pressure variability among hypertensive and normotensive patients with acute thrombotic stroke: clinical relevance and implications

This study was aimed to assess the circadian changes in the blood pressure, heart rate variability and the circadian changes of cortisol level in normotensive as well as hypertensive patients with acute thrombotic stroke to determine whether there is abnormality or not in their diurnal changes and their relation to stroke severity. The heart rate variability [time domain and frequency domain] from 24-hour ECG recordings were analyzed in 30 patients with first acute ischemic stroke [within 24 hours of onset]. Eighteen were known hypertensives and 12 were normotensives. Brain C-T scan and NIHSS were done after admission. Patients were monitored with a bedside monitor for 24 hours to assess blood pressure every 15 minutes and blood cortisol level was measured every 6 hours. The parasympathetic oscillation, the diastolic and mean blood pressure variability indices were reduced in hypertensive patients than normotensives. However, in the late night the parasympathetic oscillation increased in hypertensives but tend to be reduced in normotensives. Increasing in sympathetic daily variation and reduced systolic blood pressure variation were associated with increasing in the stroke severity in normotensives, but decreasing in parasympathetic daily changes were associated with increasing the stroke severity in both groups. Hypertension seemed to cause significant changes of the cardiovascular autonomic regulatory system manifested as abnormalities of heart rate and diastolic pressure variability [especially late night]. The stroke severity was increased with reduced diurnal changes of parasympathetic fluxes in both normotensives and hypertensives and excess sympathetic daily fluctuations in normotensives

Neuropsychological assessment of global and specific cognitive functions in children with epilepsy

Impairment of cognitive functions is an important problem in epileptic children that can burden their learning abilities and academic achievement. The present study aims at assessment of cognitive functions in epileptic children and to explore the relation of various neuropsychological functions to other variables such as seizure type, frequency, duration of epilepsy, EEG changes and antiepileptic drugs. The study included 58 epileptic children, 6-12 years old [39 males and 19 females]. All children were subjected to detailed history, full neurological and psychiatric examination, EEG and a battery of psychometric tests. Results confirmed that epileptic children have significant impairment in cognitive functions and this impairment is most evident in females, generalized seizures, higher frequency of seizures, right sided focus in EEG, poor seizure control and poly therapy

Helicobacter pylori infection and hyperemesis gravidarum: possible causal relationship with evaluation of a new immunoassay in stool compared with standard diagnostic techniques

The aim of the present study was to investigate any possible association between infection with Helicobacter pylori [H. pylori] and hyperemesis gravidarum [HG]. Moreover; evaluation of different methods used in the diagnosis of H. pylori during pregnancy aiming to present a simple non-invasive and reliable method. 68 pregnant women with hyperemesis gravidarum and 72 control pregnant women were enrolled in the study. All participants were examined both for H. pylori serum immunoglobulin G antibodies [HpIgG Ab], showing chronic infection, and H. pylori stool antigens [HpSA], and showing active gastrointestinal colonization. Serologically positive H. pylori infection was detected in 59 [86.8%] subjects of the hyperemesis gravidarum group and in 32 [44.4%] of the controls [P<0.01]. HpSA was detected in 45.6% of patients with hyperemesis gravidarum, whereas only 5.6% of patients in the control group were positive for this specific antigen [P<0.001]. The new stool immunoassay test had a sensitivity of 96% [95% confidence interval 90.6% to 100%], specificity of 93% [85.1% to 99.5%], positive predictive value of 92%, and negative predictive value of 96%. In conclusion, this study supports the studies suggesting an association between H. pylori and HG. Infection with H. pylori should be kept in mind in cases of HG in pregnant women. The findings of the current study have, also, demonstrated that HpSA as a relatively simple, inexpensive and time saving noninvasive test is a reliable method for detection of active H. pylori infections in pregnant women with hyperemesis gravidarum. This stool immunoassay represents a new, accurate, and non-invasive method for H pylori infection that overcomes the limitations of existing tests

Polymerase chain reaction for rapid diagnosis of a recent lumpy skin disease virus incursion to Egypt

In early 2006, a lumpy skin disease [LSD] outbreak has invaded cattle in different localities of Egypt, exerting severe economic losses to livestock industry. Representative specimens [skin biopsies] were collected form nodular skin lesions of infected foreign [imported from Ethiopia, at Ismailia private quarantine] and local cattle [at Fayoum, Menofia and Sharquia governorates]. A polymerase chain reaction [PCR] assay was used, as a basic step, for rapid diagnosis of the causative agent in clinical specimens to control spread of infection in the rest of Egypt. The PCR assay, utilizing a LSDV P32 based primer set, could identify LSDV in all outbreak clinical specimens. The specific PCR amplification products [amplicons] were purified and subjected to direct nucleotide sequencing. Blast search, multiple alignments and phylogenetic analyses of the nucleotide sequence data revealed that outbreak LSDV is closely related to other capripoxviruses of LSD, sheep pox and goat pox. Selection and processing of clinical specimens, methods of DNA isolation, and PCR assay applied in this endeavor, presented a reliable laboratory diagnostic tool for LSDV

Role of descending venography and endovenous embolization in treatment of females with lower extremity varicose veins, vulvar and posterior thigh varices

To evaluate the prevalence of refluxing pelvic veins among female patients with lower extremity varicose veins and the role of embolization treatment in these cases. Of 158 female patients suffering from primary varicose veins of the lower extremities presented to the Venous Disease Clinic at Dhahran Health Center between January 2002 and December 2004, 25 patients [15.8%] were noted to have vulvar or postero-medial thigh varices or both. Those were referred for trans-jugular descending pelvic venography with or without subsequent embolization of the contributing refluxing veins. Venous reflux contributing to the vulvoperineal or posterior thigh varices was detected in 23 patients [92%] on catheter venography. Left ovarian venous reflux was responsible for 60% of all cases. Embolization, using multiple coils, was successful in 18 patients with positive reflux [78.3%]. One patient had primary vulvar venous malformation that required additional percutaneous sclerotherapy using dehydrated ethanol. Four patients had femoro-saphenous reflux contributing to the varices and required subsequent surgical ligation excision. All treated cases showed significant improvement of their symptoms without any procedure related complications. In patients with vulvar or postero-medial thigh varicose veins, radiological study of ovarian and hypogastric venous reflux should be considered. Trans-jugular descending venography and embolization is a feasible, effective and safe diagnostic and therapeutic modality

Genetic identification of the foot-and-mouth disease virus caused 2006 outbreak in Egypt

In early February 2006, a foot-and-mouth disease [FMD] outbreak has struck cattle and buffaloes in different localities of Egypt exerting severe economic losses to livestock industry. Representative specimens [tongue epithelium and foot vesicular fluid] were collected from severely infected foreign [imported from Ethiopia] and local cattle in different governorates [Ismailia, Sharqia and Behairah]. Several assays of reverse transcription [RT] using random decamer primers, followed by FMDV VP1- based polymerase chain reaction [PCR], were used for rapid identification of the causative agent in clinical specimens, basically to circumscribe the countrywide spread of infection. The first PCR assay, utilizing a FMDV universal primer set, could identify the outbreak causative agent as a FMDV in all clinical specimens. FMDV specific primers were then utilized to determine the outbreak FMDV serotype. The specific PCR amplification products [amplicons] were purified and subjected to direct nucleotide sequencing. Blast searches, multiple alignments and phylogenetic analyses of the nucleotide sequence data revealed that outbreak FMDV is a serotype "A" which is a new serotype incursion to Egypt. Direct sequencing of the PCR amplicons was proved a relevant discriminative tool for genetic characterization of FMDV strains / isolates. Results of this endeavor initiated the potential to produce a bivalent FMDV vaccine, containing both of serotypes A and O[1], for the first time in Egypt

Estrogen-lowering medical treatment after laparoscopic surgery for symptomatic endometriosis stage III-IV: is it of value?

In order to decrease endometriosis recurrence after surgical therapy, it has been proposed to use a post-surgical estrogen-lowering medical treatment. The aim of the present study was to evaluate the efficacy of a post-operative regimen of GnRH analogue and danazol in women underwent laparoscopic conservative surgery for endometriosis stage III-IV .This was studied in a randomized trial in which no post-surgical therapy was compared with a protocol consisting of a 3 months of GnRH analogue and danazol. The primary objective was to assess whether this surgical/medical combined approach could produce a significantly longer relief of pain symptoms. The between-group differences in both objective disease recurrence and pregnancy rates among women wanting children were also evaluated. All patients conservatively operated at laparoscopy for stage III-IV endometriosis from March 2004 to May 2006 were requested to enter the study. Patients who underwent surgery for recurrent endometriosis were excluded from the study, as well as patients who had taken hormonal therapies before laparoscopy. A total of 134 women were randomized, by computer-generated list/ after laparoscopic conservative surgery for symptomatic endometriosis stage III-IV to three groups: Group I [n 44]; receive monthly i.m. injections of gonadotropin-releasing hormone [GnRH] analogue, leuprolide acetate depot [3.75 mg] for 3 months. Group II [n 45]: Postoperative treatment with danazol 600 mg daily for 3 months. Group III [n - 45]: Subjected to an expectant management, All patients were regularly followed up every 3 months for at least one year for evaluation of pain symptoms, fertility and objective disease recurrence. During the follow-up period, which lasts for at least 12 months, five [35.7%] of the 14 women who wanted children and who were allocated the GnRH analogue, five [33.3%] of the 15 women in the danazol group/ and six [40%] of the 15 given no treatment became pregnant [not significant]. Moderate/severe pelvic pain recurred during the follow-up in 10 [23%] of the 44 women with pelvic pain allocated the GnRH analogue, 10 [22.2%] of the 45 women given postoperative danazol/ and 11 [24%] of the 45 allocated no. Treatment Four women [9%] treated with GnRH analogue, five [11%] allocated to danazol treatment and four [9%] who received no treatment had objective disease recurrence as demonstrated by gynecological examination and/or pelvic ultrasonography [not significant]. This study does not support the routine post-operative use of a 3 month course of GnRH analogue or danazol after laparoscopic surgery for stage III-IV endometriosis with respect to postoperative expectant management

Passive smoking and pregnancy outcome: Is there any harm?

Adverse health effects of exposure to environmental tobacco smoke [ETS] among non-smokers have been studied occasionally in developing countries. The aim of this work is to study the effects of exposure to ETS on the maternal and fetal outcome in pregnancy. 282 nulliparous pregnant women with singleton pregnancy from Department of Obstetrics and Gynaecology, Tanta University Hospital, were included in this prospective study. A pre-designed structured questionnaire was used to record the details of exposure to ETS at home or at work place. The maternal and fetal variables were compared among those who were exposed to ETS vs. not exposed. Unpaired Student t-test was used for the comparison of continuous variables and Fisher's Exact test was used for categorical variables. Multiple logistic regression analysis was performed after including all variables found to have significant differences on univariate analysis. Of the 282 women studied, 169 [59.9%] reported exposure to ETS from the husband and other family members or at work place [Passive smokers], and 113 [40.1%] did not have any exposure to tobacco smoke [Control group]. In the mothers exposed to ETS, there was a significantly higher incidence of pre-term birth [24.3% vs. 15.9%; p<0.05] and small-for-gestation babies [31.4% vs.16.8%; p<0.001] as compared to unexposed mothers. The mean birth weight of the babies born to the mothers exposed to ETS was 230 g less than that of babies in the unexposed group [2550 +/- 0.479 g vs. 2780 +/- 0.563 g respectively, p=0.016].The multiple logistic regression analyses showed that ETS exposure during pregnancy was significantly associated with a higher risk of small-for-gestation babies [OR 2.3; 95% CI: 1.1-4.6]. In conclusion, this prospective study links passive smoking during pregnancy to more than two-fold higher risk of small-for-gestation baby even after adjusting for all possible confounders. The incidence of preterm labor and anemia were, also, higher among pregnant women exposed to ETS

Face recognition performance with a bioptic telescopic device

To determine to what extent performance in face recognition can be improved using a bioptic device. 15 patients with central visual loss were recruited for the study. Their age ranged from 16 to 75 years. Distance visual acuity ranged between 6/24 to 6/120. perceived disability in face recognition was assessed by a four-item questionnaire. These tasks were repeated with the patients using a bioptic telescope. visual acuity improved in all patients with the use of the bioptic telescope. Mean visual acuity improved from 6/36 to 6/12. Face recognition performance improved in 80% of patients [median gain = 33%].A bioptic low vision device can offer a significant improvement in performance for face recognition and may be useful in reducing the handicap associated with this disability

Expression of some apoptosis-controlling proteins in children with acute lymphoblastic leukemia

The aim of this study was to determine the serum levels of some apoptosis-controlling proteins [Bcl-2 and soluble Fas] in children with acute lymphoblastic leukemia [ALL], and to find out the relation between their expression and the clinico-laboratory parameters as well as outcome of the disease. The study included 20 children with ALL [13 males and 7 females], their age ranged from 0.5-13 years. Twelve apparently healthy children were included as a control group. Cases and controls were subjected to full history taking, thorough clinical examination, and determination of serum levels of Bcl-2 and soluble Fas proteins [sFas], and complete blood picture [CBC]. Bone marrow examination, CSF examination, immunophenotyping, and radiological evaluation were done for cases only. One-year follow-up of cases was performed for evaluation of the prognosis and the outcome of the disease. The results showed that serum levels of Fas and Bcl-2 were significantly elevated in patients with ALL when compared to control [P: 0.007 and P: 0.003 respectively]. Serum levels of sFas were significantly elevated in cases with CNS involvement compared to those without CNS involvement [p <0.01], in cases with white blood cell count >50.000/mm[3] in peripheral blood compared to those having lower cell counts [p<0.05], and in patients with T cell lineage compared to those with B lineage [p<0.01]. Serum levels of Bcl-2 were not significantly different as regard these parameters. Serum levels of Bcl-2 were significantly lowered after treatment [P<0.001], while serum sFas didn't differ significantly before and after treatment. Levels of sFas and Bcl-2 were higher in ALL patients resistant to induction chemotherapy compared to those showing complete remission, but the difference did not reach the level of significance. Our study shows that 1] increased serum expression of Bcl-2 and soluble Fas [sFas] can be demonstrated in children with ALL. 2] increased expression of sFas [but not Bcl-2] has been found to be associated with certain unfavorable prognostic features such as T-lineage ALL, CNS involvement, and higher WBCs count and 3] the higher levels of sFas and Bcl-2 in these cases were not associated with poor response to therapy

Urinary S-100B protein as an early biochemical indicator of hypoxic-ischemic encephalopathy after birth asphyxia in term newborn infants

Measurements of serum and cerebrospinal fluid concentrations of S-100B protein has been used to detect brain distress, and in the perinatal period are correlated with brain maturation and are used to assess cerebral damage after perinatal asphyxia. As S-100B protein is eliminated by the kidneys, and because collecting urine is a simpler procedure than collecting cerebrospinal fluid or blood, especially in high-risk infants in whom anemia attributable to repeated blood sampling is common, we aimed to investigate the relation of urinary S-100B protein to the severity of hypoxic-ischemic encephalopathy [HIE] and to the neurological outcome in full-term newborns with HIE. Routine laboratory variables neurologic patterns, ultrasound imaging, and urine concentrations of S-100B protein were determined at first urination and at 24 hours after birth in 34 infants with perinatal asphyxia and in 25 control subjects. The concentrations of S-100B protein in urine were measured using an immunoluminometric assay. Neurological examination and Denver Developmental Screening Test [DDST] were performed at 12 months in the survivors. The results were correlated with the degree of HIE, and the presence or absence of neurologic abnormalities at age 12 months. Urinary levels of S-100 protein [micro g/L] were significantly higher in asphyxiated infants with favorable outcome [group I] [0.93 +/- 0.31 at 2 hours, and 1.05 +/- 0.30 at 24 hours] and in asphyxiated infants with adverse outcome [group II] [2.62 +/- 0.92 at 2 hours and 4.78 +/- 2.11 at 24 hours] compared to controls [0.18 +/- 0.04 at 2 hours and 0.24 +/- 0.08 at 24 hours, P=0.001 for all]. Also, these levels were significantly higher in asphyxiated infants with severe HIE than infants with moderate HIE, and those with no or mild HIE, with P <0.001 [at 2 hr] and P <0.003 [at 24 hr]. S-100 levels were negatively correlated with perinatal pH in the infants and associated with abnormal CTG at admission to the labor ward. For prediction of neonatal outcome measured as severe HIE, the sensitivity of S100 >0.32 micro g/L [at 2 hours] was 100%, and the specificity was 92.3%. At 24 hours, the sensitivity of S100 >0.58 micro g/L was 100%, and the specificity was 97.4%. For prediction, of adverse outcome at 12 months, the sensitivity of S100 >0.32 micro g/L [at 2 hours] was 100%, and the specificity was 92%. At 24 hours, the sensitivity of S100 >0.58 micro g/L was 100%, and the specificity was 97%. The use of S-100B as a pathologic marker in urine offers a tool to identify which asphyxiated infants are at risk of hypoxic-ischemic encephalopathy and its possible neurologic sequelae, and provide a new perspective for improving the monitoring and care of newborns

Histopathologic variants of minimal change nephrotic syndrome among Egyptian children: clinical significance and long-term evolution

It is widely accepted that minimal change nephrotic syndrome [MCNS] is the most common cause of nephrosis in children. Minimal change disease typically shows no abnormalities in light microscopy. However, there are some minor light microscopic abnormalities that are considered to be MCNS variants. The aim of this study was to investigate the clinical importance and long-term outcomes of some minimal change variants. This retrospective study included 124 children with idiopathic MCNS, diagnosed between 1998 and 2001 at the Urology and Nephrology Center, Mansoura University. Their clinical records, follow up data and renal samples were reviewed. Among them 76 were males and 48 were females, and their age ranged from 2 to 12 years [median 4.2 years]. They were classified into three subgroups: nil disease [62 patients], mild mesangial hypercellularity [MMH] [38 patients], and mild mesangial thickening [MMT] [24 patients]. Patients with MMH had significantly higher age at onset and significantly higher number of relapses prior to biopsy compared to the nil disease group [p: 0.02 and p: 0.09, respectively]. Patients with MMH had significantly higher serum creatinine, and significantly lower creatinine clearance than those with MMT [p=0.011 for both]. There was no significant difference between the groups as regards the incidence of permanent remission, steroid dependence, steroid resistance, infrequent relapses or frequent relapses over the four years after renal biopsy. Serial creatinine clearance done yearly for four years showed insignificant differences among the three groups. Mild mesangial hypercellualrity may differ initially from other minimal change variants as regard age of onset frequency of relapses, and renal function, but follow-up for 4 years revealed insignificant differences between these groups clearance

Obesity, is it an indication or contraindication for laparoscopic appendectomy?

Laparoscopic appendectomy [LA] has been associated with a faster recovery and less postoperative pain than the open appendectomy [OA]. The aim of this study was to assess the influence of obesity [body mass index, BMI> 25] on the outcome of laparoscopic versus open appendectomy. The records of 302 patients who underwent appendectomy for acute appendicitis [open or laparoscopic] between January 2002 and December 2004 were reviewed. Eighty-seven obese patients [BMI >/= 25] were classified into LA group. [19 patients] and OA group [86 patients]. Comparison between the patients groups and their non-obese counterparts included the age, sex, pathology of the appendix, anesthesia and operative time, complications, conversion from laparoscopic to open technique, length of hospital stay and postoperative full recovery time. Obese patients had significantly higher age [30 and 41.7 years for LA and OA groups, respectively] than non-obese patients [14.9 and 24.9 years for LA and OA groups respectively]. P< 0.01 In OA, the operating time for obese patients was significantly longer than that for non-obese patients [54 vs. 34 mm, p< 0.001]. In LA, there was no difference in operating time between the normal and overweight patients. Obese patients who underwent LA had longer anesthesia times than their OA counterparts [112 vs. 73 mm, p<0.01]. However this was not related to prolonged operating time [68 vs. 54 mm, p= 0.11]. Obese patients who underwent OA had significantly greater pain than those treated with LA [p< 0.05]. There were no significant differences between the two operating techniques in terms of complications. Hospital stay was longer for obese patients than for normal weight patients undergoing OA [4 vs. 2, p < 0.01]. Time to full recovery was greater in overweight patients subjected to OA than in the overweight patients in the LA group [21 vs. 15 days, p < 0.001]. We suggest considering overweight [BMI > 25] an indication rather than contraindication for laparoscopic appendectomy

Endoscopic vs. percutaneous inguinal field block [IFB] for postoperative pain control after total extra-peritoneal [TEP] inguinal hernioplasty

Despite the proven merits of using inguinal field block in open hernia repair, there is little data examining its use in laparoscopic hernioplasty. Interestingly, complete field block can be approached endoscopically with minimal hazards. The objective of this prospective randomized study is to compare the outcome of two different approaches of inguinal field block [IFB] for postoperative pain control following endoscopic total extra-peritoneal laparoscopic [TEP] inguinal hernioplasty. Between January 2001 and December 2003, a total of 77 male patients attending Dhahran Health Center, underwent unilateral endoscopic TEP hernioplasties, were randomized to receive either preoperative percutaneous IFB [group A, n = 38] or intraopertive endoscopic IFB [group B, n = 39]: using 50 mls of levobupivacaine [0.25%]. Postoperative pain was assessed by visual analogue score on a scale from 0 to 6. The intraopertive anesthetic requirements, time from end of surgery till extubation, postoperative narcotic analgesia requirement; length of hospital stay and return to full activity were compared among the two groups. Comparison between the two groups showed that patients in group A had significantly less requirements of intraoperative [Fentanyl, analgesia 65.2 +/- 16.8 [micro g] and shorter recovemy time 7.3 +/- 1.7 [min] than patients in group B [98.4 +/- 27.9 [micro g and 8.4 +/- 2.l [min]]. Postoperative pain scores were slightly higher in group A in the first 4-6 hours [p = NS]. Postoperative IV morphine requirement was significantly higher in the first 12 hours [Day surgery cases] in group A [13.2 +/- 3 mg] than in group B [9.2 +/- 2.5 mg]. This difference was not significant among patients hospitalized within the next 24 hours. Almost one third of the patients were able to go home on same day of surgery [11 in group A and 15 in group B, p= NS] Inguinal field block for TEP hernioplasty provides merits for the patients regarding the postoperative pain control and short hospital stay. However, endoscopic IFB was shown to have better control of postoperative pain than the percutaneous IFB during the first 12 hours

Carotid endarterectomy the influence of the standard surgical technique on the outcome of surgery

Carotid endarterectomy has been validated as effective therapy for both symptomatic and asymptomatic carotid stenosis. However, many aspects of this procedure remain controversial. This retrospective study was carried out to test the influence of standardization of the surgical technique on the final outcome. During the last 5 years, at Dhahran health center, we have been utilizing internal shunting and patch angioplasty as a routine practice and on selective basis as previously practiced in the previous 5 years experience. Computerized charts and medical records of cases underwent CEA between 2000 and 2004 were reviewed. The patient data and procedure outcome were compared with our initial reported experience between 1994 and 1999. Thirty-four patients underwent 37 carotid endarterectomies between February, 2000 and December, 2004. There was no significant change in our population demographic data, underlying risk factors or the indications for the surgery. The overall stroke rate was 5.4% [2 cases] and mortality was 2.7% [one patient]. None of the patients developed postoperative cardiac events, wound infection or cranial nerve injury. The overall operative complication was significantly lower in the past 5 years than previously reported from the same institute, 5.9% and 25.7% respectively [P< 0.05]. Conclusions: Over the past 5 years of our experience there is a trend towards improved outcome of CEA with standardization of a surgical technique that is mastered by the surgical team

Incidental appendectomy during laparoscopic cholecystectomy in children with sickle cell disease and symptomatic gallstones retrospective comparative case-control study

Laparoscopic cholecystectomy [LC] has become a standard treatment for symptomatic gall stones in children and adolescents with sickle cell disease. Incidental appendectomy has been advocated during LC in order to avoid the diagnostic dilemma of differentiating surgical and medical causes of abdominal pain in this group of patients. To evaluate the impact of this proposal on the outcome of surgery; a 10 years retrospective case- control review was conducted on 106 sicklers below age of 18 years who underwent LC with or without appendectomy in the Eastern province of Saudi Arabia. The patients were divided into two groups; group I [LCA], included cases who had laparoscopic incidental appendectomy during cholecystectomy [51 cases] and group II [LC] included those who had laparoscopic cholecystectomy only [55 cases]. The groups were compared regarding the demographic and clinical patients data, operative time, conversion rate, postoperative morbidity and mortality, hospital stay and overall long term outcome. Seven out of the 106 cases were converted to open procedure [6.6%]. These cases had relatively higher morbidity [20 7%], mortality [1.8%.] and longer hospital stay [5.5 +/- 3.9] days. Other than the longer operative time in the LCA group, there was no statistical or clinical significant difference between the two groups regarding the short or long term outcome. When technically feasible, incidental appendectomy is recommended during laparoscopic cholecystectomy for.sicklers with gall stones and recurrent abdominal pain