Water quality assessment of Lake Burullus, Egypt, utilizing statistical and GIS modeling as environmental hydrology applications.

GIS is a very powerful tool for analyzing huge amount of data and connecting them with the geography; moreover, recently, there is great advancement in the field. The main objective of this study is to assess the water quality (WQ) and trophic status (TS) conditions of Lake Burullus, Egypt, using statistical modeling (PCA/FA and CA), WQ index (L-WQI), and trophic status index (Carlson TSI and TRIX) approaches, in addition to using GIS tools for building models able to automatically calculate the various indices and producing color coded maps for the lake. The results indicated that PCA/FA grouped the twenty-four WQ parameters into nine principal components explaining 72.6% of the total variance, domestic, and agriculture pollution were dominant. CA divided the twelve sampling stations into most and least polluted groups. The lake WQ was classified as a "Very Poor," according to L-WQI. Moreover, the results of the Carlson TSI and TRIX indices were coincided and classified the eutrophication levels in the lake as "Hyper-Eutrophic" and "Elevated Trophic," respectively. Based on the results of this study, Lake Burullus needs urgent plans for recovering its WQ. Pre-treatment for its drains' effluents and implementing of a periodical WQ monitoring program are highly recommended.

Advanced breast conservation and partial breast reconstruction - a review of current available options for oncoplastic breast surgery.

Breast cancer is the most common cancer affecting one in three women with new cancer diagnosis in England. Breast-conserving surgery is the primary surgical option in a vast majority of these patients. Use of oncoplastic techniques in breast conservation surgery has significantly improved the aesthetic outcomes without compromising the oncological safety of cancer resections. Oncoplastic breast-conserving surgery (OPBCS) has transformed the specialty with a paradigm shift in ideology and the recognition that aesthetic and oncological resections are synonymous when planning surgical intervention for patients with breast cancer. The two main options for OPBCS are therapeutic mammoplasty and partial beast reconstruction using pedicle-based flaps. This review aims to highlight key concepts in OPBCS demonstrating an overview of these surgical techniques, their safety, outcomes and the emergence of extreme oncoplastic breast surgery.

Water quality modeling and management for Rosetta Branch, the Nile River, Egypt.

Rosetta Branch (RB) is the Nile western branch, which is considered the main freshwater resource for the western governorates of the Nile Delta, in addition to El-Beheira governorate, Egypt. This work aims to investigate the effectiveness of applying six feasible water quality management scenarios for the RB at Kafr Elzayat (KZ) City, where two major pollution sources (industrial companies and the Tala Drain) are discharging their effluents to the branch. A hydro-ecological model for the branch was developed based on MIKE 11 modeling system (3 modules). The developed model was calibrated using field hydrodynamic and water quality records for the branch during the period from November 2014 to August 2015. The calibrated model results were considered a base case for the simulated management scenarios. According to the study results, diverting the Tala Drain effluents to the nearest main drain will significantly enhance the branch water quality, while diverting of the industrial companies' effluents to the city sewer system will significantly enhance the water quality conditions downstream of the study. The expected scenario of decreasing the RB discharge, due to future climatic changes and/or construction of the new Ethiopian dams, will significantly affect the RB water quality status in a negative way. Urgent management plans, based on the presented scenarios results (or a combination of them), should be applied to enhance the branch water quality. The Tala Drain should be, at least, provided by a water quality treatment plant, and the branch freshwater discharge should be increased.

Change detection for Lake Burullus, Egypt using remote sensing and GIS approaches.

Lake Burullus is the second largest natural coastal lake in Egypt. It has an economic importance for fish yield. However, several anthropogenic activities such as industrial, agriculture, and reclamation activities lead to a deterioration of its water quality and a decrease of the water body area of the lake. This study aims to detect the spatiotemporal changes of Lake Burullus in the period 1972-2015 using 12 Landsat {(1,3-MSS), (4,5-TM), and (7-ETM+)} imageries and water indices approach. To extract water feature from imageries, the Normalized Difference Water Index (NDWI) and the Water Ratio Index (WRI) were applied. The NDWI was applied to the MSS imageries. For other TM and ETM+ imageries, the WRI was applied. Obtained results show a significant decrease in the water area of the Lake Burullus, where it lost about (49%) of its surface area during the period from the year 1972 to the year 2015. A rapid decrease in the lake surface area was noticed through the period from 1972 to 1984. A prediction model was built depending on the calculated water area of the lake. Finally, the multi-temporal maps of the lake surface area are overlaid to produce a map for the changes of the lake surface area using Geographic Information System (GIS).

The impact of tamoxifen brand switch on side effects and patient compliance in hormone receptor positive breast cancer patients.

BACKGROUND: In 2006 Nolvadex was discontinued and replaced by a variety of alternative generic tamoxifen brands for the adjuvant treatment of breast cancer. Anecdotally, patients are switching brands and taking alternative medications to reduce treatment related symptoms. Nevertheless, more severe side effects may equate to better relapse prevention. This study evaluates generic tamoxifen adherence and its correlation with side effects and brand switch. METHODS: Consecutive disease free ER positive patients (stage I-III) were invited to respond to a questionnaire. 165 of 327 questionnaires were returned (50% response). Pearson's Chi Square test was used for data analysis. RESULTS: 63 patients (38%) reported a switch between generic tamoxifen. 59% of all patients experienced side effects associated with tamoxifen treatment of which 53% were severe. Patients experiencing differential symptoms dependent on tamoxifen brand reported more severe side effects (p = 0.02). Non-prescribed supplements were taken by 42% of all patients with no significant improvement in climacteric symptoms (p = 0.05). The concomitant use of SSRIs appeared to have no effect on symptoms. A significant number of patients considered discontinuing tamoxifen because of the side effects (p = 0.001), yet this did not translate into discontinuation or non-adherence (p = 0.8 and 0.08 respectively). CONCLUSION: Severe tamoxifen side effects are commonly experienced by breast cancer patients and can be significantly altered by change in tamoxifen brand. Most patients will continue to take tamoxifen, despite side effects to avoid cancer relapse. Supplementation and antidepressants did not improve tamoxifen related side effects in our cohort.

A case of idiopathic tracheal stenosis.

Acquired tracheal stenosis is a condition that often results from trauma, neoplasm, infection, vasculitis, inflammatory or infiltrative processes. Idiopathic tracheal stenosis is a rare entity and represents a diagnosis of exclusion. We report a case of severe localized extrathoracic tracheal stenosis in a 35 year old female who was initially suspected to have asthma as the cause of several months of chronic dyspnea.

Hepatic splenosis mimicking HCC in a patient with hepatitis C liver cirrhosis and mildly raised alpha feto protein; the important role of explorative laparoscopy.

BACKGROUND: Splenosis is a heterotropic implantation of splenic fragments onto exposed vascularised peritoneal and intrathoracic surfaces, following splenic injury or elective splenectomy. CASE PRESENTATION: A 60 year old cirrhotic patient was referred to us with a hepatic mass, suspected to be HCC in a cirrhotic liver. A computerized tomography scan (CT) demonstrated a cirrhotic liver with a 2 x 2.7 cm focal hypervascular nodule, lying peripherally at the junction of segment 7 and 8. Diagnostic laparoscopy demonstrated a 3 cm exofitic dark brown splenunculus attached to the diaphragm and indenting the surface of segment 7 of the liver. The lesion was easily resected laparoscopically and shaved from the live surface with no need for a liver resection. The histopathological assessment confirmed the diagnosis of splenunculus, with no evidence of neoplasia. CONCLUSION: Hepatic splenosis is not a rare event and should be suspected in patients with a history of splenic trauma or splenectomy. Correct diagnosis is essential and will determine subsequent management plans. In doubtful cases laparoscopic investigation can offere essential information and should be part of the standard protocol for investigating suspected splenosis.

Laparoscopic versus open left lateral hepatic sectionectomy: A comparative study.

BACKGROUND: Laparoscopic liver surgery has been difficult to popularize. High volume liver centres have identified left lateral sectionectomy (LLS) as a procedure with potential for transformation into a primarily laparoscopic procedure where surgeons can safely gain proficiency. METHODS: Forty-four patients underwent either laparoscopic (LLLS) or open (OLLS) left lateral sectionectomy (of segments II/III) for focal lesions at Southampton General Hospital. RESULTS: OLLS and LLLS groups were matched for age, sex and tumour types resected. Median operative time in the LLLS group was 180 (40-340) min and 155 (110-330) min in the OLLS group (p=0.885) with median intra-operative blood loss in the LLLS group 80 (25-800) ml versus a larger 470 (100-3000) ml; p=0.002 for patients receiving OLLS. Post-operative stay was also shorter in the LLLS group (3.5 (1-6) days) compared to the OLLS group (7 (3-12) days; p<0.001). Resection margin was not different in the two groups (11 (1.5-30) mm (LLLS) versus 12 (4-40) mm (OLLS); p=1) and neither was the complication rate (13% for LLLS versus 25% for OLLS; p=0.541). There were no conversions to open in the LLLS group and no deaths in either group at 90 days. Between the first and second 12 LLLS the median operative time fell from 240 (70-340) min to 120 (40-120) min; p=0.005 as well as median post-operative hospital stay from 4.5 (2-6) days to 2 (1-4) days, p=0.001. CONCLUSION: LLLS is a viable alternative to OLLS with potential improvements in intra-operative blood loss and shorter hospital stay without adversely affecting successful resection or complication rates. Larger prospective studies are required to explore this new avenue in laparoscopic liver surgery.

Management of a ruptured pseudoaneurysm of common hepatic artery following pancreaticoduodenectomy.

Postoperative pseudoaneurysm formation is one of the most feared complications of pancreatic leak following pancreaticoduodenectomy (PD). Surgical repair may be compromised due to a persistent enzymatic insult on the repaired vessel; therefore, preventive measures should be adopted. We report a case of ruptured hepatic artery pseudoaneurysm occurring 12 days following PD in a patient with a postoperative pancreatic fistula. Emergency surgery revealed that the pseudoaneurysm was situated at the point of surgical transfixation of the gastroduodenal artery. The pseudoaneurysm was successfully managed by under-running of the bleeding point combined with the direct application of hemostatic products to the bleeding surface (TachoSil and Tisseel) to act as a barrier from the pancreatic secretions.

Laparoscopic inguinal hernioplasty: a community hospital's experience.

Although controversial, laparoscopic inguinal hernia repair has become increasingly popular among surgeons. The overall advantages of this procedure over conventional hernia repair have not as yet been substantiated. One hundred and three consecutive laparoscopic, transabdominal, preperitoneal inguinal hernia repairs in 91 patients were evaluated retrospectively. Patients' satisfaction was assessed using the Visick grading system. The mean follow-up was 18.3 months. One case was converted to an open procedure. Eighty-eight patients (91%) were discharged on the day of surgery. Eighty-seven patients (96%) were satisfied with the operation (Visick grades I & II). Twenty-nine patients who previously underwent a traditional open herniorraphy stated that they would have preferred the laparoscopic method if they had the choice. Early complications included wound infection (n = 1), urinary retention (n = 1) and intestinal obstruction necessitating a laparotomy (n = 1). All patients were ambulating without significant pain after a mean of 7.6 days, and returned to work after 2.4 weeks on average. There was one case of recurrence. In conclusion, patients are satisfied with the laparoscopic hernioplasty technique, which is associated with a low morbidity and short term recurrence rate. Laparoscopic hernioplasty should be considered a viable and valuable alternative to the open method. It appears especially attractive for recurrent or bilateral hernias.

Ultrasonography in the diagnosis of acute appendicitis.

The purpose of this study was to assess our results of using graded compression ultrasonography (US) to confirm the diagnosis of acute appendicitis. Graded compression US was performed on 94 patients who presented at the Lehigh Valley Hospital, Allentown, Pennsylvania with an equivocal clinical picture of acute appendicitis. When used to diagnose acute appendicitis, US provided a specificity of 93.7%, sensitivity of 74.2%, and accuracy of 87.2%. We conclude that graded compression US was useful to rule out the diagnosis of acute appendicitis and helped to avoid unnecessary appendectomies and reduced negative laparotomies. Our results proved to be comparable to previously reported studies.

Protective effects of trifluoperazine on the microcirculation of cold-stored livers.

Previous studies have shown a protective effect of trifluoperazine (TFP), a calmodulin inhibitor, upon the microcirculation of cold-stored kidneys. The present study points to similar beneficial effects of TFP on the microcirculation of cold-stored livers; 25 canine livers were preserved for 24 hr with Euro-Collins' solution (EC) (n = 8), University of Wisconsin solution (UW) (n = 7), or UW + TFP (n = 10). The stored livers underwent heterotopic transplantation (HLTX); hepatic-artery and portal-vein pressure and flow were monitored; oxygen consumption and extraction were measured before HLTX and at 15-min intervals after reperfusion, for 1 hr. Mean hepatic-artery and portal-vein flow (HAF & PVF) prior to donor hepatectomy were 172 and 530 cc/min, respectively. Poor HAF and PVF occurred in EC-HLTX (mean 35, 175 cc/min, respectively). The damaged EC-flushed livers could not compensate to the decreased hepatic blood flow by increased oxygen extraction (oxygen consumption and extraction, 8.7 vol.% and 48%, respectively). Light and electron microscopy showed severe liver necrosis and periportal hemorrhages. Improved hepatic-artery and portal-vein flows were seen in UW HLTX (105 and 254 cc/min), and oxygen consumption and extraction were 16.4 vol.% and 66%, respectively. Liver biopsy taken just before reperfusion revealed well-preserved liver architecture. Liver biopsy obtained 1 hr after reperfusion revealed marked edema of the portal triad, sinusoid congestion, and hemorrhage. Electron-microscopy biopsies obtained during reperfusion at 15-min intervals revealed severe vasospasm of the terminal hepatic arterioles and progressive damage to the liver microcirculation. The addition of TFP to the UW-flush solution resulted in excellent protection of the liver microcirculation. Marked increase in hepatic-artery and portal-vein blood flow was noted after reperfusion (mean 167 and 421 cc/min, respectively (P 0.02 vs. UW: P 0.001 vs. EC). The recovery of metabolic activity was evident by the high oxygen consumption and extraction (25.8 vol.% and 80%, respectively). And serial liver biopsies obtained after reperfusion have shown excellent protection of liver architecture and the absence of hepatic arteriolar vasospasm. Taken together, these data suggest that the addition of TFP to the UW solution protects the liver microcirculation by rendering the hepatic microcirculation insensitive to vasospastic stimuli during reperfusion, thus permitting better metabolic recovery after transplantation.

Recent results of treatment of infantile hypertrophic pyloric stenosis.

During the five year period December 1980 to November 1985, 106 infants with hypertrophic pyloric stenosis were treated. There were no operative deaths, but two late deaths occurred from associated abnormalities. The combination of preoperative rehydration, skilled anaesthesia, and the use of the Fredet-Ramstedt operation (pyloromyotomy) have virtually eliminated mortality from uncomplicated infantile hypertrophic pyloric stenosis. The most common complications were gastro-oesophageal reflux in 11 (11%), perforation of the duodenal fornix in nine (8%), and wound infection in five (5%); no wound dehisced.

Unusual complication of the Fowler-Stephens orchidopexy.

A boy who had an intraabdominal testis complicated by a large inguinal hernia is reported. This combination of abnormalities is unusual. Following a Fowler-Stephens orchidopexy the child developed another inguinal hernia.