Difficult Laparoscopic Cholecystectomy and Trainees: Predictors and Results in an Academic Teaching Hospital.

Laparoscopic cholecystectomy (LC) is one of the first laparoscopic procedures performed by surgical trainees. This study aims to determine preoperative and/or intraoperative predictors of difficult LC and to compare complications of LC performed by trainees with that performed by trained surgeons. A cohort of 180 consecutive patients with cholelithiasis who underwent LC was analyzed. We used univariate and binary logistic regression analyses to predict factors associated with difficult LC. We compared the rate of complications of LCs performed by trainees and that performed by trained surgeons using Pearson's chi-square test. Patients with impacted stone in the neck of the gallbladder (GB) (OR, 5.0; 95% CI, 1.59-15.77), with adhesions in the Triangle of Calot (OR, 2.9; 95% CI, 1.27-6.83), or with GB rupture (OR, 3.4; 95% CI, 1.02-11.41) were more likely to experience difficult LC. There was no difference between trainees and trained surgeons in the rate of cystic artery injury (p = .144) or GB rupture (p = .097). However, operative time of LCs performed by trained surgeons was significantly shorter (median, 45 min; IQR, 30-70 min) compared with the surgical trainees' operative time (60 min; IQR, 50-90 min). Surgical trainees can perform difficult LC safely under supervision with no increase in complications albeit with mild increase in operative time.

Eosinophilic annular erythema: successful response to ultraviolet B therapy.

Eosinophilic annular erythema (EAE) is a rare and relatively newly described eosinophil-rich dermatosis. Debate still exists as to whether it represent a subtype of Well syndrome or a separate disease entity. We report an 8-year-old boy with a 4-year history of recurrent, asymptomatic annular lesions, which were diagnosed after clincopathological correlation as EAE. This condition usually runs a relapsing and remitting course with resistance to multiple treatments. Prednisolone and hydroxychloroquine have been reported as successful but the response to these was limited in this case. Complete resolution occurred after treatment with ultraviolet B (UVB) therapy. To our knowledge, this is the first report of a favourable response of EAE to such therapy.

The role of (124)I-PET in diagnosis and treatment of thyroid carcinoma.

Iodine-124 is a positron-emitting iodine isotope, enabling measurement of iodine uptake using positron emission tomography (PET). There is a number of situations where the use of (124)I-PET/computed tomography (CT) can improve the current clinical practice in the diagnosis and treatment of thyroid cancer. Firstly, (124)I-PET/CT can aid in the staging of patients, because of better detection of metastatic disease and measurement of metabolic tumour volume, and thus separate low-risk from high risk patients. Secondly, the much higher sensitivity and spatial resolution of PET compared to gamma scintigraphy can also improve detection of recurrent disease. Furthermore, (124)I-PET can be used for patient-specific radioiodine therapy radiation dosimetry. Simultaneous administration of the therapeutic dose of (131)I and a tracer dose of (124)I allows for accurate measurement of iodine uptake during therapy. The decay scheme of (124)I, with few positrons and many gamma rays emitted per decay, often simultaneously, poses a challenge to quantitative PET imaging. Improved correction methods and the use of last-generation PET/CT scanners with faster electronics and better energy resolution can overcome this.

Prognostic index for primary adenocarcinoma of the urinary bladder.

AIM: To determine the working independent prognostic factors and the prognostic index of adenocarcinoma of the urinary bladder. The effect of adding postoperative radiotherapy to radical cystectomy on this prognostic index was also investigated. PATIENTS AND METHODS: Two hundred and sixteen patients having adenocarcinoma of the urinary bladder were treated with radical cystectomy and pelvic lymphadenectomy with (82 patients) or without (134) postoperative radiotherapy. Postoperative radiotherapy (PORT) was given to the whole pelvis in a dose of 50 Gy/25 fractions over 5 weeks, and started 4-10 weeks after surgery. RESULTS: The 5-year disease-free survival rate was 44 +/- 4% for the whole group. Postoperative radiotherapy improved the disease-free survival significantly from 33 +/- 6% for cystectomy alone Introduction to 58 +/- 6% for PORT patients (P = 0.002). The independent prognostic factors for DFS were the pathological stage, histological subtypes, nodal involvement and the addition of postoperative radiotherapy. The stratification of patients using prognostic indices according to the pathological findings produces identifiable prognostic groups. Postoperative radiotherapy improved the DFS significantly in the intermediate and high risk indices (p = 0.0004 and 0.0002 respectively). CONCLUSIONS: The identified prognostic indices with their prognostic group could be used not only as a predictor of disease-free survival but also as a good predictor for the need to add adjuvant therapy in adenocarcinoma of the urinary bladder.

A del(X)(p11) carrying SRY sequences in an infant with ambiguous genitalia.

BACKGROUND: SRY (sex-determining region, Y) is the gene responsible of gonadal differentiation in the male and it is essential for the regular development of male genitalia. Translocations involving the human sex chromosomes are rarely reported, however here we are reporting a very rare translocation of SRY gene to the q -arm of a deleted X chromosome. This finding was confirmed by cytogenetic, fluorescent in situ hybridization (FISH) and polymerase chain reaction (PCR). CASE PRESENTATION: A 7-month infant was clinically diagnosed as an intersex case, with a phallus, labia majora and minora, a blind vagina and a male urethra. Neither uterus nor testes was detected by Ultrasonography. G-banding of his chromosomes showed 46,X,del(X)(p11) and fluorescent in situ hybridization (FISH) analysis showed a very small piece from the Y chromosome translocated to the q-arm of the del(X). Polymerase chain reaction (PCR) analysis revealed the presence of material from the sex-determining region Y (SRY) gene. CONCLUSION: It is suggested that the phenotype of the patient was caused by activation of the deleted X chromosome with SRY translocation, which is responsible for gonadal differentiation.

Spectrophotometric and spectrofluorimetric determination of fluorouracil in the presence of its degradation products.

Three reliable spectrophotometric and spectrofluorimetric procedures are described for the determination of fluorouracil in bulk powder and ampoules in the presence of its degradation products. One spectrophotometric procedure, based on measurement at 555 nm of the violet-coloured complex formed by fluorouracil with cobalt(II), has a detection limit of 0.03 mg mL(-1). Two sensitive spectrofluorimetric procedures are also proposed. One is based on measurement of the intrinsic fluorescence of the liberated fluorouracil at 375 nm, after precipitation as its cobalt(II) complex, decomposition of the precipitate with sulphuric acid and excitation at 295 nm. The second depends on excitation of the fluorouracil-cobalt(II) complex at 395 nm and measuring its fluorescence at 483 nm. The limits of detection of the two spectrofluorimetric procedures are 0.5 and 2 microg mL(-1), respectively. The three procedures have been used successfully for the determination of fluorouracil ampoules. The validity of the methods has been assessed by applying the standard addition technique.

Microcoated wire sensors for the determination of anticancer drugs cyclophosphamide and ifosphamide in the presence of their degradates.

The construction and electrochemical response characteristics of poly (vinyl chloride) and poly (vinyl chloride) carboxylate membrane sensors for the determination of cyclophosphamide and ifosphamide are described. Based on the formation of an ion-pair complex between the drug cation and sodium tetraphenylborate, two poly (vinyl chloride) sensors, namely a cyclophosphamide membrane sensor and ifosphamide membrane sensor were fabricated. They show a linear response for both drugs over the concentration range 10(-2)-10(-4) M with cationic slopes of 56 and 54.6 mV per concentration decade, for sensor 1 and sensor 2, respectively. Based on the interaction between the drug solution and the dissociated COOH groups in the poly (vinyl chloride) carboxylate, sensor 3 was fabricated. It shows a linear response for both drugs over the concentration range 10(-3)-10(-5) M with a cationic slope of 49.7 mV per concentration decade. The direct potentiometric determination of cyclophosphamide and ifosphamide in their pharmaceutical preparations using the proposed sensors gave average recoveries of 101.3+/-0.6, 100.8+/-10.7 and 102.0+/-11.0% for the sensors 1, 2 and 3, respectively, which compares reasonably well with the data obtained using the British Pharmacopoeial method (1993). Sensors 1 and 2 were also used to follow up the stability of the drugs studied in the presence of their degradates. These degradation products have no diverse effect on the responses of sensors 1 and 2.

Clinical and pharmacokinetic study of praziquantel in Egyptian schistosomiasis patients with and without liver cell failure.

The pharmacokinetics and therapeutic efficacy of praziquantel (Distocide; Epico, El-Asher-Men-Ramadan City, Egypt) were studied in 40 patients with schistosomiasis mansoni and various degrees of hepatic dysfunction. The patients were allocated into four groups: the first included 10 patients with simple active schistosomiasis while the other three were made up of patients with schistosomiasis associated with liver cirrhosis and splenomegaly according to Child's classification of hepatocellular function. Every patient was treated with 40 mg/kg of praziquantel as a single oral dose. The efficacy of the drug was evaluated after two months by rectal snip examination. The pharmacokinetic parameters did not differ significantly between patients with simple active schistosomiasis (group 1) and those with hepatosplenomegaly with liver involvement but without ascites and jaundice (group 2). However, as liver cell dysfunction became more evident (groups 3 and 4), pharmacokinetic parameters of praziquantel such as the half-life of elimination, the half-life of absorption, the maximum concentration, the time to maximum concentration, and the area under the concentration-time curve increased proportional to the degree of hepatic insufficiency. Linear correlations were found between each of the these parameters on the one hand and hepatic function test results (total bilirubin, direct bilirubin, and serum albumin) on the other. In spite of these pharmacokinetic differences, the cure rates were 70%, 80%, 90%, and 90% in the four groups, respectively. Although the incidence of side effects was high (53%), such effects were transient and mild.