Surgical treatment of chronic sacrococcygeal pilonidal sinus. Open method versus primary closure.

OBJECTIVE: To study the comparison between the primary closure and open technique after excision of chronic sacrococcygeal pilonidal sinus. METHODS: A randomized study was designed and 77 patients with chronic sacrococcygeal pilonidal sinus were included in this study. This study took place in Rizgary Teaching Hospital, Erbil, Kurdistan, Iraq, from January 1997 to August 2003. The patients were separated into 2 groups; Group A (37 patients) were treated by open method (excision and healing by secondary intention) and Group B (40 patients) for whom primary midline suturing was performed after excision of the pilonidal sinus. The follow up ranged from 1.5-5.5 years (mean 4.16) was through outpatient visits. RESULTS: The Student t test was applied for statistical analysis for the operating time, hospital-stay, time off from work and wound healing time; and the results show extremely significant differences between the 2 groups (p < 0.0001). The statistical analysis of the total number of postoperative complications of both techniques showed a significant difference (p = 0.0401), while the differences were insignificant for each complication when analyzed separately. CONCLUSION: Excision and primary closure for chronic sacrococcygeal pilonidal sinus is superior to excision and healing by secondary intention. We believe that primary midline suturing is a useful method for management of chronic sacrococcygeal pilonidal sinus.

Serosurvey of prevalence of human immunodeficiency virus amongst high risk groups in Port Sudan, Sudan.

During October, 1987, 593 sera were collected from risk groups in Sudan's only major deepwater port, Port Sudan. The risk groups included prostitutes, lorry drivers and prisoners. A large proportion of the study participants practised high risk behaviour which included sexual promiscuity, medical treatment by injection, scarification and tattooing. Despite high risk behaviour and evidence of a high prevalence of hepatitis B infection, a virus transmitted in a manner similar to HIV, no study participants were positive for HIV infection. This data suggests that the prevalence of HIV infection amongst high risk groups in Port Sudan is very low. These findings confirm a lack of clinical cases of AIDS in hospitalized patients in Port Sudan and the small number of reported cases in other areas of northern Sudan.

PIP: The high prevalence of hepatitis B markers in the Sudan (up to 80% of those surveyed) suggests the potential for a rapid spread of human immunodeficiency virus (HIV) since both viruses are transmitted in similar ways. Although clinical cases of acquired immunodeficiency syndrome (AIDS) have not been reported from Port Sudan, southern Sudan borders on several countries with a high prevalence of HIV infection. Sudan's National AIDS Committee plans a series of surveys to determine the prevalence of HIV infection in high risk groups and the general population in several geographic regions. The 1st such survey was conducted in Port Sudan in 1987 among 593 high-risk individuals (203 prostitutes, 103 lorry drivers, 118 prisoners, and 169 in mixed occupations). The study population included 330 males and 263 females. About half of the participants were married and in the 21-30-year age group. Over 75% had been exposed to hepatitis B and 76% had been treated for malaria, largely through injection. Overall, the incidence of non-sex-related risk factors for HIV infection among Port Sudan subjects was: injection, 48%; scarification, 40%; and tatoos, 38%. 32% reported a prior history of a sexually transmitted disease. 71% of the males had used prostitutes. Surprisingly, no study participants were positive for HIV infection. This finding presumably reflects Port Sudan's geographic isolation from other Central and East African countries with large numbers of HIV-positive individuals. On the other hand, Port Sudan is the site of importation of all goods by sea into the country and many people from other African and Arab countries are associated with the seaport. Thus, once the HIV virus is introduced by infected persons from other areas, the risk factors suggest the potential for rapid transmission.

A clinicopathologic study of Ki-67 proliferation index in colorectal carcinoma.

OBJECTIVES: To investigate Ki-67 immunoexpressions in colorectal cancer and analyze possible correlations with variable clinicopathological prognostic factors. METHODS: A cross-sectional study of tissue sections from 50 formalin-fixed and paraffin-embedded tumor specimens were examined at the Histopathology Laboratory of Rezgary Teaching Hospital in Erbil, Iraq between January 2010 and July 2011. Ki-67 labeling index is calculated immunohistochemically using the monoclonal antibody MIB-1, and the standard streptavidin-biotin immunoperoxidase method. The clinicopathologic and prognostic features were statistically analyzed. RESULTS: Over-expression of Ki-67 proliferation protein was found in 31 (62%) cases. Statistical analyses revealed a significant relation between Ki-67 proliferation index and histologic type (p=0.005) and tumor grade (p=0.018); but no significant relation was calculated with the other clinicopathological parameters such as age, gender, tumor's size, site, depth, stage, nodal status, and vascular invasion (p>0.05). CONCLUSION: Ki-67 immune overexpression is a frequent finding in our colorectal cancer cases; but it is not enough to monitor Ki-67 proliferation index alone for prognosis in colorectal cancer.

Serum opacity factor of Staphylococcus epidermidis.

Three Staphylococcus epidermidis strains produced a factor giving rise to opacity in different sera but not in albumin. Serum opacity factor was resistant to age and heat and active in acidic media.

Streptococcal impetigo and acute glomerulonephritis in children in Cairo.

Impetigo contagiosa in Cairo affected young children of both sexes, the face being the main site. Post-impetigo nephritis, confirmed by a low serum C3 level and by urinalysis, occurred in only 11% of cases. Streptococcus pyogenes strains were recovered from 84% of the skin lesions. Sixteen types were identified according to their T-protein, and most infections were associated with T3/B3264, T13/B3264, T5, T11, T12, T8/25/Imp 19 and T14/49; the majority of these types were also recovered from houseflies. The types isolated from cases of post-impetigo nephritis were T4 (M 60), T14/49 (M49), T8/25/Imp 19 (mostly M 55) and T11. Seventy percent of the patients infected with T4 (M 60) and 40% of those infected with T14/49 (M 49) developed nephritis. Strains isolated from the skin bore a closer resemblance to those isolated from the nose than to those found in the throat. The ASO response was poor in uncomplicated impetigo but the titre rose more aften in post-impetigo nephritis.

HLA antigen frequencies in children with cardiac disease in Cairo.

The study of Histocompatibility Locus Antigen (HLA) frequencies in 48 cases with congenital heart disease (CHD) in children in Cairo showed high incidence of A10. Cases with atrial septal defect have shown a significant association with A3 besides A10. There is also a significant association between B12-45 and right loop anomalies (Fallot's and pulmonary stenosis) together with A10. On the other hand, children with rheumatic heart disease have shown strong positive association with HLA group B8 and negative association with A28.

HLA typing intestinohepatic schistosomiasis.

Patients with simple and/or complicated intestinal bilharziasis and normal controls were chosen for CBC, complete urine and stool analysis, liver function tests, liver biopsy, sigmoidoscopy and rectal biopsy. HLA typing was done by microcytotoxicity test. A statistically significant increased frequency of HLA-B8 antigen was present in with or without polyposis and with or without hepatosplenomegaly, as compared to controls (P less than 0.01). Also HLA-B8 showed a statistically significant increased frequency in those with or without polyposis and with hepatosplenomegaly and without polyposis (P less than 0.05). The HLA-A25 and A26 showed a significant increased frequency among all groups (P less than 0.05). HLA-A1, A9, B18 were variable in frequency among all groups. It was concluded that patients with bilharzial hepatosplenomegaly specially with intestinal polyposis have a high frequency of HLA-B8.

comparative study between small dose dexamethasone, tropisteron, metoclopramide and normal saline in reducing nausea and vomiting after laparoscopic cholecystectomy

Nausea and vomiting are among the most common distressing complications encountered by patients postoperatively. The aim of this study is to evaluate the prophylactic effect of small dose of dexamethasone [5 mg] on postoperative nausea and vomiting [PONV] after laparoscopic cholecystectomy [LC]. A prospective double blind placebo controlled study of 160 patients who under-went elective LC at Rizgary Teaching and Hawler Private Hospitals in Erbil, Kurdistan in a period between Jan 2009 and Dec 2009. Preoperatively the patients were allocated randomly to one of the four groups [n = 40 each]. 1. The dexamethasone group received dexamethasone 5mg. 2. The metoclopramide group received metoclopramide 10mg. 3. The tropisetron group received tropisetron 2mg. 4. The placebo group received normal saline 2ml. Both the dexamethasone and tropisetron groups were significantly different from the placebo group in the incidence of nausea and vomiting. The differences between the dexamethasone and tropisetron groups were not significant [P = 0.799]. prophylactic IV dexamethasone 5 mg significantly reduces the incidence of PONV in patients undergoing LC

clinicopathologic study of Ki-67 proliferation index in colorectal carcinoma

To investigate Ki-67 immunoexpressions in colorectal cancer and analyze possible correlations with variable clinicopathological prognostic factors. A cross-sectional study of tissue sections from 50 formalin-fixed and paraffin-embedded tumor specimens were examined at the Histopathology Laboratory of Rezgary Teaching Hospital in Erbil, Iraq between January 2010 and July 2011. Ki-67 labeling index is calculated immunohistochemically using the monoclonal antibody MIB-1, and the standard streptavidin-biotin immunoperoxidase method. The clinicopathologic and prognostic features were statistically analyzed. Over-expression of Ki-67 proliferation protein was found in 31 [62%] cases. Statistical analyses revealed a significant relation between Ki-67 proliferation index and histologic type [p=0.005] and tumor grade [p=0.018]; but no significant relation was calculated with the other clinicopathological parameters such as age, gender, tumor's size, site, depth, stage, nodal status, and vascular invasion [p>0.05]. Ki-67 immune overexpression is a frequent finding in our colorectal cancer cases; but it is not enough to monitor Ki-67 proliferation index alone for prognosis in colorectal cancer

Para umbilical hernias in Erbil

To study the distribution and causes of Paraumbilical hernias in Erbil city. This is a prospective study comprising 182 consecutive patients with Paraumbilical hernias who attended general hospitals in Erbil city, during the period from 1[st] September 2008 to 31[st] May 2009. The data collected by a special questioner. All patients operated on under GA, except 2 of them who were operated upon by spinal anesthesia due to their unfitness for GA. The total number of the patients was 182 patients. The female: male ratio was 12:1. The age of the patients ranged from 1.5-76 years [mean was 41.7]. The most common age group was between [31-40] years. One-hundred- and-ten patients [61%] were obese, [67%] of patients had history of 4-15 pregnancies. Only one child [female] had this type of hernia. Recurrent hernias were found in 14% of the cases. Operation was done for [74%] of the patients [50% simple repair, 16% Mayo's repair, and 34% repair by prosthetic mesh]. Paraumbilical hernia is a common disease in Erbil. It is more common in females than males. It is more common in multiparous and obese adult female patients. It may rarely occur in children

role of preoperative ultrasound in predicting difficulties encountered during laparoscopic cholecystectomy

Pre-operative prediction of difficulties which may occur during laparoscopic cholecystectomy can help in reduction of operative and postoperative complications. The aim of our study was to study the value of preoperative ultrasound findings for predicting difficulties encountered during LC and to assess the usefulness of these findings to identify patients at high risk of conversion from laparoscopic to OC. A prospective study of 200 consecutive patients who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis in the period between October 2005 and March 2007 in Rizgary Teaching and Howler Private Hospitals in Erbil, Kurdistan, Iraq. Abdominal ultrasound was done pre-operatively, the diagnosis of gall stones was made and the presence of ancillary findings was recorded. Five ancillary ultrasound findings were assessed. These included; thickened gall bladder wall more than 4mm, presence of pericholecystic fluid, severely contracted gall bladder, empyma, and gall bladder filled with stones. Ultrasound findings were compared with the operative findings. In 36 patients who had one or more of these findings laparoscopic Cholecystectomy was difficult in 22 [61.1%] of them. The statistical analysis showed that thick wall gall bladder > 4mm has the highest sensitivity [69%] and the presence of pericholecystic fluid has the highest specificity [100%] in predicting difficult laparoscopic cholecystectomy and the presence of more than 2 ancillary findings yielded an accuracy rate of [100%]. Conversion to open cholecystectomy was needed in 13.9% of these patients. The rates of difficult laparoscopic cholecystectomy and conversion to laparotomy were much lower in those patients who had no ancillary findings [4.3%] and [1.2%] respectively. Preoperative ultrasound findings are of value for predicting difficulties encountered during laparoscopic cholecystectomy which may require conversion to open cholecystectomy

Immunoexpression of p53 and p21 [WAF1/CIP1] proteins in colorectal cancer: correlation with clinicopathological parameters

Both p53 and p21 [WAF1/CIP1] proteins belong to the cell cycle-regulating family of proteins, and the loss of their activity seems to be one of the most important regulatory mechanisms of carcinogenesis in colorectal cancer. The aim of this study was to evaluate the tumor suppressor genes p53 and p21 [WAF1/CIP1] expressions in colorectal cancer and assessment the relationship between p2 [WAF1/CIP1] and p53 immunoreactivity with special emphasis on the prognostic significance of their expression with variable clinicopathologic parameters. Tissue sections from 50 formalin-fixed and paraffin-embedded tumor specimens were examined. The standard streptavidin-biotin immunoperoxidase method was used for immunostaining of p53 protein and p2[WAF1/CIP1] protein.The extent of positive p53 and p21 [WAF1/CIP1] staining was graded semiquantitatively. The clinicopathologic and prognostic features were statistically analyzed. Over-expression of p53 and p2l [WAF1/CIP1] were found in 27 cases [54%] and 22 cases [44%] respectively. Statistical analyses revealed a highly significant correlation between p21 [WAF1/CIP1] and p53 immunopositivity [p=0.003]; but no significant correlation could be calculated between p53 or p21 [WAF1/CIP1] proteins expression with the Clinicopathological parameters such as [age, sex, tumor size, gender, TNM staging, and vascular invasion] except there was significant statistical correlation of p53 expression with tumor type [p<0.05]. Our investigation results suggest that p53 and p2l [WAF1/CIP1] immunoexpression are common findings in colorectal cancer and the induction of p21 [WAF1/CIP1] occur in a p53-dependent or independent pathways

Surgical treatment of chronic sacrococcygeal pilonidal sinus. Open method versus primary closure

To study the comparison between the primary closure and open technique after excision of chronic sacrococcygeal pilonidal sinus. A randomized study was designed and 77 patients with chronic sacrococcygeal pilonidal sinus were included in this study. This study took place in Rizgary Teaching Hospital, Erbil, Kurdistan, Iraq, from January 1997 to August 2003. The patients were separated into 2 groups; Group A [37 patients] were treated by open method [excision and healing by secondary intention] and Group B [40 patients] for whom primary midline suturing was performed after excision of the pilonidal sinus. The follow up ranged from 1.5-5.5 years [mean 4.16] was through outpatient visits. The Student t test was applied for statistical analysis for the operating time, hospital-stay, time off from work and wound healing time; and the results show extremely significant differences between the 2 groups [p<0.0001]. The statistical analysis of the total number of postoperative complications of both techniques showed a significant difference [p=0.0401], while the differences were insignificant for each complication when analyzed separately. Excision and primary closure for chronic sacrococcygeal pilonidal sinus is superior to excision and healing by secondary intention. We believe that primary midline suturing is a useful method for management of chronic sacrococcygeal pilonidal sinus