[Show abstract][Hide abstract] ABSTRACT: Aim: The objective of this randomized, prospective study is to provide a critical appraisal comparing laparoscopic gastric banding versus laparoscopic sleeve gastrectomy in the treatment of morbidly obese patients. Methods: The study involved 100 patients, in the period between May 2005 and November 2007. They were randomly assigned to: Group 1: 52 patients subjected to laparoscopic adjustable gastric band or Group 2: 48 patients subjected to laparoscopic sleeve gastrectomy. Results: After 1 year of follow-up, there was a statistically significant difference between the two groups regarding the percentage of excess weight loss (%EWL) and the rate of complications (p<0.05). The %EWL was 63.6±5.4 in group 1 and 68.4±6.2 in group 2. Staple line leakage was reported in 2 cases (4.2%) and band erosion in 2 cases (3.8%). After 3 years of follow-up, there was no significant difference between the two groups regarding the rate of complication, but there was a statistically significant difference between the 2 groups regarding the %EWL; being 71.3±7.3 for patients in group 1 and 78.5±5.2 in group 2. Four patients (8.3%) in group 2 acquired pouch dilatation. Port site hernia developed in one patient (2.1%) in group 2. Insufficient weight loss noticed in 2 patients (3.8%) in group 1 and in 2 patients (4.2%) in group 2, which was not statistically significant. Conclusion: Sleeve gastrectomy is significantly more effective than gastric banding in terms of late complications, late reoperations, and long-term results on weight loss.
[Show abstract][Hide abstract] ABSTRACT: Aim: The aim of this work is to assess the value of using intraoperative cholangiogram during laparoscopic cholecystectomy. Methods: Thirty patients scheduled for laparoscopic cholecystectomy were subjected to intraoperative cholangiogram in the period between June 2006 and June 2009. Results: Four (13%) cholangiograms revealed short wide cystic ducts. Three (10%) cholangiograms revealed stones in the CBD. One of them was totally unsuspected preoperatively. The remaining two patients had mild elevation of liver enzymes preoperatively, without any clinical evidence. The operative time for the cholangiography procedure was 25 (15-40) minutes. Conclusions: Despite the increased operative time in using intraoperative cholangiogram, it helps to identify abnormal anatomy especially in difficult cases, avoid leaving an excessive length of the cystic duct stump and detect unsuspected biliary duct stones. Intraoperative cholangiogram is recommended especially in difficult cases and with unclear anatomy. Surgeons should train themselves to use operative cholangiography to the point of perfection and should have a low threshold for performing it to define ductal anatomy.
[Show abstract][Hide abstract] ABSTRACT: A B S t r A c t introduction: The rapid emergence and dissemination of antimicrobial resistant microorganisms in hospitals worldwide is a problem of crisis dimensions. Although infections caused by drug resistant bacteria can strike anyone, they are especially grave for immuno-compromised patients whose such as the hospitalized in Intensive Care Units (ICUs). Extended Spectrum beta Lactamases (ESBLs) is a neglected healthcare crisis that is intended to provoke a debate. Aim of the Work: This study aimed to determine the prevalence of extended spectrum beta-lactamases multidrug resistant isolates of Enterobacteriacea in all samples (urine, respiratory, surgical and body fluid, blood) collected in ICU patients at El Damardash Hospital. Also, to study the antibiogram profiles of the ESBLs organisms isolated. Subjects and methods: A total of 1065 different samples collected from patients admitted to the surgical long term care and ICUs were cultured. The antibiogram carried out for the possible ESBLs gram negative isolates by screening preliminary method, thereafter confirmed for Klebsiella pneumoniae (K.pneumoniae), Escherichia coli (E. coli) and Proteus mirabilis (P.mirabilis). results: Out of the 1065 samples the total positive urine, respiratory, surgical and blood cultures were 434, 202, 352 and 77, respectively, where 670 gram negative organisms were isolated from the urine, respiratory, surgical and body fluid and the blood specimens were 299, 164, 187 and 20, respectively. The isolated Gram negative bacteria were 273 E. coli, 114 K. penumoniae and 20 Proteus mirabilis isolates. The gram negative organisms isolated from the urine culture was 68.9 %(299 /434), 64%(190/299) of the gram negative organisms were E. coli, 13.2 % (25/190) were ESBL producers. 14% (41/299) the gram negative organism isolated from urine were K. penumoniae, 9.8% (4 /41) were ESBL producers. About 4% (11/299) of the gram negative organisms were P. mirabilis and they were all non ESBLs producers. As regards, the gram negative organisms isolated from the respiratory specimens were 81.2% (164/202), 12% (20/164) of the gram negative organisms were E.coli, 15% (3/20) were ESBL producers, 19.5% (32/164) of gram negative organisms were K. penumoniae, 3% (1/32) of them were ESBL producers and 1.8% (3/164) of gram negative respiratory cultures were Proteus mirabilis, 33% (1/3) were ESBL producers. conclusion: ESBLs is a neglected healthcare crisis in Egypt that needs strategies to treat, prevent and control the rising rate. In addition, clinical laboratories need to have adequate funding, equipment and expertise to provide a rapid and clinically relevant antibiotic testing service. Besides, the controlled use of 3 rd generation cephalosporin along with implementation of infection control measures are the most effective means of controlling and decreasing the spread of ESBL isolates.