Nagui E Mikhail’s research while affiliated with Theodor Bilharz Research Institute and other places

Key words: Jaundice, obstruction, ERCP, pre-operative endoscopic drainage, stent Patients with obstructive jaundice are prone to recurrent cholangitis, sepsis, bacterial translocation, impaired mononuclear phagocytic as well as intestinal barrier and renal functions. Pre-operative biliary drainage can lower serum endotoxins and improve mononuclear phagocytic functions. A retrospective evaluation of the results of surgery after endoscopic biliary drainage was made for 86 patients with surgical obstructive jaundice seen in the last five years at Theodor Bilharz Research Institute. Median follow up was 30 months. Endoscopic retrograde cholangiopancreatography (ERCP) and stent insertion were successful with a progressive relief of jaundice and cholestasis in 65 (75.6%) and could not be achieved in 21 (24.4%) patients because of complete interruption of the biliary tree in 12 (13.9%) or failed stenting in 9 (10.5%) patients. Complications following ERCP and stent insertion had occurred in 5 (6%) patients including one fatal cholangitis with Charcot's pentad. Unsettling calcular and malignant obstructive jaundice were seen in 43 (50%) and 21 (24.4%) patients respectively. Iatrogenic biliary injuries, resulting in complete bile ducts interruption or stricture, and benign biliary stricture, due to chronic pancreatitis were found in 12 (14%), 4 (4.65%) and 2 (2.3%) patients respectively. In addition, 4 (4.65%) patients had rare causes of obstructive jaundice. Postoperative relief of jaundice was achieved in all patients (80 patients), early and late morbidities due to wound infection (8 patients, 10%), stomal stenosis after the first year (one patient, 1.25%) and recurrent cholangitis (2 patients, 2.5%) were respectively observed. There was no operative death. In conclusion, endoscopic stenting followed by timed surgery is believed to be the optimum treatment for surgical obstructive jaundice.

We report a case of schistosomal orchitis simulating malignancy. The patient presented with a unilateral hydrocele, testicular enlargement and loss of testicular sensation. Orchiectomy was performed because of suspected malignancy. Tissue diagnosis was schistosomiasis. The incidence, pathogenesis and pathology of genital schistosomiasis are discussed, and the literature is reviewed.

Hundred patients undergoing elective major abdominal surgery, who had no clinical risk factors for DVT and did not receive prophylactic anticoagulant therapy perioperatively, were included in this study. In addition to routine coagulation testing namely prothrombin time (PT) and concentration (PConc), partial thromboplastin time (PTT) and thrombin time (TT), Thrombophilic risk factors: protein C (PC), protein S(PS), antithrombin (AT) in addition to FVL, Prothrombin G 20210 A (PT G20210 A) and methylenetetrahydrofolate reductase (MTHFR) gene mutations (by PCR) were assessed. D-Dimer level was measured as well. The patients were followed up post operatively for any signs and symptoms of DVT. In addition daily portable Doppler was done during the inpatient period till discharge. Patients were also followed up as outpatients for a month. Patients with any suspicion of DVT were referred for colored duplex study. All patients studied had normal screening coagulation tests. Regarding PC, PS and AT deficiencies, they were detected in 12%, 5% and 1% respectively among our subjects. High D-Dimer (>400 ng /ml) was obtained in 10% of patients before surgery and it was increased to 17% postoperatively. All of them had one or more of thrombophilic risk factors. FVL was detected in 11%, 2 out of them had PT G 20210 A variant added to FVL, all were heterozygous for both abnormalities. None of our patients showed positive MTHFR gene mutation. DVT developed in 13 of our patients during the post-operative period. Nine of these patients were carriers for FVL, three of them had combined PC deficiency, one had PS deficiency, another patient had AT deficiency, two cases had combined FVL and PT G 20210 A gene mutations and the remaining two patients had solely FVL mutant gene. The other four subjects who developed DVT had combined PC and PS deficiencies. All DVT patients had elevated D-Dimer levels. There is a high prevalence of FVL among Egyptians (11%). Its presence either solely or combined with other thrombophilic risk factors, is associated with an increased risk for DVT, about 17.8 fold over non carriers. D-Dimer testing is shown to have a good predictive value for the presence of thrombotic risk factor in addition to be a highly sensitive test for the presence of DVT. Collectively, these data denote that giving prophylactic anticoagulant in all patients undergoing major abdominal surgery should be seriously considered especially with the advent of the safer low molecular weight heparin, otherwise it may be important to apply testing strategies among individuals attending major abdominal surgery in an attempt to determine patients with high risk of thrombosis.