Mosaad Morshed

Comparative study of the house advancement flap, rhomboid flap, and y-v anoplasty in treatment of anal stenosis: a prospective randomized study.

PURPOSE: Anal stenosis represents a technical challenge for surgical management. We compared the effects of house flap, rhomboid flap, and Y-V anoplasty procedures in a randomized study in patients with anal stenosis. METHODS: Consecutive patients treated for anal stenosis at our institution were evaluated for inclusion. Participants were randomly allocated to receive house flap, rhomboid flap, or Y-V anoplasty. Follow-up visits were after 1 week, 1 month, 6 months, and 1 year. Study variables included caliber of the anal canal (measured with a conical calibrator), clinical improvement, patient satisfaction (visual analog scale), incontinence (Pescatori incontinence scale), and quality of life (GI Quality of Life Inventory). RESULTS: Sixty patients with anal stenosis were randomized and completed the study. Operative time was 62 ± 10 minutes for house flap, 44 ± 13 minutes for rhomboid flap, and 35 ± 9 minutes for Y-V anoplasty (P = .042). At 1 year, anal caliber was 23.9 ± 2.33 mm for house flap, 18.1 ± 2.05 mm for rhomboid flap, and 16.4 ± 2.05 mm for Y-V anoplasty (P = .04), with a highly significant increase for the house flap (P = .001). The groups differed significantly regarding clinical improvement at 1 month (95% for house flap, 80% for rhomboid flap, and 65% for Y-V anoplasty, P = .01) and differences persisted at 1 year. Significant differences were seen among groups at 1 year in GI Quality of Life Inventory scores (P = .03), with significant improvement only for the house flap (P = .01). CONCLUSION: Anal stenosis can be effectively managed with the house flap procedure, with the sole disadvantage of longer operative time. Although all 3 procedures are simple and easy to perform, the house flap appears to produce the greatest clinical improvement, patient satisfaction, and improvement in quality of life, with the fewest complications.

Enteropathogenic Escherichia coli (EPEC): Does it have a role in colorectal tumourigenesis? A Prospective Cohort Study

BACKGROUND Despite the characterization of many aetiologic genetic changes. The specific causative factors in the development of sporadic colorectal cancer remain unclear. This study was performed to detect the possible role of Enteropathogenic Escherichia coli (EPEC) in developing colorectal carcinoma. PATIENTS AND METHOD Fresh biopsy specimens have been obtained from the colonic mucosa overlying the colorectal cancer as well as from the colon of the healthy controls. Culture, genotyping and virulence of EPEC were done using (nutrient broth culture, and PCR). Strains biochemically identified as Escherichia coli were selected from the surface of a MacConkeys plate and were serogrouped by slide agglutination tests. RESULTS From January 2011 to June 2014, 213 colorectal cancer patients (Group 1) and 248 healthy controls (Group 2) were prospectively enrolled in this study. EPEC was positive in 108 (50.7%) in group 1 and 51 (20.6%) in group 2 (P = 0.0001). A significant difference between both groups was observed regarding serotyping, genotyping (eae gene) and virulence category (P = 0.0001). A significant difference between the 2 subgroups of colorectal cancer cases was observed regarding genotyping (eae, bfb genes) and virulence category. CONCLUSION The incidence EPEC was higher significantly in patients with colorectal cancer. E. coli in patients with colorectal cancer significantly differed serotypically and genotypically from the E. coli in normal population. E. coli colonization of the colonic mucosa may be a cause colorectal cancer.

Indications for and outcome of primary repair compared with faecal diversion in the management of traumatic colon injury

Injuries of the colon are a serious sequel of abdominal trauma owing to the associated morbidity and mortality. This study aims to assess postoperative outcome and complications of faecal diversion and primary repair of colon injuries when applied according to established guidelines for the management of colon injuries.

Functional Assessment of the Esophagogastric Junction After Laparoscopic Sleeve Gastrectomy

The relation between bariatric procedures and gastroesophageal reflux disease (GERD) seems to be quite complex and unclear. The present trial aimed to assess the functional changes that occur in the esophagogastric junction (EGJ) after laparoscopic sleeve gastrectomy (LSG) using objective methods for assessment as esophageal manometry and ambulatory 24-hour pH monitoring in attempt to correlate these changes with either the deterioration or the alleviation of GERD symptoms after LSG. This prospective case series study was conducted on patients with morbid obesity who were treated with LSG in the General Surgery Department, Mansoura University Hospitals. All patients were assessed pre- and postoperatively for the presence of GERD both clinically and with esophagogastrodudenoscopy (EGD). Functional assessment of the EGJ was done before LSG and at six months of follow-up using esophageal manometry and ambulatory 24-hour esophageal pH monitoring. Twenty morbidly obese patients (16 females & 4 males) of a mean age of 29.4 years had underwent functional assessement of the EGJ before and at six months after LSG. The mean BMI at the time of surgery was 51.6 ± 8.7 kg/m². Thirteen patients had no symptoms related to GERD preoperatively, all of these patients remained symptom-free after LSG. Seven (35%) patients had preoperative symptoms of GERD, three reported no change in their symptoms at six months of follow-up, and four reported significant improvement of their symptoms six months after LSG. Overall, no significant changes in the manometric parameters were noticed. However, a significant decrease in the resting LES pressure was noticed after LSG in patients with no preoperative GERD symptoms, but not in patients with symptomatic GERD. Seven (35%) patients had high preoperative DeMeester scores and prolonged total acid reflux time percentage, all of them got normalized postoperatively except two patients. Absolute concordance of the four parameters studied was observed in seven (35%) patients only. Esophageal manometry has a limited utility in the detection or exclusion of GERD postoperatively since the significant decrease in the resting LES pressure observed was not associated with symptoms of GERD. On the other hand, 24-hour pH monitoring was able to detect improvement or persistence of GERD in the patients studied.

Prevalence of Serum p53 Antibodies against Tumor p53 Protein in Colorectal Cancer

AbstractBackground: Genetic events associated to colorectal carcinoma are well characterized, but there is scanty information about this issue in Egyptian subjects. The aim of this study was to investigate tissue p53 overexpression in paraffin embedded tumor and serum p53 antibodies in colorectal cancer patients with special reference to patient outcome. Patients and Methods: The study was conducted to 135 consecutive colorectal cancer patients. The tumor p53 protein was overexpressed in 60% and serum p53 antibodies in 35%, also tumor p53 accumulation is not necessarily associated with serum p53 antibodies positive cases. Tumor p53 overexpression was more frequent in distal colorectum than in proximal tumor (63.7% vs 41%) (p > 0.05). Results: Both tumor p53 overexpression and serum p53 antibodies increased signficantly with the stage of the tumor and lymph node involvement, but not with the grade, histopathological types and other histologic parameters. After a follow-up of 5 years, in the Kaplan Meier univariate analysis the factors stage (p = 0.0004), tumor p53 immunostaining (p < 0.0001) and serum p53 antibodies (p < 0.04) had a prognostic value. Conclusion: In conclusion p53 overexpression was associated with advanced histopathological stage and a high risk of recurrence.ZusammenfassungHintergrund: Genetische Vorkommnisse im Zusammenhang mit kolorektalen Karzinomen sind in der Literatur gut beschrieben, es gibt jedoch nur geringe Informationen darüber bei ägyptischen Patienten. Ziel der vorliegenden Studie war die Untersuchung von Gewebe-p53-Überschuss bei in Paraffin gegossenem Tumorgewebe und Serum-p53-Antikörpern kolorektaler Karzinompatienten mit besonderem Bezug zu den Behandlungsergebnissen. Patienten und Methoden: Die Studie umfasste 135 konsekutive kolorektale Karzinompatienten. Das Tumor-p53-Protein war bei 60% überhöht und die Serum-p53-Antikörper bei 35% der Patienten, obwohl die Tumor-p53-Akkumulation nicht unbedingt mit positiven Serum-p53-Antikörperfällen in Verbindung stand. Tumor-p53-Überschüsse fanden sich häufiger bei Patienten mit Erkrankung des distalen Kolorektums als bei proximalen Tumoren (63,7% vs. 41%) (p > 0,05). Ergebnisse: Während Tumor-p53-Überschuss und Serum-p53-Antikörper deutlich mit dem Tumorstadium und einer Lymphknotenbeteiligung anstiegen, zeigte sich das nicht im Zusammenhang mit dem Tumorgrad, den histopathologischen Arten und anderen histologischen Parametern. Während eines Nachuntersuchungszeitraums von 5 Jahren zeigten die Faktoren Stadium (p = 0,0004), Tumor-p53-Immunfärbung (p < 0,0001) und Serum-p53-Antikörper (p < 0,04) in der Kaplan-Meier-Univarianzanalyse prognostischen Vorhersagewert. Schlussfolgerung: Schlussfolgernd kann zusammengefasst werden, dass p53-Überschüsse mit einem fortgeschrittenen histopathologischen Stadium und einem hohen Rezidivrisiko vergesellschaftet waren.