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Hamad M.A.,Assiut University | Nada A.A.,Cairo University | Abdel-Atty M.Y.,Menofiya University Hospital | Kawashti A.S.,Al - Azhar University of Egypt
Surgical Endoscopy and Other Interventional Techniques | Year: 2011

Background: The ongoing debate between routine and selective users of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) has not yet come to an end. Routine users argue that IOC decreases the rate of biliary complications such as bile duct injury, biliary leak and missed common bile duct (CBD) stones, a claim that selective users do not fully support. On the other hand, a third policy that was adopted by many other centers is performing LC without IOC. In this retrospective study, we are exploring the results of a relatively large multicenter series of LC without IOC regarding major biliary complications. Methods: We performed a retrospective analysis of LC cases operated by experienced laparoscopic surgeons, without resorting to IOC, in four surgical units of university hospitals in Egypt during a 6-year period (January 2004 through December 2009). Excluded from the study were cases with positive predictors of CBD stones, namely, sonographically detected CBD dilatation and/or CBD stones, elevated bilirubin and/or alkaline phosphatase, persistent biliary pancreatitis, cholangitis, and those who had preoperative magnetic resonance cholangiography. Results: Of the 2,955 cases of LC reviewed, 241 were excluded, leaving 2,714 cases enrolled in the study. Fifty-five cases (2%) were converted to open surgery. Five cases (0.18%) had major bile duct injuries requiring surgical repair. Postoperative bile leakage was encountered in seven cases (0.26%). Missed CBD stones were reported in six cases (0.22%). There was no perioperative mortality in the present study. Conclusion: LC can be performed safely without the use of IOC, with acceptable low rates of biliary complications provided that proper detection of patients with silent CBD stones is done and facilities for pre- and postoperative endoscopic retrograde cholangiopancreatography are available. © 2011 Springer Science+Business Media, LLC.

Shoeib S.,Menofiya University hospital | Abdel-Atti E.,Menofiya University hospital | Dala A.G.,Menofiya University hospital | El-Noamany M.,Menofiya University hospital | And 2 more authors.
Life Science Journal | Year: 2012

Background & Aim: The prevalence of hyperuricaemia (HU) in type 2 diabetic patients (T2DM) and its relation with diabetic micro- and macro-vascular complications has been conflicting. The aim of the present study was to investigate the relationship between HU and both micro and macroangiopathies (IHD and diabetic nephropathy and neuropathy) in patients with type 2 diabetes mellitus. Methods: The cohort of this cross-sectional study was sixty T2 diabetic patients (26 men and 34 women, aged 52.4±8.6 years). They have been recruited from the Outpatient Department of Menofia University Hospital between January and June, 2010. In addition to comprehensive clinical examination, they were subjected to laboratory check-up for serum uric acid, fasting blood glucose (FBG) and postprandial blood glucose (PPBG), glycated hemoglobin A1c (HbA1c), serum lipids, 24-hours urine collection for microalbuminuria (μA), stress ECG and coronary angiography as indicated. Results: HU was detected in 18 out of out 60 (30%) type 2 diabetic patients. The frequency of hypertension (HT), ischaemic heart disease (IHD), peripheral neuropathy (PN) and μA were significantly higher in diabetic patients with (78%, 67%, 78% and 78%, respectively) than in those without HU (48%, 5%, 38% and 33% respectively) (P=0.04, 0.0001, 0.01 and 0.001, respectively). We also observed a significantly higher FBG, PPBG and HbA1c in the diabetic patients with compared to those without HU (P=0.02, 0.01 and 0.01 respectively) have. Likewise, total cholesterol, triglyceride (TG) and creatinine levels in diabetic patients with HU were again significantly (P=0.02, 0.001 and 0.001, respectively) above their counterparts values in diabetics without HU. Conclusion: The cheap, basically available and modifiable serum uric acid level we observed to prevail in T2 diabetic patients would be a useful investigational tool to prompt a cost-effective search for other cardiovascular risk factors known to cluster in them.

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