Pathogenesis of hydrocaele in Egypt.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
A el-Fiky
Publications and source records attributed to A el-Fiky.
Fundal varices: problem and management.
BACKGROUND/AIMS: The pathophysiology of gastric varices may be due to generalized or segmental portal hypertension. A considerable debate has arisen regarding the role of injection sclerotherapy in the pathogenesis of gastric varices. METHODOLOGY: During the period from 1987 to 1997, a total of 1686 cases with bleeding varices were presented to our center and 225 cases (13.3%) with bleeding gastric varices were diagnosed. There were 198 males and 27 females with a total mean age of 45.7 years (+/- 7.6). Primary fundal varices (FV) were found in 121 (54%) cases and secondary FV were found in 104 (46%) cases. All patients with isolated FV presented with repeated attacks of upper gastrointestinal bleeding. RESULTS: The pathological diagnosis was studied in 120 cases; it was schistosomal in 8.3% of cases, non-schistosomal in 33.3% of cases, and mixed (Schistosomal with post viral cirrhosis) in 58.3% of cases. Seventy-five cases were subjected to splenectomy and gastroesophageal decongestion (SGED), 64 cases were subjected to distal splenorenal shunt (DSRS), and 86 cases were subjected to sclerotherapy. Mortality after DSRS was 7.8%, after SGED it was 12%, and after sclerotherapy it was 21%. Rebleeding was the major complication and occurred in 3% after DSRS, in 13% after SGED, and in 18% of cases after sclerotherapy. CONCLUSIONS: Gastric varices are not an uncommon condition as a cause of upper gastrointestinal bleeding. Our findings support the hypothesis that gastric varices may be considered a late sequel of injection sclerotherapy, though they may also be considered as one of the pathophysiologies of generalized portal hypertension. Finally, DSRS was found to be the treatment of choice in the management of fundal varices.
Adult↗
Hepatocellular carcinoma in Mansoura-Egypt: experience of 385 patients at a single center.
BACKGROUND/AIMS: Hepatocellular carcinoma is one of the commonest malignancies in the world. The two main etiological factors for hepatocellular carcinoma are cirrhosis and viral hepatitis. Although the first choice of treatment for hepatocellular carcinoma is surgical resection, most of them are unresectable at the time of diagnosis. METHODOLOGY: From January 1994 to June 1999, 385 patients with hepatocellular carcinoma were presented to the Gastroenterology surgical center, Mansoura University, Egypt and subjected to similar diagnostic process. Forty-five (11.6%) of these patients (34 males and 13 females) with a mean age of 50.9 years (+/- 7.53 years) were subjected to different types of hepatic resection. RESULTS: The underlying liver pathology was cirrhosis in 85%. Positive virology was found in 82.5% (HCV 61%, HBV 14.5% and combined 7%). The main presentation were asymptomatic in 144 (37.4%) patients, abdominal pain in 92 (23.9%) patients, ascites in 95 (24.6%) patients, jaundice in 53 (14%) patients and upper gastrointestinal hemorrhage in 26 (6.75%) patients. Only 45 (11.6%) were resectable, they were subjected to hepatic resection with operative mortality in 2 cases (4.4%) and with overall mortality in 29 (64.4%) cases after 48 months (32.8 +/- 19 months) of follow-up. The main causes of late mortality were recurrence in 14 (31.1%) cases, hepatic cell failure in 7 (15.5%) cases and other causes in 6 (13.3%). CONCLUSIONS: Hepatocellular carcinoma is now a common malignancy in Egypt, which usually develops on top of cirrhosis of viral origin in 82%. Hepatic resection is the only method of treatment with a low resectability rate.
Adult↗
Is resection for large hepatocellular carcinoma in cirrhotic patients beneficial? Study of 38 cases.
BACKGROUND/AIMS: Hepatocellular carcinoma in cirrhotic patients generally carries a poor prognosis either due to recurrence or to postoperative morbidity or both. Several factors affect the prognosis of hepatocellular carcinoma resection as presence of cirrhosis of the liver, tumor diameter and tumor capsulation. METHODOLOGY: Thirty-eight patients with large hepatocellular carcinoma greater than 5 cm with a background of cirrhotic liver were divided into two groups according to tumor diameter. Group A (n = 20) with tumors less than 10 cm in diameter, and group B (n = 18) with tumors larger than 10 cm. All patients underwent preoperative investigations including clinical laboratory tests, sonography, computed tomography, selective angiography and upper gastrointestinal endoscopy. All patients were subjected to different types of hepatic resection. RESULTS: A significant difference in tumor size, capsulation, and operation time were recorded between the two groups, of patients. No significant difference was detected between both groups regarding sex, age, viral markers, pathologic features, and Child classification. Hospital mortality occurred in 5% versus 11.1% of both groups, respectively. Postoperative jaundice and ascitis occurred in 30%, 35% versus 44.4%, 72.0%, respectively (P < 0.005, P < 0.04). Late mortality occurred in 65% of patients in group A and in 77% of group B. Recurrence was detected in 42% of group A and 62% in group B. Recurrence after resection in capsulated tumors was significantly lower than in noncapsulated tumors in group A (P < 0.01), but not significant in group B. Also, survival rate in patients with capsulated tumors was significantly better in both groups (P < 0.01) than that with noncapsulated tumors. CONCLUSIONS: Resection of hepatocellular carcinoma with diameter larger than 10 cm recorded bad prognosis regarding recurrence and mortality rates than tumors less than 10 cm. However, capsulated tumors gave better postoperative prognosis than noncapsulated ones.
Adult↗
Clinico-immunogenetic study on Egyptian multicase tuberculous families.
Thirteen multicase Egyptian families (having more than one sib affected) with pulmonary tuberculosis have been studied. They include 26 parents (4 were tuberculous) and 53 sibs (30 tuberculous and 23 healthy). For all of them the following have been carried out: (a) Clinical, radiological, and bacteriological examination for diagnosis and evaluation of the disease severity; HLA-antigen determination using 9(A), 16(B) and 6(DR) antigens. The analysis of data revealed: (1) high incidence of tuberculosis among sibs in families having A2 B5 in their haplotypes compared to those having A2 X or B5 X--affected sibs with A2 B5 showed more severe manifestations than those having only one of the two antigens; (2) aggregation of HLA concordance among the sib pairs, both fully identical and haploidentical, while none of the sib pairs is non-identical; (3) Lod score studies showed linkage between the genetic control of susceptibility to pulmonary tuberculosis and HLA; (4) identity by descent study confirms the dominant pattern of transmission. The recommendation is that in a clinical setting of genetic counselling healthy individuals having either A2 or B5 antigens in their haplotypes should be vaccinated with BCG. Furthermore tuberculous patients having these HLA antigens should be managed aggressively, especially those having A2 B5 haplotypes in whom the disease is likely to run a severe course.
Adolescent↗
Hepatic resection in cirrhotic liver for treatment of hepatocellular carcinoma in Egyptian patients. Experience with 140 cases in a single center.
BACKGROUND/AIMS: In many centers hepatic resection is still the treatment of choice for hepatocellular carcinoma in cirrhotic liver. Several factors affect the prognosis; one of them is the extent of resection. This study retrospectively evaluates outcome after different types of hepatic resection in cirrhotic liver. METHODOLOGY: Hepatectomy was performed in 245 patients. From them, 140 patients were subjected to hepatic resection for hepatocellular carcinoma in cirrhotic liver. According to the type of resection the patients were divided into three groups (A, B and C), major resection (group A) in 79 (56.3%), segmental resection (group B) 31 (22.1%) and localized resection (group C) in 30 (21.4%). Early postoperative mortality and morbidity as well as long-term survival and recurrence were assessed. RESULTS: The overall hospital mortality rate was (8.6%) with total complications 26%, recurrence rate 32.8% and median survival was 24 months (3-120). Group A showed high incidence rate of hospital mortality, total complications and hepatic cell failure than the other two types (p>0.05). On the other hand, group C patients showed high incidence of wound infection and recurrence rate after hepatic resection than the other two types (p>0.05). At the end of the study, the median survival was 18 months (4-120), 24 months (3-48) and 24 months (3-120) for the three groups respectively without significant difference. The overall 5-year survival rate was 20%, 0% and 15.3% for the three groups respectively (p>0.05). CONCLUSIONS: Although major liver resection in cirrhotic liver has high incidence of early mortality and morbidity, it gives low incidence of recurrence and better survival in comparison with segmental and localized resection. However it has to be reserved for large tumor in good liver and early cirrhosis.
Adult↗