BackgroundHerein we present our experience with laparoscopic common bile duct exploration (LCBDE) in managing common bile duct stones.MethodsData of 129 consecutive patients who underwent laparoscopic cholecystectomy (LC) and LCBDE done at our institutes from April 2011 through June 2016 were prospectively recorded and retrospectively reviewed.ResultsSince 2011, 3012 laparoscopic cholecystectomy were performed at our institutes, intraoperative cholangiogram (IOC) was done in 295 (9.8%) patients which detected choledocholithiasis in 129 (4.3%) of them. LCBDE was successful to clear the common bile duct (CBD) in 123/129 (95.4%). Six patients underwent postoperative endoscopic retrograde cholangiopancreatography (ERCP) because of incomplete CBD clearance (4 cases), symptomatic stenosed papilla (2 cases). LCBDE was performed in 103 patients via trans-cystic approach and choledochotomy one in 26 patients. In the choledochotomy group, seven patients had primary closure of the CBD, CBD was closed over T-tube in nine patients whereas the remaining 10 patients the CBD was closed over antegrade inserted stent. The median time of hospital stay was 4 (range; 1–15) days. No patients showed retained CBD stones with mean follow up was 9 ± 3.4 months.ConclusionLCBDE is a safe and cost effective option for CBD stones in short-term outcome and can be performed provided proper laparoscopic expertise and facilities are available.
Background: Voodoo is a newly emerged hallucinogenic substance in Egypt that target the youth aged 15-30 years causing many reported cases of acute toxicity. This made the Egyptian Ministry of Health in 2014 to list it in drug schedule 1 and warned traffickers and users that they are now under criminal penalties. Aim: this work was conducted to investigate the acute toxic effects of this hallucinogenic substance on human and experimental animals. Methods: this work included both clinical and experimental studies. The clinical study included 17 patients with acute Voodoo poisoning admitted to Poisoning Control Unit-Zagazig University Hospitals between July, 2015 and April, 2016. The experimental study included forty adult male albino rats were used for calculation of LD50 of Voodoo extract. The extract was prepared using Gas chromatography/ Mass spectrophotometry (GC/MS) to be given intra peritoneally to experimental animals. Results: the patients' main complaints were hallucination, disorientation and extreme fear of death, a picture resemble acute cannabis poisoning but with negative urinary screening test for cannabis and other common addictive substances. GC/MS analysis revealed the chief substance in the extract (54.54%) was a chemical analogue of PB 22; a designer synthetic cannabinoids. LD 50 of the extract was estimated to be 1334 mg/Kg. Liver, kidneys and brain were the most affected studied organs. The liver showed severe congestion and macro vesicular steatosis with diffuse intracytoplasmic esinophlic bodies. Kidneys showed focal vacuolar degeneration of renal tubules, accentuation of glomerular basement membrane, hyallinosis of renal tubules with large areas of epithelial necrosis. Brain cells were markedly shrunken and vacuolated. Conclusion: it could be concluded that Voodoo proved to have many toxic effects on human and experimental animals and further studies are warranted to evaluate other toxic effects of this substance. Acute toxicity, Hallucinogen, LD 50, Synthetic cannabinoids, Voodoo extract.
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