Both penicillin+gentamicin and clindamycin+amikacin are safe and effective for the prevention of SSI in clean contaminated operative procedures. In a resource limited hospital, a regimen including penicillin+gentamicin is a cost-effective alternative for the more expensive and broader coverage of clindamycin+amikacin. Timing of PA is effective in preventing SSIs when administered 30min before the start of surgery.

Aberrant expressions of AKT, GSK3-B, and BCL2 are common events in HCV-associated LD and HCC. AKT, GSK3-B and IL-6 are significantly associated with cirrhosis and could be used as biomarkers for both early detection and molecular target therapy for the prevention of HCC development. TNFRII, GSK3-B and s-AFP could be used as prognostic factors that can predict the clinical outcome of HCC patients.

The mucosal lesions in the lower urinary tract were examined in 86 cystectomy specimens of bilharzial bladder cancer. Squamous cell carcinoma occurred in 66 cases, transitional cell carcinoma in 18 cases, and adenocarcinoma in two cases. Multiple infiltrative carcinomas were found in 19 cases (22.1%), and these were commonly of the transitional cell type (63.9%). Squamous metaplasia was found in 65.1%, columnar metaplasia in 52.3%, and carcinoma in situ in 40.7%. The ureters, trigone, and urethra were rarely affected by these lesions. Carcinoma in situ was more commonly associated with multiple carcinomas (68.4%) than with single tumors (32.8%). Squamous metaplasia was found in 81.8% of squamous cell carcinomas and in 16.7% of transitional cell carcinomas. The two cases of adenocarcinoma were associated with columnar metaplasia in the adjacent mucosa. Squamous cell carcinoma and adenocarcinoma probably arise from metaplastic epithelium. Total or subtotal cystectomy is recommended because of the high incidence of carcinoma in situ (40.7%) and multiple carcinomas (22.1%).

Considerable controversy persists regarding the optimal technique for hypopharyngeal reconstruction. The ideal procedure should provide low mortality and morbidity, short hospitalization, a high success rate, few complications, and the greatest potential for neopharyngeal speech and deglutition. In this study, a variety of fasciocutaneous free flaps were used for reconstruction of the hypopharynx. Over a two-year period, fasciocutaneous flaps were used for reconstruction of pharyngoesophageal segments following total laryngopharyngectomies in 16 patients at The National Cancer Institute, Cairo University, Cairo, Egypt. Flap survival, recipient vessels used, and complications were examined. The ultimate functional and cosmetic outcomes of free flaps were compared. Of the 16 patients included in this study, nine were males, and seven were females. Free flaps used for reconstruction included the radial forearm (8), lateral arm (2), anterolateral thigh (3), and posterolateral thigh (3) flaps. Free flaps were successful in 15 patients. One patient had total flap loss. Salvage surgery was successful for one flap that developed venous congestion. Eleven patients received adjuvant radiation therapy. The commonly used recipient vessels were the small arteries of the neck and the external jugular vein. Five patients developed minor pharyngocutaneous fistulas that healed spontaneously. Six patients developed anastomotic line stricture. Donor-site morbidity was more significant with the radial forearm flap, compared to other flaps. Fasciocutaneous free flaps have a definite place in pharyngoesophageal reconstruction. The flap should be selected with reference to the type of the defect and patient obesity; however, donor-site morbidity should also be considered.

OBJECTIVETo compare an ileocaecal orthotopic bladder, (which has been the standard procedure in Egypt for > 30 years) with the ileal neobladder, as there is no ideal continent orthotopic bladder replacement for patients after cystectomy for bladder cancer. PATIENTS AND METHODSBetween June 1999 and December 2001, 60 patients with invasive bladder cancer were randomized into two groups. Group A comprised 29 patients who had radical cystectomy and reconstruction with an ileal neobladder (median age 50 years, 27 men and two women) and group B included 31 who had an ileocaecal bladder substitution after radical cystectomy (median age 51 years, 28 men and three women). RESULTSThe complication rate after surgery in group A was 17%, with two deaths, one from acute myocardial infarction and the other from haematemesis. In group B, the complication rate was 13%, with two deaths, one from a massive pulmonary embolism and the other from liver cell failure. Daytime continence was achieved in 93% of patients in group A and 90% in group B. The mean ( SD ) postvoid residual urine volume was larger in group A than group B, at 90 (72) vs 12 (20) mL. Acidosis and hyponatraemia were evident in the patients in group A but in none in group B ( P < 0.05). The pelvicalyceal systems were preserved in 85% of patients in group A and 93% in group B during the 2-year follow-up. The mean ( SD ) renal cortical thickness was less in group A than in group B, at 1.8 (0.5) and 1.9 (0.2) cm, respectively. Although the cystometric capacity was greater and the basal pressure less in group A than B, these were not reflected in the degree of diurnal and nocturnal continence or back pressure on the renal units. CONCLUSIONContinence in both pouches was similar but the renal units were preserved better in the ileocaecal than in the ileal neobladder. Residual urine volume was greater in the ileal neobladder, with its potential complications of infection and stone formation, and acidosis was more evident.

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